Trends of Patients' Preferences in the Management of First and Early Second Trimester Pregnancy Loss Towards the Choice of Medical or Surgical Termination of Pregnancy in a Tertiary Care Center in Oman

Background: This study aimed to find out the patients preference towards the managementof pregnancy loss to either Misoprostol or dilatation and evacuation or curettage (D&C) in two different study periods.
Methods: Retrospective chart review study included a total of 411 patients. The first study period was January to December 2010 and the second study period was January to December 2014. All patients were managed in Sultan Qaboos University Hospital of Oman.
Results: Misoprostol was more preferable than dilatation and curettage D&C in both 2010 and 2014, with percentages of 79.30% and 69.57%, respectively. There was a slight increase in the preference toward D&C in 2014. There was a slight increase in the preference toward D&C with older age group as well as in patients with history of miscarriages.
Conclusion: In comparison between 2010 and 2014 data, there was no significant change in patients’ preference. There was a slight increase in the preference toward D&C in the older age group and in patients with previous history of abortion in both years.

The Effect of Behavioral Couple Therapy on the Improvement of Mental Health and Reduction of Marital Conflict in Infertile Couples in Kermanshah: A Randomized Controlled Trial (RCT)

Background: Infertility is a common disorder, exposing couples to complication such as the loss of mental health and the increase of marital conflicts. The aim of this study was to evaluate the effect of behavioral couple therapy on the enhancement of mental health and reduction of marital conflicts.
Methods: In this clinical trial, 24 couples were selected using convenience sampling and were divided randomly into control (12 couples) and experimental (12 couples) groups. Mental Health Questionnaire (GHQ-28) and Kansas Marital Conflict Scale (KMCS) were used to collect data. These questionnaires were filled and pretest, posttest and followup were done in two months. Data were analyzed by Repeated Measures Analysis of Variance, chi-square, independent sample T test, and Bonferroni tests using SPSS-16 software. The significant level of the test was 0.05.
Results: The results of the data analysis between experimental and control groups of females in the marital conflict variable showed that the effect of time (p=0.002) and time and group interactional effect (p=0.001) were significant. Moreover, in both experimental and control groups of males, time effect was significant (p=0.01), but time and group interactional effect was not significant (p=0.14). Also, the results of the data analysis between experimental and control groups of females in the mental health and time effect was significant (p=0.001) and time and group interactional effect was significant as well (p=0.001). But in both experimental and control groups of males, time effect (p=0.71) and time and group interactional effect were not significant (p=0.60).
Conclusion: Behavioral couple therapy can be used in the treatment of infertile couples, especially in women.

Effects of Tamoxifen on DNA Integrity in Mice

Background: Tamoxifen (TX) is widely used to treat idiopathic infertility in men. Using TX has been shown to produce sperm in patients with oligospermia and azoospermia and improve male fertility. The aim of this study was to evaluate the effects of TX on DNA and chromatin quality in mice regarding the importance of chromatin quality and sperm DNA at all stages of reproduction.
Methods: 24 male NMRI mice were divided into 3 groups including dose 0.4 mg/kg/day that received basal diet and TX, dose 0.6 mg/kg/day that received basal diet and TX, and group 3 that received vehicle for 35 days as the control. After that, epididymal spermatozoa were analyzed for nuclear DNA quality. One-way ANOVA was performed with a Tukey test to compare sperm DNA fragmentation at different times. The p<0.05 was considered significant.
Results: The use of different doses of TX may have detrimental effects on sperm chromatin protamination and DNA integrity in mice. According to Acridine Orange (AO) staining, the rate of increased single-stranded DNA damage was observed at 0/6 mg/kg/day TX dose (p<0.05).
Conclusion: The use of different studied TX doses in the animal sample was found to increase the amount of protamine deficiency and DNA defect in treated mice.

The Impact of Infertility on Daily Occupations and Roles

Background: Infertility impacts approximately 16% of couples in the United States- roughly five million individuals. Experiencing infertility takes a physical and psychological toll on the infertile individual, as well as his/her partner. The goal of the current study was to explore and provide better insight into how infertility affects the roles and daily occupations (Such as self-care and work related tasks) of females. This information can better assist health care providers in providing quality care to such clients.
Methods: 21 participants, females ranging in age from 20 to 46 years and experiencing infertility, participated in this qualitative, phenomenological research study. They partook in two telephone interviews aimed at exploring how infertility has impacted their roles and daily occupations. Inductive content data analysis was utilized to analyze the data.
Results: Findings resulted in three main themes. Quotes from participants were used to title the themes. They are "when you’re dealing with infertility, every aspect of your life is impacted by it", "infertility impacted my areas of interest in life" and "infertility is very lonely".
Conclusion: Infertility has the potential to impact every area of a female’s life. The emotional impact infertility may have on women, in addition to the physical and time constraints involved with pursuing fertility treatments, frequently resulted in decreased occupational engagement and fulfillment of roles as spouse or friend. Those experiencing infertility need more resources and support to navigate their journey.

Comparing the Impact of Autologous Platelet-rich Plasma and Granulocyte Colony Stimulating Factor on Pregnancy Outcome in Patients with Repeated Implantation Failure

Background: Despite the advancements in assisted reproductive technologies, repeated implantation failure (RIF) still remains a challenging problem for patients and clinicians. The aim of the present study was to compare the impact of intrauterine infusion of autologous platelet-rich plasma (PRP) and systemic administration of granulocyte colony stimulating factor (GCSF) on pregnancy outcome in patients with repeated implantation failure.
Methods: The present retrospective cohort study included 123 patients with history of more than two repeated failed embryo transfers. Cycles were divided into two groups of intrauterine infusion of PRP (n=67) and systemic administration of GCSF (n=56). Pregnancy outcome was compared between two groups. The p-value less than 0.05 was considered statistically significant.
Results: The clinical pregnancy rate was significantly higher in PRP group than GCSF group (40.3% versus 21.4%, p=0.025). The crud and adjusted odds ratios (95% confidence interval (CI)) were 2.5 and 2.6 (p=0.025, CI: 1.11-5.53 and p=0.03, CI: 1.10-6.15), respectively.
Conclusion: It seems that intrauterine infusion of PRP can positively affect pregnancy outcome in RIF patients in comparison with systemic administration of GCSF and more studies need to be designed to conclude the effectiveness of this method.

Relationship Between Unintended Pregnancy and Antenatal Care Use During Pregnancy in Hadiya Zone, Southern Ethiopia

Background: Unintended pregnancy has direct relation with poor utilization of maternal health care services and also associated with unhealthy behaviors during pregnancy. Few studies have examined the association between unintended pregnancy and maternal health behaviors during pregnancy in developing countries including Ethiopia. The purpose of the study was to determine the association of unintended pregnancy with use of antenatal care during pregnancy among pregnant women in Hadiya zone, southern Ethiopia.
Methods: Community based cross sectional study design was employed in Hadiya zone, southern Ethiopia in 2017. 748 pregnant mothers were included using single population proportion. Study participants were selected by simple random sampling technique. A structured interviewer administered questionnaire was used to collect data. Descriptive, bivariate and multivariate logistic regression was employed to identify the independent effect of unintended pregnancy on the outcomes of interest. The level of significance was confirmed if p-value was less than 0.05.
Results: More than one third (36.2%) of women reported unintended pregnancy. Unintended pregnancy was significantly associated with use of antenatal care. Women with unintended pregnancy were 69% less likely to receive ANC (AOR=0.31, 95% CI; 0.21–0.46) and were four times more likely to have late ANC initiation (AOR=4.40, 95% CI; 1.70–11.40) during pregnancy as compared to counterparts.
Conclusion: This study finding showed an association between unintended pregnancy and ANC use during pregnancy. Women with unintended pregnancy were less likely to use antenatal care and more likely to delay initiation of antenatal care. Longitudinal studies are recommended on relationship between unintended pregnancy and ANC use.

Effect of Artificial Oocyte Activation on Intra-Cytoplasmic Sperm Injection Outcomes in Patients with Lower Percentage of Sperm Containing Phospholipase Cζ: A Randomized Clinical Trial

Background: Artificial oocyte activation (AOA) is a specialized method in assisted reproductive technique (ART). According to increasing concern about using AOA, it is necessary to evaluate sperm-borne oocyte activating factors (SOAFs) including phospholipase C zeta (PLCζ). In this study, PLCζ before AOA was evaluated first and then the impact of AOA on pre-implantation embryo development was investigated.
Methods: This prospective clinical trial enrolled couples subjected to ICSI. By evaluating PLCζ, semen samples were categorized into two groups; I (Control) and II (PLCζ deficient). Retrieved oocytes from partners were put into three categories: control group (Injected with sperm from group I, n=113), group without AOA (Injected with sperm from group II and no exposure to AOA, n=106), and group AOA (Injected with sperm from group II and exposure to AOA, n=114). Finally, fertilization results were compared via Kruskal-Wallis followed by Dunn’s multiple comparison test. The p<0.05 was considered statistically significant.
Results: Fertilization rate was significantly lower in the group without AOA compared to control group (41.9±6.3 vs. 78.1±4.7, p<0.001). AOA improved fertilization rate in group AOA compared to the group without AOA (69.5±3.9 vs. 41.9±6.3, p<0.01); however, cleavage (91.7±2.8, 90.9±4.6, and 95.2±3.4, respectively) and embryo quality (2.5±0.1, 2.3±0.2, and 2.4±0.2, respectively) scores were not substantially different between groups of control, with and without AOA.
Conclusion: We showed that PLCζ can be considered as a good biomarker in evaluation of oocyte activation capability. Further studies are required to establish the best use of PLCζ as a biomarker in clinics.

It Is the Time to Treat Endometriosis Based on Pathophysiology

The First ongoing Pregnancy Following Comprehensive Aneuploidy Assessment Using a Combined Blastocenetesis, Cell Free DNA and Trophectoderm Biopsy Strategy

Background: The exact origin of cell-free DNA found in spent culture media or blastocoel fluid is currently unknown but with the potential to become an improved source of DNA for chromosomal analysis than trophectoderm biopsy samples, it provides a superior representation of the fetal genetic status. However, the genetic material contained within the blastocoel cavity may be more reliable to assessment of embryo euploidy in a clinical context than trophectoderm of cell-free DNA.
Case Presentation: This is the first UK case report where all three sources of DNA were analyzed in a clinical setting on 29 th January 2018 at the Centre for Reproductive and Genetic Health, London, leading to an ongoing clinical pregnancy.
Conclusion: The experience from this case report suggests that removal of blasto-coel fluid, sampling of spent culture media and trophectoderm biopsy can be carried out in parallel. Gathering genetic information from two to three independent samples of embryo DNA may provide enhanced diagnostic accuracy and may clarify cytogenetic status of mosaic embryos.