Subcutaneous progesterone versus vaginal progesterone for luteal-phase support in frozen-thawed embryo transfer: A cross-sectional study

Background: Luteal-phase support is a complex and controversial issue in the field of reproductive management. Objective: To compare the safety and efficacy of low-dose subcutaneous progesterone with the vaginal progesterone for luteal-phase support in patients undergoing rozenthawed embryo transfer. Materials and Methods: In this cross-sectional study, information related to 77 women that had frozen-thawed embryo transfer was reviewed. The patients were divided into two groups based on the route of progesterone administration used as a luteal-phase support. When the endometrial thickness reached ≥ 8 mm, in one group progesterone (Prolutex) 25 mg/ daily subcutaneous and in another group, vaginal progesterone (Cyclogest®) 400 mg twice or (Endometrin®) 100 mg thrice daily, were administrated and continued until menstruation or in case of clinical pregnancy for 8 wk after the embryo transfer when the fetal heart activity was detected by ultrasonography. Results: The patient’s characteristics were matched and there was no significant difference. The chemical and clinical pregnancy rate was higher in the vaginal progesterone group compared to the prolutex group, but statistically unnoticeable, (40% vs. 29.6%, p = 0.367) and (28% vs. 22.2%, p = 0.581), respectively. C Conclusion: The findings of this study demonstrate that the new subcutaneous progesterone can be a good alternative for intramuscular progesterone in women that dislike and do not accept vaginal formulations as luteal-phase support in assisted reproductive technology. Key words: Progesterone, Subcutaneous, Vaginal, Pregnancy

Codifying the Strategic program for Valiasr Hospital in Arak using TOPSIS method

Attention to strengths, opportunities and efforts to improve them and assess weaknesses and threats to address them is the point of strategic planning and health policy. The present research has tried to apply strategic thinking and method towards the development of a program and a performance enhancement approach in Valiasr Hospital in Arak. In fact, Arak city as one of the industrial poles of the country and Valiasr Hospital of this city as one of the most important hospitals in Arak city and central province need to use strategic planning and methodology. In this regard, the present research has tried to first recognize the different dimensions of performance and factors affecting this performance. Then, by using the obtained knowledge, by combining SWAT and Tapsis methods to analyze these factors, then they are going to extrapolate different strategies of Valiasr Hospital. Finally, a strategic proposition is presented to improve performance and eliminate deficiencies and threats. Keywords: Strategic, Hospital, Arak, program. DOI: 10.7176/RHSS/9-3-1

Is there any correlation between Estradiol supplementation, as luteal phase support, and clinical pregnancy in ART cycles? A cross-sectional study

Background: Endometrial receptivity is one of the important factors in assisted reproductive technology (ART) success. In the luteal phase of an ART cycle, serum estradiol (E2) and progesterone are often placed in low levels. Supporting the luteal phase with progesterone is a usual method. Objective: To evaluate the effects of E2 supplementation plus progesterone on the luteal phase support in the antagonist protocol who have undergone intracytoplasmic sperm injection-embryo transfer cycles. Materials and Methods: In this cross-sectional study, 200 patients with antagonist stimulation protocol, who had undergone intracytoplasmic sperm injection treatment, were divided into two groups based on the use of E2 supplementation. In both groups, 400 mg progesterone suppositories (Cyclogest®), twice a day/vaginally, was administered starting from the day of oocyte collection until the fetal heart activity. However, in the E2 group, in addition to progesterone, 4 mg tablet of E2 was received daily. Beta hCG was checked 14 days after the embryo transfer, and the clinical pregnancy rate was the main endpoint. Results: The patients’ characteristics were matched, and insignificant differences were observed, except for endometrial thickness. The clinical outcomes showed the rate of pregnancy was higher in the E2 group compared to the control group; nonetheless, statistically, there was no noticeable difference. Conclusion: E2 supplementation had no beneficial effect in the luteal phase support of IVF cycles. Nevertheless, more studies are required to confirm the supportive role of E2 supplementation for embryo implantation and to improve the outcomes in ART cycles. Key words: Luteal phase, Estradiol, Progesterone, ICSI, Pregnancy rate

The effect of low-dose aspirin on the pregnancy rate in frozen-thawed embryo transfer cycles: A randomized clinical trial

Background: The results of previous studies on the effect of low-dose aspirin in frozenthawed embryo transfer (FET) cycles are limited and controversial. Objective: To evaluate the effect of low-dose aspirin on the clinical pregnancy in the FET cycles. Materials and Methods: This study was performed as a randomized clinical trial from May 2018 to February 2019; 128 women who were candidates for the FET were randomly assigned to two groups receiving either 80 mg oral aspirin (n = 64) or no treatment. The primary outcome was clinical pregnancy rate and secondary outcome measures were the implantation rate, miscarriage rate, and endometrial thickness. Results: The endometrial thickness was lower in patients who received aspirin in comparison to the control group. There were statistically significant differences between the two groups (p = 0.018). Chemical and clinical pregnancy rates and abortion rate was similar in the two groups and there was no statistically significant difference. Conclusion: The administration of aspirin in FET cycles had no positive effect on the implantation and the chemical and clinical pregnancy rates, which is in accordance with current Cochrane review that does not recommend aspirin administration as a routine in assisted reproductive technology cycles. Key words: Aspirin, Embryo transfer, Pregnancy rates

Early oocyte triggering followed by in vitro maturation is a good approach in women with resistance ovary syndrome: A case-series

Background: Some women represent the inability to respond to endogenous and exogenous gonadotropins during in vitro fertilization/intracytoplasmic sperm injection cycles leading to the follicular developmental arrest. The women with resistant ovaries could benefit from in vitro maturation. Case: This case-series presents pregnancies resulting from initially scheduled conventional in vitro fertilization which led to arrested cycles because of resistant ovary syndrome. The protocol was changed to early oocyte triggering for 15 women due to the small follicles ≤ 12 mm in diameter on day 15 after stimulation with high doses of exogenous gonadotrophins instead of cycle cancellation. Germinal vesicle and metaphase I oocytes that were retrieved from follicles were matured in vitro and inseminated by intracytoplasmic sperm injection. Twenty formed embryos were transferred on day 3 after oocyte retrieval. This resulted in a 30.76% chemical pregnancy out of which no abortion occurred. Therefore, we reported a 30.76% singleton ongoing pregnancy. Conclusion: It seems that early oocyte triggering followed by in vitro maturation may be considered as a good modality in women experiencing follicular resistance to gonadotropins. These cycles can be rescued from cancellation with satisfactory clinical outcomes. Key words: Arrested stimulation cycle, Early oocyte triggering, In vitro maturation, Clinical outcome

Dual stimulation in unexpected poor responder POSEIDON classification group 1, sub–group 2a: A cross-sectional study

Background: Poor ovarian response management is a complex and controversial issue in the field of reproductive medicine. Objective: The aim of this study was to apply double stimulation in the same cycle in unexpected poor responders in POSEIDON classification group 1, sub group 2a and compare assisted reproductive technology outcomes between luteal phase and follicular phase ovarian stimulation. Materials and Methods: In this cross-sectional study, 10 women with age < 35 yr, antral follicle count > 5, and anti-müllerian hormone > 1.2 ng/mL were enrolled. All participants received conventional antagonist protocol in the follicular phase and only the cycles with retrieved oocytes < 4 in this phase included. The luteal phase ovarian stimulation was initiated from the day of first oocytes retrieval by 300 IU of human menopausal gonadotropin / day. When dominant follicles amounted to 14 mm in mean diameter, 0.25 mg/day of gonadotropin-releasing hormone antagonist was initiated and 10,000 IU human chorionic gonadotropin was injected when at least two follicles with a mean diameter of 17 mm were observed. Oocyte retrieval was carried out 34-36 hr following human chorionic gonadotropin injection. Finally, a comparison was made between the two phase in terms of the number of retrieved oocytes as well as the number of obtained embryos and fertilization rates. Results: Numbers of retrieved oocytes (p = 0.004), mature oocytes (p = 0.016), and embryos (p = 0.013) was significantly higher in luteal phase in compared with follicular phase. Quality of embryos was similar in two phases. Conclusion: Double stimulation protocol can increase number of retrieved oocytes in unexpected PORs. Key words: Dual stimulation, Poor responder, POSEIDON classification, Luteal-phase, Follicular phase, Ovarian stimulation

Long GnRH Agonist versus GnRH Antagonist Protocols in Women with Endometrioma and Good Ovarian Reserve Undergoing IVF/ICSI Cycles

Background: The best ovarian stimulation protocol in the case of endometrioma-related infertility is still debated. In this study, we examined the effect of two ovarian stimulation protocols on in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) outcome in patients with good ovarian reserve suffering from endometrioma. Methods: In a retrospective study, 101 women with endometrioma and good ovarian reserve were recruited. Women received either gonadotropin-releasing hormone (GnRH) agonists (n=65) or GnRH antagonists (n=36) in an IVF or ICSI cycle. Clinical and chemical pregnancy rate, live birth rate, implantation rate, fertilization rate and fertilization proportion, as well as miscarriage rate, were evaluated in both groups. Results: Chemical (25% vs. 28.6%), clinical (19.6% vs. 25%), and live birth rates (19.6% vs. 25%) as well as implantation rate (11.7% vs. 15%) were not significantly different between the two groups. Miscarriage rate, fertilization rate and fertilization proportion were similar in the two groups. Conclusion: GnRH antagonist protocol with the main advantages of short duration and lower cost of treatment could be applied in infertile patients with endometrioma and good ovarian reserve

The effects of a strengthening exercise program with EMG biofeedback to correct patellar alignment and reduce knee pain in women with patellofemoral pain syndrome

Background and aims: EMG biofeedback as a relatively new tool in helping to relieve muscle dysfunction has been proposed. The aim of this study was to investigate the effects of a strengthening exercise program with electromyographical biofeedback on the alignment corrections of the patella and the knee pain in patients with patella-femoral pain syndrome. Methods: This research was a clinical trials study. 22 participants with patella-femoral pain syndrome were randomly divided into two equal groups (n=11). The first group underwent a strengthening exercise program with biofeedback electromyography. The second group also recieved a strengthening exercise program without biofeedback electromyography. Using VAS questionnaire, the knee pain was assessed. Radiography technique was also applied to evaluate the knee alignments including Sulcus, congruence and tilt angles and Q angle assessed by clinical tests. Pair t-test and Independent t-test with SPSS were used for statistical analysis. Results: The results showed that the knee pain, congruence and Q angle had significant decrease after the therapy in both groups (P<0.05). However, the patellar tilt displayed a significant decrease only in the strengthening exercise program in the biofeedback electromyography group (P<0.05). In between group comparisons, pain and Q angle reduction after strengthening exercise program with biofeedback electromyography group was significantly more than strengthening exercise program without biofeedback electromyography group (P<0.05). Conclusion: Muscular strengthening exercise with electromyographical biofeedback displayed a better treatment outcome for pain reduction and correction of knee alignment. It seems that the provision of electromyographic biofeedback be preferred in comparison with the muscular strength training method without electromyographic biofeedback by creating more motivation for performing the exercises precisely and it can be used as a supportive tool in rehabilitation

The Bulletin, Annual Catalogue, Academic Year 1952-1953, Series 48, Number 1, August (1952)

https://red.mnstate.edu/bulletins/1032/thumbnail.jp

Effectiveness of Theory-Based Intervention on Knowledge Level, Psychological Constructs, Metabolic Index and Physical Activity Status in Patients with Type 2 Diabetes: Application of the Health Action Process Approach (HAPA) Model

Objective: The aim of the study was to determine the effect of the educational intervention based on the health action process approach (HAPA) model on the level of knowledge, metabolic indicators, psychological constructs and physical activity status in type 2 diabetes (T2D) patients in 2022–2023. Material and methods: The present study was a randomized controlled trial and 100 T2D patients were equally assigned to experimental and control groups using multistage random sampling. The educational program included six online sessions, targeted pamphlets, educational audio files and reminder messages. Data were collected before and 3 months after intervention with demographic items, awareness scale, constructs of HAPA model, IPAQ-s, HbA1c and fasting blood glucose (FBG). Data were entered to SPSS 25.0 and analyzed with chi-square, ANOVA and ANCOVA. Results: After controlling the effect of the pre-test variable, the mean of the HAPA model constructs and mean of physical activity improved significantly in posttest. In addition, educational intervention explained 30.2%, 57.8%, 33.2%, 64.4%, 76.3%, 25.3%, 24.6%, 36.1% and 36.9% of the variance of health awareness, risk perception, outcome expectancy, action self-efficacy, maintenance self-efficacy, action plan, coping plan, behavioral intention and physical activity, respectively. In addition, the mean of FBG and HbA1c in the experimental group improved significantly after the intervention by controlling the pre-test effect (p &lt; 0.001). Conclusions: Providing theory-based educational interventions through the web and mobile can increasingly promote the effectiveness of cognitive behavioral interventions and facilitate the process of behavior change in T2D