Assisted human reproduction techniques: necessities, achievements and the need

The purpose of this paper is to show that the current Iranian law is poor and unclear in the area of legal and ethical aspects of using ART in human reproduction. Legal literature of this area is also poor and possibly misleading. It is also shown that the proposed draft to the Parliament is also non-embracing and inefficient. To tackle this problem a new legislation is needed. To achieve this aim making a widespread and multidisciplinary study is suggested. For this purpose, it is attempted to identify the matters in question and legal gaps in light of a comparative study. It is also suggested that the legislation is to be all embracing and comprehensive covering all aspects of the required issues. For having a guideline to make legislation, the following principles are suggested:(1) the welfare and interests of any person born or to be born as a result of a treatment procedure are paramount;(2) human life should be preserved and protected; (3) the interests of the family should be considered; (4) infertile couples should be assisted in fulfilling their desire to have children.

The Contribution of Couple’s Attachment Style to the Adjustment to Infertility

As a major life crisis, infertility is a very stressful and distressing experience leading to psychological maladjustments and disorders. To examine the contribution of attachment style to the adjustment to infertility, 46 married couples (N=92) undergoing infertility evaluation and treatment were included in this study. All 92 subjects completed the Aduit Attachment Inventory, the Mental Health Inventory and the Dyadic Adjustment Scale. Secure attachment style was shown to be significantly related to psychological adjustment to infertility. Secure persons reported more psychological well-being, less psychological distress and more dyadic adjustment than insecure persons. Partners of secure persons also reported higher levels of well-being and dyadic adjustment and lower levels of disterss than partners of insecure persons. Results and implications are discussed in terms of attachment theory.

Infertility related stress and marital life in Iranian infertile women who referred to Isfahan infertility treatment clinic

The literature is full of anecdotal evidence about linkage between infertility and stress and deleterious impacts that infertility stress can have on the functioning of a marriage and the couple’s life quality. This study was designed to determine the corrilation between infertility related stress and marital adjusment in women who reffered to Isfahan and infertility treatment clinic A Corrolational-one group research design was used to measure infertility related stress and marital adjusment of infertile women using data from a questionnaire including [socio-demographic data, infertility related stress and Dyadic adjusment scale (DAS)] and investigation of relationship of these two variables from different aspects. All of the participants had experienced infertility stress (in different degrees) and about half of them (46%) were maritally distressed . for these women, infertility stress scores were significantly related to economical problems, family composition, duration of treatment and confidence one will have a child for marital adjusment, duration of infertility and a positive history of failed pregnancy were only variables that were significantly related to this variable. For these women infertility stress scores singnificantly related to deterioration of marital adjusment.(r=-0.39, P<0.001) As hypothesized, infertility related stress, had deleterious impact on the marital life of infertile women. Meaningful characteristics were identified that could guide clinicians to those women at risk for increasing stress and marital distress. These variables are as follows: a low socioeconomic status, and unsuccessful treatment outcome, failed treatment cycles, family composition and duration of infertility and it’s treatment.

Effects of IL-6 on steroidogenesis of human granulosa cells in vitro

Recent studies suggest that in addition to gonadotropins, immunological factors, such as cytokines play an important role in production of steroid hormones. The purpose of this study was to examine effects of IL-6 on basal and FSH stimulated secretions of estradiol and progesterone in the presence of androstendione by human granulosa cells (GC) in vitro. Graunlosa cells were harvested at the time of follicular aspiration after ovarian hyperstimulation according to standard protocols with hMG from patients undergoing IVFET. The cells (2 x 104 viable cells per well) were cultured with HAM's F-10 without any supplements (control) or increasing concentrations of recombinant human (rh) IL-6, (8,16,32,64,128 pg/ml) added in the absence or presence of FSH (96 IU/ml). Media were collected after 24,48,72 and 96 hours at a 24h interval and estradiol and progesterone levels were measured by an enzyme immunoassay (EIA) with automated system. Results of this study showed that leuteinized GC in the absence of FSH and the presence of androgen was able to produce estradiol and progesterone in vitro. This production was significantly increased in the presence of FSH. Basal and FSH stimulated productions of estradiol were significantly (P<0.05) inhibited by increasing amounts of IL-6. Although this inhibitory effect on basal production of progesterone was not significant. IL-6 in a dose-dependent manner significantly (P<0.05) inhibited FSH stimulated production of progesterone by GC. These results suggest that IL-6 may play an important role in the production of estradiol and progesterone and any disorders in level of IL-6 may cause estradiol and progesterone release disturbances.

Kenowlege and practice of Iranian women toward cervical cancer

Cervical cancer is a preventable disease, However more than 500,000 cases of invasive cervical cancers can be detected yearly. It has been proven that having information about the screening tests and regular practicing of Pap smear test decreases prevalance of malignant cervical cancer and prevents related mortality. A national cross-sectional study were desinged to assess knowledge and practice of 20-46 years old married women about cervical cancer. Using cluster sampling method 10449 married women were recuited and interviwed. The study demonstrated that 60-80% of women were informed about cervical cancer. 41.6% of women had practiced Pap smear test, at least once. However 21.1% of women claimed that they practice the test more than 2 years ago. Regression model were used to indentify knowledge and practice of women toward cervical cancer. Using this model, Factors such as: educatioanl level, age residence have significant effect on their practice. For improving knowledge and practice of women toward cervical cancer, using modern educational methods can be recommended.

PCO Prevalance in adolescents with menstrual irregularity

This is a comparative cross – sectional prospective study with the aim of evaluation of prevalence and correlation between menstrual irregularity and PCO in postmenarcheal age. This evaluation has done in two groups of healthy adolescent girls 12-19 years old who admitted in shahid Mostafa Khomeini hospital, IRIB Clinic and a private clinic. We compared 47 adolescent girls who had irregular menstruation (as study group) with 22 adolescent girls who had normal menses (as control group) We did abdominal ultrasonography (US) in both groups and evaluated US features of PCO on them .This research shows that PCO was seen to be more common in adolescent girls with menstrual irregularity (42/5% vs 13.6% , p<0.011) with a tendency to be more frequent in oligomenorrhea–amenorrhea group than in polymenorrhea (51.6%vs 25% P>0.08).We have also seen increased LH/FSH in 86.9% and abnormal androgens profiles in 69.5% in girls with PCO. These results suggest that US changes compatible with PCO is a frequent finding in adolescent girls with menstrual disturbance preferably in those with oligoamenorreha

Relationship between ovarian volume, BMI and follicular number and clomiphene

Polycystic ovary syndrome (PCOS) is one of the most common causes of anovulation in women during reproduction years. In this syndrome the first choice for ovulation induction is clomiphene citrate. Approximately 15-25% of patients have been shown to be resistant to even high levels clomiphene and fail to ovulate. To assess the relationship between ovarian unresponsiveness to clomiphene and some clinical and paraclinical factors in PCOS, a prospective, randomized clinical trial was performed on patients referring to the Royan Institute between May 1998 to May 2000. Fifty three PCOS patients with at least 5 successive years of infertility and an age range of 25-35 years were randomly selected. All patients suffered from oligomenorrhea, hirsutism and in all patients baseline concentrations of FSH, LH, testosterone, FBS, fasting insulin, androstandione, 17--hydroxy progesterone and DHEAs were determined. In all patients the body mass index (BMI), ovarian volume and the number of follicles in each ovary were measured. After transvaginal sonography on 3rd day of menstrual cycle, the patients were treated with clomiphene citrate in 2 cycles. In the first cycle 100 mg/day clomiphene citrate was administered from day 5 to day 9 of the cyle and if no response, the second cycle included 150 mg/day clomiphene citrate and the rate of ovulation was studied. With respect to ovulation the patients were divided in 2 groups, group 1 with ovulation and group 2 without ovulation Usingt student test, the two groups were statistically compared. The ovarian volumes were 8.64.3ml (MeanSD) and 8.743.7ml in groups 1 and 2, respectively.The BMI in the 2 groups were 28.03.8 and 29.724.36 (meanSD), respectively. No siginficant difference were observed between the 2 groups in these cases. However, 72.4% of patients in group 1 and 45.8% in group 2 had <10 follicles in each ovary (p<0.05). There results suggest no correlation between ovarian volume or BMI and response to clomiphene. However, our findings are highly suggestive of a correlation between number of primary follicles in each ovary and responsiveness to clomiphene, and thus measurement of primary follicle number in ovaries may be a predictive factor for clomiphene responsiveness.

Chlamydia and Fertility

Chlamydia trachomatis infection is the most common sexually transmitted disease all around the world. For a long time, Chlamydia trachomatis has been recognized as the common cause of urethritis, cervicitis, and other complications such as pelvic inflammatory disease (PID), ectopic pregnancy, etc. However, today there is more concern on its role in male and female fertility and infertility and many studies have concentrated on this issue all over the world. There is good evidence based on seroepidemiologic studies on relationship between serum Chlamydial antibodies and infertility due to tubal factor in women with or without PID. However, there are many questions about Chlamydia trachomatis and its influence on IVF outcome and the exsisting information is controversial. The impact of Chlamydia trachomatis on male infetility is under investigation and it seems able to cause destruction of different parts of male genital tract in addition to high rate of transmission to women. With regard to these data, it seems that prevention, early diagnosis and treatment of Chlamydial infections are importart and cost effective.