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Hazari V, Sarvi F, Alyasin A, Agha-Hosseini M, Hosseinimousa S. Enhancing endometrial receptivity in FET cycles: exploring the influence of endometrial and subendometrial blood flow along with endometrial volume. Front Med (Lausanne) 2024; 11:1260960. [PMID: 38651066 PMCID: PMC11033323 DOI: 10.3389/fmed.2024.1260960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Fetal health and a receptive and healthy endometrium are two essential factors in achieving successful implantation. If the endometrium is unreceptive, postponing the transfer cycle to a suitable time can enhance the chances of pregnancy. This study aims to assess the impact of endometrial and sub-endometrial blood flows measured by Doppler ultrasound, as well as endometrial volume, on endometrial receptivity in frozen embryo transfer (FET) cycles. Methods 112 patients with a mean age of 33.93 ± 4.93 years underwent in vitro fertilization (IVF). Serum β-hCG level was used to confirm pregnancy, and among the participants, 50 (44.6%) achieved pregnancy after IVF. Results The study results revealed a significant difference in endometrial blood flow between the pregnant and non-pregnant groups, with a higher pregnancy rate observed in participants exhibiting multi-focal and spare endometrial blood flows (p < 0.05). Furthermore, there was a notable association between endometrial blood flow and pregnancy outcome, as indicated by higher ongoing pregnancy rates in those with multi-focal and spare endometrial blood flows (p < 0.05). However, no significant differences were observed in endometrial variables such as volume, length, width, thickness, and pattern between the pregnant and non-pregnant groups. Additionally, contextual parameters showed no significant relationship with pregnancy outcome (p > 0.05). The study also found that endometrial measurement indices did not have a significant impact on pregnancy outcomes, with no significant differences observed between the groups (p > 0.05). Conclusion In conclusion, endometrial blood flow is crucial for a successful pregnancy after IVF, while the predictive value of the endometrial volume is limited for pregnancy outcomes.
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Affiliation(s)
- Vajihe Hazari
- Department of Obstetrics and Gynecology, Rooyesh Infertility Center, Birjand University of Medical Science, Birjand, Iran
| | - Fatemeh Sarvi
- Department of Obstetrics and Gynecology, Tehran University of Medical Science, Tehran, Iran
| | - Ashraf Alyasin
- Department of Obstetrics and Gynecology, Tehran University of Medical Science, Tehran, Iran
| | - Marzieh Agha-Hosseini
- Department of Obstetrics and Gynecology, Tehran University of Medical Science, Tehran, Iran
| | - Sedigheh Hosseinimousa
- Department of Obstetrics and Gynecology, Tehran University of Medical Science, Tehran, Iran
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Hosseinimousa S, Moradpanah S, Talebian M, Pourmahmoudian R. Effect of endometrial injury on pregnancy outcomes in infertile women undergoing intrauterine insemination. Turk J Obstet Gynecol 2024; 21:1-6. [PMID: 38440961 PMCID: PMC10920967 DOI: 10.4274/tjod.galenos.2024.60533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 03/06/2024] Open
Abstract
Objective One of the most common treatments for infertility is intrauterine insemination (II). The objective of this study was to determine the effect of endometrial injury on pregnancy outcomes in unexplained infertility in women undergoing II. Materials and Methods In this randomized clinical trial, 122 women with unexplained infertility who were referred to Shariati Hospital from 2018 to 2020 were enrolled. They underwent ovulation induction using letrozole and gonadotropins. On day 9 of stimulation, they were randomly assigned to two similar groups of the same size. The first group underwent endometrial local injury by pipelle endometrial sampling, and the second group (control group) received no intervention. Only 1 II cycle was performed for each patient. Patients with negative pregnancy outcomes were followed up for 3 months. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, miscarriage rate, and spontaneous pregnancy rate after the II cycle were compared between the two groups. Results Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, and miscarriage rate in the same II cycle were not different between the two groups (p>0.05). However, the spontaneous pregnancy rate after the II cycle was significantly higher in the endometrial injury group (p=0.02). Conclusion Endometrial injury increases pregnancy rates in later cycles but not in the same II cycle.
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Affiliation(s)
- Sedigheh Hosseinimousa
- Shariati Hospital, Tehran University of Medical Sciences, Department of Obstetrics and Gynecology, Infertility Unit, Tehran, Iran
| | - Somayeh Moradpanah
- Ziaeean Hospital, Tehran University of Medical Sciences, Department of Obstetrics and Gynecology and Reproductive, Tehran, Iran
| | - Marzieh Talebian
- Kashan University of Medical Sciences, Department of Obstetrics and Gynecology, Kashan, Iran
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Hosseinimousa S, Navaei S, Talebian M. Molar cesarean scar ectopic pregnancy: Report of 2 cases with review of literature. Int J Reprod Biomed 2024; 22:161-168. [PMID: 38628776 PMCID: PMC11017214 DOI: 10.18502/ijrm.v22i2.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/22/2023] [Accepted: 01/13/2024] [Indexed: 04/19/2024] Open
Abstract
Background The occurrence of hydatidiform mole at the cesarean scar site is a rare problem. Few cases have been reported, thus there is not enough information for accurate diagnosis and management of this event. Case Presentation Herein, we present 2 cases of an invasive hydatidiform mole embedded in cesarean scar tissue, one presented with occasional hypogastric pain and nausea and another with spotting both with a history of cesarean section. Transvaginal ultrasonography and a considerably high titer of beta-human chorionic gonadotropin blood test suggested the existence of molar pregnancy on the cesarean scar, which was confirmed through histological assessment. In the first case, evacuation of molar pregnancy followed by scar resection at the cesarean scar site led to successful fertility preservation management. Conclusion The presence of abdominal pain and unexplained bleeding in a pregnant woman without gestational sac in ultrasonography, strongly suggests ectopic pregnancy. The process of diagnosis should be followed by definitive diagnostic evaluation, including beta-human chorionic gonadotropin titer measurement, ultrasonographic assessment (2 and 3-dimensional), magnetic resonance imaging, diagnostic laparoscopy, and finally biopsy of the lesion.
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Affiliation(s)
- Sedigheh Hosseinimousa
- Department of Obstetrics and Gynecology and Reproductive, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Saymaz Navaei
- Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Marzieh Talebian
- Department of Obstetrics and Gynecology, Kashan University of Medical Sciences, Shahid Beheshti Hospital, Kashan, Iran
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Jabarpour M, Amidi F, Rostami S, Aleyasin A, Aghahosseini M, Khodarahmian M, Najafian A, Hosseinimousa S, Abbasi Y, Nashtaei MS. High Anti-Müllerian Hormone Strongly Correlates with Reproductive Outcomes in Women Undergoing Assisted Reproduction. Clin Lab 2023; 69. [PMID: 38084695 DOI: 10.7754/clin.lab.2023.230524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND In a retrospective cohort of 881 women with gynecologic and unexplained infertility, we aimed to study the relationship between serum AMH levels and ART outcomes. This retrospective cohort includes 881 infertile women aged 20 - 45 who underwent their first fresh autologous non-preimplantation genetic diagnosis ART cycles between 2012 and 2020. METHODS We assessed the correlation between AMH levels and reproductive outcomes among infertile women with different causes of infertility (including endometriosis, polycystic ovary syndrome (PCOS), and unexplained infertility). RESULTS We found a strong correlation between high AMH levels and reproductive outcomes independent of age and the cause of infertility in women undergoing ART. In all patients with gynecologic and unexplained infertility, higher AMH correlated with the improved number of oocytes (p < 0.001), MII oocytes (p < 0.001), good-quality embryos (p < 0.001), chemical pregnancy rate (p < 0.001 in women < 37; and p = 0.002 in women over 37), clinical pregnancy rate (p < 0.05), and live birth rate (p = 0.05). CONCLUSIONS Serum AMH concentrations can be invaluable for predicting ovarian reserve and reproductive outcomes in young and advanced-age infertile patients undergoing ART. However, it should not be used as the sole predictive marker for disqualifying infertile women from ART treatment. Further large cohort studies are warranted to determine an exact cutoff point for AMH to provide an accurate ART success prediction.
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Najafian A, Alyasin A, Aghahosseini M, Hosseinimousa S, Kazemi SN. Beneficial effects of intraovarian injection of platelet-rich plasma in women with poor ovarian response. Clin Exp Reprod Med 2023; 50:285-291. [PMID: 37995757 DOI: 10.5653/cerm.2023.06086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/19/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Infertility can result from a diminished ovarian reserve, but a potential remedy exists in the form of platelet-rich plasma (PRP) administration. This treatment involves both biological factors and tissue trauma mechanisms, which stimulate folliculogenesis, making it a promising and effective strategy. We assessed the impact of direct PRP injections into the ovaries on the fertility outcomes of women classified as poor responders. METHODS A quasi-experimental study was conducted from April 2021 to December 2022, focusing on patients classified as POSEIDON grade 3 or 4. PRP injections were administered into both ovaries. After 3 months, data were collected on anti-Müllerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and the numbers of oocytes, mature oocytes, and good-quality embryos following ovarian stimulation. We then compared the data from before and after PRP injection. RESULTS This study included 50 women, with a mean of 39 years (interquartile range [IQR], 35 to 43) and 4 years (IQR, 2 to 6) for age and infertility duration, respectively. FSH levels decreased after treatment, while AMH levels and the numbers of oocytes, metaphase II oocytes, and high-quality embryos increased. However, only the increase in high-quality embryos was significant. The pregnancy and spontaneous pregnancy rates were 20% and 14%, respectively. Notably, women with secondary infertility exhibited a significantly higher pregnancy rate than those with primary infertility. CONCLUSION Ample evidence suggests that PRP can enhance ovarian function. However, further studies are needed to identify the appropriate candidates for this procedure, establish the optimal PRP preparation method, and standardize the procedure for its adjuvant use in assisted reproductive technology cycles.
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Affiliation(s)
- Aida Najafian
- Department of Infertility, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Ashraf Alyasin
- Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Aghahosseini
- Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hosseinimousa
- Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Neda Kazemi
- Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran
- Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mansour A, Mirahmad M, Mohajeri-Tehrani MR, Jamalizadeh M, Hosseinimousa S, Rashidi F, Asili P, Sajjadi-Jazi SM. Risk factors for insulin resistance related to polycystic ovarian syndrome in Iranian population. Sci Rep 2023; 13:10269. [PMID: 37355686 PMCID: PMC10290663 DOI: 10.1038/s41598-023-37513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) has significant metabolic sequelae linked to insulin resistance. This study aimed to compare clinical, metabolic, and hormonal characteristics of PCOS women with and without insulin resistance. The second aim was to compare the clinico-biochemical profiles of the various PCOS phenotypes. In this cross-sectional secondary analysis, we combined the baseline data from two separate randomized controlled trials (RCTs) in women diagnosed with PCOS. PCOS patients were categorized into the four Rotterdam PCOS phenotypes according to the presence of at least two criteria of oligomenorrhea/anovulation (O), hyperandrogenism (H), and polycystic ovary morphology (P): O-H-P, H-P, O-H, and O-P. Participants were categorized into two groups according to the homeostasis model assessment index of insulin resistance (HOMA-IR) levels: < 3.46, and ≥ 3.46. The correlation between the HOMA-IR and biometric, clinical, and biochemical variables was assessed in normal weight (BMI < 25) and overweight/obese (BMI ≥ 25) PCOS women. Then, the association between PCOS phenotypes and insulin resistance was investigated using logistic regression analysis. A total of 125 PCOS patients aged 18-40 years were included in the present study. Based on our results, the HOMA-IR index was positively correlated with diastolic blood pressure, free androgen index, and triglycerides levels; and negatively correlated with sex hormone-binding globulin in overweight/obese PCOS women. In addition, the HOMA-IR index was found to be positively correlated with alanine transaminase and negatively correlated with diastolic blood pressure in normal weight PCOS women. Moreover, individuals with O-H-P phenotype (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.02-6.24) had about two-fold increased risk of insulin resistance. In conclusion, the full-blown PCOS (O-H-P) phenotype has an increased risk of insulin resistance. Accordingly, phenotype division may help physicians to predict adverse metabolic outcomes.
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Affiliation(s)
- Asieh Mansour
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mirahmad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Jamalizadeh
- Endocrinology and Metabolic Research Center, Institute of Basic and Clinic Physiology Science and Department of Internal Medicine, Kerman University of Medical Science, Kerman, Iran
| | - Sedigheh Hosseinimousa
- Department of Obstetrics and Gynecology, Infertility Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rashidi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pooria Asili
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Mahmoud Sajjadi-Jazi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Hosseinimousa S, Safdarian L, Aleyasin A, Aghahosseini M, Marzieh T, Talebian M. Can Laparoscopic Cystectomy Improve Pregnancy Outcomes in Endometrioma? A Prospective Clinical Trial Study. Int J Fertil Steril 2022; 16:206-210. [PMID: 36029058 PMCID: PMC9396010 DOI: 10.22074/ijfs.2021.521378.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Indexed: 11/27/2022]
Abstract
The purpose of this prospective study was to compare the ovarian response and pregnancy outcomes<br />in the infertile women with endometrioma undergoing assisted reproductive technologies (ART) in two<br />groups, who were underwent laparoscopic cystectomy and received gonadotropin releasing hormone-agonist<br />(GnRH-agonist) and who only received GnRH-agonist without any surgery.<br />Materials and Methods: In this prospective clinical trial study, 79 infertile women with asymptomatic endometriomas<br />cyst (2-6 cm) were enrolled and randomly assigned to two groups. First group underwent laparoscopic<br />cystectomy and received GnRH-agonist. Second group only received GnRH-agonist without any surgery. Following<br />ovulation induction, all patients underwent intracytoplasmic sperm injection (ICSI). Different parameters<br />such as the number of retrieved oocytes and embryos; were made our outcomes that analyzed using SPSS.<br />Results: The pregnancy rate, chemical and clinical, and live birth rate were higher in the combined group,<br />although these differences were not statistically significant (48.48% vs. 30.8%, P=0.12, 36.36% vs. 25.6%,<br />P=0.32, 36.36% vs. 23.1%, P=0.29). The number of injections, antral follicles, retrieved oocytes, mature oocytes,<br />total embryos, transferred embryos and duration of stimulation were similar in two groups.<br />Conclusion: Laparoscopic cystectomy followed by receiving GnRH-agonist improves pregnancy outcomes in endometrioma<br />prior to treatment with ART (registration number: IRCT201106116689N2).
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Affiliation(s)
- Sedigheh Hosseinimousa
- Department of Obstetrics and Gynecology and Reproductive, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,P.O.Box: 1411713135Department of Obstetrics
and Gynecology and ReproductiveShariati HospitalTehran University of
Medical SciencesTehranIran
| | - Leili Safdarian
- Department of Obstetrics and Gynecology and Reproductive, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Aleyasin
- Department of Obstetrics and Gynecology and Reproductive, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Aghahosseini
- Department of Obstetrics and Gynecology and Reproductive, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Talebian Marzieh
- Department of Obstetrics and Gynecology, Kashan University of Medical Sciences, Kashan, Iran
| | - Marzieh Talebian
- Department of Obstetrics and Gynecology and Reproductive, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Safdarian L, Ghalandarpoor Attar SN, Aleyasin A, Aghahosseini M, Sarfjoo FS, Hosseinimousa S. Investigation of anti-mullerian hormone (AMH) level and ovarian response in infertile women with endometriosis in IVF cycles. Int J Reprod Biomed 2018; 16:719-722. [PMID: 30775688 PMCID: PMC6350853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endometriosis, can cause ovarian conflict and reduced ovarian reserve that could lead to lower response to assisted reproductive techniques. OBJECTIVE Current study was conducted to determine the association between level of anti-mullerian hormone (AMH) and the infertility treatment outcomes in infertile females with endometriosis versus the non-endometriosis infertile subject. MATERIALS AND METHODS In this case-control study, 64 infertile females who referred to Shariati Hospital from April 2015 to November 2017 were enrolled. They were divided in two groups of 32 patients (endometriosis and non-endometriosis women). The anti-mullerian hormone level among all subjects was determined, treatment outcomes were evaluated and association between these factors was assessed. RESULTS It was seen that the anti-mullerian hormone (p=0.06), the number of retrieved oocytes (p=0.7) and embryos (p=0.7), implantation rate (p=0.6) and clinical pregnancy rate (p=0.9) were similar between two groups. In patients with stage 3 or 4 endometriosis who had lower serum AMH level significantly (p=0.001) less oocytes were retrieved (p=0.001) and less transferrable embryos (p=0.03) were achieved. However, implantation and pregnancy rates did not differ (p=0.7) (p=0.6). CONCLUSION Totally, according to the obtained results, it may be concluded that ovarian reserve has more significant role in predicting infertility treatment outcome rather than receptive endometrium.
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Alleyassin A, Ghasemi M, Aghahosseini M, Safdarian L, Sarvi F, Almasi-Hashiani A, Hosseinimousa S, Najafian A, Esmailzadeh A. Final oocyte maturation with a dual trigger compared to human chorionic gonadotropin trigger in antagonist co-treated cycles: A randomized clinical trial. Middle East Fertility Society Journal 2018. [DOI: 10.1016/j.mefs.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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