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 Primary Tuberculosis of Cervix: A Coincidental Finding <p>Background: 95% of Tuberculosis (TB) of the female genital tract (FGT) is located in tissues other than the cervix. A rare case of primary TB of the cervix which was diagnosed coincidently in a patient of endometrioma was reported in this study.<br /> Case Presentation: A 34 year old nullipara, a diagnosed case of endometrioma had a small cervical growth. Pap smear and biopsy was taken and sent for histopathological examination. Her histopathological examination revealed multiple epitheloid cell granuloma and langerhans type giant cell caeseation. Ziehl neelsen staining was positive for acid fast bacilli (AFB). The patient was started on antituberculosis under directly observed therapy along with oral contraceptive pills. Patient was on regular follow-up and clinically she was doing well.<br /> Conclusion: Although cervical tuberculosis is very rare but for an abnormal looking cervix, cervical tuberculosis should be considered in the differential diagnosis in woman of all the age groups especially in areas where tuberculosis is rampant since these cases are potentially curable with medical therapy. Many of these patients are in reproductive age group. In young women, early diagnosis prevents further damage in reproductive tract and can improve their reproductive potential.</p> https://www.jri.ir/article/673 Cyclic Variation of Cellular Clock Proteins in the Mouse Estrous Ovary <p>Background: The mammalian ovary is controlled by a number of biological rhythms, which regulate the recruitment and release of mature oocytes. The main objective of this study was to investigate the role of cellular clock proteins during follicle maturation in the mouse estrous ovary.<br /> Methods: Immunohistochemical (IHC) studies were performed on ovaries from 50 estrous staged mice culled at two time points of 09:00 [day] and 01:00 [mid-point of the dark cycle]. Six antibodies were used to identify the expression of core cellular clock proteins (BMAL1, CLOCK, CRY1, CRY2, PER1 and PER2) within the ovary and four follicle stages, primordial, primary, antral and corpus lutea. IHC data was scored using the Allred protocol and significance determined by Mann-Whitney tests. Differences were considered significant at p&lt;0.05.<br /> Results: All four follicle stages presented greater BMAL1 and CLOCK protein scores during the day and up regulation of CRY1-2 and PER1-2 at night. In primordial follicles, BMAL1 and CLOCK increases were significant (p&lt;0.05) and CRY-1 and PER-1 were highly significant (p&lt;0.001), and CRY-2 did not reach significance. Primary follicles demonstrated a similar response with BMAL1 and CLOCK, and CRY-1, PER-1-2 all reaching significant expression (p&lt;0.05; p&lt;0.001; p&lt;0.001 respectively). CRY-2 expression was not significant. Antral follicles did not show significant BMAL1 or CLOCK expression, CRY-1 and PER-1 were highly significant (p&lt;0.001) and CRY-2 had a small but significant increase (p&lt;0.05). Corpus lutea demonstrated significant BMAL1 increase but CLOCK had no significant variation. CRY-1, PER1-2 increases were highly significant (p&lt;0.001) and CRY-2 was up regulated but failed to reach significance.<br /> Conclusion: The ovary demonstrated a cellular clock response to the light: dark cycle and in addition, as the ovarian follicles mature changes in the positive and negative arms of both clock responsive proteins were observed.</p> https://www.jri.ir/article/676 Frequency of Y Chromosome Microdeletions Among Iranian Infertile Men with Azoospermia and Severe Oligozoospermia: A Meta-analysis <p>Background: While multiple factors can contribute to male infertility, genetic factors, such as chromosomal disorders or Y-chromosome microdeletion, are responsible for about 10% of male infertility. Considering the role of Y-chromosome microdeletions in men with oligozoospermia who volunteer for <em>in vitro</em> fertilization (IVF), the prevalence of such microdeletions in each particular community needs to be exactly determined. Hence, the present study attempted to analyze the available literature on the frequency of chromosome microdeletion among Iranian infertile men.<br /> Methods: In the first stage, a systematic search was performed on international and Iranian databases including PubMed, Scopus, Web of Science, IranMedex, MEDLIB, and Scientific Information Database in order to extract all relevant studies published until December 1, 2014.<br /> Results: According to the literature review and meta-analysis process, Y chromosome microdeletions were present in about 12.1% (95% CI, 6.5-21.5) of Iranian infertile men with azoospermia and severe oligozoospermia.<br /> Conclusion: Because of the presence of Y-chromosome microdeletion in at least 12% of Iranian infertile men, it is necessary all the IVF centers, implement this Y-chromosome microdeletion screening tests in the work-up of male infertility.</p> https://www.jri.ir/article/679 Distress in Infertile Males in Manipal-India: A Clinic Based Study <p>Background: Being infertile comes as an overwhelming realization for couples trying to conceive. In consideration of rising rates of infertility worldwide, clinicians in India have also begun exploring this field for new possibilities, development and research. The purpose of this study was to estimate the proportion and predictors of infertility specific stress in males diagnosed with primary infertility.<br /> Methods: This cross-sectional research was conducted in an assisted reproduction center, Manipal, India, on 300 infertile married males. The tools were &quot;semi-structured questionnaire&quot; compiled by the authors, &quot;ICD-10 Classification of Mental and Behavioural Disorders (Clinical Descriptions and Diagnostic Guidelines) and&quot; Psychological Evaluation Test for infertility. Multiple logistic regression analysis was carried out on data with p-value fixed as 0.05.<br /> Results: The presence of stress was reported in 72% of male participants. The predictors of stress were nature and severity of their infertility diagnosis, sperm defects, urological condition and experience of corrective surgery undergone for it. Psychological stress in men was also predicted by present and past history of significant psychiatric morbidity and coping difficulties associated with it.<br /> Conclusion: The stress is both a common experience and at times a clinical condition associated with deteriorating mental and physical health in men seeking fertility treatments. As a prerequisite, Indian fertility clinics need to treat stress as an identifiable condition and devise ways of addressing it at all stages of assisted conception and reproductive treatments.</p> https://www.jri.ir/article/680 Thyroid Function and Autoimmunity Versus Number of Pregnancies <p>Background: Thyroid autoimmunity may be linked to infertility, in both thyrotropin (TSH)-dependent and TSH-independent fashion. The aim of the present study was to assess this presumed reciprocal relationship of thyroid autoimmunity and pregnancy.<br /> Methods: TSH and antithyroid peroxidase autoantibodies (anti-TPO) were evaluated retrospectively over an eight-year period in 444 Greek women who had previously none or at least one pregnancy (&gt;28 weeks). Statistics were done with analysis of covariance (ANCOVA) and the Chi square test.<br /> Results: Thyrotropin was higher in women with one pregnancy and lower in those with two or more pregnancies compared to women with no pregnancies. Furthermore, significantly more women with no pregnancies were anti-TPO (+), compared to women with one or those with at least two pregnancies.<br /> Conclusion: Because pregnancy might contribute to the development of thyroid autoimmunity, women should be monitored for development of thyroid autoimmunity long after their pregnancies, even after an uneventful first conception, pregnancy and delivery of a live infant.</p> https://www.jri.ir/article/681 The Relation Between Marital Adjustment and Posttraumatic Growth in Infertile Couples: The Mediatory Role of Religious Coping Strategies <p>Background: Infertility as a crisis can both lead to negative reactions and stress in infertile couples and bring about positive reactions and growth, to which henceforth posttraumatic growth is referred. This study was conducted to model the relation between martial adjustment and posttraumatic growth through the mediation of religious coping strategies in infertile couples.<br /> Methods: This correlation-based study was performed on 250 couples at the infertility center of Shariati hospital, Tehran, Iran, selected via convenience sampling. They answered to the Marital Adjustment Scale, the Posttraumatic Growth Inventory, and the Religious Coping Strategies Inventory. This study used Structural Equation Modeling.<br /> Results: The results showed significant positive relationships between marital adjustment and both positive religious coping strategies and posttraumatic growth. A significant positive relationship between positive religious coping strategies and posttraumatic growth was also detected. Positive religious coping strategies were observed to play a mediatory role between marital adjustment and posttraumatic growth. This was the case while attributing such a mediatory role to negative coping strategies was not possible.<br /> Conclusion: Based on the results, this study can be seen as further evidence showing the necessity of focusing on the role of positive religious coping strategies in marital adjustment and posttraumatic growth in infertile couples.</p> https://www.jri.ir/article/682 Intention for Cesarean Section Versus Vaginal Delivery Among Pregnant Women in Isfahan: Correlates and Determinants <p>Background: Iran has the second highest rate of cesarean section in the world. the corresponding rate in the third metropolitan city of Iran, Isfahan, is even higher. This paper aimed to assess correlates and determinants of intention for cesarean section versus normal vaginal delivery (NVD) among pregnant women in Isfahan.<br /> Methods: A study was conducted among 400 pregnant women aged 18-38 years, with gestational age of 24-40 weeks who attended labor clinics of nine hospitals in Isfahan during June and July 2014. Probability proportional to size was used to estimate the number of cases required to be selected for each hospital. T-test, chi-square and logistic regression analysis were employed to analyze the data.<br /> Results: Mean age of women was 26.6&plusmn;4.4 years. Multivariate analysis identified selected factors as determinants of intention for CS. These were &quot;the role of physician&quot; (OR=1.33, p&lt;0.001), &quot;subjective norms&quot; (OR=1.19, p&lt;0.01) and &quot;body Image&quot; (OR=1.46, p&lt;0.001) upon control of education, income and intended fertility (number of children intended). Moreover, path analysis showed that &quot;attitude towards cesarean section&quot; and &quot;individualism&quot; influence CS decision through subjective norm.<br /> Conclusion: Choosing cesarean section voluntarily is a multifaceted decision which is shaped by various factors; hence, comprehensive interventions are suggested to discourage voluntary cesarean section. These interventions need to encompass changes in physicians&rsquo; role, social norms, body image and correcting misperceptions among women towards CS and NVD during prenatal courses.</p> https://www.jri.ir/article/685 Short Term Organ Culture of Mouse Ovary in the Medium Supplemented with Bone Morphogenetic Protein 15 and Follicle Stimulating Hormone: A Morphological, Hormonal and Molecular Study <p>Background: Bone morphogenetic protein 15 (BMP15) is a growth factor derived from oocyte and is essential for <em>in vivo</em> ovarian follicular growth and in this study, its effects on the improvement of growth and development of follicles during <em>in vitro</em> culture of neonatal mouse ovaries was investigated.<br /> Methods: Two week old mice were cultured for 7 days in the basic culture media with or without follicle stimulating hormone (FSH) and BMP15 as four experimental groups; FSH<sup>-</sup>/BMP15<sup>-</sup>, FSH<sup>+</sup>/BMP15<sup>-</sup>, FSH<sup>-</sup>/BMP15<sup>+</sup> and FSH<sup>+</sup>/BMP15<sup>+</sup>. The ovarian follicles at different developmental stages in paraffin embedding sections of cultured and non-cultured ovaries were counted and compared. The 17-&beta; estradiol (E2) and progesterone (P4) levels were analyzed in collected culture media. The expression ratio of developmental genes (PCNA, BMPR-IB, BMPR-II, FSH-R, CYP17 and ZP3) to housekeeping gene (GAPDH) was analyzed by real time PCR (RT-PCR) in comparison with non-cultured control ovaries. The data was compared by independent t-test and one-way ANOVA (with Tukey&rsquo;s Post Hoc test). The p&lt;0.05 was considered significant.<br /> Results: The percentage of antral follicles, ovarian size, concentration of E2 and P4 and the expression ratio of PCNA and ZP3 genes in the ovaries cultured in medium supplemented with BMP15 and FSH increased significantly in comparison with other cultured groups (p&lt;0.05). The BMPR-IB, BMPR-II and FSH-R mRNA level was significantly lower (p&lt;0.05) and CYP 17 mRNA level did not change in the FSH<sup>+</sup>/BMP15<sup>+</sup> group than other cultured groups.<br /> Conclusion: This study demonstrated a favorable effect of BMP15 in combination with FSH on <em>in vitro</em> development of small size mouse follicles to antral stage.</p> https://www.jri.ir/article/686 A Rare Case of Gestational Gigantomastia with Hypercalcemia: The Challenges of Management and Follow up <p>Background: Gigantomastia is a breast disorder marked by exaggerated rapid growth of the breasts, generally bilaterally. Since this disorder is very rare and has been reported only in sparse case reports its etiology has yet to be fully established. Treatment is aimed at improving the clinical and psychological symptoms and reducing the treatment side effects; however, the best therapeutic option varies from case to case.<br /> Case Presentation: The present report described a case of gestational gigantomastia in a 30-year-old woman, gravida 2, parity 1, 17 week pregnant admitted to Pars Hospital, Tehran, Iran, on may 2014. The patient was admitted to hospital at week 17 of pregnancy, although her breasts initially had begun to enlarge from the first trimester. The patient developed hypercalcemia in her 32nd week of pregnancy. The present report followed this patient from diagnosis until the completion of treatment.<br /> Conclusion: Although gestational gigantomastia is a rare condition, its timely prognosis and careful examination of some conditions like hyperprolactinemia and hypercalcemia is essential in successful management of this condition.</p> https://www.jri.ir/article/689 ART Strategy for Treatment of Recurrent Pregnancy Loss: Isn’t It Better to Forget? https://www.jri.ir/article/695