https://www.jri.ir/ "Journal of Reproduction & Infertility" is owned, published, and copyrighted by ©2009 Avicenna Research Institute. No parts of this journal may be reproduced in any form or by any means unless properly referenced or sent a notification letter through www.jri.ir en Morphometrical study of the effects of ovulation induction drugs in long protocol on ultrastructure of human endometrial epithelium during the implantation Window Introduction: The use of ovulation induction drugs such as: GnRHa, HMG and HCG to induce super ovulation and harvest more oocyte, known as long protocol, is now a commonplace in Assisted Reproductive Techniques (ART). Recent studies and experiences indicate that the rate of successful implantation in stimulatory cycles is less than natural cycles. In the present study we have investigated the possible effects of the above mentioned drugs on ultra structures of human endometrial tissues (luminal and glandular epithelium) on the 20th day of menstrual cycle (LH+6). Materials and Methods: Biopsies were obtained from infertile women who were under super ovulation treatment and from fertile women (as control) who referred to infertility center of Tabriz University of Medical Sciences between 2001- 2003, on day LH+6. The control group (n=5) were normal fertile women who had not received ovulation induction medications and the study group (n=10) were under standard long protocol but the embryo had not been formed due to male factor problem. After preparation and taking light and electron micrographs photographs from samples, qualitative and quantitative evaluations (morphologic and morphometric) were accomplished and the data were compared using unpaired student t test. Results: Qualitative results revealed the presence of nuclear channel system (NCS), vacuoles of glycogen & giant mitochondria in both groups. Quantitative analysis showed that volume fraction of organelles in glandular & luminal endometrial epithelium such as euchromatin to nucleus, RER to cell, mitochondria to cells in test group were significantly higher than those in the control group (P<0.05) which shows a higher state of activation than those in the controls. Conclusion: These results suggest that ovulation drugs distort the normal development of endome-trium in midluteal phase, coincident with implantation window, and consequently decrease the imp-lantation success rate. Therefore, ART protocols without the use of ovulation induction drugs may improve the successful implantation rate. https://www.jri.ir/article/146 Inhibitory effect of Decidual Culture Supernatants on Antigen Presentation by Dendritic cells Introduction: Despite the unrecognized nature of fetal antigens for maternal immune system, the fetus is usually not rejected and is rather sustained by maternal immune system. The immunological mechanisms that protect the fetus from rejection are not completely understood. One of the main hypotheses is the appearance of immuno-suppressive factors in the feto-maternal interface that suppress maternal immune responses against the fetus. Although the effects of decidual or placental cell culture supernatants on the function of different immune cells have been studied, the effects of such factors on dendritic cells (DCs) have not been evaluated yet. In this study the immunomodulatory activity of decidual cell culture supernatants on in vivo antigen presentation by DCs has been addressed. Materials and Methods: Decidual cells obtained from the uteri of allogenic pregnant mice (Balb/c× C57BL/6) on day 12 post conception, were cultured for 48 hours and supernatants collected. DCs were purified from Balb/c mice spleens by a four step method including collagenase digestion of splenic tissues, selection of low density cells by Optiprep density gradient centrifugation, plastic adherence and overnight culture. The purity of dendritic cells was detected by flow cytometry method using anti CDllc antibodies. During overnight cultures, DCs were pulsed with antigen. In some cultures decidual supernatants were added at 5%, 10% or 20% fractions of the final volume. Antigen pulsed DCs were injected into the footpads of syngeneic mice and after 5 days, draining lymph nodes were excised. Lymph node cells of immunized mice were cultured in the presence of antigen and the rates of cell proliferation were measured on the 4th day by thymidine incorporation. Results: The results showed that antigen-pulsed DCs primed antigen-specific lymphocytes efficiently and the primed lymphocytes did proliferate vigorously in response to recall antigen in vitro (cpm=89210 3632). Treatment of DCs with decidual culture supernatants by any concentration, markedly blocked antigen presention by these cells and significantly reduced the extent of antigen-specific proliferation of lymphocytes primed with such DCs. (cpm= 6200582) (p<0.0001). Conclusion: To our knowledge this is the first report on the effect of decidual culture supernatants on antigen presentation by DCs. It seems that inhibition of antigen presentation by DCs is one of the main mechanisms of maternal immunological tolerance to the fetus since DCs, as the most potent antigen presenting cells, could potentially present paternal antigens to maternal T lymphocytes and thereby provoke destructive immunological responses to the fetus. https://www.jri.ir/article/147 Relationship between level of lipid peroxidation markers in seminal plasma and sperm motility Introduction: Although all leading causes of impaired sperm motility are not completely understood, poor sperm forward motility (asthenozoospermia) is considered to contribute to the infertility of a significant number of males. One of the major factors that can potentially cause asthenozoospermia is oxidative stress induced by reactive oxygen species (ROS). The aim of this study was to investigate lipid peroxidation by measuring a novel marker of lipid peroxide-tion, F2α-isoprostane, and malondialdehyde (MDA) in seminal plasma of normozoospermic vs. asthenozoospermic men, and their relationship with sperm motility. Materials and Methods: We designed a case-control study with a total subject of 30 males. After semen analysis subjects were determined to be either normozoospermic, as the control group (n=15), or asthenozoospermic, as the case group (n=15). Seminal plasma level of F2α-isoprostane was measured using a commercially available enzyme immunoassay (EIA) kit. The amount of MDA was determined by the thiobarbituric acid (TBA) assay. The Mann-Whitney test was used to compare results of the two groups. Coefficients of correlation between sperm quality parameters and the concentration of Isoprostan F2α and MDA were calculated using Spearman’s correlation analysis. Results: The mean level of F2α-isoprostane did not show a significant difference between the two groups (p>0.05). But, the difference of mean MDA between the two groups was statistic-ally significant (p<0.05). Sperm motility was inversely correlated with both F2α-isoprostane and MDA levels (p<0.05). Conclusion: Our results suggest that sperm membrane lipid peroxidation might not have a significant role in asthenozoospermia etiology, but further investigations are needed for confirmation. https://www.jri.ir/article/148 Effect of Ketotifen as mast cell blocker on sperm parameters and sperm chromatin in unexplained male infertility Introduction: Mast cells play an important role in inflammation, hypersensitivity and fibrosis. Mast cells are normally present in most of peripheral tissues including testes. Studies of literatures suggest that there is a prominent increase in number of testicular mast cells in testes of infertile patients which might result in peritubular fibrosis and consequently disruption in spermatogenesis. Therefore, it appears that treatment with mast cell blockers prevents mast cell release of vasoactive substances and thereby, reduction in inflammation and fibrosis might improve semen parameters. The aim of this study was to evaluate the effect of ketotifen, as a mast cell blocker, on semen parameters and sperm chromatin quality in infertile males. Materials and Methods: This prospective study was carried out on 10 oligospermic and 14 non-oligospermic infertile males, who referred to Isfahan Fertility and Infertility Center, all of cases had normal gonadotropin and testosterone levels, without female factor defect. The two groups were treated with 1mg ketotifen, twice daily for 3 months. Semen parameters and sperm chromatin (CMA3 and aniline blue staining) were assessed on days 0, 45 and 90 after ketotifen administration. Results were analyzed by SPSS software using paired samples student t-test. Results: In the oligospermic group, only seminal volume increased significantly on day 45 (P=0.005), however on day 90, seminal volume, total sperm density, percentage of normal morphology, normal head morphology and sperms with normal histone were increased significantly (P≤0.05), though sperm motility decreased (P=0.025). Two pregnancies were recorded in this group (20%). In non-oligospermic infertile males, the sperm density decreased significantly on day 45 compared to day 0(P=0.03), however, this value rebounded to pre-treatment value by day 90 (P>0.05). The percentage of sperms with normal morphology, normal head and normal histones increased significantly on day 90 (P≤0.05), whereas, percentage of protamine deficient sperm decreased significantly (P≤0.05). Two pregnancies were recorded in this group (14.3%). The mean values of FSH, LH and testosterone did not change significantly before and after treatment (P>0.05). Conclusion: Considering the improved sperm morphology and sperm chromatin quality, treatment with ketotifen as a mast cell blocker is advised for the treatment of unexplained infertility patients. Meanwhile, since the success rate of Assisted Reproduction Technique (ART) depends on the quality of sperm, pretreatment ketotifen is recommended for patients who undergo ART. https://www.jri.ir/article/149 Comparison of effectiveness of two vaginal Misoprostol regimens, 400 &#956;g and 600 &#956;g on pregnancy termination in the 2nd trimester Introduction: In a number of complications including intrauterine fetal death, premature rupture of membrane, chorioamniotitis and preeclampsia, gynecologists have to terminate the pregnancy in the 2nd trimester to save the mother’s life. The methods of pregnancy termination in a uterus larger than 14 weeks in size, include spontaneous contractions, PGE1 and PGE2 vaginal suppositories, intravenous oxytocin injection, intra amniotic injection of PGF2α, Ethacrynic Acid, and hypertonic saline. Misoprostol, a synthetic PGE1 analogue, which was developed for the prevention of peptic ulcer disease with potent uterotonic and cervical ripening activity, is nowadays applied in the management of obstetric problems like termination of pregnancy. The goal of the present clinical trial is to compare the effectiveness, side effects, hospitalization period and the need for surgical evacuation, when 400 μg and 600 μg Misoprostol is applied to terminate a second trimester pregnancy. Materials and Methods: One hundred women with medical indications for termination of pregnancy in the second trimester were recruited in Mirza Koochak Khan Hospital in 2002- 2003. They were randomly divided into two groups (each group with 50 cases). One group received 400 μg vaginal Misoprostol suppositories (Group A) and the other group 600 μg (Group B) every 12 hours in posterior fornix, upto a maximum total of 4 doses. For Comparison of the results in the two groups 2 and t- test were used. Results: In the group A, 84%, as compared to 80% in the group B, had a complete expulsion of the product of conception. Fourteen percent in group A and 20% in group B needed curettage. The success rate of treatment (complete expulsion of pregnancy products) after 48 hours was 98% and 100% in Group A and group B, respectively. The interval between induction and expulsion of fetus was shorter in the group B (9.26.7 hours) than in the group A (12.27.7 hrs, p=0.003) and in patients with intrauterine fetal death (7.42.8 hrs) compared with premature rupture of membrane (11.9 9.6 hrs, p=0.005). The placenta was expelled after the fetus with shorter interval in group A (p=0.02). There was no statistically significant difference between the two groups concerning the duration of hospitalization and maternal complications such as nausea, vomiting, diarrhoea, fever, unrelenting abdominal pain and hemoglobin drop. Conclusion: Vaginal administration of Misoprostol is a quite safe, efficient and cost effective method for termination of pregnancy in the second trimester. In emergency situations such as chorioamniotitis and preeclampsia, 600 μg dose might be recommended for rapid expulsion of products of conception, otherwise 400 μg dose is a less costly alternative. https://www.jri.ir/article/150 Effects of uterine fibroma on implantation and abortion in infertile patients under ART Introduction: Surveys indicate that 10-15% of couples in reproductive ages are infertile. Fur-thermore, 20% of women will develop a fibroid during their reproductive life. Fibroid is infer-quently considered as a sole primary etiology of infertility. However, Considering the signify-cance of infertility in gynecology and the prevalence of uterine fibroids in reproductive age, as well as the discrepancies in the results of different studies regarding the impact of fibroids on fertility, accurate management of fibroids in infertile cases deserves greater Consideration. Considering the disagreements in this background, the present study was designed to study the effects of uterine fibroids on implantation and abortion in assisted reproductive techniques. Materials and Methods: In our cohort study 120 and 240 ART cycles in infertile patients with & without fibroma, respectively, admitted to Shariati Hospital in 2001-2003, were assessed for the effects of fibroids on implantation and abortion by using logistic regression analysis for confounding variables. Results: Successful Implantation in patients with and without fibroma was 16.7% and 28.7% respectively, with a statistically significant difference (P=0.014, OR=1.72, CI=1.1– 2.7). This relation was more prominent after logistic regression analysis for confounding variables, raising the adjusted OR from 1.72 to 2.17. Implantation rate, in less than 3 cm fibroma was more than 3.1 - 5 cm fibroma. Abortion rates in patients with and without fibroma were 71.4% & 34.9% respectively, that indicates abortion rate is significantly higher in the presence of fibroids even after elimination of other factors (P=0.024). Conclusion: In this study the negative effect of fibroma on implantation and increasing rate of abortion were obtained by logistic regression analysis, however, further clinical trials are essential to verify the competence of operative resection of different size fibroids to improve the outcome of ART. https://www.jri.ir/article/151 Effect of behavioral-cognitive education on reduction of anxiety in women with primary infertility who undergo GIFT and ZIFT Introduction: Infertility is a complex crisis in life that leads to psychological and emotional stress in couples. Infertility and its treatment are breeding grounds for stress. Cycles of hope followed by crushing disappointment, along with the high costs and low success rates of medical therapies, can lead to depression, anxiety and many other psychological problems. Since, the success in programs called Assisted Reproduction Technology (ART) depend on the adjustment strategies to anxiety and stress which significantly arise during treatment procedures, a quasi experimental research project was designed to determine the effects of one of the behavioral-cognitive techniques on reduction of anxiety in women with primary infertility who undergo GIFT/ZIFT, in infertility clinic of Shariati Hospital during July- Febuery 2002. Materials and Methods: The sample group composed of 60 women with primary infertility who were allocated into two experimental (n=30) and control (n=30) groups. The preliminary evaluation of the state and trait anxiety of all subjects was conducted on day 21 of the menstrual cycle by Spielberger Anxiety Inventory. The intervention in the experimental group included a behavioral cognitive training program, cognitive restructuring and relaxation for 15-20 days. The control group received only routine cares. The state and trait anxiety were again evaluated in all participants 2 days before and 2 days after the operation. Results: Results showed that the state and trait anxiety scores at the beginning and the end of study were not significantly different between the two groups. But the state and trait anxiety scores before GIFT/ZIFT operations were significantly lower in the experimental group (P=0.002 and 0.028, respectively). The state and trait anxiety was significantly different between before and after intervention in experimental group (p=0.0001), but not in control group. The mean variation of state and trait anxiety from following intervention to after study and form before intervention to after study was significantly different in the two groups (p<0.05). Conclusion: The results showed that behavior cognitive education are effective in reduction of anxiety in primary infertility cases that undergo ART treatment. Besides, in women who showed anxiety reduction following intervention, the rate of successful treatment was significantly higher compared with the control group. Concerning the positive effect of behavior cognitive education and emotional support of infertile cases on reduction of anxiety and improvement of success rate, we recommend, the instructional and supportive programs to be promoted by the expert teams including psychologists. https://www.jri.ir/article/152 Case report on a huge paraovarian cyst Introduction: Paraovarian cysts originate from peritoneum, tube or Wolfian ducts. They are usually very small and their maximum diameter is two centimeters, most often discovered accide-ntttally during the operation. In sonographic view, they have the same characteristics as ovarian cysts, being differentiated by smaller size, adjacency to ovary and persistence. Rupture, hemorrh-age and torsion of paraovarian cysts occasionally occur, but their voluminous enlargement rarely happens. The aim of the present case report is introduction of the probability, diagnosis and treat-ment of huge paraovarian cysts. Case Report: The patient was a 48 years old woman with history of four cesarean deliveries and no abortions (G4P4Ab0), referred to Gynecology Clinic of Shahid Yahya Nejad Hospital, Babol, complaining about abdominal distension and vaginal bleeding. In physical examination, a distend-ed abdomen with a soft tumor extended form pelvis to over umbilicus was palpable. Laparotomy was planned using sonographic diagnosis of pelvic mass. The uterine size was found to be larger than normal (1109481mm) during the operation. The right ovary was normal but the left ovary contained a small 3cm cyst. A huge cystic mass, originating form lateral side of the right ovary, filled the whole abdominal cavity up to the diaphragm. A sample of 20ml of the cystic fluid was first aspirated with syringe and sent for cytological study. Then 2800 ml fluid from the cyst was evacuated. Finally, cystectomy and total hysterectomy with bilateral salpingo-oophorectomy was performed. The pathology report was paraovarian cyst. Conclusion: According to many reports, when a sonographic study shows the ovaries close to a pelvic cyst, paraovarian cyst is one of the first diagnostic choices and accordingly the treatment plan could be selected with a cyst aspiration followed by laparoscopic cystectomy or laparotomy. https://www.jri.ir/article/153