International Journal of Fertility and Sterility

246-251

Authors: Muhammad Haddad, Rafat Esmail, Homayoun Khazali

Monosodium glutamate (MSG) is a flavour enhancer that is used as a food additive (E621) in many parts of the world, especially in East Asian countries. However, in recent studies, it has been used as a neurotoxin because MSG is reported to cause neural degeneration in the hypothalamic arcuate of neonatal animals. The results of several studies show the negative effects of MSG injections on different parts of the hypothalamic-pituitary-gonadal (HPG) axis, in addition to its ability to inhibit secretion many reproductive neuropeptides, neurotrophic factors, and hormones, all of which play vital roles in the regulation of reproductive function. Oral administration or injection of large quantities of MSG into newborn animals results in a decrease in or overabundance of the production of many regulatory peptides of the male and female reproductive systems. In this review, we summarize the results of the most important studies that have examined the effect of oral consumption or injection of MSG on regulatory peptides of the HPG axis.

258-262

Authors: Mahdieh Nikfarjam, Leila Rashki Ghaleno, Abdolhossein Shahverdi, Shahab Mirshahvaladi, Seyed Mehdi Ghoreishi, Alireza Alizadeh Moghadam Masouleh

Background: Pomegranate is an ancient fruit containing Punicalagin, which has known as an effective antioxidant. Pomegranate peel was recognized as a phenol and tannin source, and pomegranate seed contains unique fatty acid (Punicic acid). Limited information exists about the influences of pomegranate peel and seed on antioxidant enzymes and proteins in the male reproduction system. This study was performed to determine the pomegranate peel and seed effects on the expression of antioxidant genes and DJ-1 protein in ram’s testis. Materials and Methods: In this experimental study, twenty-one mature Iranian rams were randomly divided into three groups (n=7 in each group), and fed experimental diets consisted of a control diet (C), a diet containing dry pomegranate seed pulp (S), and a diet containing pomegranate peel (P) for 80 days. All rams were offered isoenergetic and isonitrogenous rations. Testicular tissue samples were collected, and expression of Gpx1, Gpx4, Prdx4, Prdx5, and Sod2 genes was quantified by real-time polymerase chain reaction (RT-PCR). In addition, western blotting was used to evaluate DJ-1 expression at the protein level. Results: Gpx1 and Sod2 mRNA levels in the peel group were significantly (P<0.05) higher than control. Prdx5 mRNA level was increased (P<0.05) in the seeds group than in the control group. Gpx4 and Prdx4 expression were statistically not affected significantly by the experimental diet. Data analysis showed a significant (P<0.05) increase (1.5-fold) in the expression level of DJ-1 in peel groups than in control. Conclusion: The expression of antioxidant genes and DJ-1 protein in ram testes are more influenced by pomegranate peel than seed.

269-274

Authors: Risk Factors Associated with Recurrent Pregnancy Loss and Outcome of Pre-Implantation Genetic Screening of Affected Couples

Background: Recurrent pregnancy loss (RPL) is a multifactorial disorder which affects up to 5% of couples around the world. Several factors are considered to be involved in RPL; but, the etiology remains unexplained in 35-60% of cases. The aim of this study was to assess the frequency of risk factors associated with RPL in a group of our clinic clients, and their pre-implantation genetic screening (PGS) outcome. Materials and Methods: We designed a retrospective descriptive study among, 602 Iranian couples referred to the Royan Reproductive Clinic (Tehran-Iran) from 2006 to 2018. Their karyotyping test and PGS outcomes were analyzed. PGS had been applied by array comparative genomic hybridization (array-CGH) on embryos from these patients. Also, karyotyping test had been performed using standard cytogenetic techniques. Results: G-banding analysis revealed a frequency of 15.61% chromosomal abnormalities in RPL couples. Also, the reciprocal translocations were more frequent (33/1204 cases) compared to the other structural abnormalities. Pregnancy rate per embryo transferred were 50% with array-CGH approach. Conclusion: Our findings could confirm a positive correlation between chromosomal abnormalities and RPL rate. Applying PGS for the RPL couples, leads to improvement of pregnancy success rate.

280-285

Authors: Ghazal Neysanian, Mahboube Taebi, Atefeh Rezaeian, Mohammad Hosein Nasr-Esfahani, Maryam Jahangirifar

Background: Based on studies on animal models, vitamin D plays an essential role in reproduction by controlling Ca and Mg levels. Despite these findings, the effects of vitamin D deficiency and supplementation on the outcome of assisted reproductive techniques (ART) remain controversial. Therefore, the aim of the present study was to assess the relationship between serum and follicular fluid 25-OH vitamin D levels on reproductive outcomes of infertile women. Materials and Methods: This prospective cohort study included 150 infertile women who underwent in vitro fertilization(IVF) or intracytoplasmic sperm injection (ICSI). The participants were allocated to one of the three groups according to their serum and follicular fluid 25-OH vitamin D concentrations (less than 10 ng/ml, between 10 and 30 ng/ml and more than 30 ng/ml), and fertilization, cleavage and biochemical and clinical pregnancy rates were compared among the groups. Data was analyzed by SPSS software and using Chi-square and Spearman correlation coefficient. Results: Serum and follicular fluid vitamin D levels significantly correlated with biochemical (P=0.008), (P=0.003) and clinical pregnancy (P=0.017), (P=0.001) rates respectively . However, the quality of embryos (P=0.125), (P=0.106)and fertilization rate (P=0.082), (P=0.059) were not associated with the level of serum and follicular fluid vitamin D. Conclusion: This study found that women with higher levels of vitamin D in their serum and follicular fluid are significantly more likely to achieve pregnancy but without affecting the quality of embryo and fertility rate.

294-299

Authors: Bahar Shakerian, Engin Turkgeldi, Sebile Guler Cekic, Sule Yildiz, İpek Keles, Baris Ata

Background: This study compared outcomes of the standard 6000 IU human chorionic gonadotropin (hCG) trigger with a dual trigger comprised of 6000 IU hCG and 1 mg leuprolide acetate for final oocyte maturation in an intracytoplasmic sperm injection (ICSI) cycle. By convention, ICSI was performed in most cases at the clinic. Materials and Methods: In this retrospective study, a total of 50 women were included in each arm. Participants were matched for age, indication and number of prior assisted reproduction technology (ART) cycles. Women at risk for ovarian hyperstimulation syndrome (OHSS) were excluded. A flexible gonadotropin releasing hormone (GnRH) antagonist protocol was used and final oocyte maturation was triggered when two leading follicles were >17 mm. Distribution of variables was evaluated visually with histograms. Continuous variables were defined by mean (standard deviation) or median (25th-75th percentile) depending on distribution characteristics. Categorical variables were defined by numbers and percentages. Continuous variables were compared between the groups with the t test or Mann-Whitney U test as appropriate. Categorical variables were compared by the chi-square test and its derivatives as appropriate. A two-sided P<0.05 indicated statistical significance. Results: Both groups had similar antral follicle counts, median parity (0) and number of previous failed cycles (0). The median number of oocytes (8 vs. 7), metaphase-two oocytes (6 vs. 5.5), blastocysts (1 vs. 1), clinical pregnancy rates (CPR) (28% vs. 22%), ongoing pregnancy rates (OPR) (22% vs. 20%) and pregnancy rate per transfer (53.3% vs 53.8%) were similar between the dual trigger and hCG only groups, respectively. Conclusion: Dual trigger for oocyte maturation stimulation failed to improve the ICSI outcome.

303-304

Authors: Koray Görkem Saçıntı, Yavuz Emre Şükür, Murat Sönmezer, Cem Somer Atabekoğlu

Although ovarian tissue cryopreservation is still considered as an experimental technique, several authors from around the world have reported successful and promising results. Currently, oocyte cryopreservation seems to be the most feasible technique for fertility preservation when there’s some kind of a time constraint in adolescents and adults. However, it has been estimated that a young woman would be expected to have a 94% likelihood of having a live birth with 20 mature frozen oocytes (1). At age 34 years, however, this expectation is decreased to 90% with 20 mature frozen oocytes. In addition to age-related limitations, an immediate obstacle for obtaining oocytes in cancer patients is the fact that only one controlled ovarian hyperstimulation (COH) cycle can usually be performed in these women because of time constraints, yielding a relatively low number of oocytes and/or embryos. For this reason, results from egg donation programs cannot be extrapolated to cancer patients, nor can the quality of oocytes be guaranteed. Hence, a combined fertility preservation technique can be of valuable in increasing the chances of successful future pregnancies following gonadotoxic cancer therapies. Previously, Dolmans et al. (2) suggested that cryopreservation of bilateral ovarian cortex followed by COH is a feasible and safe approach to preserve fertility before gonadotoxic treatment, and that the number of cryopreserved embryos was similar to the controls. We have been offering the option of the combined technique to fertility preservation patients for a couple of years and have performed it in a series of eight candidate patients. All patients had enough time for COH before oncology treatments. We first performed laparoscopic ovarian resection for ovarian tissue cryopreservation and then started COH on postoperative day 0 or 1 in each patient (Table 1). The main point in our findings is that ovarian resection is performed from the side with less antral follicle count of the patients. We suggest that this approach can increase the oocyte yield in a single available COH cycle. The data is limited on the effectiveness of combined technique and more long-term follow-up studies are needed in larger groups with appropriate controls. According to our clinical experience, we believe that combined technique is a valid approach, which is expanding beyond the experimental stage and has become a clinical technique for fertility preservation. We particularly suggest selecting the ovary with a low antral follicle count for wedge resection to increase oocyte yield. The information gathered from large international multicenter reports would encourage physicians to agree that the method should complete the experimental phase and be ready for wider clinical use in female fertility preservation.

167-177

Authors: Cyrus Jalili; Fuzieh Khani Hemmatabadi; Mehrdad Bakhtiyari; Amir Abdolmaleki; Fatemeh Moradi

Background: Prior to chemotherapy interventions, in vitro maturation (IVM) of folliclesthrough vitrification can be used to help young people conserve their fertility. Materials and Methods: This experimental study was conducted on immature female BALB/c mice (12-14 days). Follicles were gathered mechanically and placed in α-Minimal Essential Medium (α-MEM) containing 5% fetal bovine serum (FBS). Some pre-antral follicles were frozen. The fresh and vitrified follicles were cultured in different concentrations of sodium alginate (0.25%, 0.5%, and 1%) and two dimensional (2D) medium for 12 days. The samples were evaluated for viability percentage, the number of MII-phase oocytes and reactive oxygen specious (ROS) level. Additionally, Gdf9, Bmp15, Bmp7, Bmp4, Gpx, mnSOD and Gcs gene expressions were assessed in the samples. Results: The highest and lowest percentages of follicle viability and maturation in the fresh and vitrified groups were respectively 0.5% concentration and 2D culture. There was no significant difference among the concentrations of 0.25% and 1%. Viability and maturation of follicles showed a significant increase in the fresh groups in comparison with the vitrified groups. ROS levels in the both fresh and vitrified groups with different concentrations of alginate showed a significant decrease compared to the control group. ROS levels in follicles showed a significant decrease in the fresh groups in comparison with the vitrified groups (P≤0.0001). The highest gene expression levels were observed in the 0.5% alginate (P≤0.0001). Moreover, the viability percentage, follicle maturation, and gene expression levels were higher in the fresh groupsthan the vitrified groups (P≤0.0001). Conclusion: Alginate hydrogel at a proper concentration of 5%, not only helps follicle get mature, but also promotes the expression of developmental genes and reducesthe level of intracellular ROS. Follicular vitrification decreases quality of the follicles, which are partially compensated using a three dimensional (3D) cell culture medium.

189-196

Authors: Mahboubeh Taebi; Nourossadat Kariman; Ali Montazeri; Hamid Alavi Majd

Background: Infertility stigma is a phenomenon associated with various psychological and social tensions especially for women. The stigma is associated with a feeling of shame and secrecy. The present study was aimed to explore the concept of infertility stigma based on the experiences and perceptions of infertile women. Materials and Methods: This qualitative conventional content analysis study was conducted in Isfahan Fertility and Infertility Center, Iran. Data were collected through in-depth interviews with 17 women who had primary infertility. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The Standards for Reporting Qualitative Research (SRQR) checklist was followed for this research. Results: Eight hundred thirty-six initial codes were extracted from the interviews and divided into 25 sub-categories, 10 categories, and four themes. The themes included “stigma profile, self-stigma, defensive mechanism and balancing”. Stigma profile was perceived in the form of verbal, social and same sex stigma. Self-stigma was experienced as negative feelings and devaluation. Defensive mechanism was formed from three categories of escaping from the stigma, acceptance and infertility behind the mask. Two categories; empowered women and pressure levers, created a balancing theme against the infertility stigma. Conclusion: Infertile women face social and self-stigma which threatenstheir psychosocial wellbeing and self-esteem. They use defensive response mechanisms and social support to mitigate these effects. Education focused on coping strategies might be helpful against infertility stigma.

202-209

Authors: saeed Azizollahi; Maryam Bagheri; Fedyeh Haghollahi; Seyyede Momeneh Mohamadi; Batool Hosein Rashidi

Background: Gonadotropin-releasing hormone (GnRH) analogues have been extensively utilized in the ovarian stimulation cycle for suppression of endogenous rapid enhancement of luteinizing hormone (LH surge). Exclusive properties and functional mechanisms of GnRH analogues in in vitro fertilization (IVF) cycles are clearly described. This randomized clinical trial was performed to evaluate clinical and molecular impacts of the GnRH agonist and antagonist protocols in IVF cycles. For this purpose, gene expression of cumulus cells (CCs) as well as clinical and embryological parameters were evaluated and compared between two groups (GnRH agonist and antagonist) during the IVF cycle. Materials and Methods: Twenty-one infertile individuals were enrolled in this double-blind randomized clinical study. Subjects were randomly allocated into two groups of GnRH agonist (n=10) treated patients and GnRH antagonist (n=11) treated individuals. The defined clinical embryological parameters were compared between the two groups. Expression of BAX, BCL-2, SURVIVIN, ALCAM, and VCAN genes were assessed in the CCs of the participants using the real-time polymerase chain reaction (PCR) technique. Results: The mean number of cumulus oocyte complex (COC), percentage of metaphase II (MII) oocytes, grade A embryo and clinical parameters did not show noticeable differences between the two groups. BAX gene expression in the CCs of the group treated with GnRH agonist was remarkably higher than those received GnRH antagonist treatment (p <0.001). The mRNA expression of BCL-2 and ALCM genes were considerably greater in the CCs of patients who underwent antagonist protocol in comparison to the group that received agonist protocol (p <0.001). Conclusion: Despite no considerable difference in the oocyte quality, embryo development, and clinical outcomes between the group treated with GnRH agonist and the one treated with antagonist protocol, the GnRH antagonist protocol was slightly more favorable. However, further clinical studies using molecular assessments are required to elucidate this controversial subject (Registration number: IRCT20101115005181N16).

219-225

Authors: Induja Manikandan; Sushmita Bora; Prashant Adole; Chitra Thyagaraju; Rajesh Ganesh

Background: Because of the widespread use of organophosphate (OP) pesticides in agriculture, they are major environmental contaminants in developing countries. OP pesticides decrease sperm concentration and affect its quality, viability, and motility. Studies have demonstrated the association between abnormal semen analysis and OP pesticides exposure among the high-risk population. Asthere is limited data on the percentage of OP pesticides exposure, the study aimed to determine the OP pesticides exposure in Southern Indian men with idiopathic abnormal semen analysis and find the possible source of their OP pesticides exposure. Materials and Methods: In this cross-sectional pilot study, fifty men with idiopathic abnormal semen analysis as cases and fifty men with normal semen analysis as controls were recruited. Detailed history wastaken and general and systemic examinations were carried out. OP pesticides exposure was determined by assessment of pseudocholinesterase and acetylcholinesterase levels and urinary OP pesticides metabolites dialkyl phosphate (DAP) consisting of dimethyl phosphate (DMP), diethyl thiophosphate (DETP), and diethyl dithiophosphate (DEDTP). Results: Cases had statistically significantly lower levels of pseudocholinesterase (5792.07 ± 1969.89 vs. 10267.01 ± 3258.58 IU/L) (P=0.006) and acetylcholinesterase [102.90 (45.88-262.74) vs. 570.31 (200.24-975.30) IU/L] (P=0.001) as compared to controls. Cases had a statistically significantly higher percentage of urinary DAP positivity as compared to controls (80 vs. 38%) (p <0.0001). Hence, cases had a significantly higher percentage of OP pesticides exposure as compared to controls (20 vs. 4 %) (P=0.015). OP-exposed cases had significantly higher urinary DETP and DEDTP levels as compared to OP non-exposed cases. Also, urinary DETP and DEDTP levels were significantly negatively associated with sperm concentration, motility, and normal morphology among OP-exposed cases. Conclusion: Southern Indian men with idiopathic abnormal semen analysis had a significantly higher percentage of OP pesticides exposure as compared to men with a normal semen analysis.

234-240

Authors: Arezoo Bagheri; Mahsa Saadati

Background: Total fertility rate (TFR) in Iran decreased from the year 2000 and recently Iran has experienced fertility rates below replacement level. Birth interval is one of the most important determinants of fertility levels and plays a vital role in population growth rate. Due to the importance of this subject, the aim of this study was analyzing three birth intervals using three Survival Recurrent Event (SRE) models. Materials and Methods: In a 2017 cross-sectional fertility survey in Tehran, 610 married women, age 15-49 years, were selected by multi-stage stratified random sampling and interviewed using a structured questionnaire. The effects of selected covariates on first, second and third birth intervals were fitted to the data using the Prentice-Williams- Peterson-Gap Time (PWP-GT) SRE model in SAS 9.4. Results: Calendar-period had a significant effect on all three birth intervals (p <0.01). The Hazard Rate (HR) for a short birth interval for women in the most recent calendar-period (2007-2017) was lower than for the other calendarperiods. Women’s migration influenced second (P=0.044) and third birth intervals (P=0.031). The HR for both birth intervals in migrant women was 1.298 and 1.404 times shorter, respectively than non-migrant women. Women’s employment (P=0.008) and place of residence (p <0.05) also had significant effects on second birth interval; employed women and those living in developed, completely-developed and semi-developed areas, compared to unemployed women and those living in developing regions, had longer second birth intervals. Older age at marriage age increased the HR for a short third birth interval (p <0.01). Conclusion: The analysis of birth interval patterns using an appropriate statistical method provides important information for health policymakers. Based on the results of this study, younger women delayed their childbearing more than older women. Migrant women, unemployed women and women who live in developing regions gave birth to their second child sooner than non-migrant employed women, and women who lived in more developed regions. The implementation of policies which change the economic and social conditions of families could prevent increasing birth intervals and influence the fertility rate.

8-14

Authors: Rezvan Bahmyari, , Ali Ariafar, Mehrab Sayadi,Shirzad Hossieni, Sara Azima

Background: Male infertility may originate from a wide spectrum of conditions while in 30-40 percent of cases, no significant reason can be identified. Thereby, it is recognized as male idiopathic infertility. This study was undertaken to investigate the effect of daily intake of selenium, vitamin E and folic acid on sperm parameters in males with idiopathic infertility. Materials and Methods: Seventy infertile men were selected to participate in this single-blind, randomized controlled clinical trial using convenience sampling. They were equally divided into two groups via permuted block randomization method. The intervention group received selenium tablet (200 μg per day, oral), vitamin E capsule (400 IU per day, oral) and folic acid tablet (5 mg per day, oral).The placebo group received matching placebo for three months. Semen volume, total sperm motility, sperm concentration, progressive sperm motility, normal sperm morphology, sperm motility index (SMI) and functional sperm concentration (FSC) were assessed by sperm quality analyzer-v (SQAV) before and after the intervention. Paired t test, and independent t test were used to compare the results within and between the groups, respectively. The IBM SPSS V.16.005 was used for data analysis. A P<0.05 was considered statistically significant. Results: After three months, according to within-group analysis, a significant difference was found in mean SMI (P=0.007) and FSC (P=0.001) in the intervention group. According to between-group analysis, no significant difference was found in mean semen volume (P=0.610), sperm concentration (P=0.126), total sperm motility (P=0.765), progressive sperm motility (P=0.767), normal sperm morph (P=0.403), SMI (P=0.556) or FSC (P=0.706) between the groups. Conclusion: Consumption of selenium, vitamin E and folic acid in infertile men with asthenozoospermia was not effective (Registration number: IRCT2017012432153N1).

20-25

Authors: Mozhgan Raigani, Niknam Lakpour, Meysam Soleimani, Behrooz Johari, Mohammad Reza Sadeghi

Background: The relation between key enzymes in regulation of folate metabolism and male infertility is the subject of numerous studies. We aimed to determine whether 5, 10-methylenetetrahydrofolate reductase (MTHFR) C677T and methionine synthase reductase (MTRR) A66G genotypes are associated with male infertility in Iranian men and to evaluate its effect on seminal levels of folate and vitamin B12. Materials and Methods: In this retrospective study, semen and peripheral blood samples were collected from 254 men with oligoasthenoteratozoospermia (OAT) and 77 normozoospermic men who attended Avicenna infertility clinic. Single nucleotide polymorphism (SNP) analysis was carried out in genomic DNA by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method for MTHFR C677T and MTRR A66G gene polymorphisms. Results: In MTHFR C677T, our founding showed that T carrier was conversely lower in OAT than normozoospermic men (χ2-test=7.245, P=0.02) whereas in MTRR A66G, A and G carrier showed no significant difference between the two groups (χ2-test=1.079, P=0.53). The concentration of seminal folate was not different between normozoospermic (18.83 ± 17.1 ng/ ml) and OAT (16.96 ± 14.2 ng/ml) men (P=0.47). The concentration of vitamin B12 was slightly higher in normozospermic men (522.6 ± 388.1 pg/ml) compared to OAT men (412.9 ± 303.6 pg/ml, P=0.058). Conclusion: The MTHFR C677T and MTRR A66G have no effect on the concentrations of seminal folate and vitamin B12. The present study showed that two SNPs of MTRR A66G and MTHFR C677T cannot be seen as a risk factor for male factor subfertility.

34-39

Authors: Reiko Shiba; Masayuki Kinutani; Shinichiro Okano; Maki Ikeda; Emi Fukunaga; Yoshihisa Harada; Reo Kawano; Yuko Kikkawa

Background: Luteal phase support (LPS) is essential for hormone replacement therapy (HRT) for frozen-thawed embryo transfer (FET). However, the optimal dose and serum progesterone (P4) levels required for pregnancy are controversial. We attempted to determine the association between pregnancy outcomes and serum P4 levels administered via vaginal suppository for HRT-FET cycles on embryo transfer day. Materials and Methods: This was a secondary analysis of the dataset from the EXCULL trial, which prospectively investigated pregnancy outcomes of four different P4 vaginal suppositories (Lutinus, Utrogestan, Luteum, and Crinone) for HRT-FET. It was conducted at a private fertility clinic between December 2016 to December 2017. During this trial, 235 cycles were divided into four groups based on serum P4 values (quartile [Q] 1 group: <7.8 ng/mL; Q2 group: 7.8-10.8 ng/mL; Q3 group: 10.8-13.7 ng/mL; Q4 group: >13.7 ng/mL). We investigated clinical pregnancy rate (CPR), positive fetal heart rate (FHR), live birth rate (LBR), and miscarriage rate (MR) for each group. A logistic regression analysis was performed using age, body mass index (BMI), and transferred embryos as covariates. Results: Serum P4 values (ng/mL) of each drug were as follows: Lutinus, 13.3 ± 4.9; Utrogestan, 9.3 ± 3.3; Luteum, 13.6 ± 4.2; and Crinone, 8.7 ± 3.2 (mean ± standard deviation, P<0.001).The percentages of Utrogestan and Crinone were higher in the Q1 group, while the percentages of Lutinus and Luteum were higher in the Q4 group. Nonetheless, there were no statistical differences between the Q1 and Q4 groups in CPR, FHR, LBR, and MR. Conclusion: When vaginal P4 was used for FET, although serum P4 levels on transfer day differed based on the drug that was administered, no relationship was observed between serum progesteronelevels and pregnancy outcomes (Registration number: UMIN000032997).

44-50

Authors: Shabnam Shirazi; Bahram Pourghassem Gargari; Azimeh Izadi; Shiva Taghizadeh; Marziyeh Parizad

Background: Angiogenesis disturbances are common in women with polycystic ovary syndrome (PCOS). Vitamin E has antiangiogenic properties. Data on the effects of vitamin E on angiogenesis in PCOS is limited, so the current study was conducted to evaluate its effects on angiogenic indices in PCOS patients. Materials and Methods: This randomized, double-blind, placebo-controlled trial was performed on 43 women aged 20-40 years, diagnosed with PCOS (Rotterdam criteria). It was performed at the referral clinic affiliated to Tabriz University of Medical Sciences, Tabriz, Iran, from April 2017 to September 2017. Patients were randomly assigned into two groups to receive either 400 IU/day vitamin E -as alpha tocopheryl acetate- (n=22) or placebo (n=21), for 8 weeks. Anthropometric, and angiogenic parameters including body weight, fat mass and fat free mass, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), angiopoietin-1 (Ang- 1), and angiopoietin-2 (Ang-2) were measured by standard methods at the beginning and at the end of study. Statistical Package for Social Science version 25 was used for statistical analysis and P<0.05 were considered significant. Results: After adjusting for potential confounders, we observed that vitamin E supplementation significantly reduced body weight, fat mass, Ang-1, Ang-1/Ang-2 ratio and VEGF (P<0.01). We did not observe any considerable effect for vitamin E on Ang-2 level or bFGF. Conclusion: Vitamin E supplementation for 8 weeks in the PCOS women had beneficial effects on body weight, Ang- 1, Ang-1/Ang-2 ratio, and VEGF level (Registration number: IRCT201610193140N18).

60-64

Authors: Hajar Lotfollahi; Hedyeh Riazi; Reza Omani Samani; Saman Maroufizadeh; Ali Montazeri

Background: Sexual self-concept has a considerable impact on mental and sexual health. However, the relationship between sexual self-concept and infertility is unknown. This study aimed to compare sexual self-concept between fertile and infertile women. Materials and Methods: This cross-sectional study was conducted on a sample of 250 fertile and 250 infertile women who had referred to 9 health centers affiliated to Medical universities in Tehran and Royan infertility treatment clinics in Tehran, Iran in 2017. Sexual self-concept was measured using the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ) consisting of 20 subscales. Analysis of covariance (ANCOVA) was performed to compare sexual self-concept between the two groups. Results: The mean age of fertile and infertile women was 34 ± 5.62 and 29.74 ± 5.29 years, respectively. The highest score in both groups was for the sexual self-schemata subscale (mean score for fertile=3.21 ± 0.68 and for infertile= 3.42 ± 0.62). The lowest score was for sexual-depression subscale (mean score for fertile=0.59 ± 0.81 and for infertile=0.61 ± 0.76). After adjustment for the age of each subject, the husband's age, duration of marriage, and women’s education, we analyzed the sexual-satisfaction, the power-other sexual control, and the fear-of-sex subscales, which were found to be significantly lower in infertile women (P<0.05). No other significant differences between the fertile and infertile groups were observed. Conclusion: We observed significant differences between fertile and infertile women in terms of sexual-satisfaction, the power-other sexual control, and the fear-of-sex, but not in other sexual self-concept subscales. These findings suggest that there is need to improve sexual self-concept among both fertile and infertile women. Indeed implementation of educational and counseling programs by reproductive health specialists might play an important role in enhancing sexual self-concept among these populations.

73-79

Authors: Mohammad Hossein Nasr-Esfahani; Khadijeh Ahmad khanbeigi; Ali Hasannia

Background: Human cloning is a recent occurrence that is not confined to bio-issues; rather, it has provoked numerous questions worldwide and presented scientific and religious challenges. These series of articles aim to examine the proposed approaches and analyze the aspects of human cloning in terms of tenets, morals, jurisprudence, and laws. In this paper, we analyze the ideological and theological evidences, regardless of scientific, ethical and legal problems that exist in the reproduction method. Materials and Methods: We used a descriptive-analytical method to consider the challenges of human cloning according to the “system of Divine creativity” and “the will of God”, as well as the “pairing system” and “diversity in nature” with emphasis on the Holy Qur’an and Qur’anic commentaries. Results: According to the Qur’an, although any type of physical changes and retouching of the human body are forbidden, the alteration of God's creation may not prove the prohibition of cloning. Cloning is not contradictory to the principle, precedent, and rule of coupling, and it may be one of the hidden precedents of creation. Therefore, not only does a clone not contradict the precedent of the variety of men, but this variety is a sign for men and not a precedent predominated over the order of nature. Conclusion: It is proven that cloning does not give life; instead, it utilizes the life bestowed by God. This technique does not contradict the precedents of existence. It is a way to discover some precedents of God and is under the order of cause and effect of the world. Cloning is not considered as a challenge to human beliefs, nor is it a change in Divine creation. Moreover, cloning does not contradict the theological teachings and concepts of the Holy Qur’an and Shiite Muslims.