Evaluation of the relationship between serum estradiol levels on human chorionic gonadotropin administration day and intracytoplasmic sperm injection outcomes: A retrospective population-based study

Background: The correlation between high estradiol (E2) levels induced by controlled ovarian hyperstimulation (COH) and pregnancy is controversial. Objective: To assess the effect of serum E2 levels on the day of human chorionic gonadotropin administration on the intracytoplasmic sperm injection (ICSI) outcome. Materials and Methods: The current study included 551 participants who had undergone ICSI between May 2014 and May 2016. Based on E2 levels, the individuals aged < 37 yr (n = 502) and 37-42 yr (n = 49) were categorized into six and three groups, respectively. ICSI outcomes including the number of retrieved oocytes (NRO), number of embryos (NE), pregnancy rate, and abortion rate were analyzed in both groups. Results: Among participants aged < 37 yr, the NRO and NE were 8.69 ± 3.82 and 5.24 ± 2.32, respectively and they had a significant correlation with the E2 level on human chorionic gonadotropin administration day (p < 0.001 for both). Among participants aged > 37 yr, NRO and NE were 5.18 ± 3.17 and 3.40 ± 2.23, respectively, and the NRO (p < 0.001), NE (p < 0.001), pregnancy rate (p < 0.001), abortion rate (p = 0.007), and the number of grade A and B embryos (p = 0.003) had a significant association with the E2 level. Conclusion: COH is a costly procedure that may have negative effects on endometrial receptivity. Thus, in order to prevent these effects and also to reduce the costs of COH, we recommend gaining optimum number of oocytes rather than maximum number during the procedure. Key words: Intracytoplasmic sperm injection, In vitro fertilization, Estradiol, Pregnancy

Persistence of Hemorrhage and Hypertensive Disorders of Pregnancy (HDP) as the Main Causes of Maternal Mortality: Emergence of Medical Errors in Iranian Healthcare System.

This study aimed to assess factors affecting substandard care and probable medical errors associated with obstetric hemorrhage and HDP at a Northwestern Iranian health care system.In a community-based descriptive cross-sectional study, data on all maternal deaths occurred at West Azerbaijan Province, Iran during a period of 10 years from March 21, 2002 to March 20, 2011 was analyzed. The principal cause of death, main contributory factors, nature of care, main responsible staff for sub-standard care and medical error were determined. The data on maternal deaths was obtained from the national Maternal Mortality Surveillance System (MMSS) which were covered all maternal deaths. The "Three delays model" was used to recognize contributing factors of maternal deaths due to obstetric hemorrhage and HDP.There were 183 maternal deaths, therefore the Mean Maternal Mortality Ratio (MMR) in the province was 32.8 per 100 000 live births (95% CI, 32.64-32.88). The most common causes of maternal deaths were obstetric hemorrhage in 36.6% of cases and HDP in 25.7%. The factors that most contributed to the deaths were all types of medical errors and substandard care with different proportions in management of obstetric hemorrhage and HDP.A substandard care and medical error was the major contributing factor in both obstetric hemorrhage and HDP leading to maternal mortality, therefore, it is necessary to improve the quality of health care at all levels especially hospitals

Relationship between progesterone level on the day of human chorionic gonadotropin administration with outcomes of intra-cytoplasmic sperm injection in infertile couples

Background: Gonadotropin-releasing hormone agonists or antagonists are used in assisted reproductive technique cycles as premature luteinizing hormone secretion inhibition. Studies have been reported different and contradictory results on the serum progesterone effect on intra-cytoplasmic sperm injection. Objective: The purpose of this study was to evaluate the effect of serum progesterone level on the day of Human chorionic gonadotropin (HCG) administration on the intra-cytoplasmic sperm injection (ICSI) outcome in infertile women. Materials and Methods: 249 infertile couples candidated for ICSI were enrolled in the study. Their serum progesterone level on the day of HCG administration was measured and according to serum level, patients were divided into four groups of less than 0.9, 0.9-1.4, 1.5-1.9, and ≥2 ng/mL. The four groups were compared with each other regarding fertility outcomes. Results: Pregnancy rate was not significantly different among the four groups (p>0.05). Also, there was no significant difference among the groups regarding frequency of abortion and ectopic pregnancy. Conclusion: Serum progesterone level on the day of HCG administration does not have any significant effect on pregnancy outcomes, including abortion, ectopic pregnancy, and pregnancy rate in patients undergoing ICSI treatment

Evaluation of serum estradiol/ progestrone ratio on day of embryo transfer and it’s effect on intra-cytoplasmic sperm induction outcome

Background : One of the important problems in fertilization in vitro (IVF) is failure of implantation. This could be the result of estrogen and progesterone effects in endometrial acceptance during ovulation stimulation. Although progesterone has a vital role in primary phase of pregnancy, but the estradiol role in luteal phase is unknown. The aim of this study is assessment of the ratio of estradiol to progesterone in embryo transfer day on Intracytoplasmic sperm injection (ICSI) outcomes. Methods : This is a cohort study. The subjects were 311 infertile women referred to Urmia Kosar infertility clinic & Urmia reproductive health research center who treated with ICSI method between August-Jan 2011 . Five cc blood was drawn for determine of estradiol and progesterone in transfer day. Transfer occurred after a variable in vitro culture period ranging from 48 to 72 hours after ovulation induction. Chemiluminescent ELICA the level of mention hormones was used to determine the ratio of the progesterone level to the estradiol serum level and was compared based on treatment outcomes. Results : A total of 311 patients, 115 (37%) were pregnant and happened abortion were 18 (5.8%) . The mean ratio of estradiol to progesterone in transfer day in two groups of miscarriage/ non miscarriage and pregnant/ non pregnant was 32.26±23.86 , 28.17±26.5 and 28.58±2.4 , 36.09±4.39 respectively. There is no significant difference between two groups in regard of estradiol on progesterone ratio (P=0.5, P= 0.2) . Conclusion: The results of this prospective cohort study show that there is no effect of estradiol to progesterone ratio on day of embryo transfer, successful pregnancy in ICSI cycles and abortion rate following of ICSI

Relationship between Helicobacter pylori infection and spontaneous abortion

Background: Helicobacter pylori (HP) infection may be having no clinical symptoms and if not treated will be persisting. This infection was considered as gastric diseases even during pregnancy. During the last decade its relationship with pregnancy related- disorders has been strongly reported in literature. In this study we evaluated the effect of positive IgG and CagA strains helicobacter pylori on incidence of early spontaneous abortions. Methods: A cross-sectional study was carried out on 100 women were referred to health centers and Motahari Hospital, Urmia, Iran, from October 2012 to March 2013. Fifty women with first miscarriage as cases and 50 women with previous normal delivery as controls were studied. A 2-cc blood sample was taken from each patient to evaluate the specific IgG titer by ELISA method. All results of samples with positive H. pylori IgG, were assayed for anti-CagA, IgG antibodies. A questionnaire was filled for each subject. The associations between CagA positive cases with odds of spontaneous abortion incidence were analyzed by using SPSS software, ver. 19 (Chicago, IL, USA). Results: Mean (±SD) of age were 21.0±5.78 and 30.78±5.10 years for cases and controls group respectively. There was no significant difference in mean of age (P=0.25), and parity (P=1) between two groups. H. pylori IgG antibodies were positive among 23 and 24 (46% vs. 48%) in women with aborted and normal pregnancy respectively. Relationship between IgG status and miscarriage was not significant (OR=0.92, CI95%: 0.39-2.17, P=0.84). In particular anti-CagA antibodies were positive among 18 and 13(78.3% vs. 54.2%) in women with aborted and normal pregnancy respectively. Among women with CagA positive strains had higher odds of miscarriage (OR=3.05, CI95%: 0.73-13.76, P=0.08), but it wasn’t significant. Conclusion: According to the result of this study there was not any association between HP infection and miscarriage. We recommend more studies with larger sample size for determining the effect of CagA positive strains on miscarriage

Association of Helicobacter Pylori Infection and Ectopic Pregnancy

Objective: To evaluate the importance of cytokine type in embryo implantation in uterus specified and activated macrophages interfere the tube movements and embryo retention in uterine tubes by smooth muscle relaxation and disrupting ciliary function. Therefore, increased risk of infection with HP during pregnancy, we investigated relation between Helicobacter pylori (HP) infection and prevalence of ectopic pregnancy (EP) in this study. Materials and methods: This is cross-sectional study from March 2012 to May 2013. Totally 207 women were enrolled randomly from which 101 had EP (Case group) and 106 were selected as control group with normal pregnancy. A 2-cc blood sample was taken from each patient to evaluate the specific IgG titer by ELISA method. All results of samples with positive H. pylori IgG were assayed for anti-CagA, IgG antibodies. A questionnaire was filled for each subject. The associations between CagA positive cases with odds of Ectopic pregnancy incidence were analyzed by using SPSS software, ver. 19 (Chicago, IL, USA). Results: Mean (± SD) of age were 21.0 ± 5.78 and 30.78 ± 5.10 years for cases and controls group respectively. These groups didn’t show any significance difference in age and parity.H. pylori IgG antibodies were positive among 99 and 103 (98.2% vs. 97.2%) in women with EP and normal pregnancy respectively. Relationship between IgG status and EP was not significant (OR = 1.31: 95% CI = 0.7-2.52, Pvalue = 0.37). In particular anti-CagA antibodies were positive among 45 and 39(45.92% vs. 36.97%) in women with EP and normal pregnancy respectively. Among women with CagA positive strains had higher odds of Ep (OR = 1.46: 95% CI = 0.8-2.65, Pvalue = 0.18), but it wasn’t significant. Conclusion: According to the result of this study there was not any association between HP infection and Ectopic pregnancy. We recommend more studies with larger sample size for determining the effect of CagA positive strains on EP

Clinical results of microinjection with long protocol and prednisolone addition

Background: Last decades, we have observed major improvements in treating infertility by using microinjection. However, reduction in abortion or increase in fertility has not been significant. It seems use of corticosteroids improves clinical outcomes during assisted reproductive technology (ART) techniques. Therefore, this study tried to show how corticosteroids therapy improves the results of intracytoplasmic sperm injection (ICSI). Methods: This semi clinical trial study without control group was included infertile women with more than one year’s infertility and were candidate to ICSI which were referred to Kosar Infertility Center, Urmia University of Medical Sciences from April 2011 to September 2013. Patients received prednisolone which was started 20 mg/day from one day before embryo transfer to 7 days, then for 2 days more 1 tablet and stopped. Pregnancy outcomes were chemical and clinical pregnancy, ectopic pregnancy, multiple pregnancy and rate of abortion before 20 weeks. Beta human chorionic gonadotropin (HCG) test was performed. Patients with positive pregnancy test were followed by sonography in 6, 12 weeks and 20 weeks of pregnancy. Results: One hundred and eighty one patients entered to the study. The mean± SD of age and fertility duration were 30.42± 6.07 and 7.69± 5.54 years. The mean± SD of transferred embryo was 4.60± 1.10 and embryo grading was 138 (44.7%) grade A, 124 (40.1%) grade B, 47 (15.2%) grade C, respectively. There were no significant difference between fresh/frozen embryo transfer in pregnancy outcomes (P> 0.05 in all of outcomes comparison). The incidence rate of biochemical pregnancy was 48.1% (87), clinical pregnancy rate with appearance of fetal heart was 44.2% (80), incidence rate of abortion before appearance of fetal heart (6 weeks) in women with intra-uterine pregnancy was 5.9% (5), incidence rate of abortion before 20 weeks was 12.9% (11). Incidence rate of ectopic pregnancy was 2.3% (2) and rate of multiple pregnancies was 32.5% (26). Conclusion: Our study suggests that the infertile patients who receive prednisolone in ICSI cycle, had improved pregnancy outcomes. Additional confirmatory studies are needed

Effects of antibiotic consumption on children 2-8 years of age developing asthma

OBJECTIVES Antibiotic exposure in children is a possible contributor to the increasing asthma prevalence in several countries. The present study aimed to investigate the association between antibiotic exposure and the risk of developing childhood asthma at 2-8 years of age. METHODS A case-control study was undertaken among children aged 2-8 years old between March and September 2010 in the Urmia district in the northwest of Iran. The cases were doctor-diagnosed asthmatic children based on Global Initiative for Asthma criteria (n=207), and the controls were children without respiratory symptoms (n=400) selected by frequency matching by age and gender. Clinical data including antibiotic exposure was collected by a validated and reliable questionnaire, which was completed by interviewing parents/guardians. RESULTS Antibiotic consumption during the first year of life increased the odds ratio [OR] of asthma symptoms at 2-8 years of age (crude OR, 2.26; 95% confidence interval [CI], 1.53-3.35; p<0.01), and the strength of association was similar after adjusting for a family history of asthma or atopic disorder, preterm delivery, birth order, and delivery method (adjusted OR, 1.91; 95% CI, 1.27-2.88; p=0.03). CONCLUSIONS Our study suggests that antibiotic consumption in children was associated with an increased risk of childhood asthma, and an additional confirmative study is needed