تعيين آنتي‌بادي ضد اسپرم در سرم ومايع انزالي مردان آزواسپرم به منظور پيشگويي موفقيت استخراج اسپرم از بيضه Antisperm antibody detection in serum and semen of infertile men for prediction the outcome of testicular sperm extraction 2 1 پيدايش ميكرواينجكشن، در عرصه درمان ناباروري مردان، تحول بزرگي ايجاد كرده است. در اين روش با تعداد كم ويا تنها يك اسپرم امكان باروري وجود دارد؛ لذا با به‌دست آوردن تعداد كم اسپرم از بيضه به روش TESE باروري ميسرخواهد بود. بدين‌ترتيب با استفاده از چنين‌ روش‌هايي امكان درمان بيماران آزوسپرم غيرانسدادي فراهم گرديده است كه قبلا امكان درماني براي آنها فراهم‌نبود، از طرف ديگر يافتن اسپرم‌هاي معدودي كه احتمالاً در بيضه وجود دارند اهميت بيشتري يافته است. براي پي‌بردن به وجود اسپرم و كانون‌هاي اسپرماتوژنز تحقيقاتي انجام شده است تا عوامل پيشگويي در ميزان موفقيت استحصال اسپرم از بيضه و رديابي آن مشخص گردد. در اين مطالعه از عملكرد سيستم ايمني در مواجهه با اسپرم و توليد آنتي‌بادي عليه آن استفاده گرديد. سيستم ايمني نسبت به آنتي‌ژن‌هاي اسپرماتوزوئيد كه در زمان بلوغ بارز مي‌شوند شناختي ندارد و در صورت مواجهه با آنها سيستم ايمني تحريك شده و باعث توليد آنتي‌بادي ضد اسپرم(ASA) مي‌شود. در اين بررسي ارتباط وجود ASA در سرم و ترشحات مايع انزالي مردان مبتلا به آزواسپرمي غيرانسدادي با يافتن اسپرماتوزوئيد در بيضه بررسي گرديد. براي اين منظور از94 نفر مرد ناباروري كه آزواسپرمي داشتند و براي بررسي و تشخيص علت آزواسپرمي احتياج به بيوپسي تشخيصي از بيضه (TESE) داشتند، نمونه‌گيري سرم و مايع انزالي و آزمايشات آنتي‌بادي ضد‌اسپرم به روش تست Mar غيرمستقيم انجام شد. سپس نتايج وجود آنتي‌بادي ضد اسپرم در سرم و مايع سمينال با ميزان موفقيت يافتن اسپرم از بافت بيضه بررسي گرديد. نتايج نشان داد كه سطح IgG در مردان با نتيجه مثبت TESE (يافتن اسپرم) بالاتر ازمواردي است كه TESE منفي بود (عدم وجود اسپرم) (=0/360,p=0/000 spearman r). بطوريكه در 40 نفر از اين مردان نتيجه تست MAR بيش از 10% بود كه در نمونه ‌34 نفر از اين گروه اسپرم يافت شد؛ لذا ارزش اخباري مثبت اين آزمايش 85% و ارزش اخباري منفي آن 52% مي‌باشد. اگر ميزان 40% براي IgG ضد اسپرم در تست MAR به عنوان تست مثبت درنظرگرفته شود، ارزش اخباري مثبت آن 100% خواهد بود. البته ASA منفي نمي‌تواند وجود اسپرماتوژنز را رد كند يا به عبارتي آزمايش منفي ارزشي در پيشگويي ندارد. بدين ترتيب بر اساس نتايج اين مطالعه در بيماران نابارور مبتلا به آزواسپرمي غيرانسدادي وجود آنتي‌بادي ضد اسپرم در مايع سمينال و سرم امكان يافتن اسپرم در بيوپسي بيضه را تقويت مي‌كند. 2 Male Infertility treatment has reached to prominent improvements in recent years by emergence of microinjection. In this method even with finding at least one spermatozoa, through Testicular Sperm Extraction (TESE), fertility would be possible. By such facilities, the treatment of non obstructive azoospermic men would be possible and finding of at least a few sperm from testis was signified. In order to predict the probability of retrieving spermatozoa from testis, different study was performed. Immune system and its role in production of antisperm antibody was considered in this study. Sperm antigens which appear at puberty are unfamiliar for immune system and their encounter with immune system stimulate and produce antisperm antibody (ASA). So, this study evaluated the relationship between antisperm antibodies in serum and semen of infertile men with outcome of testicular sperm extraction. This study included 94 azoospermic men who needed diagnostic biopsy or TESE. ASA was detected by indirect MAR test for IgG and IgA and the correlation between level of ASA and success rate of TESE were evaluated by statistic tests. The results showed that in men with positive TESE, level of IgG was more than negative one.(rspearman=0.360, p=0.000). In 40 men the result of MAR test was more than 10% and sperm found in samples of 34 men. So in this study the positive predictive value of antisperm IgG was 85% and its negative predictive value was 52%. By having the level of IgG in MAR test equal or more than 40%, its positive predictive value would be 100%. It is worthy to note that negative ASA does not predict the absence of spermatogenesis. In other word, negative test has not predictive value. Generally our results showed that antisperm antibody in serum and semen of azoosperic infertile men has a good prognosis for finding testis spermatozoa. 273 280 Seyyed Mohammad SM Kazemeyni سید محمد کاظمینی Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences Iran kazemeyni@yahoo.com Mohammad Ali MA Sedighi محمد علی صدیقی گیلانی Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences Iran Farid F Dadkhah فرید دادخواه Department of Urology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences Department of Urology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences Iran Hossein H Hadi Nadooshan حسین هادی ندوشن Immunology Department, Faculty of Medicine, Tehran Medical Sciences University Immunology Department, Faculty of Medicine, Tehran Medical Sciences University Iran Male infertilityAntisperm antibodyAzoospermiaMicroinjectionPredictor factorTesticular sperm extraction 130.pdf Tournaye H.,Devroey P., Liu J., Nagy Z., Lissens W., Van Steirteghem A. Microsurgical epididymal sperm aspiration and interacytoplasmic injection:##Craft I., Tsirigotis M. Simplified recovery, preparation and cryopreservation of testicular spermatozoa. Hum Reprod.1995;1623-1627.##Siber S.J.Quantitative analysis of testicular Biopsy. Fertil Steril.1981;36:480-485.##Siber S.J. Sertoli cell-only syndrome. Hum Reprod.1996;11:229-233.##Silber S.J. Normal pregnancies resulting from testicular sperm extraction and interacytoplasmic sperm injection for azoospermic due to maturation arrest. Fertil Steril.1996;66:110-117.##Tournaye H., Verheyen G., Nagy P., Ubaldi F., Goossens A., Silber S.J., Van Steirteghem A.C., Devroey P. Are there any predictive factors for successful testicular sperm recovery in azoospermic patients? Hum Reprod.1997;12:80-86.##Ezeh U. I., Moore H.D., Cooke I. D.Correlation of testicular sperm extraction with morphological, biophysical and endocrine profiles in men with azoospermia due to primary gonadal failure. Hum Reprod.1998;13:3066-3074.##Jensen T.K., Andersson A.M., Hjollund N.H.I., et al. Inhibin B as a serum marker of spermatogenesis: correlation to differences in sperm concentration and follicle-stimulating hormone levels. A study of 349 Danish men. J Clin Endocrinol Metab.1997;82:4059–4063.##Pierik F.H., Vreeburg J.T., Stijnen T., De Jong F.H, Weber R.F.A. Serum inhibin B as a marker of spermatogenesis. J Clin Endocrinol Metab. 1998;83:3110–3114.##Sigrid V., Eckardstein M. S., Martin. Bergmann., Gerhard F., Weinbauer Paul Gassner, Andreas G., Schepers., Eberhard N. Serum Inhibin B in Combination with Serum Follicle-Stimulating Hormone (FSH) Is a More Sensitive Marker Than Serum FSH Alone for Impaired Spermatogenesis in Men, But Cannot Predict the Presence of Sperm in Testicular Tissue Samples . J Clin Endo Metab. 1999;84(7)2496-2501.##Turek P.J. Infections, Immunology,and male infertility Clinics of north America.1999;10:435-470.##

تاثير فلورباكتريال كانال سرويكس بر نتايج باروري در مراجعه كنندگان به مركز باروري و ناباروري اصفهان The effect of bacterial flora of cervical canal on fertility outcome in patients referring to Isfahan fertility and infertility center 2 1 با وجود پيشرفت‌هاي حاصل در درمان‌هاي نوين ناباروري از جمله روش لقاح آزمايشگاهي (IVF) و روش تزريق اسپرم به داخل سيتوپلاسم تخمك (ICSI)، به طور كلي درصد باروري همچنان پايين مي‌باشد. يكي از عوامل مهم در روند باروري، لانه‌گزيني جنين است. عده‌اي از محققين معتقدند كه انتقال فلورباكتريال سرويكس در حين عمل انتقال جنين به داخل اندومتر مي‌تواند بر اين روند تاثير منفي گذاشته و موجب كاهش درصد باروري گردد. با توجه به ضد و نقيض بودن اطلاعات و همچنين عدم وجود اطلاعات منطقه‌اي در اين زمينه، بر آن شديم كه در يك مطالعه مقطعي تاثير فلورباكتريال كانال سرويكس را بر روند باروري بررسي نماييم. در مطالعه حاضر نمونه‌هايي از اندوسرويكس 100 زن داوطلب ICSI با استفاده از كاتتر انتقال جنين تهيه و پس از انتقال جنين‌ها، قطعه‌اي از نوك كاتتر به محيط‌هاي كشت اختصاصي باكتريال منتقل گرديد و پس از انكوبه كردن در شرايط ويژه كشت باكتري و با بكارگيري روشهاي متداول باكتري شناسي، باكتريهاي موجود در نمونه‌ها، جداسازي و تشخيص داده شدند. HCG βمثبت به منزلة لانه‌گزيني جنين تلقي گرديد. آناليز نتايج و فرضيات بر اساس آزمون 2 انجام پذيرفت. نتايج اين مطالعه نشان مي‌دهد كه 17% از بيماران لانه‌گزيني موفق و83 % لانه‌گزيني ناموفق داشتند. كشت مثبت باكتريال كاتتر در گروه‌هاي موفق و ناموفق به ترتيب 4/29 % و4/49 % برآورد گرديد ودرصد باروري در گروه داراي آلودگي و بدون آلودگي سرويكس به ترتيب 8/10% و 2/22% بود. اين نتايج مؤيد آن است كه حضور باكتري‌هاي بالقوه پاتوژن در اندوسرويكس زنان با باروري ناموفق بطورمعني‌داري(05/0 P<) بيشتر از زنان با باروري موفق مي‌باشد؛ به عبارت ديگر درصد باروري در بيماران با آلودگي‌هاي دهانه سرويكس نسبت به بيماران بدون آلودگي دهانه سرويكس به‌طور معني‌داري(05/0 P<) پايين‌تر مي‌باشد. اين امر احتمالاً نشان دهنده تاثير منفي باكتريها و اندومتريت بر لانه گزيني و تكامل جنين مي‌باشد. 2 In spite of advances in the filed of assisted reproductive techniques including in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI), the pregnancy rate remained low. One of the major events in fertility is implantation process. Researchers believe that introduction of cervical bacteria into uterus during embryo transfer might have an inhibitory effect on implantation and thereby pregnancy rate. The reason for performing this study was the contradictory reports in this field and lack of regional information. In this cross-sectional study, endo-cervical samples from one hundred women who were undergoing intra-cytoplasmic sperm injection (ICSI) were prepared by using embryo transfer catheter tips. Catheters tips were transferred to selective culture media and after incubation in special conditions by using current bacteriological methods, bacteria in the samples were isolated and characterized. Implantation was confirmed by measurement of β- hCG in serum. Analysis of the results were carried out by chi-square. The overall implantation rate per transfer was 17 %. Positive cultures in the successful and unsuccessful implantation groups were 29.4% and 49.4%, respectively. In other words, implantation rates in patients with and without cervical infection were 10.8% and 22.2%, respectively. Our study showed that, potentially pathogenic bacteria in endo-cervix of women with unsuccessful implantation is more prevalent than those with successful implantation (p0.05). Therefore, the results of this study imply the negative effects of cervical bacteria on the implantation process. 280 288 Mohammad Hossein MH Nasr-Esfahani Embryology Department, Royan Institute, Iranian Academic Center for Education, Culture & Research (ACECR) Embryology Department, Royan Institute, Iranian Academic Center for Education, Culture & Research (ACECR) Iran mh_nasr@med.mui.ac.ir Seyyed Ali SA Fazeli سید علی فاضلی Department of Bacteriology & Virology. Faculty of Medicine, Isfahan University of Medical Science Department of Bacteriology & Virology. Faculty of Medicine, Isfahan University of Medical Science Iran Fariborz F Kianpoor فریبرز کیانپور Department of Microbiology, Clinical Laboratory, Al-zahra Hospital, Faculty of Medicine, Isfahan University of Medical Science Department of Microbiology, Clinical Laboratory, Al-zahra Hospital, Faculty of Medicine, Isfahan University of Medical Science Iran Seyyed Akbar SA Tabibian سید اکبر طبیبیان Department of Bacteriology & Virology. Faculty of Medicine, Isfahan University of Medical Science Department of Bacteriology & Virology. Faculty of Medicine, Isfahan University of Medical Science Iran Seyyed Mehdi SM Ahmadi سید مهدی احمدی Isfahan Fertility and Infertility Center Isfahan Fertility and Infertility Center Iran Seyyed Asadollah SA Kalantari سید اسدا... کلانتری Isfahan Fertility and Infertility Center Isfahan Fertility and Infertility Center Iran InfertilityICSIImplantationBacterial flora of the cervix<i>In Vitro</i> fertilizationEmbryo transfer 131.pdf Paulson R.J., Sauer M.V., Lobo R.A. Factors affecting embryo implantation after human in vitro fertilization: a hypothesis. Am J Obstet Gynecol.1990;163:2020-23.##Fanchin R., Harmas A., Benaoudia F., Lundkvist U., Olivennes F., Frydman R. Microbial flora of cervix assessed at the time of embryo transfer adversely effects in vitro fertilization outcome. Fertil Steril.1998;70:866-870.##Egbase P.E., al-Sharhan M., al-Othman S., al-Mutawa M., Udo E.E., Grudzinskas J.G. Incidence of microbial growth from the tip of the embryo transfer catheter after embryo transfer in relation to clinical pregnancy##Ralph S.G., Rutherford A.J., Wilson J.D. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. BMJ.1999;319(7204):220-223.##Faro S. Chlamydia trachomatis: female pelvic infection. Am J Obstet Gynecol.1991;164: 1767-70.##Witkin S.S., Sultan K.M., Neal G.S., Jeremias J., Grifo J.A., Rosenwaks Z. Unsuspected Chlamydia trachomatis infection and in vitro fertilization outcome. Am J Obstet Gynecol.1994; 171(5):1208-1214.##Bartlett J.G., Moon N.E., Goldstein P.R., Goren B., Onderdonk A.B., Polk B.F. Cervical and vaginal bacterial flora: ecologic niches in the female lower genital tract. Am J Obstet Gynecol. 1978; 130(6):658-661.##Nishikawa Y. Adherence of Escherichia coli in pathogensis of endometritis and effects of estradiol examined by scanning electron microscopy. Infect Immun.1985;47(1):318-21.##Drbohlav P., Halkova E., Masata J., Rezacova J., Cerny V., Rossova D. The effect of endometrial infection on embryo implantation in the IVF and ET program. Ceska Gynekol. 1998; 63(3):181-5.##Salim R., Ben-Shlomo I., Colodner R., Keness Y., Shalev E. Bacterial colonization of the uterine cervix and success rate in assisted reproduction: esults of a prospective survey. Hum Reprod. 2002;17(2):337-340.##Bailey & Scott`s Diagnostic microbiology. 8th Edition.1990;323-558.##Mackie & McCartney Practical medical microbiology.13 th Edition.1989;303-583.##Czernobilsky B. Endometritis and infertility. Fertil Steril.1978;30(2):119-30.##Tabibzadeh S., Babaknia A. The signals and molecular pathways involved in implantation, a symbiotic interaction between blastocyst and endometrium involving adhesion and tissue invasion. Hum Reprod.1995;10(6):1579-1602.##Lessey B.A., Damjanovich L., Coutifaris C., Castelbaum A., Albelda S.M., Buck C.A. Integrin adhesion molecules in the human endometrium. Correlation with normal and abnormal menstrual cycle. J Clin Invest.1992:90:188-195.##Winberg J., Herthelius- Elman M., Mollby R., Nord CE. Pathogenesis of urinary tract infection experimental studies of vaginal resistance to colonization. Pediatr Nephrol.1993;7:509-14.##

بررسي فاكتور رشد شبه انسوليني نوع I (IGF-I) و آنتي‌ژن اختصاصي پروستات (PSA) در خون و سيمن مردان نابارور Insulin like-Growth Factor- I (IGF-I) and Prostate Specific Antigen (PSA) in blood and semen of infertile males 2 1 عقيده بر اين است كه فاكتور رشد شبه انسوليني نوع I (IGF-I)، كه غلظت آن به‌طور عمده توسط هورمون رشد كنترل مي‌شود، تكثيرو تمايز سلول‌هاي زايا را تحت تاثير قرارمي‌دهد. عملكرد اين فاكتور متأثر از پروتئين‌هاي متصل‌شونده به آن (IGFBPs) و آنتي‌ژن اختصاصي پروستات (PSA) است. هدف از اين مطالعه بررسي ميزان سطح سرمي و پلاسماي سمينال IGF-I و PSA در مردان مبتلا به ناباروري ايديوپاتيك بود. به همين منظور مطالعه‌مورد- شاهدي حاضر با روش نمونه‌گيري تصادفي طراحي شد. گروه مورد شامل 29 مرد نابارور دچار اليگواسپرمي و گروه شاهد شامل 23 مرد نابارور نرمواسپرم بودند. ميزان سطح IGF-I و PSA با روش ايمنوراديومتريك اسي(IRMA) اندازه‌گيري‌شد. آناليز داده‌ها جهت مقايسة پارامترهاي كمي و كيفي اسپرم (مورفولوژي، تعداد و تحرك اسپرم) و سطح سرمي و پلاسماي سمينال IGF-I و PSA بين گروه مورد و شاهد از طريق آزمون‌ t-test انجام شد. مقايسة تحرك اسپرم بين دو گروه با استفاده از آزمون آماري غيرپارامتري Mann-Whitney انجام شد. كليه آزمون‌هاي آماري به صورت دو دنباله‌اي با 05/0= α درنظر گرفته‌شد. ميانگين سطح IGF-I پلاسماي سمينال مردان نابارور اليگواسپرم به‌طورمعني‌داري كمتر از‌ مردان نابارور نرمواسپرم بود (01/0 P<)؛ اما ميانگين سطح IGF-I سرم و نيز PSA سرم و پلاسماي سمينال اختلاف معني‌داري را بين دو گروه نشان‌نداد. براساس نتايج اين مطالعه مي‌توان نتيجه‌گرفت كهIGF-I ممكن‌است به‌عنوان يك فاكتور ميتوتيك و تمايزي در تكامل سلول‌هاي زايا داراي نقش‌باشد. 2 Insulin-like growth factor-I (IGF-I) is believed to be involved in the development of germ cells. IGF-I whose level is mainly controlled by concentration of growth hormone, induces cell proliferation and differentiation. Its action is mediated by Insulin-like growth factor binding-proteins (IGFBPs) and prostate-specific antigen (PSA).The aim of this case-control study was to evaluate serum and seminal plasma levels of IGF-I and PSA in idiopathic oligospermic and normospermic infertile males with simple random sampling. The case group was consisted of 29 infertile males with idiopathic oligospermia compared to 23 normospermic men with idiopathic infertility as control group. PSA and IGF-I were measured by immunoradiometric assay (IRMA).Comparison of sperm morphology, sperm count, serum and seminal plasma IGF-I and PSA between two groups were carried out using t-test. Sperm motility was compared between two groups by non-parametric Mann-Whitney test. Two-tailed test with =0.05 was the level of statistically significance. Results showed that mean IGF-I level in seminal plasma of oligospermic group were significantly lower than normospermic group (p<0.01). But, there were no significant differences in serum IGF-I and serum and seminal plasma PSA levels between two groups. We concluded that IGF-I and PSA might be considered as a mitotic and differentiation factor in development of male germ cells. 288 295 Nosratollah N Zarghami نصرت‏الله ضرغامی Department of Clinical Biochemistry, Drug Applied Research Center, Tabriz University of Medical Department of Clinical Biochemistry, Drug Applied Research Center, Tabriz University of Medical Iran nzarghami@hotmail.com Mohammad M Rahbani Nobar محمد رهبانی نوبر Department of Clinical Biochemistry, Drug Applied Research Center, Tabriz University of Medical Department of Clinical Biochemistry, Drug Applied Research Center, Tabriz University of Medical Iran Maerefat M Ghaffari معرفت غفاری نوین Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Ali A Khosrowbeygi علی خسروبیگی Department of Clinical Biochemistry, Drug Applied Research Center, Tabriz University of Medical Department of Clinical Biochemistry, Drug Applied Research Center, Tabriz University of Medical Iran Naser N Safaei ناصر صفایی Department of Cardiovascular surgery, Shahid Madani Hospital, Faculty of Medicine, Tabriz University of Medical Science Department of Cardiovascular surgery, Shahid Madani Hospital, Faculty of Medicine, Tabriz University of Medical Science Iran InfertilityInfertile menIGF-IPSASeminal plasmaSpermatozoaSperm 132.pdf Glander H.J., Kartzseh J., Weiserich C.H., Birkenmeier G. Insulin–like growth factor–I and ?2–macrogolobulin in seminal plasma correlate with semen quality. Hum Reprod.1996;11:2454-60.##Colombo J.B., Naz R.K. Modulation of insulin-like growth factor- I in the seminal plasma of infertile men. J Androl.1999;20:118-25.##Macpherson M.L., Simmen R.C., Simmen F.A., Hernandez J., Sheerin B.R., Varner D.D., et al. Insulin-like growth factor-I and Insulin-like growth factor binding protein-2 and –5 in equine seminal plasma: association with sperm characteristics and fertility. Biol Reprod.2002; 67:648-54.##Henricks D.M., Kouba A.J., Lackey B.R., Boone W.R., Gray S.L. Identification of Insulin-like growth factor-I in bovine seminal plasma and its receptor on spermatozoa: influence on sperm motility. Biol Reprod.1998;59:330-7.##Minelli A., Liguori L., Collodel G., Lattaioli P., Castellini C. Effects of the purified IGF-I complex on the capacitation and acrosome reaction of rabbit spermatozoa. J Exp Zool.2001; 290:311-7.##Yoshida K., Yamasaki T., Yoshiike M., Takano S., Sato I., Iwamoto T. Quantification of seminal plasma motility inhibitor/semenogelin in human seminal plasma. J Androl.2003;24:878-84.##Elzanaty S., Richthoff J., Malm J., Giwercman A. The impact of epididymal and accessory sex gland function on sperm motility. Hum Reprod. 2002;17:2904-11.##Lee K.O., Oh Y., Giudice L.C., Cohen P., Peehl D.M., Rosenfeld R.G. Identification of insulin-like growth factor-binding protein-3 (IGFBP-3) fragments and IGFBP-5 proteolytic activity in human seminal plasma: a comparison of normal and vasectomized patients. J Clin Endocrinol Metab.1994;79:1367-72.##World Health Organization: WHO Laboratory Manual for the Examination of Human Semen and Semen-Cervical Mucus Interactin. Cambridge University Press, Cambridge, UK,1999.##Hoeflich A., Reichenbach H.D., Schwartz J., Grupp T., Weber M.M., Foll J., Wolf E. Insulin-like growth factors and IGF-binding proteins in bovine seminal plasma. Domest Anim Endocrinol. 1999;17:39-51.##

تاثير هورمونهايrFSH و تستوسترون بر بلوغ اسپرماتيد گرد موشي در سيستم هم‌كشتي سلول‌هاي Vero The effects of rFSH and Testosterone on in vitro maturation of mouse round spermatid in co-culture with Vero cells 2 1 اسپرم‌سازي يك فرآيند سنجيده و دقيق است كه در سن بلوغ آغاز شده و در سراسر زندگي توليد مثلي ادامه مي‌يابد. سلول‌هاي ژرمينال در محيط كشت تحت شرايط خاصي قادر به تمايز حين ميوز و بعد از آن هستند. سيستم‌هاي هم‌كشتي در حفظ سلول‌هاي سازندة اسپرم و روند اسپرم‌سازي نقش مهمي داشته و امكان حمايت از روند اسپرم‌سازي را فراهم مي‌نمايد. از اين رو از اين سيستم‌ها جهت بلوغ سلولهاي ژرمينال و غلبه بر توقف تمايز سلول‌هاي سازندة اسپرم استفاده مي‌شود. هورمون‌هاي FSH و تستوسترون نيز در شروع و بقاء اسپرم‌سازي مهم بوده و كاهش آنها سبب نقص در اسپرم سازي در محيط In Vivo مي‌گردد. از آنجا كه همراهي سيستم هم‌كشتي با هورمون‌ها در مطالعات انجام شده وجود نداشت در اين پژوهش، اثرات دو سيستم هم‌كشتي با سلولVero و سيستم هم‌كشتي با سلولVero حاوي هورمونهايrFSH و تستوسترون بر بلوغ سلول‌هاي اسپرماتيد گرد مورد بررسي قرار گرفت. به‌ اين منظور سوسپانسيون سلولي از بيضه موش نژاد NMRI با سن 12-8 هفته تهيه و به سه قسمت تقسيم گرديد. يك قسمت در محيط DMEM حاوي سرم (گروه شاهد)، قسمت ديگر بر روي تك لايه سلول Vero (آزمون 1) و بخشي نيز در محيط حاوي تك لايه سلول‌هاي Vero به اضافه هورمون‌هاي rFSH و تستوسترون(آزمون2) به مدت 96 ساعت كشت داده‌شد. تعداد سلول‌هاي اسپرماتيدگرد، اسپرماتيدهاي در حال طويل شدن و اسپرماتيدهاي طويل شده قبل از كشت و همچنين روزانه به مدت 96 ساعت با استفاده از ميكروسكوپ نوري بررسي و ثبت گرديد. ميزان درصد زنده ماندن انواع سلول‌هاي اسپرماتيد نيز در طي ساعات ذكر شده، با استفاده از آزمون تريپان بلو ارزيابي شده و نتايج حاصل توسط آزمون آماري repeated measure ANOVA مقايسه شد. نتايج حاصل حاكي از آن بود كه در سيستم هم‌كشتي Vero در 24 ساعت اول كشت تعداد سلول‌هاي اسپرماتيد در حال طويل شدن نسبت به گروه شاهد افزايش معني‌دار نشان داد (001 0/0P< ). در سيستم هم‌كشتي حاوي هورمون‌هاي rFSH و تستوسترون نيز پس از 24 و48 ساعت كشت، به ترتيب تعداد سلول‌هاي اسپرماتيد در حال طويل شدن و طويل شده نسبت به گروه شاهد افزايش معني‌دار داشت( 0001/0P<)؛ ولي پس از سپري شدن زمان‌هاي فوق، به مرور تعداد انواع سلول‌هاي اسپرماتيد كاهش يافت. از نظر تعداد سلول‌هاي اسپرماتيد در‌حال طويل شدن در محيط كشت تفاوت معني‌دار بين گروه‌هاي آزمون مشاهده نشد. درتمامي گروه‌ها ميزان درصد زنده ماندن سلول‌هاي اسپرماتيد در طول مدت زمان كشت، كاهش داشت و در گروه‌هاي آزمون به‌دليل اثرات مثبت سيستم‌هاي هم‌كشتي وهورمون‌ها حيات سلول‌ها با درصد بالاتري حفظ شد. در مجموع نتايج اين تحقيق نشان داد كه بلوغ سلول‌هاي اسپرماتيد گرد در هر دو سيستم هم‌كشتي و هم‌كشتي- هورمون حاصل مي‌شود و سلول‌ها براي مدت زمان كوتاهي (حداكثر 48 ساعت) قادر هستند كه مراحل تمايزي را پشت سر گذارند. لازم به ذكر است كه از جهت زنده ماندن در محيط كشت و همچنين بلوغ، سيستم هم‌كشتي كه به آن هورمون افزوده شده باشد بهتر عمل مي‌كند. 2 Co-culture systems have important roles in maintenance of spermatogenic cells and process of spermatogenesis. These systems are used for in vitro maturation of germ cells and overcome on differentiation arrest of spermatogenic cells. FSH and Testosterone hormones are important in initiation and maintenance of spermatogenesis. Lack of these hormones causes spermatogenesis deficiency in vivo. In this study, the effects of both co-culture system with Vero cell and co-culture supplemented with rFSH and Testosterone were determined on maturation of round spermatids. Cell suspension was isolated from testis of NMRI male mice (8-12 weeks old) and divided into three parts. Suspensions in three groups include: control (culture on DMEM with 10% FBS), experimental 1 (culture on monolayer of Vero cell) and experimental 2 (culture on monolayer of Vero cell supplemented with rFSH and Testosterone), were cultured for 96-hours. The numbers of round, elongating and elongated spermatids, before and after of culture were recorded for 96-hr using light microscope. Survival rates of all kind of spermatids were evaluated using trypan blue test and the results of each group were compared statistically by repeated measure ANOVA test. The results of this study showed that in co-culture system on the first 24-hr, the number of round spermatid cells were reduced but elongating spermatid cells increased significantly(P<0.0001). In co-culture system supplemented with rFSH and Testosterone, the numbers of elongated and elongating spermatid cells increased significantly after 24 and 48 hours respectively (P<0.001) but after that the number of all kind of spermatid cells were reduced. Viability rates of all kinds of spermatid cells reduced during 96-hours culture and there were no significant differences. In conclusion, the results of this study confirms that round spermatid cells by using of co-culture system with and without hormones can progress into elongating over a short period (maximum 48 hours). Vero cell culture supplemented with rFSH and Testosterone can support in vitro maturation and viability of spermatogenic cells better than Vero cells without hormones. 295 306 Aliraza A Ajeen علیرضا آژین Anatomy Department, Faculty of Medical Sciences, Tarbiyat Modares University Anatomy Department, Faculty of Medical Sciences, Tarbiyat Modares University Iran Mansoureh M Movahedin منصوره موحدین Anatomy Department, Faculty of Medical Sciences, Tarbiyat Modares University Anatomy Department, Faculty of Medical Sciences, Tarbiyat Modares University Iran movahedm@hotmail.com Mojtaba M Rezazadeh Valojerdi مجتبی رضا زاده ولوجردی Anatomy Department, Faculty of Medical Sciences, Tarbiyat Modares University Anatomy Department, Faculty of Medical Sciences, Tarbiyat Modares University Iran Anooshirvan A Kazemnejad انوشیروان کاظم‌نژاد Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Iran InfertilitySpermatogenesis arrestSpermatidCo-CultureIn vitro maturationrFSHTestosterone 133.pdf Barrat C.L.R., Grudzinsky J.G., Yovich, J.L. Spermatogenesis in gametes: the spermatozoon. Cambridge University Press: Cambridge.1995; 245-251.##Nomen M.N., Mousa M.M., Karasky A.O. Testicular biopsy in azoospermia and severe oligozoospermia. Arch Androl.1984;12:109-122.##Hosoi Y., Miyake M., Utsumu K., Iritani A. Development of rabbit oocytes after microinjection of spermatozoa. (Abstr.331). Proc11th Int. Cong Anim Reprod Artif. Insemin. ,1988.##Goto K., Kinoshita, A., Ogawa K. Fertilization of bovine oocytes by the injection of immobilized, killed spermatozoa. Vet Rec.1990;127:517-520.##Ahmadi A., Ng Sc., Liow, S.L. Intracytoplasmic sperm injection of mouse oocytes with 5mM Ca2 at different intervals. Hum Reprod.1995;10:431-435.##Palermo G., Joris H., Devoroey, P., Van Steirtghem A.C. Pregnancies after intracytoplasmic injection single spermatozoon into an oocyte. Lancet.1992;340:17-18.##Balaban B., Urman B., Isiklar A. Progression to the blastocyst stage of embryos derived testicular round spermatids. Hum Reprod. 2000; 15:1377-1382.##Kimura Y., Yanagimachi R. Mouse oocytes injected with testicular spermatozoa or round spermatids can develop in to normal offspring. Development.1995;121:2397-2405.##Tesarik J. Sperm or spermatid conception? Fertil Steril.1997;68:214-216.##Bongso A., Fong C.Y., Ng, S.C., Ratnam, S. The search for improved in-vitro systems should not be ignored: Embryo co-culture may be one of them. Hum Reprod.1993;80:1155-1162.##Kervancioglu M.E., Djahanbakhch O., Aitken R.J. Epithelial cell co-culture and the induction of sperm capacitation. Fertil Steril.1994;61:1103-1108.##Mansour R.T., Aboulghar M.A., Serour G.I. The life span of sperm motility and pattern in co-culture. Fertil Steril.1995;63:660-662.##Cremades N., Bernabeu R., Barros A., Sousa M. In-vitro maturation of round spermatids using co-culture on vero cells. Hum Reorid. 1999; 14:1287-1293.##Cremades N., Sousa M., Bernabeu R., Barros, A. Developmental potential of elongating & elongated spermatids after in-vitro maturation of isolated round spermatids. Hum Reprod.2001; 16:1938-1944.##Tesarik J., Greco E. Differentiation of spermatogenic cells during in-vitro culture of testicular biopsy samples from patients with obstructive azoospermia: effect of recombinant follicle stimulating hormone. Hum Reprod. 1998; 13:2772-2781.##Tesarik J., Greco E. Differentiation of spermatogenic cells during in-vitro culture of testicular biopsy samples from patients with obstructive azoospermia: effect of recombinant follicle stimulating hormone. Hum Reprod. 1998;13:2772-2781.##Nematollahi N., Rezazadeh Valojerdi M. Effect of vero cell coculture on the development of frozen-thawed two-cell mouse embryos. J Assist Reprod Gen.1999;16:380-384.##Paria B.C., Dey S.K. Preimplantation embryo development in vitro cooperative interactions among embryos and role of growth factors. Proc Natl Acad Sci.1990;87:4756-4760.##Chen H.F. Peptides extracted from vero cell cultures overcome the blastocyst block of mouse embryos in a serum-free medium. J Assist Reprod Gen . 1994;11:165-171.##Menck M.C., Guyader- Joly C., Peyton N., Le Boyrhis, D., Lobo, R.B., Renard, J.P., Heyman, Y. Benefical effects of vero cells for developing IVF bovine eggs in two different co-culture systems. Reprod Nutr Dev.1997;37:141-150.##Maeda J., Kotsaji F., Negaimi A., Kamitami N., Tominagat T. In vitro development of bovine embryos in conditioned media for bovine granulose cells and vero cells cultured in exogenous protein and aminoacid free chemically defined human tubal fluid medium. Biol Reprold. 1996;54:930-936.##Tanaka A., Nagayoshi M., Awata S., Mawatari Y., Tanaka I., And Kusunoki H. Completion of meiosis in human primary spermatocytes through in vitro coculture with Vero cells. Fertil Steril.2003;79:795-801.##Jamal H.S., Amarin Z.O. Round spermatid separation and in vitro maturation. Saudi Med J.2000;21: 960-963.##Tesarik J., Guido M., Mendoza C. Humn spermatogenesis in vitro: Respecive effect of follicle-stimulatig hormone and testosterone on meiosis, spermiogenesis,and sertoli cell apoptpsis. J Clin Endocrinol Metab.1998;83:4467-4473.##Tesarik J., Nagy P., Abdelmassih R., Greco E., Mendoza C. Pharmacological concentrations of follicle-stimulating hormone and testosterone improve the efficacy of in vitro germ cell differentiation in men with maturation arrest. Fertil Steril.2002;77:245-251.##Tsutsumi O. and Takami, O.A. Physiological role of epidermal growth factor in male reproductive function. Science.1986;233:975-977.##Chen y., Dicou E., Diakiew D. Characterization of nerve growth factor precursor protein expression in rat round spermatids and the trophic effects of nerve growth factor in the maintenance of sertoli cell viability. Mol Cell Endocrinol.1997;127:129-136.##Sun, T., Wreford, N.G., Roberston, D.M. and De Krester, D.M. Quantitive cytological studies of spermatogenesis in intact and hypophysectomized rats: identification of androgen – dependent stages. Endocrinol.1990;127:1215-1223.##Tesarik, J. and Mendoza, C. In vitro differentiation of germ cells from frozen testicular biopsy specimens. Hum Reprod.2000;15:1713-1716.##Meachem SJ, Wreford NG, Robertson DM, McLachlan RI. Androgen action on the restoration of spermatogenesis in adult rats: effects of human chorionic gonadotrophin, testosterone and flutamide administration on germ cell number. Int J Androl. 1997;20(2):70-9.##Baarends W.M., Grootegoed J.A. Molecular biology of male gametogenesis. In Fauser, B.C., Rutherford, A.J., Strauss, J.F. and Van Steirteghem, A. (Edititors), Molecular biology in reproductive medicine. Parthenon New York, 1999; pp.271-295.##O´Donnel L., Mc Lachlan R.T., Wreford N.G. Testosterone withdrawal promotes stage specific detachment of round spermatids from the rat seminiferous epithelium. Biol Reprod.1996; 55:895-901.##Print C.G., Loveland K.L. Germ cell suicide: new insights into apoptosis during spermatogenesis. Bio Essay.2000;22:423-430.##Tesarik J., Mendoza C. and Greco E. In-vitro maturation of immature human male germ cells. Mol Cell Endocrinol.2000;166:45-50.##

بررسي تأثير بازگذاشتن پريتوان جداري بر ميزان چسبندگي در زنان تحت عمل سزارين بستري در زايشگاه نيك نفس بيمارستان شهيد باهنر كرمان The effect of non-closure parietal peritoneum on adhesion in cesarean women attending Nicknafs delivery ward of Shahid Bahonar hospital in Kerman 2 1 چسبندگي‌هاي بعد از عمل يكي از علل مهم عوارض بعد از عمل جراحي از قبيل انسداد روده، ناباروري و مشكلات حين عمل در اعمال جراحي بعدي مي‌باشد. بر اساس نتايج برخي مطالعات انجام شده بر روي حيوانات و نمونه‌هاي انساني، بازگذاشتن پريتوان جداري چسبندگي كمتري را به دنبال دارد. با توجه به اختلاف نظر در مورد بستن يا بازنگهداشتن پريتوان جداري، اين مطالعه كه بيش از 5 سال به طول انجاميد، به منظور تعيين تاثير بازنگهداشتن پريتوان جداري بر ميزان چسبندگي بعد از عمل سزارين صورت گرفت. از 300 زن باردار واجد شرايط كه وارد مطالعه شدند، در مورد 148 نفر عمل سزارين با بستن و 152 نفر با بازنگهداشتن پريتوان جداري صورت گرفت. در عمل جراحي بعدي (سزارين يا هيستركتومي‌ حداقل 34-31 ماه بعد) ميزان چسبندگي و فتق در محلهاي مختلف مشاهده و ثبت گرديد. نتايج نشان داد متغيرهاي سن، وزن، تعداد زايمان و عفونت لگن بين دو گروه مورد مطالعه تفاوت معني‌داري ندارد. ولي از نظر نوع عمل (اورژانس يا انتخابي) و فاصله زماني بين دو عمل اختلاف معني‌دار بود (05/0 P>). بروز چسبندگي متوسط يا شديد در هر يك از نواحي جدار شكم، فاشيا، پريتوان، امنتوم، روده‌ها و مثانه در زناني كه پريتوان جداري آنها بسته نشده بود به ترتيب 5/38%، 1/8%، 9/18%، 4/7%، 7/2% و1/31% و در گروهي كه پريتوان بسته شده بود به ترتيب 98%، 3/53%، 6/81%، 4/72%، 4/18% و1/94% بدست آمد. مقايسه شدت چسبندگي در نواحي مذكور و مجموع نواحي در دو گروه تفاوت معني‌دار آماري را نشان داد (0001/0 P<)؛ به طوري ‌كه در همة موارد بازنگهداشتن پريتوان چسبندگي كمتري را به دنبال داشت. مقايسه كل چسبندگي در هر يك از گروهها بر حسب متغيرهاي سن، وزن و تعداد زايمان در هيچ موردي تفاوت معني‌داري را نشان نداد؛ گرچه برتري بازنگهداشتن پريتوان در پيشگيري از ايجاد چسبندگي بعد از عمل سزارين بر اساس نتايج اين تحقيق مورد تاييد قرار گرفته است، اما نمي‌توان نتايج آن را به كليه اعمال جراحي شكمي‌ تعميم داد. بنابراين تكرار چنين نتايجي در پژوهشهاي بعدي و نيز در مورد ساير اعمال جراحي شكمي، امكان كاربرد قطعي آن را فراهم مي‌سازد. 2 Post operative adhesion is the most common cause of small bowel obstruction, infertility and technical problem in later surgical procedure. According to some results on animals or human, non-closure parietal peritoneum have performed less adhesion. Since there are considerable controversies over closure or non-closure parietal peritoneum on amount of adhesion after cesarean section. 300 pregnant women were included in this study. The parietal peritoneum in 148 patients was closed and in 152 patients left opened. In their next cesarean section, which was at least 31- 34 months later, the amount of adhesion and hernia were evaluated and recorded. The results showed that there were no statistically significant difference between the two groups over age, weight, parity and pelvic infection but there was a significant difference between the interval of two successive surgeries and type of surgeries: elective or emergency (p<0.05). The adhesion evaluation of abdominal wall, fascia, peritoneum, omentum, bowel and bladder in non-closure and closure peritoneum patients were 38.5%- 98%, 8.1%- 53.3%, 18.9%- 7.4%, 72.4%- 2.7%, 18.4%- 31.1% and 94.1% respectively. The reaults showed a significant difference in the amount of adhesion between two groups (p<0.001). It was much lower in the non-closure group. The comparision of total score of adhesion with age, weight and parity in two groups were not statistically significant. Althouh the results of our study showed the open peritoneum is better than closed parietal peritoneum but we can not generalize for all abdominal surgery. Therefore more reseach would be necessary. 306 314 Irandokht I Mehri Mahani ایراندخت مهری ماهانی Department of Obstet . and Gynecol Faculty of Medicine, Kerman University of Medical Siences Department of Obstet . and Gynecol Faculty of Medicine, Kerman University of Medical Siences Iran Iranmahan@yahoo.com Sakineh S Mohammad Alizadeh سکینه محمدعلیزاده Department of Pediatrics Nursing, Nursing & Midwifery Faculty, Kerman University of Medical Siences Department of Pediatrics Nursing, Nursing & Midwifery Faculty, Kerman University of Medical Siences Iran Cesarean sectionPariatalPeritoneal closurePeritoneal non- closureAdhesionIncisional hernia 134.pdf Dizeraga G.S. Contemporary adhesion prevention. Fertil Steril. 1994;61:219-235.##Monk B.J., Berman N.L., Montz F.J. Adhesion after extensive gynecologic surgery: Clinical significant, etiology and prevention. Am J Obstet Gynecol.1994;170:1396-1403.##Dizerega G.S., Rodger K.E. The peritoneum. New York, Springer-Verlage,1992;pp:11-23.##Raftery A.T.Cellular events in peritoneal repair, a review in pelvic surgery adhesion formation and prevention. New York: Sparinger-Verlag,1997;pp:3-10.##Gutmann J.N., Diamond M.P. Principles of laparoscopic microsurgery and adhesion prevention practical manual of operative laparoscopy and hysteroscopy. New York, Springer-Verlag,1992;pp:55-64.##Mowafi D.M.E., Diamond M.P. Gynecologic surgery and subsequent bowel.Obstet Res.2003;1-14.##Macdonald M.N. Adhesion formation and prevention after peritoneal injury and repair in the rabbit. J Reprod Med.1998;33:436-439.##Milewczyk M. Experimental studies on the development of peritoneal adhesions cases of suturing and non-suturing of the peritoneum in rabbits. Ginekol pol.1989;609:1-6.##Ling F.W., Stoval T.G., Mayer N.L. and et al. Adhesion formation associated with use a absorbable staples in comparision to other typers of peritoneal injury. Int J Gynecol Obstet.1989; 30:361-6.##Elkins T.E., Stovall T.G., Waren J.Ling F.W., Meyer N.L. A historical evaluation of peritoneal repair. Implication for adhesion formation. Obstet Gynecol.1987;70:225-8.##Liebman S.M., Langer J.C., Marshall J., Collins S. Role of mast cells in peritoneal adhesion formation. Am J.1993;105:127-9.##Szigetvari I., Feinman M., Barad D., and et al. Association of perivious abdominal surgery and significant ashesion in laparacopic sterilization patients. J Reprod Med.1989;34:456-466.##Tulandi T., Hum H.S., Gelf M.M. Closure of laparatomy incisions with or without peritoneal suturing and second look laparascopy. Am J Obstet Gynecol.1988;158:536-7.##Gunningham F.G., Gant N.F., Leveno K.J., Gilistrap L.C., H auth J.C., wenstrom K.D. William,s Obstetircs. 21st Edition, 2001;pp:551.##Campbell M.J., Machin D. Medical statistics a common sense approach. 2nd Edition.1995;pp:156.##Berek J.S. Novak’s Gynecology. 13th Edition, 2002;pp:45.##Scott J.R., Gibbs R.S., Karlan B.Y., Haney A.F. Danfurth’s Obstetrics and Gynecology.9th Edition, 2003; pp:43:758.##Donnez J., Nissolle M. An atlas of operative laparoscopy and hysteroscopy. 2th Edition, 2001; pp:148-9.##Stenchever M., Droegmueller W., Herberst AL., Mishell D.R. Comperhensive Gynecology. 4th Edition,2001;pp:1198.##Stricke B., Binco J. and Fox H.E. the gynecologic contribution to intestinal obstraction in females. J Am Coil Surg.1994,178,pp:617-6,20.##Kadanali S., Erten O., Kuckozkant T. Pelvic and periaortic peritoneal closure or nonclosure at lymphadencetomy in ovrian cancer. Eur J Surg Oncol.1996;22(3):282-85.##Bivins J.H.A., Callup D.G. Cesarean section closure techniques which work is best. Obstet Gynecol Management. 2000;(4):98.##Woyton J., Florjanski J., Zimmer M. Nonclosure of the viceral peritoneum during cesarean section. Ginekol Pol.2000;71(10):1245-50.##Nather A., Zeisler H., Sam C.E. Husslein P., Joura E.A. Non-closure of peritoneum at cesarean section.Wienklinwochenschr.2001;113(11-12): 451-453.##Tulandi T., Al Janroudi D. Nonclosure of prentoneum: A reappraisal. Am J Obstet Gynecol. 2003;189(2):609-12.##

تاثير دو نوبت تلقيح داخل رحمي اسپرم(IUI) بر ميزان حاملگي در سيكل‌هاي تحريك تخمك‌گذاري با كلوميفن سيترات Effect of double IUI on pregnancy rate in Superovulated cycles with clomiphene citrate 2 1 ناباروري با شيوع حدود 15-10% يكي از مشكلات اساسي جوامع بوده كه گاهي حتي تداوم زندگي مشترك را تهديدمي‌كند. تلقيح داخل رحمي اسپرم(IUI) به‌طور شايع در درمان زوجهاي نابارور با علل مختلف به كارمي‌رود. اختلاف در ميزان حاملگي به‌دنبال دوبار تلقيح داخل رحمي نسبت به يك‌بار گزارش شده‌است. در مطالعه حاضر تاثير انجام دوبار IUI، يكي‌ قبل از تخمك‌گذاري و ديگري پس‌از انجام تخمك‌گذاري با گروه داراي فقط يك‌بار IUI در سيكل‌هاي كلوميفن سيترات مورد مقايسه قرارگرفت. اين تحقيق يك مطالعه كنترل‌شدة تصادفي و آينده‌نگر بود كه درآن 200 زن نابارور با فاكتور مردانة خفيف ويا بدون فاكتور مردانه و داراي ساير علل ناباروري، به عنوان كانديد IUI انتخاب شدند و با تجويز mg100كلوميفن به‌مدت 5 روز و تزريقIU000/10 هورمون HCG تحريك تخمك‌گذاري شدند. بيماران درروز تزريق HCG به‌طور تصادفي به دو گروه تقسيم‌شدند، در گروه اول، IUI، 36 ساعت پس‌از تزريق HCG ودر گروه دوم، IUI دو نوبتي 18 و42 ساعت پس‌از تزريق HCG انجام و ميزان حاملگي باليني در هر سيكل در دو گروه مقايسه‌گرديد. مشخصات فردي بيماران در دو گروه مشابه‌بود. ميزان حاملگي در گروه يك نوبتي 14% و در گروه دو نوبتي 13% بود؛ بنابراين اختلاف معني‌داري بين دو گروه ازنظر ميزان حاملگي در سيكل‌هاي تحريك‌شده تخمداني با كلوميفن سيترات وجودنداشت. يافته‌هاي اين مطالعه نتوانست فايده دوبارIUI را نسبت‌به يك‌بار در سيكل‌هاي كلوميفن/HCG نشان دهد. با توجه به نتايج حاصله توصيه‌مي‌شود در مطالعات بعدي در بيماران كانديد IUI به خصوص در تحريك تخمك‌گذاري با HMG/HCG و نيز در افراد نابارور با فاكتور مردانه، IUI دو‌نوبتي انجام و نتايج آن با IUI يك نوبتي مقايسه‌شود تا در صورت مناسب‌بودن، جهت افزايش موفقيت درمان ناباروري مورد استفاده قرارگيرد. 2 Infertility with an incidence of about 10-15% is one of the community burdens that even threatens the continuity of the family life. Intrauterine insemination (IUI) is frequently used in the treatment of infertile couples with various causes of infertility. The difference in pregnancy rates following a double IUI versus a single IUI has been reported. In this study we compared the effectiveness of double IUI before and after ovulation with a single IUI in superovulated cycles with clomiphene citrate. This was a prospective randomized controlled trial study. Our study was carried on 200 women with mild male factor or without male factor infertility, and other female factor as a IUI candidate. They were stimulated with clomiphene 100 mg for 5 days plus HCG 10000 IU. On the day of HCG administration, patients were randomly divided into one of two groups; in group I, IUI was performed 36 hours after HCG injection and in group II, Double IUI was performed 18 and 42 hours after the HCG injection. Clinical pregnancy rates in both groups were compared per cycle. The demographic data for two groups were similar. Pregnancy rate of the first group was 14% versus 13% for the second group, so there was no statistical significance difference between two groups (double and single IUI) for the pregnancy rates in super ovulation cycles with clomiphene citrate. (P=0.834) The result of this study did not show a benefit for double IUI over single IUI in clomiphene citrate/ HCG cycles. Regarding our Findings for future research in IUI candidate couple, using double IUI and comparing it with single IUI especially with HMG/HCG superovulation protocol and also infertile couple with male factor is suggested. 314 322 Nayereh N Khadem نیره خادم Department of Obstet . and Gynecol Imam Reza Hospital, Faculty of Medicine, Mashhad Medical Sciences University Department of Obstet . and Gynecol Imam Reza Hospital, Faculty of Medicine, Mashhad Medical Sciences University Iran Zhinous Z Rafie Zadeh ژینوس رفیع‌زاده Department of Obstet . and Gynecol Imam Reza Hospital, Faculty of Medicine, Mashhad Medical Sciences University Department of Obstet . and Gynecol Imam Reza Hospital, Faculty of Medicine, Mashhad Medical Sciences University Iran Intrauterin inseminationSingle IUIDouble IUIClomiphene citratePregnancy rateInfertility 135.pdf Berek J.S. Infertility. In: Yao M., Schust D.(Editors). Novak’s Gynecology. 13th Edition. Williams & Wilkins Company,2002;pp:973-1046.##Ajossa S., Mellis G.B., Cianci A., et al. An open multicenter study to compare the efficacy of intraperitoneal insemination and intrauterine insemination following multiple follicular development at treatment for unexplained infertility. J Assist Reprod Genet.1997;14##Ryan K.J., Berkowitz R.S., Barbiere R.L., Dunai F.A. Infertility. In: Mitchell S., Barbiere R.L (Editors). Kistner’s Gynecology Principles and practice, 7th Edition, Mosby Yearbook, 1999;pp:325-365.##Keye W.R., Chang R.J., Rebar R.W., Semen analysis, sperm processing IVF, Techniques in ART.W.B. Saunders Company.1995;pp:788-789.##Ferraro F., Costa M., Ferraiolo A., et al. Intrauterine insemination with husband,s semen as alternative to other assisted reproduction techniques. Acta Eur Fertile.1995;pp;26(2):63-7.##Duran H.E., Morshedi M., Kruger T., Ochinger S. Intrautrine Insemination: A systematic review on determinats of success. Hum Reprod update. 2002;8(4):373-6.##Cressman B.E., Pace Owens S., Pliego J.F., et al. Effect of sperm dose on pregnancy rate from Intrauterine Insemination: a retrospective analysis. Tex Med.1996;92(12):74-9.##Gregoriou O., Vitoratos N., Papadias C., et al. Pregnancy rates in gonodotrophin stimulated cycles with timed intercourse of intrauterine insemination for the treatment of male subfertility. Eur J Obstet Gynecol Reprod Biol. 1996;64(2):213-6.##Tomlinson M.J., Amissah J., Thompson K., et al. Prognostic Indicators for Intrauterine insemination (IUI): Statistical model for IUI success. Hum Reprod.1996;11(9):1982-6.##Tur R., Buxaderas C., Martinez F., et al. Comparison of the role of cervical and Intrauterine Insemination techniques on the incidence of multiple pregnancy after artificial insemination with donor sperm. J Assist Reprod Genet.1997;14(5):250-3.##Nuojua H. S., Tuomivaara L., Juntunen K., et al. Comparison of fallopian tube sperm perfusion with intrauterine insemination in the treatment of infertility. Fertil Steril.1997;67(5):939-42.##Goldfarb J.M., Peskin B., Austin C., et al. Evaluation of predictive factors for multiple pregnancies during gonadotropin / IUI treatment. J Assist Reprod Genet.1997;14(2):88-91.##Chung C.C., Fleming R., Jamieson M.E., et al. Randomized comparison of ovulation induction with and without intrauterine insemination in the treatment of unexplained infertility. Hum Reprod.1995;10(12):3139-41.##Arcaini L., Bianchi S., Baglioni A., et al. Superovulation and intrauterine insemination VS. superovulation alone in the treatment of unexplained infertility.A randomized study. J Reprod Med.1996; 41(8):614-8.##Kutteh W.H., Byrd W., Blankenship L., et al. Cervical mucus antisperm antibodies: treatment with intrauterine insemination. Am J Reprod Immunol.1996;35(4):429-33.##Keel B.A., May J.V. Assisted Reproduction Laboratory. 1th Edition. CRC press LLC USA,2000;pp:124 -153.##Quilligan E. J., Zuspan P.F. Male infertility Intrauterine Insemination. In: pasquale partrizio (Editors). Current therapy In obstetrics and Gynecology, 5th Edition. W.B. Saunders Company, 2000;pp:107.##Speroff L., Glass R.H., Kase N.G. Infertility in women, male infertility, induction ovulation. Robert H. Glass R H. In: Clinical Gynecologic Endocrinology and Infertility. 6th Edition, Baltimore, lippincott, Williams & Wilkins, 1999;pp:1090.##Silverberg K.M., Johnson J.V., Olive D.L., Burns W.N., Schenken R.S.A prospective randomized trial comparing two different Intrauterine Insemination regimens in controlled ovarian hyperstimulation cycles. Fertil Steril. 1992;57(2):357-61.##Ragni G., Maggioni P., Guermandi E., et al. Efficacy of double Intrauterine Insemination in controlled ovarian hyperstimulation cycles. Fertil Steril.1999;72(4):619-622.##Ranson M. X., Blotner M.B., Bohrer M., Corsan G., Kemmann E. Does increasing frequeny of Intrauterine Insemination improve pregnancy rates significantly during superovulation cycles. Fertil Stril.1994;61:303-307.##Zeyneloglu H.B., Bagis T., Lembet A., et al. Double IUI in clomiphene citrate cycles do not provide any advantage over single IUI: A randomized controlled trial. Fertil Steril. 2002;78(3):Suppl.1:S55.##Cantineau A.E., Heineman M.J., Cohlen B.J. Single versus double IUI in stimulated cycles for subfertile couples. Cochrane Database Syst Rev. 2003;1:CD003854.##Nardo F., Aosta S., Bonanno A. Results of multiple follicular growth with CC Pure FSH HCG, and IUI with washed semen. Minerva Gynecol.1994;46(s):235-41.##Matthews C.D., Broom T.J., Crawshaw K.M., Hopkins R.E., Kerin J.F., and Svigos J.M. The influence of insemination timing and semen characteristics on the efficiency of a donor insemination program. Fertil Steril.1979;31:45-47.##Centola G.M., Herko R., Andolina E., Weisensel S. Comparison of sperm separation methods: effect on recovery, motility, motion parameters and hyperactivation. Fertil Steril. 1998;70:1173-1175.##Khalifa Y., Redgment C.J., Tsirigotis M., Grudzinskas J.G., Craft I.L. The value of single versus repeated Insemination in Intra-uterine donor insemination cycles. Hum Reprod. 1995;10:153-154.##Lincoln S.R., Long C.A., Cowan B.D. One artificial insemination per cycle with donor sperm is as efficacious as two insemination. J Assist Reprod Genet.1995;12:67-69.##Matilsky M.,Geslevich Y.,Ben Ami M., et al. Two day IUI treatment cycles are more successful than one – day IUI cycles when using frozen – thawed donor sperm. J Androl.1998;19(5):603-607.##

ميزان سقط و عوارض مادري- جنيني در بيماران قلبي داراي دريچة‌ مصنوعي تحت درمان با وارفارين Frequency of abortion and fetal- maternal complications in pregnant women with prosthetic heart valves on warfarin therapy 2 1 وجود دريچة مصنوعي قلب در بيماران، موجب عوارض ترومبوآمبولي مي‌شود كه براي كاهش اين موارد بايد داروهاي ضد انعقاد را در سراسر زندگی خود مصرف کنند. در بيماران حامله كه دريچه مصنوعي مكانيكي دارند علاوه بر عوارض ترومبوآمبولي، داروهاي ضد انعقادي باعث عوارضي مانند ناهنجاري جنيني، سقط، سكته مغزي و گرفتگي دريچه مصنوعي در مادران مي‌شود؛ كه عمدتاً به دنبال اين عوارض ميزان مرگ و مير افزايش مي‌يابد. به منظور تعيين نتايج حاملگي در بيماران داراي دريچة مصنوعي مكانيكي در بيمارستان قلب شهيد رجايي مطالعة حاضر انجام گرفت. این مطالعه برروي 80 زن كه بين 45ـ12 سال سن داشتند و بين سال‌هاي 1377ـ1357 در بيمارستان قلب شهيد رجايي تحت عمل جراحي تعويض دريچه قلبي قرار گرفته بودند، انجام شد. در اين بیماران كه در تمام مدت حاملگي خود وارفارين مصرف كرده بودند 144 مورد حاملگي و از اين ميان 18 مورد سقط اختياري رخ داده بود. 7/58% زنان تحت عمل تعويض دريچه ميترال،‌ 3/16% تحت تعويض دريچه آئورت و 25% تحت تعويض دريچه آئورت و ميترال قرار گرفته بودند. بطور كلي 68/89%حاملگي‌ها عارضه‌اي براي مادر نداشت و56/5% حاملگي‌ها منجر به عوارضي مانند سكته مغزي، فشار خون، ادم، تنگي نفس و گرفتگي دريچة منجر به عمل مجدد و در76/4% منجر به مرگ مادر شده بود. در‌مجموع حاملگي‌ها منجر به09/38% تولد نوزاد سالم،‌50% سقط، 18/3% نوزاد ناهنجار و 73/8% منجر به مرده‌زائي و مرگ نوزاد به‌دنبال زايمان زودرس و مرگ مادردر حین حاملگی شده‌بود. براساس نتايج حاصل از اين مطالعه احتمال داده مي‌شود كه عوارض مادري- جنيني حاملگي در بيماران قلبي داراي دريچة مصنوعي قلب تحت درمان با داروهاي ضدانعقاد به نسبت جامعة معمول بيشتر ‌باشد كه جهت مشخص شدن اين موضوع لازم است بررسي‌هاي كاملتر و بيشتري در طولاني مدت انجام شود. در مجموع بيشترين ميزان از دست‌دادن محصول حاملگي در بيماران با دريچه مصنوعي قلب در ارتباط با مصرف وارفارين در زمان بارداري مي‌باشد ولي در مواردي كه ميزان مصرفي وارفارين كمتر از mg5 در روز است تبديل آن به هپارين جايز نمي‌باشد؛ زيرا وارفارين با دوز كم، خطر كمتري براي مادر و جنين دارد. 2 There is a risk of thromboembolic complications in patients with prosthetic heart valves, to reduce this risk, anticoagulant drugs should be used. Besides thromboembolic events in pregnant women with prosthetic heart valves, anticoagulants may cause embryopathy, abortion, C.V.A. and valve thrombosis in mothers with generally high mortality. So, this study was performed to determine the pregnancy outcome in patients with prosthetic heart valves in Shahid Rajaee Heart Hospital. Eighty women aged 12-45 years old who underwent heart valve replacement at this hospital between 1978 and 1998 were included in this study. In these patients who had warfarin therapy during the whole period of pregnancy, 144 pregnancy and 18 elective abortion was occurred. Mitral Valve Replacement (MVR) was performed in 58.7%, Aortic Valve Replacement (AVR) in 16.3% and MVR plus AVR in 25%.Generally, 89.68% of the pregnancies were without any complications for mothers, but 5.56% of them had complications such as C.V.A., hypertention, edema, dyspnea and prosthetic valve malfunction. Mother death occurred in 4.76% of them. There were 38.09% normal birth with healthy baby, 50% abortion, 3.18% congenital deformities and 8.73% infant death following premature delivery, still birth and maternal death during pregnancy. Our findings showed that fetal and maternal complications in women with prosthetic heart valve using anticoagulant drugs were more common in comparison with the normal population and suggests the more clear and complete assesments in this respect. Although most pregnancy losses in women with prosthetic valve were due to warfarin use, in cases the dose of warfarin is less than 5mg/day, shifting to heparin is not recommended because a low dose of warfarin has low maternal and fetal risks. 322 328 Mohammad Bagher MB Tabatabaei محمدباقر طباطبایی Department of Cardiovascular Surgery, Shahid Rajaee Hospital, Faculty of Medicine, Iran University Department of Cardiovascular Surgery, Shahid Rajaee Hospital, Faculty of Medicine, Iran University Iran mbtaba@rhc.ac.ir Fahimeh F Kashfi فهیمه کشفی Shahid Rajaee Hospital Shahid Rajaee Hospital Iran Amir Jamshid AJ Khamoshi امیرجمشید خاموشی Department of Cardiovascular Surgery, Shahid Rajaee Hospital, Faculty of Medicine, Iran University Department of Cardiovascular Surgery, Shahid Rajaee Hospital, Faculty of Medicine, Iran University Iran Saeed S Hosseini سعید حسینی Department of Cardiovascular Surgery, Shahid Rajaee Hospital, Faculty of Medicine, Iran University Department of Cardiovascular Surgery, Shahid Rajaee Hospital, Faculty of Medicine, Iran University Iran Majid M Maleki ‌مجید ملکی Department of Cardiology, Shahid Rajaee Hospital, Faculty of Medicine, Iran University of Medical Sciences Department of Cardiology, Shahid Rajaee Hospital, Faculty of Medicine, Iran University of Medical Sciences Iran Fereydoun F Noohi فریدون نوحی Department of Cardiology, Shahid Rajaee Hospital, Faculty of Medicine, Iran University of Medical Sciences Department of Cardiology, Shahid Rajaee Hospital, Faculty of Medicine, Iran University of Medical Sciences Iran PregnancyMechanical heart valveAbortionMaternal complicationsFetal complications 136.pdf Roodpeyma S.H. Rheumatic fever in Iranian children.Med J I.R.I.1995;9(3):179-182.##Bloomfield P. Choice of heart valve prosthesis. Heart.2002;87:583-589.##Cunningham F., Macdonald P., Gant N., et al. Williams Obstetrics. 20th Edition, Prentice Hall. 1997;pp:1088-1092.##Braunwald E. Heart disease, a textbook of Cardiovascular Medicine. Vol(1), 6 th Edition, W.B. Saunders, U.S.A. 2001;pp:2172-2186.##Hanania G. Management of anticoagulations during pregnancy.Heart.2001;86:125-126.##Bonow R.O., Curobelo B., Deleon A.C., et al. ACC/AHA Guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol.1998;32:1486-1588.##Elkayam U. Pregnancy through a prosthetic heart valve. J Am Coll Cardiol.1999;33:1642-1645.##Hanania G., Thomas D., Michel P.L., et al. Grossesses chez les porteuses de prostheses valvulaires: etude cooperative retrospective francaise (155 case). Arch Mal Coeur.1994; 87:429-437.##Hung L., Rahimtoola., ShH. Prosthetic heart valves and pregnancy. Circulation.2003;107:1240.##Sbarouni E., Oakley C.M. Outcome of pregnancy in women with valve prostheses. Br Heart J.1994;71:196-201.##Elkayam U., Khan S.S. Pregnancy in the patient with artificial heart valve. Cardiac problems in pregnancy. 3 th Edition, New York, Wiley-Liss, 1998;pp:61-78.##Vitale N., Defeo M., De Santo L.S., et al. Dose–dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J AM Coll Cardiol.1999;33:1637-1641.##Hall J.G., Pauli R.M., Wilson K.M. Maternal and fetal sequelae and anticoagulation during pregnancy. Am J Med.1980;68:122-140.##Lee L.H., Liavw P.C.Y., Ng A.S.H. LMWH for thromboprophylaxis during pregnancy in two patients with mechanical heart valve replacement. Thromb Haemost.1996;76:627-31.##AL-Lawati A.M., Venkitraman M., AL–Delaime T., et al. Pregnancy and mechanical heart valves replacement: dilemma of anti coagulation. Eur J Cardiothorac Surg.2002; 22:223-227.##Sadler L., Mccowan L., White H., et al. Pregnancy outcomes and cardiac complications in women with mechanical, bioprostetic and homograft valves. BJOG.2000;10(2):245-253.##Vitale N., Defeo M., Cotrufo M.Anticoagulation for prosthetic heart valves during pregnancy:The importance of warfarin daily dose. Eur J Cardio Thorac Surg 2002;22:656-657.##

شيوع پيکا در زنان باردار مراجعه‌کننده به مراکز بهداشتي، درماني شهر زاهدان در سال 1381 The prevalence of pica in pregnant women referring to health centers in Zahedan, 2003 2 1 برخي از زنان باردار انواعي از مواد غيرغذايي مانند خاک، خاک‌رس، رنگ، گچ و يخ مي‌خورند. مصرف اين‌گونه مواد غيرطبيعي که ارزش تغذيه‌ای ندارند پيکا ناميده مي‌شود. پيکا اکثراً در زنان باردار و شيرده، کودکان، افراد عقب ماندة ذهني و نيز افراد دارای مشکلات روحي- رواني ديده مي‌شود. پيکا يک اختلال جدی خوردن محسوب مي‌شود که در بعضي موارد منجر به مشکلات جدی و خطرناکي مانند مسموميت با مواد شيميايي و فلزات سنگين مانند سرب، انسداد روده، آنمي فقرآهن و. . . مي‌گردد. طي يك مطالعة مقطعي(توصيفي - تحليلي) با روش نمونه‌گيري چند مرحله‌اي 560 زن باردار كه در فاصلة ارديبهشت لغايت مرداد ماه 1381به مراکز ‌بهداشتي‌، درماني شهر زاهدان مراجعه كرده‌بوند، از نظر شيوع پيكا مورد بررسي قرار‌گرفتند. اطلاعات بوسيلة پرسشنامه‌اي مشتمل بر سئوالاتي در مورد عادت پيكا، سطح تحصيلات، شغل، درآمد خانوار، تعداد فرزندان، رتبه بارداري، سن بارداري، نوع مادة غير غذايي مصرفي و وجود عادت پيكا در مادر يا اطرافيان فرد باردار، طي مدت چهار ماه جمع‌آوري شد و پس از آن با استفاده از آزمون 2 و نرم‌افزارSPSS مورد تجزيه و تحليل قرار گرفت. شيوع پيکا بين زنان باردار مورد بررسي 5/15% بود که از اين بين3/25% آنها خاک، 9/60% يخ، و بقيه نيز موادي مانند گچ، مهر و تسبيح، برفك يخچال، تفالة چاي و ديگر مواد غيرغذايي مصرف مي‌كردند. از آنجايي‌که پيکا محدود به فرهنگ، نژاد، جنس و طبقة اجتماعي - اقتصادی خاصي نمي‌گردد و نيز با توجه به مشکلات جدي و خطرناکي كه ممکن است پيكا در فرد ايجادکند، ارائة برنامه‌های آموزشي مناسب به زنان باردار و نيز افزايش آگاهي‌های عمومی ضروری بنظر مي‌رسد. 2 Some pregnant women cravings for non-food substances with no nutritional value which is called pica such as dirt, clay, paint chips, chalk, ice, etc. Most frequently, pica occurs in children, persons with mental retardation and women during their pregnancies or while they are breast-feeding. Pica is considered to be a serious eating disorder, sometimes resulting in serious health problems such as lead poisoning, bowel blockage, and iron deficiency anemia. In a cross-sectional survey (with randomized multi stage sampling) the prevalence of pica was studied in 560 pregnant women who referred to health centers in Zahedan. Using a structured questionnaire, over a four-month period information were obtained from all mothers. The prevalence of pica among the subjects was 15.5%, in which 25.3% of them ate dirt, 60.9% ice, and others substances such as chalk, rosary praying clay, freezer frost, tea stuff and other non-food substances. Considering that pica is not limited to any culture, race, sex or socioeconomic background and also can result in dangerous and serious health problems, therefore needs to raise public awareness of the adverse effects of this practice is suggested. 328 335 Zinat Z Mortazavi زینت مرتضوی Public Health Department, Faculty of Health, Zahedan Medical Sciences University Public Health Department, Faculty of Health, Zahedan Medical Sciences University Iran zimoiran@yahoo.com Mehdi M Mohammadi مهدی محمدی Department of Epidemiology & Statistics , Faculty of Health, Zahedan Medical Sciences University Department of Epidemiology & Statistics , Faculty of Health, Zahedan Medical Sciences University Iran PicaWomenPregnancyPrevalencenon-food substabcesComplicationsEating disorder 137.pdf کارین هاگدن رابینسون، ترجمه ناهید خلدی. اصول تغذیه رابینسون. چاپ اول، تهران، نشر سالمی سال 1378، صفحه: 201-197.##فروزانی مینو. تغذیه در دوران بارداری، شیردهی، شیرخواری و کودکی. چاپ سوم، انتشارات چهر1374، صفحات 18،65-64.##Thomas B. Manual of Dietetic Practice. Blackwell scientific publications,1988.,pp:252.##Walker A.R.P., Walker B.F., Sookaria F.I., Cannan R.J. Pica. J Roy Soc Health.1997;117 (5):280-84.##Woywodt A., Kiss A. Perforation of the sigmoid colon due to geophagia. Arch surg. 1999;134:88-89.##Rose E.A. Pica: common but commonly missed. J Am Board Fam Pract.2000;13: 353-8.##Cynthia R.E. Eating disorder: Pica. eMed J. 2003;3(1):1-12.##Smulian J.C., Motiwala S., Sigman R.K. Pica in a rural obstetric population. South Med J.1995;88 (12)1236-40.##Horner R.D., Lackey C.J., Kolasa L., Warren K. Pica practices of pregnant women. J Am Diet Assoc.1991;91(1):34-8.##Morales L., Hayes-Bautista D. Pica may be harmful to the fetus and mother. West J Med 2000;173:25.##Rainville A.J. Pica practices of pregnant women are associated with lower maternal hemoglobin level at delivery. Am J Diet Assoc. 1998;98(3):293-6.##Geissler P.W., Shulman C.E., Prince R.J., Mutemi W., Mzani C., Friis H., Lowe B. Geophagy, iron status and anaemia among pregnant women on the coast of Kenya. Trans R R Soc Trop Med Hyg.1998;92(5):549-53.##Edwards C.H., Johnson A.A., Knight E.M., Oyemade U.J., Cole O.J., and et al. Pica in an urban environment. J Nutr. 1994;124(6 suppl): 954S-62S.##Hamilton S., Rothenberg S.J., Khan F.A., Manalo M., Norris K.C. Neonatal lead poisoning from maternal pica behavior during pregnancy. J Natl Med Assoc.2001;93(9):317-19.##Sayetta R.B. Pica: an overview. Am Fam Physician.1986;33(5):181-5.##Melville B., Francis V. Dieting habits and superstition of Jamaican women during pregnancy. Eur J Clin Nutr.1992;373-4.##Sule S., Madugu H.N. Pica in pregnant women in Zaria, Nigeria.Niger J Med.2001;10(1):25-7.##Simpson E., Mull J.D., Longley E., East J. Pica during pregnancy in low-income women born in Mexico. West J Med.2000;173 (1):20-4.##al-Kanhal M.A., Bani I.A. Food habits during pregnancy among Saudi women. Int J Vitam Nutr Res.1995;65(3):206-10.##