The Effect of the CO2 Fractional Laser or Premarin Vaginal Cream on Improving Sexual Function in Menopausal Women: A Randomized Controlled Trial

Introduction:Sexual dysfunction is a complex problem in postmenopausal women with a prevalence rate of 68 - 86 %. This study aimed to evaluate the effect of a fractional CO2 laser or vaginal cream on the improvement of sexual function in menopausal women. Methods:This is a two-group clinical trial study.   Postmenopausal women with the inclusion criterion were enrolled and randomly divided into two groups of intervention (n=25) and control group (n=25). In the intervention group, the CO2 laser therapy was performed every month for three months, and in the control group, Premarin vaginal cream was applied (0.625 mg  )، 1 gr, three nights a week for 3 months. Vaginal Health Index scoring( VHI)  and Female Sexual Function Index( FSFI) questionnaires were completed before and after three months of treatment.Results:The effects of the laser treatment was greater than the Premarin group with respect to improvement in sexual desire, orgasms, sexual satisfaction, less pain during sexual relations, and overall sexual function. ( P<0.05)Conclusion:It seems that the fractional CO2 laser may be more effective than hormonal therapy in improving sexual function in postmenopausal women

The effect of vitamin D supplementation on the size of uterine leiomyoma in women with vitamin D deficiency

Background: Uterine leiomyomas (fibroids) are the most common benign pelvic tumors in women of reproductive age with an incidence ranging from 5.4 to 77, Also, there is a high prevalence of vit D deficiency in Iran and there are the numbers of in vivo and vitro biological studies on the relationship of vitamin D and uterine leiomyomas. The aim of this study was to evaluate the effect of vit D supplementation on the size of uterine leiomyoma in women with vit D deficiency. Methods: This double-blind prospective clinical trial was performed on 69 patients with uterine leiomyomas who had vit D deficiency. Group A (n=35) was treated with vit D 50,000 IU every 2 weeks for 10 weeks, while group B (n=34) received placebo with same color and shape. Finally, the leiomyoma size in both groups was compared (IRCT: 20160521027998N5). Results: After a 10-week intervention, 25-hydroxyvitamin D3 levels were significantly higher in group receiving vitamin D (36.08 vs 16.25 ng/ml). (P<0.001) Leiomyomas size in vit D group significantly decreased as compared to placebo group (52.58 vs 61.11 mm, respectively). Conclusion: Our results showed that administration of vit D3 may reduce the size of leiomyoma. It seems that vitamin D administration is the effective way to treat leiomyoma

Evaluation of follicular fluid’s Beta-Human chorionic gonadotropin in the follicles of patient undergoing Intracytoplasmic sperm injection: A cross-sectional study

Background: The failure to retrieve oocytes from mature ovarian follicles is referred to as empty follicle syndrome. There is no exact explanation to this problem and it cannot be predicted using ultrasound or serum hormonal levels. The underlying mechanism of Empty follicle syndrome remains obscure. Objective: In this study, the authors have investigated the relationship between the Beta-Human chorionic gonadotropin (βHCG) levels in the follicular fluid with or without the oocyte in the follicles of patients undergoing Intracytoplasmic Sperm Injection. Materials and Methods: Seventy-three infertile couples underwent standard long protocol induction ovulation for Intracytoplasmic sperm injection. On the day of oocyte retrieval, each patient had two samples; follicular fluid including 2–3 follicles with oocyte and follicular fluid including of 2–3 follicles without oocyte were collected in separate tubes. These follicles had similar shape and size. The Samples were transferred to a laboratory for measuring the βHCG level, after which the βHCG levels were compared to the follicles with and without the oocyte in each patient. Results: In this study, the βHCG level of follicular fluid in the follicles containing oocyte was 18.20 (8.35–42.92) IU/L and in the follicles without the oocyte was 13.50 (5.45– 25.81) IU/L. Levels of βHCG in the follicular fluids containing the oocyte were higher than without oocytes, This difference was not statistically significant (p = 0.16). Conclusion: It seems that the follicular fluid βHCG isn’t caused by empty follicle syndrome, and that dysfunctional folliculogenesis may be the cause of this syndrome. Key words: Intracytoplasmic sperm injection, Empty follicle syndrome, HCG

Does Endometrial Compaction Predict Clinical Pregnancy Rate after Cleavage Stage Frozen Embryo Transfer?

Objectives: This study aimed to determine the relationships between endometrial compaction and pregnancy outcome in patients receiving artificial endometrial preparation for frozen embryo transfer (FET) cycles. Materials and Methods: This prospective cohort study was performed in a university-affiliated fertility clinic from March 2020 to March 2021. The eligible women undergoing their first or second FET cycle and having the top grading cleavage stage embryos were enrolled. All patients received the same endometrial preparation regime. The alteration in endometrial thickness (EMT) between the day of progesterone initiation and the day of embryo transfer (ET) was measured using consecutive transvaginal sonography. The patients were divided into three groups based on the percentage of endometrial compaction (i.e., the difference of EMT at end of the estrogen-only phase and after three days of progesterone administration (ET day) divided by the EMT on the terminal day of the estrogen-only exposure). Results: Overall, 300 eligible women were evaluated and only 27.3% (82/300) of the studied cycles showed ≥5% compaction, whereas 72.6% (218/300) either expanded or showed minimal compaction. The clinical and ongoing pregnancy rates in group 2 (any expansion) were significantly higher than those in groups 1 and 3 (P=0.002 and P=0.01, respectively). Multivariable logistic regression test indicated that the cycles with any expansion in ET were independently associated with 3.1 times improvement in clinical pregnancy rate in comparison to those with any compaction (P=0.002). Conclusion: Gross endometrial compaction occurred in one-third of FET cycles with no significant positive effect on pregnancy outcomes after cleavage-stage ET

One Side Ovarian Rejuvenation: A Quasi-Experimental Study of the Effect of the Autologous Platelet Rich Plasma in Poor Ovarian Responders in IVF

BACKGROUND: The poor ovarian response is the most important limiting factor in the success of in vitro fertilization (IVF). The aim of this study was to evaluate the outcome of intraovarian injection of autologous platelet-rich plasma (aPRP) on the oocyte number and IVF outcomes in poor ovarian responders (POR). METHODS: This quasi-experimental study was performed from August 2021 to December 2021, in Vali-e-Asr Infertility Clinic affiliated with Tehran University of Medical Sciences, Tehran, Iran. There were 12 POR patients selected based on the criteria of Bologna group 4 who underwent two IVF cycles with similar antagonist regimens in a 70-day-interval. Immediately after the Oocytes Pick-Up (OPU), there was a 4cc of autologous PRP multifocal intramedullary injection done into their right ovaries in the first IVF cycle (case group). On the other hand, their left ovaries were considered as the control group. The patients underwent the second IVF cycle after 70 days. RESULTS: Those who had undergone aPRP experienced a significant increase of the mean of antral follicular count (AFC) (from 1.91±0.79 to 2.50±0.90, p=0.043). There was a significant increase in the number of embryos from the right ovary (intervention group) compared to the left ovary (control group) after PRP, but there was no significant difference in the number of embryos in the right ovary before and after the intervention (from 0.25 ±0.45 to 1.08±0.79, p=0.705). There was no significant change in the number of oocytes, AMH, and FSH in the case and control groups before and after the intervention (p>0.05). CONCLUSION: According to the results of this study, it seems that in females with POR, intraovarian aPRP had no effect on the outcomes (embryos number, number of oocytes, FSH and AMH level), except for an increase in AFC

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

The effect of Achillea millefolium and Hypericum perforatum ointments on episiotomy wound healing in primiparous women

Background: The purpose of this study was to assess the efficacy of Achillea millefolium and Hypericum perforatum ointments on episiotomy wound healing in primiparous women.Materials and methods: This is a double-blind clinical trial study performed on 140 primiparous women. They were randomly divided into four groups, each group containing 35 women: 2control groups including nonintervention and placebo ointment; and 2 case groups including Hypericum perforatum ointment and Achillea millefolium ointment. Healing process was assessed by five specifications: redness, ecchymosis, edema, discharge and wound dehiscence on 7th, 10th, and 14th days after delivery; pain level was assessed by means of visual analog scale.Results: There was significant difference between groups in perineal pain level at 7th, 10th and 14th days postpartum, redness and edema at 7th and 10th days postpartum and ecchymosis at 7th day postpartum; the pain level, redness, edema and ecchymosis in groups who consume Hypericum perforatum and Achillea millefolium ointments were less than the control groups (p0.05).Conclusions:Achillea millefolium and Hypericum perforatum ointments reduce perineal pain level, redness, edema and ecchymosis of episiotomy wound, so it seems that consuming them was useful for episiotomy treatment

The effect of Aloe vera gel and sweet almond oil on striae gravidarum in nulliparous women

Background and objective: Striae are linear depressions of the skin and causes psychological and sexual problems in person. Different methods are used to prevent and treat them but there is no definitive method. We compared the effect of Aloe vera gel and sweet almond oil on striae gravidarum.Materials and methods: In this double-blind clinical trial, 160 nulliparous women were enrolled and randomly divided into three case groups and one control group. The four groups were given 700g Aloe vera, sweet almond oil, and base cream to use topically on the abdominal skin and forth group don't receive any medication as control group in five steps, they were examined study's variables (itching, erythema, and spread of striae) using statistical tests in SPSS.Result: The findings showed that Aloe vera and sweet almond oil creams are more effective than the base cream and the control group to decrease itching and erythema and to prevent the spread of striae on the surface of abdomen (p.05).Conclusions:Aloe vera and sweet almond oil creams reduce the itching of striae and prevent their progression

How Does Platelet-Rich Plasma Injection in Ovaries of Poor Responders Affect the Retrieved Oocytes, and Anti Mullerian Hormone: A Clinical Trial

Objective: Platelet Rich Plasma (PRP) is proposed to have important role in cell division and proliferation, angiogenesis and health. This study evaluates the effect of a single injection of autologous PRP on ovarian response markers in women with poor ovarian response (POR). Materials and methods: This non-randomized clinical trial was conducted between August 2020 and September 2021. Fifty six women with Bologna criteria for POR willingly chose to participate in one of the following groups: PRP for one cycle in the time of oocyte pickup (OPU) (intervention group, n= 34) or control group (n=22).The primary outcomes were: number and quality of oocytes in coming 2 cycles of ICSI, and Anti Mullerian Hormone (AMH) level two months after PRP injection. The secondary outcomes were the number and quality of embryos and chemical pregnancy rate after embryo transfer. Results: A total of 45 participants continued the study, of which 23 were in the intervention group and 22 in control group. There were no demographic differences between two groups. At a two cycle follow up, PRP group experienced a significant improvement in AMH level and there was no respective change in control group. In one year follow up the overall pregnancy rates were same in both groups (3% Vs. 0, p=.60), while there was no difference in cumulative number and quality of embryos. Conclusion: PRP injection can improve ovarian reserve marker without adverse effects. Further evidence is required to evaluate the impact of PRP on assisted reproduction outcomes

The Impact of Emotional Intelligence on Citizenship Behavior of Physicians (With Emphasis on Infertility Specialists)

Objective: To survey emotional intelligence in promoting of the citizenship behavior (manner gesture) of physicians. Materials and methods: In a descriptive study, co relational and statistical community approach of research were used. Cases were doctors having subspecialty of the infertility in Islamic Republic of Iran. Using simple random sampling method 212 cases were selected. Questionnaire was used for data collection. After summarization, structural equation modeling techniques were used for analyses and interpretation of research data. Results: Findings confirmed that three of the five aspects of EI have had significant positive impact on the citizenship manner of physicians that these factors in order to their priority impact are: 1) Empathy, 2) Self motivation and 3) Self control. Conclusion:EI interpersonal elements have greater influence on the citizenship behavior of physicians.