Outpatient Infertility Clinic Research Articles

Hysteroscopic Endometrial Biopsy after Intracytoplasmic Sperm Injection Failure for women with Unexplained Infertility

Background: Hysteroscopy is one of the most significantexaminations in females with recurrent implantation failure (RIF). It permits dependable visual evaluation of the cervical canal and uterine space and it taken into consideration as a gold standard for diagnosing intra-uterine pathology and has slight intra-operative and postoperative morbidities. Objectives: This work aimed to clarify the roles of Hysteroscopy and endometrial biopsy in evaluation of endometrium after ICSI failure in females with un-explained Infertility. Patients and methods: This was a prospective cohort investigation carried out at outpatient infertility clinic of the Assisted Reproductive Unit, Obstetrics and Gynecology department, Qena University Hospital. Women attend to Assisted Reproductive unit planned for intracytoplasmic sperm injection (ICSI). Results: Based on histology as a reference standard, hysteroscopy identified the chronic endometritis pathology in 26 patients (true positives) that also found by histology. Our study revealed that Hysteroscopy had overall sensitivity, specificity, and diagnostic accuracy of 49.06%, 53.19% and 51% respectively in detecting the chronic endometritis in our patients with positive predictive value (PPV) was 54.17% while the negative predictive value (NPV) was 48.08%. Conclusion: Hysteroscopy is of a great value in the assessment and diagnosis of the endometrial pathology in patients with unexplained RIF. There is no consensus on the everyday use of hysteroscopy before ICSI; hence, the importance of hysteroscopy as a routine in the managing of non-fertile females still remains a subject of investigation.

Comparison of anxiety scores between unexplained primary and secondary infertile couples

Objective To investigate the anxiety levels among infertile women and their partners also factors that may affect the anxiety status Study design A total of 403 infertile couples who applied to Infertility Outpatient Clinics of a University-affiliated Teaching and Research Hospital were included in the study. The infertile group was divided into two groups as primary and secondary infertile. One hundred and thirty-two fertile couples who applied to Gynecology Outpatient Clinics composed the control group. Hamilton Anxiety Rating Scale (HAM-A) form was filled by the infertile couples to evaluate the anxiety status before they started their treatment. Results Three hundred and twenty infertile and 84 fertile couples completed the study. The mean total scores of HAM-A of women were similar between the groups. So were the scores of their husbands. In all groups, women had significantly higher mean total HAM-A scores than their husbands. There was no association between the mean HAM-A score of women and age, BMI, AFC, duration of marriage, duration of infertility, number of previous treatment cycles. Education status, working status and family structure of women did not correlate with the mean HAM-A score. Conclusion Unexplained primary and secondary infertile couples had similar anxiety scores before the commencement of fertility treatments. However, the scores were higher in women than their male partners. Since the burden of treatment and the likelihood of treatment failure might increase the level of anxiety the women could be offered proper cognitive coping and relaxation interventions.

Relationship between coping/attachment styles and infertility-specific distress in Iranian infertile individuals: A cross-sectional study.

Background Infertility has been recognized as a stressful clinical condition, significantly affecting couples' emotional functioning.Objective To investigate the relationship between coping/attachment styles and infertility-specific distress (ISD) in infertile participants.Materials and MethodsAtotal number of 240 infertile participants (120 women and 120 men) who attend the Outpatient Infertility Clinic in Sari, Iran between February and October 2017 were selected using the convenience sampling method. Data were collected using a questionnaire addressing sociodemographic variables. In addition, coping and attachment styles were evaluated via the Coping Strategies Questionnaire and the Revised Adult Attachment Scale by Collins and Read (1990); respectively. Ultimately, the Infertility Distress Scale was used to assess ISD.ResultsThe mean ISD score was 42.53 9.63. Secure and insecure attachment styles were observed in 37.9% and 62.1% of the cases, respectively. There was a significant difference among ISD and different groups of attachment styles (p = 0.001) and emotion-focused coping style (p = 0.021). However, no significant relationship was found between problem-focused coping style and ISD (p = 0.985).Conclusion Considering the relationship between coping/attachment styles and ISD, it was recommended to implement stress prevention and coping education within the framework of coping/attachment theories for infertile individuals.

Psychometric properties of two abbreviated Connor-Davidson Resilience scales in Chinese infertile couples.

This study aimed to evaluate the psychometric properties of the 10-item and 2-item Connor-Davidson Resilience Scale (CD-RISC), the agreement between these two versions, and the measurement invariance of the CD-RISC-10 across genders in Chinese infertile couples. A total of 170 infertile couples were enrolled from an infertility outpatient clinic between September 2019 and January 2020. The CD-RISC scores were tested for floor and ceiling effects. Reliability was evaluated by calculating Cronbach's α. Convergent and divergent validity were assessed by bivariate correlations between resilience and infertility-related stress, depression, anxiety, and two divergent variables. Agreement between the two versions was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. A multiple-group confirmatory factor analysis (CFA) was conducted to assess the measurement equivalence of CD-RISC-10 across genders. No floor or ceiling effects were observed. Internal consistencies of CD-RISC-10 and CD-RISC-2 were 0.91 and 0.63, respectively. The CFA analysis indicated an excellent model fit for a one-factor structure of CD-RISC-10 (TLI > 0.950, CFI > 0.950, RMSEA < 0.060). Both scales displayed good convergent and divergent validity, and the agreement between them was significant with an ICC of 0.80 (95% CI ranging from 0.76 to 0.84). Measurement invariance across genders was supported by multigroup CFA, and a higher level of resilience was found in men than in women. Our findings showed significant reliability, validity, and stability of CD-RISC-10 and acceptable internal consistency and validity of CD-RISC-2. CD-RISC-10 is recommended as a resilience measure in clinical evaluations of infertile patients.

A prospective, observational clinical trial on the impact of COVID-19-related national lockdown on thyroid hormone in young males

Trying to manage the dramatic coronavirus disease 2019 (COVID-19) infection spread, many countries imposed national lockdown, radically changing the routinely life of humans worldwide. We hypothesized that both the pandemic per se and the consequent socio-psychological sequelae could constitute stressors for Italian population, potentially affecting the endocrine system. This study was designed to describe the effect of lockdown-related stress on the hypothalamic-pituitary-thyroid (HPT) axis in a cohort of young men. A prospective, observational clinical trial was carried out, including patients attending the male infertility outpatient clinic before and after the national lockdown for COVID-19 pandemic. The study provided a baseline visit performed before and a follow-up visit after the lockdown in 2020. During the follow-up visit, hormonal measurements, lifestyle habits and work management were recorded. Thirty-one male subjects were enrolled (mean age: 31.6 ± 6.0 years). TSH significantly decreased after lockdown (p = 0.015), whereas no significant changes were observed in the testosterone, luteinising hormone, follicle-stimulating hormone, estradiol and prolactin serum levels. No patient showed TSH serum levels above or below reference ranges, neither before nor after lockdown. Interestingly, TSH variation after lockdown was dependent on the working habit change during lockdown (p = 0.042). We described for the first time a TSH reduction after a stressful event in a prospective way, evaluating the HPT axis in the same population, before and after the national lockdown. This result reinforces the possible interconnection between psychological consequences of a stressful event and the endocrine regulation.

Intrauterine Insemination Success Rates Between Patients TSH Level of 2.5 mIU/L and 2.5-4.5 mIU/L

The aim of this study to assess whether there is a need to decrease the TSH level below 2.5 mIU/L in unexplainable infertility patients who were undergoing intrauterine insemination and determining the difference between patients with a TSH level of 2.5 mIU / L and patients with a TSH level of 2.5-4.5 mIU/L in terms of the success of intrauterine insemination. This study conduct via cross-sectional examinations of the 272 patients who applied to Ümraniye Training and Research Hospital infertility outpatient clinic between 01.06.2017-01.10.2019, who underwent intrauterine insemination with the diagnosis of unexplained infertility. Results research the mean age of the cases participating in our study is 31.65 ± 5.28, and the mean BMI measured as 24.17 ± 4.30 kg / m2. TSH values range from 0.3 to 5.2, with an average of 1.84 ± 0.93; while TSH value of 174 cases (77.3%) is below 2.5 mIU/L, TSH value of 51 cases (22.7%) is between 2.5-4.5mIU/L. Within the control group with TSH &lt;2.5 mIU/L, the cycle was canceled in 13 cases (7.5%), pregnancy did not occur in 143 cases (82.2%). While ongoing pregnancy was achieved in 17 cases (9.8%), clinical pregnancy was achieved in 1 case (0,6%). Also, within the study group with a TSH value of 2.5-4.5 mIU/L, cycles were canceled in 7 cases (13.7%), pregnancy did not occur in 40 cases (78.4%), and ongoing pregnancy was achieved in 4 patients (7.8%). There was no statistically significant difference in terms of intrauterine insemination success between the control group with TSH &lt;2.5 mIU / L and the study group with TSH 2.5-4.5 mIU/L. Widespread randomized controlled prospective studies need to determine the optimal TSH threshold value before TSH treatment of the women receiving infertility treatment.

Eğitim Düzeyi Kısırlıkta Destekleyici Tedavi Yöntemini Belirleyen ve Etkileyen Bir Faktördür

ABSTRACT Objective: İn this study, we planned to investigate the view of community to the supportive treatment methods and use of them according to the educational level. Material method; it is a cross-sectional survey survey involving 300 patients of different ages, socio-economic levels and demographics who applied to infertility outpatient clinic. Results; most of the participants were between the ages of 20-30 and the majority of the illiterates had no information on support treatment, but they received the most information from the doctors. We found that as the level of education increases, the level of knowledge increases, and the level of learning from doctors as well as the internet, media and communication tools increases. The use of onion juice, chaste grass, ginger, karabas grass decreased as the level of education increased, while the use of probiotics and aloe-vera increased as the level of education increased proportionally. Manipulative and body-based treatments (massage, etc.), body-mind therapy( hypnosis, relaxation, etc.) as supportive treatment methods were found to increase as the level of education increased proportionally. Conclusion;We have concluded that infertile patients feel the need to seek support treatments as well as medical treatment, and that, when deciding which treatment to choose, the near environment, relatives are effective in those with low education levels, and the internet and mass media are more used as education levels increase

İnfertilite Tedavisi için Başvuran Çiftlerde Erkeğin Eşine Gösterdiği Şiddet ve Evliliğe Uyum Düzeyi

INTRODUCTION: Infertility is a life-changing experience that brings with it medical, psychiatric, psychological, and social problems, with cultural, religious, and social aspects, individual-specific, leadings to stress in couples, resulting in social labeling, sexual dysfunction. Many factors can trigger or increase the severity of infertility. Couples failing to achieve one of the basic functions of the family institution, also experience negativities in marriage. This study aimed to determine the severity of violence by men to his partner and the marital adjustment level in men in couples applying for infertility treatment. METHODS: The study population consisted of 286 men from the couples applying to Cukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Infertility Outpatient Clinic June -October 2017. The data was collected using the Sociodemographic Data Form, Conflict Tactic Scale-2, Marital Adjustment Scale. Data analyzed using SPSS 20.0 Statistical analysis program. RESULTS: The mean age of men was 34.79±7.24 years, the mean duration of marriage was 5.87±4.86 years and the mean age at first marriage was 26.33±5.09 years. Of the participants, 93.4% were violent against their spouses based on the Conflict Tactics Scale-2 results. There was no significant relationship between the overall violence by men and any of the sociodemographic data. Marital Adjustment Scale revealed that there was a marital adjustment in 80.4% of men. A significant relationship was found between marital adjustment and sociodemographic variables including occupation, previous infertility treatment, and marital status. DISCUSSION AND CONCLUSION: The men practiced violence against their wives and that the most common type of violence was psychological violence. In infertile couples, the majority of men had good marital adjustment and they did not seem to be affected by infertility.

Effect of Educational Program about Life style behaviors for infertile Couples at infertility outpatient clinic in women’s health Hospitals.

In recent times, the modifiable lifestyle factors have been shown to affect the chance of conception in both infertile and general population. There is strong evidence that weight, smoking, alcohol consumption, caffeine intake, nutritional habits, physical activity, Stress, exposure to animals, pollution and Recreational drugs had an adverse impact on reproductive health. Aim: assess the perception of infertile couples regarding the effect of lifestyle factors on fertility; compare the lifestyle factors between fertile and infertile couples. Methods: A descriptive cross-sectional design was used to conduct this study. It was conducted at infertility outpatient clinic women’s health Hospitals, Assiut University, Egypt. Sample: included 117 infertile couples. Structured interview questionnaire was used and included two parts: Socio-demographic data and questions to assess perception of infertile couples regarding lifestyle. Simple Lifestyle Indicator Questionnaire. Results: A highly statistically difference was found between infertile husbands and wives regarding perceived the smoking habits. No significant difference was found among infertile couples regarding drinking alcohol, over or underweight, stress, exposure to animals and environmental pollution, dietary habits, and influence of caffeine, exercises and taking recreational drugs. Conclusion: perceptions of the impact of lifestyle factors on fertility vary by sex, socioeconomic factors and treatment. Lifestyle factors significantly affected couples fertility, as BMI, exercises, nutritional status and stress with a statistical difference between groups. Recommendation: In-services educational program for infertile couples for maintaining lifestyle habits to improve their chance of spontaneous conception.

The impact of adding a nitric oxide donor as adjuvant therapy to clomiphene citrate to improve pregnancy rate in polycystic ovarian syndrome, a randomized controlled trial

Aim: This study aimed to compare the effect of adding a nitric oxide donor to clomiphene citrate in women with polycystic ovarian syndrome for induction of ovulation to attempt and reverse the anti-estrogenic effect and thus improve the clinical pregnancy rate.Material and Methods: This is an open labelled randomized controlled trial in a University Hospital infertility out-patient clinic. Eighty participants, fulfilling the inclusion criteria were enrolled in the study from January 2019 till December 2019. They were divided into 2 groups, group A received clomiphene citrate (CC) and Isosorbide mononitrate (ISMN), while group B received CC only. The primary outcome was the clinical pregnancy rate.Results: The clinical pregnancy rate was higher in the ISMN group but did not show statistical significance. Although, the addition of ISMN had a favorable outcome on the number of follicles, endometrial volume, cervical mucus score, uterine artery RI.Conclusion: The addition of nitric oxide donors to CC in the induction of ovulation in polycystic ovarian syndrome improved cycle parameters but did not significantly increase clinical pregnancy rates and thus should be cautiously used for such purpose.

Relationship Between Marriage Satisfaction and Sexual Functions in Couples Undergoing Infertility Treatment

Objectives To determine the relationship between marriage satisfaction and sexual functions in couples undergoing infertility treatment. Methods This cross-sectional study was conducted with 110 heterosexual couples who attended an outpatient infertility clinic in Turkey, between June 2018 and June 2019. Results In the study, 77.3% of the women and 43.6% of the men receiving infertility treatment experienced sexual dysfunction. Increased marital satisfaction is linked with better sexual function for infertile couples. Age, economic status, duration of marriage, type of marriage, duration of treatment, marriage satisfaction were determined to be significant predictive factors of the sexual functions of the infertile couples. Conclusion Healthcare providers may apply psychosocial care, education and counseling services toward increasing the marriage satisfaction and sexual functions of infertile couples.

A Comparative Study Between Clomiphene Citrate and Tamoxifen for induction of Ovulation in Women Complaining of Polycystic Ovary Syndrome

PCOS is the most common endocrine disorder among women between the ages of 18 and 44. It affects approximately 2% to 20% of this age group depending on how it is defined. PCOS is due to a combination of genetic and environmental factors. Objective: To compare the efficacy of Clomiphene citrate and Tamoxifen induction of ovulation women with polycystic ovary syndrome. Patients and Methods: This clinical trial study was conducted at Al-Husien Hospital from June 2019 to December 2019 after approval of the research ethics committee, on 100 patients with P.C.O. The participants were recruited from women attending the outpatient infertility clinic of Al-Husien Hospital.Patients are classified randomly into 2 groups: Group A: 50 patients (clomiphene Group). Group B: 50 patients (tamoxifene Group).Results: Ovulation rate was significantly better under tamoxifen therapy. Pregnancy rate was significantly better under tamoxifen therapy. Number of stimulated follicles was not significantly different between the two drugs.Endometrial thickness was significantly better under tamoxifen therapy both preovulatory and midluteal. Endometrial perfusion volume (EV), Vascularization index (VI), and Vascularization flow index (VFI) were significantly better under tamoxifen therapy. Adverse effects with thetwo drugs were non-significant. Endometrialperfusion indices weresignificantly better pregnant versus non-pregnantcases.Conclusion:Tamoxifen can give similar or even better results than clomiphene citrate induction of ovulation women with PCOS. Each of them can be used as a first line option for induction of ovulation women with PCOS in selected cases.

IMPACT OF LAPORSCOPIC OVARIAN DRILLING ON HORMONAL PROFILE OF PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Background: Polycystic ovary syndrome (PCOS) is complex with reproductive, metabolic and psychological features. It is characterized by chronic anovulation, biochemical and/or clinical evidence of hyperandrogenism and enlarged ovaries. Objective: Is to evaluate the effect of ovarian drilling on the hormonal profile levels on blood in women with polycystic ovary syndrome. Hormonal profile including: Serum FSH, LH, E2, Prolactin and androgens (total &free testosterone and dehydroepiandrosterone sulfate (DHEA-S). Patients and Methods: Fifty infertile women diagnosed with PCOS attending the infertility outpatient clinic at Syed Galal university hospital were selected for prospective interventional study. Hormonal assessment for FSH, LH, E2, prolactin and androgens (total & free test oster on and DHEA-S) were done before laparoscopic ovarian drilling (LOD), and 3month after LOD. Main outcome measures were changes in hormonal profile including LH, LH/FSH ratio, E2, Prolaction and androgens (total &free testosterone and DHEA-S). Results: Laparoscopic ovarian drilling (LOD) was successfully employed without any surgical complications and on an average, follow-up time three months after the procedure. During the follow up, serum values for prolaction and E2 have increased significantly. (LH, LH/FSH ratio, total & free Testosterone and DHEA-S) have decreased significantly and FSH levels remained unchanged after the procedure. Conclusion: The LOD in patients with PCOS may avoid or reduce the risk of OHSS and the multiple pregnancy rate induced by gonadotrophin therapy and the cost effectiveness of procedure after an attractive management for patients with PCOS. However, LOD can be considered as second line treatment after clomiphene citrate treatment failure and /or resistance.

IMPACT OF LAPORSCOPIC OVARIAN DRILLING ON HORMONAL PROFILE OF PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Background: Polycystic ovary syndrome (PCOS) is complex with reproductive, metabolic and psychological features. It is characterized by chronic anovulation, biochemical and/or clinical evidence of hyperandrogenism and enlarged ovaries. Objective: Is to evaluate the effect of ovarian drilling on the hormonal profile levels on blood in women with polycystic ovary syndrome. Hormonal profile including: Serum FSH, LH, E2, Prolactin and androgens (total &free testosterone and dehydroepiandrosterone sulfate (DHEA-S). Patients and Methods: Fifty infertile women diagnosed with PCOS attending the infertility outpatient clinic at Syed Galal university hospital were selected for prospective interventional study. Hormonal assessment for FSH, LH, E2, prolactin and androgens (total & free test oster on and DHEA-S) were done before laparoscopic ovarian drilling (LOD), and 3month after LOD. Main outcome measures were changes in hormonal profile including LH, LH/FSH ratio, E2, Prolaction and androgens (total &free testosterone and DHEA-S). Results: Laparoscopic ovarian drilling (LOD) was successfully employed without any surgical complications and on an average, follow-up time three months after the procedure. During the follow up, serum values for prolaction and E2 have increased significantly. (LH, LH/FSH ratio, total & free Testosterone and DHEA-S) have decreased significantly and FSH levels remained unchanged after the procedure. Conclusion: The LOD in patients with PCOS may avoid or reduce the risk of OHSS and the multiple pregnancy rate induced by gonadotrophin therapy and the cost effectiveness of procedure after an attractive management for patients with PCOS. However, LOD can be considered as second line treatment after clomiphene citrate treatment failure and /or resistance.

Clinical aspects and the quality of life among women with endometriosis and infertility: a cross-sectional study

BackgroundThe quality of life (QoL) of patients with endometriosis and infertility was assessed in different stages and correlated with the clinical features of the cases.MethodsThe present study was a cross-sectional study; 106 women were included, divided in two endometriosis groups (Grade I/II, 26 women, and Grade II/IV, 74 women). All participants attended the Endometriosis and Infertility Outpatient Clinic of the Instituto Ideia Fértil de Saúde Reprodutiva, Faculdade de Medicina do ABC, São Paulo, Brazil, were and responded to the Short Form (SF) Health Survey-36. Convenience sampling was used due to the authors’ access to the study population; however, the sample number was calculated to be sufficient for 95% power in both groups.ResultsHomogeneity was observed between Grade I/II and Grade III/IV staging, with similar mean ages (35.27, ±3.64 years and 34.04, ±3.39 years, respectively, p = 0.133); types of infertility (p = 0.535); infertility time (p = 0.654); degrees of pain (p = 0.849); and symptoms common to endometriosis, namely, dysmenorrhea (p = 0.841), dyspareunia (0.466), chronic pelvic pain (p = 0.295), and intestinal (p = 0.573) or urinary (p = 0.809) diseases. Comparisons of median scores in the QoL domains demonstrated that the distributions of QoL and clinical symptoms were significantly related between the types of dyspareunia and the following domains: physical functioning (p = 0.017), role- emotional (p = 0.013), and general health (p = 0.001). Regarding pain outside of menstruation, there was significance in the pain domain (p = 0.017), and degree of pain was significance in physical functioning (p = 0.005) and role-physical (p = 0.011) domains.ConclusionsThe present study pointed out that it is not the stage of endometriosis that interferes in the quality of life of women with endometriosis and infertility but rather the clinical manifestations, such as dyspareunia and pain. Thus, we can conclude that the patient’s perception of the disease should be considered in health care and that the losses are independent of the degree of endometriosis in this population with the aggravating factor of infertility.

The Effects of Sperm Parameters on Pregnancy Results in Patients with Intra Uterine Insemination Using Recombinant FSH

Aim of the study: Although there is an assisted reproductive technique commonly used in intrauterine insemination (IUI) assisted reproductive techniques, there is no definite consensus about sperm parameters affecting the possibility of pregnancy. The aim of this study is to evaluate the effects of motile sperm and morphology on pregnancy rates and determine optimal sperm parameters in patients undergoing IUI with rFSH ovulation induction (OI). Material and Methods: Between January 2009 and December 2010, Dr. Zekai Tahir Burak Women's Health Education and Research Hospital is a retrospective study involving 300 IUI cycles applied to 170 infertile patients in the infertility outpatient clinic. IUI cycles were divided into 10 million according to TPMSS (total progressive motile sperm count) after washing, ≤%4 and> 4% according to morphology, the effect of two parameters on pregnancy results. Findings: In our study, a total of 44 pregnancies were applied to 170 infertile patients with 300 cycles of IUI. Pregnancy was 14.6% according to the number of cycles and 25.8% according to the number of patients. While the pregnancy rate was 17.8% in the spouses of men with sperm morphology 4 4%, the pregnancy rate in the spouses of the patients with morphology> 4% was found 13.9% (p = 0.133). While the pregnancy rate of the spouses of men with TPMSS> 10 million was 14.8%, the pregnancy rate of the spouses of men with TPMSS <10 million was 13.3% (p = 0.668). Result: In our study, it was found that female age is important in the treatment of infertility, and pregnancies in infertility treatment usually occur in the first cycle. Morphology was found to be more important in terms of pregnancy, one of the sperm parameters. It was found that TPMSS alone was not related to pregnancy rates. It was determined that smoking does not affect pregnancy rates in women and it decreases pregnancy rates by disrupting morphology especially in men. Keywords: IUI, infertility, sperm parameters DOI: 10.7176/JSTR/6-05-08

A moderated mediation model of perceived stress, negative emotions and mindfulness on fertility quality of life in women with recurrent pregnancy loss.

This study aimed to investigate the level of fertility related quality of life (FertiQoL) in women with recurrent pregnancy loss (RPL), and to further examine moderated mediation effects of dispositional mindfulness and negative emotions on the relationship between perceived stress and FertiQoL. A cross-sectional study was conducted with 262 participants recruited from the infertility outpatient clinics. A self-administered, structured questionnaire including the Simplified Chinese version of FertiQoL tool, the Perceived Stress Scale-10 (PSS-10), the Chinese Version of the Hospital Anxiety and Depression Scale (HADS), and the Mindfulness Attention Awareness Scale (MAAS) was used to collect information in this research. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS. The mean score of Core FertiQoL was 64.59 (SD = 14.76) among women with RPL. Mediation analysis revealed that the association between perceived stress and FertiQoL was partially mediated by negative emotions (indirect effect = - 0.194 for anxiety, and - 0.151 for depression, all P < 0.001). Moderated mediation analysis indicated that the indirect effects of perceived stress on FertiQoL through negative emotions were significantly moderated by dispositional mindfulness. Specifically, the indirect effects of perceived stress on FertiQoL through negative emotions decreased were significant as dispositional mindfulness levels increased. Overall, women with RPL experienced poor FertiQoL. The Moderated mediation model provides a better understanding of how perceived stress, negative emotions and dispositional mindfulness work together to affect FertiQoL. Interventions aiming to improve FertiQoL in women with RPL should consider targeting these aspects.

L-Carnitine and Clomiphene Citrate for induction of ovulation in women with Polycystic Ovary Syndrome : Randomized controlled trial

Aim: The aim of the study was to assess the efficacy of adding L-carnitine to clomiphene citrate for increasing the ovulation and the pregnancy rate in women with PCOS. The primary outcome was the ovulation rate and the secondary outcome was the pregnancy rate.Materials and Methods: This study was a randomized controlled clinical trial that was conducted on 94 women who attended at the Obstetrics and Gynecology Outpatient Infertility Clinic at Ain-Shams University Maternity Hospital, and they were diagnosed with PCOS according to the Rotterdam Criteria (11). The women were distributed randomly into two equal groups; Group L (n=47) received 100 mg of clomiphene citrate plus 3 gm of L-carnitine orally from day 3 to day 7 of the cycle with continuation of L-carnitine till the day of pregnancy test and Group C (n=47) received 100 mg of clomiphene citrate orally from day 3 to day 7 of the cycle.Results: There was a significant difference (P 0.05) between the two groups regarding the pregnancy rate (Group L: 8.5%; Group C: 6.4%). There was a highly significant difference (P 0.05) between the two groups regarding the level of progesterone after 8 days from the hCG injection.Conclusion: L-carnitine added to clomiphene citrate for induction of ovulation in PCOS women had a significant effect on the ovulation rate, but it didn’t have a significant effect on the pregnancy rate when compared to clomiphene citrate alone.

Effect of Educational intervention about Nutrition for Infertile Women on their Knowledge in Preconception Period

Background: Human fertility affected by many factors as nutrition (unbalanced nutrition and unhealthy diet) be together to affect reproduction security in women. Evidence suggests that nutrition can play an important role in altering fertility-related outcomes in both men and women. Aim: this study aims to assess level of knowledge about nutrition that increases fertility in infertile women, and evaluate effect of educational intervention about nutrition on infertile women’s knowledge in preconception period. Methods: Quasi experimental (pre – posttest) research design was carried out in this study. It was conducted at infertility outpatient clinic women’s health Hospitals, Assiut University, Egypt. Sample included 100 infertile women. Structured interview questionnaire was used and included two parts: Sociodemographic data and questions to assess knowledge regarding fertility's nutrition. Results: There are statistical significant differences between pretest and posttest regarding total knowledge of infertile women about nutrition, P-Value is 0.001. Conclusion: Educational program about nutrition that may increase fertility is very important to enhance infertile women’s knowledge regarding nutrition that may increase and decrease fertility. Recommendations: implementing a continuing educational program for women including counseling skills about importance of fertility nutrition during preconception period.

LETROZOLE VERSUS CLOMIPHENE CITRATE FOR OVULATION INDUCTION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Backround: Ovulation is the central event in the reproduction cycle. Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility. Polycystic ovarian syndrome (PCOS) with abnormalities in the metabolism of androgens and estrogen and in the control of androgen production remains one of its leading causes .Polycystic ovary syndrome (PCOS) is a common multisystem endocrine disorder in women, with long-term health consequences Objectives: Comparing the efficacy of Letrozole and Clomiphene citrate, as a first line treatment for induction of ovulation in cases of polycystic ovary syndrome. Patients and Methods: This study was randomized comparative study involving 100 Egyptian women having polycystic ovary syndrome attending Al-Azhar University Maternity hospital (Sayed Galal/ Infertility outpatient clinic, And 6th October Health Insurance Hospital). During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (50 Patients) or 100 mg Clomiphene citrate (50 Patients) from the third until the eighth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The difference between Letrozole and Clomiphene citrate for ovulation rate was 44 (88%) versus 30 (60%) respectively. Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of 9.2 mm (SD 2.37) versus 8.4 mm (SD 1.61) for patients taking Clomiphene citrate, and these differences were statistically significant. In terms of pregnancy rate, Letrozole facilitated pregnancy induction in 19 patients (38%) versus 8 patients (16%) for Clomiphene citrate, which was statistically significant. More dominant follicles exhibiting a mono-follicular morphology were observed in patients treated with Letrozole compared to patients treated with Clomiphene citrate, with a mono-follicular dominant follicle observed in 23 (46%) versus 14 (28%) patients respectively. Conclusion: Letrozole provided a more efficient stimulation compared to Clomiphene citrate in terms of ovulation induction, thickening of the endometrial lining and achievement of a successful pregnancy.