Are IVF Clinics Ready to Deal with Any Potential Crisis or Disaster? 2 1 140271 2 In the quality management programs of healthcare systems and hospitals, there is a special focus on emergency preparedness and risk management as a requirement in preventive action plans. IVF clinics are at the forefront of this attention. The vulnerability of IVF clinics to various threats, including regional wars and conflicts, natural disasters and crisis, power outages and cyberattacks, is greater compared to other healthcare facilities. In addition to planning for protection of patients and staff in IVF clinics, special considerations and measures are necessary due to elevated vulnerability of stored biological materials and the irreparable loss of gametes, embryos, and reproductive tissues. The loss or threat to stored biological materials in IVF clinics has significant legal and emotional consequences for the patients, service providers, and the healthcare system (1). IVF clinics should implement a range of comprehensive strategies, to ensure the safety of staff and patients as well as the continuity and security of reproductive materials in emergencies, through delineating funda-mental principles of accreditation, quality management, and experiences from past incidents and disasters. Accreditation and quality management systems (QMS) play a key role in emergency preparedness. IVF clinics are always advised to operate with the core principles of accreditation, even if they are not formally accredited. Formal accreditation as a requirement provides a framework and principle of proactive planning to withstand disruptions and protect critical reproductive care services. A robust QMS, as a quality framework, is essential to govern all operational practices and manage potential risks. Professional societies such as ASRM, ESHRE, SAR, and SRBT emphasize that such systems must address: ensuring the safety and protection of staff and patients; maintaining the safety and viability of fresh and frozen biological materials such as embryos, oocytes, sperm, and tissues; protecting and securing critical data including patient and laboratory records, financial documents, and equipment; and finally establishing clear guidelines for continuing or discontinuing patient treatment. All these plans require "all-hazards" risk assessment encompassing pandemics, natural disasters (e.g., fires, floods, earthquakes, hurricanes, and blizzards), power outages, terrorist attacks, cyberattacks, and equipment failures (1-3). IVF clinics are recommended to establish procedures to monitor adequate liquid nitrogen (LN2) levels and temperatures in all critical storage containers. This includes checking dewars at least three times a week or using continuous electronic monitoring systems with 24-hr remote alarms that immediately notify personnel if critical values are reached. For faster response to vacuum failures, LN2-immersed level probes are preferred over vapor-immersed temperature probes. An adequate supply of LN2 should be maintained on site, possibly including double ordering in anticipation of shipping delays. LN2 availability must be evaluated by risk assessment programs, which may be achieved through agreements with other facilities to share the costs of an LN2 generator. It is preferable to visually inspect the tanks for damage such as sweating, cracking, or rust, and any tank losing LN2 faster than expected should have its contents transferred to a spare tank and replaced. It is beneficial that the new storage tanks undergo a rigorous 30-day performance validation process, including thermal imaging, dual probe temperature checks, and weight monitoring, before being put into active use. Access to cryo-storage tanks and the LN2 source should be limited to authorized and trained personnel. Furthermore, tanks are advised to be located in well-ventilated areas, and oxygen monitors with audible and visual alarms are essential to detect hypoxic environments caused by LN2 release. Moving LN2 tanks to a safer location is recommended if there is adequate warning of an impending emergency. These new locations need to be secured and marked so that non-medical personnel (e.g., fire, police) can easily identify them, and the relevant authorities are notified in advance. In fact, moving large tanks is more difficult and requires careful planning (1, 4, 5). In crises and disasters, operations should be hibernated, new cycled halted, and all gametes and embryos immediately frozen until the implementation of safe strategies. Emergency freezing of day zero to day five (D0-D5) oocytes and embryos is a safe and effective protective measure during disasters. For example, during the Zhengzhou flood in 2021, 1,246 oocytes and embryos from 155 patients were successfully frozen with only emergency power supplies. Similarly, during the 2025 Iran-Israel twelve-day war, oocytes and embryos were frozen at all IVF clinics in war-involved areas. In some cases, embryologists may strategically freeze and store D0/D1 embryos to reduce the potential risks of freezing (4). Duplicate records for recognizing sample ownership should be maintained in a secure location separate from the primary storage site, ideally off-site or on a secure web server for proper data management and security. In the event of power outage or cyberattack, paper documents become critical for patient and embryology records. Printing electronic documents in preparation for anticipated disasters is a good strategy. Healthcare organizations are vulnerable to cyber threats, so emergency plans must include protocols for complete computer shutdown, with a focus on recovering electronic medical record (EMR), laboratory systems, and imaging archive modules that are critical for resuming normal clinical practice. Moreover, staff training in manual documentation and procedures is essential. Recruiting adequate staff for all clinic procedures and emergency response who receive emergency preparedness training commensurate with their job responsibi-lities is a great step in emergency plans. Announced and unannounced maneuvers should be conducted per-iodically to educate staff on safety features, evacuation plans, and to test their ability to execute the emergency action plan. In addition, clear and prompt communication from management is critical to support staff (1, 3). A proper policy to diminish the risks of power outages in disasters, incorporating UPS systems for providing 6–8 hr of full-load operation, and on-site generator fuel for at least 3–4 days of continuous operation represent optimal practices in IVF clinics. Ensuring a suitable and uninterrupted power supply of incubator gases, including pre-mixed gas compositions, is critical to maintain ideal culture conditions. Adequate stocks of consumables (e.g., 3 months of supply) should be maintained and substitute and pre-evaluated suppliers be identified to minimize supply chain disruptions. It is suggested to properly secure equipment against potential damage and to ensure alarm systems notify personnel of their malfunction or adverse environmental con-ditions. Re-validation of equipment after a period of non-use in emergencies is also essential (1, 4). IVF clinics are encouraged to establish formal "mutual support agreements" with one or more nearby clinics to ensure continuity of care during crises. A growing number of centers are relying on off-site commercial storage facilities for long-term storage of frozen samples. These facilities are specifically designed to protect samples from disasters and provide climate-controlled environments, 24-hr monitoring, and strong security. Professional cryogenic shipping services are necessary for safe handling of biological specimens. Patients should be promptly informed via consent forms about the location and status of their stored samples, that they may be transferred to other centers in the event of an emergency, and that any compromise or destruction of tissue will be reported and documented (2, 3, 5). All in all, IVF clinics need to learn from the past. The COVID-19 pandemic highlighted vulnerabilities in the supply chains of personal protective equipment (PPE), consumables and LN2, as well as staff shortages and travel restrictions. This culminated in widespread interruptions of elective treatments globally and increased reliance on telemedicine for consultations. In another case, the NYU Langone Fertility Center in the United States experienced a power outage and its backup generator failed. However, the use of UPS units was crucial for the emergency preparation and freezing of 90 embryos, resulting in 11 live births. The center also relied heavily on its local network of IVF clinics to manage patients for oocyte retrieval, resulting in 10 live births. During Hurricane Katrina, severe flooding restricted access to frozen embryos to boat transport only, making re-entry into the city impossible for extended periods and causing the loss of embryos in incubation. All disposables had to be discarded before IVF services could be resumed. The war in Ukraine severely impacted IVF clinics, causing infrastructure disruptions (e.g., power outages and clinic damage), endangering biological samples, and creating physical and logistical challenges for maintaining operations amid blackouts and airstrikes. A documented case involves Dr. Anna Sokalska, a faculty member of Stanford University, who coordinated the transport of oocytes and embryos from Kyiv to a clinic in Poland in March 2022, and per-formed extraordinary efforts to protect vital reproductive material and continue services despite the enormous difficulties caused by the war (1, 2, 4, 6). In conclusion, the continuity and protection of reproductive materials in IVF clinics mainly rely on careful planning, adherence to accreditation principles, continuous monitoring of critical systems, robust data management, staff training and practice, and the establishment of mutual support networks and off-site storage solutions. Learning from past emergencies will continually refine these strategies and prepare facilities for the unpredictable challenges of the future. 069 72 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 140271.pdf Cairo consensus group 2023, alpha scientists in reproductive medicine. Cairo consensus on accreditation as the basis for future-proofing the ART laboratory. Reprod Biomed Online. 2025;50(1):104106.##Goldman KN, McCaffrey C, Riley J, Jungheim E, Grifo JA. Disaster preparedness in assisted reproductive technology. Fertil Steril. 2022;118(2):230-8.##Practice committees of the American society for reproductive medicine, the society for assisted reproductive technology, and the society of reproductive biologists and technologists. Electronic. Development of an emergency plan for in vitro fertilization programs: a committee opinion. Fertil Steril. 2021;115(4):870-3.##Song W, Zhang F, Wang Y, Shi H, Sun N, Jin H, et al. Effective protection: the embryonic development and clinical outcomes of emergency vitrification of 1246 oocytes and day 0-day 5 embryos in a natural disaster. Hum Reprod. 2023;38(12):2412-21.##Practice committees of the American society for reproductive medicine, society for reproductive biologists and technologists, and society for assisted reproductive technology. Cryostorage of reproductive tissues in the in vitro fertilization laboratory: a committee opinion. Fertil Steril. 2020;114(3):486-91.##Stanford Medicine. Lending a helping hand to a Ukraine IVF clinic [Internet]. Stanford (CA): Stanford School of Medicine; c2025 [cited 2025 Aug 27]. Available from: https://obgyn.stanford.edu/in-the-news/lending-a-helping-hand-to-a-ukraine-ivf-clinic.html.##

Impact of Intrauterine Growth Restriction on Fetal Cortical Brain Development: A Neurosonographic Assessment at 28-36 Weeks of Gestation 2 1 140262 2 Background: Cortical folding during fetal brain development reflects neural maturation. Fetal growth restriction (FGR) may disrupt this process, potentially affecting neurodevelopmental outcomes. Although ultrasound enables noninvasive sulcal assessment, so normative data and objective tools are lacking. The purpose of the current study was to assess the impact of FGR on fetal cortical development using neurosonography and establish a third-trimester nomogram for cortical maturation. Methods: This prospective study included 425 singleton pregnancies (330 appropriate-for-gestational-age [AGA], 54 symmetrical FGR, and 41 asymmetrical FGR) at 28–36 weeks. Conducted at a Tehran tertiary center (2023–2024), the study included cases with normal anatomy and negative aneuploidy screening. Neurosonographic parameters including Sylvian fissure (SF), insula, parieto-occipital fissure (POF), cavum septum pellucidum (CSP) width, and ventricular diameter were measured and the ratios calculated relative to biparietal diameter (BPD). ANOVA and post-hoc tests were applied and statistical significance was set at p<0.05. Results: No significant differences in neurosonographic ratios (e.g., SF/Insula, POF/ BPD, CSPW/BPD) were found between AGA and FGR groups. However, unadjusted SF and insular depths were reduced in symmetrical FGR fetuses with head circumference (HC) <10th percentile. Asymmetrical FGR showed no differences. A gestational-age-based nomogram was developed for AGA fetuses. Conclusion: While absolute sulcal measurements vary with head size in FGR, biometric adjustments (e.g., BPD ratios) improve cortical maturation assessment. The study supports ratio-based neurosonography and provides normative data for objective fetal brain evaluation. 072 81 Behrokh B Sahebdel Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Iran Reihaneh R Mortazavi Ardestani Department of Radiology, Tehran University of Medical Sciences Department of Radiology, Tehran University of Medical Sciences Iran Setareh S Soltani Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences Iran Mohammad Hossein MH Golezar Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences Iran Fatemeh F Golshahi Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Iran Nafiseh N Saedi Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Iran Fatemeh F Rahimi Sharbaf Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Iran Mahboobeh M Shirazi Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Iran Nooshin N Faraji Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Iran Mohadese M Dashtkoohi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Iran Zohreh Z Heidary Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Iran Masoumeh M Aslanpour Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Fetal an d Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences Iran dtmasiiii20@gmail.com Cortical maturationFetal brain developmentFetal ultrasoundInsulaIntra-uterine growth restrictionNeurosonographyNomogramSylvian fissure 140262.pdf Aslan Çetin B, Madazlı R. 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The Effect of Letrozole and N-Acetylcysteine on the Expression Levels of Genes Involved in Glucose Metabolism in Patients with Polycystic Ovary Syndrome: A Clinical Trial Study 2 1 140264 2 Background: N-acetylcysteine (NAC) is a supplement commonly used in patients with polycystic ovary syndrome (PCOS). The expansion of oocyte-associated cumulus cells (CCs) and the quality of the oocyte are critical factors influencing fertilization rates and clinical pregnancy outcomes in assisted reproductive techniques (ARTs). Genes such as phosphofructokinase (PFKP) and pyruvate kinase isoform M2 (PKM2) are involved in glucose metabolism and are crucial in the regulation of oocyte competence and developmental potential. The purpose of the current study was to evaluate the effects of letrozole and NAC on the expression of PFKP and PKM2 in CCs of PCOS patients undergoing ART. Methods: The study evaluated 20 PCOS women undergoing ART to assess the effect of letrozole and NAC on the expression levels of PKM2 and PFKP genes in cumulus cells. Women were randomly assigned using a simple randomization method into four groups: control, NAC, letrozole, and NAC plus letrozole, with five women in each group. Gene expression levels of PKM2 and PFKP were measured using real-time PCR. Results: The expression level of PKM2 was significantly higher in the letrozole plus NAC group compared to the control group (p<0.05). In NAC group, PFKP was significantly expressed compared to the control group (p<0.05). There were no significant differences among the other groups compared to the control group. Conclusion: NAC can improve the quality of oocytes by increasing the expression level of genes involved in the glucose metabolism (PKM2, PFKP) of CCs, thereby potentially improving ART success rate in PCOS patients. Therefore, administering NAC along with letrozole can have a synergistic effect on increasing the expression level of genes associated with blastocyst quality in PCOS patients. 081 90 Ebrahim E Jafarzadeh Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences Iran Roghiyeh R Pashaei-Asl Interdisciplinary Research Development Center, Iran University of Medical Sciences Interdisciplinary Research Development Center, Iran University of Medical Sciences Iran Parvin P Hakimi Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences Iran Parvin.hakimi56@gmail.com Maryam M Pashaiasl Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences Iran pashaim@tbzmed.ac.ir Cumulus cellsLetrozoleN-acetylcysteinePFKP genesPKM2 genesPolycystic ovarian syndrome 140264.pdf Thakker D, Raval A, Patel I, Walia R. 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Prognostic Factors for Pain and Fertility Outcomes Following Laparoscopic Endometriosis Surgery: A Single-Center Experience 2 1 140267 2 Background: Endometriosis is a prevalent condition among women, often leading to infertility. Laparoscopic surgery is widely employed as a therapeutic intervention for endometriosis. This study investigated the prognostic factors influencing the outcome of laparoscopic surgery for endometriosis. Methods: This cross-sectional study included 60 women with endometriosis referred for laparoscopic surgery at Amiralmomenin Hospital, Zabol, Iran, between 2022 and 2024. Pain intensity was measured using a visual analog scale (VAS). Statistical analyses were performed using SPSS version 26. Descriptive statistics summarized the data, while univariate analyses (t-tests and chi-square tests) assessed relationships between variables. Multivariate logistic regression identified independent predictors of pain reduction and pregnancy outcomes. Results: Patients with moderate endometriosis showed statistically significant pain reduction from 8.8 preoperatively to 1.8 at 9 months (p<0.001) and 2.2 at 12 months post-surgery (p=0.003). Those with severe endometriosis had non-significant pain reduction (8 to 6 at 12 months, p=0.12). Both intrauterine (9 to 1.1 at 12 months, p<0.001) and extrauterine involvement groups (8.6 to 3.3, p=0.004) demonstrated significant pain improvement, with no significant difference between the groups (p=0.779). Regarding fertility outcomes, treatment before the age of 30 significantly increased pregnancy likelihood (AOR=20.57, 95%CI 1.4-295.3), while other factors including BMI, CA125 levels, and parity showed no significant associations (all p>0.05). Conclusion: These preliminary findings suggest that laparoscopic surgery may reduce pain in moderate endometriosis, while the age under 30 may be associated with improved pregnancy outcomes. However, given the study’s limited sample size and wide confidence intervals, these results require validation in larger, multicenter cohorts. 090 98 Mania M Kaveh Department of Obstetrics and Gynecology, School of Medicine, Amiralmomenin Hospital, Zabol University of Medical Sciences Department of Obstetrics and Gynecology, School of Medicine, Amiralmomenin Hospital, Zabol University of Medical Sciences Iran Fatemeh F Khodayari Department of Obstetrics and Gynecology, School of Medicine, Amiralmomenin Hospital, Zabol University of Medical Sciences Department of Obstetrics and Gynecology, School of Medicine, Amiralmomenin Hospital, Zabol 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 Abolfazl A Mehdizadehkashi Abolfazl Mehdizadehkashi Department of Obstetrics and Gynecology, School of Medicine, Endometriosis Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences Department of Obstetrics and Gynecology, School of Medicine, Endometriosis Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences Iran Mehdi M Afshari Department of Community Medicine, School of Medicine, Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences Department of Community Medicine, School of Medicine, Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences Iran Zahra Z Shahraki Department of Obstetrics and Gynecology, School of Medicine, Amiralmomenin Hospital, Zabol University of Medical Sciences Department of Obstetrics and Gynecology, School of Medicine, Amiralmomenin Hospital, Zabol University of Medical Sciences Iran Kambiz K Sadegi Department of Anesthesiology, School of Medicine, Amiralmomenin Hospital, Zabol University of Medical Sciences Department of Anesthesiology, School of Medicine, Amiralmomenin Hospital, Zabol University of Medical Sciences Iran Kamsadegi@yahoo.co.uk EndometriosisLaparoscopic surgeryPostoperative painSurgical pain management 140267.pdf [No authors listed]. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223-36##Bergqvist A. Different types of extragenital endometriosis: a review. Gynecol Endocrinol. 1993;7(3):207-21.##Karlitz JJ, Tepler IA, Tanaka KE. Endometriosis with colonic wall invasion. Clin Gastroenterol Hepatol. 2007;5(3):A30.##Rana R, Sharma S, Narula H, Madhok B. A case of recto-sigmoid endometriosis mimicking carcinoma. Springerplus. 2016;5:643.##Gylfason JT, Kristjansson KA, Sverrisdottir G, Jonsdottir K, Rafnsson V, Geirsson RT. Pelvic endometriosis diagnosed in an entire nation over 20 years. Am J Epidemiol. 2010;172(3):237-43.##Practice committee of the American society for reproductive medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591-8.##Montgomery GW, Giudice LC. New lessons about endometriosis-somatic mutations and disease heterogeneity. New Engl J Med. 2017;376(19):1881-2.##Andres MP, Borrelli GM, Abrão MS. Endometriosis classification according to pain symptoms: can the ASRM classification be improved? Best Pract Res Clin Obstet Gynaecol. 2018;51:111-8.##Goncalves MOdC, Podgaec S, Dias Jr JA, Gonzalez M, Abrao MS. Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod. 2010;25(3):665-71.##Kho RM, Andres MP, Borrelli GM, Neto JS, Zanluchi A, Abrão MS. Surgical treatment of different types of endometriosis: Comparison of major society guidelines and preferred clinical algorithms. Best Pract Res Clin Obstet Gynaecol. 2018;51:102-10.##Menakaya UA, Rombauts L, Johnson NP. Diagnostic laparoscopy in pre‐surgical planning for higher stage endometriosis: Is it still relevant? Aust N Z J Obstet Gynaecol. 2016;56(5):518-22.##Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non‐invasive diagnosis of endometriosis. 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Serum Levels of CCN3 Protein in Iranian Women with Polycystic Ovary Syndrome 2 1 140270 2 Background: Polycystic ovary syndrome (PCOS) is a heterogeneous condition that encompasses several cardiometabolic and endocrinological disorders. Studies have shown that its pathogenesis aligns with several underlying mechanisms associated with recurrent pregnancy loss (RPL). Cellular communication network (CCN)-3 protein is a well-studied adipokine involved in tumorigenesis, organogenesis, inflammation, fibrosis, and glucose metabolism. The purpose of the current study was to determine the association of CCN3 levels with a number of parameters involved in PCOS pathogenesis. Methods: This is a case-control study including 120 PCOS patients (60 cases with RPL; PCOS-RPL and 60 cases with infertility; PCOS-Inf and 60 healthy controls). Circulating levels of homocysteine and high-sensitivity C-reactive protein (hs-CRP), homocysteine, and CCN3 were measured using ELISA kits. Results: Circulating levels of CCN3 were significantly elevated in PCOS-RPL and PCOS-Inf subgroups when compared to the control group (7.61±3.03 and 6.85±2.54 vs. 3.12±0.82, p<0.001). Serum CCN3 positively correlated with fasting insulin and homeostatic model assessment of insulin resistance (HOMA-IR) in the control group (p<0.05) and PCOS group (p<0.001). Moreover, CCN3 was significantly associated with PCOS (OR 4.808, 95%CI [2.744-8.423], p<0.001). Conclusion: According the results of this study CCN3 may be involved in the pathogenesis of PCOS. However, future studies are needed to evaluate the possibility of utilizing CCN3 in the diagnosis and treatment of the disease. 098 109 Akram A Vatannejad Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran Iran vatannejad@ut.ac.ir Fatima Zahraa FZ Fouani Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences Iran Reza R Fadaei Sleep Disorders Research Center, Kermanshah University of Medical Sciences Sleep Disorders Research Center, Kermanshah University of Medical Sciences Iran Asma A Kheirollahi Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran Iran Soheila S Ansaripour Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Maryam M Shabani Nashtaei Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences Iran Nariman N Moradi Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences Iran Hossein H Montakhab-Yeganeh Department of Biochemistry, Faculty of Medicine, Hormozgan University of Medical Sciences Department of Biochemistry, Faculty of Medicine, Hormozgan University of Medical Sciences Iran Faezeh F Fattahi Emergency Department, Shahid Fayazbakhsh Hospital Emergency Department, Shahid Fayazbakhsh Hospital Iran Farah F Jadidizadeh Emergency Department, Shahid Fayazbakhsh Hospital Emergency Department, Shahid Fayazbakhsh Hospital Iran AbortionC-reactive proteinHomocysteineMetabolic syndromeNephroblastoma overexpressed proteinPolycystic ovarian syndromeCCN3 140270.pdf Villa J, Pratley RE. 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Altered Expression of Toll-Like Receptors and Key Signaling Genes in Sertoli Cells of Azoospermic Patients 2 1 140266 2 Background: Azoospermia, the complete absence of sperm in the ejaculate, is a major cause of male infertility. Sertoli cells are essential for spermatogenesis, and disruptions in innate immune immune pathways, particularly Toll-like receptors (TLRs), may impair their function. This study investigated the expression of TLR1–10 and downstream signaling molecules (MYD88, NFKB, TRIF, IRF3, and TRAM) in Sertoli cells of azoospermic patients. Methods: Testicular tissue were collected from 20 azoospermic men undergoing testicular sperm extraction (TESE). Patients were categorized into two TESE positive (sperm present, n=10) and TESE negative (sperm absent, n=10). Sertoli cells were isolated using enzyme digestion and purified via fluorescence-activated cell sorting (FACS). Gene expression of TLR1–10 and signaling molecules was quantified by RT-PCR. Data were analyzed using independent-samples T-test, with significance set at p<0.05. Results: Significant downregulation was detected in TLR10 (20.6-fold, p<0.0001), TLR9 (4.6-fold, p<0.05), TLR7 (4.8-fold, p<0.01), TLR6 (12.4-fold, p<0.05), TLR5 (13.5-fold, p<0.001), TLR4 (3.2-fold, p<0.05), and TLR3 (3.1-fold, p<0.01). Among signaling molecules, MYD88 (4.1-fold, p<0.01) and IRF3 (4.2-fold, p<0.05) showed significant reductions, indicating impaired immune signaling in Sertoli cells of TESE-negative men. Conclusion: Altered expression of TLRs and associated signaling molecules in Sertoli cells of azoospermic men suggests innate immune dysregulation as a potential mecha-nism underlying defective spermatogenesis. These findings highlight immune privilege-associated pathways as possible targets for developing diagnostic biomarkers and novel therapeutic approaches for male infertility. 109 119 Mohammad Reza MR Lakpour Department of Biology, Payame Noor University Department of Biology, Payame Noor University Iran Reza R Aflatoonian 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 Mohammad Ali MA Sadighi Gilani Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Iran Reza R Hajihosseini Department of Biology, Payame Noor University Department of Biology, Payame Noor University Iran hosseini@pnu.ac.ir Marjan M Sabbaghian Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Iran m.sabbaghian@royaninstitue.org AzoospermiaMale infertilitySignal transductionSertoli cellsTESEToll-like receptors 140266.pdf Datta J, Palmer MJ, Tanton C, Gibson LJ, Jones KG, Macdowall W, et al. 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Assessment of Seminal Lactoferrin Levels in Oligoasthenoterato-zoospermic Men with Varicocele 2 1 140263 2 Background: The association between varicocele and male infertility has always been a subject of ongoing debate. Lactoferrin (LF) belongs to the transferrin family with iron-binding properties and exhibits many beneficial biological properties. The purpose of the current study was to assess seminal levels of LF in infertile oligoasthenoteratozoospermic (OAT) men with varicocele. Methods: Sixty-nine men were allocated into three groups; healthy fertile men (as controls) (n=20), infertile OAT men without varicocele (n=19), and infertile OAT men with varicocele (n=30). All men underwent history taking, genital examination, semen analysis, and determination levels of seminal LF by ELISA method. Statistical analysis was carried out using Kruskal-Wallis test followed by post-hoc analysis (Conover) for comparisons involving more than two groups, and the Mann-Whitney U test for comparisons between two groups. Spearman correlation test was used to assess the relationship between variables. The p>0.05 was set as statistically significant. Results: The median seminal LF level of the healthy fertile controls demonstrated significantly increased levels compared to both groups of infertile OAT men with or without varicocele (p<0.000001). The median seminal LF level of the infertile OAT men with varicocele grade III demonstrated a significant decrease compared to infertile OAT men with grade II (p=0.0057). Collectively, seminal LF levels exhibited significant positive correlations with sperm concentration, total sperm motility, and normal sperm morphology. Conclusion: LF can be an imperative seminal biomarker that decreases in infertile OAT men especially if associated with varicocele. 119 126 Mahmoud F MF Ghaly Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University Egypt mahmoud.fawzy@kasralainy.edu.eg Khadiga Kh Abougabal Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University Egypt Ayman A AA Allam Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University Egypt Ayad A Palani Department of Basic Sciences, College of Medicine, University of Garmian Department of Basic Sciences, College of Medicine, University of Garmian Iraq Taymour T Mostafa Department of Clinical Biochemistry, Zanko Central Laboratory Department of Clinical Biochemistry, Zanko Central Laboratory Iraq Male infertilityLactoferrinSeminal plasmaOligoasthenoteratozoospermia (OAT)Varicocele 140263.pdf Zegers-Hochschild F, Adamson GD, Dyer S. 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Assessment of seminal YKL-40 in infertile men with varicocele. Andrologia. 2020;52(10):e13756.##Mostafa T, El-Taweel AEI, Rashed LA, Mohammed NAM, Akl EM. Assessment of seminal cystatin C levels in infertile men with varicocele: A preliminary study. Andrologia. 2022;54(1):e14278.##Ammar O, Tekeya O, Hannachi I, Sallem A, Haouas Z, Mehdi M. Increased Sperm DNA Fragmentation in infertile men with varicocele: relationship with apoptosis, seminal oxidative stress, and spermatic parameters. Reprod Sci. 2021;28(3):909-19.##Shah R, Agarwal A, Kavoussi P, Rambhatla A, Saleh R, Cannarella R, Harraz AM et al. Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations. World J Mens Health. 2023;41(1):164-97.##Dutta S, Majzoub A, Agarwal A. Oxidative stress and sperm function: A systematic review on evaluation and management. 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Seminal L-carnitine in infertile oligoasthenoteratozoospermic men with varicocele. J Reprod Infertil. 2022;23(1):26-32.##Ashrafzade AM, Sadighi Gilani MA, Topraggaleh TR, Khojasteh M, Sepidarkish M, Borjian Boroujeni P et al. Oxidative stress-related miRNAs in spermatozoa may reveal the severity of damage in grade III varicocele. Andrologia. 2020;52(9):e13598.##Azab SS, Mostafa T, Abougabal KM, Tohamy AA, Nabil N. Assessment of seminal calcium and magnesium levels in infertile men with varicocele before and after varicocelectomy. Andrology. 2021;9(6):1853-8.##Steiner AZ, Hansen KR, Barnhart KT, Cedars MI, Legro RS, Diamond MP et al. Reproductive Medicine Network. The effect of antioxidants on male factor infertility: the males, antioxidants, and infertility (MOXI) randomized clinical trial. Fertil Steril. 2020;113(3):552-60.e3.##Agarwal A, Finelli R, Selvam MKP, Leisegang K, Majzoub A, Tadros N et al. 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From High Risk to Hope: A Case Report of Live Birth from Cesarean Scar Pregnancy with Placenta Percreta 2 1 140268 2 Background: Cesarean scar pregnancy (CSP) is a rare yet serious condition involving implantation of the gestational sac at the site of a prior cesarean delivery. The management becomes increasingly complex with the addition of placenta percreta. In this paper, a case of CSP complicated by placenta percreta was reported which was successfully managed through a multidisciplinary approach. Case Presentation: A 35-year-old G4P3 woman was diagnosed with CSP at 6 weeks of gestation. Despite counseling on the risks, she opted to continue the pregnancy. Placenta percreta was diagnosed at 18 weeks. A multidisciplinary team monitored the pregnancy closely, leading to the delivery of a healthy infant at 32 weeks via cesarean delivery and subsequent hysterectomy. Conclusion: Multidisciplinary management and close follow-up are crucial in managing high-risk CSP cases, especially those complicated by abnormal placentation. 126 131 Nona N Sabeti 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 ninosb2000@gmail.com Houra H Mousavi Vahed Associate Professor of obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Associate Professor of obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Iran Azam A Pourhoseini Associate Professor of obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Associate Professor of obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Iran Abnormal placentationCesarean scar pregnancyHysterectomyLive birthPlacenta percreta 140268.pdf Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23(3):247-53.##Valasoulis G, Magaliou I, Koufidis D, Garas A, Daponte A. Caesarean scar pregnancy: a case report and a literature review. Medicina (Kaunas). 2022;58(6):740.##Kutlesic R, Kutlesic M, Vukomanovic P, Stefanovic M, Mostic-Stanisic D. Cesarean scar pregnancy successfully managed to term: when the patient is determined to keep the pregnancy. Medicina (Kaunas). 2020;56(10):496.##Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207(1):44.e1-13.##Maymon R, Halperin R, Mendlovic S, Schneider D, Vaknin Z, Herman A, et al. Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Hum Reprod. 2004;19(2):278-84.##Huang J, Phillips C, Moshiri M. Scarred for life: a review of cesarean section scar pregnancy and potential pitfalls in diagnosis. Abdom Radiol (NY). 2023;48(8):2672-83.##Wang CB, Tseng CJ. Primary evacuation therapy for Cesarean scar pregnancy: three new cases and review. Ultrasound Obstet Gynecol. 2006;27(2):222-6.##Jurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ. 2011;342:d3397.##Zhang Y, Zhang Z, Liu X, Zhang L, Hong F, Lu M. Risk factors for massive hemorrhage during the treatment of cesarean scar pregnancy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021;303(2):321-8.##Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003;21(3):220-7.##Suzuki N, Kyozuka H, Fukuda T, Murata T, Kanno A, Yasuda S, et al. Late-diagnosed cesarean scar pregnancy resulting in unexpected placenta accreta spectrum necessitating hysterectomy. Fukushima J Med Sci. 2020;66(3):156-9.##Jayaram PM, Okunoye GO, Konje J. Caesarean scar ectopic pregnancy: diagnostic challenges and management options. Obstet Gynaecol. 2017;19(1):13-20.##Malhotra N, Noor N, Bansal P, Sharma K. Successful management of caesarean scar ectopic pregnancies: a report of five cases. J Reprod Infertil. 2021;22(3):220-4.##Lin R, DiCenzo N, Rosen T. Cesarean scar ectopic pregnancy: nuances in diagnosis and treatment. Fertil Steril. 2023;120(3 Pt 2):563-72.##Shiber Y, Maymon R, Gal-Kochav M, Kugler N, Pekar-Zlotin M, Smorgick N, et al. Caesarean scar pregnancy: is there a light in the end of the tunnel? Arch Gynecol Obstet. 2023;307(4):1057-64.##Rotas MA, Haberman S, Levgur M. Cesarean Scar Ectopic Pregnancies: Etiology, Diagnosis, and Management. Obstet Gynecol. 2006;107(6):1373-81.##Sun H, Wang J, Fu P, Zhou T, Liu R. Systematic evaluation of the efficacy of treatments for cesarean scar pregnancy. Reprod Biol Endocrinol. 2024;22(1):84.##Calì G, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteaugudo A, Buca D, Forlani F, et al. 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Accessory Cavitated Uterine Mass: A Diagnostic Dilemma Illustrated by Three Case Reports 2 1 140269 2 Background: Accessory cavitated uterine mass (ACUM) is a rare, unclassified Müllerian anomaly characterized by distinct imaging features. It is typically lo-cated within the uterus, close to the round ligament, and has a uterus-like struc-tural arrangement. The patient may present with pelvic pain or dysmenorrhea. Most of these cases are misdiagnosed because of a lack of awareness about this unusual entity. Case Presentation: Three cases of ACUM in young patients who experienced prolonged symptoms and had incomplete family structures were reported in this paper. Initially, two of these cases were misdiagnosed during ultrasound exami-nations (USG). The subsequent magnetic resonance imaging (MRI) revealed characteristic imaging features consistent with ACUM, which provided signifi-cant psychological relief to both the patients and their families. Two patients re-ceived hormonal therapy, both of whom were unmarried. The third patient, however, indicated a wish to conceive and was therefore initiated on analgesics. All three patients chose to forgo surgical intervention, opting instead for medi-cal management despite its limited success in alleviating their symptoms. This decision was made to minimize obstetric risks associated with surgical interven-tions in potential future pregnancies. Conclusion: Laparoscopy or open surgery is the mainstay treatment for a per-manent relief from the symptoms. However, surgical treatment should be of-fered with caution as no data are available in medical literature regarding the ef-fect of surgically induced myometrial scarring on patients’ reproductive out-comes. Since most of these patients were young and nulligravida, the therapy had to be personalized in accordance with the patient’s preference and family status. 131 138 Shruti Sh Thakur Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) India tshruti878@yahoo.in Sanjay S Kumar Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) India Sushma S Makhaik Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) India Neeti N Aggarwal Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC) India AnalgesicsConservative treatmentDysmenorrheaHormonesLaparascopyMagnetic resonance imagingPelvic painPregnancyUterus 140269.pdf Acién P, Acién M, Fernández F, José Mayol M, Aranda I. The cavitated accessory uterine mass: a Mullerian anomaly in women with an otherwise normal uterus. Obstet Gynecol. 2010;116(5):1101-9.##Betzler N, Brunes M, Anfelter P, Wedlund L, Persson J, Epstein E. Sonografic features of accessory cavitated uterine mass (ACUM) successfully treated with robotic assisted laparoscopic surgery-a case report. Clin Obstet Gynecol Reprod Med. 2019;5(6):1-4.##Zajaczkowska W, Kapczuk K. Accessory cavitated uterine mass (ACUM) as a miniature uterine anomaly causing severe lateralized dysmenorrhea: case series. Ginekol Pol. 2023;94(11):907-12.##Dekkiche S, Dubruc E, Kanbar M, Feki A, Mueller M, Meuwly JY, et al. Accessory and cavitated uterine masses: a case series and review of the literature. Front Reprod Health. 2023;5:1197931.##Acién P, del Campo FS, Mayol MJ, Acién M. The female gubernaculum: role in the embryology and development of the genital tract and in the possible genesis of malformations. Eur J Obstet Gynecol Reprod Biol. 2011;159(2):426-32.##Jain N, Verma R. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly. Indian J Radiol Imaging. 2014;24(2):178-81.##Strug M, Christmas A, Schoonover A, Romero VC, Cordoba M, Leary E, et al. Impact of an accessory cavitated uterine mass on fertility: case presentation and review of the literature. F S Rep. 2023;4(4):402-9.##Deng F, Liu K, Huang Y, Chen Q, Wang L, Xiao X, et al. Successful treatment of a rare giant accessory cavitated uterine mass: a case report. J Int Med Res. 2024;52(5):3000605241252238.##Putta T, John R, Simon B, Sathyakumar K, Chandramohan A, Eapen A. Imaging manifestations of accessory cavitated uterine mass-a rare mullerian anomaly. Indian J Radiol Imaging. 2021;31(3):545-50.##Hu Q, Guo C, Chen Q, Zhang W, Wang H, Wei W. ACUM, an easily underdiagnosed cause of dysmenorrhea-a case report. Front Med (Lausanne). 2024;11:1308299.##11. HaiJing He, XuZhi Liang, Jiangtao Fan et al. 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A Case Report of a 20-Week Unruptured Tubal Ectopic Pregnancy: An Exceptionally Rare Clinical Entity 2 1 140265 2 Background: Ectopic pregnancy remains one of the most common causes of pregnancy-related deaths in the first trimester. About 2.4% of ectopic pregnancies occur in the interstitial part of the fallopian tubes. Given the nonspecific symptoms and the increased risk of hemorrhage associated with interstitial pregnancy localization, early diagnosis is crucial and should be based not only on clinical presentation but also on adjunctive diagnostic modalities. Early diagnosis leads to better treatment-related outcomes. Tubal ectopic pregnancies rarely progress into the second trimester and are typically diagnosed during the first trimester. Case Presentation: A 25-year-old primigravida at 20 weeks of gestation was initially diagnosed with a single live intrauterine pregnancy but presented with hypovolemic shock and was intraoperatively found to have an unruptured ectopic pregnancy. Postoperatively, the patient remained hemodynamically stable and was discharged on the fifth day. To date, the highest gestational age reported for a tubal ectopic pregnancy is 14 weeks. Conclusion: Ectopic pregnancies should be diagnosed in the first trimester via expert ultrasound. In this case, delayed second-trimester ultrasound in a low-income patient led to missed diagnosis. Clinical judgment must guide antenatal care, and surgery should not be delayed despite an unidentified source of hemoperitoneum. 138 142 Meenakshi M Ruhil Department of Obstetrics and Gynecology, Government Medical College and Hospital (GMCH) Department of Obstetrics and Gynecology, Government Medical College and Hospital (GMCH) India ruhilmeenakshi@gmail.com Anil A Humane Department of Obstetrics and Gynecology, Government Medical College and Hospital (GMCH) Department of Obstetrics and Gynecology, Government Medical College and Hospital (GMCH) India Sarika S Thakare Department of Obstetrics and Gynecology, Government Medical College and Hospital (GMCH) Department of Obstetrics and Gynecology, Government Medical College and Hospital (GMCH) India Ectopic pregnancyMethotrexateUltrasonography 140265.pdf Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and non-tubal ectopic pregnancies: a review. Fertil Res Pract. 2015;1:15.##Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. The diagnosis and treatment of ectopic pregnancy. Dtsch Arztebl Int. 2015;112(41):693‐703.##Elmoheen A, Salem W, Eltawagny M, Elmoheen R, Bashir K. The largest tubal pregnancy: 14th week. Case Rep Obstet Gynecol. 2020;2020:4728730.##Shao R. Understanding the mechanisms of human tubal ectopic pregnancies: new evidence from knockout mouse models. Hum Reprod. 2010;25(3):584-7.##Kirk E, Bourne T. Ectopic pregnancy. Obstet Gynecol Reprod Med. 2011;21(7):207-11.##Nkwabong E, Tincho EF. A case of a 26-week ampullary pregnancy mimicking intrauterine fetal death. Anatol J Obstet Gynecol. 2012;1(1):1-3.##Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10-year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224-30.##Committee on practice bulletins—gynecology. ACOG practice bulletin No. 191: tubal ectopic pregnancy. Obstet Gynecol. 2018;131(2):e65-e77.##Samura TL, Vikins A, Hendessi P. Laparoscopic resection of interstitial ectopic pregnancy with placenta percreta. J Minim Invasive Gynecol. 2016;23:S147.##Gauvin C, Amberger M, Louie K, Argeros O. Previously asymptomatic ruptured tubal ectopic pregnancy at over 10 weeks' gestation: two case reports. Case Rep Womens Health. 2018;21:e00089.##Kim M, Hiramatsu K, Fukui K, Amemiya K. Unexpected tubal pregnancy at 13 weeks’ gestation that was treated with laparoscopic surgery under massive hemoperitoneum. Gynecol Minim Invasive Ther. 2019;8(1):30-2.##

Effects of Specific Antivenom on Vital and Reproductive Organs in Male and Female Pups: Pathological and Immunohistochemical Findings in Pregnant Rats Inoculated with Androctonus crassicauda Venom During Organogenesis 2 1 140249 2 Background: The purpose of the current study was to reveal how the scorpion venom of Androctonus crassicauda has a damaging effect on the vital and reproductive organs of the offspring and how specific antivenom administration reverses the damages that occur during intrauterine organogenesis. Methods: Twelve pregnant Wistar albino rats were randomly assigned into two groups: antivenom (AVG) and control healthy (C) groups. For envenomization, a venom solution at the dose of 1 ml/kg body weight was injected subcutaneously into the AVG group of rats between days 7 and 13 of pregnancy. Then, antivenom serum was administered subcutaneously at a total sublethal dose of 1 ml daily. At the end of the 21st day of pregnancy, ovariohysterectomy was performed on all dams and all pups were removed. Six male and female pups from both the AVG and control groups were selected and. After histopathology, inducible nitric oxide synthase (iNOS), mitogen-activated protein (MAP), mammalian target of rapamycin (mTOR), G protein-coupled receptor (GPCR), C-X-C motif chemokine ligand 12 (CXCL12), and cannabinoid receptor 1 (CB1) expressions were evaluated. Results: Based on the findings, it was shown that both genders exhibited increasing expressions parallel to histopathological changes, despite the stabile expressions of iNOS. However, CB1 expression in all examined organs including kidney, lung, uterus, and testicular tissues could not be adequately elevated to provide an effective cellular protection. Conclusion: Functional reproductive organs have a greater capacity for self-pro-tection. It can be concluded that the efficacy of specific antivenom applications on the organ development of offspring following scorpion stings in pregnant subjects is significant. 272 284 Mehmet ME Alcigir Department of Pathology, Faculty of Veterinary Medicine, Kirikkale University Department of Pathology, Faculty of Veterinary Medicine, Kirikkale University Turkey erayalcigir@gmail.com, erayalcigir@kku.edu.tr Ozcan O Ozkan Department of Biology, Faculty of Science, Cankiri Karatekin University Department of Biology, Faculty of Science, Cankiri Karatekin University Turkey Merve MB Turkmen Department of Pathology, Faculty of Veterinary Medicine, Kirikkale University Department of Pathology, Faculty of Veterinary Medicine, Kirikkale University Turkey Murside MA Demirel Laboratory Animals Care and Research Unit, Department of Pharmacology, Faculty of Pharmacy, Gazi University Laboratory Animals Care and Research Unit, Department of Pharmacology, Faculty of Pharmacy, Gazi University Turkey HistopathologyImmunohistochemistryRat pupsScorpion venomSerum 140249.pdf Petricevich VL. 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