Radical Changes in Infertility Practice: It Is Coming Soon 2 1 140242 2 Infertility is a medical, personal, and public health problem in all human societies that affects about 15% of couples of reproductive ages, being the significant concern of patients, doctors, and health policymakers worldwide during the last decade. The spread of assisted reproductive technologies (ARTs) has facilitated the diagnosis and treatment of infertility in most countries; however, the total number of children born from IVF is less than 0.2% of the world's population, although 1-5% of neonates are conceived by ART in some countries. Recently, ARTs have been transformed in terms of variety and quality for their wider application in correction of gene defects, treatment of genetic diseases, and gene therapy along with genetic modifications in the livestock industry. The main incentive for the advancements was the relatively low efficiency of ART outcomes and the increasing need for their implementation in the treatment of infertility (1). One of these areas of progress is the growing application of artificial intelligence (AI) in the clinical aspects of human reproduction and infertility through the integration of medicine and computer science using machine learning algorithms. Artificial intelligence has been utilized for nearly two decades in various fields of human reproduction, including diagnosis of infertility and prognosis of treatment outcomes in the form of chemical/ clinical pregnancies, live births, and repeated IVF failures. Moreover, the technology has been applicable in evaluation of ovarian reserve, ultrasound assessment of follicles growth in IVF cycle, determining endometrial quality, and its potential for embryo implantation, as well as sperm, egg, and embryo selection. Therefore, replacement of existing invasive methods with non-invasive ones based on artificial intelligence is not far from expected. In the field of male reproductive health, AI is being developed from Computer-Assisted Semen Analysis (CASA) systems to the applications evaluating environmental factors and lifestyle for predicting sperm quality. Furthermore, AI is perceived as a utilitarian alternative in diagnosing the causes of idiopathic infertility based on the biological and clinical symptoms of infertile couples (2). In addition to the development and expansion of AI application among experts in the fields of fertility and infertility, its function in basic research and clinical practice serves as an ancillary and supportive mechanism in infertility treatment. In this context, another important aspect worthy of paramount attention is the very rapid expansion of AI among community, especially among infertile couples and recipients of ART services. In the past, people with different levels of knowledge and ability had limited access to scientific and medical databases. Their education mainly hinged upon public databases and commercial websites, which provided incomplete data or sometimes conflicting information. Their reliance on untrustworthy sources could jeopardize their health and result in adverse medical and economic consequences for both themselves and the healthcare system (3). Infertile couples usually surf the net for quick access to fertility care information. For instance, A query for the term "infertility" on Google brings millions of results, many of which have not been verified for scientific and medical validity. Most of commercial websites with pseudo-scientific data use SEO techniques to improve their ranking in the top list of search results, occasionally deceiving the naïve users to sell their products or attract more customers. In fact, most people believe that the top search results are the best sources of information to address their needs, which is often not the case. However, search engines have gradually given way to chatbots, which are models of generative AI and large language models. Large language models (LLMs) are a class of deep learning architecture designed to recognize and produce human-like languages. Chatbots such as ChatGPT, Google Bard, or Claude are built on the transformer model, utilizing self-aware language processing for Natural Language Processing (NLP) and Reinforcement Learning (RL) to identify complex relationships between words. These multimodal generative AI systems have attracted considerable attention from mass media during the recent years (3, 4). Quick access to information and ease of data gathering from chatbots, such as ChatGPT, are the main prompts for infertile couples to use chatbots for their inquiries rather than visiting IVF clinic staff and infertility treatment professionals. Chatbots can translate medical information in an easier way for the general public to deeply understand and improve their level of knowledge and information. Such preliminary knowledge would facilitate patients’ participation during the diagnosis and treatment procedure. In addition to maintaining anonymity and privacy, infertile couples feel more comfortable using digital tools like ChatGPT compared to receiving information from healthcare professionals. In addition, they find the exact answers to their most private questions that they may not feel convenient to share even with the closest family members (3). The current limitation in using chatbots involves reliance on more familiar bots like ChatGPT. However, similar models such as Cloud, Microsoft Bing, and Google Bard are alternative options for addressing the needs of patients. Despite providing quick responses to patient requests, there is a possibility that chatbots are using data from unreliable sources, so that the consistency of responses may be affected during subsequent iterations (3). In one study, frequently asked questions (81 questions) about endometriosis were used to evaluate the accuracy of ChatGPT’s responses. An experienced gynecologist assigned a score from 1 to 4 for each answer provided by ChatGPT. In total, 91.4% of frequently asked questions were considered correct. ChatGPT had the highest accuracy in responses about symptoms and diagnosis (94.1%) and the lowest in responses on treatment (81.3%). In another study, the responses of three chatbots were ranked and averaged with the comments and opinions of 3 experienced gynecologists. Comparing the 3 chatbots, it was revealed that Bard had better average scores than ChatGPT or Cloud, and most of the chatbot’s responses were correct (5). All in all, the development of AI and LLM will lead to fundamental changes in the field of reproduction and infertility, which will be as revolutionary as the invention of conventional IVF or ICSI. Currently, the role of the doctor and healthcare staff is to diagnose and choose the best treatment method based on consultation, physical examination, and the results of paraclinical tests. Consequently, the personalized plan would be tailored for each individual. However, due to limited knowledge in various aspects of couples’ lives including their behavioral, biological, and medical characteristics, the treatment method chosen by the doctor is not necessarily the best alternative. With the expansion of AI and LLM to evaluate couples' fertility and addressing their needs regarding all lifestyle aspects and characteristics, the proposed treatment will be much more accurate and precise than the status quo of infertility diagnosis and treatment. The new technology would undoubtedly change the practice of infertility treatment in the clinics as well as the role of doctors and specialists. In the near future, it is expected that one couple may arrive at your IVF center requesting IUI, while others may seek TESE/ICSI/eSET, yet the next couple may request ICSI/PGT-SR, with the doctors refraining from intervening in couples’ decision for the requested treatment procedure. In this context, the diagnosis and selection of the best treatment method will be assigned to AI. From now on, we have to acknowledge that AI is a very powerful tool for the future since the technology continues to develop and advance in medical equipment and telemedicine, culminating in fundamental changes in treatment sector. 169 171 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@avicenna.ac.ir No Keyword 140242.pdf Kushnir VA, Smith GD, Adashi EY. The future of IVF: the new normal in human reproduction. Reprod Sci. 2022;29(3):849-56.##Hanassab S, Abbara A, Yeung AC, Voliotis M, Tsaneva-Atanasova K, Kelsey TW, et al. The prospect of artificial intelligence to personalize assisted reproductive technology. NPJ Digit Med. 2024;7(1):55.##Beilby K, Hammarberg K. ChatGPT: a reliable fertility decision-making tool? Hum Reprod. 2024;39(3):443-47.##Brandão M, Mendes F, Martins M, Cardoso P, Macedo G, Mascarenhas T, et al. Revolutionizing women's health: a comprehensive review of artificial intelligence advancements in gynecology. J Clin Med. 2024;13(4):1061.##Oliveira JA, Eskandar K, Kar E, de Oliveira FR, Filho AL. Understanding AI's role in endometriosis patient education and evaluating its information and accuracy: systematic review. JMIR AI. 2024:3:e64593.##

The Influence of Artificial Light Exposure on Indigenous Populations: Exploring Its Impact on Menarcheal Age and Reproductive Function 2 1 140233 2 The impact of artificial light exposure on human health has garnered significant attention in recent years. In particular, its effects on reproductive health have raised concerns. Given that the onset of menarche serves as a crucial indicator of reproductive maturity, understanding the implications of artificial light exposure becomes paramount. Age of menarche onset occurs relatively earlier in urban females than females raised in rural areas. Besides the decline in age of menarche onset, exposure to artificial light may contribute to impairment in reproductive hormones, particularly gonadotropins, by disrupting rhythms of reproductive hormones, modulating stress hormones and kisspeptin productions, and causing body weight changes. This drastic environmentally induced change may increase the proportion of teenage pregnancies, unfulfilled childhood dreams, depression, and ill-prepared marriages, thus creating a potential need for public health intervention. Due to limited studies and often lack of longitudinal data, a significant knowledge gap exists in unraveling the potential mechanism involved in alteration of these physiologic processes. The purpose of the current review was to elucidate the intricate interplay between environmental factors, cultural practices, and biological processes within indigenous communities. By meticulously examining the multifaceted influences of artificial light, including its prevalence and varying intensity based on geographical locations and light pollution levels, this study aimed to provide scholarly insights into the pathophysiologic mechanisms underlying the observed changes. The findings of this inquiry will also inform evidence-based strategies and interventions aimed at safeguarding the reproductive well-being of indigenous populations amidst the escalating challenges posed by artificial light exposure. 171 184 Mayowa MJ Adeniyi Department of Physiology, Federal University of Health Sciences Department of Physiology, Federal University of Health Sciences Nigeria 7jimade@gmail.com Ayoola A Awosika College of Medicine, University of Illinois College of Medicine, University of Illinois USA ayoolaawosika@yahoo.com Chika CI Idaguko Departments of Anatomy and Physiology, Edo State University Uzairue Departments of Anatomy and Physiology, Edo State University Uzairue Nigeria Ehitare E Ekhoye Departments of Anatomy and Physiology, Edo State University Uzairue Departments of Anatomy and Physiology, Edo State University Uzairue Nigeria Artificial night lightingCircadian rhythmCommunity healthHormonesMenarcheReproductive health 140233.pdf Stevens RG, Brainard GC, Blask DE, Lockley SW, Motta ME. 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Association of NOX5 Expression with Sperm Activity and Motility in Pathospermic Infertile Men 2 1 140235 2 Background: The newest NOX isoform, NOX5, has been found in mammalian spermatozoa. Many physiological and pathological situations in spermatozoa are mediated by reactive oxygen species (ROS). NOX5 is the main source of ROS in spermatozoa. Our purpose was to investigate the changes in NOX5 expression and the effect of NOX5 expression on sperm motility, chromatin integrity, and oxidative status in oligoasthenozoospermic compared to normozoospermic men. Methods: Semen samples were collected from 30 normozoospermic (NS) and 30 oligoasthenozoospermic (OAS) men. NOX5 protein expression in sperm samples was evaluated by immunohistochemistry and western blot. Oxidative stress status was evaluated by total antioxidant capacity (TAC), total oxidant capacity (TOC), and oxidative stress index (OSI) parameters. Chromatin integrity in spermatozoa was evaluated by toluidine blue staining. Results: NOX5 expression levels were significantly higher in OAS group than in NS group (p<0.001). In addition, chromatin integrity was significantly higher in the OAS group in comparison to NS group (p<0.001). TAC levels were higher in the NS group, but OSI and TOC levels were significantly higher in OAS group (p<0.001). It was found that NOX5 protein expression was positively correlated with oxidative stress and chromatin integrity and negatively correlated with motility (p<0.01). Conclusion: These results suggest that overexpression of NOX5 may be the source of excessive ROS production and oxidative stress injuries in oligoasthenozoospermic men. Considering that NOX5 expression is positively correlated with oxidative stress and chromatin integrity but negatively correlated with motility, it can be considered a biomarker to be used in assisted reproductive procedures. 184 193 Benay B Daylan Department of Histology and Embryology, Istanbul Medipol University, School of Medicine Department of Histology and Embryology, Istanbul Medipol University, School of Medicine Turkey benaydaylan94@gmail.com Oya O Korkmaz Department of Histology and Embryology, Malatya Turgut Ozal University, School of Medicine Department of Histology and Embryology, Malatya Turgut Ozal University, School of Medicine Turkey Olgu OE Tok Department of Histology and Embryology, Istanbul Medipol University, School of Medicine Department of Histology and Embryology, Istanbul Medipol University, School of Medicine Turkey Cagri C Cakici Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University Turkey Turkan T Yigitbasi Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University Turkey Ayse A Karahasanoglu Medipol Mega University Hospital, IVF Center Medipol Mega University Hospital, IVF Center Turkey Tuba TV Yelke Medipol Mega University Hospital, IVF Center Medipol Mega University Hospital, IVF Center Turkey Tugba TS Ustabas Medipol Mega University Hospital, IVF Center Medipol Mega University Hospital, IVF Center Turkey Sule S Ayla Department of Histology and Embryology, Istanbul Medeniyet University, School of Medicine Department of Histology and Embryology, Istanbul Medeniyet University, School of Medicine Turkey Male infertilityNADPH oxidase 5Reactive oxygen speciesSperm motility 140235.pdf Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. 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The Impact of NADPH Oxidase 5 Activity and Reactive Oxygen Species on Ca-pacitated Human Sperm 2 1 140238 2 Background: Progesterone (P4) activates sperm calcium channels (CatSper), allowing calcium to enter the cell, which activates NADPH Oxidase-5 (NOX5) and produces reactive oxygen species (ROS). While calcium and ROS are essential for sperm capacitation, the role of NOX5 in capacitated sperm is unclear. This study investigated NOX5 activity in capacitated human sperm. Methods: Forty semen samples from fertile men were processed, with motile sperm separated and divided into nine groups: control (Ham's F-10), solvent (DMSO), progesterone, diphenyleneiodonium chloride (DPI, NOX5 inhibitor), phorbol-12-myristate 13-acetate (PMA, NOX5 activator), P4+DPI, P4+PMA, Trolox, and P4+Trolox. Sperm kinematics, membrane integrity, survival rate, and ROS production was evaluated. Data were analyzed using ANOVA and Kruskal-Wallis tests, p£0.05 considered statistically significant. Results: Progressive motility significantly decreased with DPI (56.2±2.1%) and PMA (56.5±2.1%), both alone and combined with progesterone (58.0±2.0% and 57.4±2.2%), compared to the progesterone group (66.0±1.9%). No significant change was observed in the Trolox groups. Progesterone, alone or combined with DPI, PMA, and Trolox, significantly reduced sperm linearity from 0.6±0.01 to 0.5±0.01%. Straightline velocity decreased in P4+PMA and P4+Trolox groups (88.2±4.4 and 89.7±3.9 μm/s) compared to the control group (105.0±5.5 μm/s). Trolox reduced ROS content, while other treatments had no effect on ROS levels. Conclusion: NOX5 does not play a prominent role in capacitated sperm. The negative effects of PMA and DPI on sperm motility appear independent of their actions on NOX5 and ROS production. Trolox did not affect sperm motility and survival, indicating that capacitated sperm require little or no ROS. 193 201 Mohammad M Hojjati Far Department of Physiology, School of Medicine, Shiraz University of Medical Sciences Department of Physiology, School of Medicine, Shiraz University of Medical Sciences Iran Sara S Keshtgar Department of Physiology, School of Medicine, Shiraz University of Medical Sciences Department of Physiology, School of Medicine, Shiraz University of Medical Sciences Iran keshtgar@sums.ac.ir, keshtgars@yahoo.com Narges N Karbalaei Department of Physiology, School of Medicine, Shiraz University of Medical Sciences Department of Physiology, School of Medicine, Shiraz University of Medical Sciences Iran NADPH oxidase 5Reactive oxygen speciesProgesteroneSpermatozoaSperm capacitationTrolox 140238.pdf Lee KH, Hwang JY. Ca2 homeostasis and male fertility: a target for a new male contraceptive system. 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The Protective Effects of Citrulline on Testicular Injury Induced by Torsion and Detorsion in Adult Male Rats: An Experimental Study 2 1 140241 2 Background: Testicular torsion is a critical urological emergency that can lead to testicular ischemia and significant tissue damage. Citrulline, a supplement known for enhancing cellular metabolism and mitigating oxidative stress and inflammation, has been explored for its protective effects against testicular injury resulting from torsion and detorsion in rat models. Methods: This study involved 42 Wistar rats, divided into six groups: Sham, torsion/detorsion (T/D), and four groups receiving varying doses of Citrulline (300, 600, 900 mg/kg) and vitamin E (20 mg/kg). A surgical procedure was performed to induce torsion by rotating the left testicle for 4 hr, followed by reperfusion. Daily oral administration of the supplements continued for one week post-surgery. Assessments included oxidative stress markers, apoptosis, inflammation, pathology, and sperm parameters. Statistical analysis was conducted using GraphPad Prism. Results: Citrulline administration at doses of 600 and 900 mg/kg significantly reduced malondialdehyde (MDA) and reactive oxygen species (ROS) levels. Additionally, it increased glutathione (GSH) levels and decreased protein carbonyl levels at the 900 mg/kg dose. The expression of interleukin-6 (IL-6) decreased at 900 mg/kg, tumor necrosis factor-alpha (TNF-α) levels dropped at 600 and 900 mg/kg, and the pro-apoptotic factor Bax was reduced at all doses. Sperm analysis showed improved sperm count and motility at the 900 mg/kg dose. Histological examination revealed significant positive effects of Citrulline on testicular tissue. Conclusion: Citrulline effectively lowers oxidative stress, inflammation, while enhancing sperm quality and pathological outcomes. These results indicate that Citrulline has potential as a therapeutic agent for testicular torsion. 201 211 Vida V Motamed Nia Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Iran Nastaran N Rezaei Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Iran Mohammad M Shokati Sayyad Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Iran Mohammad M Seyedabadi Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Iran Fereshteh F Talebpour Amiri Department of Anatomy, Faculty of Medicine, Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences Department of Anatomy, Faculty of Medicine, Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences Iran Fatemeh F Shaki Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences Iran fshaki.tox@gmail.com CitrullineInflammationTorsionOxidative stressTestis 140241.pdf Magalhães JA, Ribeiro LS, Rego JPA, de Andrade CR. 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Cesarean Section and Its Impact on Uterine Artery Resistance and the Risk of Pre-eclampsia in Subsequent Pregnancies 2 1 140240 2 Background: The purpose of the current study was to compare the color Dop-pler findings of uterine arteries and perinatal outcomes in pregnant women with and without previous cesarean section (C/S). Methods: This cohort study enrolled 308 pregnant women aged 20-35 without underlying diseases, with at least one previous pregnancy and childbirth. The participants were divided into two groups: 154 women without C/S and 154 women with C/S. Baseline data were collected, followed by uterine artery Dop-pler scans. Then, the perinatal outcomes, including pre-eclampsia, intrauterine growth restriction (IUGR), premature delivery, and birth weight were evaluated. Results: The average age of patients in the C/S group was 30.46±3.81, which was significantly higher than the non-C/S group (28.86±4.64). It was found that uterine artery resistance was higher in women with C/S history (1.11±0.44, p<0.001) compared to those without (1.00±0.37, p<0.001). Pre-eclampsia inci-dence was also higher in C/S group (16.1%, p=0.042) compared to non-C/S group (9.1%, p=0.042). The incidence of preterm birth in the C/S group (p=0.209), the incidence of IUGR (p=0.791), and the average birth weight (p=0.291) in the two groups did not differ significantly. The average gestational age in the C/S group was 37.54±1.4, and in the non-C/S group was 38.01±1.99 weeks. The results were not affected by potential confounders such as age, the time interval between pregnancies, and also body mass index. Conclusion: Previous cesarean section can significantly increase the uterine ar-tery resistance in subsequent pregnancy. 211 219 Neda N Hashemi Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran Arash A Mohazzab School of Public Health, Iran University of Medical Sciences School of Public Health, Iran University of Medical Sciences Iran Maryam M Moshfeghi Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Iran Samaneh S Rokhgireh Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran Roya R Derakhshan Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran Nasrin N Sanaei Nasab Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS) Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS) Iran nasrin_sanaei@yahoo.com Cesarean sectionColor doppler ultrasonographyPre-eclampsiaUterine artery resistanceUterine artery 140240.pdf Albaiges G, Missfelder-Lobos H, Lees C, Parra M, Nicolaides KH. One-stage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks' gestation. Obstet Gynecol. 2000;96(4):559-64.##Zhang J, Merialdi M, Platt LD, Kramer MS. Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol. 2010;202(6):522-8.##Ciobanu A, Formuso C, Syngelaki A, Akolekar R, Nicolaides KH. Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 20 and 36 weeks. Ultrasound Obstet Gynecol. 2019;53(4):488-95.##van Zijl MD, Koullali B, Mol BWJ, Snijders RJ, Kazemier BM, Pajkrt E. The predictive capacity of uterine artery Doppler for preterm birth-A cohort study. Acta Obstet Gynecol Scand. 2020;99(4):494-502.##Roberts LA, Ling HZ, Poon LC, Nicolaides KH, Kametas NA. Maternal hemodynamics, fetal biometry and Doppler indices in pregnancies followed up for suspected fetal growth restriction. Ultrasound Obstet Gynecol. 2018;52(4):507-14.##Papageorghiou AT, Yu CK, Nicolaides KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2004;18(3):383-96.##Llurba E, Turan O, Kasdaglis T, Harman CR, Baschat AA. Emergence of late-onset placental dysfunction: relationship to the change in uterine artery blood flow resistance between the first and third trimesters. Am Perinatol. 2013;30(6):505-12.##Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341-8.##Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO statement on caesarean section rates. BJOG. 2016;123(5):667-70.##Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, et al. Impact of caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod. 2013;28(7):1943-52.##Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41(3):237-44.##Torabi S, Sheikh M, Fattahi Masrour F, Shamshirsaz AA, Bateni ZH, Nassr AA, et al. Uterine artery doppler ultrasound in second pregnancy with previous elective cesarean section. Matern Fetal Neonatal Med. 2019;32(13):2221-7.##Yapan P, Tachawatcharapunya S, Surasereewong S, Thongkloung P, Pooliam J, Poon LC, et al. Uterine artery doppler indices throughout gestation in women with and without previous cesarean deliveries: a prospective longitudinal case-control study. Sci Rep. 2022;12(1):20913.##Aygun EG, Karabuk E, Dilek TUK. A retrospective cohort study to determine whether the previous route of delivery affects the uterine artery blood flow. Cureus. 2023;15(5):e39552.##Barati M, Shahbazian N, Ahmadi L, Masihi S. Diagnostic evaluation of uterine artery Doppler sonography for the prediction of adverse pregnancy outcomes. J Res Med Sci. 2014;19(6):515-9.##Işıkalan MM, Yeniçeri H, Toprak E, Güleroğlu FY, Acar A. Effect of previous cesarean sections on second-trimester uterine artery Doppler. J Obstet Gynaecol Res. 2020;46(9):1766-71.##Jamshed S, Chien SC, Tanweer A, Asdary RN, Hardhantyo M, Greenfield D, et al. Correlation between previous caesarean section and adverse maternal outcomes accordingly with robson classification: systematic review and meta-analysis. Front Med (Lausanne). 2022;8:740000.##Wang L, Wang J, Lu N, Liu J, Diao F. Pregnancy and perinatal outcomes of patients with prior cesarean section after a single embryo transfer in IVF/ICSI: a retrospective cohort study. Front Endocrinol (Lausanne). 2022;13:851213.##Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, et al. 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Cervical Anatomical Characteristics in Women with Endometriosis: A Diagnostic Approach 2 1 140234 2 Background: Endometriosis is a gynecologic disorder which causes dysmenorrhea and infertility. Early diagnosis of endometriosis can help prevent the necessity for invasive diagnostic procedures. Medical imaging has been widely utilized to diagnose various diseases without the need for invasive procedures. The purpose of this study was to investigate the cervical length in women with endometriosis. Methods: In this case-control study, the case group consisted of nulliparous women with endometriosis, while the control group comprised nulliparous women without endometriosis. A total of 42 individuals were included in each group. Cervical length was measured using transvaginal ultrasound from the external os to the internal os. The patients in the case group underwent laparoscopy to confirm the diagnosis. Pearson chi-square test and Fisher’s exact test were employed to compare categorical variables with a p<0.05 considered statistically significant. Results: In both groups, there were no notable variations in any of the demographic characteristics. However, the severity of dysmenorrhea was significantly different between the two groups (p=0.01). The average diameter of the mediolateral cervix (29.48±6.2 and 27.14±3.8) was statistically significant between the patient group and control group, respectively (p=0.04). The mediolateral width may have a positive predictive effect on the presence of endometriosis, while cervical length appears to have a protective effect against endometriosis. Conclusion: Demographic data do not predict endometriosis. This study suggests that mediolateral width in transvaginal sonography can serve as a minimally invasive diagnostic tool for endometriosis, showing correlation with endometriosis symptoms like dysmenorrhea and dyspareunia. 219 224 Elahe E Afshari Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran Roya R Derakhshan Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran Shahla Sh Chaichian Shahla Chaichian Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran shchaichian@gmail.com Seyed Reza SR Saadat Mostafavi Department of Radiology, Iran University of Medical Sciences Department of Radiology, Iran University of Medical Sciences Iran Shima Sh Ghafourian Noroozi Department of Radiology, Iran University of Medical Sciences Department of Radiology, Iran University of Medical Sciences Iran Samaneh S Rokhgireh Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran Abolfazl A Mehdizadehkashi Abolfazl Mehdizadehkashi Endometriosis Research Center, Iran University of Medical Sciences Endometriosis Research Center, Iran University of Medical Sciences Iran Babak B Sabet Department of Artificial Intelligence, Smart University of Medical Sciences Department of Artificial Intelligence, Smart University of Medical Sciences Iran Mohanna M Khandan Student Research Committee, Mazandaran University of Medical Sciences Student Research Committee, Mazandaran University of Medical Sciences Iran Cervical length measurementEndometrial thicknessEndometriosis 140234.pdf Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1-354.e12.##Vitale SG, Capriglione S, Peterlunger I, La Rosa VL, Vitagliano A, Noventa M, et al. The role of oxidative stress and membrane transport systems during endometriosis: a fresh look at a busy corner. Oxidative Med Cell Longev. 2018;2018:7924021.##Davoodi P, J Ghadimi D, Rezaei M, Khazei Tabari MA, Shirani A, Nouri B, et al. Endometriosis and COVID-19: Clinical presentation and quality of life, a systematic review. J Obstet Gynecol Cancer Res. 2023;8(4):315-26.##Della Corte L, Di Filippo C, Gabrielli O, Reppuccia S, La Rosa VL, Ragusa R, et al. The burden of endometriosis on women’s lifespan: a narrative overview on quality of life and psychosocial wellbeing. Int J Environ Res Public Health. 2020;17(13):4683.##Benacerraf BR, Groszmann Y. Sonography should be the first imaging examination done to evaluate patients with suspected endometriosis. J Ultrasound Med. 2012;31(4):651-3.##Tripoli TM, Sato H, Sartori MG, de Araujo FF, Girão MJ, Schor E. Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med. 2011;8(2):497-503.##Sherif MF, Badawy ME, Elkholi DG. Accuracy of magnetic resonance imaging in diagnosis of deeply infiltrating endometriosis. Egyptian J Radiol Nuclear Med. 2015;46(1):159-65.##Bagaria SJ, Rasalkar DD, Paunipagar BK. Imaging tools for endometriosis: role of ultrasound, MRI and other imaging modalities in diagnosis and planning intervention. Endometriosis Basic Concepts Curr Res Trends. 2012;24:437-47.##Exacoustos C, Zupi E, Piccione E. Ultrasound imaging for ovarian and deep infiltrating endo-metriosis. Semin Reprod Med. 2017;35(1):5-24.##Marcellin L, Santulli P, Pinzauti S, Bourdon M, Lamau MC, Borghese B, et al. Age at menarche does not correlate with the endometriosis phenotype. PLoS One. 2019;14(7):e0219497.##Nnoaham KE, Webster P, Kumbang J, Kennedy SH, Zondervan KT. Is early age at menarche a risk factor for endometriosis? a systematic review and meta-analysis of case-control studies. Fertil Steril. 2012;98(3):702-12.e6.##Waller KG, Shaw RW. Risk factors for endo-metriosis: menstrual and life-style characteristics. Med Principles Pract. 1998;7(2):127-33.##Tang Y, Zhao M, Lin L, Gao Y, Chen GQ, Chen S, et al. Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case–control study in China? BMJ Open. 2020;10(9):e037095.##Selçuk A, Bayraktar M, Gürbüz A, Alkan A, Sadiye E. Uterine junctional zone thickness, cervical length and bioelectrical impedance analysis of body composition in women with endometriosis. Balkan Med J. 2012;29(4):410-3.##Tajeran Gh, Derakhshan R, Jayervand F, Rahimi M, Hajari P, Hashemi N. The predictive value of transvaginal cervical length and cervical angle ultrasonography in term delivery outcomes: a cohort study. J Matern Fetal Neonatal Med. 2024;37(1):2406344.##Tosti C, Zupi E, Exacoustos C. Could the uterine junctional zone be used to identify early-stage endometriosis in women? Womens Health (Lond). 2014;10(3):225-7.##

Assisted Reproductive Technology Outcomes After Ethanol Sclerotherapy in Poor Responder Patients with Endometriomas: A Before-After Clinical Trial 2 1 140239 2 Background: The purpose of the present study was to investigate the assisted reproductive technology (ART) outcomes after ethanol sclerotherapy (EST) in poor responder patients with endometriomas. Methods: In this before-after clinical trial, the outcomes of ART of 31 poor responders with endometriomas were evaluated after EST between July 2023 to March 2024. These patients had undergone ART at least in one cycle before and did not respond well. Recurrence rate, antral follicle count (AFC), anti-Müllerian hormone (AMH), and relief of symptoms including dysmenorrhea and abnormal uterine bleeding (AUB) were evaluated before the procedure. Follow-up assessments were conducted two and six weeks after the procedure for evaluating the complications. Fisher’s exact test, chi-square test, and paired sample t-test were used for statistical analysis using SPSS 24. Results: In this study, the levels of AFC and AMH increased significantly after endometrioma stripping therapy (p<0.05). Additionally, the number of embryos obtained increased significantly, indicating potential improvement in oocyte quality. There was a significant reduction in pelvic pain scores (p=0.001), as well as a notable decrease in dysmenorrhea (p=0.02) and dyspareunia (p=0.001). Moreover, 16.12% of patients reported recovery from intermenstrual bleeding. However, no significant difference was observed in the amount of gonadotropin used (p=0.56). Conclusion: EST is an appropriate and safe procedure before ART for poor responders who have endometriomas and can be a replacement for surgery among selected patients. 224 231 Farah F Ghasemi Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Iran mahsamoshiri00@gmail.com Ladan L Kashani لادن کاشانی Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Iran Ashraf A Moini Department of Obstetrics and Gynecology, Endocrinology and Female Infertility Unit, Arash Women's Hospital, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Endocrinology and Female Infertility Unit, Arash Women's Hospital, Tehran University of Medical Sciences Iran Maryam M Farid Mojtahedi Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Iran Roza R Shahhosseini Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Iran Farzaneh F Alemohammad Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences Iran ART outcomeEthanol sclerotherapyEndometrioma 140239.pdf Jee BC. Efficacy of ablation and sclerotherapy for the management of ovarian Endomerioma:A narrative review. Clin Exp Reprod Med. 2022;49(2):76-86.##Tsolakidis D, Pados G, Vavilis D, Athanatos D, Tsalikis T, Giannakou A, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril. 2010;94(1):71-7.##Pais AS, Flagothier C, Tebache L, Almeida Santos T, Nisolle M. Impact of surgical management of endometrioma on AMH levels and pregnancy rates: a review of recent literature. J Clin Med. 2021;10(3):414.##Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L. Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod. 2010;25(3):678-82.##Gao X, Zhang Y, Xu X, Lu S, Yan L. Effects of ovarian endometrioma aspiration on in vitro fertilization-intracytoplasmic sperm injection and embryo transfer outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet. 2022;306(1):17-28.##Tomassetti C, Adamson D, Arici A, et al. EndoART: a prospective randomized controlled trial on endometriomas in assisted reproductive technologies, comparing the effect of no intervention, surgery, and prolonged GnRH downregulation on pregnancy rates. J Endometr Pelvic Pain Disord. 2018;10(3):158-73.##Soliman M, Sisson B. What is sclerotherapy? What to expect and all else you need to know. Updated December 12, 2021. Available from: [https://www.sciencedirect.com/science/article/pii/S0972978X21001288].##Martinez-Garcia JM, Candas B, Suarez-Salvador E, Gomez M, Merino E, Castellarnau M, et al. Comparing the effects of alcohol sclerotherapy with those of surgery on anti-mullerian hormone and ovarian reserve after endometrioma treatment: a prospective multicenter pilot cohort study. Eur J Obstet Gynecol Reprod Biol. 2021;259:60-6.##Chen Y, Pei H, Chang Y, Chen M, Wang H, Xie H, et al. 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Multimed Tools Appl. 2022;81(5):6191-215.##Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Hum Reprod Update. 2002;8(6):591-7.##Park HJ, Kim H, Lee GH, Yoon TK, Lee WS. Could surgical management improve the IVF outcomes in infertile women with endometrioma? Obstet Gynecol Sci. 2019;62(1):1-10.##García-Tejedor A, Castellarnau M, Ponce J, Eulalia F, Burdio F. Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimally invasive procedure. Eur J Obstet Gynecol Reprod Biol. 2015;18:25-29.##Kim GH, Kim PH, Shin JH, Nam IC, Chu HH, Ko HK. Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis. Eur Radiol. 2022;32(3):1726-37.##Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29:400-12.##Sánchez AM, Vigano P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update. 2014;20:17-30.##Zhu W, Tan Z, Fu Z, Li X, Chen X, Zhou Y. Repeat transvaginal ultrasound-guided aspiration of ovarian endometrioma in infertile women with endometriosis. Am J Obstet Gynecol. 2011;204:61.e1-6.##Alborzi S, Ravanbakhsh R, Parsanezhad ME, Alborzi M, Alborzi S, Dehbashi S. A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril. 2007;88(2):507-9.##Chan LY, So WW, Lao TT. Rapid recurrence of endometrioma after transvaginal ultrasound-guided aspiration. Eur J Obstet Gynecol Reprod Biol. 2003;109(2):196-8.##Donnez J, Nisolle M, Gillerot S, Anaf V, Clerckx-Braun F, Casanas-Roux F. Ovarian endometrial cysts: the role of gonadotropin-releasing hormone agonist and/or drainage. Fertil Steril. 1994;62(1):63-6.##Gonçalves FC, Andres MP, Passman LJ, Gonçalves MO, Podgaec S. A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma. Int J Gynaecol Obstet. 2016;134(1):3-7.##Huang L, Chang MY, Shiau CS, Hsieh TT. Changes in anti-Müllerian hormone after ultrasound-guided aspiration and ethanol sclerotherapy of ovarian cyst. Taiwan J Obstet Gynecol. 2021;60(3):509-51.##Garcia-Tejedor A, Martinez-Garcia JM, Candas B, Suarez E, Manalich L, Gomez M, et al. Ethanol sclerotherapy versus laparoscopic surgery for endometrioma treatment: a prospective, multicenter, cohort pilot study. J Minim Invasive Gynecol. 2020;27(5):1133-40.##Suganuma N, Wakahara Y, Ishida D, Asano M, Kitagawa T, Katsumata Y, et al. 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Placental Histopathological Changes and the Level of Anti-Spike Antibody After Covid-19 Vaccination During Pregnancy: A Case Series 2 1 140236 2 Background: COVID-19 infection during pregnancy could be associated with placental histopathological changes such as vascular diseases and malperfusion. There are studies showing that mRNA vaccines are not associated with significant placental pathological changes. Our objective was to evaluate the placental histopathology in pregnant women who received Sinopharm, an inactivated virus vaccine, during pregnancy. Case Presentation: The study included placental samples collected from mothers who gave birth of living singletons through elective cesarean sections performed between March 2022 and May 2022 at Imam Khomeini Hospital Complex. The study included women who had no history of positive reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 during pregnancy, and had received at least one dose of COVID-19 vaccine during their pregnancy. Humoral levels of anti-SARS-CoV-2 spike IgG were measured in both the mothers and neonates. Results: The study included 20 mother-neonate pairs. The mean maternal age was 34±3.6 years, and all mothers received Sinopharm vaccine as their first and second doses. The last vaccine dose was administered during pregnancy, with 3 mothers receiving it in the first trimester, 9 in the second trimester, and 8 in the third trimester. The histopathological findings in the placental samples included decidual vasculopathy, subchorionic thrombosis, and chronic histiocytic intervillositis. All mothers and neonates, except one pair, were positive for anti-spike antibody. Conclusion: Multiple abnormal histopathological findings were reported in placenta of vaccinated mothers. However, similar to previous studies, these placental findings are considered mild lesions and have been observed in both vaccinated and unvaccinated mothers. 231 238 Zohreh Z Heidary Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Iran Omid O Kohandel Gargari Student Research Committee, School of Medicine, Alborz University of Medical Sciences Student Research Committee, School of Medicine, Alborz University of Medical Sciences Iran Majid M Zaki-Dizaji Human Genetics Research Center, Baqiyatallah University of Medical Sciences Human Genetics Research Center, Baqiyatallah University of Medical Sciences Iran Arman A Shafiee Student Research Committee, School of Medicine, Alborz University of Medical Sciences Student Research Committee, School of Medicine, Alborz University of Medical Sciences Iran Haniyeh H Fathi Roya R Saeednejad Irman Pathobiology Laboratory Irman Pathobiology Laboratory Iran Marjan M Ghaemi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Iran Sedigheh S Hantoushzadeh صدیقه حنطوش‌زاده Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Iran hantoushzadeh@tums.ac.ir COVID-19PlacentaSARS-CoV-2SinopharmVaccine 140236.pdf Kumari K, Yadav R, Mittra S, Kumar A, Singh J, Bajpai PK, et al. Pregnancy consequences and vertical transmission potential of SARS-CoV-2 infection: seeking answers from a preliminary observation. J Reprod Infertil. 2021;22(2):144-7.##Heidary Z, Kohandel Gargari O, Fathi H, Zaki-Dizaji M, Ghaemi M, Hossein Rashidi B. Maternal and neonatal complications, outcomes and possibility of vertical transmission in Iranian women with COVID-19. Arch Iran Med. 2021;24(9):713-21.##Kumar D, Verma S, Mysorekar IU. COVID-19 and pregnancy: clinical outcomes; mechanisms, and vaccine efficacy. Transl Res. 2023;251:84-95.##Schwartz DA, Mulkey SB, Roberts DJ. SARS-CoV-2 placentitis, stillbirth, and maternal COVID-19 vaccination: clinical-pathologic correlations. Am J Obstet Gynecol. 2023;228(3):261-9.##Boelig RC, Aghai ZH, Chaudhury S, Kazan AS, Chan JSY, Bergmann-Leitner E. Impact of COVID-19 disease and COVID-19 vaccination on maternal or fetal inflammatory response, placental pathology, and perinatal outcomes. Am J Obstet Gynecol. 2022;227(4):652-6.##Leal CRV, Maciel RAM, Corrêa Júnior MD. SARS-CoV-2 infection and placental pathology. Rev Bras Ginecol Obstet. 2021;43(6):474-9.##Shanes ED, Otero S, Mithal LB, Mupanomunda CA, Miller ES, Goldstein JA. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in pregnancy: measures of immunity and placental histopathology. Obstet Gynecol. 2021;138(2):281-3.##Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, et al. Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. N Engl J Med. 2021;384(24):2273-82.##Levine-Tiefenbrun M, Yelin I, Katz R, Herzel E, Golan Z, Schreiber L, et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med. 2021;27(5):790-2.##Mohamed K, Rzymski P, Islam MS, Makuku R, Mushtaq A, Khan A, et al. COVID-19 vaccinations: the unknowns, challenges, and hopes. J Med Virol. 2022;94(4):1336-49.##Shook LL, Atyeo CG, Yonker LM, Fasano A, Gray KJ, Alter G, et al. Durability of anti-spike antibodies in infants after maternal COVID-19 vaccination or natural infection. JAMA. 2022;327(11):1087-9.##Khong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler MA, et al. Sampling and definitions of placental lesions: amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016;140(7):698-713.##Arab M, Noei Teymoordash S, Talayeh M, Ghavami B, Javadi A, Nouri B. Evaluation of serologic changes of IgG and IgM antibodies associated with SARS-COV-2 in cancer patients: a cohort seroprevalence study. Asian Pac J Cancer Prev. 2021;22(6):1667-70.##Balou HA, Yaghubi Kalurazi T, Joukar F, Hassanipour S, Shenagari M, Khoshsorour M, et al. High seroprevalence of SARS-CoV-2 (COVID-19)-specific antibodies among healthcare workers: a cross-sectional study in Guilan, Iran. J Environ Public Health. 2021;2021:9081491.##Akhavan S, Borna S, Abdollahi A, Shariat M, Zamani N. Pathologic examination of the placenta and its benefits in treatment plan or follow-up of patients: a cross-sectional study. Eur J Med Res. 2022;27(1):113.##Singh N, Buckley T, Shertz W. Placental pathology in COVID-19: case series in a community hospital setting. Cureus. 2021;13(1):e12522.##Arcos Júnior GF, Francisco RPV, Kill B, Peres SV, Gibelli M, Ibidi SM, et al. Placental pathological findings in coronavirus disease 2019: perinatal outcomes. Placenta. 2022;128:23-8.##Al-Rawaf SA, Mousa ET, Kareem NM. Correlation between pregnancy outcome and olacental oathology in COVID-19 oregnant women. Infect Dis Obstet Gynecol. 2022;2022:8061112.##Gulersen M, Prasannan L, Tam Tam H, Metz CN, Rochelson B, Meirowitz N, et al. Histopathologic evaluation of placentas after diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection. Am J Obstet Gynecol MFM. 2020;2(4):100211.##Motwani R, Deshmukh V, Kumar A, Kumari C, Raza K, Krishna H. Pathological involvement of placenta in COVID-19: a systematic review. Infez Med. 2022;30(2):157-67.##Suhren JT, Meinardus A, Hussein K, Schaumann N. Meta-analysis on COVID-19-pregnancy-related placental pathologies shows no specific pattern. Placenta. 2022;117:72-7.##Prasad S, Kalafat E, Blakeway H, Townsend R, O'Brien P, Morris E, et al. Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy. Nat Commun. 2022;13(1):2414.##Jeewandara C, Jayampathi KCS, Ranasinghe T, Aberathna IS, Gunasekara B, Danasekara S, et al. Antibody responses to Sinopharm/BBIBP-CorV in pregnant mothers in Sri Lanka. PLOS Glob Public Health. 2022;2(7):e0000607.##Sunder A, Alqatari HM, Taha OE, Keshta MS, Bughamar FK, Darwish B. COVID-19 vaccinations in pregnancy: save mother and baby from COVID-19 pandemic. Int J Gynaecol Obstet. 2022;160(3):864-73.##Smithgall MC, Murphy EA, Schatz-Siemers N, Matrai C, Tu J, Baergen RN, et al. Placental pathology in women vaccinated and unvaccinated against SARS-CoV-2. Am J Obstet Gynecol. 2022;227(5):782-4.##Mohd Ariff NS, Abdul Halim Zaki I, Mohd Noordin Z, Md Hussin NS, Goh KW, Ming LC, et al. A review of the prevalence of thromboembolic complications among pregnant women infected with COVID-19. J Clin Med. 2022;11(19):5934.##Carbonnel M, Daclin C, Tourne M, Roux E, Le-Marchand M, Racowsky C, et al. Impact of COVID-19 on subclinical placental thrombosis and maternal thrombotic factors. J Clin Med. 2022;11(14):4067.##Fung TY, To KF, Sahota DS, Chan LW, Leung TY, Lau TK. Massive subchorionic thrombohematoma: a series of 10 cases. Acta Obstet Gynecol Scand. 2010;89(10):1357-61.##Miyagi M, Kinjo T, Mekaru K, Nitta H, Masamoto H, Aoki Y. 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The Migration of an Intrauterine Device in the Bladder of an Asymptomatic Woman: A Case Report 2 1 140237 2 Background: The use of intrauterine devices (IUDs) for contraception has in-creased in many countries. However, their application has some serious compli-cations such as uterine perforation and injury to adjacent organs. The translo-cated IUD into the bladder is a very rare occurrence. Case Presentation: Our case was a 41-year-old woman whose IUD was acci-dentally discovered in her bladder during a routine ultrasound. The IUD has mi-grated from its normal position in the uterus to the bladder. The IUD was suc-cessfully removed by cystoscopy without any complications. Conclusion: The mislocation of an IUD in the bladder, while uncommon, is a possibility that should be considered when the IUD string is not visible during examinations. 238 242 Seyedeh Azam SA Pourhoseini Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Iran Leili L Hafizi لیلی حفیظی Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Iran Mona M Jafari Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Iran JafariM4001@mums.ac.ir Contraceptive agentsContraceptive devicesIntrauterine deviceIUD migrationUterine perforation 140237.pdf Nouioui MA, Taktak T, Mokadem S, Mediouni H, Khiari R, Ghozzi S. A mislocated intrauterine device migrating to the urinary bladder: an uncommon complication leading to stone formation. Case Rep Urol. 2020;2020:2091915.##Paré AK, Ouattara A, Yé D, Kabré B, Bako A, Abubakar B, et al. Management of intrauterine device migrated into the bladder: a case report and literature review. Case Rep Urol. 2020;2020:8850087.##Mona A, Tardif D, Fawzy A, Socolov RV. Management of an intrauterine device migration resulting in a pregnancy–clinical case. Maedica (Bucur). 2020;15(4):549-51.##Rasekhjahromi A, Chitsazi Z, Khlili A, Babaarabi ZZ. Complications associated with intravesical migration of an intrauterine device. Obstet Gynecol Sci. 2020;63(5):675-8.##Aydogdu O, Pulat H. Asymptomatic far-migration of an intrauterine device into the abdominal cavity: a rare entity. Can Urol Assoc J. 2012;6(3):E134-6.##Sano M, Nemoto K, Miura T, Suzuki Y. Endoscopic treatment of intrauterine device migration into the bladder with stone formation. J Endourol Case Rep. 2017;3(1):105-7.##Azandaryani AR, Ghaderzadeh P, Farsangi LE. Intravesical migration of intrauterine device and calculi formation 12 years post missing: a case report. Case Rep Clin Med. 2017;6(1):24-30.##Christodoulides AP, Karaolides T. Intravesical migration of an intrauterine device (IUD)-case report. Urology. 2020;139:14-7.##Zhang P, Wang T, Yang L. Extensive intravesical benign hyperplasia induced by an extravesical migrated intrauterine device: a case report. Medicine (Baltimore). 2019;98(20):e15671.##Raj A, Xiaolei S, Wenjing X, Renfu C, Yunpeng P. A sandwich technique for the removal of stone embedded intrauterine devices in the urinary bladder. Urol Case Rep. 2021;38:101599.##Chakir Y, Daghdagh Y, Moataz A, Dakir M, Debbagh A, Aboutaieb R. Intra uterine device migrating into the bladder with stone formation. Urol Case Rep. 2021;40:101918.##Cheung ML, Rezai S, Jackman JM, Patel ND, Bernaba BZ, Hakimian O, et al. Retained intrauterine device (IUD): triple case report and review of the literature. Case Rep Obstet Gynecol. 2018;2018:9362962.##Verstraeten V, Vossaert K, Van den Bosch T. Migration of intra-uterine devices. Open Access J Contracept. 2024;15:41-7.##