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 Introduction: Endometriosis is the presence of endometrial glandular and stromal cells outside the uterine cavity. The disease is prevalent in about 10% of women of reproductive age and in up to 50% of infertile women. Surgery continues to be the first line of treatment in eradicating endometriotic lesions but recurrence of the condition is seen in up to 47% of the cases. VEGF is an effective factor in the establishment of endometriosis. The aim of the present study was to determine VEGF levels in a three-dimensional (3D) fibrin matrix culture of human endometrial tissue.Materials and Methods: Endometrial biopsies were obtained from the uterine fundus of 10 ovulating (at 19th to 24th day of menstruation cycle) premenopausal women attending the Toronto Center for Advanced Reproductive Technology (TCART) for the treatment of infertility, ovarian cysts or non-endometrial complaints. Each tissue fragment was divided into ten segments for culture in a total of 100 wells. The samples were cultured on three-dimensional fibrin matrices and the supernatant fluid was collected from each endometrial sample for the assessment of VEGF levels. The endometrial samples were stained by anti-Cox-2 antibody (anti-cyclooxygenase -2) for immunohistochemical evaluation of angiogenesis.Results: VEGF levels in the supernatant fluid of wells with angiogenesis was significantly higher (p<0.05) than wells with no signs of the phenomenon (492±3.11 and 183±13.2, respectively). The results were indicative of cell proliferation in 91% of the wells and angiogenesis was observed in 51 wells (56%) with cell proliferation.Conclusion: It seems that VEGF secretion plays an important role in promoting neovasculariza-tion and cell proliferation of endometrial cells. Therefore, VEGF secretion seems to be involved in the establishment of endometriosis. Seeking the relationship between cell proliferation and VEGF secretion rates is suggested. https://www.jri.ir/article/370 Introduction: Ovulation is a physiologic process with an inflammatory response that depends on a coordinated activity of gonadotropins and steroid hormones, as well as inflammatory mediators such as cytokines, prostaglandins, leptin, nitric oxide (NO), etc. Conjugated linoleic acid (CLA) is composed of polyunsaturated fatty acids (PUFA) found in dairy products, beef and lamb. There is strong evidence that dietary CLA affects mediators involved in ovulation. The aim of this study was to determine the effects of different doses of dietary CLA on systemic and local hormones and factors involved in ovulation.Materials and Methods: In this case-control study, 80 (50±2-day old) female mice were randomly divided into four groups (C as the controls and T1, T2 and T3 as the treatment groups). There were four replicates in each group and there were five mice in every replicate (20 mice, in total). The mice in the control group were fed with no CLA in their diet but the ones in the treatment group received 0.1, 0.3 and 0.5g/kg of CLA (replacing corn oil in the diet), respectively for 120 days. Later on, blood samples were obtained from the tails of animals that displayed estrus signs and estradiol (E2), progesterone (P4), LH, FSH, NO, leptin and TNFα were measured. Furthermore, the effects of CLA on the ovarian production of prostaglandins (PGs) and NO were investigated. The data were analyzed by SAS software. Results: CLA significantly decreased serum levels of FSH (p<0.05), LH, estradiol, NO, leptin and TNFα (p<0.01). In addition, CLA decreased progesterone levels but this effect was statistically insignificant. The significantly negative effects of CLA were seen on the ovarian production of PGE2 and PGF2α (p<0.01). https://www.jri.ir/article/371 Introduction: Clomiphene Citrate has been one of the effective medications in the treatment of infertility but it has undesirable side effects, such as flushing, decreased cervical mucus production, impaired postcoital test (PCT) and multiple pregnancies. Letrozole is a newer drug and it improves cervical mucus production, increases endometrial thickness and reduces the risk for multiple pregnancies. Comparing the efficacy of clomiphene citrate versus letrozole for ovulation induction in patients with Polycystic Ovarian Disease (PCOD) was the objective of this study.Materials and Methods: This clinical trial study was done on 100 infertile, 20-35 year-old women with PCOD attending Vali-e-Asr Infertility Clinic from April 2003 to April 2007. The cases were candidates for intrauterine insemination (IUI) and signed a consent form to participate in the study. The cases were assigned to two groups through simple random sampling, the first group receiving clomiphen citrate plus HMG and the second one Letrozole plus HMG. Endometrial thickness, number of mature follicles, pregnancy rates, history of abortion and multiple pregnancies were recorded and compared in the two groups.Results: Comparing the two groups, the number of mature follicles (p=0.000), the risk for ovarian hyperstimulation (40% versus 14%, p=0.003) and abortions rates (37.5% versus 11.11%, p=0.048) were significantly higher in the clomiphene group. Differences in endometrial thickness and pregnancy rates (eight subjects in the clomiphene versus nine in the letrozole group) were of no statistical significance in the two groups.Conclusion: It seems that letrozole is a good substitute for clomiphene citrate, especially in patients at risk of abortion or ovarian hyperstimulation syndrome (OHSS), or in those who cannot tolerate clomiphene citrate. Further studies are needed to be done to fully suggest letrozole as the first line treatment for controlled ovarian hyperstimulation syndrome. https://www.jri.ir/article/372 Introduction: In fertility clinics and diagnostic laboratories, a great number of male subjects undergo urinary sampling for urine analysis (U/A) after semen sampling.Despite taking thorough medical histories in these centers, questions on intercourses or ejaculations prior to the sampling are occasionally neglected. Due to the noticeable increases in urinary protein upon S/A and the possibilities for U/A parameters distortion, this study was undertaken to compare urinary indices before and after semen sampling.Materials and Methods: Urine samples were obtained from 220 men attending Avicenna Infertility Clinic in Tehran, Iran, before and after semen sampling and two urinalyses were done for each patient. Eventually, the findings were statistically compared and analyzed.Results: Biochemical and physical characteristics of urine samples, including color, blood, ascorbic acid, urobilinogen, bilirubin, nitrite, ketone, glucose and specific gravity did not undergo significant changes after semen sampling, while turbidity and protein were increased (p<0.001) and urine pH was decreased but with no statistical significance (p=0.46).Conclusion: It is recommended to ask about ejaculation or prior intercourses before urine sampling for urinalysis, especially at times when urinary protein is of importance. This will avoid unnecessary, additional diagnostic testing, which in turn will prevent psychological distress and save money and time. https://www.jri.ir/article/373 Introduction: Chlamydial infections are the most common sexually transmitted diseases with highest rates of morbidity in different societies. Chlamydia trachomatis is a known causative agent for premature rapture of membranes (PROM), preterm labor, miscarriage, low birth weight and neonatal death, and forms a copious burden of disease in many countries. This study aims to evaluate the prevalence, outcome and risk factors of chlamydial infections.Materials and Methods: This cross-sectional, descriptive-analytical study was done on 1114 pregnant women in their 11th to 32nd week of gestation who attended the hospitals affiliated to Tehran University of Medical Sciences during March 2007 to March 2009. Serum levels of IgG anti-chlamydial antibody were measured by ELIZA method, upon taking a thorough medical history.Results: Positive results for chlamydia IgG were seen in 2.9% of the cases. Chlamydia infection was 2.3 times greater in multiparous women compared to primigravids, (95% CI, 1.1- 4.8). Chorioamnionitis and neonatal death were respectively 4.7 (p=0.027) and 11.6 (p=0.008) times more prevalent in IgG-positive group compared to women without the infection.Conclusion: A relatively low prevalence of chlamydial infection was observed in the studied population. Further studies in different groups of pregnant women, especially in cases attending private health sector, are recommended to be done in order to justify the necessity of routine Chlamydia screening in pregnancy and the obligation for preventive care measurements in Iranian pregnant women. https://www.jri.ir/article/374 Introduction: Endometriosis is a chronic gynaecological disease with a prevalence of about 10% in women of reproductive age. The typical symptoms of this disease include chronic pelvic pain, dyspareunia and infertility with an overall negative impact on the psychosocial parameters in the subjects, leading to a significant reduction of quality of life. Health-Related Quality of Life (HRQL) is a multi-dimensional, dynamic concept that encompasses physical, psychological and social aspects of individuals. The aim of this study was to evaluate quality of life in patients with endometriosis. Materials and Methods: This descriptive, cross-sectional study was performed on forty 22–28 year-old women with endometriosis, attending Avicenna Infertility Clinic and Shahid Beheshti University of Medical Sciences. Endometriosis Health Profile-5 (EHP-5) questionnaire was used in interviews to collect data from individuals willing to participate in the study. Results: The mean age of participants was 35.7±8.3 years with an average duration of the disease of 32 months (6 to 84 months). All the patients were infertile, 75% suffered from dyspareunia and 32% had painful walking. Functional impairment was seen in 62% of the individuals and 92% felt as though symptoms were ruling their lives. Mood swing was seen in 55% of the patients, 37% felt depressed and 34% thought their general appearance had been affected. About 73% believed that healthy individuals and 41% believed that even medical doctors did not realize the gravity of their disease, while 29% felt hopeless because of treatment effectiveness.Conclusion: Endometriosis impairs quality of life, specially in the domains of pain, psychological and functional abilities. Although, medical and surgical measurements improve physical and psychological functions, increase energy levels and lessen pain but psychotherapy and appropriate pharmacotherapy seem to be essential in the management of endometriosis. https://www.jri.ir/article/375 Introduction: Numerous studies point to the increasing prevalence of infertility around the world. This entity has usually taken its toll on infertile couples and has left them prone to psychosocial problems. Measuring quality of life of infertile couples can help health policy makers provide services tailored to the needs of this group of people. The purpose of this study was to develop a questionnaire to measure the quality of life of infertile couples and test its validity and reliability.Materials and Methods: In this exploratory study, we defined and determined the dimensions of quality of life in infertile couples by reviewing the literature and interviewing infertile couples. Finally, Quality of Life in Infertile Couples Questionnaire (QOLICQ) with 95 Likert-type items was developed.Results: In analyzing the content validity index, items with more than 79% validity were kept and the number of items was reduced to 79 in the questionnaire. Factor analysis showed seven factors in the questionnaire. An internal consistency of 0.71- 0.95 and a test-retest reliability of 0.81 - 0.04 were calculated for the seven factors. Therefore, the seven previously mentioned factors were omitted because of decreased value in factor analysis and redundancy, leaving 72 items in the questionnaire. Content validity index (CVI) of the questionnaire was measured by a panel of 10 experts and 10 infertile couples based on its "relevance", "clarity" and "simplicity" on a four-point scale. Then, construct validity (factor analysis) was measured by 150 infertile subjects. To determine reliability, internal consistency and test-retest reliability were measured. Conclusion: The Quality of Life in Infertile Couples Questionnaire (QOLICQ), which includes 72 Likert-type items, is a valid and reliable tool for measuring quality of life of infertile couples. Measuring other types of validity, such as discriminate and concurrent validity are recommended. https://www.jri.ir/article/376 Introduction: Endometriosis is a disease defined by extra-uterine extension of endometrial glands and stroma. It usually occurs in women of reproductive age and in dependent sites of the pelvis. Theoretically, it is believed that the ectopic implantation of endometrial tissue occurs following retrograde menstruation. However, as the disease has rarely been seen in men, prepubertal girls or in unusual sites of body, other theories like coelomic metaplasia have been suggested. However, the very low prevalence rates of such cases have prevented those theories of being fully accepted. This is a case report of pelvic endometriosis in a patient with primary amenorrhea, presented as a proof for coelomic metaplasia or induction theory.Case Presentation: A 19-year old virgin girl was referred to Imam Reza Hospital in Mashad with complaints of primary amenorrhea and an abdominal mass. She had not experienced menstrual bleeding upon receiving a combination of estrogen and progesterone. Her past medical history was not noticeable except for the operation she had underwent for intestinal tuberculosis 10 years earlier, which could explain the reason for her amenorrhea. She had a normal pattern of sexual hair growth, breast development and external genitalia on examination. She also had a large pelvic mass at the level of umbilicus, which had caused compression of both ureters as demonstrated by an intravenous pyelogram (IVP). During operation, a huge adhesive mass was observed at the right side of uterus, which could not be differentiated from the right adnexal tissue and the uterus itself. The mass was excised and the normal outflow tract of the uterus was confirmed. The mass consisted of a chocolate-colored liquid that could suggest the diagnosis of endometrioma or an accessory uterine lobe with hematometra. “Endometrioma accompanied by fallopian tube” was reported upon pathological examination.Conclusion: Endometriosis in a subject with primary amenorrhea and absence of outflow tract obstruction, can strongly suggest ways other than endometrial cell implantation. One of these causes could be coelomic metaplasia, as an example of induction theory. https://www.jri.ir/article/377