Endometrial and follicular development following stair-step and traditional protocols in women with polycystic ovary syndrome: An RCT

Background: Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment. Objective: To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP). Materials and Methods: Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation. Results: Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP. Conclusion: The most appropriate dose for ovulation in patients with PCOS is 100 mg CC. Key words: Polycystic ovary syndrome, Clomiphene, Infertility, Ovulation induction

Myo-inositol effect on pregnancy outcomes in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection: A double-blind RCT

Background: Myo-inositol is an intracellular mediator which is involved in various aspects of reproduction in women. Objective: This study aimed to evaluate the impact of Myo-inositol on the outcomes of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles in infertile women. Materials and Methods: This double-blind randomized controlled trial was conducted on 70 infertile women referred to the Infertility Treatment Center, Besat hospital, Sanandaj, Iran from May 2019 to September 2019 for IVF/ICSI cycles. The participants were randomly divided into 2 intervention (n = 36) and control (n = 34) groups. The intervention group received 2000 mg of Myo-inositol and 200 mcg folic acid twice a day for 2 months and the control group received 200 mcg of folic acid twice a day for 2 months in the IVF/ICSI cycles (from the third day of cycle until the end of the second month). Finally, the number of oocytes, the quality of embryos, and the IVF/ICSI outcomes were compared between the 2 groups. Results: The mean numbers of oocytes, MII oocytes, and 2 pronuclear embryos were significantly higher in the intervention group than the control group. Also, the clinical pregnancy and live birth rates in the intervention group were significantly higher than in the controls (p = 0.04). Conclusion: The administration of Myo-inositol may increase clinical pregnancy and live birth rates by increasing the number of total and meiosis II oocytes in infertile women undergoing IVF/ICSI. Key words: Infertility, In vitro fertilization, Intracytoplasmic sperm injection, Myoinositol

Evaluating the association between first trimester screening tests and adverse perinatal outcomes

Prenatal screening tests are not diagnostic and only show and determine the risk of fetal abnormalities. This study aimed to evaluate the association between the results of double marker test and nuchal translucency (NT) in first trimester with adverse perinatal outcomes (Low-Birth-Weight, Small for Gestational Age, Intrauterine Growth Restriction, Aneuploidy, and fetal abnormalities) in pregnant women. This nested case control study was conducted on two groups of pregnant women. In case group (n=46) the result of double test in first trimester was positive (more than 1.50) and nuchal translucency was also positive (more than 3 mm). In control group (n = 77) the result of double test and nuchal translucency was negative. For each woman, data including demographic data, gestational age, gravidity, parity, number of abortion, weight and height of pregnant women, and the results of double screening test and nuchal translucency were recorded in a check list. For women who had positive test, amniocentesis (in 16 weeks of pregnancy) was performed. Borderline cases were followed using cell free fetal DNA or quadruple screening test. All women were followed during pregnancy until delivery. The prevalence of Down syndrome, intrauterine growth restriction and fetal abnormality in case group was more than the control group and difference was significant statistically (P = .001). Trisomy 18 and 13 were not found in the two groups. In terms of the frequency of spinal cord defects, respiratory distress, SGA, LBW and infant mortality there was no significant difference between the two groups. Conclusion: Our findings showed that adverse perinatal outcomes in screening positive cases were higher. Therefore the double marker test could be helpful in detecting fetal outcomes such as intrauterine growth restriction and fetal structural abnormalities

The relationship between anti-mullerian hormone and ovarian response and fertility outcome in infertile women undergoing assisted reproductive techniques (ART) and IUI

Introduction: Anti-Mullerian Hormone (AMH) is related to woman's age, the number of antral follicles, and the outcome of assisted reproductive techniques. The present study was performed with aim to evaluate the relationship between anti-mullerian hormone levels and ovarian response and pregnancy outcomes in infertile women undergoing assisted reproductive techniques (ART) and IUI.Methods: This cross-sectional (descriptive-analytical) study was performed on 186 infertile women undergoing ART referred to Besat Hospital Infertility Center, Sanandaj, Iran during 2016-2020. Demographic information, FSH level, AMH level, number of gonadotropin injections, number of antral follicles and number of fetuses were evaluated and recorded in the questionnaire.. Also, pregnancy outcomes including abortion, fetal death, fetal malformation and birth were determined and recorded in the questionnaire. Data were analyzed by SPSS software (version 22) and chi-square, Fisher exact, one-way analysis of variance and Pearson correlation. P0.05).Conclusion: Determination of AMH levels can help for administration of gonadotropins, prediction of antral follicle numbers, number of eggs retrieved and number of embryos obtained, but Anti-mullerian hormone levels are not associated with pregnancy outcomes

Comparison of the effectiveness of clomiphene citrate, tamoxifen and letrozole in ovulation induction in infertility due to isolated unovulation

Background: Unovulation is the most common cause of infertility. The first line oral treatment has been clomiphene citrate. Another anti-estrogen used for ovulation induction is tamoxifen. Many unovulatory infertile women are resistance to anti-estrogens and need another treatment. Alternative treatments are aromatas inhibitors. Objective: This study was designed to compare the effectiveness of clomiphene, tamoxifen and letrozole in ovulation induction outcomes in isolated non PCOS unovulatory patients. Materials and Methods: 150 unovulatory infertile women who had isolated non- polycystic ovarian syndrome (PCOS), randomized to 3 groups. Group A received clomiphene 50 mg to maximum 150 mg for 5 days, Group B received tamoxifen 10mg to maximum 30 mg for 5 days, Group C received letrozole 2.5 mg for 5 days, to maximum 7.5 mg until ovulation was induced. If ovulation failed to occur with 5 days treatments, drug continued for 7 days. Treatment has been stopped if they became pregnant or if patient didn’t ovulate with maximum dose for 7 days (resistant to treatment) or failed to concept after six months despite ovulation (failure of treatment). Main outcome measures were: number of mature follicles, endometrial thickness, pregnancy rate, multiple pregnancy rate, live birth and miscarriage. Results: Overall ovulation rate was 60 (73.4%), this rate in group A was 39 (78%), in group B it was 24 (68%) and in group C was 37 (74%). Pregnancy rate in groups A, B and C were, 32 (64%), 20 (40%), and 25 (50%) respectively, and live birth rate was 22 (44%) in A, 17 (34%) in B and 21 (42%) in C. Miscarriage rate with clomiphene was 10 (20%) while this was 3 (6%) in tamoxifen and 4 (8%) in letrozole group (p=0.05). One twin pregnancy was occurred with clomiphene and one with tamoxifen, while all pregnancies with letrozole were singleton. Conclusion: Because of higher pregnancy rate with clomiphene citrate than tamoxifen and letrozole, Clomiphene citrate is still the first-line therapy for ovulation induction. Surprisingly, pregnancies after tamoxifen and letrozole have lower miscarriage rate than clomiphene

Effect of early amniotomy on labor outcome in nulliparous women: a randomized clinical trial

Early amniotomy is one of the main interventions to enhance the labor progress and prevent dystocia in pregnant women. However, the efficacy of amniotomy has not been approved via labor-related indices and outcomes and has remained a subject for debate and future research. The present study was conducted to evaluate the effect of early amniotomy on labor indices and outcomes in nulliparous women. This randomized clinical trial was performed on 151 singleton pregnant women who were referred to Besat Hospital in Sanandaj, Iran, from March 2016 to March 2018. Participants were randomly divided into an early amniotomy (EA) group and a control group. Duration of the first and second phases of labor, corioamionit, dystocia rate, Apgar score at the first and fifth minutes, prolonged labor and post-partum haemorrhage were evaluated and compared between the two groups. Data were recorded in a checklist and analysed using SPSS Version 23. The p value <0.05 was considered significant. Results showed that labor indices such as duration of the first and second phases, Apgar score one and five minutes after delivery and frequency of prolonged labor, foetal distress and postpartum haemorrhage were significantly improved in patients of the early amniotomy group, compared with the control group (p≤0.05). Early amniotomy significantly decreased the total labor duration without significant increase in the rate of maternal and neonatal complications

Endometrial and Follicular Development Following Stair-step and Traditional Protocols in Women with Polycystic Ovary Syndrome: an RCT

Background: Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment. Objective: To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP). Materials and Methods: Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation. Results: Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP. Conclusion: The most appropriate dose for ovulation in patients with PCOS is 100 mg CC. Key words: Polycystic ovary syndrome, Clomiphene, Infertility, Ovulation induction