استفاده از اسپرماتيد جهت درمان بيماران آزواسپرمي غيرانسدادي Use of spermatide for treatment of non-obstructive azoospermic patients 2 1 مطالعات انجام شده نشان مي‌دهد كه قريب نيمي از موارد ناباروري، به دليل فاكتورهاي مردانه مي‌باشد، كه از اين تعداد 10% را بيماران آزواسپرم تشكيل مي‌دهند. در بيوپسي بيماران آزواسپرمي غيرانسدادي، عليرغم برداشت بيوپسي‌هاي متعدد از هر دو بيضه، در 40% موارد نمي‌توان اسپرمي كه مناسب عمل ميكرواينجكشن باشد بدست آورد. گزارشات مربوط به موفقيت استفاده از ردة سلولي قبل از اسپرم (اسپرماتيد) در انجام ICSI، عرصة جديدي را در درمان اين گونه مبتلايان گشود. در پژوهش حاضر 67 بيمار مبتلا به آزواسپرمي غيرانسدادي كه اسپرمي دربافت بيضة آنها يافت نشد،شركت داشتند كه از اسپرماتيد گرد موجود در بافت بيضة آنان به عنوان گامت نر جهت باروري تخمك همسران آنها استفاده و نتايج لقاح تخمك،‌ تشكيل جنين با كيفيت مناسب جهت انتقال و ميزان حاملگي مورد بررسي قرار گرفت.‌ بيماران براساس شرح حال، معاينة فيزيكي، بررسي سيمن، اندازه‌گيري FSH و در نهايت بيوپسي‌هاي متعدد بيضه كه فاقد اسپرم بالغ يا اسپرماتيد طويل و از طرفي وجود اسپرماتيد گرد ، انتخاب ‌شدند. پس ازكسب رضايتنامه آگاهانه در خصوص استفاده از اسپرماتيد به عنوان گامت نر براي انجام ميكرواينجكشن ، سيكل همسر بيمار شروع و همزمان با پانكچر جهت جمع‌آوري تخمك، بيوپسي باز بيضه انجام و اسپرماتيد موجود جهت تزريق به داخل تخمك مورد استفاده قرار گرفت. ميانگين سن مردان5/6 ± 32 سال و همسرآنها 8 ± 5/29 سال و ميانگين حجم بيضه راستml 1 ± 11، بيضه چپml6/0 ± 4/10 و ميانگين FSH سرم mIU/ml 2/3 ± 1/21 بود. از مجموع 760 تخمك بدست آمده، 537 عدد، با اسپرماتيد مورد تزريق قرار گرفت. ميزان لقاح تخمك‌ها 2/38% بود. در مجموع 182 جنين (8/88%) به رحم انتقال داده شد. تنها يك مورد حاملگي شيميايي مشاهده گرديد كه با ديدن ساك جنيني مورد تأييد قرار گرفت، گرچه در هفته چهارم حاملگي، سقط شد. نتايج اين بررسي امكان استفاده از اسپرماتيد را در بيماران آزواسپرمي كه اسپرم بالغ در نمونه‌هاي TESE رؤيت نمي‌شود، به عنوان يك انتخاب درماني مورد ترديد قرار داده است. 2 It has been shown that male factor is a common cause of more than half of the infertilities from which 10% are azoospermic patients. Despite multiple testis biopsies, any sperm for microinjection couldn’t be obtained in 40% of nonobstructive azoospermic patients. However, recent reports showed successful use of spermatids instead of mature spermatozoa for ICSI which opened a new horizon for these patients. In the present study, 67 nonobstructive azoospermia patients with no sperm in their testis biopsies were enrolled, from whom round spermatids were extracted from testis tissue and used as male gamete for ovum fertilization. The results including fertilization rate, embryo formation, transfer rate and pregnancy rate were evaluated. Patients were selected based on their history and physical examination, semen analysis, FSH assay and results of multiple testis biopsies with no sperm. Necessary information about use of spermatid as male gamete in microinjection was presented to the patients and their consent were taken. In appropriate time, female cycles were began and simultaneous to egg collection, testis biopsy was performed Mean age of male and female were 32±6.5 and 29.5±8 years, respectively. Mean size of right and left testis were 11± 1 and 10.4±0.6 mL, respectively and the mean of FSH level was 21.1±3.2 mIU/mL. From 760 collected eggs, 537 ovums were injected with spermatids and fertilization rate was 38.2%. Totally, 182 embryos (88.8%) were transferred to the uterus. One chemical pregnancy was observed and documented by ultrasonography, although it was aborted at fourth week. Based on the results of this study, the efficiency of spermatid use in azoospermic patients with no sperm in TESE as a treatment option for their infertility was doubted. 177 184 Mohammad Mehdi MM Akhondi محمدمهدی آخوندی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran akhondi@avicenna.ac.ir Mohammad Ali MA Sedighi محمد علی صدیقی گیلانی Andrology Department, Royan Research Center Andrology Department, Royan Research Center Iran Naser N Amirjannati ناصر امیرجنتی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Hooman H Sadri-Ardekani هومن صدری‌اردکانی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Non-obstructive azoospermiaSpermatidICSITesticular sperm extraction 122.pdf AkhondiM.M.,Sedighi M.A.,Amirjannati N. Evaluation of spermatogenesis nonobstructive azoospermic patients with histopathological and cytological methods.Med J Reprod Infert. 2003; 4(1):30-38##JowW.W., Steckel J., Schlegel P.N. Motile sperm in human testis biopsy specimens. J Androl. 1993;14(3):194-8.##Silber S.J., Vansteirteghem A., Nagyz. Normal pregnancies resulting from testicular sperm extraction and intracytoplasmic sperm injection for azoospermia due to maturation arrest. Fertil Steril. 1996;66(1):110-7.##Ogura A., Yanagimachi R. Round spermatid nuclei injected in to hamster oocytes from pronuclei and participate in syngamy. Biol Reprod. 1993;48(2):219-25.##Vanderzwalmen P., Lejeune B., Nijs M. Fertilization of anoocyte microinserminated with a spermatid in an in vitro fertilization programme. Hum Reprod. 1995;10(3):502-3.##Foshel S., Greens, Bishop M. Pregnancy after intracytoplasmic injection of spermatid Lancet. 1995;24,345(8965): 1641-2.##Ghazzawi M., Alhasani S., Taher M. Reproductive capacity of round spermatids compared with mature spermatozoa in a population of azoospermic men. Hum Reprod. 1999;14(3):736-740.##Kahraman S., Polat G., Samli M. Multiple pregnancies obtained by testicular spermatid injection in combination with intracytoplasmic perm injection. Hum Reprod. 1998;13(1):104-110##Tesarin J., Mendoza C. Spermatid injection in outcome after microinjection of fresh and frozen thawed sperm and spermatids. Hum Reprod. 2002;17(7):1800-1810.to human oocytes. Laboratory Techniques and special features of zygote development. Hum Reprod. 1996;11(4):772-9.##Vanderz Walmen P., Zech H., Birkenfeld A. Intracytoplasmic injection of spermatid retrieved from testicular tissue. Influence of testicular pathology, type of selectes spermatids and oocyte activation. Hum Repord. 1997;12(6):1203-13.##Fishel S., Green S., Hunter A. Human fertilization with round and elongated spermatids. Hum Reprod. 1997;12(2):336-240.##Bulent V., Cengiz A., Senai A. Transfer at the blastocyst stage of embryos derived from testicular round spermatid injection. Hum Reprod. 2002;17(3):741-743.##Sofikitis N.V., Miyagawa I., Incze P. Detrimental effect of left varicose on the reproductive capacity of the early haploid male gamete. J Urol. 1996;156(1):267-70.##Aslam I., Fishel S., Green S. Can we justify spermatic microinjection for severe male factor infertility. Hum Reprod Update. 1998;4(3):213-222.##Sousa M., Cremades N., Silvaj. Predictive value of testicular in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen thawed sperm and spermatids. Hum Reprod. 2002;17(7):1800-1810.##

تأثير مكمل كلسيم در دوران بارداري بر وزن هنگام تولد The effect of calcium supplementation during pregnancy on the birth weight 2 1 وضعيت تغذيه دوران بارداري و دريافت مواد مغذي ضروري بر نتيجه بارداري و سلامتي كودك مؤثر است. در اكثر مطالعات انجام گرفته در مورد تأثير دريافت كلسيم در دوران بارداري بر نتيجه بارداري از دوز بالاي كلسيم استفاده شده و نتايج حاصل از اين مطالعات نيز با هم بسيار متفاوت مي‌باشد. افزون برآن، اين مطالعات عمدتاً با هدف تعيين تأثير مكمل كلسيم بر خطر نسبي پره‌اكلامپسي انجام شده‌اند. هدف از اين كارآزمايي كنترل شده تصادفي دوسوكور، تعيين تأثير مصرف روزانه g1 مكمل كلسيم (دو كپسول mg500 كربنات كلسيم) توسط زنان باردار سالم در سه ماهه سوم بارداري بر نتيجه بارداري بود. در اين مطالعه 68 زن باردار سالم از هفته 30 - 28 بارداري وارد مطالعه شدند و بصورت تصادفي در يكي از دو گروه "مكمل كلسيم" (33نفر) يا "دارونما" (35نفر) قرارگرفتند. فشارخون، وزن و قد اندازه‌گيري و نمايه توده بدني (BMI) در دو گروه، محاسبه شد. غلظت هموگلوبين و قند خون ناشتا با استفاده از پروندة بهداشتي افراد ثبت و كلسيم دريافتي بوسيلة پرسشنامه بسامد خوراك (FFQ) از طريق رژيم غذايي برآورد شد. اندازه‌گيري‌هاي تن سنجي نوزاد شامل وزن، قد و دور سر نيز انجام گرديد. براي بررسي متغيرهاي كمي پيوسته از t-test و براي متغيرهاي كيفي از χ2 استفاده و P.Value كمتر از 05/0 به عنوان اختلاف آماري معني‌دار در نظر گرفته شد. هيچ تفاوت معني‌داربين دوگروه از نظر سن، تعداد زايمان قبلي، قد، وزن و نمايه توده بدن قبل از بارداري، فشار خون و دريافت كلسيم غذايي وجود نداشت. ميانگين ضريب پيروي از پروتكل پژوهش در هر دو گروه بالاتر از 80% بود و بين گروهها تفاوت آماري معني‌دار ديده نشد. مصرف مكمل كلسيم تأثيري بر اندازه‌هاي قد و دورسر هنگام تولد نداشت؛ ولي ميانگين وزن هنگام تولد در گروه "مكمل كلسيم" (g3241) 230 گرم بيشتر از گروه "دارونما" (g3011) بود (05/0P<). در هر گروه دو نوزاد با سن حاملگي كمتر از 37 هفته متولد شدند. پس از حذف اين چهار مورد، تأثير مكمل كلسيم بر وزن هنگام تولد همچنان باقي ماند (05/0P <). از يافته‌هاي اين كارآزمايي مي‌توان نتيجه‌گيري كرد كه مصرف مكمل كلسيم در بارداري مي‌تواند مستقل از طول مدت بارداري، وزن هنگام تولد را افزايش دهد. 2 Nutritional status during pregnancy and intake of essential nutrients affect pregnancy outcome and child health. In most previous studies, high doses of calcium supplements were used during pregnancy to evaluate the effect of calcium intake on pregnancy outcome and their results showed no consistency. In addition, those studies have been mainly carried out to determine the effect of calcium supplementation on relative risk of preeclampsia. The aim of this double blind, placebo controlled, randomized clinical trial on healthy pregnant women during the third trimester of pregnancy was to determine the effect of calcium supplementation (1 g/day, as two 500 mg calcium carbonate capsules) on pregnancy outcome. Participants were 68 healthy pregnant women, allocated randomly into "Calcium Supplement" (n=33) or "Placebo" (n=35) groups from the 28th -30th weeks of gestation through delivery. Factors such as blood pressure, weight, height and BMI were analyzed in both groups. Hemoglobin and blood glucose concentration were determined on the basis of patients’ records and dietary calcium intake was estimated by FFQ. Anthropometric parameters of neonates including weight, head circumference and length were recorded. Student t. test and c2 were used for analyses of the continuous quantitative and qualitative variables, respectively and p-value <0.05 was considered as statistically significant. There was no difference between our 2 groups regarding such factors as age, parity, height, weight, pre-pregnancy body mass index (BMI), blood pressure, and dietary calcium intake. Compliance was >80% in both groups and there was no significant and meaningful difference between them regarding this factor. As compared to the placebo, calcium supplementation increased the mean birth weight in the "Calcium Supplement" group (P<0.05). The observed effect remained unchanged after removing four neonates born before the 37th week of gestation (251 g, P<0.05). It is concluded that calcium supplementation in healthy pregnant mothers may increase birth weight independent of gestational age. 184 192 Majid M Karandish مجید کاراندیش Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Iran mkarandish@yahoo.com Abolghasem A Jazayery ابوالقاسم جزایری Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Iran Mahmoud M Mahmoudi محمود محمودی Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Iran Ahmad A Behrooz احمد بهروز Department of Obstet . and Gynecol Faculty of Medicine, Ahwaz University of Medical Sciences Department of Obstet . and Gynecol Faculty of Medicine, Ahwaz University of Medical Sciences Iran Farideh F Moramezi فریده مرمضی Department of Obstet . and Gynecol Faculty of Medicine, Ahwaz University of Medical Sciences Department of Obstet . and Gynecol Faculty of Medicine, Ahwaz University of Medical Sciences Iran Calcium supplementPregnancyPregnancy outcomeBirth weightPregnancy care 123.pdf Kaiser L.L., Allen L. Position of the American Dietetic Association:Nutrition and lifestyle for healthy pregnancy outcome. J Am Diet Assoc. 2002;102:1479-90.##The World Health Report 1998: Life in the 21st Century, A Vision for All. Geneva: WHO; 1998.##Krishnaswamy K., Naidu A.N., Prasad M.P.R., Reddy G.A. Fetal malnutrition and adult chronic disease.Nutr Rev.2002;60:S35-S39.##Barker D.J.P. Fetal origins of coronary heart disease. BMJ.1995;311:171-4.##Law C.M., Shiell A.W. Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature. J Hypertens.1996;14:935-41.##Barker D.J.P., Gluckman P.D., Godfrey K.M. Fetal nutrition and cardiovasular disease in adult life. Lancet. 1993;341:938-41.##Weaver C.M., Heaney R.P., Calcium. In:Shils M.E., Olson J.A., Shike M., Catharine A.(Editors). Modern Nutrition in Health and Disease 9 th Edition, Maryland Lippincott Williams &Wilkins; 1999. p:141-55.##Miller G.D., Anderson J.J.B. The role of calcium in prevention of chronic diseases. J Am Coll Nutr. 1999; 18:S371- S372.##Heaney R.P., Davies K.M., Barger-Lux J. Calcium and weight: clinical studies. J Am Coll Nutr. 2002; 21:152S-155S.##Heaney R.P. There should be a dietay guideline for calcium. Am J Clin Nutr. 2000;71:658-61.##United Nations’ Administrative Committee on Coordination/Sub-Committere on Nutrition. 4th report on the world nutriton situation.Geneva: ACC/SCN; 2000.##de Onis M., Villar J., Gulmezoglu M. Nutritional interventions to prevent intra-uterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998;S83-S93.##Houshiar-Rad A., Omidvar N., Mahmoodi M., Kolahdooz F., Amini M. Dietary intake,anthropometry and birth outcome of rural pregnant women in two Iranian districts. NutrRes. 1998;18:1469-82.##Ortega R.M., Martinez R.M., Quintas M.E., Lopez-Sobaler A.M.,Andres P. Calcium levels in maternal milk: relationships with calcium intake during the third trimester of pregnancy. Br J Nutr.1998;79: 501-7.##Belizan J.M., Villar J., Gonzalez L., Campodonico L., Bergel E.Calcium supplementation to prevent hypertensive disorders of pregnancy. N Eng J Med.1991; 325:1399-405.##Levine R.J., Hauth J.C., Curet L.B., Sibai B.M., Catalano P.M.,Morris C.A., et al. Trial of calcium to prevent preeclampsia. N Eng J Med.1997;337:69-76.##Lopez-Jaramillo P., Delgado F., Jacome P., Teran E., Ruano C.Calcium supplementation and the risk of preeclampsia in Ecuadorian pregnant teenagers. Obs Gyn. 1997; 90:162-7.##Niromanesh S., Laghaii S., Mosavi-Jarrahi A. Supplementary calcium in prevention of pre-eclampsia. Int J Gyn Obs. 2001;74:17-21.##Institute of Medicine. Dietary Reference Intakes for Calcium,Phosphorus, Magnesium,Vitamin D, and Fluoride. Washington,DC, National Academy Press;1997.##Fuller J., Schaller-Ayers J. Editors. Health Assessment: A Nursing Approach. Phyladelphia, J.B. Lippincott: 1990.##World Health Organization. Physical status: the use and interpretation of anthropometry.WHO Tech Rep Ser No 854. Geneva: WHO;1995.##Schieve L.A., Cogswell M.E., Scanlon K.S., Perry G., Ferre C.,Blackmore-Prince C., et al. Prepregnancy body mass index and pregnancy weight gain: associations with preterm delivery.Obs Gyn.2000; 96:194-200.##Hauth J.C., Ewell M.G., Levine R.J., Esterlitz J.R., Sibai B., Curet L.B., et al. Pregnancy outcomes in healthy nulliparas who developed hypertentension. Obs Gyn. 2000;95:24-8.##Purwar M., Kulkarni H., Motghare V., Dhole S. Calcium supplementation and prevention of pregnancy induced hypertension. J Obs Gyn Res. 1996;22:425-30.##Prentice A., Jarjou L.M.A., Cole T.J., Stirling D.M., Dibba B.,Fairweathe-Tait S. Calcium requirements of lactating Gambian mothers: effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. Am J Clin Nutr. 1995;62:58-67.##Merialdi M., Carroli G., Villar J., Abalos E., Gulmezoglu A.M.,Kulier R., et al. Nutritional interventions during pregnancy for the prevention or treatment of impaired fetal growth: an overview of randomized controlled trials. J Nutr. 2003;133:S1626- S1631.##

بالغ سازي و لقاح تخمك در شرايط آزمايشگاهي در بيماران مبتلا به سندرم تخمدان پلي‌كيستيك بدون تحريك تخمك‌گذاری In Vitro maturation and fertilization of human oocytes from unstimulated Polycystic Ovaries 2 1 تولد فرزند به عنوان يكي از رويدادهاي مهم، نقش عمده‌اي در زندگي هر فرد ايفا مي‌كند. عدم موفقيت در اين امر كه به منزله ناباروري است، از مسائل آزاردهنده‌اي است كه قريب به 20% زوجها با آن دست به گريبانند. اين حقيقت را نبايد از نظر دور داشت كه هنوز در مورد علل ناباروري، نكات مبهم و ناشناخته و مشكلات بسياري وجود دارد.از جملة اين مسائل و مشكلات مي‌توان به وجود عارضة تخمدانهاي پلي‌كيستيك (PCO ) اشاره كرد. اين مطالعه در مورد ارائه روشي است كه براي اولين بار در ايران انجام شد و طي آن تخمك‌هاي افراد مبتلا به سندرم تخمدان پلي‌كيستيك در شرايط آزمايشگاهي بدون تحريك تخمك گذاري، بالغ شده است. هدف از اين مطالعه كاهش بسياري از خطرات جانبي ناشي از روشهاي فعلي تحريك‌تخمك‌گذاري نظيرسندرم تحريك بيش از حد تخمدان ( OHSS)، آسيت، اختلال در گردش خون، اختلال در عملكرد كليه ، احتمال ترومبوز ، چند قلوزايي و … و نيز كاهش چشمگير در هزينه‌هاي درماني مي‌باشد . بدين منظور تخمك‌هاي نابالغ بدون هيچگونه تحريك تخمك گذاري با كمك سونوگرافي واژينال بوسيلة سوزن پونكسيون مخصوص برداشت شدند و روند بالغ‌سازي آنها به جاي بدن در شرايط آزمايشگاهي با استفاده از محيط كشت كامل، مشتمل بر تركيبات مورد نياز بلوغ تخمك انجام شد. سپس با تلقيح تخمك‌هاي بالغ شده نسبت به تشكيل جنين اقدام گرديد. در اين مطالعه از تعداد 52 تخمك نابالغ بدست آمده، 51 تخمك براي كشت در محيط IVM در نظر گرفته شد كه تمامي آنها(100%) به مرحله متافاز II رسيدند و گويچه قطبي آنها نيز ديده شد . از اين تعداد 49 تخمك با اسپرم شوهر تلقيح شدند ( ICSI) ، كه 35 مورد آن (71%) منجر به تشكيل جنين گشت . با توجه به آمارهاي موفقيت آميزي كه در زمينه IVM و حاملگي‌هاي حاصل از آن منتشر شده است و نيز مزاياي اين روش و همچنين كاهش چشمگير در هزينه‌هاي درماني، اين روش مي‌تواند گامي بلند در درمان ناباروري محسوب گردد. 2 Having baby is a desire which plays a major role in everybody’s life. Infertility as unsuccess in achieving this is an annoying matter, affecting approximately 20% of couples. However, this fact should not be ignored that there is still many unknown problems related to infertility. Polycystic ovarian syndrom (PCOS) is one of these Problems. In our study, recovery of immature oocytes followed by in vitro maturation (IVM) of these oocytes was developed as a new method for the first time in Iran for treatment of patients with infertility due to PCOS. The purpose of this study was to reduce the side effects of the currently used treatments such as ovarian hyperstimulation syndrome, ascites, circulation dysfunction, renal dysfunction, thrombosis, multiple pregnancy ,…, as well as their expensive cost. Immature oocytes were collected by transvaginal ultrasound and then transferred to maturation medium for culture. After 24 and 48h of incubation, mature oocytes were transferred to endometerium. Spermatozoa for ICSI were prepared by Swim up, and injected to the mature oocyte with micromanipulator system. A total of 52 immature oocytes were retrieved, all of which matured after incubation(100%); 49 mature oocytes were injected and 35 were cleaved (71%). Satisfactory results of IVM have been published, thus due to its advantages and suprising reduction of the medical cost, it could be as a miracle in curing infertility. 192 203 AbooTaleb AT Saremi ابوطالب صارمی Department of Obstet . and Gynecol Faculty of Medicine, Islamic Azad University Department of Obstet . and Gynecol Faculty of Medicine, Islamic Azad University Iran sarem@Kanoon.net Mahnaz M Azarnia مهناز آذرنیا Department of Biology, Faculty of Science, Tarbiat Moalem University Department of Biology, Faculty of Science, Tarbiat Moalem University Iran Mojtaba M Dashtizad مجتبی دشتی‌زاد Research & Development Unit, Sarem Medical Center Research & Development Unit, Sarem Medical Center Iran MaturationOocyteIn vitro maturationWithout induction of ovulation 124.pdf اسفندیاری‌نوید.بررسی‌تاثیر برخی از عوامل ایمونولوژیک و ناباروری با علت نامشخص. پایان نامه دکترای تخصصی، دانشگاه علوم پزشکی و خدمات بهداشتی، درمانی تهران، 73-1372.##Frank S. The Polycystic Ovary Syndrome. N Engl J Med.1995;333:853-61.##Futterweit W. Pathophysiology of Polycystic Ovarian Syndrome. Redmond G.P(Editor)., Androgenic Disorders. Raven Press, New York. 1995;77-166.##Balen A.H. The phatogenesis of Polycystic Ovary Syndrome.Lancet.1999;354:966-7.##Swanson M., Sauerbrie E.E., Cooperberg P.L. Medical implications of ultrasonically detec polycyctic ovaries. J Clin Ultrasound.1981;9:219-22.##Adams J., Frank S., Polson D.W., Mason H.D., Abdulwahid N., Jacobs H.S.Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotrophin releasing hormone. Lancet. 1985;1375-8.##Pincus G., Enzmann E.V. The comparative behaviour of mammalian eggs in vivo and in vitro. J Exp Med. 1935;65:665-75.##Edwards R.G., Bavister B.C., Steptoe P.C. Early stage of fertifization In Vitro of Human oocytes matured In vitro. Nature.1969;221:632-5.##Jacobs H.S. Polycystic Ovaries and Polycystic Ovary Syndrome. Gyn Endocrinol.1987;1:113-31.##Yen S.S.C. The Polycystic Ovary Syndrome. Clin Endocrinol.1980;12:177-86.##Chian R.C., Gulekli B.Pregnancy and delivery after cryopreservation of zygotes produced by in-vitro matured oocytes retrieved from a woman with Polycystic Ovarian Syndrome. Hum Reprod.2001;16,8,1700-2001.##Tim J. In vitro maturation and fertilization of oocytes from unstimulated normal ovaries,and women with polycystic ovary syndrome. Fertil Steril.2001;76,5:936-41.##Trounson A., W., C., In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients. Fertil Steril. 1994;62; (2):353-62.##Ben- ze’ev A., Amsterdam A.Regulation of cytoskeletal proteins invo lved in cell contact formation during differentiation of granulosa cells on extracellular matrix.Proc Natl Acad Sci USA.1998;83:2894-8.##Kwang Y., Cha Se., Han Y. Pregnancies and deliveries after in vitro maturation culture followed by in vitro fertilization and embryo transfer without stimulation in women with Polycystic Ovary Syndrome. Fertil Steril.2000;73(5):978-83.##Cortvrindt R., Smitz J. In vitro follicle growth: Achievements in mammalian species. Reprod Dom Anim.2001;36: 3-9.##Liu j., Katze., Garcia J.E., et al. Successful In Vitro maturation of human oocytes not exposed to human chorionic gonadotropin during ovulation induction, resulting in Pregnancy. Fertil Steril. 1997;67:566-8.##Barnes F.L., Kausche A., Tiglias J., et al. Production of embryos from in vitro matured primary human Oocyte. Fertil Steril.1996;65: 1151-6.##Willis D.S., Mason H.D. Premature response to LH of granulose cells from anovlatory women with PCOS: Relevance to mechanism of anovulation. J Clin Endocrinol Metab.1998;83:3984-91.##Almahboobi G., Anderiesz C. Functional integrity of granulose cells from polycystic ovaries. Clin Endocrinol.1996;44:571-80.##Gardner D.K., Lane M., Rodriguez-Martinez H. Fetal development after transfer is increased by replacing protein with the glycosaminoglycan hyaluronate for embryo culture. Hum Reprod. 1997;12:0-215.##Regan L., Owen E.J. Hypersecretion of luteinising hormone, infertility and miscarriage. Lancet.1990;336:1141-4.##Hardy K., Wright C.S. In vitro maturation of oocytes. Brith Med Bull. 2000;56(3):588-602.##Russell J.B., Knezevich K.M., Fabian K.F., Dickson J.A. Unstimulated immature oocyte retrieval: early versus midfollicular endometrial Priming. Fertil Steril.1997;(67):616-20.##Green D.P.L. Three- dimensional structure of the zona Pellucida.Rev Reprod.1997;2:147-56.##Schramm R.D., Baoister B.D. Follicle- Stimulating hormone priming of rhesus monkeys enhances meiotic and developmental competerce of oocytes matured invitro. Biol Reprod.1994;5151:904-12.##Cobo Ana C., Requena A. Maturation in vitro of human oocytes from unstimulated cycles: Selection of the optimal day for ovum retrieval based on follicular size. Hum Reprod. 1999; 14(7):18 64-8.##Wiley L.M., yanami S., Van Muyden D. Effect of potassium concentration, type of protein Supplement and embryo density on mouse preimplantation development in vitro. Fertil steril.1986;45:111-19.##Lane M., Gardner D.K. Effect of incubation volume and embryo density on the development and viability of Preimplantation mouse embryos in vitro. Hum Reprod.1992;7:558-62.##Ahern T., Gardner D.K. Culturing bovine embryos in groups Stimulates blastocyst development and cell allocation to the inner cell mass.Theriogenology.1998;49:194.##Gardner D.K., Lane M.W., Lane M. Development of the inner cell mass in mouse blastocysts is stimulated by reducing the embryo: incubation volume ratio. Hum Reprod.1997;12: 132.##Cumming J.M., Breen T.M., Harrison K.L., et al. A formula for scoring human embryo growh rates in invitro fertilization: its value in predicting pregnancy and in comparison with visual estimates of embryo quality.J In vitro Fertil Embryo Transf.1986;3:284-95.##Bolton V.N., Hawes S.M., Taylor C.T., Parsons J.H. Development of spare human preimplatntation embryos in vitro and analysis of the correlations among gross morphology, cleavage rates and development to the blastocyst. J In vitro Fertil Embryo Transf.1989;6:30-5.##Trounson A.O., wood C., kausche A. In vitro maturation and fertilization and developmental competence of oocytes recovered from untreated- polycystic ovarian Patients. Fertil Steril. 1994;62: 353-62.##Racowsky C., kaufman M.L. Nuclear degeneration and meiotic aberrations observed in human oocytes matured in vitro: analysis by light microscopy. Fertil Steril.1992;58:750-5.##Gras L., Mcbain J., Trounson A.o., Kola I. The incidence of chromosomal aneuploidy in stimulated and unstimulated (natural) uninseminated human oocytes.Hum Reprod. 1992;7:1396-401.##Delhanty J.D., Harper J.C., Handyside A.H., Winston R.M. Multicolour fish detects frequent chromosomal mosaicisms and chaotic division in normal Preimplantation embryos from fertile patients. Hum Genet.1997;99:755-60.##

بررسي فراواني تماس شغلي مردان داراي اختلال ايديوپاتيك اسپرم در مراجعين به مركز ناباروري رويان در سالهاي 81-78 Occupational exposure frequency in men with idiopathic abnormal spermatozoa visiting Royan Institute in 1998-2001 2 1 سيستم توليد مثل مردان به دليل تقسيم سريع سلولهاي اسپرماتوگوني نسبت به بسياري از مواد شيميايي وعوامل فيزيكي كه در فعاليتهاي صنعتي وكشاورزي توليد مي‌شود، حساس است. تغيير در تعداد اسپرم يا کيفيت منی در برخی ازمواجهات شغلی ثابت شده است. اين مواجهات شامل آفت كشها، حلالها، گرما، فلزات، تابش اشعه، استروژنها وغيره مي‌باشد. به دليل بروز ناباروري وفشارهاي روحي رواني ناشي از آن و گراني هزينه‌هاي درماني بايد دقت وتاكيد بيشتري بر پيشگيري از عوامل شغلي ومحيطي درايجاد ناباروري مردان نمود وموارد شغلي را از ايديوپاتيك جدا كرد؛ زيرا در اكثر موارد با دوري از مواجهه، اختلال اسپرماتوژنز برگشت پذير مي‌باشد. هدف از اين مطالعه تعيين توزيع فراوانی مشاغل و مواجهات مردان دارای اختلال ناشناخته يا ايديوپاتيک اسپرم درمراجعين به پژوهشکدة رويان بود. از مجموع 1550 مردی که از فروردين سال 78 لغايت اسفند 81 به دليل ناباروری به اين مرکز مراجعه داشتند 500 نفر كه دليل مشخصی برای اختلال کيفيت منی نداشتند، انتخاب شدند. بيماران داراي حداقل دو آزمايش منی بودند. پرسشنامه‌ای طراحی شد که در آن پارامترهای اسپرم آخرين آناليز منی، شغل و تماسهای شغلی افراد ثبت شد. بيماران بر حسب داشتن مواجهه وعدم مواجهه ونوع آن در گروههاي مختلفي قرار گرفتند.164 نفر (8/32%) آنها تماس شغلی با عوامل شناخته شده موثر بر اسپرماتوژنز داشتند. بر حسب نوع مواجهه 36 نفر (22%) باآفت کش‌ها، 46 نفر (28%) با حلالها، 56 نفر (1/34%) با گرما و26 نفر (9/15%) با مخلوطی از آنها و يا عوامل ديگر مواجهه داشتند. از طرفی بيماران بر حسب شغل در گروههای مختلف شغلی قرار گرفتند که فراوانی آنها در مشاغلی که اثر شناخته شده‌ای روی کيفيت منی داشتند شامل کشاورز: 34نفر (8/6%)، راننـده 40 نفـر (8/7%)،جوشکـار22 نفـر (4/4%) بود. شايعترين نـوع اختلال در ايـن مـردان آستنواسپرمـی در 444 نفـر (2/98%) و پس از آن بـه ترتيب تراتواسپرمی، اوليگواسپـرمی، اوليگوآستنواسپرمی، اوليگـوآستنوتـراتواسپرمی و آزواسپرمـی بود. انواع اختلالات اسپـرمي بـه ويژه اوليگواسپرمي و اوليگوآستنواسپـرمي در گـروه داراي مـواجهه، فراواني بيشتري داشت و فراواني آن در زير‌ گروه مخلوط بيشتر بود. همچنين ميانگين پارامترهاي اسپرم مانند تعداد اسپرم در ميلي ليتر، تعداد كل اسپرم، حركت و درصد اسپرم هاي با شكل طبيعي درگروه داراي مواجهه، كمتر از گروه بدون مواجهه بود. بنابراين تماسهای شغلی در مردان مبتلا به ناباروری ايديوپاتيک از اهميت ويژه‌ای برخوردار است و می‌تواند علتی مهم براي اختلال اسپرماتوژنز در حدود 33% اين بيماران باشد. لذا شناخت عوامل خطرساز براي دستگاه توليدمثلی،آموزش بيماران و رعايت اصول بهداشت حرفه‌ای جهت کاهش مواجهه گام موثری در پيشگيری از مشکلات فوق می‌باشد. 2 Male reproductive function is known to be highly sensitive to many chemicals and physical agents generated by industrial or agricaltural activities. Alterations in sperm count or semen quality have been documented for a number of occupational exposures. These exposures include, pesticides, solvents, heat, metals, radiation ,estrogens and etc. Because of the infertility and individual and social problems, stress and also expensive treatment, prevention of these exposures should be emphasized and the distinction of occupational type of infertility from idiopathic form is necessary. The present study determined the frequency of occupational exposures and seminal charactristics among groups of men with abnormal semen parameters (idiopathic or unexplained) referred to Royan Institute .A total of 1550 consecutive men whose spouses were unable to conceive were recruited from an infertility clinic. Of these, 500 men were found to have un known cause for their reduced semen quality. They had at least two semen analyses and the results of recent semen analysis were linked to occupational exposure data from a self- administered questionnaire. Occupational exposures known to be hazardous to fertility was present in 164 men (32.8%). Among the exposed group, 36 men(22%) were exposed to pesticides, 46 men(28%) to solvents, 56 men(34/1%) to heat and 26 men(15/9%) to mixed agents. Frequency of high risk occupational groups were farmers 6. 8% (n=34), drivers 7. 8% (n=40), welders 4.4% (n=22). Frequency of semen characteristics of this group was astenoszoospermia (98.2%), teratozoospermia, oligozoospermia, oloigoasthenozoospermia and Azoospermia, respectively. Abnormal sperm reports especially oligozoospermia and oligoasthenozoospermia had more frequency in exposed group, with most cases falling under mixed subgroup. Also, mean semen parameters including, total sperm count, motility and normal morphology was less in exposed group. We concluded that occupational exposures play an important role in idiopathic infertile men, affecting 33% of patients. Therefore, Identification of potential reproductive hazards, education and advocation of patients, and reduction of exposure level via Industrial health programs can be helpful. 203 213 Mohammad Ali MA Sedighi محمد علی صدیقی گیلانی Urology Department, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Science Urology Department, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Science Iran info@royaninstitute.org Omid O Aminian امید امینیان Department of Occupational Medicine, Faculty of Medicine, Tehran University of Medical Sciences Department of Occupational Medicine, Faculty of Medicine, Tehran University of Medical Sciences Iran Faezeh F Dehghan فائزه دهقان Department of Occupational Medicine, Faculty of Medicine, Tehran University of Medical Sciences Department of Occupational Medicine, Faculty of Medicine, Tehran University of Medical Sciences Iran Male infertilityOccupational exposuresSpermSemenSemen qualityFarmersWeldingWork 125.pdf Paul M., Frazier L. Reproductive Disorders.In: Levy B.S., Wegman D.H.(Editors).Occupational health. 4th Edition.Lippincot Williams & wilkns.2000;590-3.##Chia S.E., Alvin Lim S.T., Tay S.K., Lim S.T. Factors associated with made infertility : a case- control study of 218 infertile and 240 Fertile men. BJOG.2000;107(1):55-61##Lemasters G.K. Occupational exposures and effects on male and female reproduction. In:Rom W.N. (Editor).Environmental occupational Medicine, 3th Edition. Lippincot- Raven.1998;PP: 223-7.##Osorio A.M. Male reproductive toxicology. In:Ladou J.(Editor). Occupational environmental medicine, 2th Edition. Prentice- Hall Intrernational, Inc.1997;PP:398-400.##Carlsen E., Giwercman A., keiding N., Ska kkebaek N.E. Evidence for decreasing quality of semen during past years. BMJ.1992;305:609-613.##Whorton M. Male occupational reproductive hazards. In: ZENZ C. (Editor).Occupational medicine, 3th Edition. Mosby. 1994;PP:870-3.##M.C., Guigan M., Bailey B. Teratogenesis and reproductive toxicology. In:Sullivan J. (Editor). Clinical environmental health and toxic exposures, 2thEdition,Lippincot Williams & wilkins. 1999;PP:292-3.##Olsen G.W., Lanbam J.M., Bonder K.M., et al. Determinants of spermatogenesis recovery among workers exposed to 1,2-dibromo 3 chropropropan. J occup Med.1990;32:979-984.##National institute for occupational safetly and health. The effects of workplace Hazards on male reproductive health. Cincinnati, OH, Department of health and Human services National institute for occupational safety and health publ. No 96132,1996.##Clifton D.K., Bremner W.J., The effect of testicular X- irradiation on spermatogenesis in man. A comparison with the mouse. J Androl. 1983;4:387-392.##Figa-Talamnca I., Dell orco V., Pupi A.,et al. Fertility and semen quality of workers exposed to high temperatures in the ceramic industry. Repord Toxicol.1992;6:517-523.##Bond J.P., Hansen K.S., Levin R.J. Fertility among Danish male welders. 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Contribution of environmental factors to the risk of male infertility. Hum Reprod. 2001;16(8):1768-1776##WHO, Laboratory manual for examination of human semen and sperm- cervical mucus Intraction. 1992;P:8.##Tielemans E., Heederik D., Burdorf A; et al. Assessment of occupational exposures in a general population :comparison of different methods .Occup Environ Med.1999;56:145-151.##Penkov A., Stainslavov R., Tzvetkov. D. Male reproductive function in workers exposed to vibration. Cent Eur J Public.1996; 4(3):185-8.##Bond J.P., Ernest E. Sex hormones and semen quality in welders exposed to hexavalent chromium. Hum Exp Toxicol. 1992;11:259-263.##Eenderson J., Rennie C.G., Baker H.W.G.Association between occupational group and sperm concentration in infertile men.Clin Repord Fertil.1986;4:275-281.##Bonde J.P.Semen quality and sex hormones among mild steel and stainless steel welders:a cross sectional study.Br J Ind Med.1990;47:508-514.##kenkel S., Rolf C., Nieschiag E. 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Occupational exposure to solvents and male infertility. Occup Environ Med. 2001;58:635-640.##Welch L.S., Schrader S.M., Cullen M.R. Effects of exposure to ethylene glycol ethers on shipyard painters: male reproduction. Am J Ind Med. 1998;14:509-526.##Jelnes J.E. Semen quality in workers producing reinforced plastic. Repord Toxicol. 1988;2: 209-12.##kenkel S., Rolf C., Nieschiag E. Occupational risks for male infertility : an .analysis of patients attending a tertiary referral centre . J Androl. 2001;24(6):318-26.##Strohmer H., Boldizer A., plockinger B., et al. Agricultural work and male Infertility . Am J Ind Med.1993; 24:587-592.##Bigelow P.L., Jarrell j., Young M.K., et al. Association of semen quality and occupational factors: comparison of case- control analysis and analysis of continious variables .Fertil Steril. 1998;69 (1):11-18.##Chia S.E., Tay S.k. Occupational risk for male infertility: A case- control study of 218 Infertile and 227 fertile men. J Occup Environ Med. 2001; 43(11):946-951.##عباسی همایون، داروغه دفتر افشین. چکیده مقالات سمینار عوامل محیطی و ناباروری دانشگاه علوم‌پزشکی شهیدبهشتی 100 و 11 بهمن،1380، صفحه18.##

شيـوع كم‌خوني و تعيين ارتباط آن بـا سـن مـادر و سـن بارداري در خانمهاي بـاردار مراجعه‌كننده به بيمارستان يحيي نژاد بابل در سال 79 Prevalence of anemia and its relationship with mother’s age and gestational age in pregnant women visiting Yahyanejad hospital of Babol in 2000 2 1 بر اساس گزارش سازمان بهداشت جهاني(WHO) كم‌خوني شايعترين مشكل وابسته به تغذيه در جهان است كه بيش از دو ميليارد نفر از مردم جهان به آن مبتلا مي‌باشند. در اين ميان كودكان و زنان باردار آسيب‌پذيرتر از ساير گروهها هستند. هدف از اين مطالعه بررسي كم خوني در خانمهاي حامله و ارتباط آن با سن مادر و سن بارداري مي‌باشد. اين مطالعه بر روي 214 خانم باردار مراجعه كننده به درمانگاه زنان بيمارستان يحيي نژاد بابل در طي 6 ماه اول سال 1379 انجام گرفت. براي اين خانمها در اولين نوبت مراجعه شمارش سلولهاي خوني(CBC) درخواست شد. هموگلوبين(Hb) كمتر از mg/dl11 در سه ماهه اول و سوم و يا كمتر از mg/dl 5/10 در سه ماهه دوم، به عنوان كم خوني زمان بارداري در نظر گرفته شد. در افراد مبتلا به كم خوني جهت تشخيص نوع كم‌خوني، آزمايشات تكميلي درخواست گرديد . فراواني كم‌خوني در گروههاي مختلف سني و در سه ماهه اول، دوم و سوم بارداري مورد مطالعه قرار گرفت .ميانگين سن افراد شركت كننده در مطالعه5± 6/24 سال و ميانگين هموگلوبين mg/dl6/1± 6/12 بود. در مجموع 20 نفر (4/9%) خانمهاي باردار مبتلا به كم‌خوني بودند. بيشترين ميزان فراواني كم‌خوني (78/12%) در مراجعين با گروه سني 30-21 سال مشاهده شد. ميزان شيوع كم‌خوني در گروههاي سني داراي ريسك بالاي بارداري (كمتر از 18 سال و بيشتر از 35 سال) كمتر از گروه با سن مناسب براي بارداري (34-19 سال)بود (P<0.05). كم‌خوني در سه ماهة سوم شايعتر از سه ماهة اول و دوم بود(P<0.05). با توجه به نتايج اين مطالعه كم‌خوني فقر آهن شايعترين نوع كم خوني در خانمهاي باردار است. با توجه به فراواني بيشتر كم‌خوني در سه ماهة سوم، مصرف به موقع و مرتب مكملهاي آهن از سه ماهة دوم به بعد و بررسي مجدد هموگلوبين در اوائل سه ماهة سوم توصيه مي‌شود. 2 According to World Health Organization (WHO) report, anemia is the most common disease related to nutritional defects, which affects about 2 Billion people in the world, and among this huge population, children and pregnant women are the two major high risk groups. The purpose of the present study was to determine the prevalence of anemia in pregnant women and it’s relationship to mother’s age and gestational age. This study was done on 214 pregnant women visiting Yahyanejad Gyn & Obs clinic, during the period of March - Aug 2000. Complete Blood Count (CBC) was done at the first visit and if Hemoglobin (Hb) was less than 11mg/dl in first & third trimester or less than 10.5 in the 2nd trimester, they were considered to have the anemia of pregnancy. For diagnosis the type of anemia, the other lab tests were done. Frequency of anemia in different age groups and mean pregnancy trimester were studied. Mean age of cases was 24.6 ± 5 years old and hemoglobin was 12.6 ± 1.6. mg/dl overall, 20 (9.4%) pregnant women had anemia, the highest frequency of anemia (12.78%) was seen in women at 21-30 year old group. Frequency of anemia in high risk pregnancies (mother’s age of less than 18 & more than 35 years old ) was less than normal age group (19-34 years old ) (P< 0.05).Anemia was more common in third trimester than first & second trimesters.(P<0.05).Iron dificiency anemia was the most common anemia in pregnant women. Due to higher frequency of anemia in third trimester, it is highly advisable to start iron replacement therapy from second trimester and the mather’s Hematocrit level be checked at early third trimester. 213 220 Nesa N Asnafi نساء اصنافی Department of Obstet . and Gynecol , Yahyanejad Hospital, Babol Medical Sciences University Department of Obstet . and Gynecol , Yahyanejad Hospital, Babol Medical Sciences University Iran asnafi2001@yahoo.com Saeed S Sina سعید سینا Faculty of Medicine, Babol University of Medical Science Faculty of Medicine, Babol University of Medical Science Iran Seyyed Mohammad SM Miri سید محمد میری Faculty of Medicine, Babol University of Medical Science Faculty of Medicine, Babol University of Medical Science Iran AnemiaPregnancyGestational ageAgeHemoglobinPrevalence 126.pdf Fauci A.S., Brawnwald E., Issel Bacher K.J. Harrison’s principles of internal medicine. 15th Edition.New York, Mc Grow Hill.2001;PP:634-5.##Damaeyer E. 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Iron deficiency and anemia in pregnant women from chaco Argentina.Arch Latinoam Nutr.2002 ;52(4):336 – 43.##Marin G.H., Fazio P., Rubbo S., et al. Prevalence of anemia in pregnancy and analysis of the underlying factors . Aten Primaria.2002;29(3):158-63.##Montouz A.A., El-Said M.M., Alakija W.,et al. Anemia among pregnant women in the asir region,Saudi Arabia:an epidemiologic study.South East Asian J Trop Med Public Health.1994;25(1): 84-87.##Marti G., Pena M., Comunian G., Munaz S. prevalence of anemia during pregnancy: results of valencia (venezuela) anemia during pregnancy study . Arch Latinoam Nutr. 2002;52(1):5-11.##Massot C., Vanderpas J. A suvay of iron deficiency during pregnancy in Belgium: analysis of routin hospital labrotary data in mons. Arch Clin Belg. 2003;58 (3):169-77.##Bhagwan S., Dimple S., Nadagudi S.M., Monika M . Effects of dietary habits on prevalence of anemia in pregnant women of Dehli. 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Anemia in pregnant women in eastern Caprini, Nomibia.South Afr Med J. 1997; 87(11):1544-7.##ابراهیمـی ممقـانی مهـرانگیـز، دستگیـری سعیـد،عافیت میلانـی شمسـی و همکــاران. ارزیـابـی شیـوع کـم خـونـی، میکــروسیتیـک و مـاکـروسیتیک در زنـان سنیــن بـاروری شهرستان مرند.مجله پژوهشی حکیم،دوره دوم،شماره سوم، 1378 ، ص142 - 135.##

جدال حيات: بررسي اجمالي تئوري‌هاي سقط جنين Battle of Life: A Brief Study of Theories on Abortion 2 1 با اينكه در ابتداي سده بيست‌ويكم به سر مي‌بريم و به ميمنت فعاليت‌هاي فداكارانة پيشينيان طي سدة گذشته، ميراث‌بر يك انديشه و نظام حقوق بشر در هر دو سطح ملي و بين المللي مي‌باشيم؛ ولي متاسفانه هنوز شاهد برخوردهاي خشن، عاطفي و غيرعاقلانه ميان طرفداران و مخالفان سقط جنين هستيم. منازعات عملي پيرامون مساله سقط جنين بدون غور در مباني نظري و برساختن يك منظر موجه شدني تئوريك در اين ارتباط، قابل حل و رفع نسبي نيستند. از اين رو،‌در اين مقاله تلاش مي‌كنيم به بررسي هر چند اجمالي نظريه‌هاي عمده درباره سقط جنين بپردازيم و ضمن بيان استدلال‌هاي اصلي مورد ادعاي هر يك از اين نظريه‌ها، نقاط ضعف و قوت آن‌ها را تحليل نماييم. با اين حساب، نخست، مساله سقط جنين از يك ديد نظري بيان خواهد شد. بدين معنا كه فارغ از جنبه‌هاي عملي و به دور از غوغاهاي عاطفي و سياسي،‌سعي مي‌شود سوال‌(ها) يا مساله(هاي) بنياديني كه قبول يا رد سقط جنين با پرداختن به آن موجه شدني‌تر مي‌گردد، بيان شود. دوم، به عنوان يكي از باسابقه‌ترين نظريه‌ها، تئوري تقدس حيات در مخالفت با سقط جنين بيان و بررسي مي‌گردد. بسياري از ديدگاه‌هاي اخلاقي ديني در قالب اين نظريه شرح و بسط يافته‌اند. سوم، تئوري آزادي اراده در طرفداري از سقط جنين شرح و نقد خواهد شد كه محمل بخش عمده‌اي از ادعاها، اگرچه نه همه ادعاهاي عمده، ليبرال و همچنين تئوري‌هاي زن‌گرا مي‌باشد. پيداست كه دو تئوري ياد شده به نحو كلي و تا حدي بسيط، مدعي پذيرش يا رد اقدام به پايان دادن به حيات جنين مي‌باشند. آيا مي‌توان از چنين برخورد يكسره وكلي پرهيز كرد و به موضوع از منظري متفاوت نگريست؟ چهارم، و بر اين اساس، به تئوري ارزش سرمايه مي‌پردازيم كه علي الظاهر ديدگاهي متفاوت از دو نظريه قبلي اتخاذ كرده است. از اين ديد، مساله پايان دادن يا ندادن به زندگي موجودي به نام جنين بستگي به ميزان سرمايه‌گذاري و ارزش آن دارد. پنجم، يكي ديگر از رويكردهاي متفاوت كه در پي اتخاذ موضعي غير بسيط و موجه‌تري است يعني تئوري شخص يا تئوري هويت ناطق را به بحث خواهيم گذارد. طرفداران اين تئوري تلاش مي‌كنند سهم هر يك از عناصر گوناگون و به ظاهر متناقض مطرح در بحث سقط جنين را – مانند آزادي، حيات، ارزش سرمايه،‌والدين و جنين- بپردازند. در بيان و برپايه نقد و بررسي تئوري‌هاي مورد بحث به نتيجه‌گيري خواهيم پرداخت. سقط جنين در ميان موقعيت‌هاي جمعيتي،‌ عاطفي و اقتصادي، از يك سو و باورهاي ارزشي، اخلاقي و ديني، از ديگر سو، نيازمند توجه جدي نظري از سوي انديشمندان و سياست‌گذاران يك جامعه انساني و پويا است. 2 Despite decades of hard attempts of our predecessors during the last century, resulting in a thought and system of human rights at both national and international level, we still witness emotional, violent and irrational conflict and fight between opponents and proponents of abortion. This practical battle could not be tackled unless one probes in depth into theoretical foundations of the subject so as to construct a justifiable view in this regard. For this aim, this article attempt to set forth claims of major theories of abortion and also to evaluate those claims. Accordingly, at first stage, the problem of abortion will be depicted from a theoretical perspective. Secondly, as one of the oldest theories, “theory of life sacredness” shall be delineated. This attitude is known as the pro-life theory. Also, it is worth noting that many of religious/ethical claims are put forward in this term. Thirdly, ”theory of free-will” in defense of abortion will be explicated. This theory, known as the pro-choice attitude, has been a vehicle for most of liberal and feminist claims on the issue. It appears that the last mentioned two theories have taken a general and simple stance for or against the termination of fetus life. Could one avoid such a simple and general attitude and take another stance? Fourthly, and in this regard, “theory of investment value” that approaches to the problem in a different way, shall be elucidated. From this perspective, the question of termination of fetus life is entirely dependent on the amount of investment and it’s value. Fifthly, another theory that endeavors to put forth a different analysis of the problem, “theory of person or conscious entity” shall be spelled out. Advocates of such a theory make an effort to sufficiently attend to all constituent elements of the problem – such as freedom, life, value of investment, parents and fetus – that might seem conflicting or even contradictory. Finally, it will be attempted to make a conclusion. Abortion, entangled between facts related to emotions, population growth rate and economics, on one hand, and religious, ideological and ethical value judgments, on the other, requires a theoretical attention by scholars and policy makers of a “human” and “dynamic” society. 220 237 Mohammad M Rasekh محمد راسخ Department of Law, Faculty of Law, Shahid Beheshti University Department of Law, Faculty of Law, Shahid Beheshti University Iran m-rasekh@cc.sbu.ac.ir AbortionLife sacredness theoryFree-will theoryInvestment value theoryPerson or conscious entity theory 127.pdf www.azrtl.org.##Fieser & Dowden. Abortion in Law, History and Religion.##BBC News, Monday, 4.March 2002. on http:// news.bbc.co.uk./hi/English/worid Europe/newsid 1849000/1849395.stm##Dougherty.The Concept of ‘Person’ in American Legal Theory.##Hyams.Who Gets to Choose? Responses to the Foetal/Maternal Conflict.##Thomson J.J. Abortion.2000. on http://www. bostonreview.mit.edu.##Stairs A. warren M.A. Abortion and the Concept of a Person. 1997.on http://brindedcow.utm/edu/140/warren.htm.##Peach L. Legislating Morality. Oxford, OUP. 2002.##Suber P. Against the Sanctity of Life.1995.onhttp://www.earlham.edu/~peters/writing/snactity. html.##Steinbock B. Mother-Fetus Conflict, in A Companion to Bioethics. Kushe H.& Singer P. (Editors)Oxford, Blackwell.2001.##Chin F. A Pro-Life Belief. 2002. on http://www.hoestead .com/crumb o/prolife.html.##Beckwith F.J. Answering the Arguments for Abortion Rights: (part One The Appeal to pity. 1990. on http://www.equip.org/free/da020-2.htm.##Sullivan M.A. Thirty year perspective on personhood: How has DebateChanged?. 2002. on http://www.cedrvile.edu/dept/sm/sulivan /bio4710/personal/perspec tive.pdf##Beckwith F.J Answering the Arguments for Abortion Rights: (Part Three) Is the Unborn Human Less Than Human?.1990. on http://www.equip.org/free/da020-3.htm.##Beckwith F.J. Abortion, Bio-Ethics and Personhood.2000. on http://www.cbhd.org/ index.html.##Marquis, D. Why Abortion is Immoral? J Philosophy. 1989;80(4):183-202.##Beckwith F.J. Answering the Arguments for Abortion Rights:(Part Four) When Does a Human Become a Person?. 1990.on http://www.equip.org/ free/da020-4.htm.##Gordon D. Abortion and Rights: Applying Libertaian Principles Correctly.1999.on http:// www.141.org/library/abor-rts.html.##Green F.M.Person or Non-Person.2000.on http://californialife.org/abortion/person.html.##Beckwith F.J.Answering the Arguments for Abortion Rights: (Part Two)Arguments from Pity, Tolerance and Ad Hominem.1990.on http://www.equip.org free.da020-2.htm.##Stairs A.Jane English on Abortion and Attitudes.1998. on http://brindedcow.umd.edu/190/ english.html.##Dworkin R. Life’s Dominion: An Argument about Abortion and Euthanasia,London: Harper Collins Publishers. 1993.##Warren A.M. Abortion, in Companin to Bioethics, ed. By H. Kushe & P. 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بررسي آگاهي، نگرش و رفتار پسران نوجوان 15 تا 18 ساله تهراني درمورد بهداشت باروري- سال1381 Reproductive Knowledge, Attitude and Practice of Tehranian adolescent boys aged 15-18 years, 2002 2 1 ايران همانند تمامي كشورها تحت تاثير عوامل متعدد توسعه‌اي و اجتماعي پيچيده‌اي است كه جوانان را در معرض خطرات ناشي از رفتارهاي پرخطر جنسي و باروري قرار مي‌دهد؛ لذا هرگونه برنامه‌ريزي براي توسعه استراتژيهاي مناسب جهت پاسخ به نيازهاي اين گروه، مستلزم بررسي وضعيت موجود اين گروه در زمینه بهداشت باروري مي‌باشد. هدف این مطالعه بررسي آگاهی، نگرش و رفتار نوجوانان پسر 15 تا 18 ساله تهرانی در مورد بهداشت باروری است. این تحقیق در سال 1381 بر روي تعداد 1385 پسر نوجوان 15 تا 18 ساله شهر تهران، با استفاده از پرسشنامه سازمان بهداشت جهانی (WHO) با تغییرات متناسب با فرهنگ جامعه ایرانی به اجرا درآمد. روش نمونه‌گيري از نوع تصادفی خوشه‌اي بود. براساس نتايج اين مطالعه، درصد زيادي از نوجوانان(1/51%) در مورد فيزيولوژي باروري اطلاعات ضعيفي داشتند. 6/12% نوجوانان نسبت به روشهاي پيشگيري از بارداري هيچگونه اطلاعي نداشتند. از بين روشهاي پيشگيري، دو روش كاندوم و قرص به ترتيب روشهايي بودند که نوجوانان بيشترين شناخت را از آنها داشتند(به ترتیب 2/72 % و 58%) ولي اطلاعات عمقي و صحيح در مورد كاندوم در بين آنان كم بود؛ بطوریکه 40% نمی‌دانستند که کاندوم را نمی‌توان بیش از یکبار مصرف کرد و یا 37 % نمی‌دانستند که کاندوم یک روش موثر پیشگیری از بارداری می‌باشد. 7/94% نوجوانان نام بيماري‌هاي مقاربتي را شنيده بودند؛ ولي هنوز درصد زيادي از آنان داراي باورهاي غلط در مورد بيماري‌هاي مقاربتي و ايدز بودند، بطوریکه 6/16% آنها نمي‌دانستند كه ایدز درمان قطعي ندارد و 1/23% از وجود ظاهر سالم در فرد مبتلا به ایدز اظهار بی‌اطلاعی ‌نمودند.6/56% نوجوانان نظري مخالف با روابط نوجوانان با جنس مخالف داشتند. 7/27% نوجوانان مورد بررسي سابقه تماس جنسی را ذكر نمودند. بررسي نتايج بوسيله آزمون 2χ نشان داد ترك تحصيل يا تحصيل در مدارس شبانه(P<0.0001)،عدم پايبندي به مذهب(P<0.0001)،نبود هيچ‌يك از والدين درمنزل(P=0.007)، فوت پدر (P=0.012)، سختي برقراري ارتباط با مادر(P=0.002)،دسترسي به ماهواره(P=0.017)،كشيدن سيگار(P<0.0001) و‌نوشيدن‌مشروبات الكلي(P<0.0001) از فاكتورهايي بودند كه با دارا بودن يكي از آنها، سابقه تماس جنسي در پسران بطور معني‌داري بيشتر بود. مطالعه حاضر وضعيت آگاهي، نگرش و رفتارهاي باروري پسران نوجوان 18-15 سالة تهراني را به تصوير كشيده و بجاست كه سياستگزاران بهداشتي كشور با در نظر گرفتن وضعيت فوق، برنامه‌هاي مناسبي را جهت ارتقاء سطح سلامت باروري – جنسي نوجوانان ايراني به اجرا در آورند. 2 Similar to other countries, Iran is under influence of various and complex developmental and social factors which predispose young people to the risks associated with reproduction and sexual high risk behaviours. Therefore, any planning to develop appropriate strategies to meet their needs requires assessing the status of adolescent's reproductive health. The objective of this study was to explore knowledge, attitude and behaviour of Tehran adolescent boys (15-18 years old) with regard to reproductive health. This study was conducted among 1385 adolescent males aged 15-18 years in Tehran (Iran) in 2002 using the World Health Organisation questionnaire which was adapted according to Iranian culture. The method of randomized cluster sampling was applied. The results revealed a limited knowledge on reproductive physiology among Tehran adolescent boys (51.1%).A considerable percentage(12.6 %) of adolescents had absolutely no information about contraceptive methods. Among different contraceptive methods, condom and pills were known mostly by adolescent boys (72.2% & 58%, respectively). However the in-dept and correct information about condom was limited, so as 40% did not know that condom should be used once or 37% did not identified condom as an effective contraceptive method. Most adolescents (94.7%) had heard about sexual transmitted diseases previously but yet a great percentage of them held some misconceptions on STDs and HIV, so as, 16.6% were unaware about the lack of easy cure for AIDS at the present time and 23/1% from the existence of healthy appearance in HIV positive patients. Most (56.6 %) adolescents disagreed to any relationship between adolescents and their opposite sex. About one third (27.7%) of adolescent males reported an experience of sexual contact. Chi-Square test revealed that school drop out (P<0.0001), education in night schools (P<0.0001), lack of dependency on religion (P<0.0001), absence of both parents in the household, father’s death (p=0.007), difficulties communication with mother (P=0.002), easy access to satellite (P=0.0017), smoking (P<0.0001) and alcohol consumption (P<0.0001) were among factors which were significantly related to the experience of previous sexual contact. According to the results of the present study, the high risk behaviours which might emerge due to the lack of appropriate knowledge among Iranian adolescents should be acknowledged more than before. 237 251 Mohammad Reza MR Mohammadi محمدرضا محمدی Psychiatry Department, Roozbeh Hospital, Tehran Medical Sciences University Psychiatry Department, Roozbeh Hospital, Tehran Medical Sciences University Iran mohammadi@nrcms.org Kazem K Mohammad کاظم محمد Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Iran Farideh F Khalajabadi Farahani National Research Center of Medical Sciences National Research Center of Medical Sciences Iran Siamak S Alikhani سیامک عالی‌خانی Department of School Health, Office of Youth & School Health, Ministry of Health & Medical Sciences Department of School Health, Office of Youth & School Health, Ministry of Health & Medical Sciences Iran Mohammad M Zare محمد زارع Deputy of Research & Technology, Ministry of Health & Medical Sciences Deputy of Research & Technology, Ministry of Health & Medical Sciences Iran Fahimeh F Ramezani Tehrani فهیمه رمضانی تهرانی Deputy of Research & Technology, Ministry of Health & Medical Sciences Deputy of Research & Technology, Ministry of Health & Medical Sciences Iran Ali A Ramezankhani علی رمضان‌خانی Deputy of Health, Shaheed Beheshti University of Medical Sciences Deputy of Health, Shaheed Beheshti University of Medical Sciences Iran Farshid F Zare فرشید علاءالدینی Deputy of Research, National Research Center of Medical Sciences Deputy of Research, National Research Center of Medical Sciences Iran Alireza A Hasan Zadeh علیرضا حسن‌زاده National Research Center of Medical Sciences National Research Center of Medical Sciences Iran Mehdi M Salehi Fard مهدی صالحی‌فرد National Research Center of Medical Sciences National Research Center of Medical Sciences Iran KnowledgeAttitudePracticeReproductive healthAdolescent 128.pdf Villareal M. 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اهميت باليني وارونگي پري‌سنتريك كروموزوم 9: گزارش يك مورد سقط مكرر Clinical significant of pericentric inversion of chromosome 9:A case report of recurrent abortion 2 1 وارونگي كروموزوم شماره 9 يك نوتركيبي شايع است كه معمولاً متخصصان ژنتيك آن را نوعي وارياسيون طبيعي در نظر مي‌گيرند. در اين گزارش يك زوج به ظاهر سالم معرفي مي‌شوند كه به علت 10 مورد سقط مكرر و يك مورد مرگ داخل رحمي جنين، تحت بررسي قرار گرفتند. در سابقة فاميلي، سابقة ناباروري و سقط مكرر و مرگ داخل رحمي جنين، در بستگان درجه يك و دو خانم ديده شد. آناليز كروموزومي خون محيطي براساس دو روش Banding-G و Banding -C انجام گرفت. كاريوتايپ شوهر بيمار طبيعي بود. كاريوتايپ خانم وارونگي كروموزوم 9](13q-11p) (9).inv[ را نشان ‌داد. كشت خون محيطي، بند ناف، ويلوس‌هاي جفتي و بيوپسي عضلات در آخرين جنين سقط شده انجام گرديد كه در بررسي كروموزومي، كاريوتايپ XY 46 بود و به جز طويل بودن ناحيه سانترومر نكته خاصي را نشان نداد. به نظر مي‌رسد وارونگي كروموزوم 9 به طور شايعي در بيماران مبتلا به ناباروري، سقط مكرر و نيز مرگ داخل رحمي ديده مي‌شود، اما اهميت باليني آن به عنوان دليل سقط مكرر قابل تأمل بوده ودر اين مجال به بحث گذاشته خواهد شد. 2 Pericentric inversion of chromosome 9 is a common phenomenon which is considered as normal variant by some cytogeneticists. A phenotipically normal couple was referred for cytogenetic evaluation due to ten recurrent spontaneous abortions and one intrauterine fetal death. The history of infertility, recurrent abortion and intrauterine fetal death were seen in the family and in the first and second degree relatives of the female. Chromosomal analysis from peripheral blood was performed according to standard cytogenetic methods using G-banding and C-banding techniques. Husband’s karyotype was normal. Wife’s karyotype has shown pericentric inversion of chromosome 9,inv(9)(p11-q13). Culture of peripheral blood, umbilical cord, chorionic villi and muscle biopsy were done on the last aborted fetus. Chromosomal study of the fetus revealed 46XY without any significant problem except for elongation of centromeric region of chromosome 9. 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