International Journal of Fertility and Sterility

71-78

Authors: Pelin Ocal , Tayfur Cift , Berk Bulut , Eray Balcan , Ismail Cepni , Begum Aydogan , Tulay İrez

Background: This study evaluated the characteristics and results of patients who suffer from recurrent implantation failure (RIF). Materials and Methods: In this cross sectional study, a total of 2183 cases who were evaluated retrospectively at the Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gyneacology, IVF unit between 2000-2007. According to the data gathered, we included 1822 cases in this study. We compared 185 patients with RIF to 1637 women without RIF. Results: Pregnancy was achieved by 589 couples out of 1822 (32%). The implantation rate was 10%, which declined to 5.8% after the fourth attempt. In the RIF group, patients’ mean age was higher and there were more overweight women, the duration of fertility was longer, day 3 follicle stimulation hormone (FSH) levels and the total gonadotropin dose administered were higher, mean level of Estradiol (E2) on the human chorionic gonadotropin (hCG) day was lower, and the mean level of progesterone on the hCG day was elevated compared to the non-RIF group. Although the comparison of MII oocyte number was not significant, the mean number of fertilized oocytes was found to be significant in favor of the non-RIF group. The endometrial thicknesses were found to be similar for both groups. Comparison of sperm motility and morphology were statistically significant in favor of the RIF group. Conclusion: In our study, we have found that the group with RIF were comprised of patients with poor prognosis who were older, overweight, had a longer infertility duration, a higher FSH level, and needed more gonadotropin doses in controlled ovarian hyperstimulation (COH). Sperm motility and morphology were better in the RIF group compared to the non-RIF group, and multiple pregnancy rates were lower in RIF patients.

87-94

Authors: Leili Mosalanejad , Anahita Khodabakhshi Koolaee , Bahar Morshed Behbahani

Background: Considering the high prevalence of psychiatric disorders among infertile women, it seems that gynecologists, psychiatrists, and psychologists should be more attentive to identify and treat these disorders. The aim of this study is to determine the effect of E-cognitive group therapy with emotional disclosure on mentwal health status of infertile women who are receiving assisted reproduction. Materials and Methods: In this randomized clinical trial study, 80 infertile women who were receiving hormonal therapy or other assisted reproductive technologies (ART) were randomly allocated to the cognitive-behavioral treatment (CBT) group or the control group. The CBT group had a weekly 12-hour meeting for a period of three months. They also participated in some painting sessions (art therapy) and written and verbal emotional disclosure (both individually and in group presentation). The Depression, Anxiety, Stress Scales (DASS) test and Penn State Worry Questionnaire (PSWQ) were used for data gathering. Results: Results showed the level of psychological distress decreased in the control group, but not significantly. Psychological intervention in the treatment group significantly lowered the level of psychological distress; the mean score of DASS in all aspects was significant. The difference between the mean score of the two groups after intervention was significant (p=0.001) and also according to ANCOVA (p=0.002). Differences were significant between the mean scores of both groups in the PSWQ (p=0.001), Inventory Test (p=0.001), which was confirmed by ANCOVA (p=0.009). Conclusion: These finding suggest that CBT with emotional self-disclosure promotes coping strategies among infertile women. Results also show that these approaches develop mental health and decrease stress in infertile women. Using a psychiatric approach in medical settings could help infertile women to promote their adjustment with mental health problems due to of in infertility. (Registration Number: IRCT201108247407N2).

101-106

Authors: Behrouz Taheri Beni , Anahita Jenab , Rasoul Roghanian , Hossein Motamedi , Naser Golbang , Pouran Golbang , Javad Zaeimi Yazdi

Background: Chlamydia trachomatis (C. trachomatis) is the most prevalent cause of bacterial sexually transmitted infections (STI) recognized throughout the world. The aim of this study is to determine different genotypes of genital C. trachomatis and the association between the serological markers of inflammation and genotypes of C. trachomatis in sexually active women (n=80) attending Shahid Beheshti Hospital in Isfahan, Iran. Materials and Methods: In this descriptive study, endocervical swabs were collected from 80 women. There were 17 endocervical samples that showed positivity for C. trachomatis by plasmid polymerase chain reaction (PCR) using KL1 and KL2 primers. The omp1 gene was directly amplified in 17 plasmid PCR positive samples and was used to differentiate the clinical genotypes by omp1 gene PCR-restriction fragment length polymorphism (PCR-RFLP). The levels of IgG and IgA specific to C. trachmatis and C-reactive protein (CRP) were evaluated. Results: Based on restriction-digestion patterns, four genotypes were identified. Genotypes E (35.3%) and F (35.3%) were the most prevalent, followed by D/Da (23.5%) and K (5.9%). There was no significant association between genotypes and the presence of IgG and CRP. Patients infected with genotype E showed a serological marker of chronic inflammation, i.e. IgA seropositivity, significantly more than patients infected with other genotypes (p=0.042). Conclusion: Nested PCR could increase the sensitivity of omp1 amplification. Based on the presence of IgA, chronic C. trachomatis infections were observed more frequently among genotype E-infected patients in our population.

117-126

Authors: Shiva Houjeghani , Bahram Pourghassem Gargari , Laya Farzadi

Background: Polycystic ovary syndrome (PCOS) patients are more prone to abnormal production of some regulatory peptides. In these patients, studies on the serum levels of leptin and ghrelin are controversial. This study aims to investigate serum levels of leptin and ghrelin and their correlation with metabolic and endocrine indices in PCOS. Materials and Methods: This case-control study was conducted on 60 women; 30 with PCOS and 30 healthy women whose age and body mass index (BMI) were matched and who were referred to Alzahra Hospital, Tabriz, Iran. Serum levels of leptin, ghrelin, insulin, luteinizing hormone (LH), follicle stimulating hormone (FSH), sex hormone-binding globulin (SHBG), and testosterone were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Descriptive statistics and correlations were performed using SPSS 12.0 for Windows. Results: In PCOS women, serum levels of leptin, insulin, HOMA-IR, testosterone, LH, and LH/FSH were significantly higher, while SHBG was lower than in healthy women. Ghrelin and FSH were similar in both groups. Serum levels of leptin correlated with BMI (r=0.85, p<0.001), waist to hip ratio (WHR) (r=0.55, p<0.01), insulin levels (r=0.85, p<0.001) and HOMA-IR (r=0.67, p<0.01), while ghrelin levels had an inverse association with testosterone (r=-0.32, p=0.04). Conclusion: The results showed increased leptin levels while ghrelin remained unchanged in PCOS patients. In PCOS patients, leptin positively correlated with BMI, WHR, insulin, and insulin resistance, while ghrelin was only associated with serum testosterone levels.

131-134

Authors: Elisabetta Garavaglia , Lavinia Quaranta , Anna Redaelli , Gabriella Colombo , Federica Pasi , Massimo Candiani

Ectopic pregnancy is defined as the implantation and development of an embryo outside the uterus. Its incidence has increased over the past two decades. We report two cases of interstitial pregnancy on a tubal stump following bilateral salpingectomy and in vitro fertilization (IVF) treatments. We emphasize the importance of total salpingectomy during surgery in order to avoid interstitial pregnancy, particularly in women undergoing IVF treatments.