Luteinizing hormone changes in gonadotropin-releasing hormone antagonist protocol in in vitro fertilization cycles: A cross-sectional study

Background: Because of the unexpected and often dramatic inhibition of luteinizing hormone (LH) secretion related with the usage of gonadotropin-releasing hormone (GnRH)-antagonist, there has been a probable need for exogenous LH supplementation. There is a basic and clinical evidences that show late development of follicle needs an LH but there is a threshold for LH requirements during folliculogenesis.Objective: The purpose of this study was to evaluate the changes in serum LH and the identification of patients who benefit from the addition of LH.Materials and Methods: Seventy volunteers for antagonist protocol in IVF cycle were enrolled in this prospective cross-sectional study. The study was carried out in Reproductive Health Research Center, University of Medical Sciences between July 2016 and February 2016. Serum LH level was estimated 24 h before and after the first(GnRH) antagonist injection. The primary outcome was the serum level of LH and its change in the three groups and the secondary outcome was Egg and Embryo quality.Results: LH changes above or below 50% had no effect on the number of follicle, the number of oocyte, Germinal vesicle oocyte, metaphase 1 oocyte, metaphase 2 oocyte, endometrial thickness, and chemical and clinical pregnancy.Conclusion: We evaluated the changes of serum LH in the patients who were entered in the antagonist protocol. Our study showed no significant difference in LH levels 24h before and after the injection of the antagonist between the three groups, and LH changes did not affect the outcome of pregnancy

Infertility policy analysis: a comparative study of selected lower middle- middle- and high-income countries

Background: Infertility has recently become a salient but neglected global issue. Policies to address the sexual and reproductive health and rights (SRHR) are vital, especially in lower middle and middle-income countries (LMICs). Hence, the aim of this study was to compare the national infertility policies in the selected countries (LMICs comparing with high-income) to determine gaps or to confirm desirable policies in the given health systems. Methods: This study has executed a comparative policy analysis of infertility services using the universal health coverage framework (financial protection, population coverage, and service features) in three scopes (prevention, treatment, and supportive care). Seven countries that had infertility programs in their health sectors were selected. Results: The results showed that financial protection was good in high and middle-income countries, but in a lower middle income, and in one high-income country was poor. The findings also showed that health systems in the same countries had no infertility services for men. Preventive and supportive care services were neglected in LMICs by governments. Conclusion: The findings indicate that income is not the only factor that fulfills universal health coverage for infertility care services. Perhaps to achieve equity in infertility care services, it should be seen as a universal human right to accomplish the right to have a child and to have a life with physical and mental health for all men and women

The Association of Serum Hepcidin Levels and Insulin Resistance in PCOS Patients: A Case-Control Study

Objective: To investigate the relationship between insulin resistance and hepcidin levels in patients with PCOS. Materials and methods: In this case–control study fifty- six patients with PCOS and forty – one healthy control subjects were included. Plasma levels of hepcidin, IL-6, Serum Insulin and ferritin using ELISA method, serum iron levels using a spectrophotometric method, and Insulin resistance by using HOMA  were measured in the two groups of PCOS (case group) and  healthy subjects (control group). The results were analyzed by student’s t-test, General Linear Model, Binary logistic and linear regression tests. Results: The mean hepcidin level was 1.97 ± 0.53 pg/ml and 2.40 ± 0.25pg/ml in the case and control groups, respectively. The t-test results showed a significant difference between the two groups (p = 0.0001). The mean of insulin level in case and control group was 30.65 ± 15.02g/dl and 14.71 ± 10.46g/dl, respectively. The t-test analysis indicated a significant difference between the two groups (p = 0.0001). There was an inverse relationship between the level of hepcidin with HOMA-IR (β = -0.629, p = 0.04), and IL-6 (β = -0.243, p = 0.015) in both groups. The adjusted OR proved a statistically significant association between serum hepcidin (OR = 0.063; 95 % CI: 0.01-0.385, p-value  =  0. 003) and HOMA (OR  =  1.569; 95 % CI: 1.254–1.964, p-value  =  0.001) with PolycysticOvarian Syndrome. Conclusion: There was an inverse relationship between hepcidin levels and insulin resistance in both groups meaning decrease in hepcidin levels and increase in insulin resistance may increase the risk of PCOS

Health-related quality of life in infertile couples receiving IVF or ICSI treatment

<p>Abstract</p> <p>Background</p> <p>Infertile couples might experience psychological distress and suffer from impaired health-related quality of life. This study aimed to examine health-related quality of life in infertile couples receiving either in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.</p> <p>Methods</p> <p>This was a cross-sectional study of quality of life in infertile couples attending to Vali-e-Asr Reproductive Health Research Center or Royan Institute for either IVF or ICSI treatment in Tehran, Iran. Health-related quality of life was assessed using the Short Form Health Survey (SF-36). Patients' demographic and clinical characteristics were also recorded. Data were analyzed to compare quality of life in infertile women and men and to indicate what variables predict quality of life in infertile couples.</p> <p>Results</p> <p>In all 514 women and 514 men (n = 1028) were studied. There were significant differences between women and men indicating that male patients had a better health-related quality of life. Also health-related quality of life was found to be better in infertility due to male factor. Performing logistic regression analysis it was found that female gender, and lower educational level were significant predictors of poorer physical health-related quality of life. For mental health-related quality of life in addition to female gender and lower educational level, younger age also was found to be a significant predictor of poorer condition. No significant results were observed for infertility duration or causes of infertility either for physical or mental health-related quality of life.</p> <p>Conclusion</p> <p>The findings suggest that infertility duration or causes of infertility do not have significant effects on health-related quality of life in infertile couples. However, infertile couples, especially less educated younger women, are at risk of a sub-optimal health-related quality of life and they should be provided help and support in order to improve their health-related quality of life.</p

Developing criteria for Cesarean Section using the RAND appropriateness method

<p>Abstract</p> <p>Background</p> <p>Cesarean section rates are increasing worldwide, and a rapid increase has been observed in Iran. Disagreement exists between clinicians about when to use cesarean section. We aimed to identify the appropriateness criteria for the use of cesarean section in Iran.</p> <p>Method</p> <p>A consensus development study using a modified version of the RAND Appropriateness Method (RAM). We generated scenarios from valid clinical guidelines and expert opinions. A panel of experts participated in consensus development: first round via mail (12 members), second round face-to-face (9 members). We followed the RAM recommendations for the development of the scenario lists, rating scales, and statistical analyses.</p> <p>Results</p> <p>294 scenarios relevant to cesarean section were identified. 191 scenarios were considered appropriate, of which 125 scenarios were agreed upon. The panel found cesarean inappropriate for 21% of scenarios, and 'equivocal' for 14% of scenarios.</p> <p>Conclusion</p> <p>RAM is useful for identifying stakeholder views in settings with limited resources. The participants' views on appropriateness of certain indications differed with available evidence. A large number of scenarios without agreement may partly explain why it has been difficult to curb the growth in cesarean section rate.</p

Gonadotropin Regulation of Retinoic Acid Activity in the Testis

Initiation of spermatogenesis in primates is triggered at puberty by an increase in gonadotropins; i.e., follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Prior to puberty, testis of the monkey contains only undifferentiated germ cells. However, sermatogonial differentiation and spermatogenesis may be initiated prior to puberty after stimulation with exogenous LH and FSH. Retinoic acid (RA) signaling is considered to be a major component that drives spermatogonial differentiation. We were interested in evaluating the relative role of LH and FSH, either alone or in combination, in regulating the retinoic acid signaling in monkey testis. Sixteen juvenile male rhesus monkeys (Macaca mulatta) were infused with intermittent recombinant single chain human LH (schLH) or recombinant human FSH (rhFSH) or a combination of both for 11 days. We then analyzed the expression of the several putative RA signaling pathway related genes; i.e. RDH10, RDH11, ALDH1A1, ALDH1A2, CYP26B1, CRABP1, CRABP2, STRA6, STRA8 in the testis after 11 days of stimulation with vehicle, LH, FSH and combination LH/FSH using quantitative real-time PCR (qPCR). The qPCR results analysis showed that administration of gonadotropins affected a significant change in expression of some RA signaling related genes in the monkey testis. The gonadotropins, either alone or in combination dramatically increased expression of CRABP2 (p≤0.001), whereas there was a decrease in ALDH1A2 expression (p≤0.001). Moreover, combined gonadotropin treatment led to the significant decrease in CRABP1 expression (p≤0.05). These findings are the first evidence that the activity of retinoic acid signaling in the monkey testis is regulated through gonadotropins (LH/FSH) levels