International Journal of Fertility and Sterility

253-266

Authors: Ramaswamy Suganthi , Vijayabhavanath Vijayakumaran Vijesh , Nambiar Vandana , Jahangir Ali Fathima Benazir

Spermatogenesis is an essential stage in human male gamete development, which is regulated by many Y chromosome specific genes. Most of these genes are centred in a specific region located on the long arm of the human Y chromosome known as the azoospermia factor region (AZF). Deletion events are common in Y chromosome because of its peculiar structural organization. Astonishingly, among the several known genetic causes of male infertility, Y chromosomal microdeletions emerged as the most frequent structural chromosome anomaly associated with the quantitative reduction of sperm. The development of assisted reproductive techniques (ART) like intra-cytoplasmic sperm injection (ICSI) and testicular sperm extraction (TESE) helps to bypass the natural barriers of fertilization, but it increases the concern about the transmission of genetic defects. Experimental evidence suggested that the men with Y chromosomal microdeletions vertically transmitted their deletion as well as related fertility disorders to their offspring via these ART techniques. In India, infertility is on alarming rise. ART centres have opened up in virtually every state but still most of the infertility centres in India do not choose to perform Y chromosomal microdeletion diagnosis because of some advanced theoretical reasons. Moreover, there is no consensus among the clinicians about the diagnosis and management of Y chromosomal microdeletion defects. The current review discusses thoroughly the role of Y chromosome microdeletion screening in the workup of male infertility, its significance as a diagnostic test, novel approaches for screening Y deletions and finally a systematic review on the current status of Y chromosome microdeletion deletion screening in India.

271-274

Authors: Rüya Deveer , Mehmet Deveer , Yaprak Engin-Üstün , Eren Akbaba , Sema Uysal , Esma Sarikaya , Cavidan Gülerman , Leyla Mollamahmutoglu

Background: Reactive oxygen species (ROS) are produced in many metabolic and physiologic processes. Antioxidative mechanisms remove these harmful species. Our aim was to assess whether serum total antioxidant capacity and total oxidant status altered during first trimester pregnancies with vaginal bleeding. Materials and Methods: In this cross-sectional study, A group of pregnant women at less than 10 weeks of gestation with vaginal bleeding (n=25) and a control group of healthy pregnancies with similar characteristics (n=25) were included. All of the patients in the two groups were matched for age, gestational age and body mass index. Serum total antioxidant capacity and total oxidant status levels were determined using a Hitachi 912 analyzer and compared between the two groups. Results: Characteristics, including maternal age, parity, and gestational age were similar between the two groups. Serum total antioxidant capacity levels were significantly lower in the women with vaginal bleeding than in control women (1.16 ± 0.20 vs. 1.77 ± 0.08 mmol Trolox Equiv./L; p=0.001), whereas higher total oxidant status measurements were found in women with vaginal bleeding compared to the control group (4.01 ± 0.20 vs. 2.57 ± 0.65 μmol H2O2 Equiv./L; p=0.001). Conclusion: Increased total oxidant status might be involved in the pathophysiology of vaginal bleeding during early first trimester pregnancies.

281-290

Authors: Renata Košir Pogačnik , Helena Meden Vrtovec , Alenka Vizjak , Alenka Uršula Levičnik , Nina Slabe , Alojz Ihan

Background: To evaluate the involvement of immune abnormality in patients with idiopathic premature ovarian insufficiency (POI). In addition to the known etiology, autoimmune disorders may be a pathologic mechanism for POI. Materials and Methods: Our study was a prospective controlled trial. Twenty women with POI, reasons other than autoimmune excluded, were enrolled in this study. The control group consisted of 17 healthy women. In both groups, family and personal history were taken and the levels of follicle stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, prolactin, anti-Müllerian hormone, inhibin B, antithyroglobulin and antithyroid peroxidase antibodies were determined. Antiovarian antibodies and subpopulations of peripheral blood T-lymhocytes were also determined. Results: Participants in the study group exhibited hypergonadotropichypogonadism, while high levels of follicle stimulating hormone and low levels of inhibin B and anti- Müllerian hormone were observed. In 16 (80%) patients, POI was associated in their personal and familial history with another autoimmune disease. Fifty percent of patients presented highly elevated antithyroid antibodies. The lymphocyte subset, especially B cells, was significantly higher (p=0.014), and peripheral regulatory lymphocytes CD25+ high were significantly lower (p=0.015) in the study group than in the control group. Antiovarian antibodies were detected in 20% of patients with POI. Conclusion: We presume that the presence of anti-ovarian antibodies together with abnormalities of cellular immunity may in some cases potentially represent the involvement of an autoimmune mechanism in idiopathic POI.

301-312

Authors: Elena Morotti , Bruno Battaglia , Raffaella Fabbri , Roberto Paradisi , Stefano Venturoli , Cesare Battaglia

Background: To verify if in lean polycystic ovary syndrome (PCOS) patients, the smoking habitude might increase the risk of cardiovascular (CV) disease. Materials and Methods: In this prospective observational study, eighty-one women were divided into the following three groups: group I with 27 non-smokers, group II with 26 light-smokers (1-10 cigarettes/day), and group III with 28 heavy smokers (>10 cigarettes/ day). They were submitted to fasting blood sampling; blood measurement of nitrites/nitrates (NO2-/ NO3), biochemical and hormonal parameters; ovarian ultrasonographic (US) analysis; doppler evaluation of uterine and ophthalmic arteries; brachial artery flow-mediated vasodilatation; 24-hour ambulatory blood pressure monitoring; and oral glucose tolerance test (OGTT). Results: Doppler analysis revealed higher uterine and ophthalmic arteries pulsatility index (PI) and ophthalmic artery back pressure in group III compared with group I. The brachial artery diameter and PI, at baseline, was similar among all groups. After the reactive hyperemia, a more intense vasodilatation was observed in group I in comparison with group III. The 24-hour blood pressure demonstrated that, in group III patients, the 24-hour, day- and night-time diastolic blood pressure (DBP), was higher in comparison with non-smokers. The atherogenic index of plasma (AIP) was higher in heavy smokers than in non-smokers. The leukocytes and homocysteine (HCY) values were increased in group III. The NO2-/ NO3- plasma levels were reduced in heavy smokers in comparison with non-smokers. The insulin, glucose and C-peptide plasma values were higher in group III than in other groups. In heavy smokers, the estimates of insulin sensitivity (ISI) and pancreatic β-cell function (HOMA-B) were higher compared to the other groups. Conclusion: Smoking habitude in lean PCOS patients may increase the soft markers of CV risk.

323-330

Authors: Batoul Tarokhian , Roya Sherkat , Mohamma Hossein Nasr Esfahani , Minoo Adib , Abbas Kiani Esfahani , Behrooz Ataei

Background: Some evidence has shown a relationship between primary human cytomegalovirus (CMV) infection and pregnancy loss. The impact of CMV infection reactivation during pregnancy on adverse pregnancy outcomes is not completely understood. It is proposed that altered immune response, and therefore, recurrence or reactivation of latent CMV infection may relate to recurrent spontaneous abortion (RSA); however, few data are available in this regard. To find out about any cell mediated defect and reactivation of latent CMV infection in women with RPL, cellular immunity to the virus has been evaluated by specific cytotoxic T lymphocyte (CTL) response to CMV. Materials and Methods: In a case control study, CTL CD107a expression and intercellular IFN-γ production in response to CMV pp65 antigen and staphylococcus enterotoxin B (SEB) in women with RSA were assessed by flow cytometric analysis. Forty-four cases with history of recurrent pregnancy and forty-four controls with history of successful pregnancies were included. The FACSCaliber flow cytometer were used for analysis. Results: No significant difference was observed between CD107a expression and IFN-γ production in response to CMV PP65 antigen in RPL patients and control group. However, the cytotoxic response to SEB antigen in patients with RPL was significantly lower than control group (p=0.042). Conclusion: The results of this study show that impaired CD107a expression and IFN-γ production as CTL response to CMV does not appear to be a major contributing and immune incompetence factor in patients with RPL, but cytotoxic T cell response defect to other antigens requires to be assessed further in these patients.

337-344

Authors: Marzieh Soltani , Mohammad Reza Shairi , Rasoul Roshan , Changiz Rahimi

Background: The present study investigated the effect of emotionally focused therapy (EFT) on factors contributing to emotional distress among infertile couples. Materials and Methods: In this semi-experimental study, the subjects consisted of 12 Iranian couples: six infertile men and six infertile women. They were assessed as depressed, anxious and stressful individuals using depression, anxiety and stress scale (DASS). The subjects were randomly divided into control and experimental groups. The experimental group with six couples (i.e. three infertile men and three infertile women) received EFT, while the control group with similar number of couples (i.e. three infertile men and three infertile women) was deprived of the treatment. Results: There were no significant differences between the two groups regarding job, educational level, income, age, marriage and infertility duration. The pre- and post-test comparisons of DASS subscales showed that level of depression, anxiety and stress among couples with EFT instruction was significantly less than those without such instructions (p<0.0001). Conclusion: Emotionally focused therapy could reduce the rate of depression, anxiety and stress in infertile couples, regardless of the man or woman as the cause of infertility.

349-352

Authors: Maryam Niknejadi , Firoozeh Ahmadi , Farnaz Akhbari , Parvaneh Afsharian

Trisomy 18 (Edwards syndrome) is the second most common trisomy among live born fetuses, with poor prognosis. Estimate of its incidence is between 1 in 4000- 16000 live births. Most of the chromosomal abnormalities in fetuses are detected by prenatal ultrasound findings in the first and second trimesters. In this case report, we present a partial type of trisomy 18 occurring through de novo unbalanced translocation of chromosomes 18 and 21. The ultrasound features enabling the early detection of trisomy 18 include a delayed ossification of calvarium combined with early onset of fetal growth restriction (FGR) and the absence of nasal bone through performing triple test followed by amniocentesis. Finally, the parents decided to terminate the pregnancy.

224-231

Authors: Daniel M.Campagne

Background: Women in particular suffer from psychological stress when diagnosed with infertility. Psychosocial interventions are known to not only prevent and lessen various mental problems, but also to play a positive role in physical health and pregnancy rates. The aim of this study is to determine the unique impact of spiritual psychotherapy on concerns about infertility and their perceived psychological stresses. Materials and Methods: This study was a randomized clinical trial. The study population included nearly 800 infertile couples who attended the Maternity and Gynecology Clinic of Jahrom University of Medical Sciences, Jahrom, Iran. We enrolled65 people who were randomly divided into two groups, experimental (n=33)and control (n=32). The experimental group received spiritual group psychotherapy counseling for 12 sessions, 2 hours per week for a 3 months period. The control group did not receive any intervention, but due to ethical considerations, we gave a presentation (one session) about infertility treatment for this group after the research process was completed. We used two questionnaires to obtain data, the Penn State Worry Questionnaire (PSWQ) and Perceived Stress Scale (PSS). Data analysis was done by descriptive and analytic statistics using SPSS 16 software. Results: Psychological intervention in the treatment group significantly decreased the PSWQ (p=0.004). There were significant differences in the mean score of the PSWQ in both groups as determined by analysis of covariance (ANCOVA; p=0.009). Psychological intervention in the treatment group decreased the level of perceived stress, when compared with the control group. According to ANCOVA there were significant differences between the mean PSS scores of both groups (p=0.01). Conclusion: Logotherapy is related to stress reduction and can decrease psychiatric symptoms of worry and perceived stress. This approach tends to improve an infertile person's ability to deal with their problem of finding the meaning of life. Thus it can be concluded that logotherapy along with other treatment methods, is a useful approach for infertile couples (Registration Number:IRCT201108247407N2).

232-237

Authors: Firouzeh Ghaffari , Kiandokht Kiani , Akram Bahmanabadi , Mohammadreza Akhoond

Background: The aim of this study was to compare the effects of easy and difficult embryo transfers (ET) on implantation and pregnancy rates. Materials and Methods: In this prospective study, we analyzed the results of 706 ET procedures over a 12-month period. An easy ET was defined as a transfer that occurred without the use of force or other instrumentation. A difficult ET was defined as the use of force for catheter placement, and/or the use of additional instruments, and/or manipulation. Pregnancy rate was compared between patients with easy or difficult ETs. Results: There was a significantly higher implantation rate in the easy group (21.7%) compared to the difficult group (12.1%, p<0.05).The easy group had a higher pregnancy rate (38.1%) compared to patients who had difficult ETs (21.4%; p<0.05). Conclusion: Any uterine manipulation during ET adversely affects in vitro fertilization (IVF). Precaution should be taken to identify possibly difficult ET cases in advance.

244-249

Authors: Fatemeh Pourteymour Fard Tabrizi , Beitollah Alipoor , Mahzad Mehrzad Sadaghiani , Alireza Ostadrahimi , Aida Malek Mahdavi

Background: Metabolic syndrome (MetS) is a clustering of factors known to increase the risk for cardiovascular disease (CVD) and diabetes mellitus. Polycystic ovary syndrome (PCOS), the most common endocrine disorder among reproductive-aged women, is also closely linked to MetS. Limited information is available pertaining to the prevalence of MetS in Iranian PCOS women; therefore this study assesses the frequency of MetS and its components among PCOS women from Tabriz, Iran. Materials and Methods: In this cross-sectional study, we evaluated a total of 200 women with PCOS who referred to the only specialty and subspecialty gynecological center in Northwestern Iran. PCOS was diagnosed according to Rotterdam criteria. This study defined clinical and biochemical parameters for MetS by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Statistical analyses were performed with descriptive-analytical methods using SPSS software version 16. Results: MetS was identified in 39.5% of PCOS women. The frequencies of individual components of MetS among studied subjects were: high-density lipoprotein cholesterol level (HDL-C)<50 mg/ dL (99.5%), waist circumference(WC) ≥88cm (65%), triglycerides (TG) ≥150 mg/dL(98%), and blood pressure≥130/85 mmHg(34%).There were no fasting glucose concentrations≥110 mg/dL. The frequency of MetS increased with body mass index (BMI)as follows: normal (5.4%), overweight (41.5%) and obese (85.7%) women (p<0.0001). Conclusion: The PCOS women in this study had a high frequency of MetS and its individual components, particularly decreased HDL-C and increased triglyceride levels. These data can useful for lifestyle modification programs.

258-265

Authors: Mohammad Ali Ghaffari , Morad Rostami

Background: Spermatozoa are a group of cells that consume adenosine triphosphate (ATP) rapidly. Creatine kinase (CK), produced by creatine phosphate, is an energy reservoir for the rapid buffering and regeneration of ATP and can play an important role in sperm motility. Therefore, this study investigates the effects of cigarette smoking on human sperm CK activity in males who smoke. Materials and Methods: In this case - control study, we obtained semen samples from male smokers (n=64) and nonsmokers (n=83). Smokers were categorized as light, moderate, or heavy smokers according to the daily number of cigarettes smoked and the number of years they have smoked. Data were analyzed by the independent t test and Pearson’s analysis. Results: This investigation showed significantly lower sperm CK activity and movement in male smokers compared to nonsmokers. In addition, it was demonstrated that cigarette smoking had a dose-dependent effect on these parameters. There was a positive relation, although not significant, between sperm CK activity and its motility in male smokers. Conclusion: Smoking, by diminishing sperm CK activity, may potentially impair sperm energy homeostasis and have an association with damage to sperm motility. This effect can be an important mechanism that may cause infertility in male smokers. However, further research is necessary to elucidate the underlying mechanism of sperm motility damage caused by cigarette smoking.

272-277

Authors: Daniela Paes de Almeida Ferreira Braga , Tatiana Carvalho de Souza Bonetti , Ismael Dale Cotrim Guerreiro da Silva , Amanda Souza Setti , Assumpto Iaconelli Jr , Edson Borges Jr

Background: This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. Materials and Methods: This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection (ICSI). After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group (n=96) comprised oocytes derived from the leading follicle of the cohort and the small follicle group (n=920) consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of topquality embryos were compared between groups by Chi-square or Fisher’s exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. Results: A significantly higher percentage of oocytes derived from the leading follicle were in the metaphase II (MII) stage (100 vs. 70.0%, p<0.001). However we observed no significant differences regarding the percentage of degenerated oocytes between the large (6.25%) and small follicle (5.0%) groups (p=0.550). Regression analysis demonstrated a nearly two-fold increase in the incidence of vacuoles in oocytes derived from the largest follicle of the cohort (OR: 1.81, p=0.046). The fertilization rate (50.0 vs. 38.8%, p=0.038) and the percentage of top quality embryos (84.7 vs. 76.4%, p=0.040) were significantly higher for oocytes derived from the largest follicle. However, the percentage of abnormal fertilized oocytes was equally distributed between the large follicle (15.0%) and small follicle (12. 8%) groups (p=0.550). Conclusion: Our data suggest that intrafollicular mechanisms within the larger follicle of the cohort may allow for these follicles to amplify the responsiveness to exogenous gonadotropin, which leads to the formation of more competent oocytes with higher fertilization and developmental capacities.

286-293

Authors: Aygul Akyuz , Memnun Seven , Gonul Şahiner , Bilal Bakır

Background: The aim of this descriptive study was to evaluate the level of marital violence among Turkish women and to determine whether infertility was a risk factor for marital violence. Materials and Methods: This descriptive study was conducted during January-July 2009 at a training hospital. The study groups comprised 204 fertile and 228 infertile women. We administered the Descriptive Information Questionnaire and Scale for Marital Violence against Women (SDVW) to obtain data. Results: There was a statistically significant difference between infertile and fertile women for the total score of violence in marriage. The emotional, economic and sexual violence scores were higher in the infertile group. However, the verbal violence score was lower. Conclusion: We performed a detailed study aimed at uncovering the presence of any violence from the data collection stage to the end of treatment in infertile couples with the intent to include questions to this effect in the care plan.

304-309

Authors: Mohammad Saied Salehi , Mohammad Reza Jafarzadeh Shirazi , Mohammad Javad Zamiri , Farid Pazhoohi , Mohammad Reza Namavar , Ali Niazi , Amin Ramezani , Nader Tanideh , Amin Tamadon , Afsoon Zarei

Kisspeptin and RFamide-related peptide-3 (RFRP-3) are known to affect GnRH/luteinizing hormone (LH) in several species, including the rat. It has been hypothesized that GnRH/LH changes during the rat estrous cycle may result from changes in the expression of KiSS1 and RFRP-3 genes. Therefore, the present study investigates KiSS1 and RFRP-3 gene expression at the transcriptional level in the rat hypothalamus during the estrous cycle. In the present experimental study, 36 adult female Sprague-Dawley rats (3-4 months old) were used to study the expression of KiSS1 and RFRP-3 mRNA in the hypothalamus during the estrous cycle. Four rats were ovariectomized, whereas the remainder were allotted to four different phases of the estrous cycle (n=8 per estrus phase). Rats were decapitated, and the hypothalami were immediately dissected and frozen in liquid nitrogen. Expressions of KiSS1 and RFRP-3 mRNAs were analyzed by real-time PCR. The expression of KiSS1 mRNA during estrus was lower than other phases of the cycle (p<0.01). Expression of KiSS1 mRNA during the metestrus phase was lower than the proestrus phase (p<0.01). The expression of RFRP-3 mRNA during proestrus was lower than the diestrus phase (p<0.01). Results of the present study showed the role of coordinated expression of KiSS1 and RFRP-3 mRNA in the hypothalamus in the control of the rat estrous cycle.

7-12

Authors: Neghin Rezavand , Mozafar Khazaei , Elham Oliapanah , Hossein Nikzad , Mohammad Rasool Khazaei

Background: The endometrium plays a pivotal role in implantation and pregnancy. Cyclooxygenase II (COX-2) has an important function in biological processes such as cell proliferation and inflammation. Celecoxib is a selective inhibitor of COX-2 with numerous pharmacologic functions. The aim of present study is to investigate the effects of celecoxib on the human endometrium in a three-dimensional (3D) culture model. Materials and Methods: In this experimental study, normal human endometria (n=10) obtained from reproductive age women were cut into 1×1 mm sections. Endometrial explants were placed between two layers of fibrin gel. To create the fibrin gel, we poured a thin layer of fibrinogen solution [3 mg/ml in medium 199 (M199)] into each well of a 24-well culture dish and added thrombin enzyme. Endometrial fragments were placed in the center of each well and covered with a second layer of fibrinogen solution. M199 supplemented with L-glutamine, fetal bovine serum (FBS, 5%) and antibiotics were added to each well. The media in each experimental well contained either1, 10 or 50 μM of celecoxib. At the end of the study, we calculated endometrial tissue growth changes by scoring methods and determined the percentage of angiogenesis. Data were analyzed by the Kruskal-Wallis method. P<0.05 was considered significant. Results: The growth scores were as follows: control (1.37 ± 0.16), 1 μM (1.96 ± 0.28), 10 μM (2.01 ± 0.25), and 50 μM (1.17 ± 0.14) celecoxib, all of which were significantly different. The angiogenesis percentages were: 25.56 ± 6.72% (control), 31.98 ± 6.18% (1 μM), 42.67 ± 7.27% (10 μM) and 23.44 ± 4.03% (50 μM), which were not significantly different from each other. Conclusion: Lower celecoxib concentrations had stimulatory effects on the growth of normal endometrium.

21-28

Authors: Masoud Ghanbari , Seyed Bagher Mortazavi , Ali Khavanin , Mozafar Khazaei

Background: There is tremendous concern regarding the possible adverse effects of cell phone microwaves. Contradictory results, however, have been reported for the effects of these waves on the body. In the present study, the effect of cell phone microwaves on sperm parameters and total antioxidant capacity was investigated with regard to the duration of exposure and the frequency of these waves. Materials and Methods: This experimental study was performed on 28 adult male Wistar rats (200-250 g). The animals were randomly assigned to four groups (n=7): i. control; ii. two-week exposure to cell phone-simulated waves; iii. three-week exposure to cell phonesimulated waves; and iv. two-week exposure to cell phone antenna waves. In all groups, sperm analysis was performed based on standard methods and we determined the mean sperm total antioxidant capacity according to the ferric reducing ability of plasma (FRAP) method. Data were analyzed by one-way ANOVA followed by Tukey’s test using SPSS version 16 software. Results: The results indicated that sperm viability, motility, and total antioxidant capacity in all exposure groups decreased significantly compared to the control group (p<0.05). Increasing the duration of exposure from 2 to 3 weeks caused a statistically significant decrease in sperm viability and motility (p<0.05). Conclusion: Exposure to cell phone waves can decrease sperm viability and motility in rats. These waves can also decrease sperm total antioxidant capacity in rats and result in oxidative stress.

33-38

Authors: Qiming Wang , Yueyue Wang , Xianhu Fu , Yong Huang

Background: The present study aims to explore the significance of the expression of growth hormone-releasing hormone (GHRH) and its receptor splice variant 1 (GHRHSV1) in endometriosis (EM). Materials and Methods: In this research paper 80 EM patients who received treatment between March 2009 and September 2010 were selected, among which 20 were in stages I, II, III and IV respectively. 50 non-EM patients who underwent hysterectomy because of myoma during the same period comprised the control group. GHRH, GHRH-SV1 and their corresponding mRNA expression in eutopic endometrium and endometriotic tissue as well as ectopic endometrium were detected using immunohistochemical streptavidin-peroxidase (SP) and RT-PCR methods. Analysis of Variance (ANOVA) with Tukey Post Hoc test was used for data analysis and p<0.05 was considered significant. Results: GHRH, GHRH-SV1 and their corresponding mRNA were expressed in eutopic endometrium and endometriotic tissue as well as ectopic endometrium. The mean optical density (OD) values of the GHRH and GHRH-SV1 expression in the experimental group were significantly higher than those in the normal group (p<0.05), and the relative intensity (RI) of GHRH mRNA and GHRH-SV1 mRNA expression in the experimental group was also significantly higher (p<0.05). The mean OD values of the GHRH and GHRHSV1 expression showed significant differences among endometriotic tissue at different stages of EM (p<0.05), and the RI of GHRH and GHRH-SV1 mRNA expression also showed significant differences (p<0.05). Conclusion: GHRH and GHRH-SV1 expression levels differ significantly at different stages of endometriosis.

43-48

Authors: Somayeh Bohlouli , Mozafar Khazaei , Masoud Teshfam , Hosein Hassanpour

Background: Adiponectin is one of the most important adipokines secreted from fatty tissue that has a direct inhibitory effect on the development of cancer cells. Adiponectin plays an important role in human reproduction system and fertility of women. Adiponectin concentration decreases in women with endometriosis and endometrial cancer. The aim of the present study was to investigate the effect of adiponectin on human endometrial stromal cell (HESC) viability as well as mRNA expression of Adipo R1 and Adipo R2 receptors. Materials and Methods: In this experimental study, eight endometrial biopsies were taken and stromal cells were separated by enzymatic digestion and cell filtrations. Stromal cells of each biopsy were divided into four groups: control, 10, 100, and 200 ng/ml adiponectin concentrations. The effect of adiponectin on viability of the normal HESCs was studied by trypan blue staining and the relative expression levels of Adipo R1 and R2 were analyzed by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). Data were analyzed by one way ANOVA and unpaired student’s t test and p<0.05 was considered significant. Results: Adiponectin decreased viability of normal human endometrial stromal cells in a dose and time dependent manner. Expression of Adipo R1 and Adipo R2 receptors did not change in the presence of adiponectin. Conclusion: Adiponectin can directly influence the viability of HESCs and decrease their viability, but it didn’t change expression of adiponectin receptors.

63-66

Authors: Mohammad Hassan Ghosian Moghaddam , Mohsen Khalili , Maryam Maleki , Mohammad Esmail Ahmad Abadi

Familial recurrent molar pregnancy is an exceedingly rare condition, in which complete hydatidiform moles are mostly diploid but biparental in origin and the outcome of subsequent pregnancies is likely to be a hydatidiform mole or other type of reproductive loss. We previously reported a case of familial molar pregnancy (family K) comprising five affected members (four sisters and one of their cousins) each with at least one hydatidiform mole (HM). In addition to the molar pregnancies, these patients have a total of three miscarriages and 8 normal pregnancies leading to healthy children; but the youngest member of this family has given birth to a boy with Down syndrome. Our second family (case S) includes two sisters with diploid biparental complete moles. They have a total of six molar pregnancies with no living child. Recently the younger sister had a partial molar pregnancy with apparently normal XX fetus accompanying diffuse molar changes of the placenta that led to preeclampsia and preterm delivery. Overall, these families have had 26 pregnancies including 12 molar pregnancies (complete or partial) and three abortions. We concluded that these families are predisposed to various genetic mutations, chromosomal abnormalities and clinical manifestations, which affect their offspring. Further studies of patients are needed to determine any relationship between a history of familial molar pregnancy and trisomy or other chromosomal abnormalities in offspring and genetic mutations in the products of conception to complete the puzzle and manage familial molar pregnancy.

67-70

Authors: Najmeh Maharlouei , Seyed Mehdi Ahmadi , Kamran B. Lankarani

Women’s health is increasing identified as a global health priority. Women’s health is affected by many factors, such as the economy, environment, society, culture, religion, and biology. For this reason, the Health Policy Research Center, Shiraz, Iran decided to hold The First Iranian International Conference on Women’s Health. The aim of this conference was to provide up-to-date information on different aspects of women’s health, including healthy aging, non-communicable and communicable diseases, psycho-social aspects, health promotion, reproductive health, and nutrition. Finally, the attending specialists and experts provided recommendations to be put into practice which reinforced the recommendations for additional clinical preventive services for women, mobilizing health professionals within practice, education, and research to address the national health goals, encouraging the adoption of ongoing evidence-based prevention guidelines, gender-sensitive, and culturally appropriate, persuading all stakeholders to harmonize their endeavors on women’s health, changing the viewpoint to the women as a workforce alliance as with like men, along with considering the major role of women as the basis of the family, and improving the coverage, accessibility, and quality of women-oriented health services.

82-87

Authors: Effat Merghati Khoei , Abbas Norouzi Javidan , Mahboobeh Abrishamkar , Mir Saeed Yekaninejad , Samira Chaibakhsh , Seyyed Hasan Emami-Razavi , Asie Mansouri , Koorosh Kamali , Tannaz Shoja , Marzieh Hajiaghababaei , Abolghasem Nikfallah

Background: This study developed and validated a questionnaire to measure the sexual health of patients with spinal cord injuries (SCI). Materials and Methods: This was a cross-sectional study conducted at the Brain and Spinal Injury Research Center (BASIR), Tehran, Iran. Extensive review of literature, expert opinions, and encounters with SCI patients were used to develop and validate the questionnaires. There were 40 (32 males, 8 females) patients with SCI that presented for treatment at BASIR who enrolled in the study. Participants completed the questionnaires while they were admitted for medical care and during treatment follow-up visits. Participants completed the questionnaires twice, at a 2-4 week interval. Reliability testing for each measure was performed separately. Cronbach’s alpha was used for internal consistency and test-retest was used for reliability. Results: An expert committee approved the face and content validities of the questionnaires, Internal consistency of our questionnaires, was acceptable according to Cronbach’s alpha that ranged from 0.73 for the sexual activity measure to 0.90 for the sexual adjustment measure. Test-retest reliability was satisfactory. Intraclass Correlation Coefficient (ICC) of measures ranged from 0.65 for sexual function to 0.84 for sexual activity. Conclusion: The sexual health measures has provided a valid assessment of sexualityrelated matters in this sample of patients with SCI, which suggests that evaluation of sexual well-being may be useful in clinical trials and practice settings. Overall, the sexual health measures shows good internal consistency and test-retest reliability.

96-99

Authors: Maryam Kianpour , Mehdi Nematbakhsh , Sayad Mehdi Ahmadi , Mehrangiz Jafarzadeh , Masomeh Hajjarian , Zahra Pezeshki , Tahereh Safari , Fatemeh Eshraghi-Jazi

Background: Endometriosis is known as one of the most common disease in women of reproductive age. Due to important role of vascular endothelial growth factor (VEGF) in neo-vascularization for the implantation of endometrial cell, and also presence of different studies reported VEGF level in the serum and peritoneal fluid (PF) in endometriosis patients, this study was designed to determine the serum and PF levels of VEGF in endometriosis patients, and to compare with normal subjects. Materials and Methods: In this descriptive study, 179 women subjected to laparoscopy for the evaluation of infertility or pelvic pain were allocated into the following two groups: group I: different types of endometriosis patients (n=90) and group II: non-endometriosis patients (n=89). The PF from pelvis and venous blood samples were obtained. The VEGF concentration of the serum and PF were measured using enzyme immunoassay kit and were compared using t test. Results: The level of VEGF in serum was significantly less than that in PF in both groups (p=0.00). However, endometriosis patients had significantly higher level of VEGF in peritoneal fluid than non-endometriosis patients (p=0.043). Conclusion: According to our findings, endometriosis is not associated with change in the level of circulating VEGF.

108-115

Authors: Fatemeh Hassani , Poopak Eftekhari-Yazdi , Leila Karimian , Mojtaba Rezazadeh Valojerdi , Bahar Movaghar , Mohammad Fazel , Hamid Reza Fouladi , Fatemeh Shabani , Lars Johansson

Background: The aim of this study is to investigate the effect of ISM1 culture medium on embryo development, quality and outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. This study compares culture medium commonly used in the laboratory setting for oocyte recovery and embryo development with a medium from MediCult. We have assessed the effects of these media on embryo development and newborn characteristics. Materials and Methods: In this prospective randomized study, fertilized oocytes from patients were randomly assigned to culture in ISM1 (MediCult, cycles: n=293) or routine lab culture medium (G-1TM v5; Vitrolife, cycles: n=290) according to the daily media schedule for oocyte retrieval. IVF or ICSI and embryo transfer were performed with either MediCult media or routine lab media. Embryo quality on days 2/3, cleavage, pregnancy and implantation rates, baby take home rate (BTHR), in addition to the weight and length of newborns were compared between groups. Results: There were similar cleavage rates for ISM1 (86%) vs. G-1TM v5 (88%). We observed a significantly higher percentage of excellent embryos in ISM1 (42.7%) compared to G-1TM v5 (39%, p<0.05). Babies born after culture in ISM1 had both higher birth weight (3.03 kg) and length (48.8 cm) compared to G-1TM v5 babies that had a birth weight of 2.66 kg and a length of 46.0 cm (p<0.001 for both). Conclusion: This study suggests that ISM1 is a more effective culture medium in generating higher quality embryos, which may be reflected in the characteristics of babies at birth.

122-129

Authors: Ali Louei Monfared

Background: The lipid composition of a mammal’s spermatozoa and seminal plasma vary in both structure and function. Evidence exists to suggest that dietary supplementation with the appropriate polyunsaturated fatty acids (PUFAs) affects spermatogenesis, semen quality and sperm motility. Therefore, this study has been conducted to evaluate the correlations between serum lipid profile and histological, anatomical and seminal parameters of testes in clinically healthy goats. Materials and Methods: In this analytic, cross-sectional study, we chose a total of ten mature Iranian male goats that comprised a homogenous group through simple random sampling. Blood samples were taken from the jugular vein; the sera were separated and subsequently used for measurement of serum lipids, lipoproteins and testosterone levels. In addition, we collected semen from the animals and evaluated the seminal characteristics. We also performed histological and anatomical assessments of the testes. Results: The findings demonstrated that serum levels of high density lipoprotein (HDL-c) had a significant positive correlation with interstitial testicular tissue area (r=0.73; p<0.001), seminiferous tubule area (r=0.61; p<0.01), the number of Leydig cells (r=0.53; p<0.05), the diameter of the Leydig cell nuclei (r=0.54; p<0.05), scrotal circumference (r=0.83; p<0.001), testis weight (r=0.72; p<0.001), the number of live, normal sperm (r=0.94 ; p<0.001) and serum testosterone levels (r=0.88; p<0.001). Significant but negative correlations were found between serum triglyceride concentration and seminiferous tubule area (r=-0.53; p<0.05), the diameter of the Leydig cell nuclei (r=-0.55; p<0.05), testis weight (r =-0.64; p<0.01), total sperm number (r=-0.82; p<0.001), number of live, normal sperm (r=-0.55; p<0.05) and serum testosterone levels (r=-0.79; p<0.001). In addition, a significant negative correlation was observed between serum very low density lipoprotein (VLDL-c) concentration and the percent of live sperm (r=-0.67; p<0.01), and serum testosterone levels (r=-0.65; p<0.01). Conclusion: The present results indicated that among serum lipids only the levels of HDL-c positively correlated with testicular parameters. High serum triglyceride levels exerted direct adverse effects at the testicular level, which was mainly observed in the seminiferous tubules (STs), characterization of Leydig cells and semen quality.

138-141

Authors: Hikmet Hassa , Yunus Aydin , Tufan Oge , Vehbi Yavuz Tokgoz

We presented a cerebral venous thrombosis case associated with lack of proper medical evaluation required for confirmation of suppression and exclusion of current pregnancy before starting assisted reproductive technology (ART) cycle. This is a case-report study about a 37-year-old woman who presented to emergency room with abdominal pain and tenderness. Initial human chorionic gonadotropin (hCG) value was 17616 IU/L. Endometrium was heteregenous and incompatible with a normal intrauterine pregnancy. She had a history of antagonist protocol/controlled ovarian hyperstimulation (COH) started 38 days ago in a different in vitro fertilization (IVF) center. Because of the fertilization failure, she had no embryo transfer. With ectopic pregnancy diagnosis, we made surgical exploration and observed a material which was consistent with ectopic pregnancy on the right tuba uterina. Partial salpingectomy was applied because of actively bleeding ectopic pregnancy. Two days after discharging from hospital; she presented to emergency room again with syncope and generalized tonic-clonic seizure. By cranial tomography generalized edema, cerebral venous thrombosis was established. Enoxaparine sodium 0.6 ml twice daily was administered. Six days after hospitalisation, she was discharged with normal neurological examination under phenytoin 200 mg daily and enoxaparine sodium 0.6 ml daily. Before ART treatment, clinicians must always rule out the likelihood of existing pregnancy by measuring estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH). On the other hand, low-molecularweight heparine may be effective in cerebral venous thrombosis treatment. Therefore, intracerebral thrombosis is one of the rare mortal complications of ART.

142-146

Authors: Changjun Zhang , Haiying Peng , Yueyue Hu

A 24-year-old man was diagnosed with klinefelter’s syndrome (KS) and his wife was found to have an inversion on chromosome 9-46, XX, inv (9) (p11q21)- because of infertility. Intracytoplasmic sperm injection (ICSI) was performed for fertilization after fluorescence in-situ hybridization (FISH) was used to analyze the aneuploidy rate of the X and Y chromosomes of the ejaculated sperms of the patient, and 99 sperms were haploid among 100 sperms that were to be analyzed. A twin pregnancy was achieved. The chromosomes of the two fetuses were identified as 46, XY and 46, XY, inv (9)(p11q21) after a prenatal diagnosis at 18 weeks gestation. Two healthy twins were born through caesarean section at 32 weeks gestation because of premature rupture of membranes (PROM).

155-160

Authors: Firoozeh Ahmadi , Shiva Siahbazi , Farnaz Akhbari , Bita Eslami , Ahmad Vosough

Destruction of the endometrium due to trauma to the basal layer of endometrium may cause intra uterine adhesions, known as Asherman’s syndrome (AS). There are various types of imaging method for diagnosis of the intra uterine adhesion such as hysterosalpingography, sonohysterography, ultrasonography, and hysteroscopy which is considered as the gold standard approach. Hysterosalpingogram may suggest the presence of intrauterine adhesions, and may reveal the extent of the scar formation. Knowing different images in each technique is helpful in detection of intra uterine adhesion.

169-174

Authors: Nosrat Bahrami , Masoumeh Simbar , Somayeh Bahrami

Background: Antenatal educations provide information regarding pregnancy, birth, infant care and early parenthood. The purpose of this study was to determine effect of prenatal education on mother’s quality of life during first year after childbirth among Iranian women. Materials and Methods: This single-blind randomized control trial study was performed on 160 first-time pregnant women; with a singleton fetus; aged 18 to 35; without history of medical, psychological, and infertility diseases; as well as with at least eight prenatal visits during pregnancy. Participants were invited into two groups of intervention (n=80) and control (n=80). The antenatal education classes were consisted of eight sessions, and then, mother’s quality of life was evaluated during first year after childbirth. Data was analyzed using t test, chi-square, and Mann-Withney. Results: The interventional group demonstrated higher scores of quality of life domains than the control group (p<0.05). The interventional group (at one year postpartum) demonstrated significantly higher scores for quality of life in the physical health, psychological health, and environmental health domains compared to the control group. In addition, the interventional group showed a significant increase in the mean scores for the domains of physical, psychological, and environmental health from 6-8 weeks to 1 year postpartum. Conclusion: The study showed that women receiving prenatal education had higher level of happiness and satisfaction in their overall quality of life and health, respectively (Registration Number: IRCT201101115571N2).

181-186

Authors: Shabnam Abdi , Mojdeh Salehnia , Saman Hosseinkhani

Background: The aim of this study was to investigate follicular growth and steroid production in neonatal mouse ovary during in vitro culture. Materials and Methods: In this experimental study, 7-day-old mouse whole ovaries were cultured in α-MEM (medium supplemented with 100 mIU/ml recombinant follicle stimulating hormone, 1% insulin, transferrin and selenium (ITS), 5% fetal bovine serum (FBS), 100 IU/ml penicillin and 50 μg/ml streptomycin for 7 days. The size of whole ovary was determined as mean area during culture. The survival rates of isolated preantral follicles after culture were assessed using trypan blue staining after being mechanically isolated. Histological evaluation of whole ovary was done by hematoxylin and eosin staining. 17-β estradiol, progesterone and dehydroepiandrosterone concentrations in the medium were measured during culture. Results: The mean area of ovary increased after culture (1.47 vs. 0.21 mm2). The survival rate of isolated follicles in ovary after culture was 99.2%. There was a significant decline in the percentage of primordial follicles after seven days of culture (91.8 ± 0.2% vs. 65.1 ± 1.1%), whereas the rate of preantral follicles increased significantly (4.6 ± 0.4% vs. 29.2 ± 0.5%). The levels of estradiol, progesterone and dehydroepiandrosterone also increased significantly after culture (p<0.001). Conclusion: These results show that the growth and development of primordial follicles in contrast with hormonal production decreased during in vitro culture of neonatal mouse ovaries.

193-198

Authors: Farzaneh Bassiri , Marziyeh Tavalaee , Mohammad Hossein Nasr Esfahani

Background: Sperm membrane integrity is not only important as a barrier between intraand extra-cellular spaces, but also it can be considered as a sign of DNA integrity. Hypoosmotic swelling test reflects membrane integrity and has been used to evaluate sperm quality. Intracytoplasmic sperm injection (ICSI) in adjunct with hypo-osmotic swelling test (HOST) has been used for treatment of males with asthenozoospermia. Therefore, this study aims to evaluate correlation of different pattern of HOST with sperm parameters, protamine deficiency and apoptosis. Materials and Methods: In this case-control study, sixteen semen samples were randomly collected from infertile normozospermic men. Semen samples were divided into two portions as follows: one portion was assessed for sperm parameters according toWorld Health Organization (WHO)-2010, while the other portion, after applying HOST procedure, was used for assessment of sperm morphology, protamine deficiency and late or early apoptosis. Statistical analysis was carried out using the Statistical Package for the Social Studies (SPSS 11.5). Results: Our results showed that, the lowest odds ratio (OR) of abnormal sperm head morphology and abnormal acrosome was in d-sperm as compared to a-pattern or nonviable spermatozoa (p=0.00, p=0.01). In addition, a significant correlation was observed between d-sperm with sperm concentration and percentage of DNA damage (p=0.03 and p=0.04, respectively). A significant correlation was observed between percentage of sperm motility and DNA fragmentation (r=-0.56; p=0.01). Furthermore, significant correlations were observed between percentages of early apoptotic sperm with protamine deficiency and sperm concentration (p=0.009 and p=0.01, respectively). Conclusion: Significant correlations exist between d-pattern and sperm DNA integrity. Semen samples with low sperm concentration have low percentage of d-sperm which are mature and intact sperms.

207-216

Authors: Anne Oppenheimer , Marcos Ballester , Emmanuelle Mathieu d’Argent , Karine Morcel , Jean-Marie Antoine , Emile Daraï

Background: To evaluate the impact of the association of endometrioma with or without deep infiltrating endometriosis (DIE) after a first intra cytoplasmic sperm injection- in vitro fertilization (ICSI-IVF) cycle on pregnancy rate. Materials and Methods: In this retrospective study, women with endometrioma who underwent a first ICSI-IVF cycle from January 2007 to June 2010 were reviewed for pregnancy rate. The main outcome measure was the clinical pregnancy rate. A multiple logistic regression (MLR) was performed; including all variables that were correlated to the conception rate. Only independent factors of pregnancy rate were included in a Recursive Partitioning (RP) model. Results: The study population consisted of 104 patients (37 without DIE and 67 patients with associated DIE). Using multivariable analysis, a lower pregnancy rate was associated with the presence of DIE (OR=0.24 (95% CI: 0.085-0.7); p=0.009) and the use of ICSI (OR=0.23 (95% CI: 0.07-0.8); p=0.02). A higher pregnancy rate was associated with an anti-mullerian hormone (AMH) serum level over 1 ng/ml (OR=4.3 (95% CI: 1.1-19); p=0.049). A RP was built to predict pregnancy rate with good calibration [ROC AUC (95% CI) of 0.70 (0.65-0.75)]. Conclusion: Our data support that DIE associated with endometrioma in infertile patients has a negative impact on pregnancy rate after first ICSI-IVF cycle. Furthermore, our predictive model gives couples better information about the likelihood of conceiving.

225-238

Authors: Mrinalini Kumari , Poonam Singh

Background: Metronidazole (MTZ) is commonly used as an antibacterial and antiprotozoal drug. Various doses of MTZ have been reported to inhibit spermatogenic activity and sperm indices. Materials and Methods: In this experimental study, dose-dependent effects of MTZ on the structural and functional integrity of the testis and accessory reproductive organs have been investigated. Adult male mice of Swiss strain were administered orally with MTZ at the doses of 250 mg/kgBW/day and 500 mg/kgBW/day for 28 consecutive days to study the changes in the testis, epididymis, seminal vesicle, sperm indices and fertility. Reversal effects of the drug were also studied on the same mice, 42 days after cessation of the treatment. Results: Therapeutic dose of MTZ (250 mg/kgBW/day) neither altered the weights of the testis, epididymis and seminal vesicle nor their histoarchitecture and sperm indices. The drug at the high dose (500 mg/kg BW/day) caused significant reductions in the weights of the testis and epididymis. Histoarchitecture of the testis and epididymis at the high dose revealed marked regressive changes while that of seminal vesicle remained unaffected. Significant reductions were noticed in the motility, viability and count of epididymal spermatozoa while the concentrations of epididymal sialic acid and seminal vesicular fructose remained unaltered after the treatment. No significant changes were noticed in the mating ability as well as in the level of serum testosterone in the treated mice. Fertility of the male mice treated with high dose of MTZ declined markedly leading to an increase in pre- and postimplantation loss while a significant decrease was noticed in the number of live blastocysts in females impregnated with such males. MTZinduced changes in the male reproductive organs and fertility were reinstated 42 days after cessation of the treatment. Conclusion: High dose of MTZ induced reversible deleterious effects on the male reproduction and fertility.

243-244

Authors: Firoozeh Ahmadi , Hadieh Haghighi

Recent advances in reproductive medicine have created a demand for more accurate and safe imaging modalities before assisted reproductive treatment (ART) (1). Gradually, the important role of three-dimensional (3D) ultrasonography in the diagnosis of uterine congenital anomalies has been proved (2-4). The aim of this article is to evaluate a communicated uterus through 3D image, while to compare this result with quite similar images of this patient with hysterosalpingography (Fig1).The patient’s past medical history indicated three first -trimester miscarriages. Therefore, she underwent a hysterosalpingogram (HSG), and was also referred to 3D ultrasound as part of her infertility treatment (before ART). Figure 2 shows an image taken through a 3DXI (ACCUVIX XQ, Medison, South Korea) ultrasound with a 6.5-MHz transvaginal probe equipped with three-dimensional imaging. The uterus was examined systematically .On the coronal view, a long septum divides the cavity and cervix into two parts, and between the divided parts, a connection in isthmus can easily be identified. Congenital malformation of uterus is caused by a numerous anomalies during embryogenesis. The American Society for Reproductive Medicine (ASRM) has classified müllerian duct anomalies (MDAs) to provide substantial assistance in the clinical application of infertility and preoperative decision (5). A communicating uterus, as a rare type of müllerian duct anomaly, does not fall into the classification system of ASRM (6). An alternative embryological deficiency, reviewed by Musset’s classification, describes this anomaly (6). According to this theory, fusion first occurs at the level of the uterine isthmus, and simultaneously, proceeds into the both directions of caudal and cephalad. Later, uterine corpus and cervix are formed by midline resorption initiating at the isthmus, followed by rapid cellular bidirectional resorption of septum. It is not clear whether this is the mechanism for normal müllerian development, or a developmental failure which is unique to other rare anatomical divergence (7). Recent developments in three-dimensional ultrasonography can greatly strengthen diagnostic potential of female reproductive tract anomalies, and also, should be considered as first-line examination. It has the advantages of an easy, inexpensive, reproducible and noninvasive tool for analyzing of morphologic anatomy, which deserves more attention by gynecologists (2). In certain cases, MRI, hysteroscopy and laparoscopy are more effective techniques than others. (3).