Tehran University Medical Journal

Background: The aim of this study was to assess the knowledge, attitude and practice of pregnant women about benefits and doses of folic acid consumption during pregnancy.

Materials and Methods: A simple randomized study has been done with 300 pregnant women in (Mahdied, Shohada, Shariati) hospital. Women were asked about their information and about consumption of folic acid in order to prevent nural tube defect and reasons for not taking it.

Results: There were 300 women, 150 (50%) had been recommended before to consume folic acid but only 46 (31%) of them used it during pregnancy. There were 37 (12%) who aware about taking it.

Conclusion: Although 50% of women had been recommended to consume of folic acid, less than 50% of the women who were surveyed have been taking it. Strategies are required to increase folate intake among pregnant women and inform of the benefits of folate supplementation by the health eduction.

Background: Oocyte donation and assisted reproductive technology (ART) give women with ovarian failure, advanced reproductive age, inheritable disorders or recurrent implantation failure, the ability to conceive. The success of oocyte donation is reportedly influenced by multiple parameters of the oocyte donor and recipient. The objective of this study was to evaluate the donor and recipient variables affecting the outcome of oocyte donation.

Methods: In this retrospective study, we analyzed 51 oocyte donation cycles of 45 women in an in vitro fertilization clinic. Data collected included age, body mass index, endomet-rial thickness, cycling and gravidity of recipients and the age of donors.

Results: The clinical pregnancy rate was 40% per recipient and 35% per cycle resulting in 9 singleton, 7 twin and 2 triplet gestations. Embryo implantation rate was 27%. Oocyte fertilization rates among patients who had become impregnated and those who had not were 75% and 79%, respectively of 18 pregnancies, 15 culminated in a live birth (33% live birth rate). There was no significant relationship between incidence of pregnancy and mean age, BMI, gravidity, cyclicity of recipients and age of donors. There was a significant difference between the endometrial thickness of patients who became pregnant and those who did not (p=0.048). The number of transferred embryos was positively associated with pregnancy (p=0.006).

Conclusion: The factor that most reliably predicts the outcome of oocyte donation cycles is oocyte recipient endometrial thickness. Donor age from 20-34 years dose not affect clinical pregnancy rates. Donors in their early 30's are considered to be the best candidates for oocyte donation.

Background: Ovarian hyper stimulation syndrome (OHSS) and its consequences, especially thromboembolic events, are of the most dangerous complications of assisted reproductive technologies (ART). It is unclear whether a thrombophilic predisposition or changes in blood components during clinical presentation of OHSS increase thrombotic risks. Testing for certain thrombophilias in selected high risk patients may help risk assessment and decision-making about prophylactic measures.

Methods: In this study carried out in April 2010 to March 2011, 108 in vitro fertilization candidates with ≥20 follicles following ovarian stimulation were recruited. Protein S, protein C, antithrombin, lupus anticoagulant and anticardiolipin antibodies were measured. Blood tests were compared between severe and non-severe OHSS groups and their changes were traced after onset of clinical OHSS in 43 patients presenting with severe symptoms by repeating the tests at hospital admission.

Results: Mean protein S activity was lower in severe OHSS group (101.7±16.3 vs. 118.4±17.0 P<0.001). After clinical presentation of severe OHSS, this level decreased to 91.6±20.1 (P<0.001). Antithrombin levels decreased 2.09% after the onset of symptoms in the group with severe OHSS, but this difference was not statistically significant (P=0.051). Protein C, lupus anticoagulant and anticardiolipin antibodies were not correlated to severe OHSS development.

Conclusion: Patients with relatively lower protein S activity were at higher risk for the development of severe OHSS, and its dangerous consequences. During clinical OHSS presentation, protein S decreased even more, and patients were more vulnerable to hypercoagulability states. These points should be kept in mind in risk assessment and adoption of prophylactic strategies.

Background: Endothelial dysfunction can influence fertility rate in women with polycystic ovary syndrome (PCOS) as flow mediated dilatation (FMD) is impaired in patients with the disease. The aim of this study was to compare two methods of ovulation induction by letrozole or letrozole plus human menopausal gonadotropins (HMGs) in infertile women with PCOS who were resistant to clomiphene citrate based on brachial artery ultrasound findings.

Methods: In this double -blind randomized clinical trial, 59 infertile women who had the inclusion criteria for PCOS were evaluated in the Infertility Clinic of Shariati Hospital in Tehran, Iran in 2010-2011. The patients were assigned to two letrozole and letrozole plus HMG groups and were evaluated for FMD in the brachial artery by transvaginal ultrasonography. Later, the values were recorded and analyzed statistically.

Results: In the letrozole group, infertility treatment was successful in 15 (57.7%) but it failed in 11 (42.3%) patients. In letrozole plus HMG group, the treatment was successful in 18 (54.5%) while it failed in 15 (45.5%) patients. The mean FMD values in the groups with successful and unsuccessful treatment results were 19.42±10% and 18.57±7.2%, respectively, but the difference was not statistically significant (P=0.712). Moreover, the average endometrial thickness in groups with successful and unsuccessful treatment results were 8.4±1.3 mm and 9.8±3.9 mm, respectively but the difference was not significant either (P=0.06).

Conclusion: In infertile women with polycystic ovary syndrome that are resistant to clomiphene, letrozole or letrozole combined with gonadotropin can be equally effective for ovulation induction.