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Background and purpose: Both the condition of infertility and its treatment cause stress in couples. ÏN-Vitro Fertilization (ÏVF) is a stressful procedure for patients. Ëvidence has shown that, in addition to biomedical factors (such as age and history of pregnancy), psychological factors are related to the outcome of ÏVF treatment.
Materials and methods: This cohort study was performed in 2008 on 70 (35 patients in case group and 35 patients in control group) candidates for ÏVF in two infertility clinics in Sari. Psychiatric assessment of patients was done before Gonadotropine injection for ÏVF by a psychiatrist with standard questionnaires. Ânxiety and depression questionnaires were completed by the patients. Based on the results drawn from the questionnaires, the control group was formed from individuals with no anxiety or depression or individuals suffering from mild anxiety and depression or either of them. Ïndividuals of the case group were suffering from moderate to severe anxiety and depression or either of them.
Results: Mean age of patients was 30.25 ± 4.63 year in case group and 30.37 ±4.67 year in control group. Pregnancy rate was 31.42% in case and 54.54% in control group. Relative risk for not becoming pregnant in individuals suffering from moderate to severe anxiety and depression was1.5 and attributable risk was 33%.
Çonclusion: Pregnancy rate in normal individuals or individuals suffering mild anxiety and depression or either of them, was higher. Than those suffering from moderate to severe depression.

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Background and purpose: In the past three decades with the advent of modern assisted reproductive techniques (ART) and transfer of fresh or freeze embryos into the uterus, pregnancy has resulted in many cases of infertility. The studies of authers were shown comparable gestational and perinatal outcomes in two methods and sometimes better outcomes in freezeembryo transfer. Material and methods: This case series study was done on pregnant women who underwent intracytoplasmic microinjectionand embryo transfer (ICSI-ET) at the infertility clinics in Sari city. Pregnancy and perinatal outcomes were evaluatedand compared in two transfer way, fresh embryo transfer (fresh-ET) and freeze embryo transfer (freeze-ET). Results: Male factors cause infertility in 199 cases (49.8%) and female factors cause in 92 cases (23%). In 53 cases (13.3%) both male and female factors contributed.The cause of infertility was unknownin 56 cases (14%). None of maternal and fetal complications of pregnancy had significant differences in this two embryos transfer methods.In the fresh-ET cycles, 5 patients (3.3%) were hospitalized due to threatened abortion versus 3 patients (1.2%) in freeze-ET cycles. There was no statistically significant difference in two methods about NICU admission and the need of respiratory support. Conclusion: In this study, we have demonstrated that gestational and perinatal outcomes in both embryo transfer methods, fresh and freeze ET were similar

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Background and purpose: Abortion is considered recurrent when it spontaneously occurs at least three times. Recent studies suggest a correlation between uterine artery resistance and recurrent miscarriage (RM). There are few studies on the ovarian arteries. Therefore, this study evaluated the resistance of uterine and ovarian arteries in unexplained recurrent miscarriage and normal fertile women. Material and methods: The participants included women with history of unexplained recurrent miscarriage (study group, no. = 57). Also, 57 healthy fertile women were selected as a control group. Transvaginal power Doppler ultrasonography was performed for all patients in the midluteal phase of the nonpregnant subjects to detect uterine and ovarian arteries pulsatility index (PI) and resistance index (RI). The indices were then compared between the two groups. Results: The women with recurrent pregnancy loss had a significantly higher uterine artery PI and RI compared with those of the control group (2.4 ± 0.31 vs. 1.9 ± 0.28 for PI and 0.84 ± 0.31 vs. 0.63 ± 0.29 for RI), but the two groups did not have any significant difference in ovarian artery PI and RI (0.81 ± 0.19 vs. 0.7 ± 0.18 for PI and 0.52 ± 0.11 vs. 0.4 ± 0.13 for RI). Conclusion: Uterine arterial resistance is associated with RM. This study also showed the efficacy of Pulsed Doppler ultrasonography in identifying women with unexplained RM who have impaired uterine circulation. Hence, screening should be carried out to detect individuals at risk, thereby decrease the rate of RM. However, additional studies are recommended to verify and further clarify these results.

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Background and purpose: Infertility is one of the most commonly diagnosed disease in women that is associated with physical, psychological, and social problems. A major problem that such women are faced with is on their sexual and reproductive health (SRH). Despite extensive studies on the satisfaction and sexual function of infertile couples, there is no studies that investigates SRH issues. The current study aimed at investigating SRH and its related factors among women.
Materials and methods: A cross sectional study was conducted and 400 women attending two infertility centers in Sari, Iran, were recruited using convenience sampling (2016-2017). Inclusion criteria included women > 18 years of age with infertility (primary or secondary) with any cause. The Sexual and Reproductive Health Needs Assessment Questionnaire was administered. The participants recorded their stress scores (0-5). Descriptive statistics were reported and logistic regression was used to evaluate the factors related to SRH.
Results: The SRH was found to be inappropriate in 250 (62.5%) women. According to multivariate regression analysis, inappropriate decision making in self health care (AOR=1.75, 95% CI (1.06-2.9)), high stress level (AOR=1.39, 95%, CI (1.14-1.7)), old age at marriage (AOR=0.94, 95% CI (0.9-0.99)), and secondary infertility (AOR=4.5, 95% CI (2.6-7.9)) were associated with SRH.
Conclusion: Factors such as the person making decision about health care, the level of stress, and age at marriage were found to be the variables which could improve SRH in infertile women by appropriate planning and preventive measures.
 

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Background and purpose: One of the problems of in vitro fertilization (IVF) cycles is recurrent failure of implantation. The present study aimed to investigate the effect of intrauterine saline infusion in luteal phase of previous menstrual cycle on occurrence of pregnancy in infertile patients undergoing frozen-thawed embryo transfer.
Materials and methods: This clinical trial was conducted in 70 infertile women attending the infertility center in Sari Imam Khomeini Hospital who were undergoing frozen-thawed embryo transfer in 2020. The participants were randomly divided into an intervention group and a control group (n= 35 per group) using random number table. In intervention group, intrauterine injection of saline with ultrasound guidance was performed on day 21 of previous menstrual cycle, while the control group received no intervention. Pregnancy outcomes were compared between the two groups. Data analysis was performed using Chi-square and t-test.
Results: The intervention group and control group were found to be significantly different in rate of clinical pregnancy (6.5%, 28.1%) (P=0.003) and live birth (6.5%, 28.1%), respectively (P=0.02).
Conclusion: In this study, saline infusion sonohysterography did not have positive effect on clinical pregnancy and live birth, which could be due to small sample size, performing the procedure on day 21 of cycle, or ineffectiveness of this method in causing inflammation following scratches compared to conventional methods. Further molecular and cellular studies are needed to compare the effect of these methods on increasing the level of inflammatory factors.
 
(Clinical Trials Registry Number: IRCT20160815029374N8)

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Background and purpose: Complementary medicine plays a major role in treatment of infertility. The aim of this study was to evaluate the effect of royal jelly on sperm parameters and testosterone levels in infertile men.
Materials and methods: In this quasi-experimental study, 100 infertile men attending the infertility treatment center in Sari Imam Khomeini Hospital were monitored for two months and then underwent a spermogram test. Afterwards, they were treated with royal jelly (100 mg/daily) for two months and spermograms were performed again. Statistical analysis was performed in SPSS V21.
Results: Royal jelly significantly increased sperm motility, improved morphology, and increased testosterone levels (P≤0.001), but, no significant difference was seen in sperm count before and after consumption of royal jelly (47.76 ± 23.59 and 50.28 ± 29.44, respectively, P≥ 0.2).
Conclusion: According to current study, royal jelly could be used as a supplement along with other medications to boost fertility and treat male infertility.
 
(Clinical Trials Registry Number: IRCT20180609040028N2)
 

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 Background and purpose: Recurrent implantation failure is one of the problems associated with in vitro fertilization cycles. The aim of this study was to evaluate the results of pregnancy using intralipid infusion in infertile women with history of two implantation failures.
Materials and methods: A clinical trial was conducted in 80 infertile women in the infertility center in Sari Imam Khomeini Hospital, Iran 2020. In all samples, the level of peripheral blood natural killer (NK) cells was measured two weeks before the intervention using flow cytometry. The participants were divided into an intervention group (n=40) and a control group (n=40) by SAS statistical software. Two days before embryo transfer, patients in intervention group underwent intra lipid infusion (2 ml of 20% solution in 250 ml sterile saline) for two hours and the control group received normal saline (250 ml) infusion. Clinical pregnancy (detection of fetal heart rate by ultrasound) rate was compared between the two groups. Data were analyzed using Chi-square, Mann-whitney, and t-test.
Results: Clinical pregnancy rate was higher in intervention group after intralipid infusion (30%) compared with the control group (10%) (P=0.025). There were no significant differences between the two groups in the level of NK cells and peripheral blood lymphocytes (P<0.05).
Conclusion: Intralipid infusion improved clinical pregnancy rate in women with history of recurrent implantation failure. However, further studies are required on the possible mechanism of immunological effects of interlaipid in NK cells.

(Clinical Trials Registry Number: IRCT20140305016858N5)
 

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Background and purpose: Infertility has been raised as a reproductive health problem all over the world. Based on the other studies the prevalence of infertility in different regions of the world is different, and its prevalence in Iran is higher than the global average. There are various methods for treating infertility, one of the most important of which is the IVF microinjection method, which is considered one of the last treatment methods for infertile couples. Because various factors play a role in the success of this treatment, many of which may not be known yet, so this study was conducted to investigate the paraclinical and demographic factors affecting infertility treatment by IVF microinjection method in the infertility treatment center of Imam Khomeini Hospital in Sari.
Materials and methods: The data of this cross-sectional study were extracted using information from the files of infertile women who are being treated at the Infertility Treatment Center of Imam Khomeini Hospital in Sari. Information was collected on cases that were Iranian couples, married women whose diagnosis of infertility was definite, and the problem of infertility was related to the woman. Paraclinical and demographic factors affecting the success of infertility treatment by IVF microinjection method were investigated using a logistic regression model. First, using a univariate model, important variables were identified, and a multivariate model was fitted. SPSS21 software was used for data analysis.
Results: 64 people (19.9%) were successfully treated using the IVF microinjection method. Women who were successfully treated had a lower average age at the time of diagnosis of infertility than women who were not treated successfully (P= 0.015). Also, the treatment success rate in women who had a history of psychiatric diseases is higher than in women who did not have (P= 0.005). Also, less than one year after the diagnosis of infertility, an increase in the age of the woman at the time of diagnosis of infertility, reduces the chances of successful IVF microinjection treatment. The success rate of treatment for women who were treated for less than one year was 17/5% (13/3% - 22.4%), and for women who were treated for more than one year was 31.5% (20/3% - 44.6%).
Conclusion: The overall success rate of microinjection IVF treatment in this study was lower than in similar studies, although, in women who had been treated for less than one year, this rate was lower than in women who had been treated for more than one year. So, continuing infertility treatment by IVF microinjection method for a longer period after the start of treatment increases the chance of treatment success. A woman's age when infertility is diagnosed is one of the most important factors in the treatment of infertility, and the younger the infertility is diagnosed and the sooner treatments are started, the higher the chance of success in treatment and fertility. Therefore, early referral to a specialist can affect the success of the treatment. The success of treatment was higher in women with a history of psychiatric diseases than other women, which could be due to their insistence on treatment.

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Background and purpose: Due to specific metabolic changes during pregnancy, identifying pregnancy risks and timely intervention can improve the health of the mother and baby. The best results for preventing gestational diabetes are achieved through lifestyle measures early in pregnancy. Today, abnormal fasting plasma glucose (FBS) is routinely measured in early pregnancy, but its association with pregnancy outcomes is ambiguous. This study aims to investigate the incidence of gestational diabetes mellitus and other pregnancy outcomes in women with FBS levels in the first trimester of pregnancy.
Materials and methods: This prospective descriptive study was conducted on 230 women with singleton pregnancies at the clinic of Imam Khomeini Hospital in Sari in 2022. After obtaining informed consent, blood samples were collected from pregnant women in the first trimester of pregnancy, and FBS levels were recorded. Additionally, between the 24th and 28th weeks of pregnancy, women underwent a re-examination based on the results of the 75g glucose tolerance test (OGTT). Based on FBS levels, women were divided into two groups: normal (92-100 mg/dL) and abnormal (101-126 mg/dL). All mothers were followed up during pregnancy, and on average, 2 days after giving birth, the pregnancy outcomes of both the mother and the baby were recorded. Data were analyzed using SPSS version 22 software.
Results: The mean and standard deviation of mothers' age in the mothers of the normal FBS group were 31.05 ± 5.61 years, and in the mothers of the abnormal FBS group, it was 32.46 ± 6.24 years. The number of pregnancies in 64% (n=80) and 51.4% (n=54) of mothers was less than or equal to two pregnancies, and the number of deliveries was less than or equal to 2 births in 75.2% (n=94) and 66.7% (n=70) respectively. The most common underlying disease was hypothyroidism, which was present in 20% of mothers with normal FBS and 21% of mothers with abnormal FBS. The results showed that in weeks 24 to 28 of pregnancy, 56.5% (n=130) of mothers had impaired oral glucose tolerance tests, which was statistically significant (P=0.048). The relationship between stillbirth (P=0.593), IUGR fetus (P=0.392), blood pressure disorders related to pregnancy (P=0.904), neonatal hypoglycemia (P=1), liquid ammonia level in the 28th week of pregnancy (P=0.915) and the 36th week of pregnancy (P=0.537), and the Apgar score of the first minute (P=0.514) and the fifth minute (P=0.296) were not significant with abnormal FBS in the first pregnancy. There was a substantial relationship between impaired OGTT and first-pregnancy FBS, and 69.5% of mothers with first-pregnancy FBS in the range of 101-126 mg/dL had impaired OGTT (P<0.0001). Also, the type of cesarean delivery (P=0.037) insulin intake (P=0.031), and gestational age less than 37 weeks at the time of delivery (P=0.047), had a significant relationship with the first FBS of pregnancy.
Conclusion: The results showed that FBS in the first trimester is related to gestational diabetes and pregnancy outcomes and can be used as a simple and low-cost screening test to identify pregnancies at risk of GDM and some adverse pregnancy outcomes, including the type of delivery. Insulin and gestational age should be assessed at the time of delivery.