Tehran University Medical Journal

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Background: Polycystic ovary syndrome (PCOS) is a common cause of ovulation insufficiency and then infertility. Therapeutic options to induce ovulation in anovulatory PCOS patients are clomiphene citrate, metformin, tamoxifen, dopamine agonists (bromocriptin), Gonadotrophin and laparoscopic ovarian electrocautery (LOE). Gonadotrophin and LOE are important options in anovulatory clomiphene citrate-resistant patients with PCOS. Literature data regarding compare of the efficacy of these two treatments are few. Therefore we aimed to study the pregnancy rates of these treatments in infertile clomiphene citrate-resistant patients with PCOS. Methods: A randomized clinical trial study was carried out in infertile clomiphene citrate-resistant patients with PCOS, referred to infertility clinic of Mirza Koochackhan Hospital of Tehran University of Medical Science in Tehran, Iran, between 2003 and 2008. Results: A total of 100 patients women were randomly allocated in two groups. There were no differences in age and pimary and secondary infertility duration. In LOE treatment group, eight cases (16%) were pregnant and all delivered at term. in gonadotrophin treatment 14 cases (28%) were pregnant, 10 cases (20%) delivered at term but four cases aborted. The cost in gonadotrophin treatment was significantly more than laparoscopic ovarian diathermy (p<0.001). In logistic regression analysis, age, BMI, cost and kind of treatment had no significant effect on pregnancy rate. Conclusions: Pregnancy and abortion rate in gonadotrophin treatment was more than LOE but the difference was not significant. More studies are needed.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Insulin resistance is common in women with Polycystic Ovary Syndrome (PCOS) and can cause poor outcome of infertility treatment. The aim of our study was to assess the effect of treatment with metformin on outcome of Intra Cytoplasmic Sperm Injection (ICSI) in infertile PCOS women.

Methods: A randomized clinical trial study was carried out in infertile women with PCOS, before ICSI, referred to infertility clinic of Mirza Koochackhan Hospital of Tehran University of Medical Science Tehran, Iran, between 2006 and 2008. The patients were randomized in two groups of metformin 500 mg Po, three times daily, six weeks before the ICSI cycle and placebo patients in each group were divided into BMI <28 kg/m² and BMI &ge28 kg/m².

Results: Of 52 study women 26(50%) were in metformin group. mean age were 29.8±4.9 year in metformin group versus 29.4±5.9 year and placebo groups. Treatment with metformin, in subgroup of BMI <28 kg/m², significantly increased number of mature follicle (p=0.01), embryo (p=0.04), oocytes (p=0.007) and mature oocytes (p=0.03) but in subgroup of BMI&ge28 kg/m², there was no significant difference in the metformin and placebo groups (p>0.05). Metformin treatment caused more chemical and clinical pregnancy rates, and less abortion rate in overweight and normal patients, but the differences were not significant (p>0.05). Logestic regression analysis showed, adjusting number of mature follicle, number of embryos, quality of embryos, oocytes and BMI and treatment showed no significant effect on clinical pregnancy rates (p>0.05).

Conclusions: Among normal weight PCOS women, effect of treatment with metformin is better than overweight PCOS women. However further studies are needed.

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Background: Some complications of pregnancy such as abortion, gestational diabetes mellitus, preeclampsia, and preterm delivery are more common among women with polycystic ovary syndrome (PCOS). Recently it has been reported that metformin treatment during pregnancy reduces pregnancy complications, so this study was conducted to demonstrate the possible effects of metformin on the uteroplacental circulation and pregnancy complications. Methods: Seventy pregnant women with polycystic ovary syndrome (PCOS) from 1386 to 1388 were enrolled in a randomized, double-blind, placebo-controlled trial of metformin during pregnancy in Shariati hospital. Doppler ultrasound examinations of the uterine arteries and umbilical artery were performed at 12th and 20th weeks of gestation. All patients were followed up to the end of pregnancy, then the effect of metformin on the uteroplacental circulation was evaluated by the comparison of the pulsatility index (PI) of uterine arteries and prevalence of obstetric complications between two groups. Results: The mean reduction of PI in metformin group from 12th to 20th weeks of gestation was 0.38 versus 0.16 in placebo group (p=0.016). Gestational diabetes mellitus,pre-eclampsia and preterm delivery, were more common in pregnant women in placebo group but the difference was not statistically significant. Conclusions: Metformin treatment in pregnancy accompanied with reduced uterine artery impedance between 12 and 20 weeks of gestation but this reduction showed no effect on the pregnancy complications such as preterm delivery, preeclampsia and gestational diabetes

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cyclooxygenase 2 is a key enzyme which converts arachidonic acid into prostaglandins. Cyclooxygenase 2 is triggered by inflammatory stimuli, such as cytokines. Its expression increases in tumors and Alzheimer's disease and ovarian hyperstimulation syndrome. Polycystic ovarian syndrome is a heterogeneous disease characterized by pathological angiogenesis and chronic anovulation. In the present study, the probable role of cyclooxygenase 2 in Wistar rats with polycystic ovarian syndrome was investigated.
Methods:  Thirty female Wistar rats (170-200 gr) were equally divided into three groups: 2 mg estradiol valerate was intramuscularly administered to each rat in the experiment group or group 1 the rats in group 2 were regarded as the sham group and received sesame oil injections and group 3 or the control group received no injections. After 60 days of treatment, animals were anaesthetized with chloroform and killed by decapitation. Ovaries were collected for histological and immunohistochemical evaluations. All the experiments were repeated three times.
Results:  Morphologically, ovaries from the control group exhibited follicles in various stages of development and many fresh corpus luteum. In estradiol valerate group small follicles in early development were observed in addition to follicles showing evidence of atresia and many large cysts with thickened theca cell layer. Corpus luteum was rare or absent in group 2. The immunohistochemical analysis for cyclooxygenase 2 expression showed an increased expression of cyclooxygenase 2 enzyme in group 1.
Conclusion: The results suggested the involvement of cyclooxygenase 2 in the progression to polycystic ovarian syndrome in a rat model.

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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.

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Background: We are in new era of knowledge and treatment of women with PCOS. We should find management modalities that can improve their life quality. Due to high prevalence of PCOS, and zinc deficiency in Iran, importance of antioxidants such as zinc on treatment and improvement of PCOS complications, and due to the disadvantages of the current treatment for the disease (i.e. OCPs), finding an efficient alternative therapy with no or less side effects seems to be as important as some methods for changing the life style of these women. This study was performed to assess zinc levels in PCOS versus non PCOS patients to determine if zinc can be helpful in PCOS management.
Methods: This is a case-control study which was performed from January 2012-2013 in 100 infertile women aged 20-45 years who were referred to Vali-e-Asr infertility clinic. Fifty patients had PCOS according to Rotterdam Criteria (case group) and 50 were infer-tile women without PCOS (control group). In both group, serum Zinc levels were deter-mined and the data was gathered using the SPSS software and analyzed by descriptive (percent, mean, standard deviation) and analytical 2, ANOVA, Mann-Whitney and Correlation).
Results: Results did not show a significant difference between case group and control group in respect to serum Zinc levels (P>0/05).
Conclusion: Due to no difference between case group and the control one in zinc levels, it seems that zinc supplementation in PCOS patients is not necessarily useful or of clinical importance. Obviously studies with larger sample size can probably define the role of zinc in these patients.

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Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Chronic infections have been mentioned as one of the different etiologic factors related to PCOS. Due to the high prevalence of Helicobacter pylori infection especially in developing countries, its probable role in the pathogenesis of PCOS and the limited information available in this area, serologic study of H.Pylori infection in patients with PCOS, was performed. Methods: This research was performed as a case control study from Dec 2010 until May 2012 in 82 patients (and their spouses) with polycystic ovary syndrome (case group) and 82 non PCOS patients (control group) with an age range of 20-40 referred to Vali-e-Asr Hospital infertility clinic. Both groups and their husbands filled a questionnaire and were examined by testing their serum H.Pylori IgG and IgA antibody levels. Statistical testing and analysis was performed by t-student and λ2 tests. Results: Mean age of the women and men and also other demographic characteristics except their profession showed no significant difference (P>0.05) in the two groups (PCOS and non PCOS). H.Pylori antibody IgG serum level was positive in 78% and 76.5% and H.Pylori antibody IgA level in 30.5% and 37% of PCOS versus non PCOS patients respectively which showed no statistically significant difference (P>0.05). There was also no significant difference between the H.Pylori antibodies levels in the spouses in the two groups (P>0.05). Conclusion: This study showed no significant difference in serologic examination re-sults in PCOS versus non PCOS patients. The finding of high prevalence of H.Pylori IgG and IgA positive levels in both PCOS and non PCOS patients can be probably re-lated to the high prevalence of H.Pylori infection or exposure in Iranian population and therefore suggest an issue for further investigation.

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Background: Polycystic ovary syndrome (PCOS) that occurs with chronic lack of ovulation, systemic inflammation and hyperandrogenism is manifested most common endocrine disorder in women of reproductive age. Ziziphora tenuior L. due to possess its Pulegone, flavenoid and anthocyanin has anti-inflammatory and anti-oxidant activity. This study investigates the modulating effects of Ziziphora tenuior L. extract by its anti-inflammatory properties on hormonal profile and the improvement of tissue symptoms of estradiol valerate- induced PCOS. Methods: In this experimental study that established in Laboratory,s Animal Center and Cellular And Molecular Research Laboratory, Kharazmi University, Karaj, from October 2012 to November 2013, 144 female adult Wistar rats divided into three groups of control (without injection), estradiol valerate- induced polycystic ovarian syndrome (2 mg/rat estradiol valerate, subcutaneously) and Ziziphora tenuior L. extract-treated groups. After induction of the syndrome within 60 days, experimental groups were injected 100, 150 and 200 mg/kg bw Ziziphora tenuior L. extract for 10 consecutive days intraperitoneally. The animals were anesthetized by chloroform. Their ovaries and blood serum was harvested to hormonal analysis and histomorphometric studies. Data using of one-way ANOVA test and P< 0.05 was considered significant level. Results: The ovarian sections in PCOS group exhibited a significant reduction in thickness granulosa layer (82%), number of corpus luteums (54%), appearance of some cysts (79%) and increased CRP serum level (68%) compared with the control group, while the histological changes in Ziziphora tenuior L. extract-treated ovaries did not have significant difference compared with control (P= 142). The decrease of LH, estradiol, and testosteron was significant in Ziziphora tenuior L. extract-treated groups compared with the estradiol valerate- induced PCOS. Conclusion: It seems that Ziziphora tenuior L. extract may improve functional and endocrine disturbances of estradiol valerate- induced PCOS and modulate the hormone level by anti-inflammatory effects. Ziziphora tenuior L. extract also starts the ovulation process again in polycystic ovary syndrome group.

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Background: Polycystic ovary syndrome (PCOS) is a common complex condition. Evidences from studies on women with PCOS and rat PCO model suggest that the sympathetic regulatory drive to the ovary may be unbalanced (hyperactivity). Findings that support the involvement of sympathetic nervous system in the pathophysiology of PCOS are that the catecholaminergic nerve fibers in the polycystic ovaries of women with PCOS are denser than in normal ovaries. The purpose of this study was reduction of this hyperactivity.

Methods: This study was clinical trial and was performed in Reproductive Health Research Center, Tehran University of Medical Sciences, Iran, during January 2013 to 2015. A total of 61 women between aged 20-40 years and BMI under 28 kg/m2, who were previously diagnosed with PCOS were assessed. The diagnosis of PCOS was made according to joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). The study objectives were explained to the patients before they entered the study, and an informed consent was obtained from all. They were divided into three groups as follows: (i) two study group (n=39) and (ii) control group (n=22). For evaluating effects of alpha-2 inhibitors (Clonidine and Yohimbine) by Eliza, the following variables were evaluated before and after drug therapy: serum cortisol adrenaline (A) noradrenalin (NA) beta-endorphin (&beta-End) insulin as well as sex hormones including FSH, LH and Estradiol.

Results: Our results showed that, Clonidine as central anti-adrenergic drug causes 61% of all pregnancies in the study group. This is high percentage of the pregnancy rate compared with yohimbine (P< 0.001). Yohimbine (Indol alkaloid) as alpha-2 adenoceptor antagonist increases follicular development in this disease. This follicle growth is higher than clonidine (P< 0.01).

Conclusion: Our findings showed that increasing the pregnancy rate and follicular development represent the strategic role of sympathetic nervous system (SNS) in polycystic ovary syndrome and) SNS may thus offer a novel biological and pharmacological target in treatment of PCOS.

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Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorders in reproductive age women. These women confer with complications of pregnancy such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and neonatal complications such as small for gestational diabetes (SGA) are more prevalence in women with PCOS. The aim of this study was to evaluate the incidence of complications associated with PCOS in pregnant women.

Methods: This was an observational and prospective study which recruited 205 pregnant women with PCOS from Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences (AJUMS) between 2013 and 2014. Inclusion criteria were women with PCOS and gestational age over 20 weeks. The demographic and clinical variables including mother's age, body mass index (BMI) and conditions of pregnancy including pregnancy-induced hypertension, preeclampsia, gestational diabetes and overt diabetes and neonatal complications such as preterm labor (PTL), SGA and intrauterine fetal death (IUFD) were recorded.

Results: The prevalence of hypertension disorders, preeclampsia, gestational diabetes and overt diabetes were observed in 44 (21.5%), 18 (8.8%), 29 (14%) and 22 (11%) patients, respectively. The history of familial diabetes was shown in 28 patients (13.6%). In addition, the history of pregnancy induced hypertension was reported in 25 patients (12.1%). Only 6 patients (2.9%) had history of gestational diabetes. Among neonatal complications due to PCOS, SGA with 15.3% and then PTL with 12.6% had highest prevalence. IUFD was shown only in 2 patients.

Conclusion: Pregnant women with PCOS are at the higher risk for pregnancy and neonatal complications. Specifically, these women should be evaluated for pregnancy induced hypertension during pregnancy than others.

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Background: Polycystic ovary syndrome (PCOS) is a common complex condition in women associated with reproductive and metabolic systems and also psychological disorders. There is considerable evidence to suggest that the sympathetic nervous system is involved in PCO and metabolic syndromes. Noradrenalin (NA), corticotrophin releasing hormone (CRH) and nerve growth factor (NGF) are the strong stimulants for two axes: hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-ovarian (HPO) axes which are regulators for the female reproductive system. Following previous studies on sympathetic nervous system over activity in PCOS, the main purpose of this study is to evaluate the role of CRH and NGF as two important findings from the perspective of the psycho-emotional.

Methods: This case-control study was conducted in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran, Iran in the September of 2011. 170 women participated in this study. The diagnosis of PCOS was made according to the joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). All women have 20-40 years of age and body mass index (BMI) of less than 28. Demographic questionnaire was used in this study and blood sample was obtained from all participants before 8AM. All analysis was done in SPSS software, version 19 (IBM SPSS, Armonk, NY, USA). P-value less than 0.05 considered as significant level.

Results: Serum levels of CRH and NGF in patients with polycystic ovary was significantly lower than the control group (P< 0.001). This reduction can disrupt two neural axes: the sympathetic nervous system (SAS) and hypothalamus-pituitary-adrenal (HPA). These axes have a fundamental role in psycho-emotional reactions in women with PCOS. Moreover, using demographic questionnaire quantitative and qualitative characteristics of the population studied, the results of which are reported in the regression model.

Conclusion: The results of this study confirmed previous studies. This reduction in serum levels of CRH and NGF shows the hyperactivity of sympathetic nervous system in polycystic ovary syndrome can be one of the causes of mental disorders in women with PCOS.

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Background: Clomiphene citrate is very successful in inducing ovulation; there is usually a discrepancy between ovulation and pregnancy rate. If treatment is started early in the cycle this negative effect is reduced. The aim of this study was to investigate the effect of the time of administration of clomiphene citrate on follicular growth, endometrial thickness and ovulation and pregnancy rates in PCOS (Polycystic ovary syndrome) patients.

Methods: This randomized controlled trial study was performed on 115 PCOS (Polycystic ovary syndrome) women in Fateme Zahra Fertility and Infertility Research Health Center in April 2012. Patients randomly divided into two groups. Patients in the early group (No. 55) received 100 milligrams of clomiphene citrate tablet daily starting the next day after finishing medroxyprogesterone acetate tablet for 5 day, whereas the patient in the late group (No. 60) received 100 milligrams of clomiphene citrate tablet daily for 5 day starting on day 3 of the menstrual cycle. Then on follicular growth, endometrial thickness and ovulation and pregnancy rates by SPSS software, version 16 (Armonk, NY, USA) were compared in two groups. Results: 36.4% of patients of early administration of clomiphene and 60% of patients in the later administration of Clomiphene were able to build dominant follicle. This difference was statistically significant (P<0.011). There was no statistically significant difference between the two groups on age, body mass index, duration of infertility. Findings showed that in the early group 14 (63.6%) and in the late groups 8 (36.4%) women who made dominant follicle, were pregnant. There was significant difference between these two groups (P<0.001). But, in the number of follicles, endometrial thickness and pregnancy rate, there were no significant difference. In the early administration of clomiphene, the pregnancy rate was 25.5%. However in the later administration of clomiphene it was 13.3% (P=0.882). Conclusion: According to the results of this study, if the dominant follicle was made, with administration of clomiphene citrate in luteal phase the incidence of successful pregnancy is higher.

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Results: The mean weight and BMI (P=0.002), hirsutism and irregular menstruation cycle in the study group were greater than the control (P<0.001). In the study group the mean score of the sleep questionnaire in three dimensions: sleep problems (P=0.024), drug use (P=0.048), and the sufficiency of sleep (P=0.049) were higher than control. Regression analysis showed that there is a significant relationship between quality of life and menstruation cycle (P=0.046), as well as the three dimensions of negative affecting situations with family income (respectively, 0.015, 0.016 and P=0.035). Conclusion: The environmental factors can easily affect the quality of life in PCO women. Sleep patterns were not favorable, and the effect of menstruation on mood and low family income caused negative emotions in women with PCOS.