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Abstract Long non-coding RNA (lncRNA) H19 has gained significant recognition as a pivotal contributor to the initiation and advancement of gynecologic cancers, encompassing ovarian, endometrial, cervical, and breast cancers. H19 exhibits a complex array of mechanisms, demonstrating dualistic effects on tumorigenesis as it can function as both an oncogene and a tumor suppressor, contingent upon the specific context and type of cancer being investigated. In ovarian cancer, H19 promotes tumor growth, metastasis, and chemoresistance through modulation of key signaling pathways and interaction with microRNAs. Conversely, in endometrial cancer, H19 acts as a tumor suppressor by inhibiting proliferation, inducing apoptosis, and regulating epithelial-mesenchymal transition. Additionally, H19 has been implicated in cervical and breast cancers, where it influences cell proliferation, invasion, and immune evasion. Moreover, H19 has potential as a diagnostic and prognostic biomarker for gynecologic cancers, with its expression levels correlating with clinical parameters and patient outcomes. Understanding the functional roles of H19 in gynecologic cancers is crucial for the development of targeted therapeutic strategies and personalized treatment approaches. Further investigation into the intricate molecular mechanisms underlying H19’s involvement in gynecologic malignancies is warranted to fully unravel its therapeutic potential and clinical implications. This review aims to elucidate the functional roles of H19 in various gynecologic malignancies.

Introduction: Recent researches have indicated that pregnancies with frozen embryo transfer are associated with the increment of risk of maternal and neonatal complications, especially hypertension during pregnancy. The present study aimed to compare the occurrence rate of gestational hypertension in pregnancy with frozen embryo transfer and normal pregnancy. Materials and Methods: This research, as a retrospective cross-sectional study, was performed on pregnant women with frozen embryo transfer (n = 97) and women with normal pregnancies (n = 164) referring to medical centers under the supervision of Ahvaz University of Medical Sciences in 2021. Women aged 18–35 were included in the study after week 20th of pregnancy. Maternal and neonatal outcomes including hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), preterm birth (before the week 37th), low birth weight (lower than 2500 g), neonatal asphyxia (Apgar score >7 in minute 5th), intrauterine growth restriction (IUGR) and bleeding in the first trimester of pregnancy were evaluated. The association between frozen embryo transfer and pregnancy outcomes was evaluated using multiple logistic regressions. Results: The findings of this study indicated that pregnancy hypertension was observed in 23 people (23.7%) from the frozen embryo transfer group vs. 18 people (11.0%) from the normal pregnancy group (P = 0.006). Frozen embryo transfer pregnancy has a higher risk of gestational hypertension (OR = 2.521, 95% CI: 1.281-4.962; P = 0.007), preterm birth (OR = 2.264, 95% CI: 1.335-3.840; P = 0.002), and low birth weight (OR = 2.017, 95% CI: 1.178-3.455; P = 0.011). However, the incidence of birth asphyxia (P = 0.850), intrauterine growth restriction (P = 0.068), first-trimester bleeding (P = 0.809), and placenta accreta (P = 0.143) did not show a significant difference between two types of normal pregnancy and frozen embryo transfer pregnancy. Conclusion: Frozen embryo transfer pregnancy was associated with a higher risk of maternal and neonatal complications, hypertension, preterm birth, and low birth weight compared to natural and spontaneous pregnancies.

Background: Uterine natural killer (uNK) cells have a significant impact on pregnancy and related complications. Given the importance of receptors in the activity of uNK cells, the present study aimed to determine the number of uNK cells and NKp46 (one of the most important NK cell-activating receptors) expression in the endometrium of women with recurrent miscarriage (RM) or a history of in vitro fertilization (IVF) failure. Materials and Methods: This case-control study was performed on 48 participants, including 16 healthy controls, 27 cases with RM, and 5 cases with repeated implantation failure (RIF) during the mid-luteal phase according to a standardized diagnostic protocol. All participants were assessed using transvaginal ultrasound to determine embryo survival rate and confirm gestational age. Endometrial specimens were collected and subjected to immunohistochemistry (IHC) staining using an anti-human NKp46 antibody expressed by uNK cells. Results: A significantly higher number of cells positive for NKp46 was obtained among two groups of cases versus healthy subjects (patients: 1.46±0.78, controls: 0.82±62, P=0.006), and the number of CD56+cells was significantly higher in patients than in controls (patients: 18.14±7.14, controls: 11.71±6.17, P=0.003). Additionally, there was not a significant difference in the frequency ratio of NKp46+NK cell subset to CD56+uNK cells between the patients (P=0.59) and control healthy group. Conclusion: The increase in the number of uterine NK cells and their cytotoxic activity during implantation and early pregnancy, possibly resulting from an excessive expression of inflammatory cytokines, confirms a significant association between uNK cell activity and a higher risk of RM and RIF. Therefore, immunomodulatory treatments may benefit these patients.

Abstract Background: Preimplantation genetic diagnosis (PGD) has been used as an option for couples with the possibility of having a baby with a genetic disorder. The common method for performing this test involves isolating 1 cell from day 3 or a few cells from day 5 embryos and performing genetic studies on the cell-extracted DNA. This method is invasive and can cause abortion after implantation in the uterus. Because of this, 2 noninvasive methods for performing a PGD have been studied: PGD using blastocyst fluid and PGD using embryo culture medium. Objective: The aim of this study is to determine the sensitivity of the polymerase chain reaction (PCR) technique to detect the Y chromosome using cell-free DNA within a culture medium for gender prediction of blastocysts. Materials and Methods: In this study, the gender of 30 embryos on day 5 was determined using embryonic DNA extraction from the culture medium and the PCR technique to evaluate the sex-determining region Y and fragile X mental retardation genes. Then, the accuracy was assessed using ultrasound. Results: The results of the PCR technique showed that 7 embryos were male, but an ultrasound revealed that 13 were male. Conclusion: The given results indicated that, because of the low amount of DNA extracted from the culture medium, the diagnosis of the existence of the Y chromosome by this method is still not accurate enough for detecting the gender of the embryo.

Introduction: Postpartum pain is one of the common problems in mothers، and mothers tend to use medicinal plants for soothing the pain. In recent years، the clinical performance، according to evidence، was noticed. Therefore، this clinical trial was designed and implemented to determine the effects of Zataria multiflora Boiss capsule and Ibuprofen on postpartum pain. Method: This randomized double-blinded clinical trial was performed on 100 mothers that had natural vaginal birth in Imam Khomeini hospital in Ahwaz in 2016. The women were randomly assigned into two groups of Zataria multiflora Boiss capsule and Ibuprofen. Then, the subjects received one capsule every 6 h for 24 h. The pain intensity was studied before each intervention and 1 h after that using the numerical scale of pain. The data were analyzed by SPSS software (version 18) and statistical tests, including Mann-Whitney U test، t-test، Chi-square test, and Repeated measures. P-value less than 0.05 was considered statistically significant. Results:In this study, both groups had no statistically significant difference in the interventions, such as the age، number of delivery, and weight of neonate (P>0/05). Comparing the mean scores of postpartum pain intensity between the two groups after the fourth intervention showed no significant difference (P=0/057), and in both groups, the intensity of postpartum pain decreased. Conclusion: According to the results of the present study, Zataria moltiflora Boiss capsule similar to Ibuprofen can decrease the postpartum pain intensity.

Background Failure in the endometrial receptivity may account for a significant number of infertility cases including unexplained infertility in women. Reduction in the endometrial estrogen receptor-alpha (ER-α) expression during implantation may be a critical event that coincides with the expression of specific genes and the formation of a receptive endometrium. The aim of the present study was to assess the expression of ER-α in the mid-secretory phase in the endometrium of women with unexplained infertility. Materials and Methods This case-control study was carried out on randomly selected fertile (n=10) and infertile (n=16) women whose source of infertility remained unexplained. We evaluated the expression of ER-α and glycode-lin-A (GdA) through mRNA level measurement with real-time polymerase chain reaction (PCR) in the endometrium of fertile women and patients suffering from unexplained infertility and fertile women. Endometrial biopsies of each subject were collected during a single menstrual cycle 7 days after the peak of luteinizing hormone (LH+7). Results Endometrial expression level of ER-α was significantly (P < 0.05) higher in the patients with unexplained infertility compared to the control. Significantly (P < 0.05) lower levels of GdA expression were seen in women with unexplained infertility. A statistically non-significant negative correlation was observed between ER-α and GdA mRNA expression. Conclusion Our findings demonstrate that reduction in the endometrial GdA expression is associated with elevated expression of ER-α in mid-luteal phase. Disruption in the endometrial ER-α expression, which leads to defects in uterine receptivity, may contribute to unexplained infertility.

Background: Despite all attempts to increase pregnancy rates, overall success rate of Intrauterine Insemination (IUI) is still not acceptable. Proof of ovulation is an important indicator to determine the time of IUI, but to date there is no test proving that the ovulation has definitely occurred. Objective: This study was aimed to compare the efficiency of ultrasound in measuring the size of follicles and urinary Luteinizing Hormone (uLH) kit in determining LH surge for IUI timing. Method: In this comparative, nonrandomized, not blinded clinical trial, 311 IUI cycles in 262 infertile couples who were candidate of IUI were assigned into two groups of ultrasound (n=100 cycles) and uLH kit (n=211 cycles) for IUI timing. Two weeks after doing the IUI, the ßHCG was checked, and chemical pregnancy was confirmed. Four weeks after positive chemical pregnancy test, the fetal heart activity was confirmed by pelvic ultrasonography to confirm clinical pregnancy. Results: Chemical pregnancy rate was lower in ultrasonography group but not significant in comparison to LH kit (14.3% and 18.4%, respectively (P= 0.11)). Clinical pregnancy rate in the groups of ultrasonography and LH kit was respectively 10.3% and 10.3% which did not differ significantly (P= 0.3). Conclusion: Considering that the use of uLH kit is a simple and low cost way and can be done at home by the patients, so the patients can have an active participation in their treatment process.

Background Abnormal uterine bleeding (AUB) is one of the most common clinical problems in gynecology. Transvaginal sonography (TVS) and hysteroscopy are two diagnostic methods for patients with AUB. For most of the patients with AUB, diagnostic hysteroscopy can be done in clinic with minimal discomfort and much lower expense than operative room. Materials and methods In our clinical trial study, from March 21, 2005 to March 20, 2007, patients with AUB in Ahwaz Imam Khomayni hospital, after history and physical examinations underwent TVS. Of those, 147 patients with normal TVS entered the study and were considered for outpatient hysteroscopy. Patients with endometrial cavity lesion were scheduled for operation room, and those with empty endometrial cavity aspiration biopsy were done outpatiently. Specimens were sent to pathologist for examination. Results All the patients were divided into three groups: group 1 or minority was under 30 years old (7 women), group 2 was 30-40 years, and group 3 or majority was over 40 years old (96 women). 115 patients (78.2%) had normal and 32 patients (21.8%) had abnormal hysteroscopic results. 116 patients (78.8%) had normal and 31 patients (21.2%) had abnormal pathologic results; moreover, cervical canal polyp was the most common lesion hysteroscopically and pathologically in all groups. Conclusion Of 147 patients (100%) with AUB and normal TVS, 32 patients (21.8%) were abnormal hysteroscopically. Cervical canal polyps may be missed by transvaginal sonography, but can be diagnosed by hysteroscopy. In patients with AUB and normal TVS, hysteroscopy can be used as the second step.

We aimed to use celecoxib to suppress preterm labor instead magnesium sulfate (MgSO4) to prevent preterm labor. Methods. It was a randomized clinical trial study, which was done on 600 pregnant women. All subjects were divided into two groups by simple random sampling. One group was given 4 grams of MgSO4 intravenously and second group was given 100 mg of celecoxib orally every 12 hours for at least 2 days. The data were entered and analyzed using SPSS 11 and performed using t-test and chi-square test. Results. The finding of this study has shown that preterm labor may be prevented in 75.7% of subjects who had received celecoxib and there were no significant difference between two groups in frequency of history of preterm labor (P=1), frequencies of nulliparity (P=0.99), duration of drug use and arrest contraction (P=0.29), delivery before 48 hours (P=0.20), and mean gestational age in lack of response to treatment (P=0.24). Conclusions. Result has shown that celecoxib was similar to MgSO4 as a medication to prevent preterm labor; it was recommended to be prescribe to prevent preterm labor, because it was cheaper than magnesium sulfate.