En 1680-6433 2008-2177 jalali 1385 8 10 gregorian 2006 11 1 4 2 online 1 fulltext

En 1680-6433 2008-2177 Factors affecting the successful embryo transfer The main factors affecting pregnancy and implantation rates are uterine receptivity, embryo quality, and transfer efficiency. Embryo transfer (ET) is the last step of critically important procedure of in vitro fertilization (IVF) and probably the least successful step in Assisted Reproductive Technology (ART) treatment cascade; though simple in most of the cases, it may pose to be the most difficult in some. No matter how good the IVF laboratory culture environment is, the physician can ruin everything with a carelessly performed embryo transfer. The entire IVF cycle depends on delicate placement of the embryos at the proper location near the middle of the endometrial cavity. Pregnancy rates will be significantly increased with the following procedures: 1. Trial transfer 2. Avoiding the initiation of uterine contractility by using soft catheters, gentle manipulation and by avoiding touching the fundus. 3. Removal of cervical mucus, wash and lavage of cervix with culture media. 4. Ultrasound-guided ET with full bladder. 5. Deposition of the embryo 2 cm below the uterine fundus. 6. Examination of catheter following transfer for retained embryos, blood and mucus. Slow withdrawal of the embryo transfer catheter, the use of a fibrin sealant, bed rest after embryo transfer, sexual intercourse and routine administration of antibiotics following embryo transfer remained to be studied by randomized clinical trials (RCTs). The main factors affecting pregnancy and implantation rates are uterine receptivity, embryo quality, and transfer efficiency. Embryo transfer (ET) is the last step of critically important procedure of in vitro fertilization (IVF) and probably the least successful step in Assisted Reproductive Technology (ART) treatment cascade; though simple in most of the cases, it may pose to be the most difficult in some. No matter how good the IVF laboratory culture environment is, the physician can ruin everything with a carelessly performed embryo transfer. The entire IVF cycle depends on delicate placement of the embryos at the proper location near the middle of the endometrial cavity. Pregnancy rates will be significantly increased with the following procedures: 1. Trial transfer 2. Avoiding the initiation of uterine contractility by using soft catheters, gentle manipulation and by avoiding touching the fundus. 3. Removal of cervical mucus, wash and lavage of cervix with culture media. 4. Ultrasound-guided ET with full bladder. 5. Deposition of the embryo 2 cm below the uterine fundus. 6. Examination of catheter following transfer for retained embryos, blood and mucus. Slow withdrawal of the embryo transfer catheter, the use of a fibrin sealant, bed rest after embryo transfer, sexual intercourse and routine administration of antibiotics following embryo transfer remained to be studied by randomized clinical trials (RCTs). Embryo transfer, In vitro fertilization, Pregnancy rate. Embryo transfer, In vitro fertilization, Pregnancy rate. 45 50 - - - No

En 1680-6433 2008-2177 Conscious sedation with and without paracervical block for transvaginal ultrasonically guided oocyte collection: A comparison of the pain and sedation levels, and postoperative side effects Background: The quality of intraoperative analgesia with paracervical block (PCB) during egg collection in in-vitro fertilization (IVF) is still unclear. Objective: This study performed to compare the pain levels during egg collection and the subsequent intra and postoperative side effects in patients receiving a conscious sedation with and without paracervical block. Materials and methods: In this prospective, double-blind, and placebo–controlled study, 60 patients undergoing egg collection in their first IVF cycle were randomized to receive conscious sedation in conjunction with paracervical block with 10 ml lidocaine 1.5% (sedation + PCB patients or study group) or with 10 ml normal saline (sedation patients or placebo group). Results: Patients in study group experienced significantly less vaginal (10.40±8.40 mm vs 20.77±4.60 mm respectively; p<0.0005) and abdominal pain (10.87±5.08 mm vs 35.33±4.27 mm respectively; p<0.0005) during egg collection, compared with those in placebo group. Propofol requirements was 8.67±2.42 mg in PCB patients vs 25.60±5.29 mg in placebo group (p<0.0005). Incidence of intraoperative (9.90% vs 50% respectively; p=0.002) and postoperative (3.33% vs 56.66% respectively; p<0.0005) side effects were significantly less in study patients compared with placebo group. Conclusion: Conscious sedation with PCB appears to be an effective and safe method of providing analgesia and anesthesia for transvaginal retrieval of oocyte. Background: The quality of intraoperative analgesia with paracervical block (PCB) during egg collection in in-vitro fertilization (IVF) is still unclear. Objective: This study performed to compare the pain levels during egg collection and the subsequent intra and postoperative side effects in patients receiving a conscious sedation with and without paracervical block. Materials and methods: In this prospective, double-blind, and placebo–controlled study, 60 patients undergoing egg collection in their first IVF cycle were randomized to receive conscious sedation in conjunction with paracervical block with 10 ml lidocaine 1.5% (sedation + PCB patients or study group) or with 10 ml normal saline (sedation patients or placebo group). Results: Patients in study group experienced significantly less vaginal (10.40±8.40 mm vs 20.77±4.60 mm respectively; p<0.0005) and abdominal pain (10.87±5.08 mm vs 35.33±4.27 mm respectively; p<0.0005) during egg collection, compared with those in placebo group. Propofol requirements was 8.67±2.42 mg in PCB patients vs 25.60±5.29 mg in placebo group (p<0.0005). Incidence of intraoperative (9.90% vs 50% respectively; p=0.002) and postoperative (3.33% vs 56.66% respectively; p<0.0005) side effects were significantly less in study patients compared with placebo group. Conclusion: Conscious sedation with PCB appears to be an effective and safe method of providing analgesia and anesthesia for transvaginal retrieval of oocyte. Transvaginal egg collection, Conscious sedation, Paracervical block, Pain relief Transvaginal egg collection, Conscious sedation, Paracervical block, Pain relief 51 56 - - - No

En 1680-6433 2008-2177 Outcome of newborns conceived through artificial reproductive techniques in Tehran Iran Background: Today there is a rise in the number of newborns conceived by artificial reproductive techniques (ART). Numerous studies have been performed on the perinatal outcome of these pregnancies. However, there is limited data about the condition of health of these newborns in Iran. Objective: Regarding the higher prevalence of probable complications and symptomatic congenital anomalies, we aimed to determine the state of health of newborns born by ART. Materials and methods: A total of 109 newborn who were conceived through ART and 479 newborns of spontaneous conception were enrolled into our study. The study was prospective, case-control study in Tehran, Iran, from March 2003 to March 2004. Both case and control groups were adjusted in regard to race, sex, type of delivery, chronic disease of mother, age of mother, and antenatal steroids administration. All newborns were examined by neonatologist after birth and their outcome were followed until hospital discharge or death. Data pertaining to clinical and laboratory findings of newborns and death were entered into a questionnaire and subsequently analyzed by appropriate statistical tests. Confidence interval was 95%. Results : Prematurity, low birth weight (LBW), very low birth weight (VLBW), twins and triplets, small for gestational age (SGA), need for resuscitation at birth, respiratory distress syndrome (RDS) and NICU admission were significantly higher among newborns born after ART than those born through spontaneous conception (p<0.05). Regression logistic analysis showed that RDS and NICU admission were more strongly associated with weight at birth and gestational age than with method of conception. However, increased rate of SGA in the case group was associated with multiple pregnancy. Also, there was no significant statistical relationship between the method of conception and the prevalence of congenital anomalies, large for gestational age (LGA), congenital pneumonia, necrotizing entrocolitis (NEC), respiratory air leakage syndromes (ALS), hydrops fetalis, hyperbilirubinemia sepsis, meconium aspiration syndrome (MAS), isseminated intravascular coagulopathy (DIC), cardiac failure, lung hemorrhage, hypoglycemia, hypocalcemia, neutropenia, thrombocytopenia and hemolysis. Conclusion: Newborns who were conceived by ART were more likely in need of resuscitation at birth regardless of other factors. Furthermore, newborns born after ART were at higher risk of developing prematur birth, LBW, and multiple birth. Background: Today there is a rise in the number of newborns conceived by artificial reproductive techniques (ART). Numerous studies have been performed on the perinatal outcome of these pregnancies. However, there is limited data about the condition of health of these newborns in Iran. Objective: Regarding the higher prevalence of probable complications and symptomatic congenital anomalies, we aimed to determine the state of health of newborns born by ART. Materials and methods: A total of 109 newborn who were conceived through ART and 479 newborns of spontaneous conception were enrolled into our study. The study was prospective, case-control study in Tehran, Iran, from March 2003 to March 2004. Both case and control groups were adjusted in regard to race, sex, type of delivery, chronic disease of mother, age of mother, and antenatal steroids administration. All newborns were examined by neonatologist after birth and their outcome were followed until hospital discharge or death. Data pertaining to clinical and laboratory findings of newborns and death were entered into a questionnaire and subsequently analyzed by appropriate statistical tests. Confidence interval was 95%. Results : Prematurity, low birth weight (LBW), very low birth weight (VLBW), twins and triplets, small for gestational age (SGA), need for resuscitation at birth, respiratory distress syndrome (RDS) and NICU admission were significantly higher among newborns born after ART than those born through spontaneous conception (p<0.05). Regression logistic analysis showed that RDS and NICU admission were more strongly associated with weight at birth and gestational age than with method of conception. However, increased rate of SGA in the case group was associated with multiple pregnancy. Also, there was no significant statistical relationship between the method of conception and the prevalence of congenital anomalies, large for gestational age (LGA), congenital pneumonia, necrotizing entrocolitis (NEC), respiratory air leakage syndromes (ALS), hydrops fetalis, hyperbilirubinemia sepsis, meconium aspiration syndrome (MAS), isseminated intravascular coagulopathy (DIC), cardiac failure, lung hemorrhage, hypoglycemia, hypocalcemia, neutropenia, thrombocytopenia and hemolysis. Conclusion: Newborns who were conceived by ART were more likely in need of resuscitation at birth regardless of other factors. Furthermore, newborns born after ART were at higher risk of developing prematur birth, LBW, and multiple birth. Assisted reproduction technique, Premature, Prenatal outcome, Congenital malformation Assisted reproduction technique, Premature, Prenatal outcome, Congenital malformation 57 62 - - - No

En 1680-6433 2008-2177 Induction of Endometriosis by implantation of endometrial fragments in female rats Background: Endometriosis is defined as the growth of endometrial tissues in ectopic places outside the uterus. This disease has an important effect on the health and fertility of affected women. It’s etiology is not clearly known. For better understanding the pathophysiology of this disease, many researchers study on several aspects of the disease on animals. Objective: In this experimental study endometriosis was induced in female rats surgically and then its side effects were investigated with special focus on adhesion formation that is a major problem in women with this disease. Materials and methods: In Protestrous phase, female rats were randomly divided into two groups. In both groups, under intra peritoneal anesthesia, laparotomy was done and left horn and associated fat were removed. In experimented group (A), the removed endometrium was cut to six square pieces (2mm each) and they were sutured to the peritoneum, near ovaries and subcutaneous. In sham group (B), the same procedure was done for the fat tissues around the removed horn and the pieces were sutured to the same places. After 8 weeks, in Protestrous phase, clinical adhesion and size of implants were evaluated. Results: The total mean size of implants was calculated in each group, and this was significantly larger in experimented group (25.4 mm versus 2 mm p=0.000). The mean diameter of implants that calculated for each site of implantation in experimented group were significantly larger in left peritoneum (p=0.002), followed by right (p=0.000) and left (p=0.000) ovaries. The endometrial tissues grew in 100% of implants in subcutaneous area. Clinical adhesions (Score ≥ 2) were detected in 7 out of 10 in experimented group and in 2 out 10 in control group. The number of Esterous cycle were similar in both groups. Conclusion: Our study showed that after inducing endometriosis by surgical approach, only endometrial implants grew as a cystic structures and this is a unique aspect of endometrial cells. Our results showed that endometriosis had a direct effect on adhesion formation, not surgery alone and induction of this disease didn't have any adverse effect on ovarian function in female rats. Background: Endometriosis is defined as the growth of endometrial tissues in ectopic places outside the uterus. This disease has an important effect on the health and fertility of affected women. It’s etiology is not clearly known. For better understanding the pathophysiology of this disease, many researchers study on several aspects of the disease on animals. Objective: In this experimental study endometriosis was induced in female rats surgically and then its side effects were investigated with special focus on adhesion formation that is a major problem in women with this disease. Materials and methods: In Protestrous phase, female rats were randomly divided into two groups. In both groups, under intra peritoneal anesthesia, laparotomy was done and left horn and associated fat were removed. In experimented group (A), the removed endometrium was cut to six square pieces (2mm each) and they were sutured to the peritoneum, near ovaries and subcutaneous. In sham group (B), the same procedure was done for the fat tissues around the removed horn and the pieces were sutured to the same places. After 8 weeks, in Protestrous phase, clinical adhesion and size of implants were evaluated. Results: The total mean size of implants was calculated in each group, and this was significantly larger in experimented group (25.4 mm versus 2 mm p=0.000). The mean diameter of implants that calculated for each site of implantation in experimented group were significantly larger in left peritoneum (p=0.002), followed by right (p=0.000) and left (p=0.000) ovaries. The endometrial tissues grew in 100% of implants in subcutaneous area. Clinical adhesions (Score ≥ 2) were detected in 7 out of 10 in experimented group and in 2 out 10 in control group. The number of Esterous cycle were similar in both groups. Conclusion: Our study showed that after inducing endometriosis by surgical approach, only endometrial implants grew as a cystic structures and this is a unique aspect of endometrial cells. Our results showed that endometriosis had a direct effect on adhesion formation, not surgery alone and induction of this disease didn't have any adverse effect on ovarian function in female rats. Rat, Endometriosis, Endometrial implants, Fat implants, Adhesion formation Rat, Endometriosis, Endometrial implants, Fat implants, Adhesion formation 63 67 Afsaneh Mohammadzadeh af23mohammadzadeh@yahoo.com No

En 1680-6433 2008-2177 Comparison of twin pregnancy outcome after assisted reproductive technology with and without embryo reduction Background: Spontaneous occurrences of multifetal pregnancies always have been a medical problem. The risks of perinatal morbidity and mortality and maternal morbidity increase with enhancement of the number of fetuses. In our prospective experimental study, the outcome of twin pregnancy after Assisted Reproductive Technologies (ART) with and without Multifetal Pregnancy Reduction (MFPR) is compared relating to perinatal and maternal complications. Objective: The aim of this study was to compare the gestational age at delivery, birth weight, and other complications of surviving twins following MFPR to those in a control group of non-reduced twins. Materials and methods: In this prospective experimental study, from infertile couples who were referred to Isfahan Fertility- Infertility Center (IFIC) and were candidate for ART (Invitro Fertilization or Intra Cytoplasmic Sperm Injection), 30 couples who have had twin (control group) and 35 couples with quadruplet or higher order pregnancies (experimental group) were selected. In cases with experimental group MFPR was done, and pregnancy outcome-miscarriage, premature labor, Premature Preterm Rupture of Membranes (PPROM) and Pregnancy Induced Hypertension (PIH)-were compared between two groups. Results: Distribution of complications in experimental vs. control groups was as follows: miscarriage: 23.3 vs. 16 .7%, premature labor: 15.7% vs. 13.3 %, pregnancy induced hypertension: 13.3% vs. 16.7%, abruption: 6.7% vs. 6.7%, and premature preterm rupture of membranes: 23.3% vs. 26.7 %. Mean neonatal weight at birth (2239 vs. 2240 gr) and mean gestational age at delivery (33.5 vs. 34.1 w) were similar. The differences between two groups were not statistically significant (P>0.05). Conclusion: MFPR during early pregnancy is a safe, effective and simple operative for the purpose of reducing perinatal and maternal complications. Background: Spontaneous occurrences of multifetal pregnancies always have been a medical problem. The risks of perinatal morbidity and mortality and maternal morbidity increase with enhancement of the number of fetuses. In our prospective experimental study, the outcome of twin pregnancy after Assisted Reproductive Technologies (ART) with and without Multifetal Pregnancy Reduction (MFPR) is compared relating to perinatal and maternal complications. Objective: The aim of this study was to compare the gestational age at delivery, birth weight, and other complications of surviving twins following MFPR to those in a control group of non-reduced twins. Materials and methods: In this prospective experimental study, from infertile couples who were referred to Isfahan Fertility- Infertility Center (IFIC) and were candidate for ART (Invitro Fertilization or Intra Cytoplasmic Sperm Injection), 30 couples who have had twin (control group) and 35 couples with quadruplet or higher order pregnancies (experimental group) were selected. In cases with experimental group MFPR was done, and pregnancy outcome-miscarriage, premature labor, Premature Preterm Rupture of Membranes (PPROM) and Pregnancy Induced Hypertension (PIH)-were compared between two groups. Results: Distribution of complications in experimental vs. control groups was as follows: miscarriage: 23.3 vs. 16 .7%, premature labor: 15.7% vs. 13.3 %, pregnancy induced hypertension: 13.3% vs. 16.7%, abruption: 6.7% vs. 6.7%, and premature preterm rupture of membranes: 23.3% vs. 26.7 %. Mean neonatal weight at birth (2239 vs. 2240 gr) and mean gestational age at delivery (33.5 vs. 34.1 w) were similar. The differences between two groups were not statistically significant (P>0.05). Conclusion: MFPR during early pregnancy is a safe, effective and simple operative for the purpose of reducing perinatal and maternal complications. Assisted reproductive technology, Multifetal pregnancy reduction, IVF, ICSI. Assisted reproductive technology, Multifetal pregnancy reduction, IVF, ICSI. 69 72 Fatemeh Mostajeran - No

En 1680-6433 2008-2177 Study of psychiatric disturbance in infertile women Background: The experience of infertility can be extremely stressful and associated with a range of psychiatric problems in infertile women. Generally; some of the risk factors which may lead to psychiatric problem are repeated unsuccessful treatment of infertility, low socioeconomic status, lack of partner support, being female, life events, etc. Objective: In this study, we have analyzed the psychiatric problems of infertile women by means of primary health questionnaire (PHQ). Materials and methods: In a cross sectional study 100 infertile women were selected and advised to fill up PHQ. After obtaining their consents psychiatric problems such as somatoform, panic, other anxiety disorder major depressive and other depressive disorders, were assessed, and their results were analyzed and compared with these results from 98 fertile women. Results: According to PHQ results major depression and anxiety disorders were significantly more frequent in infertile women, but considering somatoform and panic disorder there was no significant difference between infertile and fertile women. Conclusions: Infertility may be considered as one of the major casual factor in major depressive and anxiety disorders in association with other social problems. Background: The experience of infertility can be extremely stressful and associated with a range of psychiatric problems in infertile women. Generally; some of the risk factors which may lead to psychiatric problem are repeated unsuccessful treatment of infertility, low socioeconomic status, lack of partner support, being female, life events, etc. Objective: In this study, we have analyzed the psychiatric problems of infertile women by means of primary health questionnaire (PHQ). Materials and methods: In a cross sectional study 100 infertile women were selected and advised to fill up PHQ. After obtaining their consents psychiatric problems such as somatoform, panic, other anxiety disorder major depressive and other depressive disorders, were assessed, and their results were analyzed and compared with these results from 98 fertile women. Results: According to PHQ results major depression and anxiety disorders were significantly more frequent in infertile women, but considering somatoform and panic disorder there was no significant difference between infertile and fertile women. Conclusions: Infertility may be considered as one of the major casual factor in major depressive and anxiety disorders in association with other social problems. Infertility, Psychiatric disorders, Women, PHQ Infertility, Psychiatric disorders, Women, PHQ 73 75 Marjan Anvar anvarm@fums.ac.ir No

En 1680-6433 2008-2177 Comparison of Anticardiolipin antibody and Antiphospholipid antibody in women with recurrent abortions Recurrent abortion is a critical problem in which many factors play a crucial role such as anticordiolipin antibody and antiphospholipid antibody. This study was conducted to evaluate the frequency of anticardiolipin antibody and antiphospholipid antibody in pregnancy failures in women with the history of recurrent pregnancy loss. In 154 women with the history of two or more recurrent pregnancy losses, serum anticardiolipin and serum antiphospholipid were measured using ELISA method. The positive IgG anticardiolipin and IgG antiphospholipid were detected in 12. 34% (19 patients) and 6.5% (10 patients) of patients respectively. Although 16 out of 19 patients with positive IgG anticardiolipin were negative for IgG antiphospholipid and 7 out of 10 patients with positive IgG antiphosphplipid were negative IgG anticardiolipin, but there was a significant correlation between IgG anticardiolipin and IgG antiphaspholipid ( r = 0.222 p=0.000). Our data concluded that anticardiolipin antibody is found to be more important than anti phospholipid antibody in recurrent abortion. Recurrent abortion is a critical problem in which many factors play a crucial role such as anticordiolipin antibody and antiphospholipid antibody. This study was conducted to evaluate the frequency of anticardiolipin antibody and antiphospholipid antibody in pregnancy failures in women with the history of recurrent pregnancy loss. In 154 women with the history of two or more recurrent pregnancy losses, serum anticardiolipin and serum antiphospholipid were measured using ELISA method. The positive IgG anticardiolipin and IgG antiphospholipid were detected in 12. 34% (19 patients) and 6.5% (10 patients) of patients respectively. Although 16 out of 19 patients with positive IgG anticardiolipin were negative for IgG antiphospholipid and 7 out of 10 patients with positive IgG antiphosphplipid were negative IgG anticardiolipin, but there was a significant correlation between IgG anticardiolipin and IgG antiphaspholipid ( r = 0.222 p=0.000). Our data concluded that anticardiolipin antibody is found to be more important than anti phospholipid antibody in recurrent abortion. Anticardiolipin antibody, Antiphospholipid antibody, Recurrent abortion Anticardiolipin antibody, Antiphospholipid antibody, Recurrent abortion 77 79 Seyed Mahmood Ghoraishian smghoraishin@Hotmail.com No

En 1680-6433 2008-2177 Extragonadal germ cell tumor and male infertility Background: Over recent decades a possible decrease in sperm quality and an increase in the incidence of testicular cancer have been reported in many populations. Some recent findings, as cohort studies, showed an increased risk of testicular cancer in men with abnormal semen analysis. Case: A 30 years old man referred to our clinic with chief compliant of infertility for 3 years. Spermogram revealed azoospermia and right extratesticular intrascrotal mass was detected by ultrasound examination. Right inguinal surgical approach showed intact small sized atrophic right testis and an intrascrotal mass. In microscopic examination of the mass mixed germ cell tumor with teratoma, yolk sac and embryonal components were reported. Conclusion: Extragonadal germ cell tumors, like their testicular counterparts are associated with primary germ cell defects. The higher incidence of antecedent infertility suggests that either congenital or acquired primary germ cell defect contributes to defective spermatogenesis and therefore, there is higher risk of cancer development in incompletely migrated germ cells. We recommend complete evaluation of cancer in patients with infertility and azoospermia. Background: Over recent decades a possible decrease in sperm quality and an increase in the incidence of testicular cancer have been reported in many populations. Some recent findings, as cohort studies, showed an increased risk of testicular cancer in men with abnormal semen analysis. Case: A 30 years old man referred to our clinic with chief compliant of infertility for 3 years. Spermogram revealed azoospermia and right extratesticular intrascrotal mass was detected by ultrasound examination. Right inguinal surgical approach showed intact small sized atrophic right testis and an intrascrotal mass. In microscopic examination of the mass mixed germ cell tumor with teratoma, yolk sac and embryonal components were reported. Conclusion: Extragonadal germ cell tumors, like their testicular counterparts are associated with primary germ cell defects. The higher incidence of antecedent infertility suggests that either congenital or acquired primary germ cell defect contributes to defective spermatogenesis and therefore, there is higher risk of cancer development in incompletely migrated germ cells. We recommend complete evaluation of cancer in patients with infertility and azoospermia. Germ cell tumor, Extragonadal, Azoospermia Germ cell tumor, Extragonadal, Azoospermia 81 83 Behrouz Ilkhanizadeh ilkhani_b@yahoo.com No