International Journal of Fertility and Sterility

182-190

Authors: Jenniffer Puerta Suárez, Stefan du Plessis, Walter D. Cardona-Maya

The 100,000th scientific article on the subject of spermatozoa was recently published. Numerous studies evaluated the characteristics of this important cell that led to tremendous discoveries. Since its first observation and description in 1677, many important characteristics have been described regarding this highly fascinating gamete. In this review, we intend to provide a historical account of the numerous milestones and breakthroughs achieved related to sperma- tozoa. We conducted a review of the literature by selecting the most important subjects with regards to spermatozoa. Since their discovery by van Leeuwenhoek, spermatozoa have been studied by scientists to better understand their physiology and process of interaction with their female counterpart, the oocyte, in order to treat and resolve infertility problems. Three centuries after van Leeuwenhoek’s discovery, the 100,000th article about these cells was published. It is encouraging that sperm research reached this landmark, but at the same time it is clear that further research on male reproductive physiology and spermatozoa is required to shed more light on their function and pathology in order to reduce the number of unexplained infertility cases.

200-206

Authors: Shahideh Jahanian Sadatmahalleh, Saeideh Ziaei, Anoshirvan Kazemnejad, Eesa Mohamadi

Background The aim of this study is to evaluate the menstrual pattern, sexual function, and anxiety, and depression in women with poststerilization regret, and potential influencing factors for regret following tubal ligation (TL) in Iranian women. Materials and Methods In this cross-sectional study, 166 women with TL were subdivided into two groups including women with poststerilization regret (n=41) and women without poststerilization regret (n=125). They were selected from a health care center in Guilan province (Iran) during 2015-2016. Menstrual blood loss was measured using the Pictorial Blood Loss Assessment Chart (PBLAC) and through a self-administered questionnaire. In addition, sexual function was assessed by the Female Sexual Function Index (FSFI), and psychological distress was measured by employing the Hospital Anxiety and Depression Scale (HADS). Student’s t test and Chi-square test were used to reveal the statistical differences between the two groups. We used logistic regression to determine the influencing factors associated with regretting sterilization. Results Women with poststerilization regret had more menorrhagia (78 vs. 57.6%, P=0.03) than those who did not regret sterilization. A significant difference was found in sexual dysfunction in orgasm (P=0.02), satisfaction (P=0.004), pain (P=0.02), and total FSFI scores (P=0.007) between the two groups. Also, there was a significant difference between the two groups in anxiety, depression and total scores HADS (P=0.01). In the logistic regression model, age of sterilization [odds ratio (OR=2.67), confidence interval (CI): 1.03-7.81, P=0.04)], pre-sterilization counseling (OR=19.92, CI: 6.61-59.99, P<0.001), score of PBLAC (OR=1.01, CI: 1.004-1.01, P=0.001), the number of days of bleeding (OR=1.37, CI: 1.01-1.99, P=0.04), and the length of menstrual cycles (OR=0.91, CI: 0.84-0.99, P=0.03) were significantly associated with regretting sterilization. Conclusion Complications due to sterilization are the main causes of regret; therefore, it is necessary to pay due attention to mentioning the probable complications of the procedures such as menstruation disorders, sexual dysfunction, and anxiety and depression in women during pre-sterilization counseling.

213-217

Authors: Farideh malekzadeh, Ashraf Moini, Elham Amirchaghmaghi, Leila Daliri, Mohammad Reza Akhoond, Mehrak Talebi, Rihaneh Hosseini

Background Endometriosis is a common gynaecological disease that affects quality of life for women. Several studies have revealed that both environmental and genetic factors contribute to the development of endometriosis. The aim of this study was to investigate the distribution of ABO and Rh blood groups in Iranian women with endometriosis who presented to two referral infertility centers in Tehran, Iran. Materials and Methods In this case-control study, women who referred to Royan Institute and Arash Women’s Hospital for diagnostic laparoscopy between 2013 and 2014 were assessed. Based on the laparoscopy findings, we categorized the women into two groups: endometriosis and control (women without endometriosis and normal pelvis). Chi-square and logistic regression tests were used for data analysis. Results In this study, we assessed 433 women, of which 213 patients were assigned to the endometriosis group while the remaining 220 subjects comprised the control group. The most frequent ABO blood group was O (40.6%). The least frequent blood group was AB (4.8%). In terms of Rh blood group, Rh+ (90.1%) was more frequent than Rh- (9.9%). There was no significant correlation between ABO (P=0.091) and Rh (P=0.55) blood groups and risk of endometriosis. Also, there was no significant difference between the two groups with regards to the stage of endometriosis and distribution of ABO and Rh blood groups (P>0.05). Conclusion Although the O blood group was less dominant in Iranian women with endometriosis, we observed no significant correlation between the risk of endometriosis and the ABO and Rh blood groups. Endometriosis severity was not correlated to any of these blood groups.

223-228

Authors: Homayoun Khazali, Fariba Mahmoudi, Mahyar Janahmadi

Background: The inhibitory effects of morphine and the stimulatory influence of kisspeptin signaling have been demonstrated on gonadotropin releasing hormone (GnRH)/luteinizing hormone (LH) release. Hypothalamic kisspeptin is involved in relaying the environmental and metabolic information to reproductive axis. In the present study, the role of kisspeptin/ GPR54 signaling system was investigated on relaying the inhibitory influences of morphine on LH hormone secretion. Materials and Methods: In this experimental study, 55 wistar male rats weighing 230-250 g were sub-grouped in 11 groups (in each group n=5) receiving saline, kisspeptin (1 nmol), peptide234 (P234, 1 nmol), morphine (5 mg/kg), naloxone (2 mg/kg), kisspeptin/P234, morphine/naloxone, kisspeptin/morphine, kisspeptin/naloxone, P234/morphine or P234/naloxone respectively. Blood samples were collected via tail vein. Mean plasma (LH) concentrations and mean relative KiSS1 or GPR54 mRNA levels were determined by radioimmunoassay (RIA) and real time reverse transcriptase-polymerase chain reaction (RT-PCR), respectivwely. Results: Morphine significantly decreased mean plasma LH concentration and mean relative KiSS1 gene expression compared to saline; while it did not significantly decrease mean relative GPR54 gene expression compared to saline. Naloxone significant increased mean LH level and mean relative KiSS1 gene expression compared to saline; while it did not significantly increase mean relative GPR54 gene expression compared to saline. Injections of kisspeptin plus morphine significantly increased mean LH concentration compared to saline or morphine, while simultaneous infusions of them significantly declined mean plasma LH level compared to kisspeptin. In kisspeptin/naloxone group mean plasma LH level was significantly increased compared to saline or naloxone. Co-administration of P234/morphine significantly decreased mean LH concentration compared to saline. Conclusion: Down regulation of KiSS1 gene expression may be partly involved in the mediating the inhibitory effects of morphine on reproductive axis.

235-241

Authors: Mahnaz Poorhassan, Fatemeh Navaee, Simin Mahakizadeh, Mahshid Bazrafkan, Banafsheh Nikmehr, Farid Abolhassani, Sahar Ijaz, Nazila Yamini, Nasrin Dashti, Kobra Mehrannia, Gholamreza Hassanzadeh, Mohammad Akbari

Background Hypoxia causes detrimental effects on the structure and function of tissues through increased production of reactive oxygen species that are generated during the re-oxygenation phase of intermittent and continuous hypobaric hypoxia. This study was carried out to evaluate the effects of flaxseed (Fx) in reducing the incidence of hypoxia in rat testes. Materials and Methods In this experimental study, 24 adult Wistar rats were randomly divided into four groups: i. Control group (Co) that received normal levels of oxygen and food, ii. Sham group (Sh) that were placed in hypoxia chamber but received normal oxygen and food, iii. Hypoxia induction group (Hx) that were placed in hypoxia chamber and treated with normal food, iv. Hypoxia induction group (Hx+Fx) that were placed in hypoxia chamber and treated with 10% flaxseed food. Both the Hx and Hx+Fx groups were kept in a hypoxic chamber for 30 days; during this period rats were exposed to reduced pressure (oxygen 8% and nitrogen 92%) for 4 hours/day. Then, all animal were sacrificed and their testes were removed. Malondialdehyde (MDA) and total antioxidant capacity (TAC) levels were evaluated in the testis tissue. Tubular damages were examined using histological studies. Blood samples and sperm were collected to assess IL-18 level and measure sperms parameters, respectively. All data were analyzed using SPPSS-22 software. One way-ANOVA or Kruskal-Wallis tests were performed for statistical analysis. Results A significant difference was recorded in the testicular mass/body weight ratio in Hx and Hx+Fx groups in comparison to the control (P=0.003 and 0.027, respectively) and Sh (P=0.001 and 0.009, respectively) groups. The sperm count and motility in Hx+Fx group were significantly different from those of the Hx group (P=0.0001 and 0.028, respectively) .Also sperm viability (P=0.0001) and abnormality (P=0.0001) in Hx+Fx group were significantly different from Hx group. Conclusion This study therefore suggests that the oral administration of flaxseed can be useful for prevention from the detrimental effects of hypoxia on rat testes structure and sperm parameters.

249-256

Authors: Amir M. Bassam Elnagar, Abdelnasser Ibrahim, Amro Mohamed Soliman

Background Titanium dioxide (TiO2) is a white pigment which is used in paints, plastics, etc. It is reported that TiO2 induces oxidative stress and DNA damage. N-acetylcysteine (NAC) has been used to fight oxidative stress-induced damage in different tissues. The objective of this study was to evaluate the toxic effects of orally administered TiO2 nanoparticles and the possible protective effect of NAC on the testes of adult male albino rats. Materials and Methods In this experimental study, 50 adult male albino rats were classified into five groups. Group I was the negative control, group II was treated with gum acacia solution , group III was treated with NAC, group IV was treated with TiO2nanoparticles, and group V was treated with 100 mg/kg of NAC and 1200 mg/kg TiO2nanoparticles. Total testosterone, glutathione (GSH), and serum malondialdehyde (MDA) levels were estimated. The testes were subjected to histopathological, electron microscopic examinations, and immunohistochemical detection for tumor necrosis factor (TNF)-α. Cells from the left testis were examined to detect the degree of DNA impairment by using the comet assay. Results TiO2nanoparticles induced histopathological and ultrastructure changes in the testes as well as positive TNF-α immunoreaction in the testicular tissue. Moreover, there was an increase in serum MDA while a decrease in testosterone and GSH levels in TiO2nanoparticles-treated group. TiO2resulted in DNA damage. Administration of NAC to TiO2- treated rats led to improvement of the previous parameters with modest protective effects against DNA damage. Conclusion TiO2-induced damage to the testes was mediated by oxidative stress. Notably, administration of NAC protected against TiO2’s damaging effects.

263-266

Authors: Mania Kaveh, Kobra Tahermanesh, Abolfazl Mehdizadeh Kashi, Banafsheh Tajbakhsh, Gazal Mansouri, Kambiz Sadegi

Endometriosis affects about 10% of women of reproductive age. Its main feature is the presence of stroma and endometrial glands in sites other than the uterus, mainly in pelvis. Pelvic peritoneum, ovaries, uterine ligaments, bladder, intestines, andcul-de-sac are among the affected areas. Sometimes endometriosis can be found outside of the pelvis and even above abdominal cavity, like indiaphragm.Herein, we present a case of an asymptomatic diaphragmatic endometriosis that was discovered incidentally during laparoscopy of pelvic endometriosis, as well as our appropriately proposed treatment protocol.

92-98

Authors: Maryam Barekat, Shahnaz Ahmadi

Hypertensive disorders (HDs) as the most prevalent medical problem during pregnancy, predispose the patient to a lot of comorbidities and may even cause maternal or fetal death. The rate of infertility has been increasing in recent decades. So, we collected and summarized data about the co-existence of these two entities and found that HDs are somewhat more common in women receiving fertility treatments regardless of pathophysiologic correlation of infertility and hypertension or older age and chance of multiple pregnancies.

106-113

Authors: payam Amini, Abbas Moghimbeigi, Farid Zayeri, Hossein Mahjub, Saman Maroufizadeh, Reza Omani Samani

Background: Abnormalities in birth weight and gestational age cause several adverse maternal and infant outcomes. Our study aims to determine the potential factors that affect birth weight and gestational age, and their association. Materials and Methods: We conducted this cross-sectional study of 4415 pregnant women in Tehran, Iran, from July 6-21, 2015. Joint multilevel multiple logistic regression was used in the analysis with demographic and obstetrical variables at the first level, and the hospitals at the second level. Results: We observed the following prevalence rates: preterm (5.5%), term (94%), and postterm (0.5%). Low birth weight (LBW) had a prevalence rate of 4.8%, whereas the prevalence rate for normal weight was 92.4, and 2.8% for macrosomia. Compared to term, older mother’s age [odds ratio (OR)=1.04, 95% confidence interval (CI): 1.02-1.07], preeclampsia (OR=4.14, 95% CI: 2.71-6.31), multiple pregnancy (OR=18.04, 95% CI: 9.75- 33.38), and use of assisted reproductive technology (ART) (OR=2.47, 95% CI: 1.64-33.73) were associated with preterm birth. Better socioeconomic status (SES) was responsible for decreased odds for postterm birth compared to term birth (OR=0.53, 95% CI: 0.37-0.74). Cases with higher maternal body mass index (BMI) were 1.02 times more likely for macrosomia (95% CI: 1.01-1.04), and male infant sex (OR=1.78, 95% CI: 1.21-2.60). LBW was related to multiparity (OR=0.59, 95% CI: 0.42-0.82), multiple pregnancy (OR=17.35, 95% CI: 9.73-30.94), and preeclampsia (OR=3.36, 95% CI: 2.15-5.24). Conclusion: Maternal age, SES, preeclampsia, multiple pregnancy, ART, higher maternal BMI, parity, and male infant sex were determined to be predictive variables for birth weight and gestational age after taking into consideration their association by using a joint multilevel multiple logistic regression model

119-124

Authors: Behnaz Navid, Maryam Mohammadi, Saman Maroufizadeh, Payam Amini, Zahra shirin, Reza Omani samani

Background: Many infertile couples experience psychological distress and suffer from impaired quality of life. Generally, when couples are dealing with uncontrolled events such as infertility, it is important to manage it well and to use the suitable coping style; so this can represent an example of attribution style. The purpose of this study is to investigate the quality of life, relationship beliefs and attribution style in infertile couples. Materials and Methods: This cross-sectional study consisted of 50 infertile couples, who were at least 18 years of age and could read and write in Persian. Participants provided demographic and general characteristics and completed the quality of life (SF-12), relationship belief inventory (RBI) and attribution style (ASQ) forms. Data was analyzed by the paired t test, Pearson correlation tests and multiple linear regression analysis, using SPSS version 22 statistical software. Results: Overall, 50 infertile couples participated in our study. The males had a significantly higher score for quality of life compared to the females (P=0.019). In RBI subscales except “Disagreement is Destructive” all others significantly higher in wives than husbands. All subscales of RBI had a negative correlation with the quality of life. The quality of life had a significant correlation with positive internal (r=0.213, P=0.033). The adjusted regression model showed that the quality of life for males was higher than in females (β=-3.098, P=0.024). Conclusion: The current data indicate that in infertile couples, the husbands have a higher quality of life in comparison to their wives. Also, all subscales of relationship beliefs have a negative correlation with the quality of life, but in attribution style, just internal attribution style for positive events is associated with the quality of life. In general, there is a correlation between relationship beliefs and the quality of life in infertile couples.

130-135

Authors: Asma Tiyuri, Seyyed Abolfazl Vagharseyyedin, Marziyeh Torshizi, Najmeh Bahramian, Morteza Hajihosseini

Background: Infertility is a common clinical problem. Psychological adjustment to infertility refers to changing the viewpoint and attitude of an infertile person toward infertility problems, treatments and possible outcomes. The present study aims to prepare a valid and reliable scale for assessing the psychological adjustment to infertility, by determining the cultural adaptation, validity and reliability of the Persian version of the Fertility Adjustment Scale. Materials and Methods: This is a cross-sectional study performed to localize and validate the Fertility Adjustment Scale, in which 40 infertile women and 40 healthy subjects (fertile or having children) were detected by a gynecologist and the subjects who completed the Fertility Adjustment Scale (FAS) questionnaire were recruited. This study had four steps: in the first step, the literature was reviewed, in the second step, the scale was translated, in the third step, the content and construct validity indicators were calculated, and in the fourth step, reliability of the scale was validated. Results: The mean (± SE and range) of fertility adjustment total scores in the infertile group and the control group were 43.2 (1.2 and 27-57) and 42.3 (1.5 and 18-57), respectively (P=0.623). The content validity was good according to Content Validity Index score (0.7-0.8). A two-component structure was extracted from factor analysis which approximately justifies 52.0% of the cumulative variations. A Cronbach’s alpha value of 0.68 showed moderate reliability. Conclusion: The results of this study revealed that the infertility adjustment scale is a useful tool for the analysis of psychological reactions towards infertility problems and evaluation of the consequences of treating this social-clinical problem.

142-146

Authors: Abdelhafid Benksim, Noureddine Elkoudri, Rachid Ait Addi, Abdellatif Baali, Mohammed Cherkaoui

Background: The main objective of this survey was to determine the difference between primary and secondary infertility in Morocco and the associated factors among women, who are referred to public and private health centers in Morocco. Materials and Methods: In this cross-sectional study, 619 infertile women referring to public and private health centers in Marrakech-Safi region, were selected by simple random sampling method. This study was conducted between 1 October 2013 and 31 December 2015. Socio-economic status, demographic characteristics, couple’s age, nutritional status and other data related to both male and female reproductive organs were collected by a questionnaire. Logistic regression was used to identify the associated factors to infertility. Statistical significance was set at 0.05. Results: The rates of primary and secondary infertility were 67.37, and 32.63%, respectively. Multivariate analysis identified a model with three significant predictive factors of secondary infertility: duration of marriage [odds ratio (OR)=12.263: 2.289-65.685], socio-economic status (OR=3.83: 1.011-14.70) and the ages of women (OR=1.268: 1.038-1.549). Conclusion: The causes of primary and secondary infertility were not always a woman’s problem, but both man and woman contribute to infertility. Multiple regression analysis showed that women’s age, duration of marriage, and socioeconomic status are predictive variables that decrease the chance of fertility among women with secondary infertility.

152-156

Authors: Sahar Bagheri, Rasoul Roghanian, Naser Golbang, Pouran Golbang, Mohammad Hossein Nasr Esfahani

Background: Chlamydia trachomatis (CT) infection is the most common sexually transmitted disease in the world that can persist and also ascend in the genital tract. This intracellular and silent infection is related to some adverse pregnancy outcomes, such as miscarriage. The aims of this study were to explore the best CT screening tests using blood and vaginal samples and to investigate the correlation between CT infection and the incidence of miscarriage. Materials and Methods: This case-control study was done in October 2013 through June 2014, using purposive sampling from 157 female participants with or without a history of miscarriage. The samples were taken after each participant had signed a letter of consent and had completed a questionnaire. To achieve the objectives of this study, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests were performed on vaginal swabs and blood samples, respectively. Results: PCR results showed a significantly higher CT infection rate in the miscarriage group compared to the control group (11.3 vs. 0%, P=0.007). Anti-CT IgG and IgA antibodies were found in 4.2 and 2.1% of cases in the miscarriage group, and in 1.7 and 6.7% of cases in the control group, respectively (P>0.05). Despite lower humoral responses in this study, positive samples were detected only by one of the following techniques; PCR, ELISA IgA and ELISA IgG. It also should be noted that PCR worked best in terms of detection. Conclusion: Based on the obtained data, there is a strong association between molecular evidence of CT infection and miscarriage. A higher rate of CT detection in molecular tests compared to serological assays suggests that PCR could be used as the first-choice assay for detection of C. trachomatis. However, the importance of serological tests in detecting potential past CT infection or upper genital infection not amenable to sampling is undeniable.

164-168

Authors: Nafiye Yilmaz, Ebru Ersoy, Aytekin Tokmak, Ayla Sargin, Ayse Seval Ozgu Erdinc, Salim Erkaya, Halil Ibrahim Yakut

Background: Recent studies have shown that vitamin D has an essential role in the reproductive system. In this study, we aimed to investigate the effect of vitamin D levels in patients undergoing ovulation induction (OI), and subsequent intrauterine insemination (IUI) procedure. Materials and Methods: One hundred and four infertile and one hundred and three fertile women were recruited in this cross-sectional study which was conducted in a tertiary level maternity hospital. Infertile patients were divided into pregnant and non-pregnant subgroups after treatment. Individual characteristics and 25-hydroxyvitamin D3 [25 (OH) D3] levels were compared between the groups. Results: The vast majority of our study population consisted of women who had vitamin D deficiency (96.6%). There was no statistically significant difference between infertile and fertile groups in terms of serum 25 (OH) D3 levels (P=0.512). Similarly, no significant difference was observed between the pregnant and non-pregnant subgroups of infertile patients regarding 25 (OH) D3 levels (P=0.267). Conclusion: There is no association between female infertility and serum vitamin D levels. Vitamin D does not predict pregnancy in infertile women undergoing OI with IUI. Further research which will provide a comparison between much more women who have deficient and sufficient 25 (OH) D3 levels is warranted.

173-177

Authors: Ardeshir Bahmanimehr, Shahryar Zeighami, Bahia Namavar Jahromi, Zahra Anvar, Mohammad Ebrahim Parsanezhad, Maryam Davari, Somayeh Montazeri, Najmeh Moein Vaziri, Afsoon Zarei

Background: Y chromosome deletions (YCDs) in azoospermia factor (AZF) region are associated with abnormal spermatogenesis and may lead to azoospermia or severe oligozoospermia. Assisted reproductive technologies (ART) by intracytoplasmic sperm injection (ICSI) and testicular sperm extraction (TESE) are commonly required for infertility management of patients carrying YCDs. The aim of this study was to estimate the frequency of YCDs, to find the most frequent variant in infertile men candidate for ART and to compare YCD distribution with a control fertile group. The semen parameters, hormonal profiles and ART outcomes of the infertile group were studied. Materials and Methods: This case-control study consisted of 97 oligozoospermic or non-obstructive azoospermic (NOA) infertile men, who had undergone ART, as the case group and 100 fertile men as the control group. DNA samples were extracted from blood samples taken from all 197 participants and YCDs were identified by multiplex polymerase chain reaction (PCR) of eight known sequence-tagged sites. The chi-square test was used to compare the mean values of hormone and sperm parameters between the two groups. P<0.05 was considered statistically significant. Results: No YCD was detected in the control group. However, 20 out of 97 (20.6%) infertile men had a YCD. AZFc, AZFbc and AZFabc deletions were detected in 15 (75%), four (20%) and one (5%) YCD-positive patients. No fertilization or clinical pregnancy was seen following ICSI in this sub-group with YCD. The mean level of FSH was significantly higher in the group with YCD (28.45 ± 22.2 vs. 4.8 ± 3.17 and 10.83 ± 7.23 in YCD-negative patients with and without clinical pregnancy respectively). Conclusion: YCD is frequent among NOA men and YCD screening before ART and patient counseling is thus strongly recommended.

1-5

Authors: Robabeh Taheripanah, Mahshid Vasef, Marzieh Zamaniyan, Anahita Taheripanah

Background The aim of the current study is to compare quinagolide with cabergoline in prevention of ovarian hyperstimulation syndrome (OHSS) among high risk women undergoing intracytoplasmic sperm injection (ICSI). Materials and Methods This randomized clinical trial study was performed from March 2015 to February 2017. One hundred and twenty six women undergoing ICSI who were at high risk of developing OHSS (having over 20 follicles of >12 mm), were randomized into two groups. The first group received cabergoline 0.5 mg and the second group received quinagolide 75 mg every day for 7 days commencing on the day of gonadotropin-releasing hormone (GnRH) agonist administration. Then OHSS symptoms as well as their severity were assessed according to standard definition, 3 and 6 days after GnRH agonist administration. Ascites were determined by trans-vaginal ultrasound. Other secondary points were the number of oocytes and the number of embryos and their quality. Quantitative and qualitative data were analyzed using Student’s t test, and Chi-square or fisher’s exact test, respectively. A P<0.05 was considered statistically significant. Results The incidence of severe OHSS in the quinagolide-treated group was 3.1% while it was 15.8% in cabergolinetreated subjects (P<0.001). Ascites were less frequent after treatment with Quinagolide as compared to cabergoline (21.9 vs. 61.9%, respectively) (P=0.0001). There was no significant statistical deferences between the two groups in terms of mean age, number of oocytes, metaphase I and metaphase II oocytes, and germinal vesicles. There was a significant difference between cabergoline and quinagolide groups regarding the embryo number (P=0.037) with cabergoline-treated group showing a higher number of embryos. But, the number of good quality embryo in quinagolide-treated individuals was significantly higher than that of the cabergoline-treated group (P=0.001). Conclusion Quinagolide seems to be more effective than Cabergoline in prevention of OHSS in high-risk patients undergoing ICSI (Registration number: IRCT2016053128187N1).

13-18

Authors: Marzieh Ghasemi gojani, Masoumeh Kordi, Negar Asgharipour, Habibolah Esmaily

Background The outcomes of fertility treatments are unpredictable, and levels of depressive symptoms increase in patients during the waiting period of the result of intrauterine insemination (IUI) treatment. The aim of this study was to compare the effects of a positive reappraisal coping intervention (PRCI) and problem-solving skills training (PSS) on depression during the waiting period of the result of IUI Treatment. Materials and Methods This randomized control clinical trial was done among 108 women undergoing IUI treat- ment. In the control group, the women received routine care. In the PRCI group, women attended two training sessions and were asked to complete coping thoughts cards and fill out daily monitoring forms during the waiting period. In the PSS group, PSS were taught over three sessions. The depression was measured by the beck depression inventory. Results On the 10th day of the IUI waiting period, there were significant differences between the control group (21.42 ± 11.42) and the PSS group (12.52 ± 8.05) and PRCI groups (13.14 ± 9.7) (P<0.001), but no significant difference between the PRCI group and the PSS group. Conclusion According to the results of this randomized control trial there is no difference between a PRCI and PSS on depression during the waiting period of the result of IUI treatment. This suggests that both interventions can be used to help infertile women combat depression during the waiting period of the result of fertility treatments (Registration number: IRCT2016020926490N1).

27-30

Authors: Azadeh Ghaheri, Aliakbar Rasekhi, Reza Omani Samani, Ebrahim Hajizadeh

Background Women undergoing in vitro fertilization (IVF) cycles should successfully go through multiple points during the procedure (i.e., implantation, clinical pregnancy, no spontaneous abortion and delivery) to achieve live births. In this study, data from multiple cycles and multiple points during the IVF cycle are collected for each individual to model the effects of factors associated with success at different stages of IVF cycles in Iranian infertile women. Materials and Methods This historical cohort study includes 996 assisted reproductive technology (ART) cycles of 511 infertile women. Covariates considered in this study were women’s age, type of cycle (fresh or frozen embryo transfer), number of embryos transferred and having polycystic ovarian syndrome during IVF cycles. Generalized estimating equations were used for calculation of odds ratio (OR) and 95% confidence intervals (95% CI) of success at different stages during IVF cycles. Cluster-weighted generalized estimating equations (CWGEE) was also fitted to handle informative cluster size. Results After adjusting for potential confounders, it was seen that receiving frozen embryo transfer was associated with higher odds of success compared to receiving fresh embryo transfer (adj OR: 2.26, 95% CI: 1.66-3.07); however, cycles with fresh embryo transfer exhibited better results in clinical pregnancy compared to those receiving frozen embryo. Being in the age category of 38 to 40 was associated with lower odds of success compared to the reference category (<35) in CWGEE model (adj OR: 0.67, 95% CI: 0.45-1.00). The number of embryos transferred was positively associated with the odds of success in CWGEE (adj OR: 1.21, 95% CI: 1.03-1.42) as well as the GEE model. Conclusion Receiving frozen embryo was positively associated with odds of success compared to cycles with fresh embryo. The number of embryos transferred and women’s age were significantly associated with odds of success.

37-42

Authors: Mehran Dorostghoal, Hamid-o-allah Ghaffari, Farideh Marmazi, Narjes Keikhah

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.

51-55

Authors: Ramin Abdoli, Seyed Ziaeddin Mirhoseini, Navid Ghavi Hossein-Zadeh, Pouya Zamani

Background The presence of different missense mutations in sheep breeds have shown that the bone morphogenetic protein receptor 1B (BMPR1B), bone morphogenetic protein 15 (BMP15) and growth differentiation factor 9 (GDF9) genes play a vital role in ovulation rate and prolificacy in ewes. Therefore, the present study aims to investigate BM- PR1B, BMP15 and GDF9 gene mutations in prolific ewes of Iranian fat-tailed Lori-Bakhtiari sheep. Materials and Methods In the present experimental study, genomic DNA was extracted from whole blood of 10 prolific Lori-Bakhtiari ewes with at least two twinning records in the first four parities to identify point mutations of the BMPR1B, BMP15 and GDF9 genes, using DNA sequencing. Results The results obtained from DNA sequencing showed a new synonymous mutation (g.66496G>A) in exon 8 of the BMPR1B gene, without any amino acid change. Sequencing of the BMP15 gene revealed a deletion of 3 bp (g.656_658delTTC) in exon 1, leading to an amino acid deletion (p.Leu19del). Four single nucleotide polymorphisms (G1:g.2118G>A, G2:g.3451T>C, G3:g.3457A>G and G4:g.3701G>A), were detected in exons 1 and 2 of the GDF9 gene, two of which caused amino acid substitutions (G1: p.87Arg>His and G4: p.241Glu>Lys). These amino acid alterations are proposed to have a benign impact on structure and function of the GDF9 polypeptide sequence. Conclusion Three major prolificacy genes (BMPR1B, BMP15 and GDF9) were polymorphic in Lori-Bakhtiari sheep, although none of the major causative mutation was detected in this sheep type. Further studies using high throughput methods such as genome-wide association study (GWAS) and evaluation of other candidate genes are necessary in the future.

61-67

Authors: Fardin Amidi, Zahra Khodabandeh, Mohamad Hossain nori Mogahi

Background Oocyte cryopreservation is an essential part of the assisted reproductive technology (ART), which was recently introduced into clinical practice. This study aimed to evaluate the effects of two vitrification systems-Cryotop and Open Pulled Straw (OPS)-on mature oocytes gene expressions. Materials and Methods In this experimental study, the survival rate of metaphase II (MII) mouse oocytes were assessed after cryopreservation by vitrification via i. OPS or ii. Cryotop. Then we compared the fertilization rate of oocytes produced via these two methods. In the second experiment, we determined the effects of the two vitrification methods on the expression of Hspa1a, mn-Sod, and ß-actin genes in vitrified-warmed oocytes. Denuded MII oocytes were vitrified in two concentrations of vitrification solution (VS1 and VS2) by Cryotop and straw. We then compared the results using the two vitrification methods with fresh control oocytes. Results mn-Sod expression increased in the vitrified-warmed group both in OPS and Cryotop compared with the con- trols. We only detected Hspa1a in VS1 and control groups using Cryotop. The survival rate of the oocytes was 91.2% (VS1) and 89.2% (VS2) in the Cryotop groups (P=0.902) and 85.5% (VS1) and 83.6% (VS2) in the OPS groups (P=0.905). There were no significant differences between the Cryotop and the OPS groups (P=0.927). The survival rate in the Cryotop or the OPS groups was, nevertheless, significantly lower than the control group (P<0.001). The fertilization rates of the oocytes were 39% (VS1) and 34% (VS2) in the Cryotop groups (P=0.902) and 29 %( VS1) and 19.7% (VS2) in the OPS groups (P=0.413). The fertilization rates were achieved without significant differences among the Cryotop and OPS groups (P=0.755). Conclusion Our results indicated that Cryotop vitrification increases both cooling and warming rates, but both Cryo- top and OPS techniques have the same effect on the mouse oocytes after vitrification.

72-80

Authors: Poonam Sharma, Irshad Khan, Rambir Singh

Background Many autocrine and paracrine elements that are produced within follicular niche have been the focus of much in vitro maturation (IVM) research. The present study was carried out to compare retinoic acid (RA) and basic fibroblast growth factor (bFGF) efficacy on IVM of mouse oocytes, and their further dual consumption to reach an optimal protocol. Materials and Methods In this experimental study, germinal vesicle (GV) oocytes obtained from two-months-old NMRI mice were randomly divided into control, sham and three experimental groups. The basic culture medium was α-MEM supplemented with 10% fetal bovine serum (FBS), 50 mg/l streptomycin, 60 mg/l penicillin and 10 ng/ ml epidermal growth factors. Each of the experimental groups received one of the following treatments: RA (2 µM), bFGF (20 ng/ml) or combination of RA and bFGF with the indicated concentrations. After 24 hours, capacitated spermatozoa were added to in vitro matured oocytes. Five hours later, the oocytes were cultured in fresh droplets of M2 medium for 24 hours and assessed for cleavage to the two-cells stage. Results As compared with the control group, the rate of maturation was significantly increased in the RA (P<0.001) and bFGF+RA (P<0.02) groups with 58 ± 10 and 57 ± 3.46, respectively. The rate of maturation was significant in the RA (P<0.02) and bFGF+RA (P<0.03) groups, in comparison with the bFGF group. The bFGF+RA group had higher rate (83 ± 1.52) of two-cells development, than control (33 ± 1, P<0.001). Conclusion Our findings showed beneficial effects of 2 µM RA and 20 ng/ml bFGF combination on mouse oocyte IVM.

88-90

Authors: Sepideh Khodaverdi, Leila Nazari, Abolfazl Mehdizadehkashi, Mansoureh Vahdat, Samaneh Rokhgireh, Ali Farbod, Banafsheh Tajbakhsh

Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests.

238-246

Authors: Bashir M Ayad, Gerhard Van der Horst, Stefan S Du Plessis

Variation in the ejaculatory abstinence period suggested by different guidance bodies have resulted in a growing concern among researchers and clinicians over what the precise period of ejaculatory abstinence ought to be for an optimal semen sample. Several studies have thus been undertaken to examine the association between the length of sexual abstinence and semen characteristics. Not all studies, however, have arrived at the same conclusions. This study aims to review all existing literature published during the past few decades pertaining to the influence of ejaculatory abstinence on semen quality. For the purpose of this systematic review, all data related to sexual abstinence duration and seminal parameters were re-analysed to homogenize the current data. Thorough PubMed, MEDLINE and Google Scholar, a literature search was conducted using the keywords “sexual abstinence”, “ejaculatory abstinence”, “semen”, “spermatozoa”, “semen analysis”, “sperm parameters”, “motility”, “reactive oxygen species (ROS)” and “DNA fragmentation”. After carefully reviewing all the literature, 30 relevant papers, both written in English and published between January 1979 and December 2016, were included in this review. The weight of the evidence suggests that the decline in semen volume and sperm concentration with shorter abstinence periods is accompanied by a substantial improvement in sperm motility characteristics, especially progressive motility and velocity. Nevertheless, available data are insufficient to support definitive conclusions regarding the influence of the ejaculatory abstinence period on advanced semen parameters (ROS, DNA fragmentation and seminal plasma antioxidant capacity) and pregnancy rates. In conclusion, taking all data into account, shortening of the abstinence period may be beneficial to sperm quality. Furthermore, we recommend that the current guidelines regarding the prescribed abstinence period should be revisited.

253-257

Authors: Afsaneh Mojtabanezhad Shariatpanahi, Hassan Ahmadnia, Adam Torkamanzehi, Mahnaz Mansouri Torshizi, Mohammad Amin Kerachian

Background Approximately 15% of couples are infertile with the male factor explaining approximately 50% of the cases. One of the main genetic factors playing a role in male infertility is Y chromosomal microdeletions within the proximal long arm of the Y chromosome (Yq11), named the azoospermia factor (AZF) region. Recent studies have shown there is a potential connection between deletions of the AZF region and recurrent pregnancy loss (RPL). The aim of this study is to examine this association by characterizing AZF microdeletions in two infertile groups: in men with non-obstructive infertility and in men with wives displaying RPL. Materials and Methods In this is a case-control study, genomic DNA was extracted from 80 male samples including 40 non-obstructive infertile men, 20 males from couples with RPL and 20 fertile males as controls. Multiplex polymerase chain reaction was used to amplify 19 sequence tagged sites (STS) to detect AZF microdeletions. Differences between the case and control groups were evaluated by two-tailed unpaired t test. P<0.05 were considered statistically significant. Results Only one subject was detected to have Y chromosome microdeletions in SY254, SY157 and SY255 among the 40 men with non-obstructive infertility. No microdeletion was detected in the males with wives displaying RPL and in 20 control males. Y chromosome microdeletion was neither significantly associated with non-obstructive infertility (P=0.48) nor with recurrent pregnancy loss. Conclusion Performing Testing for Y chromosome microdeletions in men with non-obstructive infertility and couples with RPL remains inconclusive in this study.

263-269

Authors: Elham Ghanbari, Mohammad Rasool Khazaei, Mozafar Khazaei, Vahid Nejati

Background Royal jelly (RJ) is a complementary diet widely prescribed by traditional medicine specialists for treatment of in- fertility. The aim of present study was to evaluate the effects of RJ on a set of reproductive parameters in immature female rats. Materials and Methods In this experimental study, thirty two immature female rats (30-35 g) were divided into four groups (n=8/group): three experimental groups and one control. The experimental groups received 100, 200 and 400 mg/kg/body weight doses of RJ daily for 14 days, and the control group received 0.5 ml distilled water interaperito- nearly (i.p). The treated rats were sacrificed and their ovaries were dissected for histological examination. The serum levels of ovarian hormones, nitric oxide (NO) and ferric reducing antioxidant power (FRAP) were evaluated, and the ratios of the ovarian and uterine weight to body weight were calculated. One-way ANOVA was used for data analysis. Results The body weights were significantly different (P=0.002) among the rat groups, with an increase in all RJ treated animals. Uterine and ovarian weights and the serum levels of progesterone (P=0.013) and estradiol (P=0.004) were significantly increased in experimental groups compared to the control group. In addition, a significant increase in the number of mature follicles and corpora lutea (P=0.007) was seen in RJ recipients compared to the controls. A significant increase in the serum levels of FRAP (P=0.009) and a significant decrease in NO level (P=0.013) was also observed. Conclusion RJ promotes folliculogenesis and increases ovarian hormones. This product can be considered as a natural growth stimulator for immature female animals.

279-286

Authors: Saowapak Prathoomthong, Yada Tingthanatikul, Srithean Lertvikul, Nittaya Rodratn, Wanwisa Waiyaput, Kanthnadon Dittharot, Morakot Sroyraya, Areepan Sophonsritsuk

Background Progestin has been used for symptomatic treatment of adenomyosis, although its effect on the immune system has not been studied. The aim of this study was to investigate the changes of macrophage and natural killer (NK) cell infiltration in tissues obtained from women with adenomyosis who did or did not receive oral progestin dienogest. Materials and Methods In this randomized controlled clinical trial study, 24 patients with adenomyosis who required hysterectomy were enrolled. Twelve patients received dienogest 28-35 days before surgery, and the other 12 patients were not treated with any hormones. The endometrial and myometrial tissue samples were immediately collected after hysterectomy, and immunohistochemistry for a macrophage marker (CD68) and a NK cells marker (CD57) was performed. Results The number of CD57 cells was significantly increased in endometrial glands of the treated group compared to the untreated group (P=0.005) but not in stroma in the endometrium of the treated patients (P=0.416). The difference in the number of CD68 cells was not statistically significant between treated and untreated groups in the endometrial glands (P=0.055) or stromal tissues (P=0.506). Conclusion Administration of oral progestin dienogest to patients with adenomyosis increased the number of uterine infiltrating NK cells in glandular structure of eutopic endometrium. The differential effects of progestin on NK cells depended on the site of immune cell infiltration. The effects of oral progestin on uterine NK cells in adenomyosis have the potentials to be beneficial to pregnancies occurring following discontinuation of treatment in terms of embryo implantation and fetal protection (Registration number: TCTR20150921001).

293-297

Authors: Bahia Namavar Jahromi, Mahsa Mansouri, Sedighe Forouhari, Tahere Poordast, Alireza Salehi

Objective Infertility has an adverse effect on Quality of Life (QoL). The present study aimed to evaluate QoL and its effective factors in infertile couples. Materials and methods Fertility Quality of Life (FertiQoL) Instrument was used to measure QoL among 500 volunteer couplesattending the infertility clinic of Mother and Child Hospital in Shiraz, Iran. The participants’ demographic and clinical characteristics were assessed by an additional questionnaire. Finally, QoL was measured and the confounding factors related to QoL were investigated through multiple regression analysis. Results The subjects with lower income levels obtained lower relational, mind/body, emotional, and total core scores. In addition, the female participants without academic education gained lower scores in the emotional subscale, while the male participants showed lower scores in emotional, mind/body, relational, social, and total QoL domains. Moreover, the subjects who had undergone any type of treatment, including pharmacological treatment, Intrauterine Insemination (IUI), Intra-Cytoplasmic Sperm Injection (ICSI), and In Vitro Fertilization (IVF), showed significantly lower scores in the environmental domain. On the other hand, the participants with lower infertility duration obtained significantly greater QoL scores. Finally, tolerability, emotional, and environmental domains were significantly more desirable when the infertility problem was related to a male factor. All the tests were conducted at the 5% significance level. Conclusion QoL was higher in the infertile couples with a male factor. On the other hand, the infertile couples with lower income levels, without academic education, and those who had undergone any kind of treatment had lower QoL.

304-308

Authors: Ramin Mozafari Kermani, Mansoureh Farhangniya, Seyed Abolhassan Shahzadeh Fazeli, Pezhman Bagheri, Mahnaz Ashrafi, Ahmad Vosough Taqi Dizaj

Background: Multiple pregnancies occur more frequently in assisted reproductive technology (ART) compared to normal conception (NC). It is known that the risk of congenital malformations in a multiple pregnancy are higher than single pregnancy. The aim of this study is to compare congenital malformations in singleton infants conceived by ART to singleton infants conceived naturally. Materials and Methods: In this historical cohort study, we performed a historical cohort study of major congenital malformations (MCM) in 820 singleton births from January 2012 to December 2014. The data for this analysis were derived from Tehran’s ART linked data file. The risk of congenital malformations was compared in 164 ART infants and 656 NC infants. We performed multiple logistic regression analyses for the independent association of ART on each outcome. Results: We found 40 infants with MCM 29 (4.4%) NC infants and 14 (8.3%) ART infants. In comparison with NC infants, ART infants had a significant 2-fold increased risk of MCM (P=0.046). After adjusting individually for maternal age, infant gender, prior stillbirth, mother’s history of spontaneous abortion, and type of delivery, we did not find any difference in risk. In this study the majority (95.1%) of all infants were normal but 4.9% of infants had at least one MCM. We found a difference in risk of MCMs between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). We excluded the possible role of genotype and other unknown factors in causing more malformations in ART infants. Conclusion: This study reported a higher risk of MCMs in ART singleton infants than in NC singleton infants. Congenital heart disease, developmental dysplasia of the hip (DDH), and urogenital malformations were the most reported major malformations in singleton ART infants according to organ and system classification.

314-317

Authors: Hanan Al-taee, Ban J. Edan

Background: Identifying predictors of the probabilities of conception related to the timing and frequency of intercourse in the menstrual cycle is essential for couples attempting pregnancy, users of natural family planning methods, and clinicians diagnosing for possible causes of infertility. The aim of this study is to estimate the days in which the likelihood of conception happened by using first trimester ultrasound fetal biometry in natural cycles and spontaneous pregnancy, and to explore some factors that may affect them. Materials and Methods: This study is retrospective cohort study, with random sampling. It involved 60 pregnant ladies at first trimester; the date of conception was estimated using: i. Crown-rump length biometry (routine ultrasound examinations were performed at a median of 70 days following Last menstrual period or equivalently 10 weeks), ii. Date of last menstrual cycle. Only women with previous infertility and now conceiving naturally with a certain date of Last menstrual period were selected. Results: The distribution of conception showed a sharp rise from day 8 onwards, reaching its maximum at day 13 and decreasing to zero by day 30 of Last menstrual period. The older and obese women had conceive earlier than younger women but there was insignificants difference between the two groups (P>0.05). According to the type of infertility, the women with secondary infertility had conceived earlier than those with primary infertility. There was a significant difference between the two groups (P<0.05). Conclusion: Day specific of conception may be affected by factors such as age, BMI, and type of infertility. This may be confirmed by larger sample size in metacentric study.

321-325

Authors: Chiara Petrosellini, Sala Abdalla, Tayo Oke

Endometriosis is defined by the presence of ectopic endometrial tissue outside the uterine cavity. Although it is a leading cause of chronic pelvic pain and infertility, its clinical presentation can vary, resulting in diagnostic and therapeutic challenges. Extrapelvic endometriosis is particularly difficult to diagnose owing to its ability to mimic other conditions. Endometrial tissue in a surgical scar is uncommon and often misdiagnosed as a granuloma, abscess, or malignancy. Cyclical hemorrhagic ascites due to peritoneal endometriosis is exceptionally rare. We report the case of a pre-menopausal, nulliparous 44-year-old woman who presented with ascites and a large abdominal mass that arose from the site of a lower midline laparotomy scar. Five years previously, she had undergone open myomectomy for uterine fibroids. Soon after her initial operation she developed abdominal ascites, which necessitated percutaneous drainage on multiple occasions. We performed a laparotomy with excision of the abdominal wall mass through an inverted T incision. The extra-abdominal mass consisted of mixed cystic and solid components, and weighed 1.52 kg. It communicated with the abdominopelvic cavity through a 2 cm defect in the linea alba. The abdomen contained a large amount of odourless, brown fluid which drained into the mass. There was a large capsule that covered the small and large bowel, liver, gallbladder, and stomach. Final histology reported a 28×19×5 cm mass of endometrial tissue with no evidence of malignant transformation. The patient recovered well post-operatively and has remained asymptomatic. Our case illustrates that, despite being a common disease, endometriosis can masquerade as several other conditions and be missed or diagnosed late. Delay in diagnosis will not only prolong symptoms but can also compromise reproductive lifespan. It is therefore paramount that endometriosis is to be considered early in the management of premenopausal women who present with an irregular pelvic mass or hemorrhagic ascites.