The aim of this study was to investigate the prevalence of insulin resistance (IR) according to the phenotypic subgroups of polycystic ovary syndrome (PCOS) and to determine the associations of TSH ...levels and body mass index (BMI) with IR in infertile women with PCOS. In this cross-sectional study, we included 400 infertile women with a diagnosis of PCOS according to Rotterdam criteria who were referred to the infertility clinic of amir-al-Momenin University Hospital from April 2018- to January 2020. They were classified into four different phenotypic subgroups according to ESHRE guidelines. The homeostasis model (HOMA-IR) was used to measure IR. The prevalence of insulin resistance was 39.3% in infertile women with PCOS. Among women with PCOS, the commonest phenotype was type I (68%), with type II (18.2%), type III (8.8%), and type IV (5%), respectively. Furthermore, there was no significant difference in the prevalence of IR among different phenotypes of PCOS. Logistic regression analysis showed that the chance of insulin resistance was higher in overweight (OR: 1.76, 95% CI: 1.07, 2.88, P=0.024) and obese PCOS women (OR: 3.25, 95% CI: 1.86, 5.67, P<0.001) compared with those who were normal or underweight. Moreover, the chance of IR was higher in PCOS women with TSH ≥2.5 μIU/ml as compared with those who had TSH <2.5 μIU/ml (OR: 2.00, 95% CI: 1.18, 3.40, P<0.001). Insulin resistance is a prevalent disorder among infertile Iranian women with PCOS BMI, and serum levels of TSH ≥2.5 μIU/ml are independent predictors of IR.
The diagnosis of polycystic ovary syndrome (PCOS) and metabolic syndrome (MS) in adolescents is clinically challenging. It is on the rise as consistent with the increasing trends in obesity rates. ...This study aimed to investigate the prevalence of PCOS in adolescents by the National Institutes of Health (NIH) criteria and compare the prevalence of insulin resistance (IR) and metabolic syndrome (MS) between obese (OB) and non-obese (NOB) adolescents with PCOS. This was cross-sectional research with multi-stage cluster random sampling. Participants were 15-18-year-old girls from high schools in Semnan, Iran. The ones who had a history of menstrual dysfunction underwent clinical and hormonal tests. From among a total of 900 participants, 74 girls (8.2%) had a history of menstrual dysfunction. The prevalence of PCOS was 6.44% by NIH criteria. The prevalence of abnormal glucose metabolism, MS, and IR in girls with PCOS were 8(13.7%), 6(10.3%), 24(41.4%), respectively. The OB-PCOS group with a mean BMI of 28.21±1.26 kg/m2 had a significantly greater prevalence of MS, high BP, waist circumference ≥88 cm, and higher IR than NOB-PCOS cases with a mean BMI of 20.54±2.97 kg/m2. Abnormal glucose metabolism was prevalent in adolescents with PCOS and occurred with equal frequency in OB and NOB PCOS groups. Obesity could worsen IR, MS, and some of the components of Mets in PCOS adolescents.
The prognostic value of peripheral natural killer (pNK) cells, as a screening test in women with recurrent pregnancy loss (RPL) and unexplained infertility, is still a matter for discussion. The ...purpose of this study was to compare the percentage of circulating CD56
NK cells, CD69 and perforin markers between women with unexplained infertility and RPL with the healthy control group.
In this case-control study, the percentage of CD56
NK cells and activation markers (CD69 and perforin levels) in the peripheral blood were measured in 25 women with unexplained infertility, 24 women with idiopathic RPL and 26 women from the healthy control group, using specific monoclonal antibodies by flow cytometry.
The percentage of CD56
NK cells was significantly higher in patients with infertility in comparison with the healthy control group (P=0.007). There were not significant differences either in the total number of CD56
cells between the RPL group and the control group (P=0.2) or between the RPL group and the infertile group (P=0.36). The percentage of CD69
lymphocytes in RPL group was significantly higher than in the infertility group (P=0.004). There was a statistically significant difference in Perforin levels between RLP and control (P=0.001) as well as RPL and infertile (P=0.002) groups.
An increased percentage of CD56
NK cells in patients with unexplained infertility, an elevated expression of CD69 on NK cells in patients with RPL and infertility and a high level of perforin on CD56
cells in the RPL group might be considered as immunological risk factors in these women.
This study aimed to compare the effects of clomiphene citrate (CC) combined with metformin or placebo on infertile patients with poly cystic ovary syndrome (PCOS) and insulin resistance (IR).
We ...included 151 infertile women with PCOS and IR in a university hospital from November 2015 to April 2022 in this prospective, double-blind, randomized, placebo-controlled trial. Patients were randomized into two groups; group A: received CC plus metformin (n = 76) and group B: received CC plus placebo (n = 75). The ovulation rate was the main outcome measure. Clinical pregnancy, ongoing pregnancy, live birth and abortion rates were secondary outcome measures.
There was no remarkable difference in ovulation rate in two groups. Moreover, no significant changes were observed in clinical pregnancy, ongoing pregnancy, live birth and abortion rates between two groups. A larger proportion of women in group A suffered from side effects of metformin (9.3% versus 1.4%; p=0.064), although this was not significant.
In IR infertile women with PCOS, metformin pre-treatment did not increase the ovulation, clinical pregnancy and live birth rates in patients on clomiphene citrate.
Infertility is a problem affecting a large number of couples in the world. One of the causes of infertility can be chromosomal rearrangements such as insertions. In this case report study, the ...outcome of two intra-cytoplasmic sperm injection (ICSI) cycles of an infertile woman with de novo chromosomal insertion is explained.
A couple with a 10-year history of infertility referred to our infertility clinic. The husband had a daughter in his first previous marriage. The wife had a 7 and a 10 year history of infertility in the first and second marriages, respectively. In the first marriage, she reported a history of 2 failed intra-uterine insemination (IUI) cycles. In the second marriage, she had a history of 1 spontaneous abortion at 12 weeks of pregnancy, 4 failed IUI cycles, and 1 failed ICSI cycle. The couple was subjected to ICSI cycles twice and failed due to embryo development arrest. The couple referred for karyotyping. The husband showed a normal male karyotype. In comparison, the wife revealed an abnormal female karyotype with two rearrangements: chromosome 13 with an interstitial deletion between bands q14.2 and q21.1, and a derivative chromosome 7 containing this segment of chromosome 7 as an insertion onto short arm at the p14 position.
To the best of our knowledge, this is the first report of insertion 46 XX, ins(7:13)(p14; q14.2q21.1) which is associated with the embryo development arrest following assisted reproductive technique.
Objective To compare the efficacy, tolerability, and convenience of two formulations of the follitropin-α (Gonal-f) pen device versus the conventional form in Iranian women undergoing ovarian ...stimulation for intracytoplasmic sperm injection. Design Randomized, single-center trial, parallel-group, single blind. Setting Tertiary referral center, University Hospital. Patient(s) A total of 100 patients undergoing intracytoplasmic sperm injection. Intervention(s) After down-regulation with busereline acetate, patients were randomized to receive the pen device or the conventional syringe of follitropin-α. A computer-generated randomization list was used to allocate the patients to one of these two groups. Main Outcome Measure(s) The primary outcomes were patients' satisfaction, convenience, occurrence of local tolerance symptoms, and pain. Total dose of follitropin-α, duration of follitropin-α treatment, number of oocyte retrieved, number of viable embryos, and clinical pregnancies were secondary outcome measures. Data collection was performed by means of a questionnaire designed for the purpose of this study. The pain scored according to the Visual Analogue Scale. Result(s) Self-administration and patients' satisfaction were significantly higher in the pen device group than the conventional syringe group. Local reactions at injection sites and pain were significantly higher in the conventional syringe group than in the pen device group. There were no statistically differences in secondary outcome measures and convenience between two groups. Conclusion(s) Among the Iranian patients that we studied, the pen device of Gonal-f is safe, convenient, and less painful, with more patients' satisfaction than the conventional syringe form, but both forms have equal efficacy in intracytoplasmic sperm injection cycles.
Background: The use of Methotrexate (MTX) is a good and common practice for the treatment of women who were diagnosed early with ectopic pregnancy (EP). The aim of this study is to determine the ...predictors of treatment failure with a single dose of MTX injection. Methods: In this quasi-experimental research, we studied 70 women with ectopic preg-nancies who were treated with MTX, according to a single dose protocol from 2010 to 2013. EP was diagnosed whenever an intrauterine gestational sac was not identified by transvaginal ultrasonography (TVUS), accompanied by an abnormal rise or plateau in human chorionic gonadotropin (beta-hCG) concentration. Briefly, women with ectopic pregnancies were considered candidates for MTX treatment if they were hemodynami-cally stable; did not desire surgical therapy, agreed to weekly follow-up; and did not have hepatic, hematologic, or renal disease. A Patient was considered a treatment suc-cess (group 1) if her beta-hCG levels decreased ≤10 m IU/ml after the first dose of MTX. Treatment failure (group 2) was defined as the need for a second or a third dose of MTX or surgery. The following risk factors were compared between the two groups: serum beta-hCG on the days 1 and 4, a ≥ 15% decrease in serum beta-hCG between the days 1-4 of the treatment, age, parity, gravidity, the size of the ectopic mass and the endometrial thickness. Results: The success rate of MTX treatment was 77.1%. There were no significant dif-ferences between the two groups in regard to the age, parity, gravidity, the size of ec-topic mass and the endometrial thickness in vaginal sonography, but the mean serum beta-hCG concentration on days 1 and 4 was lower in the success group than the failure group. We also observed a ≥ 15% decrease in serum beta-hCG in 80.9% of the women from the success group and in 38.5% of the cases whose treatment had failed. The presence of fetal heart activity was seen in only one patient and this patient’s treatment failed. Two patients had previous history of ectopic pregnancy and the treatment of both ended in failure. Conclusion: Among women with ectopic pregnancies who were candidates for MTX treatment, a high serum beta-hCG concentration on the days 1-4 and also a ≤ 15% fall in serum beta-hCG between the days 1-4 treatment, are the most important factors associated with the failure of the treatment with a single dose MTX protocol. It is better to use these factors for making decisions about the initiation of the treatment or the continuation of it.
Preterm birth is a global health priority. Using a progestogen during high-risk pregnancy could reduce preterm birth and adverse neonatal outcomes.
We did a systematic review of randomised trials ...comparing vaginal progesterone, intramuscular 17-hydroxyprogesterone caproate (17-OHPC), or oral progesterone with control, or with each other, in asymptomatic women at risk of preterm birth. We identified published and unpublished trials that completed primary data collection before July 30, 2016, (12 months before data collection began), by searching MEDLINE, Embase, CINAHL, the Maternity and Infant Care Database, and relevant trial registers between inception and July 30, 2019. Trials of progestogen to prevent early miscarriage or immediately-threatened preterm birth were excluded. Individual participant data were requested from investigators of eligible trials. Outcomes included preterm birth, early preterm birth, and mid-trimester birth. Adverse neonatal sequelae associated with early births were assessed using a composite of serious neonatal complications, and individually. Adverse maternal outcomes were investigated as a composite and individually. Individual participant data were checked and risk of bias assessed independently by two researchers. Primary meta-analyses used one-stage generalised linear mixed models that incorporated random effects to allow for heterogeneity across trials. This meta-analysis is registered with PROSPERO, CRD42017068299.
Initial searches identified 47 eligible trials. Individual participant data were available for 30 of these trials. An additional trial was later included in a targeted update. Data were therefore available from a total of 31 trials (11 644 women and 16185 offspring). Trials in singleton pregnancies included mostly women with previous spontaneous preterm birth or short cervix. Preterm birth before 34 weeks was reduced in such women who received vaginal progesterone (nine trials, 3769 women; relative risk RR 0·78, 95% CI 0·68–0·90), 17-OHPC (five trials, 3053 women; 0·83, 0·68–1·01), and oral progesterone (two trials, 183 women; 0·60, 0·41–0·90). Results for other birth and neonatal outcomes were consistently favourable, but less certain. A possible increase in maternal complications was suggested, but this was uncertain. We identified no consistent evidence of treatment interaction with any participant characteristics examined, although analyses within subpopulations questioned efficacy in women who did not have a short cervix. Trials in multifetal pregnancies mostly included women without additional risk factors. For twins, vaginal progesterone did not reduce preterm birth before 34 weeks (eight trials, 2046 women: RR 1·01, 95% CI 0·84–1·20) nor did 17-OHPC for twins or triplets (eight trials, 2253 women: 1·04, 0·92–1·18). Preterm premature rupture of membranes was increased with 17-OHPC exposure in multifetal gestations (rupture <34 weeks RR 1·59, 95% CI 1·15–2·22), but we found no consistent evidence of benefit or harm for other outcomes with either vaginal progesterone or 17-OHPC.
Vaginal progesterone and 17-OHPC both reduced birth before 34 weeks' gestation in high-risk singleton pregnancies. Given increased underlying risk, absolute risk reduction is greater for women with a short cervix, hence treatment might be most useful for these women. Evidence for oral progesterone is insufficient to support its use. Shared decision making with woman with high-risk singleton pregnancies should discuss an individual's risk, potential benefits, harms and practicalities of intervention. Treatment of unselected multifetal pregnancies with a progestogen is not supported by the evidence.
Patient-Centered Outcomes Research Institute.
The aim of this study is to determine if simvastatin pretreatment would change clomiphene response in clomiphene citrate-resistant (CC-R)women with (PCOS).
This quasi experimental study included ...twenty five clomiphene resistant women with PCOS. All patients received cyclic oral contraceptives pills (OCP) (30µg of ethinyl estradiol and 150µg of desogestrol) from the 5th day of their spontaneous or progesterone (P) induced menstrual cycle; in addition, they received simvastatin (20mg/day) from the first day of cycle for two consecutive months. Then, patients were given 100 mg clomiphene citrate (CC) (Iran Hormone, Iran) for five days starting from day three of their menstrual cycles. The primary outcome measures were ovulation and pregnancy rates. The change in body mass index (BMI), the mean number of follicles ≥ 18 mm, the mean of follicular size and endometrial thickness on the day of human chorionic gonadotropin (HCG) administration were secondary outcome measures.
Ovulation occurred in 5 out of 25 (20%) patients, but none of the patients conceived in this study. No important change in BMI was observed after using simvastatin (0.28 + 1.13; p = 0.228). In all patients with ovulation, the number of follicles ≥ 18mm was one. The mean follicular size and endometrial thickness on the day of HCG administration were 19.67 ± 2.04 and 7.00 ± 1.34, respectively.
In this study, we did not observe the favorable effect on ovulation and pregnancy rates with CC following of simvastatin pretreatment in CC-resistant PCOS women. So, further studies with a larger number of patients, higher doses of CC and more cycles are necessary to make this obvious.
Introduction: Polycystic ovary syndrome (PCOS) is one of the most common causes of anovulatory infertility. Clomiphen citrate (CC) is the first line therapy for women with infertility and PCOS. These ...patients usually respond to clomiphene citrate in doses between 50-100 mg/day. However, fialure of the patient to respond to a dosage of 150 mg/day of clomiphene citrate is considered as clomiphene resistant. The aim of this study was to compare between pregnant and non-pregnant women in cases of PCOS patients with CC resistant. Meanwhile, we evaluated ovulatory rate, pregnancy rate and live birth rates. Materials and Methods: We studied 106 CC-resistant PCOS patients who attended to Amir-Al- Momenin Hospital (Semnan, Iran) during the years 2005-2008. After an initial 6-8 weeks of metformin (1500mg daily: 500mg q8h), they received 2.5mg letrozole for 5 days starting on cycle day 3. If they failed to show ovluation with 2.5mg letrozole, doses were increased to 5 and 7.5 mg daily in the subsequent cycles. Results: One patient developed generalized rash with metformin and excluded from the study. 14 of 105 patients (13.33%) conceived with metformin alone. Overall, ovulation rate was 83.91(91.2%). Overall, pregnancy rate was 60/105 (57.14%) with 45 (74.9%) full term pregnancies, 10 (16.7%) abortions and 5 (8.3%) preterm births. The only significant difference between the responder and non-responder was found in the age of patients (P=0.008) . No significant differences were found in BMI, period of infertility, menstrual pattern, hirsutism, pictures of PCO in one or two ovaries in sonography, LH, and FSH or LH/FSH ratio. Conclusion: Combination of metformin with incremental doses of letrozole associated with a good pregnancy rate in CC-resistant PCOS patients. The treatment seems especially more effective in young weman.
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