بررسي حركات جنين متعاقب تزريق وريدي قند به مادران حامله Evaluation of fetal movments following of maternal intravenous glucose infusion 2 1 حركات كافي يكي از نشانه‌هاي سلامت جنين است و تحت تأثير عوامل متعدد پاتولوژيك و غيرپاتولوژيك تغيير مي‌يابد. از آنجائيكه قند ماده‌اي انرژي‌زا است و در دسترس‌بودن قند كافي براي سيستم مغزي-عصبي، امكان هماهنگي حركات را از طريق كنترل بهتر اين سيستم فراهم مي‌كند؛ لذا در بررسي حاضر تاثير تزريق قند به مادر را بر روي تعداد حركات جنين توام با افزايش ضربان قلبي جنين ارزيابي گرديد. اين مطالعه شش ماهه دوم سال 1379 بر روي 40 مادر باردار مراجعه‌كننده به بيمارستان يحيي‌نژاد شهر بابل انجام شد. مادران بطور متناوب به دو گروه بيست نفري تقسيم شدند. سن زير 30 سال مادران، حاملگي 36-28 هفته، نداشتن سابقه بيماريهاي داخلي و عوارض بارداري و سونوگرافي طبيعي جنين، معيارهاي ورود به مطالعه بودند. در هر دو گروه قندخون به صورت ناشتا به عنوان قندخون پايه اندازه‌گيري شد. همزمان شمارش حركات جنين و مانيتورينگ ضربان قلب آنها انجام مي‌شد. سپس g25 قند (گروه مورد) و حجم برابر از سرم فيزيولوژي (گروه شاهد) به نمونه‌ها تزريق شد. در فواصل 15، 30، 45، 60 دقيقه بعد، براي هر يك از بيماران مجدداً خونگيري، شمارش حركات و مانيتورينگ قلب جنين انجام شد. جمع داده‌هاي مطالعه با نرم‌افزار SPSS و با استفاده از T-test و همبستگي پيرسون ارزيابي شد. در نتيجه، تزريق قند در گروه مورد در دقايق 15، 30 و 45 قند خون غلظت ميانگين بيشتري از گروه كنترل داشتند(006/0=P). از طرفي افزايش ميانگين حركات جنين در گروه مورد نيز نسبت به شاهد در همان دقايق معني‌دار بود(007/0=P). ولي همبستگي بين حركات جنين و تغييرات قند خون مادر در تمامي دقايق از نوع همبستگي ناقص پيرسون و حداكثر حركات جنين در دقيقه 30 و حداكثر غلظت قند خون در دقيقه 15 در گروه مورد بود. بنابراين انفوزيون قند به مادران حامله تأثير مثبت روي حركات جنين دارد؛ اما اين يك رابطه مستقيم و خطي نيست. علت تأخير افزايش حركات نسبت به افزايش قند خون، نياز به فرصت كافي براي متابوليزه‌كردن قند در بدن جنين است. 2 Adequate fetal movement is one of its health markers, and can be altered under influence of pathologic and nonpathologic causes. Since, glucose is an energetic agent, and it’s availability for central nervous system (CNS) provides better coordination of movements through the complex control of CNS, So in present study, we evaluated the effect of maternal glucose infusion on fetal movements accompanied by fetal heart rate acceleration. This 6 month trial was performed on 40 pregnant women, who were admitted to yahyanejad Hospital in Babol. They were divided into two groups with 20 numbers via frequency matching. Patient selection criteria were: age less than 30 years, GA 28-36 week, no history of medical or pregnancy disorders, and normal sonographic findings of fetus. We started the test with blood sampling in order to determine the basal blood suger, fetal movements counting, heart monitoring with infusion of 25 g glucose (to case group) and the same volume of distilled water (to control group). The same determinants were assessed at 15, 30, 45 and 60 minutes later. Data entered to SPSS and analyzed by t- test and pierreson correlation test. There were significant increases in blood glucose level (P=0.006) and fetal movements (P=0.007) between two groups at minute 15, 30 and 45. But the correlation of them was incomplete pierreson type. The maximum fetal movements were at minute 30, and the maximum of blood glucose level was at minute 15. So, the infusion of glucose to pregnant women had positive effect on increasing fetal movements, but it didn’t have direct correlation. Need to adequate time for glucose metabolization is responsible for delayed correlation between fetal movements and blood glucose level 106 115 Haydeh H Samiee هایده سمیعی Department of Obstet . and Gynecol , Yahyanejad Hospital, Babol Medical Sciences University Department of Obstet . and Gynecol , Yahyanejad Hospital, Babol Medical Sciences University Iran Samieehaydeh@yahoo.com Vida V Falah Mehne ویدا فلاح مهنه Faculty of Medicine, Babol University of Medical Science Faculty of Medicine, Babol University of Medical Science Iran Fetal movementGlucose infusionFetal heart monitoring 115.pdf Maria D., Velazquez M.D., William F. Rayburn M.D. Antenatal evaluation of the fetus using fetal movement monitoring. Clin Obs Gyn. 2002;45(4): 993-1004.##Richardson B.S., Gagon R. In Creasy R.K. & Resnik R. Edition. Maternal-Fetal Medicine.4th Edition.Philadelphia, WB Saunders. 1999;PP: 231-247.##Tsubokura H. Clinical significance of general movements. No to Hattatsu. 2002;34(2):122-8.##Christensen F.C., Rayburn W.F. Fetal movement counts. Obs Gy Clin North Am. 1999;26(4):607-21.##Meniham C.A., Ellen Kopel. Electronic fetal monitoring, Philadelphia, Lippincott. 2001;##Canningham f.G., Intrapartum assessment. William’s obstetrics. 21th Edition. Appleton and large united states, Asimon & Schuster company.2001; PP:1330-1359.##Cerri V., Tarantini M., Zuliani G., Schena V., Redaelli C. Intravenous glucose infusion in labor does not affect maternal and fetal acid-base balance. J Marten Fetal Med. 2000;9(4):204-8.##Chamberlain D.B. Life in the in the womb: Dangers and opportunities. J Perinatal PsycholHealth.1999;14(1-2),31.##American college of obstetricians & Gynecologist. Antepartum fetal surveillance. ACOG, Practice Bulletin. 1999;9:1-19.##Nijhuis J.G., Prechtl H.F.R., Martin C.B. Jr., Bots R.S. Are there behavioral states in the human##Wright T.E., Martin D., Qualls C. Effects of intrapartum administration of invert sugar and D5LR on neonatal blood glucose levels. J Perinatol. 2000;20(4):217-8.##Martin E.J. Intrapartum Management modules. 3th Edition, Philadelphia: WB Saunders. 2002;PP:97-103.##Baston H., Monitoring fetal wellbeing during routine antenatal care. Pract Midwife. 2003;6(4):29-33.##Velazquez M.D., Rayburn W.F. Antenatal evaluation of the fetus using fetal movement monitoring. Clin Obs Gyn. 2002;45(4):993-1004.##Fukushima K., Morokuma S., Sato S., Nakano H. Fetal monitoring. Masui. 202;51:95-104. Review. Japanese.##Gold Stein I., Makhoul I.R., Nisman D., Tamir A., Escalante G., Itskovitz-Eldor J. Influence of maternal carbohydrate intake on fetal movements at 14 to 16 weeks of gestation. Prenat Diagn. 2003;(2):95-7.##Robertson S.S., Dierker L.J. Fetal cyclic motor activity in diabetic pregnancies: sensitivity to maternal blood glucose. Dev Psychobiol. 2003;42(1):9-16.##

ايجاد پاسخ فوليكولي با تجويز دوز واحد مترودين در بيماران مبتلا به سندرم تخمدان پلي‌كيستيك(PCOS) مقاوم به كلوميفن سيترات Induction of ovulation with a single dose of metrodin in PCOS patients resistant to clomiphene citrate 2 1 سندرم تخمدان پلي‌كيستيك (PCOS) با طيف وسيعي از علل و تظاهرات باليني به‌صورت عدم تخمك‌گذاري مزمن تعريف مي‌شود. براي بررسي اثر تجويز دوز واحد مترودين در ايجاد پاسخ فوليكولي در بيماران مبتلا به سندرم تخمدان پلي كيستيك مقاوم به كلوميفن مطالعه‌اي بصورت Clinical Trial مداخله‌اي در سال هاي 81-1380 در بخش درمان ناباروري بيمارستان شريعتي انجام شد. در بين بيماران مبتلا به PCOS مراجعه‌كننده به اين بخش، افرادي كه سندرم PCO به‌عنوان تنها علت ناباروري در آنها تشخيص داده شده بود، يك دوره درمان با كلوميفن سيترات، از روز سوم تا هفتم سيكل قاعدگي- به ميزان روزانه mg 150 (حداكثر دوز معمول) - دريافت كردند و با سونوگرافي واژينال از نظر پاسخ فوليكولي كنترل شدند. 60 نفر داراي پاسخ فوليكولي به شرح ذيل وارد مطالعه شدند: به هر يك از 60 بيمار از روز سوم تا هفتم سيكل قاعدگي بعدي، مجدداً كلوميفن سيترات به ميزان روزانه mg 150 تجويز شد. علاوه بر آن در روز سوم سيكل، يك عدد آمپول مترودين (IU 75) به شكل عضلاني به هر يك تزريق شد. با انجام سونوگرافي واژينال و پيگيري بيماران وقتي در روزهاي 14 تا 16 سيكل فوليكول غالب به اندازه mm 18 رؤيت شد، به عنوان پاسخ فوليكولي تلقي گشت. سپس همان روز IU000/10 آمپول HCG به شكل عضلاني به بيمار تزريق شد. در روز تزريق و دو روز بعد توصيه به انجام مقاربت مي‌شد. در روز 21 سيكل قاعدگي، ميزان پروژسترون سرم اندازه گيري شد. سطح پروژستروني بيشتر يا مساوي ng/ml 3 به منزله تخمك گذاري تلقي شد. در صورت تأخير در ايجاد قاعدگي، در روز 32 و مجدداً 34 سيكل سطح ß-HCG سرم اندازه گيري شد و مقادير بيشتر يا مساوي IU/l200 و يا افزايش قابل توجه آن نشانه حاملگي شيميايي بود. سپس براي اطمينان از حاملگي طبيعي داخل رحمي، در هفته هفتم سونوگرافي واژينال انجام شد كه رؤيت ساك حاملگي، جنيني و ضربان قلب جنين مؤيد حاملگي بود. از ميان 60 بيمار، 31 نفر (7/51%) پاسخ فوليكولي داشتند. 30 نفر (50%) تخمك گذاري كردند و از اين ميان 15 نفر (25%) تست حاملگي مثبت داشتند. يك نفر از بيماران پس از مثبت شدن تست حاملگي و قبل از رؤيت حاملگي در سونوگرافي، سقط خودبخودي داشت و 2 مورد پس از مشاهده حاملگي در سونوگرافي، سقط داشتند. 2 مورد از بيماران زايمان زودرس و در 9 مورد حاملگي تا ترم ادامه يافت. عوارض درماني تنها در 4 نفر از بيماران مشاهده شد. تجزيه و تحليل داده ها با استفاده از آزمون هاي Chi-Square Fisher Testانجام شد. با توجه به متغيرهاي سن، BMI، نوع ناباروري و چگونگي قاعدگي، تفاوت معني داري در ايجاد پاسخ فوليكولي ديده نشد. بين درصد حاملگي و ميزان پروژسترون روز 21 بيماران ارتباط معني داري وجود داشت(0001/0P<) و با افزايش ميزان پروژسترون، درصد حاملگي‌ در دو گروه افزايش يافت. نتايج حاصل از اين مطالعه نشان مي‌دهد كه دوز واحد مترودين بطور موفقيت‌آميزي در بيماران موجب پاسخ فوليكولي و تخمك‌گذاري و حاملگي مي شود و علاوه بر آن عوارض جانبي ناچيز آن نيز قابل اغماض مي‌باشد. 2 Polycystic Ovary Syndrome (PCOS) is a common cause of chronic anovulation and is frequently associated with different clinical symptoms. The main objective of this clinical trial was to evaluate the therapeutic effects of single dose of metrodin administration to induce follicular response in PCOS patients at Shariati hospital (2001-2002). PCOS was the main cause of the infertility in selected patients. All the patients were treated with maximal dose of clomiphene citrate (150mg/d) from the 3rd to the 7th days of their menstrual cycle while controlling with vaginal sonography for the follicular response. Sixty patients with follicular response were selected and studied we combined the previous strategy of clomiphene citrate administration with muscular injection of single dose (75 IU) of metrodin at the 3th day of cycle. The positive follicular response was the appearance of dominant follicle with 18 mm diameters in the 14th to 16th days. In the presence of positive follicular response, 10000 IU of HCG was injected at the same day. Intercourse was allowed that night and the 2 subsequent days. Progesterone level was measured in the 21th day of the cycle, with levels equal or above the 3 ng/ml suggesting “ovulation”. β-HCG level was measured in the 32th and 34th days of the cycle, If the menstruation was delayed. The levels equal or more than 200IU/l or significant increase in β-HCG level suggested chemical pregnancy. To confirm a normal intrauterine pregnancy, vaginal sonography was performed in the 7th week; in which, visualization of the gestational sac, fetal pole, and monitoring of fetal heart rate were suggestive. Among total sixty patients, 31 (%51.7) had positive follicular response, 30 (%50) had ovulation and 15 had positive pregnancy tests. One patient had spontaneous abortion after positive pregnancy test and before sonography. Two patients had spontaneous abortion after positive sonography and two patients had preterm labor. Nine patients had term pregnancy. Complications were observed in four patients. The achieved data were analyzed, by fisher and x2 tests. Although there was no significant correlation between follicular response and variants such as age, BMI, infertility type or menstrual state, there was a statistically high correlation between pregnancy rate and progesterone level at 21th day of cycle (p<0.0001). The result of this study suggests that using a single dose metrodin administration, has a significant influence on follicular response, induction of ovulation and creating pregnancy. 115 123 Marzieh M Agha Hossinei مرضیه آقاحسینی Infertility Treatment Ward, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences & Health Services University Infertility Treatment Ward, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences & Health Services University Iran Aghahm@yahoo.com Ashraf A Alyasin اشرف آل یاسین Infertility Treatment Ward, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences & Health Services University Infertility Treatment Ward, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences & Health Services University Iran Afsaneh A Khademi افسانه خادمی Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Iran Shadi Sh Salehpour شادی صالح پور Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Iran MetrodingFollicular responseClomiphene citrateInfertilityPolycystic ovary syndrome 116.pdf Speroff leon; Glass Robert H., Kase Nathan G. Clinical Gynecologic Endocrinology and Infertility.Lippincot Williams & Wilkins, 6th Edition 1999;(12):492-7,(15):577,(30):1102-5.##Ernest N.H., Flora T.O., William S.W., Ho P.C. A prospective, open randomized clinical study to assess the efficacy and safety of two gonadotropin preparations adminstered in who group II anovulatory subfertile women. Obs Gyn Res. 1988;24(5):355-61.##Ghosh S., Goswami S., Chakravarty B.N. Induction of ovulation with a single dose of Metrodine - HP in PCOS. 56th Annual Meeting of the American Society for Reproduction Medicine. Fertil Steril 2000;74(3):33.##Chen W., Zhang Y., Dai Q. Chronic low dose follicle stimulation hormone step up regimen in the treatment of polycystic ovary syndrom related anovulatory infertility with clomiphene resistance. ZhonghauFu Chan Ke Za Zhi. 2000;35(10):588-90.##Raj S.G., Berger M.J., Grimes E.M., Taymor ML. The use of gonadotropins for the induction of ovulation in women with polycystic ovarian disease. Fertil Steril. 1977;28(12):1280-4.##Hughes E., Collins J., Vandekerchckhove P. Ovulation induction with urinary follicle stimulating hormone versus human menopausal gonadotropin for clomiphene resistant polycystic ovary syndrom. Syst Rev 2000; 2:CD000087:1.##Nugent, D., Vandekerckhove P., Hughes E., Arnot M., Lifford R. Gonadotropin therapy for ovulation induction in subfertility associated with polycystic ovary syndrom. Cochrane Database Sys Rev 2000;4:CD 0001410:1-2.##Homburg R., Howles CM. Low dose FSH therapy for anovulatory infertility associated with polysystic ovary syndrom: rational, results, reflections and refinements. Hum Reprod Update. 1999;5(5):493-9.##

مقايسه اثرات HMG و متفورمين همراه با HMG با دوز پايين در افراد مبتلا به PCOS مقاوم به كلوميفن سيترات Comparing the effect of low dose HMG plus metformin and low dose HMG in PCOS patients resistant to Clomiphene citrate 2 1 سندرم تخمدان پلي‌كيستيك (PCOS) از بيماريهاي شايع است كه با اختلال تخمك‌گذاري و ناباروري همراه مي‌باشد. شيوع اختلال تخمك‌گذاري در جامعه عمومي 40% گزارش شده است. اولين قدم در درمان PCO كاهش وزن و پس از آن درمان دارويي است. كلوميفن سيترات اولين دارو براي القاي تخمك‌گذاري است؛ ولي با توجه به مقاومت بعضي از بيماران به كلوميفن، براي درمان بيماران از روشهاي ديگر استفاده مي‌كنند. اين مطالعه جهت ارزيابي اثر متفورمين روي تحريك تخمدان همراه با استفاده از دوز پايين HMG در بيماران مبتلا به PCOS مقاوم به كلوميفن انجام گرفت. 34 بيمار مقاوم به كلوميفن به طور تصادفي يك در ميان به دو گروه مساوي تقسيم شدند. 17 بيمار، متفورمين همراه با HMG دريافت نمودند (گروه A). به 17 بيمار ديگر فقط HMG داده شد(گروه B). قبل از تجويز متفورمين، بيماران تحت بررسي هورموني و GTT قرار گرفتند. متفورمين به ميزان mg500 سه بار در روز تجويز شد. سپس ماه بعد HMG به بيماران تزريق گرديد. پاسخ به درمان بر اساس تعداد و ميزان رشد مناسب فوليكولي (mm 18-16) و ميزان باروري ارزيابي شد. هر دو گروه به يك ميزان تحت تحريك تخمك‌گذاري قرار گرفتند و در طول يك سيكل با هم مقايسه شدند. يافته‌ها با استفاده از آزمونهاي آماري T-test و Chi-Square آناليز شد. بر اساس نتايج اين مطالعه در گروه A بطور متوسط در هر فرد 9/1±4/2 و در گروه دوم به طور متوسط 4/1±3/1 فوليكول رشد مناسب داشت. همچنين در گروه A بطور متوسط طول تحريك 4/1±5/10 روز (77/0=P) و در گروه B مدت زمان تحريك 4/1±10 (17/0=P) روز بود. بين دو گروه از نظر روزهاي تحريك، تعداد آمپول‌هاي مصرفي و تعداد فوليكول‌هاي رشد كرده اختلاف آماري معني‌داري وجود نداشت. ميزان حاملگي در گروه A 4/29% و در گروه B 8/11% بود كه اين اختلاف معني‌دار نبود. در گروه A، 4 بيمار هيپرانسولينمي داشتند كه همگي داراي رشد فوليكولي مناسب بودند؛ ولي در گروه B، 5 بيمار هيپرانسولينمي و يك نفر رشد فوليكولي مناسب داشتند. در نتيجه مي‌توان گفت متفورمين هميشه نمي‌تواند در همه بيماران PCOS مقاوم به كلوميفن مفيد باشد و توصيه مي‌شود از آن در بيماران هيپرانسولينمي مقاوم به كلوميفن استفاده شود. 2 Polycystic ovary syndrome (PCO) is the most common problem among ovarian dysfunctions that accompany infertility and ovulation problem. The prevalence of ovulation dysfunction is reported as high as 40% in general population. The first step in management of PCO is weight reduction and then drug therapy. Clomiphen citrate is the first choice for ovulation induction. Considering the resistance of some patients to this drug, other methods have been also employed. This study evaluated whether metformin had beneficial effect in clomiphen resistant patients with polycystic ovarian syndrome in an infertility clinic or not. Thirty-four patients resistant to clomiphene were randomly divided in to 2 groups. One group was treated with metformin plus HMG (group A) and the other with HMG alone (group B). Hormonal assessment and GTT were performed before administration of 1500 g of metformin (500mg three times daily). HMG was injected the next month. The response was assessed by the restoration of follicle growth (16-18mm) and pregnancy rate. The findings were analyzed by T-test and Chi-Square. In the first group, we had 2.4±1.9 adequate follicle response in each patient. In the second group we had 1.3±1.4 adequate follicle responses. For the first group the number of HMG was 6.2±1.4 while for the second group it was 6.1±1. In the first group (P=0.17) the stimulation length was 10.5±1.4 days (P=0.77), and in the second group, it was 10±1.4 days. There was no significant difference in length of stimulation and total HMG received among the two groups. For the first group, the pregnancy rate was 29.4% and in the second groups, the rate appeared to be 11.8% (P=0.199), the difference was not statistically significant. In the first group, there were four patients with hyperinsulinemia, all of them had follicle growth. But in the second group, there were five patients with hyperinsulinemia but only one of them had follicle response. Metformin is not always beneficial when given to clomiphene-resistant infertile women with PCO in clinical practice. We recommend that the use of metformin in PCO patients with hyperinsulinemia. 123 129 Tahereh T Nazari طاهره نظری Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Iran nazaritahere@yahoo.com Mahmoud M Haji Ahmadi محمود حاجی احمدی Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Iran Mahtab M Zeinalzadeh مهتاب زینال زاده Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Iran Sedigheh S Esmaeilzadeh Department of Social Medicine, Faculty of Medicine, Babol University of Medical Science & Health Services Department of Social Medicine, Faculty of Medicine, Babol University of Medical Science & Health Services Iran Maryam M Gholizadeh مریم قلی زاده Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Iran Mehrangiz M Baleggi مهرانگیز بالغی Babol University of Medical Sciences Babol University of Medical Sciences Iran Ovulation inductionPolycystic ovaryMetforminHuman menopausal genadotropin 117.pdf Speroff L., Glass R.H., Kase N.G. Clinical Gynecology Endocrinology and Infertility. 6th Edition, Lippincott Williams & Wilkins. 1999;PP:487-513.##Ryan K.J., Berkwits R.S., Barbieri R.L., DunaifA. Kistners Gynecology & Womens Health. 7th Edition, A Times Miror Co. 1999;PP:443-462.##Berek J.S., Adashi E.Y., Hillard P.A. Novaks Gynecology. 13th Edition, Baltimore Williams & Wilkins. 2002; PP:876.##Martens J.W., Geller D.H., Arlt W. Enzimatic activties of P450c 17 stably expressed in fibroblasts form patients with the polycystic ovary syndrome. J Clin Endocrinol Metab. 2000;85(11): 4338-46.##Luboureau S., Barbosa S., Rodin P., Rohmer V. Polycistic ovary syndrome. Fertil Steril. 1999;72(72):282-5.##Velazques E.M., Mendoza S.T., Sosa F., Glueck C.J. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia and systolic blood pressure, while facilitating normal menses and pregnancy. Metabol Clin Exp. 1994;(43):647-654.##Dunaif A., Scott D., Finegood D., Quintana B., Whitcomb R. The insulin sensitising agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovarian syndrome. J Clin Endocrinol Metab. 1996;81: 3299-3306.##Rossing M.A., Daling J.R., Weiss N.S., Moore D.E., Self S.G. Ovarian tumours in a cohort of infertile women. N Engl J Med. 1994;331:771-776.##Lobo R.A., Gysler M., March C.M., Goebelsmann U., Mishel D.R. Clinical and laboratory predictors of clomiphene response. Fertil Steril. 1982;37:168-174.##Roy M.B., HomBurc B.S. Polycysticovary syndrome. Martin Dunitz LTD. 2001;P:12.##Sturrock N.D., Lannon B., Fay T.N. Metformin dose not enhance ovulation induction in clomiphene resistant polycystic ovary syndrome in clinical practice. Br J Clin Pharmacol. 2002;53(5): 469-73.##Nestler J.E., Jakubowicz D.J., Evans W.S., Pasquali R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. Diabetologia. 1998;338:1876-1880.##DeLoe V., La Marca A., Ditto A., Morgante G., Cianic A. Effect polycystic ovary syndrome. Fetil Steril. 1999;72(72): 282-5.##Vandermolen D.T., Ratts V.S., Evans W.S. Metformin increases the ovulatory rate and pregnancy rate from clomiphene citrat alone. Fertil Stril. 2001;75(2):310-5.##زینال‌زاده مهتاب، آل‌یاسین اشرف، آقاحسینی مرضیه. موفقیت حاملگی بدنبال مصرف متفورمین در بیماران با سندرم تخمدان پلی‌کیستیک تحت درمان با ART. مجله باروری و ناباروری. 1381، سال سوم، شماره 10، 24-19.##Seale F.G., Robinson R.D., Neal G.S. Association of metformin and pregnancy in the polycistic ovary syndrome a report of the three cases. J Repred Med. 2000;45(6):507-10.##Yarali H., Yildyz B.O., Demirol A. Co-administration of metformin during FSH treatment in patients with clomiphenecitrate-resistant PCOS. Hum Reprod. 2002;17(9):2481-2.##

مصرف اتينيل استراديول براي تعديل اثرات آنتي‌استروژنيك كلوميفن سيترات در بيماران كانديد IUI Modulating the antiestrogenic effects of clomiphene citrate by ethinyl estradiol in patients undergoing intrauterine insemination 2 1 ناباروري باشيوع حدود 15-10% يكي از مشكلات جامعه بوده كه گاهي تداوم زندگي زناشويي را تهديد مي‌كند. كلوميفن سيترات يكي از شايع‌ترين داروهاي مصرفي در درمان ناباروري مي‌باشد. هدف از اين مطالعه مقايسه اثرات كلوميفن به تنهايي و يا همراه با اتينيل استراديول براي تحريك تخمك‌گذاري در بيماران كانديد IUI بود. اين مطالعه از نوع كارآزمايي باليني تصادفي بود كه در مركز درمان ناباروري دانشگاه علوم پزشكي مشهد انجام شد. 159 زن نابارور بين 20 تا 30 ساله كه مدت ناباروري آنها حدود 1 تا 10 سال بود به طور تصادفي به دو گروه درماني تقسيم شدند. گروه اول (59 نفر) mg100 كلوميفن همراه با mg05/0 اتينيل استراديول و گروه ديگر (100 نفر) mg100 كلوميفن به تنهايي دريافت نمودند. تعداد فوليكول و قطر آن، ضخامت اندومتر و با سونوگرافي ترانس واژينال ميزان حاملگي و ميزان سقط مورد بررسي قرار گرفت و آناليز آماري با استفاده از آزمونهاي آماريx2 و T-test انجام شد. اختلاف ضخامت اندومتر دو گروه از نظر آماري معني‌دار بود (mm9/7 در گروه اول در مقايسه با mm0/7 در گروه دوم، 001/0P=)؛ ولي تفاوتي در ميزان حاملگي و سقط وجود نداشت. ميزان حاملگي در گروه اول 6/12% و در گروه دوم 5/14% (55/0=P) بود. ميزان سقط سه ماهه اول در گروه اول 21% و در گروه دوم 1/25% بدست آمد (9/0=P). يافته‌هاي اين مطالعه نشان داد كه اتينيل استراديول مي‌تواند اثرات نامطلوب كلوميفن سيترات ‌را بر روي ضخامت اندومتر تعديل كند؛ اما قادر به افزايش ميزان حاملگي و كاهش ميزان سقط خود به خودي نمي‌باشد. 2 Infertility with an incidence of about 10-15% is a social problem that sometimes threatens the continuity of the family life. Clomiphen Citrate (C.C.) is one of the most commonly used drugs in the treatment of infertility. The purpose of this study was to compare the pregnancy and abortion rates after IUI in two groups of patients who received clomiphen citrate alone or C.C. in combination with ethinyl E2 to stimulate ovulation in patients undergoing IUI. This was a randomized clinical trial study performed at the Infertility Center of Mashad Medical Science University. The subjects were 159 women, aged 20-30 years with infertilty back ground of 1-10 years who were randomly assigned to two groups. The first group received C.C. plus ethinyl E2 and the other group C.C. alone. The number and diameter of the follicles, endometrial thickness, and pregnancy and abortion rates were evaluated by transvaginal ultrasonography and analyzed by chi-square and T-test. There was a significant difference in endometrial thickness between the two treatment groups (7.88 mm in group I vs. 7.02 mm in group II, p=0.001). There were no significant differences between pregnancy and abortion rates in the two groups. Pregnancy rate was 18.6% in group I vs. 14.5% in group II and first trimester abortion rate was in group I, 21% vs in group II, 25%. Ethinyl E2 can modulate the deleterious effects of C.C. on endometrial thickness, which could not contribute to higher pregnancy rates and lower spontaneous abortion rates. 129 137 Nayereh N Khadem نیره خادم Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashad University of Medical Sciences Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashad University of Medical Sciences Iran parisa_e77@yahoo.com Parisa P Ensafi پریسا انصافی Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashad University of Medical Sciences Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashad University of Medical Sciences Iran Clomiphene citrateEthinyl estradiolPregnancy rateAbortion rateIntra uterine insemination 118.pdf Speroff L., Glass R.H., Kase N.G. Clinical gynecologic endocrinology and infertility. 6th Edition. Baltimore,Lippincott, Williams- Wilkins. 1999;1098-1105.##Zabrek Edward M., Faco G. Can I get pregnant? The basic infertility work up. Clin Obs Gyn. 1996; 39:230-232.##Duran H.E., Morshedi M., Kruger T., Oehinger S. Intrauterine insemination: a systemic review on determinant of success. Hum Reprod update. 2002;8:373.##Miskry T., Chapman M. The use of intrauterine insemination in Australia and New Zealand. Hum Reprod. 2002;17:956-9.##Dhaliwal L.K., Sialy R.K., Gopalan S., Majumdar S. Minimal stimulation protocol for use with intrauterine insemination in the treatment of infertility. J Obs Gyn Res. 2002; 28:295-9.##Dickey R.P., Taylor S.N., Lu P.Y., Sartor B.M., Rye P.H., Pyrzak R. Relationship of follicle numbers and estradiol levels to multiple implantation in 3,608 intrauterine insemination cycles. Fertil Steril. 2001;75(1):69-78.##Biljan M.M., Mahutte N.G., Tulandi T., Tan S.L. Prospective randomized double-blined Trial of the correlation between time of administration and antiestrogenic effects of clomiphene citrate on reproductive end organs. Fertil Steril. 1999;71: 633-8.##Gerli S., Gholami H., Manna C. Use of ethinyl estradiol to reverse the ant estrogenic effects of clomiphene citrate in patients undergoing intrauterine insemination: a comparative, randomized study. Fertil Steril. 2000;73(1):85-9.##Gelety T.J., Buyalos R.P. The effect of clomiphene citrate and menopausal gonadotropins on cervical mucus in ovulatory cycles. Fertil Steril. 1993;60:471-6.##Massai M.R., de Ziegler D., Lesobre V., Bergeron C., Frydman R., Bouchard P. Clomiphene citrate effects cervical mucus and endometrial morphology independently of the changes in plasma hormonal levels induced by multiple follicular reccuitment. Fertil Steril. 1993;59:1179-86.##Scirarra J.J, Watkins T.S. Sciarra Gynecology and Obstetrics. USA, JBL Lippincott. 1995;68 (5):2-5.##Dickey R.P., Olar T.T., Taylor S.N., Curole D.N., Rye P.H. Sequential clomiphene citrate and human menopausal gonadotrophin for ovulation induction: comparison to clomiphene citrate alone and human menopausal gonadotrophin alone. Hum Reprod. 1993;8:56-9.##Hammond M.G., Halme J.K., Talbert L.M. Factors affecting the pregnancy rate in clomiphene citrate induction of ovulation. Obs Gyn. 1983;62:196-202.##Unfer V., Costavil L., Gali S., Papleo E., Marelli G., Renro G. Low dose of ethinyl estradiol can reverse the antiestrogenic effects of clomiphene citrate on endometrium. Gyn Obs Invest. 2001;511:120-123.##Taubert H.D., Dericks-Tan J.S. High doses of estrogens do not interfere with the ovulation- induction effect of clomiphene. Fertil Steril. 1976;27:375-82.##Insler V., Zakut H., Serr D.M. Cycle pattern and pregnancy rate following combined clomiphene-estrogen therapy. Obs Gyn. 1973; 41:602-7.##Yagel S., Benchetrit A., Anteby E., Zacut D., Hochner-Celnikier D., Ron M. The effect of ethinyl estradiol on endometrial thickness and uterine volume during ovulation induction by clomiphene citrate. Fertil Steril. 1992;57;33-6.##Bateman B.G., Nunley W.C. Jr., Kolp. L.A. Exogenous estrogen therapy for treatment of clomiphene citrate induced cervical mucus abnormalities: is it effective? Fertil Steril. 1990; 54:577-9.##Ohno Y., Fujimoto Y. Endometrial estrogen and progesterone receptors and their relationship to sonographic appearance of the endometrium. Hum Reprod Update. 1998;4:560-4.##Ransom M.X., Doughman N.C., Gareia A.J. Menotropins alone are superior to a clomiphene citrate and menotropin combination for super ovulation induction among clomiphene citrate failures. Fertil Steril. 1996;66:863-5.##Maegawa M., Kamada M., Takayanagi M., Naka O., Irahara M., Aono T. Difference of the hormonal profile of the periovulatory phase in pregnant and non pregnant cycles of infertile woman with unexplained etiology. Gyn Obs Invest.1993; 35:228-31.##Goldstein D., Zuckerman H., Harpaz S., Barkai, Gera A., Gordon S. Correlation between estradiol and progesterone in cycles with luteal phase deficiency. Fertil Steril. 1982;37:48-54.##Yeko T.R., Nicosia S.M., Maroulis G.B., Bardawil W.A., Dawood M.Y. Histology of midluteal corpus luteum and endometrium from clomiphene citrate-induced cycles. Fertil Steril. 1992;57:28-32.##Randall J.M., Templeton A. Transvaginal sonographic assessment of follicular and endometrial growth in spontaneous and clomiphene citrate cycles. Fertil Steril. 1991;56: 208-12.##Eden J.A., Place J., Carter G.D., Jones J., Alaghband-zadeh J., Pawson M.E. The effect of clomiphene citrate on the follicular phase increase in endometrial thickness and uterine volume. Obs Gyn. 1989;73:187-90.##Shimoya K., Tomiyama T., Hashimoto K. Endometrial development was improved by transdermal estradiol in patients treated with clomiphene citrate. Gyn Obs invest. 1999;47: 251-254.##Ben-Ami M., Geslevich Y., Matilsky M ., Battino S., Shalev E. Exogenous estrogen therapy concurrent with clomiphene citrate lack of effect on serum sex hormone levels and endometrial thickness. Gyn Obs Invest.1994;37:180-182.##Check J.H., Dietherich C., Lurie D. The effect of consecutive cycles of clomiphene citrate therapy on endometrial thickness and echopattern. Obs. 1995;86:341-345.##Chang M.Y., Chiang C.H., Chiu T.H., Hsieh T.T., Soong Y.K. The antral follicle count Predicts the outcome of pregnancy in a controlled ovarian hyper stimulation/ intrauterine insemination program. J Assist Reprod Genet.1998;15:12-7.##Dickey R.P., Taylor S.N., Lu P.Y., Sartor B.M., Rye P.H., Pyrzak R. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate- intrauterine insemination.Fertil Steril. 2002;78:1088-95.##

اختلالات كروماتين اسپرم بر تشكيل پرونوكلئوس با اندازه نامساوي در IVF و ICSI The effect of sperm chromatin anomalies on pronucleus different size after IVF and ICSI 2 1 براساس تحقيقات مختلف اندازه، مرفولوژي و وضعيت قرارگيري پرونوكلئوس‏ها مي‏تواند بر كيفيت رويان، لانه‏گزيني و حاملگي تأثير داشته باشد. در اين تحقيق رابطه احتمالي بين تستهاي بلوغ كروماتين اسپرم (CMA3، آنيلين بلو، SDS، SDS+EDTA) و شاخصهاي اسپرم با درصد جنينهاي داراي پرونوكلئوس نامساوي ارزيابي شد. نمونه‏هاي جمع‌آوري شده از 115 بيماري كه براي ICSI و IVF مراجعه نمودند، براي ارزيابي غلظت، تحرك، مرفولوژي اسپرم همچنين تستهاي بلوغ هسته اسپرم قبل و بعد از آماده‏سازي، استفاده شد. 17 تا 19 ساعت پس از مجاورت اسپرم با تخمك در IVF يا ICSI، با توجه به حضور و اندازه پرونوكلئوس‏ها، زيگوتها امتيازدهي شدند و رابطه بين درصد زيگوتهاي با پرونوكلئوس نامساوي با شاخصهاي اسپرمي و تستهاي بلوغ هسته اسپرم تعيين گرديد. بين درصد زيگوتهاي با پرونوكلئوس نامساوي و كمبود پروتامين (به روش CMA3) و هيستون اضافي (با رنگ‏آميزي آنيلين بلو) و توانايي كروماتين اسپرم براي خروج از تراكم (SDS+EDTA) يك رابطه مثبت معني‏دار در بيماران ICSI بدست آمد؛ اما در بيماران IVF بين هيچ يك از شاخصهاي اسپرمي و تست‏هاي مذكور با درصد زيگوت‏هاي با پرونوكلئوس نامساوي رابطه‏اي مشاهده نشد، در صورتيكه بيماران را به دو گروه CMA3 مثبت كمتر از 30% و بيش از 30% تقسيم كنيم در هر دو روش ICSI و IVF يك اختلاف معني‏داري بين درصد زيگوتهاي با پرونوكلئوس نامساوي و ميزان لقاح در دو گروه بدست آمد. ارزيابي وضعيت كروماتين بسيار مهم است چون كمبود پروتامين نه تنها اثر مستقيم بر ميزان لقاح و كيفيت پرونوكلئوس دارد بلكه براساس نتايج اين مطالعه بر روي تكامل رويان در هر دو روش ICSI و IVF تأثير مي‌گذارد. تأثير وضعيت كروماتين غيرطبيعي ممكن است به واسطه تشكيل غيرطبيعي پرونوكلئوس باشد؛ زيرا احتمال دارد در روش ICSI اسپرم با كروماتين غيرطبيعي به داخل اووسيت تزريق شود. 2 Pronucleus size, morphology and orientation are known to affect embryo quality, implantation and pregnancy success. The present study was aimed at evaluation of the possible relationship between sperm chromatin maturity tests (CMA3, aniline blue, SDS, SDS+EDTA) and semen parameters with percentage of zygotes with pronucleus size asynchrony. Semen of 115 men from IVF and ICSI couples were analyzed for sperm concentration, motility, morphology and the said tests. At least 17-19 hours after sperm insemination or ICSI, oocytes were scored for presence and relative size of their pronuclei and then the relationship between percentage of zygotes with pronucleus size asynchrony and semen parameters and the above tests was evaluated. A positive significant relationship was obtained between percentage of zygotes with unequal pronucleus size with protamine deficiency, excessive histones and ability of sperm to undergo decongestion in ICSI cases. However, no correlation was observed between this phenomenon and any of semen parameters and aforementioned tests in IVF cases. The result of this study and other studies show that evaluation of chromatin status is of paramount importance, since protamine deficiency not only directly affects fertilization rate, but also affects pronuclear morphology which influences embryo development, implantation and pregnancy success in IVF and ICSI. The effect of abnormal chromatin status on development of zygote might be mediated via abnormal pronucleus formation since sperms with abnormal chromatin are injected into oocytes during ICSI. 137 146 Mohammad Hossein MH Nasr-Esfahani Embryology Department, Royan Institute, Iranian Academic Center for Education, Culture & Research (ACECR) Embryology Department, Royan Institute, Iranian Academic Center for Education, Culture & Research (ACECR) Iran Nasrmhn@yahoo.com Shahnaz Sh Razavi شهناز رضوی Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Iran Mohammad M Mardani محمد مردانی Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Iran Afsaneh A Mafi افسانه مافی Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Iran Abbas A Moghaddam عباس مقدم Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Iran Safoura S Tofigh صفورا توفیق حسابی Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Department of Embryology, Faculty of Medicine, Isfahan Medical Science University Iran Sperm chromatinPronucleus size asynchronyICSIIVFProtamine deficiency 119.pdf Palermo G.، Joris H.، Devrory P.، Van Steirteghem A.C. Pregnancy after intracytoplasmic injection of single spermatozoa into an oocyte. Lancet. 1992; 340:17-18.##Van Steirteghem A.C., Liu J., Joris H., Nagy Z., Janssenwillen C., Tournay H., Deroey P.C. Higher success rate by intracytoplasmic sperm injection by sub zonal insemination: Report of a second series of 300 consecutive treatment. Hum Reprod. 1993;8: 1055-60.##Iranpour F.G., Nasr-Esfahani M.H., Valojerdi M.R., al-Taraihi T.M. Chromomycin A3 staining as a useful tool for evaluation of male fertility. J Assist Reprod Genet. 2000;17(1):60-6.##Sakkas D., Urner F., Bianchi P.G., BizzaroD., Wagnar I., Jaquenoud N., Manicardi G., Campana I. Sperm chromatin anomalies can influence decongestion after intracytoplasmic sperm injection. Hum Reprod.1996;11:837-43.##Nasr-Esfahani M.H., Razavi S., Mardani M. Relation between different human sperm nuclear maturity tests and in vitro fertilization. J Assist Reprod Genet. 2001;18 (4):199-205.##Esterhuizen A.D., Franken D.R., Lourens J.G.H., Van Zyl C., Muller I.I., Van Rooyen L.H. Chromatin packaging as an indicator of human sperm dysfunction. J Assist Reprod Genet. 2000;17(9):508-14.##Ludwig M., Schopper B., Katalinic A., Sturm R., Al-Hasani S., Diedrich K. Experience with the elective transfer of two embryos under the conditions of the German embryo protection law: results of retrospective data analysis of 2573 transfer cycles. Hum Reprod. 2000;15(2):319-24.##Scott L., Alvero R., Lenodires M., Miller B. The morphology of human pronuclear embryo is positively related to blastocyst development and implantation. Hum Reprod. 2000; 15(11): 2394-403.##Wittemer C., Bettahar-Lebugle K., Ohl J., Rongieres C., Nisand I., Gerlinger P. Zygote evaluation: an efficient tool for embryo selection. Hum Reprod. 2000;15(12):2591-7.##Garello C., Barker H., Rai J., Montgomery S., Wilson P., Kennedy C.R., Hartshorne G.M. Pronuclear orientation, polar body placement, and embryo quality after intracytoplasmic sperm injection and in-vitro fertilization: further evidence for polarity in human oocytes? Hum Reprod. 1999;14(10):2588-95.##Goud P., Goud A., Van Oostveldt P., Van der Elst J., Dhont M. Fertilization abnormalities and pronucleus size asynchrony after intracytoplasmic sperm injection are related to oocyte post maturity. Fertil Steril.1999;72(2):245-52.##Ma S., Yuen H. Intracytoplasmic sperm injection could minimize the incidence of prematurely condensed human sperm chromosomes. Fertil Steril. 2001;75(6):1095-101.##Fishel S., Aslam I., Tesarik J. Spermatid conception: A stage too early, or a time too soon? Hum Reprod. 1996;11(3):1371-5.##Terquem A., Dadoune J.P. Aniline blue staining of human spermatozoa chromatin: Evaluation of nuclear maturation.1983; In Andr J (editor), The sperm cell, J andr (ed), London, Martinus Nijhoff publishers, pp 696-701.##Gonzales G.F., Salirrosas A., Dicina-Torres L.N., Sanchez A., Villena A. Use of clomiphene citrate in the treatment of men with high sperm chromatin stability. Fertil Steril. 1998;69:1109-114.##Kruger T.F., Acosta A.A., Simmons K.F., Swanson R.J., Matta J.F., Oehninger S. Predictive value of abnormal sperm morphology in vitro fertilization. Fertil Steril. 1988;49:112-7.##Perrault S.D., Barbee R.R., Slott V.L. Importance of glutathione in the activity and maintenance of sperm nuclear decondensing activity in maturing hamster oocytes. Dev Biol. 1988;125:181-6.##Yoshida M., Ishigaki K., Nagai T., Chikyu M., Purset V.G. Glutathione concentration during maturation and after fertilization in pig oocytes: relevance of the ability of the oocytes to form male pronucleus. Biol Reprod. 1993;49: 89-94.##Flaherty S.P., Payne D., Matthews C.D. Fertilization failures and abnormal fertilization after intracytoplasmic sperm injection. Hum Reprod. 1998;13(Suppl 1): 155-64.##Bedford J.M., Bent M.J., Calvin H. Variation in the structural character and stability of the nuclear chromatin in morphology normal human spermatozoa. J Repod Fertil. 1973;33:19-29.##Perrault S.D. Chromatin remodeling in mammalian zygotes. Mutat Res. 1992;296:43-55##Sakkas D., Manicardi G.C., Tomlinson M., Mandrioli M., Bizzaro D., Bianchi P.G., Bianchi U. The use of two density gradient centrifugation techniques and swim up method to separate spermatozoa with chromatin and nuclear DNA anomalies. Hum Reprod. 2000; 15: 1112- 1116.##Hammadeh M.E., Kuhnen A., Amer A.S., Rosenbaum P., Schmidth W. Comparison of sperm preparation methods: effect on chromatin and morphology recovery rates and their consequences on the clinical outcome after in vitro fertilization embryo transfer. Int J Androl. 2001;24(6):360-8.##Foresta C., Zorzi M., Rossato M., Varotto I. Sperm nuclear instability and staining with aniline blue:Abnormal persistence of histones in spermatozoa in infertile men. Int J Androl. 1992;15:330-7.##Sakkas D., Urner F., Bizzaro D., Manicardi G., Bianchi U., Shoukir Y., Campana A. Sperm nuclear DNA damage and altered chromatin structure :Effect on fertilization and embryo development. Hum Reprod.1998;13:11-19.##Nasr-Esfahani M.H., Behdadi Pour Z., Abbasi H., Zaman Soltani F., Mardani M., Abuhamzeh B. The effect of varicocelectomy on sperm parameters, membrane integrity and chromatin condensation. Yakhteh (cell) 2000;5:7-11.##Fulka J., Horska M., Moor R.M., Fulka J. and Kanaka J. Oocyte-Specific modulation of female pronuclear development in mice. Dev Biol. 1996;178:1-12.##

وضعيت سلامت روان دوران بارداري و عوامل مؤثر بر آن در زنان مراجعه‌كننده به مراكز بهداشتي درماني شهركرد، سال 81 -1380 The quality of mental health status in pregnancy and it’s contributing factors on women visiting the health care centers of Shahrekord, (2001-2002) 2 1 دوره حاملگي و پس از آن، با تغييرات روانشناختي و فيزيولوژيك بسيار مهمي همراه است كه گاهي با تغييرات پاتولوژيك نيز همراه مي‌گردد؛ بنابراين لازم است تيم پزشكي قادر باشند مراجعه‌كنندگان و خانواده آنها را كه مستعد ابتلاء به اختلالات رواني در طي دوره حاملگي و پس از زايمان هستند شناسايي و در مورد مراقبت‌ها و حمايت‌هاي اين دوره آنها را راهنمايي كنند. لذا پژوهش حاضر با هدف بررسي وضعيت سلامت روان دوران بارداري و عوامل مؤثر بر آن به صورت يك مطالعه توصيفي- تحليلي از نوع مقطعي بر روي 267 مادر باردار مراجعه‌كننده براي انجام مراقبتهاي دوران بارداري به مراكز بهداشتي درماني شهركرد انجام شد. ابزار پژوهش پرسشنامه 28-GHQ و پرسشنامه مربوط به عوامل مستعدكننده بود. براي تعيين سلامت روان، مادران باردار در سه ماهه اول، دوم و سوم حاملگي با پرسشنامه 28-GHQ بررسي شدند و براي تعيين عوامل مستعد‌كننده از پرسشنامه مربوط به اين عوامل در سه ماهه سوم استفاده گرديد. براساس نتايج حاصل ميزان شيوع اختلالات رواني در سه ماهه اول 7/29%، سه ماهه دوم 6/28% و سه ماهه سوم 6/39% مي‌باشد و بين اختلالات رواني دوران حاملگي با عوامل فردي، رواني و اجتماعي- اقتصادي رابطه معني‌داري وجود دارد (05/0P<)؛ لذا با توجه به شيوع بالاي اختلالات رواني دوران بارداري و تأثير عوامل مختلف بر آنها، اهميت تأكيد بر مراقبتهاي رواني دوران بارداري به موازات مراقبتهاي جسمي مشخص گرديده و براساس نتايج اين پژوهش بايد مادران مستعد را شناسايي و با مراقبتهاي روحي و رواني در طي دوران قبل و بعد از زايمان از بروز اين اختلالات پيشگيري كرد. 2 There are many psychological and physiological changes during pregnancy and postpartum periods that are sometimes they become pathologic. Thus, it is necessary for a medical team to identify those patients and their families who have a predisposition to mental disorders and to guide them through this period. Aimed at assessing the prevalence and predisposing factors of mental disorders during pregnancy, an analytical-descriptive and cross-sectional study was performed on 267 pregnant women. The data were collected through interview using the General Health Questionnaire and the questionnaire of the predisposing factors. Mental health was assessed with GHQ through the first second and third trimesters of pregnancy, and predisposing factors were assessed with the questionnaire of the predisposing factors in the third trimester. Results showed that the prevalence of mental disorders in the first trimester was 29.7%, in the second trimester 28.6%, and in the third trimester 39.6%. There was a significant correlation between mental disorders and personal, psychological and socioeconomic predisposing factors (P<0.05). Therefore, taking into account the high prevalence and different predisposing factors of mental disorders, it can be said that mental health care during pregnancy is as important as physical care. Based on the results of this study, susceptible mothers may be defined and identified, and measures may be taken to prevent such disorders. 146 156 Nasrin N Forouzandeh نسرین فروزنده Department of Psychological Nursing, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Department of Psychological Nursing, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Iran nas_for@yahoo.com Masoumeh M Delaram معصومه دل‌آرام Department of Midwifery, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Department of Midwifery, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Iran Fatemeh F Deris فاطمه دریس Department of Statistic& Epidemiology, Faculty of Medicine, Shahrekord University of Medical Science Department of Statistic& Epidemiology, Faculty of Medicine, Shahrekord University of Medical Science Iran Mental healthPregnancyPredisposing factorPersonalPsychologicalSocioeconomicGeneral health questionnaire 120.pdf فروزنده نسرین. بررسی میزان شیوع و عوامل مستعدکننده افسردگی پس از زایمان در زنان مراجعه‌کننده به مراکز بهداشتی، درمانی شهری شهرستان شهرکرد در سال 1376. پایان نامه کارشناسی ارشد پرستاری، دانشگاه علوم پزشکی اهواز، خردادماه 1377.##Harris B., Lovett L., Smith J., Read G. Cardiff puerperd mood and hormone study III, postnatal depressrion at 5 to 6 weeks post partum and its hormonal correlelates across the prepartum period. Br J Psychiatry. 1996; 168:739-44.##کاپلان سادوک کرپ. خلاصه روان‌پزشکی علوم رفتاری. ترجمه پورافکاری نصرت ا.... تهران، انتشارات شهرآب، 1375، ص 45-50.##مجتهدی سید یوسف، کیانی کیانوش، قنبرپور مقدم رضا. روانپزشکی. تهران، انتشارات شهرآب، 1375، ص 126-239.##Kitamura T., Toda M.A., Shima S., Sugawara M. Validity of the repeated GHQ among pregnant women: a study in a japanese genaral hospital. Int J Psychiatry Med. 1996;24(2):149-56.##Evans J., Heron J., Francomb H., Oke S., Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257-60.##Barnent B., Jeffe A., Duggan A.K., Wilson M.D. Depressive symotom, stress and social support in pregnant and post partum a dolescents. Arch pediat Adolesc Med. 1996; 150:64-9.##Areias M.E.D., Kumar R., Barros H., Figueiredo E. Correlates of pre and postnatal depression in mothers and father.Br J Psychiatry. 1996;169:36-41.##Villanueva L.A., Perez F., Fayardo M.M., Fernando; Iglesias L. Sociodemographic factorsassociated with depression in pregnant adolescents. Gyn Obs Mex. 2000; 68:143-8.##Kurki T., Hiilesmaa V., Raitasalo R., Maottila H., Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obs Gyn. 2001;95 (4):487-90.##Kelly R.H., Russo Y., Katon W. Somatic complaints among pregnant women cared for in obstetrics: normal pregnancy or depressive and anxiety symptom amplificatron revisited?. Gen Hosp Psychiatry. 2001;23(3):101-103.##Abiodun O.A., Adetoro O.O., Ogunbode-O.O. Psychiatric morbidity in a pragnant population in Nigeria. Gen Hosp Psychiatry.1993;15(2):125-8.##احمدی کامران. بهداشت اپیدمیولوژی آمار حیاتی. تهران، مؤسسه فرهنگی انتشاراتی تیمورزاده، 1376، ص 76.##کریم‌زاده محمدرضا. زایمان و بهداشت روانی. مجله پزشکی و جامعه، سال نهم، شماره 2، 1372، ص 9-25.##باقری‌یزدی سیدعباس، بوالهری جعفر، پیروی حمید. بررسی وضعیت سلامت روانی دانشجویان ورودی سال تحصیلی 74-73، دانشگاه تهران. مجله اندیشه و رفتار. سال اول، شماره 4، 1374، ص 30-39.##Goldberg D.P. Screening for psychiatric disorder. In Williams P ‘Wilkson G’ Rawnsley K. Edition, The cope of epidemiological psychiatry. London, Rout ledge, 1989;50-79.##یعقوبی نورالله، نصر مهدی، براهنی محمدتقی، شاه محمدی داوود. بررسی همه گیرشناسی اختلالات روانی درشهرستان صومعه سرا. مجله اندیشه و رفتار، سال اول، شماره 4، 1374، ص 55-6.##WHO. Mental health: new understanding, new hope. World Health Report. 2001;24.##نوربالا احمدعلی، محمدکاظم، باقری یزدی سیدعباس، یاسمی محمدتقی. بررسی وضعیت سلامت روان افراد 15سال و بالاتر در جمهوری اسلامی ایران در سال 1378، مجله پژوهشی حکیم، سال اول، شماره 5، 1381، ص 10-2.##Burroughs Arlene. Maternity nursing : an introductory text. 7th Edition. 1997;118-9.##Da-Costa-D., Larouche J., Dritsa M., Brender W. Psychosocial correlates of prepartum and postpartum depressed mood. J Affect Disord. 2000;9(1):31-40.##McKee M.D., Cunningham M., Jankowski K.R., Zayas L. Health related functional status in pregnancy: relationship to depression and social support in a multi ethmic population. Obs Gyn. 2001;97 (6):988-93.##ویلسون رابرت. مامایی و بیماریهای زنان، ترجمه کاظمی داریوش. تهران انتشارات دانش پژوه، 1374، ص56-61.##سیف سوسن. بهداشت روان دوران بارداری و وظایف همسر و جامعه. مجله اصول بهداشت روانی، سال اول، شماره 2، 1378، ص 86-91.##Da-Costa D., Larouche J., Dritsa M., Brender W. Variations in stress levels over the course of pregnancy: Factors associated with elevated hassles, state anxiety and pregnancy specific stress. J Psychsom Res. 1999;47(6):609-21.##Stein A., Dennis H., Janet B., Alison B. The relationship between postnatal depression and mother child interaction. Br J Psychiatry. 1991; 158: 46-52.##کوشان محسن، واقعی سعید. روان پرستاری. انتشارات انتظار. تهران، 1378،ص 152-5.##Lindyren K. Relationship among maternal fetal attachment, prenatal depression and health practices in pregnant. Res Nurs Health. 2001;24 (3):203-17.##

شيوع علائم اضطرابي در بيماران مبتلا به واژينيسموس ارجاع شده به يك كلينيك خصوصي در تهران سال 80-81 The prevalence of anxiety symptoms in patients with vaginismus referred to a private psychiatric clinic in Tehran (2001-2002) 2 1 رفتارهاي جنسي پاسخي است به يك انگيزه زيستي كه براي تعالي نسل ضروري مي‌باشد و از سوي ديگر بر رضايت از زندگي زناشوئي نيز تاثيرگذار است. كژكاري جنسي (Sexual Dysfunction) در حدود 30 تا 50% موارد هر دو جنس را درگير مي‌كند و مي‌تواند عواقب ناگواري روي زندگي زوجين برجاي بگذارد. واژينيسموس يكي از كژكاري‌هاي جنسي شايع زنان است و همراهي آن با اضطراب و ترس و واكنش‌هاي اجتنابي ديده شده است. هدف از اين پژوهش دستيابي به شيوع مشكلات اضطرابي در بيماران مبتلا به واژينيسموس مراجعه‌كننده به يك كلينيك خصوصي روانپزشكي در شهر تهران مي‌باشد. براي انجام اين پژوهش پرسش‌نامه SCL-90 در اختيار 27 بيماري قرار گرفت كه بر اساس ارزيابي متخصص زنان و زايمان دچار واژينيسموس بودند. خرده مقياس‌هاي اضطراب عمومي، ترس مرضي و وسواس-اجبار از پرسش‌نامه SCL-90 بطور اختصاصي مورد توجه بود. داده‌ها توسط آزمون‌هاي Chi-Square و Fisher exact testتجزيه و تحليل شد. بر اساس معيارهاي SCL-90، 13 نفر (1/48%) از اضطراب عمومي، 10 نفر (37%) از ترس مرضي و 19 نفر (4/70%) از علائم وسواس- اجبار، رنج مي‌بردند. اين نتايج با مطالعات ديگر در اين زمينه همسو بوده است. رويكرد تلفيقي مشتمل بر دارو درماني و روان‌درماني در درمان بيماري واژينيسموس توصيه مي‌شود. 2 Sexual behavior as a response to biological instinct is essential for survival, and affects ones’ satisfaction from marital life. The prevalence of sexual dysfunction reaches 30-50% in both sexes. It can be of adverse consequences on the couples’ life. Vaginismus is one of the frequently observed sexual dysfunctions in women. It is accompanied by anxiety, phobia and avoidance reactions. The aim of this study is to assess the prevalence of anxiety features in patients suffering from vaginismus. Symptom check list-90 questionnaire was given to 27 patients diagnosed as vaginismus by Gynecologist referred to in a private psychiatric clinic. “Generalized anxiety, phobia and obsession-compulsion” subscales of SCL-90 questionnaire were particularly investigated. Data were analyzed by Chi-Square and Fisher’s exact tests. According to SCL-90 scores, 13 patients (48.1%) suffered from generalized anxiety, 10 patient (37%) from phobia and 19 patient (70.4%) from obsession-compulsion symptoms. The results were consistent with those of other studies on this subject. Integrated approach to vaginismus consisting of both psycho therapy and pharmacotherapy is there fore recommended. 156 164 Masoumeh M Amin Esmaeli معصومه امین‌اسماعیلی Department of Psychiatric, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti Medical Science University, & Health Services University Department of Psychiatric, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti Medical Science University, & Health Services University Iran Kia_Masi@yahoo.com Mahyar M Azar ماهیار آذر Department of Psychiatric, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti Medical Science University, & Health Services University Department of Psychiatric, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti Medical Science University, & Health Services University Iran Changiz C Iranpour چنگیز ایرانپور Department of Psychiatric, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti Medical Science University, & Health Services University Department of Psychiatric, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti Medical Science University, & Health Services University Iran Generalized anxietyPhobiaObsession- compulsionVaginismusSexual dysfunction 121.pdf Spence S.H. psychosexual therapy: a cognitive behavioral approach. 3th Edition, Published by Champan & Hall, London. 1991; pp:100-102.##Reamy K. Sexual counseling for the non-therapist. Clin Obs Gyn. 1984;27:781-8.##Kaplan H.I., Sadock B.J. Synopsis of psychiatry. 8th Edition, Published by Williams &Wilkins, Maryland. 1998;pp:690.##Kaplan H.S.The new sex therapy: active treatment of sexual dysfunction. Published by Brunner & Mazel, Newyork, 1974; pp 412-28.##Segraves R.T. psychiatric illness and sexual function. Int J Obs Gyn. 1998;10s(2):131-3.##Fuchs K. Therapy of vaginismus by hypnotic desensitization. Am J Obst Gyne.1980;137(1):1-7.##Dennerstein L., Burrow G.D. The management of vaginismus. Aust Fam physician.1977;6(12):1545-9.##Katz R.C., Frazer N., Wilson L. Sexual fear are increasing. Psychol Report.1993;79(2):476-8.##Duddle M. Etiologic factor in unconsummated marriage. J Psych Res. 1991;2:157-160.##Derogatis L.R , Riekels K., Rock A.F. The SCL-90 and MMPI , a-step in validation of a new self report scale. Br J Psych. 1976;128:280-89.##میرزائی رقیه. ارزیابی پایایی و اعتبار آزمون SCL-90 در ایران. پایان‌نامه کارشناسی ارشد روانشناسی و علوم رفتاری . تهران، سال 1359، انستیتوی روانپزشکی.##Norton G.R, Jehu D. The role of anxiety in sexual dysfunction: a review. Arch Sex Behav.1984;165-83.##Halvorsen J.G, Metz M.E. Sexual dysfunction, part I: classification, etiology and pathogenesis.J Am Board Pract. 1992;5(1):51-61.##باقری یزدی سید عباس. بررسی همه‌گیر شناسی اختلالات روانی در مناطق روستائی میبد یزد. پایان‌نامه فوق لیسانس روانشناسی و علوم رفتاری. تهران، سال 1372، انستیتوی روانپزشکی.##

توليد رده‌هاي‌ جديد سلولهاي‌ بنيادي‌ جنيني‌ از موش‌ نژاد Balb/c Establishment of new murine embryonic stem cell lines from Balb/c strain 2 1 سلولهاي‌ بنيادي‌ جنيني (ES)، سلولهايي‌ پرتوان و با قابليت‌ نوسازي هستند. اين‌ سلولها از توده‌ سلولي‌ داخلي بلاستوسيستها به‌ دست‌ مي‌آيند. تحت‌ شرايط خاص‌مي‌توان‌ اين‌ سلولها را در جهت‌ خاصي‌ در محيط آزمايشگاهي‌ متمايز كرد. حتي‌ با دستكاري‌ ژنتيكي‌ آنها مي‌توان‌ موشهاي‌ ترانس‌ ژن‌ و يا موشهايي كه يك ژن آنها از كار افتاده است (Knockout) ايجاد كرد. به دليل‌ اهميت‌ فراوان‌ سلولهاي‌ ES، اين‌ مطالعه براي‌ توليد رده‌هاي‌ جديدي‌ از موش‌ انجام‌ شد. بدين‌ منظور، بلاستوسيستهاي ‌5/3 روزه‌ از موشهاي‌ نژاد Balb/cبدست‌ آمدند و روي فيبروبلاستهاي‌ جنين‌هاي‌ موشي‌ در محيط ES حاوي‌ IU/ml1000 و IU/ml5000 فاكتور ممانعت‌كننده‌ لوكميايي (LIF) كشت‌ شدند. رده‌هاي‌ حاصل‌ از نظر كاريوتيپ‌ ساده‌، نواربندي C، واكنش‌ زنجيره‌اي‌ پـــــلي‌مراز ژن‌ تــــــعيين‌‌كننده‌ بيضه (SRY-PCR)، آلكالين‌ فسفاتاز و بيان فاكتور رونويسي Oct-4 با استفاده از RT-PCR مورد ارزيابي‌ قرار گرفتند. بدين‌ روش‌ سه‌ رده‌ سلولي‌ با مشخصات‌ مورفولوژيكي‌ سلولهاي‌ ES در غلظت IU/ml‌ 5000 از فاكتورLIF به دست‌ آمد. سه‌ رده‌ حاصل‌ نر بودند. اما مشخصات‌ كاريوتيپ‌ آنها نشان‌ داد كه‌ دو رده‌ داراي‌ كاريوتيپ‌ طبيعي‌ و ديپلوييد هستند و يك‌ رده‌ تتراپلوييد مي‌باشد. هر سه‌ رده‌، آلكالين‌ فسفاتاز و Oct-4 را بيان‌ مي‌كردند. نتايج‌ مذكور نشان‌ داد كه‌ دو رده‌ سلولي‌ نر از نژاد Balb/c با مشخصات‌ سلولهاي‌ ES (مورفولوژي‌، كاريوتيپ‌ طبيعي‌ همراه‌ با فعاليت‌ آلكالين‌ فسفاتاز و (Oct-4 بدست‌ آمد. 2 Embryonic stem cells are pluripotent cells with self renewal ability that are derived from inner cell mass of blastocysts. It is possible to differentiate the cells under appropriate culture conditions into specific cells. Moreover, manipulation of their genome in-vitro allows the creation of transgenic and knockout mice. Owing to the significance of ES cells, this study was conducted to produce new lines of mice-blastocysts aged 3.5 days were recovered from BALB/c mouse strain and cultured on mouse embryonic fibroblasts in ES media supplemented with 1000IU/ml or 5000IU/ml leukemia inhibitory factor (LIF). Established lines were analyzed for simple karyotype, C-banding, polymerase chain reaction of SRY gene (PCR-SRY), alkaline phosphates, and Oct-4 expression (RT-PCR). Three ES cell lines were produced morphologically. These lines were isolated in 5000 IU/ml LIF only. All three lines were male. Two lines had normal karyotype (40 chromosomes) and one line was tetraploid. C-banding and SRY-PCR showed that all lines had XY sex chromosome composition. 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