Effectiveness of Autologous Platelet-Rich Plasma Therapy in Women with Repeated Implantation Failure: A Randomized Clinical Trial

Background: Platelet-rich plasma (PRP) therapy has been shown to enhance tissue regeneration by expressing severalcytokines and growth factors (GFs). This study investigated the effect of intrauterine infusion of PRP as a noninvasiveautologous GF on pregnancy outcomes in women with repeated implantation failure.Materials and Methods: This randomized clinical trial was conducted to compare the pregnancy rates between twogroups of women who were candidates for the frozen-thawed embryo transfer with a history of two or more implantationfailures. The PRP group (n=33) was treated with hormone replacement therapy+0.5 cc to 1 cc PRP infusedinto the uterine cavity two days before the embryo transfer. The control group (n=33) was only treated with hormonereplacement therapy. The endometrial preparation process was done similarly in both groups. The chemical, clinical,and ongoing pregnancy, and implantation rates were compared between the two groups.Results: Our results showed that the chemical pregnancy rate was not statistically higher in the PRP group in comparisonwith the control group (36.4 vs. 24.2%). In addition, the clinical pregnancy, ongoing pregnancy, and implantationrates were higher in the PRP group than the control group; however, the difference between the two groups was notstatistically significant.Conclusion: Administration of intrauterine PRP before embryo transfer in women with repeated implantation failure(RIF) does not affect assisted reproductive technology (ART) outcomes (registration number: IRCT2016090728950N3)

A novel mutation in CYP17A1 gene leads to congenital adrenal hyperplasia: A case report

Background: Congenital adrenal hyperplasia is a rare autosomal recessive disorder where the mutation in P450 family 17 subfamily A member 1 gene (CYP17A1) is involved in its etiology. The disorder represents itself with low blood levels of estrogens, androgens, and cortisol that generally couples with hypertension, Hypokalemia, sexual primary amenorrhea, infantilism and in affected individuals. Case: In this study, the CYP17A1 gene in a 14-year-old female was examined. The karyotype of the patient was 46, XX, and the analysis of the CYP17A1 gene by Sanger sequencing revealed a novel homozygous deletion c.1052-1054CCT which led to isolated 17,20-lyase deficiency. Conclusion: In conclusion, this study report an in-frame deletion which results in isolated 17, 20-lyase deficiency, and the mutation might be used for diagnosis in other patients with distinctive clinical symptoms

The effect of 24 hours delay in oocyte maturation triggering in IVF/ICSI cycles with antagonist protocol and not-elevated progesterone: A randomized control trial

Background: The best time of final oocyte maturation triggering in assisted reproduction technology protocols is unknown. This time always estimated by combined follicular size and blood progesterone level. Objective: The aim of this study was evaluation of the effect of delaying oocyte maturation triggering by 24 hr on the number of mature oocytes (MII) and other in vitro fertilization cycle characteristics in antagonist protocols with not-elevated progesterone (p ≤1 ng/ml). Materials and Methods: All patients' candidate for assisted reproduction technology underwent controlled ovarian hyperstimulation by antagonist protocol. When at least 3 follicles with ≥18 mm diameters were seen by vaginal ultrasonography; blood progesterone level was measured. The patients who had progesterone level ≤1 ng/dl entered the study. The participants' randomizations were done and patients were divided into two groups. In the first group, final oocyte maturation was done by human chorionic gonadotropin at the same day, but in the second group, this was performed 24 hr later. Oocytes retrieval was done 36 hr after human chorionic gonadotropin trigger by transvaginal ultrasound guide. Results: Number of retrieved oocytes, mature oocytes (MII), fertilized oocytes (2PN), embryos formation, number of transferred embryos and embryos quality has not significant differences between two groups. Also, fertilization and implantation rate, chemical and clinical pregnancy did not differ between groups. Conclusion: Delaying of triggering oocyte maturation by 24 hr in antagonist protocol with not-elevated progesterone (progesterone ≤1 ng/ml) have not beneficial nor harmful effect on the number of mature oocytes (MII) and other in vitro fertilization cycle characteristic

Primary Bilateral Intrapelvic Hydatid Cyst Presenting With Adnexal Cystic Mass: A Case Report

Hydatid disease, caused by Echinococcusgranulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. But primary hydatid cyst in the pelvis is rare. We report a case of bilateral hydatid cyst of the pelvis in a 53years old woman presented with adnexal cystic mass

Pregnancy outcome in delayed start antagonist versus microdose flare GnRH agonist protocol in poor responders undergoing IVF/ICSI: An RCT

Background: Over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet. Objective: This study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone (GnRH) antagonist and microdose flare-up GnRH agonist protocol in poor ovarian responders. Materials and Methods: This randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. They were divided randomly in delayed-start antagonist protocol (with estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation) and microdose flare-up GnRH agonist protocol. The main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2PN number, fertilization rate, and implantation rate. Results: Fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. Number of retrieved oocytes (5.10±3.41 vs. 3.08±2.51) with p=0.002, mature oocytes (4.32±2.69 vs. 2.34±1.80) with p=0.003, number of 2PN (3.94±1.80 vs. 2.20±1.01) with p=0.001 and implantation rate (19.40% vs. 10.30%) with p=0.022 were significantly higher in delayed antagonist group. Conclusion: The delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle developmen

Therapeutic Effect of Vitex Agnus Castus in Patients with Premenstrual Syndrome

Medical therapies have been widely used for premenstrual syndrome (PMS), but in all of them side effects are predominant. Herbal remedies rarely have side effects and people have more tendencies toward them than chemical therapies. In this study the therapeutic effect of Vitexagnuscastus on women who had the PMS, in comparison with placebo, were investigated. In this randomized, placebo-controlled, double-blind study, from134 selected patients 128 women suffered from PMS were evaluated (active 62, placebo 66).All patients answered to a self assessment questionnaire about their headache, anger, irritability, depression, breast fullness and bloating and tympani during the premenstrual period before the study. Forty drops of Vitexagnus extract or matching placebo, administrated for 6 days before mensesfor 6 consecutive cycles. Patients answered the self-assessment questionnaires after 6 menstrual cycles, again. Each item rated using a visual analogue scale (VAS). The mean age was 30.77 (SD=4.37) years in the active group and 30.89 (SD=4.02) years in the placebo group.Rank of variables had significantly difference in active and placebo group before and after the study (P<0.0001)also we noticed significant differences on the use of VitexAgnus in comparison with placebo (P<0.0001).Vitexagnus can be considered as an effective and well tolerated treatment for the relief of symptoms of mild and moderate PMS

Metformin Therapy Decreases Hyperandrogenism and Ovarian Volume in Women with Polycystic Ovary Syndrome

Background: It is well known that there is a close relationship between elevated androgen plasma levels and the ultrasound findings of stromal hypertrophy in polycystic ovary syndrome (PCOS). The objective of this study was to investigate the effects metformin on the hyperandrogenism and ovarian volume in PCOS. Methods: The study is an unrandomized clinical trial with before–after design. Twenty eight patients with infertility (male or female factor) meeting the Rotterdam ESHRE/ASRM criteria for PCOS were studied during the 2008-2009. The anthropometric characteristics of the patients, mean bilateral ovarian volume, and morphology by trans vaginal sonography as well as the plasma levels of leutinizing hormone, follicle stimulating hormone, estradiol, testosterone, 17-α-hydroxyprogesterone, and dehydroepianderosterone sulfate were obtained before and after treatment with metformin (500 mg three times a day) for three months. Paired t, Pearson's Correlation Coefficient, or Partial Correlation test was used to analyze the findings. Results: The patients had a mean age of 25.67 years. A significant reduction in mean ovarian volume (11.70±4.31 ml vs 8.27±3.71 ml P=0.001), body mass index (BMI, 28.11±4.55 kg/m2 vs 26.84±4.55 kg/m2 P=0.000) and serum androgen levels was seen after three months of treatment with metformin. There was positive correlations between the ovarian volume and serum testosterone level (r=0.589, P=0.001) or BMI (r=0.663, P=0.000). Conclusion: Metformin therapy may lead to a reduction in ovarian volume. It is likely that the reduction of ovarian volume reflect a decrease in the mass of androgen producing tissue