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 Testis Specific Gene 10 expression in the testes of patients with non-obstructive azoospermia Introduction: Disorders in the expression of any gene effective in spermatogenic pathway is known as a probable cause of non-obstructive azoospermia and male infertility. The way respon-sible genes for sperm motility are expressed can considerably affect male fertility. Recent studies show that TSGA10 gene is effective in the natural process of spermatogenesis as protein produced by this gene in mouse results in the production of the main structure of sperm tail. Up to now, no comprehensive studies have been done on the way this gene is expressed in the infertile's testical tissue. Materials & Methods: In this study, TSGA10 mRNA expression in testicular samples of 84 patients with non-obstructive azoospermia was investigated by semi-quantitative nested RT-PCR in Avesina Infertility Clinic during 2005-6. Moreover, expression levels of TSGA10 during spermatogenesis were evaluated using Johnsen’s method for histopathological scoring of the samples. For statistical analysis, SPSS software (Version 11.2) was used. The difference between gene expressions was done based on quantitative variables by the use of t-test and covariance analysis and α<0.05 was regarded as a statistically significant value.Results: Testicular TSGA10 mRNA expression was observed in 31 patients, (36.9%), with non-obstructive azoospermia which it had a statistically significant correlation with spermatogenesis progress (p<000.0). Histopathologically, the gene had been expressed in patients with higher Johnsen’s score of spermatogenesis while a lack of expression was seen in all of those with Johnsen’s score less than 4.5. Conclusion: The findings indicate that TSGA10 is expressed in human testis and it is restricted to germ cells. It seems that lack of TSGA10 expression may have negative effects on spermato-genesis and on male fertility. On the other hand, determination of the timing of gene expression in a certain level of spermatogenesis may also be used to determine levels of spermatogenesis in azoospermic patients alongside histopathological findings. https://www.jri.ir/article/236 Effect of pregnant mouse serum on induction of indolamine 2, 3- dioxygenase in dendritic cells Introduction: Several studies have shown that many factors are involved in the maternal tolerance to the fetus. Indolamine 2, 3- dioxygenase (IDO) enzyme which catabolizes tryptophan is one of the factors that have been reported to play an important role leading to a successful pregnancy. The objective of this study was to evaluate the effects of pregnant mouse serum on the induction of indolamine 2, 3 dioxygenase in dendritic cells (DCs) which may be used as a basis for practical studies on the immunological bases of recurrent abortions. Materials & Methods: Allogenic pregnant mice sera were collected in mid-pregnancy. DCs were isolated from Balb/c mouse spleen through a three-step method, including: Collagenase digestion of spleen tissue, low density cells separation via the Nycodenz density gradient centri-fugation and plastic adherence. T cells were isolated from C57BL/6 mouse lymph nodes through nylon wool method. As stimulator cells, pregnant and non-pregnant mice sera treated DCs were irradiated and co-cultured with purified T cells (allogenic MLR). 1-methyl-tryptophan (1-MT), as the specific inhibitor of IDO, was added to some wells of MLR assay in different concentrations and T cells proliferation response was measured by 3H-Thymidine incorporation. The MLR supernatant was also analyzed by HPLC for its tryptophan and kynurenin (Trp metabolite) content. All tests were repeated for 5 times. Man-Whitneys non- parametric test was used to evaluate the differences among groups. Confidence interval was 95% and p-values <0.05 were regarded as significantResults: The results showed the ability of pregnant mice sera to reduce the dendritic cells ability in T cell proliferation induction compared to non-pregnant mice sera but addition of 1-MT did not have any significant effect on this inhibition. Additionally, IDO metabolites concentration assessment in the presence or absence of 1-MT, through HPLC method, did not show any significant difference.Conclusion: There are many factors in pregnant mice sera such as progesterone, IL-10, Vit D3, etc. Which might cause inhibition of T lymphocyte proliferation response in allogenic MLR through affecting DCs' efficiency. Although it seems that IDO expression by DCs is not respon-sible for decrease in T cell proliferation after treatment of DCs by pregnant mice sera, thus some other mechanisms might be responsible for this phenomenon which their identification needs more investigation. https://www.jri.ir/article/239 Polymorphism in Phospholipid Hydroperoxide Glutathione Peroxidase (PHGPX) gene in Iranian infertile men Introduction: Leukocytes and defective or dead spermatozoa in human semen are a source for the production of reactive oxygen species (ROS) and subsequent injury to intact sperms. Enzymatic and non-enzymatic defensive mechanisms in semen detoxify these compounds. Glutathione peroxidase-4 (GPX-4 or PHGPX) is a major selenoprotein in sperm and it is one of the enzymatic mechanisms that play multiple roles during spermatogenesis. Some of these roles are formation of the mitochondrial capsule, hydro-peroxide detoxification and sperm chromatin condensation. Any decrease in the enzyme activity or content, may create disorders in spermatogenesis and sperm fertilizing ability. Considering defects in the expression of the enzyme gene or presence of mutations which may cause decreases in PHGPX activity or content, this study was carried out to identify a number of important mutations in GPX-4 gene by PCR-RFLP method in Iranian infertile men. Materials & Methods: This study was performed on 128 Iranian men who had been referred to Avesina Infertility Clinic, including 74 infertile men with defective sperm parameters, 18 normozoospermic and 36 fertile subjects as controls. Mean ± SD for sperm parameters were determined. Genomic DNA was extrac-ted using salting out procedure from peripheral blood leukocytes. PCR-RFLP was done by two sets of primers with 237 bp and 148 bp PCR products that were designed for 1A and 4 exons of GPX-4 gene covering nucleotides of +6 (CT), +17 (GA), +1725 (GA) by MwoI, PshAI and SatI enzymes.Results: Digestion of a 237 bp intact PCR product by MwoI generates two fragments (151 bp and 86 bp). When a mutation occurs in the restriction site +6 (CT), the enzyme would not recognize the sequence, therefore 237 bp segment remains undigested. Treatment of 237 bp segment with PshAI generates two fragments (161 bp and 76) in the intact gene but the same enzyme can not digest 237 bp segment when a mutation occurs in the restriction site +17 (GA). Ultimately, digestion of 148 bp intact segment with SatI generates two fragments (108 bp and 40 bp) but when a mutation occurs in the restriction site +1725 (GA), the enzyme will not recognize the sequence; therefore 148 bp segment remains undigested. Enzy-matic digestion evaluations of 237 bp and 148 bp segments in all participants revealed that neither of the examined mutations existed in GPX-4 gene.Conclusion: According to the results of this study, it is determined that the prevalence of these mutations in Iranian infertile men is probably low and it may have no association with the etiology of the disorder affecting sperm parameters. Hence, a study with a larger number of patients is suggested to determine the exact prevalence of these and other mutations of the gene in Iranian infertile men. https://www.jri.ir/article/240 The effects of Human Chorionic Gonadotropin on germ cell maturation and testosterone secretion in neonatal mouse testis Introduction: Human chorionic gonadotropin (hCG) as an LH agonist affects spermatogenesis and germinal cell numbers, and has extensive usages in infertility treatments. The aim of this study was to determine the effects of varied doses of hCG on germinal cell proliferation and androgenic status in mouse model.Materials & Methods: In this study, hCG dosages of 5 to 50 IU were injected into 18 mice in three experimental groups and 6 mice served as the control group (Group 1). The mice in groups 2, 3 and 4 received subcutaneous injections of 5, 10 and 50 IU doses of hCG respectively, on days 15 and 25 of their lives. Blood samples were obtained from each mouse on days 28 and 65 for serum measurements of testosterone. One testis of each mouse was harvested for flow cytometric DNA analysis on day 65. Results: Serum testosterone levels on day 28 were greater in groups 2, 3 and 4 compared to that of the control group. With increasing doses of hCG, the mean testosterone levels increased too and the highest values were observed in group 4. However, serum testosterone levels on day 65 were greatest in group 1 but progressively decreased in groups 2, 3 and 4, lowest in group 4, but there were no significant statistical differences among the groups. Groups 3 and 4 had a signi-ficantly reduced mean haploid cell numbers on day 65.Conclusion: The results of this study showed that testosterone production in neonatal mouse testis increases after hCG injection and there is a linear relationship between serum testosterone and hCG injections. With the passage of time and clearance of hCG, Leydig cell stimulation decreases and subsequently testosterone levels diminish too, especially in mice with highest doses of hCG injections. Therefore, for testosterone production in neonatal mouse testis, conti-nuous stimulation of Leydig cells is essential. https://www.jri.ir/article/241 Effects of acrosomal activity and morphology on fertilization rates following ICSI Introduction: Fertilization failures after ICSI may be due to different factors related to oocyte, sperm or both of them. Considering the importance of sperm morphology, acrosomal activity in oocyte activation and fertilization rates, this study was done to evaluate the relationship between a series of events occurring during spermiogenesis such as sperm morphology and acrosomal activity as an index for acrosomal integrity and the relationship between sperm ability to induce oocyte activation with fertilization rates following ICSI.Materials & Methods: Semen samples from 68 infertile couples undergoing ICSI at Isfahan Fertility and Infertility Center were assessed. Some of each semen sample was analyzed for semen parameters according to WHO criteria, most of it was used for ICSI and the rest for Papanicolaou staining and gelatinolysis test to evaluate sperm morphology based on the strict criteria and acrosin activity respectively. The results were analyzed by SPSS software (Version 11.5) and correlation coefficient was determined. P-values less than 0.05 were considered statistically significant.Results: Results from gelatinolysis showed that the mean halo diameter had a significant positive correlation with sperm concentration (r=0.343, p=0.004), motility (r=0.282, p=0.020), sperm morphology according to the WHO criteria (r=-0.314, p=0.009), fertilization rate (r=0.270, p=0.026) and the percentage of halo formation (r=0.853, p=0.001). Conclusion: The results of the study revealed that during ICSI, spermatozoa with small acrosome, which are likely to have reduced gelatinolysis test parameters (Smaller percentages of halos and smaller mean halo diameters), have lower fertilizing potential. As gelatinolysis test is considered as an index for acrosomal and perinuclear theca integrity, lower fertilizing ability in these spermatozoa could be likely due to their reduced levels of sperm associated oocyte activating factors (SAOAFs). Therefore, studies for the identification and measurement of SAOAF levels in these kinds of spermatozoa are proposed. https://www.jri.ir/article/242 Therapeutic effects of vitamin D and calcium in patients with polycystic ovary syndrome Introduction: Polycystic ovary syndrome (PCOS) is the most important cause of oligoovulation and anovulation in women of reproductive age and in infertile women. Considering insulin resistance and hyperinsulinemia in this syndrome, it is believed that calcium, as well as vitamin D, will have a unique role in correcting the impairment in insulin secretion and help the deve-lopment of oocytes in mammals. Therefore, this study was carried out with the objectives of evaluating the effects of calcium on human ovulation and on the size of follicles in comparison with the current use of metformin.Materials & Methods: In this research, all PCOS patients (In accordance with the Rotterdam criteria and diagnosis confirmation by a gynecologist) who attended the infertility unit of Vali-e-Asr Reproductive Health Research Center from 2004 to 2005, after expressing their willingness to participate in the research were assigned to three 20-patient treatment groups as it follows: The cases were treated daily with: 1) Calcium/Vit. D (1000mg), 2) Calcium/Vit. D (1000mg) and metformin (1500mg) or 3) Metformin (1500mg) tablets for 3 months and were followed up for 3 more months. After this 6-month period, the size of dominant follicles, regularity of menses and pregnancy were checked for. After data collection and entry, statistical analysis (Kruskal Wallis, t-test, ANOVA and Generalized Estimating Equation (GEE) Regression) on the basis of the hypothesis, with a significance level of p=0.05 was performed by using SPSS software (Version 11).Results: Considering the response to treatment by the patients (Dominant follicle 12mm in size), GEE showed that the response was significantly higher during the 5th-6th months in the Calcium/Vit. D and metformin treatment group than the ones from the other groups (p= 0.03). Conclusion: Considering the effects of metformin in reducing and regulating insulin production, and vitamin-D in regulating and correcting serum insulin levels, simultaneous administration of these two medications is suggested for the treatment of insulin impairment and reduction of androgen levels for better oocyte maturation. https://www.jri.ir/article/243 The prevalence of Chlamydia trachomatis infection by molecular analysis of urine samples in women attending OB & GYN clinics in Tehran Introduction: Chlamydia trachomatis is a common and curable STI which can be symptomatic or asymptomatic. Nowadays, PCR is a very sensitive diagnostic tool for detecting Chlamydia in urine and can be used in routine screening procedures as a noninvasive test. There are few studies on the prevalence of C. trachomatis in Iranian women and most of them have small sample sizes which are not suitable for epidemiological deductions. The aim of this study was to estimate the prevalence of urogenital C. trachomatis infections by PCR on urine samples of women in their fertility years and to evaluate the necessity of screening for asymptomatic infections in Iranian women.Materials & Methods: This WHO supported descriptive-analytical and cross-sectional study was performed on 1052, 15-49 year-old women. Participants were selected randomly from attendees of 5 Obstetric-Gynecologic clinics in Tehran during summer and fall of 2003. The research material consisted of a questionnaire and urine samples which were transported to Avesina Research Institute daily to extract their DNA and prepare them for PCR tests. The gathered data were analyzed by SPSS, version 11, and evaluated statistically by t-test, Chi-square, variance analysis and logistic regression, while considering p<0.05 as significant.Results: The mean age of participants was 28.526.36 years. 56.2% of them had high school education, 94.2% were married, 91.8% were housewives, 32.5% were pregnant, 93.8% were sexually active, 99% of them were monogamous and 48.1% were on contraceptive methods. Among sexually active and non-pregnant participants, 10.4% were taking OCPs, 8.7% were using condoms, 16.3% had IUDs and the rest were on other contraceptive methods. In their reproductive history, 39% had vaginal discharges, 12.9% pelvic pains, 1% ectopic pregnancies, 21.2% abortions, 6.5% premature deliveries, 2.7% low birth weight infants and 7.2% were infertile. 129 subjects, (12.3%), had positive PCR tests. Statistically, there was no significant relationship between subjects, reproductive and personal histories of the subjects with the test results.Conclusion: Based on the estimated prevalence, it seems that chlamydial infection is prevalent in the studied population. In populations with prevalences higher than 4%, screening programs are recommended, so that Chlamydia screening can be considered as a part of health care prog-rams in Iran to reduce the burden of the disease. https://www.jri.ir/article/244 The epidemiology of primary infertility in the Islamic Republic of Iran in 2004-5 Introduction: Infertility is a common problem around the world followed by psycho-social cones-quences. Determining the prevalence of infertility in society can assist health system decision-makers to plan the provision of health and medical services more precisely. This study was conducted in response to the question of the Iranian Scientific Association of Fertility-Infertility with the aim of determining the prevalence of life-time primary and current primary infertilities in the Islamic Republic of Iran.Materials & Methods: This study was conducted by using a cross-sectional method on 12000 Iranian women aged 19-49 as the couples’ representatives in 28 provinces of the country in 2004-2005. The sampling method was based on the systematic random selection of 400 thirty-household clusters with a proportionate probability to the size of the population of urban and rural areas of each province. The life-time primary infertility was defined based on one of the two scenarios that follow: The first scenario: 1) A safe contraceptive method has been used after marriage, 2) but the use of contraceptive has been discontinued after a while, 3) 12 months or more past the first discontinuation of the contraceptive method at the time of the study and 4) The case has not become pregnant within 12 months after discontinuation of the contraception method. The second scenario: 1) A safe contraception methods has not been used after marriage, 2) No conception was achieved within 12 months after marriage. The term current primary infertility was applied to a woman who had never been conceived up to the study, as well as being defined by one of the above definitions. Data analysis was conducted by using STATA 8.0 software while considering the concepts of descriptive statistics and computing the 95% confidence intervals. Lowess smoothing method was also used to smooth the scatter plot of the relationship between infertility and age at the time of the first marriage.Results: In this study, 7350 urban and 4650 rural Iranian women, aged 19-49 in 28 provinces were interviewed. Among the 12000 interviewed subjects 630, (5.3%), cases were not eligible for the study and were left out of the study and the denominator of the primary infertility computation fraction. A history of life-time primary infertility was observed in 24.9% of the couples, (95% CI: 23.6-26.2%), as was the prevalence of current primary infertility in 3.4% of them, (95% CI: 3.0-3.8%). The trend of life-time primary infertility showed that the highest estimate was related to the lowest marriage age and the lowest prevalence was observed at the marriage age of 22 in 19% of the cases. This trend remained stable up to the age of 28 but it increased afterwards. The mean age of the subjects at the first marriage was 18.13.8 and a median of 18 years. Conclusion: About one fourth of Iranian couples experience primary infertility in their lives and 3.4% of them have this problem at any time in their life. In interpreting the prevalence of life-time primary infertility and provision of its related health and medical services, paying attention to age at the time of marriage and couples state of fertility is of importance. https://www.jri.ir/article/245 Patterns of contraceptive use in urban areas of Kohgiluyeh-Boyerahmad in 2004 Introduction: Achieving comprehensive reproductive health services, including family planning as the basis of family health and sexual health, has been internationally the main objective of governments and health policy makers in the past decades. Improving modern family planning facilities would lead to a promotion in population control. This study investigates family planning indices, its short comings and mean of reproductive variables in the urban areas of Kohgiluyeh-Boyerahmad province in comparison with the data from Demographic Health Survey carried out in Iran in 2000.Materials & Methods: Considering the high coverage of households by urban health centers in the province, 1540 married women were randomly selected from the list of names in each health center and they were interviewed during 2004. A researcher-devised questionnaire, (content validity determined by experts), was used consisting of demographic variables, family planning awareness status methods, the contraceptive method used by the couples and the number of a desired and live children. Using SPSS, version 13, the data were analyzed in a descriptive-analytical fashion with a significance level of 0.05.Results: The mean age of the respondents was 33.2+ 9.4 years. The mean numbers of pregnancies and children were 3.7 and 3.2 respectively. There was a significant relation between the mean number of children and women's educational status and job (p-value <0.001). A significant difference was also observed between the mean and the desired number of children (t=4.46, p-value <0.001). The most common family planning methods were OCP and TL (40.4% & 18.7% respectively). The highest knowledge about family planning methods was on OCP, condom and TL (94%, 65.4% & 45.2% respectively). Highest number of women with one child and women with ≥3 children were in the 21-30 and 31-40 age groups respectively. Conclusion: The findings indicate that family planning programs have had a relatively appropriate effectiveness on population control in Kohgiluyeh-Boyerahmad province and family dimension is relatively satisfactory but despite better knowledge about modern contraceptives, use of modern family planning methods is not desirable. Considering the high number of children by women from older age groups, the need for educating and promoting the use of modern contraceptives is still of importance. https://www.jri.ir/article/246 The relationship between mode of delivery and postpartum depression Introduction: Postpartum period is the most vulnerable time for the onset of mood disorders including the blues, depression and psychosis. Depression is the most important mood disorder in the postpartum period that can be associated with mother-baby and family conflictual interactions and may lead to irreparable consequences if not addresses well. Regarding different etiologies of postpartum depression, among them mode of delivery, and the existence of numerous controver-sies about this matter, the present study was conducted to determine the relationship between mode of delivery and postpartum depression in pregnant women attending some selected Health Centers affiliated to Shahid Beheshti University of Medical Sciences in 2005.Materials & Methods: In this prospective analytical study, 258 pregnant women in their 3rd trimester of pregnancy were evaluated for signs of depression within 8 months and about 50 peo-ple were excluded from the study because of depression (Getting more than 12 from Edinburgh Postnatal Depression Scale, EPDS) and those not suffering from depression were included in the study. Subjects who had histories of quitting parents before the age of 15, abortion, infertility, complications during pregnancy, prolonged pregnancy, postpartum complications, chronic diseases, nervous diseases in the family, hospitalization of the mother or the neonate and those with fetal demise were excluded from the study too. During 2 to 6 weeks from delivery, study subjects completed EPDS, marital satisfaction and social support questionnaires, were divided into NVD (73 women) and CS (75 women) groups and were matched for confounding factors before statistical analysis. Data analysis was performed by SPSS software, version 13, and the significance level was considered 0.05.Results: The mean age of subjects was 22.71+3.15 years. Most of them had high school diplomas and were housewives. The prevalence of postpartum depression was 20.3%. 13.6%of the cases in NVD and 27.6% in CS groups scored more than 12 on EPDS and they were at risk for postpartum depression. There was a significant relationships between mode of delivery and postpartum depre-ssion (p<0.05) and a two fold risk for depression was seen in CS group (OR=2). Conclusion: According to the findings of this study that postpartum depression has been twice as much prevalent in the CS group compared to that of NVD group, it can be concluded that CS should be performed in women who meet the criteria for this procedure. Implementing this strategy can have an effective role in preventing postpartum depression and help reduce expenses from its proper practice. https://www.jri.ir/article/247 Assessment of general health, stress coping and marital satisfaction in infertile women undergoing IVF treatment Introduction: Nowadays, infertility has turned to a social distress and it is accompanied by numerous psychological and social problems. This phenomenon is known as an agonizing and disappointing stressor for couples, especially for women. Infertility stress can affect personal, social and marital relationships, may cause mental instability and lead to divorce. Likewise, studies have shown IVF may be accompanied by numerous and severe psychological disor-ders. Considering psychosocial and cultural importance of fertility, especially in women, and the high birth rate in Iran, a closer look at this phenomenon with an emphasis on its psycho-social aspects is of importance. Therefore this descriptive study was undertaken to determine mental well-being, marital satisfaction and stress coping in infertile women.Materials & Methods: 150 infertile women attending the forth Shahid of Mehrab Hospital in Kermanshah were randomly selected during 2003. The data were gathered by the researchers, based on CRI-Coping Responses, Index of Marital Satisfaction (IMS) and the General Health Questionnaire (GHQ-28). For the statistical evaluation of the findings, chi-squared and t-test were calculated. P-values smaller than 0.05 were considered significant. Results: The results showed that 44% of the subjects had psychological disorders based on GHQ. Based on the findings from this questionnaire, the cases were divided into two healthy and unhealthy groups. Anxiety rates among the unhealthy group and the functional disorders in the healthy ones revealed to be significantly high (p<0.01). 34% of the infertile women, most of whom had been identified to have psychological disorders by GHQ, had excitement based reactions and 93% of the ones on the healthy group had problem-based confrontational responses. The findings also revealed that infertility had not had any unpleasant effects on the marital satisfaction of the healthy cases, whereas 35% of the unhealthy ones showed the opposite.Conclusion: Regarding the results of this study, infertility may have numerous psychological impacts on the infertile and act as a predisposing factor for psychological disorders and matri-monial problems. Therefore, a team of psychiatrists accompanying infertility treatment experts is effective in the treatment process and prevention of psychiatric problems in these patients. https://www.jri.ir/article/248 Comparing two treatment protocols for gestational trophoblastic disease: weekly single dose intramuscular and 8-day intravenous injections of methotrexate Introduction: The essentials of gestational trophoblastic disease (GTD) treatment are evacuation of the uterus followed by chemotherapy. Methotrexate, an antagonist of folinic acid and an antimetabolite agent, has an important role in the treatment of patients with gestational trophoblastic disease. The efficacy of single agent chemotherapy with methotrexate in low and medium risk GTD is well-established and nume-rous studies for lowering its toxicity and fewer numbers of expected visits and consequently lower time and money expenditures are on rise. This medication has produced excellent remission rates with acceptable toxicity, cost-effectiveness and better compliance by patients. The aim of this study was to compare two methods of weekly single-dose intramuscular and 8-day intravenous injections of methotrexate, in low and medium risk GTD patients who required single agent chemotherapy.Materials & Methods: This was a clinical trial study conducted for three years (2002-5) in the Gynecolo-gic Oncology Department of Ghaem Hospital in Mashad. All patients with low and medium risk GTD who required single agent chemotherapy were assigned into two groups. The first group consisted of 33 patients who received IV injections of methotrexate 1 mg/m2 of body surface area and folinic acid 0.1 mg/m2 every other day for a total of 8 days. The second group consisted of 14 patients that received weekly single-dose IM injections of methotrexate 50 mg/m2. These two groups were matched for age, number of pregnancies, blood groups, histological characteristics and the interval between end of the antecedent pregnancy and start of chemotherapy. The results were analyzed by SPSS software. For statistical calculations t-test and χ2 were used and a confidence internal of 95% and a p-value of 0.05, as the significant value, were regarded for the study.Results: The mean age of the first group was 25.387.33 years and 25.77.52 for the second group. Response rates fewer than four courses of chemotherapy in the first group was 45.5% and in the second group was 28.5% (p=0.018). The results showed that 9.9% of the patients in the first group and 42.1% of those in the second group needed nearly a 1.5-time increase in the dose of the medication (p=0.001). Requiring a change to the second line of therapy from methotrexate to actinomycin D was 6.6% in the first and 7.1% in the second group (p=0.715). Combination chemotherapy with EMA/CO (Etoposide, methot-rexate, actinomycin D, cyclophosphamide and vincristine) regimen were needed by 9.9% of the patients in the first and 14.2% in the second group (p=0.656). Eventually, both groups achieved complete remission with no recurrence of the disease during the follow-up period. Conclusion: The weekly single-dose intramuscular injection of methotrexate is an effective, low toxic, inexpensive and accessible method that can be performed in every center for low and medium risk GTD patients that need single agent chemotherapy as compared with 8-day intravenous injections. https://www.jri.ir/article/249 Successful infertility treatment and spontaneous pregnancy in an unconsummated marriage after 7 years Introduction: About ten percent of people are suffering from sexual disorders in Iran and stu-dies show that 50 percent of divorces are due to sexual disorders, too. If couples with sexual disorder receive consultation and undergo proper treatment, half of these divorces will not occur. An unconsummated marriage (UCM) is a marriage in which the couples have never had coitus. Etiological factors of UCM are varied: Psychogenic factors are the most prevalent and the main psychogenic factor is "Performance anxiety".Case introduction: This report is about a couple who attended "Avesina Infertility Clinic" after 7 years of UCM with a chief complaint of infertility and expression of their will to become pregnant. A team composed of a gynecologist, an andrologist and a psychiatrist achieved a successful treatment goal within 3 months. Gynecological examination of the female was normal. Andrological examinations of the male showed severe premature ejaculation and male factors impairment in his semen analysis but psychiatric evaluation showed that the couple had low sexual information and the male had high stress and phobia at the time of intercourse. Finally, by dual-sex therapy and sensate focus exercises the couple experienced the first inter-course after 3 months and the female became pregnant 3 months later. Conclusion: Regarding the lack of necessary information on sexual issues and performance anxiety as the common cause of the disorder, it seems that teachings on sexual relationships might be a necessary part of pre-marriage counseling. On the other hand, a comprehensive and simultaneous evaluation of the couples with the sexual disorder by a harmonious expert team may increase treatment success rates. https://www.jri.ir/article/251 Sertoli-Leydig cell tumor with heterologous elements with clinical presentations of amenorrhea and hirsutism (Letter to Editor) https://www.jri.ir/article/369