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اثرات انجماد شيشه‌اي بر ميزان آپوپتوز در بلاستوسيست موش Effect of vitrification on apoptosis in mouse blastocysts 2 1 مقدمه: در سال‌های اخير، پيشرفت‌های زيادی در انجماد شيشه‌اي (Vitrification) برای نگهداری جنين صورت گرفته است؛ ولي تاکنون، روش قابل اعتمادي در انجماد شيشه‌اي که بتواند ميزان بالايي از زنده ماندن جنين را نشان دهد، ارائه نشده است. زيرا مکانيسم آسيب‌هاي جنين به‌دنبال انجماد شيشه‌اي به طور دقيق مشخص نشده است. مطالعة حاضر به منظور بررسي تاثير انجماد شيشه‌اي بر روي ميزان آپوپتوز در جنين در مرحله بلاستوسيست صورت گرفته است. مواد و روشها: بدين منظور 95 عدد بلاستوسيست موش از نژاد Swiss Albino به طريق فلاش کردن شاخ رحم به دست آمد و به طور تصادفي به دو گروه تجربي(43) و کنترل(52) تقسيم شدند. در گروه کنترل بلاستوسيست‌ها پس از دريافت در محيط M16 به مدت دوساعت کشت داده شدند و ايندكس آپوپتوز در آنها پس از نشانه‌گزاري با تكنيك TUNEL و رنگ‌آميزي زمينه‌اي با PI مشخص شد. در گروه تجربي بلاستوسيست‌ها پس از دريافت بلافاصله به طريق انجماد شيشه‌اي با محلول EFS40 منجمد شدند و در تانک حاوي نيتروژن مايع به مدت يک ماه نگهداري شدند پس از طي مدت مذكور ني‌هاي حاوي بلاستوسيستها ذوب گرديدند و پس از 2 ساعت كشت در محيط M16 ميزان ايندکس آپوپتوز در اين گروه پس از رنگ آميزي با تکنيک TUNEL مشخص گرديد. نتايج: مقايسه نتايج نشان داد که ميانگين تعداد بلاستومرها در بلاستوسيست‌های گروه منجمد شده موش(47/2±91/44) نسبت به گروه کنترل (9/2±23/50)، اختلاف معنی‌داری ندارد(176/0P= ). در حاليكه ميانگين تعداد بلاستومرهاي آپوپتوتيك در بلاستوسيت‌هاي گروه منجمد شده موش (28/008/4) نسبت به گره كنترل (22/093/4) اختلاف معني‌داري را نشان داد(02/0=P) و ميانگين ميزان ايندكس آپوپتوز بر حسب درصد در گروه فريز شده (63/087/11) به طور معني‌داري نسبت به گروه كنترل (67/012/9) بيشتر بود(004/0=P). نتيجه‌گيري: اين مطالعه نشان داد که انجماد شيشه‌اي باعث افزايش ميزان آپوپتوز در بلاستومرهای بلاستوسيست موش می‌شود. 2 Introduction: In recent years there have been a great advances in vitrification of embryos. However, there is no reliable vitrification protocol to ensure a high embryo survival rate, Because the mechanisms of embryo injury has not been discovered precisely. The aim of the present study was to determine the effects of vitrification on apoptosis in mouse blastocysts. Materials and Methods: Ninety five mouse blastocysts were obtained by flushing from Swiss Albino mouse and randomly divided into control and experimental groups. Blastocysts in the control group (52) were cultured in M16 media for 2 hours and then the apoptotic index were obtained after staining by TUNEL technique with PI. Blastocysts in the experimental group (43) were vitrified just after flushing in EFS40 solution and kept in LN2 for one month. After thawing and culture in M16 for 2 hours, the apoptotic indices were obtained by TUNEL staining. Results: The results showed that the mean number of blastomers in the vitrified blastocysts group (44.912.47) was not significantly different (P=0.176) from those that seen in the control group (50.232.9), while the mean number of apoptotic blastomers in vitrified blastocysts group (4.080.28) was significantly higher (P=0.02) as compared to the control group (4.930.22). The mean apoptosis Index in vitrified blastocysts (11.870.63) was significantly higher (P<0.004) than the control group (9.120.67). Conclusion: we can conclude that the vitrification can increase apoptotic cell death in mouse blastocysts. 14 23 Farzad F Rajaei فرزاد رجایی Department of Anatomy Sciences, Faculty of Medicine, Ghazvin University of Medical Sciences Department of Anatomy Sciences, Faculty of Medicine, Ghazvin University of Medical Sciences Iran farzadraj@yahoo.co.uk Jafar J Soleimanirad جعفر سلیمانی راد Anatomy Department, Faculty of Medicine, Tabriz Medical Sciences University Anatomy Department, Faculty of Medicine, Tabriz Medical Sciences University Iran Behrooz B Niknafs Laboratory of Histology &amp; Cellular Biology, Drug Applied Research Center, Tabriz University of Medical Sciences Laboratory of Histology & Cellular Biology, Drug Applied Research Center, Tabriz University of Medical Sciences Iran Maerefat M Ghaffari معرفت غفاری نوین Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Abdorasoul A Safaeian عبدالرسول صفائیان Department of Statistic &amp; Epidemiology Faculty of Health &amp; Nutrition, Tabriz University of Medical Sciences Department of Statistic & Epidemiology Faculty of Health & Nutrition, Tabriz University of Medical Sciences Iran VitrificationApoptosisMouse blastocystTUNEL 139.pdf Kasai M. Cryopreservation of mammalian embryos. Mol Biotechnol.1997;7(2):173-9.##Dobrinsky J.R., Pursel V.G., Long C.R., Johnson L.A. Birth of piglets after transfer of embryos cryopreserved by cytoskeletal stabili- zation and vitrification. Biol Reprod.2000;62(3): 564-70.##Kasai M., Ito K., Edashige K. Morphological appearance of the cryopreserved mouse blastocyst as a tool to identify the type of cryoinjury. Hum Reprod.2002;17(7):1863-74.##Kasai M., Zhu S.E., Pedro P.B., Nakamura K., Sakurai T., Edashige K. Fracture damage of embryos and its prevention during vitrification and warming. Cryobiology.1996;33(4):459-64.##Whittingham D.G., Leibo S.P., Mazur P. Survival of mouse embryos frozen to–196°C and –269°C. Science.1972;178:411-414.##Rall W.F., Fahy G.M. Ice-free cryopreservation of mouse embryos at-196 degrees C by vitrification. Nature.1985;313(6003):573-5.##Gavrieli Y., Sherman Y., Ben- Sasson S.A. Identification of programmed cell death in situ via specific labeling of nuclear DNA fragmentation.J Cell Biol.1992;119(3):493-501.##Hardy K. Cell death in the mammalian blastocyst. Mol Hum Reprod.1997;3:919– 92.##Gavrieli Y., Sherman Y., Ben-Sasson S.A. Identification of programmed cell death in situ via specific labeling of nuclear DNA fragmentation. J Cell Biol.1992;119(3):493-501.##Yamadori I., Yoshino T., Kondo E., Cao L., Akagi T., Matsuo Y., Minowada J. Comparison of two methods of staining apoptotic cells of transferase and DNA polymerase I reactions. J leukemia cell lines. Terminal deoxynucleotidyl Histochem Cytochem.1998;46(1):85-90.##Neuber E., Luetjens C.M., Chan A.W., Schatten G.P. Analysis of DNA fragmentation of in vitro cultured bovine blastocysts using TUNEL. Theriogenology.2002;57(9):2193-202.##Pampfer S., Vanderheyden I., McCracken J.E., Vesela J., Hertogh R. 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طراحي يك روش الايزا با استفاده از آنتي‌ژن‌هاي سطحي اسپرم جهت اندازه‌گيري آنتي‌بادي ضد اسپرم و مقايسه آن با تست SpermMar Designing an ELISA method using sperm surface antigens for detection of antisperm antibody in comparison with SpermMar test 2 1 مقدمه: تاثير آنتي‌بادي ضداسپرم با ميزان شيوع 26-6% در ايجاد ناباروري به خوبي شناخته شده‌است. لذا اندازه‌گيري آن در سرم و يا مايعات بيولوژيك مردان و زنان از اهميت كلينيكي برخوردار است. امروزه يكي از مهمترين موضوعات مورد بحث در ناباروري ايمونولوژيك، طراحي روشي استاندارد جهت اندازه‌گيري ASA مي‌باشد. مطالعات انجام شده نشان مي‌دهند كه روش الايزا در بين روش‌هاي تشخيص ASA، در صورتي‌كه از آنتي‌ژن‌هاي سطحي اسپرم با حداقل آلودگي به آنتي‌ژن‌هاي غير‌اسپرمي وآنتي‌ژن‌هاي داخلي اسپرم استفاده گردد، روشي بسيار حساس و قابل اعتماد بوده و بهتر از ساير روش‌هاي تشخيص و اندازه‌گيريASA مي‌باشد. بنابراين هدف از مطالعه حاضر طراحي يك روش الايزا با روش قابل قبول استخراج آنتي‌ژن‌هاي سطح اسپرم و با حداقل آلودگي به ساير پروتئين‌‌هاي اسپرم جهت تعيين ميزان ASA مي‌باشد. مواد و روشها: در اين مطالعه، تكنيك الايزاي غيرمستقيم با استفاده از سه روش مختلف استخراج آنتي‌ژن‌هاي سطح اسپرم شامل روش سونيكاسيون، استفاده از دترجنت سديم دودسيل سولفات و نيز استفاده از دترجنت ليتيوم دي‌يدوساليسيلات، طراحي گرديد. در نهايت پس از طراحي روش، الايزاي طراحي شده با آنتي‌ژن حاصل از سه روش مختلف استخراج آنتي‌ژن‌هاي سطح اسپرم، به همراه دو كيت الايزاي تجاري مشابه با تست روتين مراكز درمان ناباروري (SpermMar) مورد مقايسه قرار گرفته است. نتايج: در تجربه عملي از 28 سرم مشكوك به ASA كه توسط تستSpermMar ، 16 مورد جواب مثبت داشتند، به روش الايزاي طراحي شده با آنتي‌ژن‌هاي حاصل از دترجنت LIS، 14 سرم، جواب مثبت حقيقي نشان داد و تنها 2 مورد جواب منفي كاذب وجود داشت و جواب مثبت كاذب نيز مشاهده نگرديد؛ در حاليكه در روش سونيكاسيون فقط 5 مـورد مثبت حقيقي داشت و 11 مورد جواب منفي كاذب نشان ‌داد. روش استفاده از دترجنت SDS نيز 13 مـورد مثبت حقيقي، 3 مورد جواب منفي كاذب و 4 مورد جواب مثبت كاذب نشان داد. به علاوه، دو كيت تجاري به ترتيب 7 و4 مورد جواب مثبت حقيقي نشان داد. در هر دو كيت‌هاي تجاري 1 مورد جواب مثبت كاذب و نيز به ترتيب با 9 و12 مورد جواب منفي كاذب همراه بودند. براساس نتايح حاصل روش الايزا با استفاده از دترجنت LIS، حساسيت(5/87%) مناسبي داشته و از ويژگي و كارآيي بسيار بالايي در مقايسه با ساير روش‌ها برخوردار است (به ترتيب 100% و 8/92%). از طرف ديگر همبستگي معني‌داري نيز بين روش طراحي شده وSpermMar وجود دارد(572/0=r). نتيجه گيري: براساس نتايج اين مطالعه روش الايزاي طراحي شده با استفاده از آنتي‌ژن‌هاي استخراج شده از سطح اسپرم به كمك دترجنت LIS داراي حداقل نتايج كاذب است و بهتر از ساير روش‌هاي استخراج آنتي‌ژن‌هاي سطحي اسپرم و كيت‌هاي مشابه خارجي جهت تشخيص و تعيين ميزان ASA مي‌باشد. 2 Introduction: The role of antisperm antibodies with a prevalence of 6-26% is well known in immunological infertility. Thus, there is clinical importance to determine ASA levels in both male and female. Nowadays, one of the most important discussed controversies in the field of immunological infertility is establishing an standard method to determine ASA. It seems that ELISA method will be more sensitive, specific and more diagnostic in determination of ASA if sperm surface antigens could be used as coated antigens, with least contamination to sperm intracellular antigens and nonspermic antigens. So, the aim of this study is designing an ELISA method by using the best method of sperm antigens extraction with at least contamination. Materials and Methods: In this study we designed an ELISA method with three different extraction methods of sperm antigens including sonication method, using SDS detergent, and application of LIS detergent, then we compared ELISA method based on the three extraction methods as well as two similar commercial ELISA kit (IBL Co, and Bioserv Co) with SpermMar test. Results: Comparing designed method with commercial kit indicated that among 28 sera which had 16 positive sera and 12 negative sera by SpermMar, 14 sera were true positive by LIS method and only 2 cases were false negative without any false positive results, whereas there were 5 true positive results and 11 cases false negative by the sonication method. The SDS method also had 13 true positive results with 3 false negative and 4 false positive results. In addition, two commercial kit had in turn 7 and 4 cases true positive and both of them had 1 case false positive and in turn 9 and 12 cases with false negative result. ELISA method designed by LIS detergent has adequate sensitivity (87.5%) with higher specificity (100%) and efficacy (92.8 %) than other extraction methods. There is a significant correlation between this designed method and SpermMar test (r=0.572). Conclusion: The results of this study indicated that ELISA method by LIS antigens has at least contamination with nonspermic antigens and it is better than other extraction methods and commercial ELISA kits for detection of antisperm antibody. 23 35 Asghar A Talebian اصغر طالبیان Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Amir Hassan AH Zarnani امیرحسن زرنانی Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR) Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR) Iran Mahmood M Jeddi-Tehrani محمود جدی‌تهرانی Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR) Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR) Iran Mohammad Mehdi MM Akhondi محمدمهدی آخوندی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mahmoud M Jalali محمود جلالی 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 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Sadeghi@avicenna.ac.ir InfertilitySpermAntisperm antibodyELISASpermMarLISSperm surface antigens 140.pdf Landsteiner K., Zur kenntnis der spezifisch auf Blutkor-Perchen wirkende sera. 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ارتباط درصد لقاح آزمايشگاهي با سطح سمينال آنتي‌بادي ضد اسپرمي اندازه‌گيري شده به روش فلوسيتومتري Correlation between in vitro fertilization with the level of antisperm antibody in seminal plasma measured by flow cytometry 2 1 مقدمه: آنتی‌بادی ضد اسپرم (ASA) در 12-8% مردان نابارور وجود دارد. در زوج‌هاي نابارور، ناشي از علل ایمونولوژیک در مردان، لقاح آزمایشگاهی (IVF) به عنوان روشي موثر در حصول باروری، پیشنهاد شده است. اگرچه روش IVF برای برطرف نمودن اثر مهاری سطوح بالای ASA بر روی قدرت باروري بکار گرفته می‌شود، ولی میزان لقاح براي نمونه‌هاي داراي ASA تقریباً به ميزان 40% موارد کاهش می‌یابد. در این مطالعه ارتباط بین ASA اندازه گیری شده به‌روش فلوسیتومتری غیرمستقیم و درصد لقاح در زوج‌های نابارور کاندید IVF مورد بررسی قرار گرفت. مواد و روشها: نمونه‌های مايع سمينال از مردان 80 زوج نابارور کاندید لقاح آزمايشگاهي (IVF) مراجعه کننده به مرکز باروری و ناباروری اصفهان دريافت گرديد.زوجها بر اساس درصد لقاح به دو گروه داراي ميزان لقاح بالا و ميزان لقاح پايين تقسيم شدند. 52 زوج ميزان لقاح بالا (>50%) و 28 زوج ميزان لقاح پایین ( 50%) داشتند. نمونه‌های پلاسمای سمينال این افراد با اسپرم متحرك و طبيعي از يك فرد دهندة سالم و فاقد آنتي‌بادي ضد اسپرم انکوبه شدند. سپس آنتی‌بادی متصل به سطح اسپرم با ایمونوگلوبولین نشاندار با FITC علیه IgA و IgG انسانی به روش فلوسیتومتری تعيين گردید. تجزیه و تحلیل‌های آماری با استفاده از آزمون‌های χ² ،T و همبستگی پیرسون انجام گرفت. نتایج: اختلاف میانگین ميزان ASA در گروه‌های با ميزان لقاح بالا و پایین از نظر آماري معنی‌داربود (001/0P<). از نظر آماری ارتباط معکوس معنی‌داری بین ميزان ASA از کلاس IgA و ميزان لقاح مشاهده شد (001/0P<، 47/0r ). از نظر آماری ارتباط معنی‌داری بین سطح ASA از کلاس IgG و ميزان لقاح مشاهده نشد (08/0P=، 2/0r ). نتیجه گیری: نتایج این مطالعه به وضوح نشان می‌دهد که سطح بالای ASA از کلاس IgA ميزان لقاح راکاهش می‌دهد. بنابراین پیشنهاد می گردد که بیماران با سطح بالای ASA از کلاس IgA کاندید ميكرواينجكشن (ICSI)گردند. 2 Introduction: Antisperm antibodies (ASA) are present in %8-21 of infertile men. In vitro Fertilization (IVF) has been recommended as an effective procedure in couples with immunological male factor. Although this procedure has been found to bypass the inhibitory effect of antisperm antibodies on fertilizing ability of spermatozoa but the fertilization rate is reduced about %40 for ASA positive samples. The goal of present study was to investigate the correlation between anti-sperm antibodies measured by indirect flow cytometry and fertilization rate in infertile couples undergoing In vitro Fertilization (IVF). Materials and Methods: Semen samples were collected from 80 infertile men undergoing IVF cycle in Isfahan fertility and infertility center. Couples were classified based on fertilization rate into high and low groups. 52 couples had high (>50%) and 28 couples had low fertilization rate (≤50%). Seminal plasma samples were incubated with normal motile spermatozoa from donor. Sperm bounded antibody was detected with FITC- labeled immunoglubin against human IgA and IgG by flow cytometer. The statistical analysis performed using χ², t-test, and Pearsonُ s correlation. Results: There was significant difference between the mean levels of antisperm antibodies in high and low fertilization rate groups (p<0.001). However there was a significant inverse relationship between IgA antisperm antibody level and fertilization rate (r=-0.47 and p<0.001). Inverse relationship between IgG antisperm antibody level and fertilization rate was not significant (r=-0.2 and p= 0.08). Conclusion: The results of this study clearly show that high level of IgA antisperm antibody decreases the fertilization rate. Therefore, it can be suggested that patients with high level of IgA antisperm antibody should become candidate for intracytoplasmic sperm injection (ICSI). 35 44 Abbas A Rezai عباس رضایی Immunology Department, Faculty of Medicine, Isfahan Medical Sciences University Immunology Department, Faculty of Medicine, Isfahan Medical Sciences University Iran rezaei@mui.ac.ir Mohammad Hossein MH Nasr-Esfahani Embryology Department, Royan Research Center Embryology Department, Royan Research Center Iran Minoo M Adib مینو ادیب Immunology Department, Faculty of Medicine, Isfahan Medical Sciences University Immunology Department, Faculty of Medicine, Isfahan Medical Sciences University Iran Farhad F Shahsavar فرهاد شاهسوار Department of Immunology, Lorestan University of Medical Sciences Department of Immunology, Lorestan University of Medical Sciences Iran Farzad F Oreizi فرزاد عریضی Immunology Department, Faculty of Medicine, Isfahan Medical Sciences University Immunology Department, Faculty of Medicine, Isfahan Medical Sciences University Iran InfertilitySpermSeminal fluidAntisperm antibody<i>In Vitro</i> fertilizationFlow cytometry 141.pdf Bronson R.Detection of antisperm antibodies: an argument against therapeutic nihilism. Hum Reprod.1999;14:1671-3.##Collins J.A., Burrows E.A.,Yeo J. Frequency and predictive value of antisperm antibodies among infertile couples.Hum Reprod.1993;8:592-8.##Gubin D.A., Dmochowski R., Kutteh W.H. Multivariant analysis of men from infertile couples with and without antisperm antibodies. Am J Reprod Immunol.1998;39:157-60.##Munuce M.J., Berta C.L., Pauluzzi F., Caille A.M. Relationship between antisperm antibodies, Sperm movement, and semen quality. Url Int.2000; 65:200-3.##Taneichi A., Shibahara H., Hirano Y., Suzuki T., Obara H., Fujiwara H., Takamiza S., Sato I. Sperm immobilizing antibodies in the sera of infertile women cause low fertilization rates and poor embryo quality in vitro. Am J Reprod Immunol. 2002;47:46-51.##Fann C.H., Lee C.Y.G. Monoclonal antibodies affecting sperm-zona binding and/ or zona-induced acrosom reaction. J Reprod Immunol.1992;21: 175-87.##Hjort T. Antisperm and infertility: an unsolvable question? Hum Reprod.1999;14:2423-6.##Mardesic T., Ulcova- Gallova Z., Huttelova R., Muller P., Voboril J., Mikova M., Hulvert J. The influence of different types of antibodies on in vitro fertilization results. Am J Reprod Immunol.2000; 43:1-5.##Mahmoud A., Comhaire F. Antisperm anti-bodies: use of the Mixed Agglutination Reaction (MAR) test using latex beads. Hum Reprod.2000; 15:231-3.##Haas G.C Jr., Cunningham M.E. Identification of antibody-laden sperm by cytofluorometry. Fertil Steril.1984;42:606-13.##Rasanen M., Hovata O.L., Penttila I.M. Detec-tion and quantitation of sperm-bound antibodies by flow cytometry of human semen. J Androl.1992;13:55-64.##KeR W., Dockter M.E., Majumdar G. Flow-cytometry provides rapid and highly accurate detec-tion of antisperm antibodies. Fertil Steril.1995;63: 902-6.##Lahteenmaki A.In vitro fertilization in the presence of antisperm antibodies detected by the Mixed Antiglobulin Reaction(MAR) and the tray agglutination test(TAT). Hum Reprod.1993;8:84-8.##Rajah S.V., Parslow J.M., Howell R.J., Hendry W.F. The effects on in vitro fertilization of auto-antibodies to spermatozoa in subfertile men. Hum Reprod.1993;8:1079-82.##Nicholson S.C., Robinson J.N., Sargent I.L, Barlow D.H. Detection of antisperm antibodies in seminal plasma by flow cytometry: comparison with the indirect immunobead binding test. Fertil Steril.1997;68:1114-9.##Nikolaeva M.A., Kulakov V.I., Korotkova I.V., Golubeva E.L., Kuyavskaya D.V., Sukhikh G.T. Antisperm antibodies detection by flowcytometry is affected by aggregation of antigen-antibody complex on the surface of spermatozoa. Hum Reprod.2000;15:2545-53.##Rasanen M., Agrawal Y.P., Saarikoski S. Seminal fluid antispirm antibodies measured by direct flow cytometry donot correlate with those measured by indirect flow cytometry,the indirect immunobead test, and the indirect mixed anti-globulin reaction. Fertil Steril.1996;65:170-5.##Vazquez – Levin M.H., Notrica J.A., De Fried E.P. Male immunologic infertility: sperm performance on in vitro fertilization. Fertil Steril. 1997; 68:675-81.##Bohring G., Krause W. Immune infertility: towards a better understanding of sperm (auto)-immunity. Hum Reprod.2003;18:915-24.##Ford W.C.L., Williams K.M., McLaughlin E.A., Harrison S,, Ray B., Hull M.G.R. The indirect immunbead test for seminal antisperm antibodies and fertilization rates at in-vitro fertilization. Hum Reprod.1996;11:1718-22.##Shibahara H., Shiraishi Y., Hirano Y., Suzuki T., Takamizawa S., Suzuki M. Diversity of the inhibitory effects on fertilization by antisperm anti-bodies bound to the surface of ejaculated human sperm.Hum Reprod.2003;18:1469-73.##Shibahara H., Tsunoda T., Taneichi A., Hirano Y., Ohno A., Takamizawa S., Yamaguchi C., Tsunoda H., Sato I . Diversity of antisperm anti-bodies bound to sperm surface in male immuno-logical infertility. Am J Reprod Immunol.2002;47: 146-50.##Zouari R., De Almedia M. Effect of sperm associated antibodies on human sperm ability to bind to zona pellucida and penetrate zona-free hamster oocytes. J Reprod Immunol.1993;24:175-86.##Kremer J., Jager S.The significance of anti-sperm antibodies for sperm-cervical mucus interaction.Hum Reprod.1992;7:781-4.##Bronson R.A., Cooper G.W., Rosenfeld D.L. Seminal fluid antisperm antibodies do not reflect those present on the sperm surface. Fertil.1987; 48:505-6.##

مقايسه تجويز پروژسترون قبل و بعد از انتقال جنين در سيكل‌هاي ART Comparison of progesterone administration before and after embryo transfer in ART cycles 2 1 مقدمه: امروزه استفاده از آگونيست‌هايGnRH در روش‌هاي كمك باروري (ART) به‌طور گسترده رايج بوده و احتمال ايجاد نقص فازلوتئال با مصرف آنها وجود دارد. لذا از پروژسترون براي حفاظت فاز لوتئال در اكثر موارد استفاده مي‌شود. زمان شروع پروژسترون مورد بحث مي‌باشد. بعضي ازمتخصصين تجويز پروژسترون را موقع پونكسيون فوليكول‌ها و بعضي ديرتر توصيه مي‌نمايند. اين مطالعه به‌منظور مقايسه نتايج درماني تجويز پروژسترون به هنگام دريافت تخمك يا انتقال جنين انجام شد. مواد و روش‌ها: مطالعه كارآزمايي باليني آينده‌نگر بر روي 575 بيمار مراجعه كننده به مركز ناباروري دانشگاه علوم پزشكي و خدمات بهداشتي، درماني شهيد صدوقي و بيمارستان مادر يزد تحت درمان ART و با استفاده از GnRH-a با پروتكل طولاني همراه گنادوتروپين انجام شد. بيماران به‌صورت تصادفي به دو گروه تقسيم شدند. براي گروه اول (307 نفر) پروژسترون در روز جمع‌آوري تخمك و به گروه دوم (268 نفر) پروژسترون بعد از انتقال جنين تجويز شد. پس از جمع‌آوري داده‌ها، تجزيه و تحليل اطلاعات با استفاده از آزمون‌هاي آماري 2 وT انجام گرفت. نتايج: سن مرد و زن و مدت ناباروري در دو گروه مقايسه و تفاوت معني‌داري مشاهده نشد. همچنين تفاوت قابل توجهي در علت ناباروري مشاهده نگرديد. تعداد فوليكول‌ها و تخمك‌‌هاي بدست آمده در دو گروه داراي تفاوت معني‌داري نبود. ميانگين تعداد جنين در گروه اول4/1±1/3 و در گروه دوم4/1±8/2 بود كه معني‌دار نمي‌باشد. نتيجه درماني يعني تست حاملگي مثبت در دو گروه درماني تفاوتي نداشت. نتيجه‌گيري: با توجه به نتايج درماني حاصل از اين مطالعه و مشكلات احتمالي همراه با تزريق عضلاني پروژسترون و به‌علاوه احتمال خونريزي با مصرف پروژسترون موقع پونكسيون، در صورت عدم انتقال جنين، توصيه به مصرف آن بعد از انتقال جنين مي‌شود. 2 Introduction: Nowadays the wide spread use of GnRH agonists in ART protocols has emerged the need for luteal phase support by progesterone. However the time of starting progesterone administration is still obscure, some investigators recommend the day of oocyte retrieval and the others later. The present study was designed to investigate the effect of the progesterone administration timing before or after embryo transfer on the outcome of ART. Materials and Methods: A randomized clinical trial was designed to study a total of 575 women referred to Shahid Sadooghi University of Medical Sciences and Yazd Madar Hospital, undergone ART treatment. Using long GnRH-a protocol, the patients were randomly divided into two groups. Progesterone administration was started on oocyte retrieval day in the first group (n= 307), versus after embryo transfer in the second group (n=268). Pregnancy rate were analyzed using statistical trials including 2 and T. Results: Regarding the age of couples, the duration and etiology of infertility, the number of follicles, retrieved oocytes and zygotes (3.01.4 in first group versus 2.81.4 in second group) no statistically significant difference was observed. The outcome, defined as a positive pregnancy test was not different in two groups. Conclusion: Considering the results and the disturbances following intramuscular injection of progesterone including the risk of bleeding, the administration of progesterone after embryo transfer is recommended. 44 52 Abbas A Aflatoonian عباس افلاطونیان Department of Obstet . and Gynecol Research and Clinical Center for Infertility, Faculty of Medicine, Yazd Shahid Sadooghi University of Medical Sciences Department of Obstet . and Gynecol Research and Clinical Center for Infertility, Faculty of Medicine, Yazd Shahid Sadooghi University of Medical Sciences Iran aflatoonian@yazdivf.org Maryam M Asgharnia مریم اصغرنیا Department of Obstet . and Gynecol Faculty of Medicine, Gilan University of Medical sciences Department of Obstet . and Gynecol Faculty of Medicine, Gilan University of Medical sciences Iran Fariba F Seyed Alshohadaei فریبا سیدالشهدایی Department of Obstet . and Gynecol Kordestan University of Medical Sciences Department of Obstet . and Gynecol Kordestan University of Medical Sciences Iran InfertilityAssisted Reproductive TechniquesOocyte retrievalEmbryo transferLuteal phase supportProgesterone 142.pdf Smitz J., De vroey P., Camus M., et al. The luteal phase and early pregnancy after combined GnRH – agonist/ UMG treatment for superovul-ation in IVF or GIFT. Hum Reprod.1988;3:585-590.##Smith E.M., Anthony F.W., Gadd S.C., et al. Ttial of support treatment with human chorionic gonadotropin in the luteal phase after treatment with buserelin and human menopausal gonadotro-pin in women taking part in an in vitro fertiliza-tion programe. Br Med J. 1989;298:1483-1486.##Belaisch- Allat J., De Mouzon J., lapousterle C., et al. The effect of HCG supplementation after combined GnRH agonist/HMG treatment in IVF programe. Hum Reprod. 1990;5:163-166.##De Mouzony J., Hopital De Bicetre., le kremlin Bicetre, France. progestrone support during the net/ferimagazine/congress/2oo2-Eshre-03.asp.##Nikunen V., Katuinen P., Piroiuen D. Progestrone support of the luteal phase IVF program a hazard? Annual Gynecol.1988;202 (s):42-4.##Patrizio P., Tucker M.J., Guelman V. A color Atlas for human Assisted Reproduction, Williamz & Williams, 2003;pp:220-221.##Smitz J., Devroey P., Faguer B., et al. A prospective randomized comparison of intra-muscular or intravaginal natural progestrone as a luteal phase and early pregnancy supplement. Hum Reprod. 1992;7:168-175.##Araujo E J.R., Benar Dini L., Frederick J.L., et al. Prospective randomized comparison of human chorionic gonadotropin versus intra-muscular progestrone for luteal phase support in assisted reproduction. J Assist Reprod Genet. 1992;11:74-78.##Tavaniotou A., smitz J., Bougain C., Deroey P. Comparison between different routes of progestrone administration as luteal phase support infertility treatments. Hum Reprod. Update. 2000;6:139-148.##Deziegler D., Bulletti C. Progestrone: A natural, life supporting hormome. Hum Reprod. 2000;15.##Pritts E.A., Atwood A.K. Luteal phas support in infertility treatment: a meta- analysis of the randomized trial. Hum Reprod. 2002;17(9):228-9.##Bourgain C., smitz J., Camus M., Erard P., De vroey P., van steirteghen A.C., Kloppel G. Human endometrial maturation is markedly improved after luteal supplementation of gonadotropin releasing hormone analoge/ human menopausal gonadotropin stimulated cycles. Hum Reprod.1994;9:32-40.##Ludwig M., Diedrich K. Evaluation of an optimal luteal phase support protocol in IVF. Acta Obstet Gynecol Scand.2001;80:452-466.##Artini P.G., volpe A., Angioni S., Glassi M.C., Battaglia C., Genazzani A.R. A comparative , randomized study of the three different progestrone suport of the luteal phase following IVF/ ET program. J Endocrinol Invest.1995;18:51-56.##Soliman S., Daya S., Collins J., et al. The role of luteal phase support in infertility treat-ment: a meta-analysis of randomized trials. Fertil Steril.1994;61: 1068-1076.##Ragni G., piloni S., Rossi P., et al. Endo-metrial morphology and ultrasound vascular findings. A randomized trial after intramuscular and vaginal progestrone supplementation in IVF. Gynecol Obstet Invest. 1999;47:151-6.##Deveker F., Govaerts I., Bertrand E., Vanden Bergh M., Gerry C., Englert Y. The long-acting gonadotropin- releaing hormone analogues Impaired the implantation rate. Fertil Steril.1996; 65(10):122-6.##Kimzey L.M., Gumowsh J., Merriam G.R., Grimes G.J. Jr., Nelson L.M. Absorption of micronized progestrone from a nonliquifying.##Claman P., Domingo M., leader A. Luteal phase support in in-vitro fertilization using gonadotropin releasing hormone analogue before ovarian stimulation a prospective randomized study of human chorionic gonadotropin versus im progestrone. Hum Reprod. 1992;7:487-489.##Pouly J.L., Bassil S., Frydman R., et al. Support de laphose luteal par la progestron vaginale: etude comparative avec la progestrone micronisee per os. Contracept Fertil Sex.1997; 25:596-601.##Lenton E.A., Sulaiman R., Sobowale O., et al. The human menstrual cycle: Plasma concentra-tion of prolactin. LH,FSH, Oestradiol and progestrone in conceiving and nonconceivung women. J Reprod Fertil.1982;65:131-139.##Garcia J.E., Acosta A.A., Hsiu J.,G., et al. Advanced endometrial maturation after ovulation induction with human menopausal gonadotropin/ human chorionic gonadotropin for in vitro fertilization. Fertil Steril.1984;41: 31-35.##Yovich J.L., Mcclom S.C., Yovich J.M., et al. Early luteal serum progestrone concentrations are higher in pregnancy cycles. Fertil Steril.1985;44: 185-189.##Mochtar M.H., Hogerzeil H.V. Mel B.M. Progestrone alone versus progestrone combined with HCG as luteal support in GnRH-a/ HMG induced IVF cycles:a randomized clinical trial. Hum Reprod.1996;11:1602-1605.##Williams S.C., Ochninger S., Gibbons W.E., Van cleave W.C., Muasher S.J., Delaying the initiation of progestrone supplementation results in decerased pregnancy rates after in vitro fertilization: A randomized, prospective study. Fertil Steril.2001;76(6):1140-3.##Sohn S.H., Penzias A.S., et al. Progestrone administration befor oocyte retrieval decreased IVF succes. Fertil Steril.1999;71:11-4.##Chang S.Y., Soong Y.K., Chang M.Y., Hsiu O.Y., Immediate versus delayed progestrone Supplementation in gamete intrafallopian transfer (GIFT). J In vitro Fertil Embryo Transfer. 1989;6(5):275.##

مقايسه توانائي سلول‌هاي دندريتيك طحال موش‌هاي حامله وغيرحامله در تحريك آلوژنيك لنفوسيت‌هاي T Allostimulatory efficiency of splenic dendritic cells from pregnant and non pregnant mice 2 1 مقدمه: توليدمثل پستانداران يك تناقض ايمونولوژيكي است؛ زيرا انتظار مي‌رود آنتي‌ژن‌هاي بيگانه جنيني كه از طريق پدر به ارث مي‌رسند سيستم ايمني مادر را تحريك كنند و منجر به سقط جنين شوند. در طي بارداري سيستم ايمني مادر علاوه بر تغييرات موضعي به صورت سيستميك هم تعديل مي‌شود. سلول‌هاي دندريتيك به عنوان سلول‌هاي حرفه‌اي عرضه‌كنندة آنتي‌ژن، در آغاز و كنترل پاسخ ايمني نقش كليدي دارند و به نظر مي‌رسد كه تغييرات عملكردي اين سلول‌ها در طي حاملگي در تحمل ايمونولوژيك سيستميك مؤثر باشد. براي اين منظور در مطالعه حاضر سلول‌هاي دندريتيك موش حامله جداسازي و تخليص گرديد و ميزان فعاليت آنها در تحريك تكثيري سلول‌هاي T آلوژن با استفاده از واكنش مختلط لوكوسيتي (MLR) آلوژنيك يك طرفه ارزيابي شد. مواد و روشها: با هضم بافت طحال توسط آنزيم كلاژناز و استفاده از محيط گراديان نايكودنز(Nycodenz) 13% و با استفاده از خاصيت چسبندگي سلول‌هاي دندريتيك به كف پليت كشت، حدود 105×7 سلول دندريتيك با خلوص بيش از 95% از هر طحال جدا شد. سلول‌هاي T آلوژن نيز به وسيله ستون نايلون‌ول(Nylon wool) وبا استفاده از خاصيت عدم چسبندگي سلول‌هاي T به نايلون ول جدا گرديد. سلول‌هاي دندريتيك جدا شده از موش Balb/c حامله و غير حامله پس از اشعه‌دادن دركشت مختلط لوكوسيتي با لنفوسيت‌هاي Tجدا شده از موش C57BL/6 مورد استفاده قرار گرفت و ميزان تكثير لنفوسيت‌هاي T پس از 72 ساعت به وسيله تايميدين راديواكتيو اندازه‌گيري شد. نتايج: از هر طحال حدود 1057 سلول دندريتيك با خلوص بيش از 95% به دست آمد. همچنين ميزان بازده لنفوسيت‌هاي T از غدد لنفاوي اينگوئينال و براكيال حدود 1065-3 عدد با خلوص 90-85% بود. نتايج حاصله نشان داد توانايي سلول‌هاي دندريتيك موش‌هاي حامله(33000cpm=) و غير حامله(35000=cpm) از نظر القاي پاسخ تكثيري لنفوسيت‌هاي T آلوژن تفاوت معني‌داري ندارد. نتيجه‌گيري: اين يافته مي‌تواند ناشي از كم بودن غلظت فاكتورهاي سركوبگر ايمني در گردش خون موش‌هاي حامله و يا به دليل جدا كردن سلول‌هاي دندريتيك از ريزمحيط حاملگي و بلوغ آنها در شرايطVitro In بدون حضور فاكتورهاي سركوبگر ايمني باشد. 2 Introduction: Mammalian reproduction looks like an immunological paradox, because fetal alloantigens encoded by father genes should induce cell mediated immune responses leading to fetal loss. Maternal immune system, in addition to local modulation, undergoes systemic modulations during pregnancy. Dendritic cells (DCs), as professional antigen presenting cells, play a key role in initiation and control of immune response and it seems that functional changes in these cells during pregnancy may contribute to the systemic immune tolerance. To address this issue, in this study we isolated and purified DCs from pregnant mice and evaluated their stimulatory potential to induce proliferative response of allogenic T cells in unidirectional mixed leukocyte reaction (MLR). Materials and Methods: Following collagenase digestion of splenic tissue, using density gradient centrifugation (13% Nycodenz) and adherence properties of DCs to the bottom of tissue culture dish, 7×105 DCs were isolated from each spleen with more than 95 percent purity. Allogenic T cells were isolated by nylon ‌wool column, using their non-adhesive character to nylon wool. After radiation, isolated dendritic cells from pregnant and non-pregnant Balb/c mice were used in mixed leukocyte culture with C57BL/6 mice T lymphocytes. T lymphocyte proliferation was measured after 72 hours by 3H- thymidine incorporation. Results: 7 105 dendritic cells with the purity of >95% were isolated from each spleen. Also the yield of T- lymphocyte form Inguinal and Brachial lymph nodes was about 3-5105 with the purity of %85-90. The results showed that there is no statistical difference between stimulatory potential of DCs form pregnant (cpm=33000) and non- pregnant (cpm=35000) mice in induction of allogenic T-Cell proliferation. Conclusion: These findings can result from low concentration of immune suppressor factors in circulatory system of pregnant mice or due to separation of dendritic cells from pregnancy microenvironment and their maturity in vitro in the absence of the immune suppressor factors. 5 14 Jaleh J Shojaeian ژاله شجاعیان Immunology Department, Faculty of Medical Science, Tarbiat Modarres University Immunology Department, Faculty of Medical Science, Tarbiat Modarres University Iran Seyyed Mohammad SM Moazzeni سید محمد موذنی Immunology Department, Faculty of Medical Science, Tarbiat Modarres University Immunology Department, Faculty of Medical Science, Tarbiat Modarres University Iran Moazzeni@dr.com Amir Hassan AH Zarnani امیرحسن زرنانی Immunology Department, Faculty of Medical Science, Tarbiat Modarres University Immunology Department, Faculty of Medical Science, Tarbiat Modarres University Iran Dendritic cellSpleenPregnancyMixed leukocyte cultureAllogenic response 138.pdf Levin R.W., Aoki K., Azuma T., Yagami Y., Okada H. 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مقايسه تأثير اكسي‌توسين و سنتومترين در جلوگيري از خونريزي بعد از زايمان A comparison between oxytocin and syntometrine for preventing postpartum hemorrhage 2 1 مقدمه: مرحله سوم و چهارم زايمان كه مشتمل بر خروج جفت و يك ساعت بعد از آن مي‌باشد، از مراحل مهم زايمان است. عوارض مرحله سوم و خونريزي بعد از زايمان از علل مهم مرگ‌ومير مادران به خصوص در كشورهاي در حال توسعه مي‌باشد. اداره فعال زايمان ومصرف داروهاي اكسي‌توسيك مي‌تواند سبب كاهش ميزان خونريزي بعد از زايمان شود. به دليل اهميت خونريزي‌هاي بعد از زايمان و مرگ ومير و ناتواني‌ ناشي از آن، اين مطالعه جهت مقايسه تأثير دو داروي اكسي‌توسين وسنتومترين در كنترل ميزان خونريزي بعد از زايمان صورت گرفت. مواد و روشها: اين مطالعه به روش كارآزمايي باليني در سال 1380 برروي زنان حامله مراجعه كننده براي زايمان به زايشگاه قدس زاهدان انجام گرفت. 618 نفر نمونه به طور تصادفي به دو گروه 309 نفري تقسيم شدند. شرايط ورود به مطالعه داشتن حاملگي يك قلو، عدم بيماري زمينه‌اي طبي وفشار خون طبيعي (كمتر ازmmHg 90/140) بود. بعد از خروج شانه قدامي نوزاد به گروه اولIU 5 اكسي‌توسين و به گروه دوم IU5 اكسي‌توسين و mg5/0 مترژن (سنتومترين) عضلاني تزريق گرديد. ميزان خونريزي غيرطبيعي بعد از زايمان بر اساس تخمين چشم و نياز به اقدامات بعدي جهت كنترل خونريزي و يا افت فشار خون سيستوليك به ميزان كمتر از mmHg100 در دو گروه تعيين شد. طول مدت مرحله سوم (زمان لازم براي خروج جفت) نيز براي تمام نمونه‌ها تعيين گرديد. نتايج: در گروه اول، 20 مورد ( 47/6%) خونريزي بيش از حد طبيعي داشتند. در گروه دوم 8 مورد (58/2%) خونريزي غيرطبيعي داشتند كه اختلاف از نظر آماري (05/0>p ) با آزمون 2 معني‌دار بود. زمان مرحله سوم وميزان احتباس جفت و نياز به برداشت جفت با دست بين دو گروه تفاوت معني‌دارآماري نداشت. عوارض جانبي در هر دو گروه غيرشايع بود. ميزان افزايش فشار خون به ميزان افزايش خون سيستول مساوي يا بيشتر از mmHg140و يا افزايش دياستول مساوي وبالاتر از mmHg90 در دو گروه تفاوت معني‌دار آماري نداشت. نتيجه‌گيري: در حاليكه بعضي از مطالعات مصرف سنتومترين را به دليل اثرات مساوي با اكسي‌توسين در كنترل خونريزي بعد از زايمان و ترس از عوارض آن منع مي‌نمايند نتايج اين مطالعه و بسياري از مطالعات ديگر نشان داد كه سنتومترين در كنترل خونريزي بعد از زايمان از اكسي‌توسين مؤثرتر است. 2 Introduction: The third and forth stages of labor which involve the separation and expulsion of the placenta and an hour immediately following delivery are the two critical phases. Many maternal deaths in the developing countries result from complications of the third stage of labor and postpartum hemorrhage. Active management of labor and use of oxytocic drugs can reduce postpartum hemorrhage. This study compares the effects of oxytocin and syntometrine in preventing postpartum hemorrhage which is an important problem causing maternal morbidity and mortality after delivery. Materials and Methods: A clinical trial was designed to study 618 patients admitted to zahedan Ghods Birth Center in 2001 for normal delivery. The patients were randomly divided into two groups. All Pregnancies were singletone, normotensive (BP<140/90) and free from medical disease. After exiting the anterior shoulder of fetus, 5 IU of oxytocin in the first group and 0.5 mg ergometrine plus 5 IU of oxytocin in the second group was injected intramusculary. The abnormal postpartum hemorrhage by obstetrician’s estimation, the need for repeated oxytocic or other interventions and less than 100 mm Hg fall in systolic blood pressure was determined. The length of third stage was determined for all of the patients. Results: Among the first group there were 20 cases (%6.47) with abnormal hemorrhage, compared to 8 cases (%2.58) in the second group. There was a significant difference between the two groups in postpartum hemorrhage (p<0.05) (using Chi-square test,CI=%95). There was no significant difference between two groups concerning the duration of third stage and the need for manual removal of placenta. The side effects were uncommon and the incidence of hypertention (Bp>140/90) was not different between two groups. Conclusion: some studies do not recommend the use of syntometrine, believing that there is no clinical difference in the effectiveness of oxytocin and syntometrine, whereas syntometrine can cause hypertention and retained placenta. Our results similar to other researches show that syntometrine is more effective than oxytocin in preventing postpartum hemorrhage. 52 62 Maryam M Khooshideh مریم خوشیده Department of Obstet . and Gynecol Ghods Birth Center, Faculty of Medicine, Zahedan University of Medical Sciences Department of Obstet . and Gynecol Ghods Birth Center, Faculty of Medicine, Zahedan University of Medical Sciences Iran alibenmahdi@yahoo.com Ali A Shahriari علی شهریاری Department of Anesthesiology, Ghods Birth Center, Faculty of Medicine, Zahedan University of Medical Sciences Department of Anesthesiology, Ghods Birth Center, Faculty of Medicine, Zahedan University of Medical Sciences Iran Third stage of laborSyntometrineOxytocinUterine atonyPostpartum hemorrhage 143.pdf Cunningham F.G., Norman F.G., Kenneth G.L. Conduct of normal labor and delivery. Williams Obsetrics. 21th Edition, New York, Mc Graw- Hill.2001;pp:321-325.##Bennett V.R., Lindak B.R. 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Grande, Anestesia for trauma .Anesthesia Ronald D., Miller M.D.4th Edition, New York, Churchill Livhngstone.1996;66:2165.##Choy C.M., Lau W.C., Tam W.H. A randomized controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour. BJOG. 2002;109(2):173-7.##Joy S.D., Sanchez-Ramos L.Misoprostol use during the third stage of labour. Int J Gynaecol Obstet.2003; 82(2):143-52.##Elbourne D., Prendiville W.J. Choice of oxitocic preparation for routine use in the management of the third stage of labour: an overview evidence from controlled trials. Br J Obstet Gynaecol.1988;95(1):17-30.##Mc Donald S.J., Prendiville W.J., Blair E. Randomized controlled trial of oxytocin alone versus oxytocin and ergometrine in active management of the third stage of labor. BMJ. 1993;307:1167–1171.##Thilanganthan B., Cutner A., Larimer J. Management of the third stage of labour in women at low risk of postpartum heamorrhage. 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حاملگي‌هاي "ناخواسته" و عوامل مؤثر بر آن در ايران "Unwanted" pregnancies and its determinants in Iran 2 1 مقدمه: مطالعات بيانگر آن است كه علي‌رغم موفقيت برنامه تنظيم خانواده در ايران در سال‌هاي اخير، نسبت قابل‌توجهي از حاملگي‌ها، ناخواسته هستند. هدف از اين مطالعه تعيين ميزان حاملگي هاي "ناخواسته" در ايران و بررسي تاثير عوامل جمعيتي و اجتماعي– اقتصادي بر روي حاملگي "ناخواسته" مي‌باشد. مواد و روشها: به‌منظور دستيابي به اهداف اين مطالعه، داده‌هاي "بررسي ويژگي‌هاي جمعيتي و بهداشتي در ايران" انجام شده در سال 1379 توسط وزارت بهداشت،‌ درمان و آموزش پزشكي مورد استفاده قرار گرفت و تعداد 5420 نفر از زنان همسردار حامله در زمان مطالعه انتخاب و بررسي گرديدند. نتايج: نتايج نشان داد كه در زمان تحقيق براي حدود 35% از حاملگي‌ها تصميم‌گيري و برنامه‌ريزي انجام نشده بود؛ كه حدود 19% آن نابهنگام و 16% ناخواسته بود. بين ميزان حاملگي‌هاي برنامه‌ريزي نشده و نوبت حاملگي زنان ارتباط وجود داشت. علاوه بر آن، درصد قابل توجهي (42% )‌ از زناني‌كه حاملگي خود را برنامه‌ريزي نشده اظهار داشتند پيش از حاملگي از يك روش پيشگيري استفاده مي‌كردند. روش‌هاي سنتي و قرص به ترتيب بالاترين روش مورد استفاده قبل از حاملگي‌هاي ناخواسته در مناطق شهري و روستائي بوده است. نتيجه‌گيري: پيشنهاد اين مطالعه اين است كه ميزان حاملگي برنامه‌ريزي نشده را مي‌توان به‌وسيله اجراي برنامه‌هاي "بهبود كيفيت خدمات تنظيم خانواده" كاهش داد. چنين برنامه‌هايي بايد زوجين استفاده كننده از روش‌هاي سنتي را در مناطق شهري و زوجين استفاده كننده از قرص پيشگيري در مناطق روستايي را به‌عنوان گروه هدف در نظر بگيرند. 2 Introduction: Despite the success of family planning programs in Iran during the recent years, surveys indicate that a significant proportion of pregnancies are unwanted. The objective of the present study was to examine the rate of unwanted pregnancies in Iran and to analyze the effect of relevant socio-economic and demographic variables on unwanted pregnancies. Materials and Methods: The data and informations for this study were obtained from the “Iran Demographic and Health Survey (IDHS)” undertaken by the Ministry of Health and Medical Education in 2000. The study was performed on 5420 married pregnant woman. Results: Results showed that around 35 percent of pregnancies were unintended, of which 19 percent were mistimed and 16 percent were unwanted. There was a meaningful relation between unintended pregnancy rate and pregnancy turn. Besides, around 42 percent of women who experienced unintended pregnancy were using a contraceptive method. Traditional methods and pills were the most prevalent methods used prior to unintended pregnancies in rural and urban areas respectively. Conclusion: Based on the results of the present study we suggest that the improvement of quality of family planning services is likely to decrease the level of unintended pregnancies in the future. The programs should target the couples who rely on traditional methods and pill in urban and rural areas respectively. 62 77 Mohammad Jalal MJ Abbasi-Shavazi محمد جلال عباسی شوازی Department of Demography, Faculty of Social Sciences, Tehran University Department of Demography, Faculty of Social Sciences, Tehran University Iran mabbasi@ut.ac.ir Meimanat M Hosseini- Chavoshi میمنت حسینی چاوشی Population Data Unit., Department of Family Health and Population, Ministry of Helath Population Data Unit., Department of Family Health and Population, Ministry of Helath Iran Bahram B Delavar بهرام دلاور Population Data Unit., Department of Family Health and Population, Ministry of Helath Population Data Unit., Department of Family Health and Population, Ministry of Helath Iran Unwanted pregnancyMistimed pregnancyUnintended pregnancyFamily planning 144.pdf Rashad H. Demographic transition in Arab countries: A new perspective. Popul Res.2000; 17:81-101.##Bulatao R.A. Introduction Rodolfo A. 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Assessing the prevalence and determinants of unwanted pregnancy and induced abortion in Nigeria. Stud Fam Plann. 1999;30(1):67-77.##Nock S. L. Abortion, Adoption, and Marriage: Alternative resolutions of an unwanted pregnancy (in exchange on the treatment of adoption and abortion in Textbooks). Fam Relations. 1994; 43 (3):277-279.##ملک‌افضلی، ‌ح. برآورد سقط جنین‌های ناشی از حاملگی‌های ناخواسته درایران. بهداشت خانواده، 1375،شماره 2، صفحات:7-2.##Lloyd C. B. Montgomery M. R., The consequences of unintended fertility for investments in children: Conceptual and methodo-logical issues.1996;Policy Research Division Working Paper No. 89. New York: Population Council.##بحرانی،‌ م. بررسی میزان‌های باروری ناخواسته و وابسته‌های آن در شهر شیراز. فصلنامه جمعیت، 1377، شماره 25-26 و صفحات 70-59.##Mensch B., Arends-Kuenning M., Jain A., Garate M. Avoiding unintended pregnancy in Peru: does the quality of family planning services matter?. Int Fam Plan Persp.1997;23(1):21-27.##Okonofua F., Odimegwu C., Ajabor H., Daru P. Johnson A Assessing the prevalence and determinants of unwanted pregnancy and induced abortion in Nigeria. Stud Fam Plan.1999;30(1) :67-77.##Mirzaie M. Swings in fertility limitations in Iran. Working Paper in Demography, No. 72, Canberra: Australian National University.1998.##Aghajanian A., Mehryar A., Fertility transi-tion in the Islamic Republic of Iran:1976-1996. Asia Pac Popul J.1999;14(1):21-42.##Mehryar A., et al. Iranian miracle: How to raise contraceptive prevalence rate to above 70% and cut TFR by two-thirds in less than a decade? Paper presented at the 24th IUSSP conference, 2001;18-24 August, Salvador, Brazil.##عباسی شوازی، محمد جلال، همگرائی رفتارهای باروری در ایران: میزان، روند و الگوی سنی باروری در استان‌های کشور طی سال‌های 1351 و 1375. نامه علوم اجتماعی 1381، شماره 18: صفحات 231-201.##عباسی شوازی، محمد جلال، ارزیابی نتایج فرزندان خود در برآورد باروری با استفاده از داده‌های سرشماری، نامه علوم اجتماعی 1379،شماره16: صفحات 135-105.##Abbasi-Shavazi M.J. Effects of marital fertility and nuptiality on fertility transition in the Islamic Republic of Iran, Working Papers in Demography, No. 84, Canberra: Australian National University,2000b.##Abbasi-Shavazi M.J., Attainment of below-replacement fertility in Iran: Fertility levels and trends during 1972-2000, Proceedings of the 3rd Conference of the Population Association of Pakistan on Population and Sustainable Develop-ment in Pakistan, Lahore, 19-21 December 2002; pp:307-317.##Abbasi-Shavazi M.J. Recent changes and the future of fertility in Iran, Paper presented at the Expert Group Meeting on Completing Fertility Transition, New York, 11-16 March.2002,pp. 425-439.##Abbasi-Shavazi M.J., Mehryar A., Jones, G., McDonald P. Revolution, war and modernization: population policy and fertility change in Iran. J Popul Res.2002;19(1):25-46.##حقجو، ن. و ییلاق بیگی، م. بررسی حاملگی‌های ناخواسته بین زنان روستائی در رشت. بهداشت خانواده و 1375، شماره 4 و صفحات 43-36.##کمال، س. بررسی شیوع حاملگی‌های ناخواسته در سمنان، بهداشت خانواده. 1376، شماره 7، صفحات11-3.##پورزکریا،‌ م. علل باروری ناخواسته زنان 49-15 ساله همسردار در جنوب تهران (مطالعه تطبیقی درمنطقه فرمانفرمایان و دولتخوان). پایان‌نامه کارشناسی ارشد جمعیت‌شناسی، دانشکده‌علوم اجتماعی، دانشگاه تهران، 1381.##Paydarfar A. Malekafzali H. Sociodemogra-phic attributes of Iranian wives who reported unwanted pregnancies, Paper presented at the Research Committee on Sociology of Population in the World Congress of Sociology, July 26-August 1, Montreal, Canada, 1998.##Jain A. Should eliminating unmet need for contraception continue to be a program priority?. Int Fam Plan Perspec.1999;25(S):39-49.##Santelli J., et al. The Measurement and meaning of unintended pregnancy. Perspec Sex Reprod Health.2003;35(2):pp.94-101.##Pulley L., Klerman L., Tang H., Baker B. A. The extent of pregnancy mistiming and its association with maternal characteristics and behaviors and pregnancy outcomes. Perspec Sex Reprod Health.2002;34(4):pp.206-211.##Lucas D., Meyer P. The background to fertility. In Beginning Population Studies. Lucas. D. Meyer P (Editors). National Centre for Development Studies, The Australian National University, Canberra:1994;56-68.##دزفولی منش، م.، رضائی، م. بررسی شیوع و تعیین کننده‌های حاملگی ناخواسته در استفاده از وسائل تنظیم خانواده. بهداشت خانواده، 1377، شماره 12، صفحات24-12##Brown B. Many women at high risk of unintended pregnancy are unaware of emergency contraception or how to use it. Fam Plan Perspec.2001;33(1):42-43.##Abbasi-Shavazi, M.J. et al. Unintended Pregnancies in the Islamic Republic of Iran: Levels and Correlates, Asia-Pacific Population Journal, 2004:19(1),pp.27-38.##Weinberger M. B. The relationship between women's education and fertility:selected findings from the World Fertility Surveys.Int Fam Plan Perspec.1987;13(2):35-46.##Montgomery M. R., Lloyd C. B., Excess Fertility, Unintended Births and Children's Schooling. Policy Research Division Working Paper No. 100. New York: Population Council, 1997.##

مقایسه تاثیر آموزش پیشگیری از ایدز توسط گروه همسالان وبزرگسالان برآگاهی، نگرش و خودبسندگی دانش‌آموزان دختردبیرستاني، منطقه 4 آموزش و پرورش شهر تهران با استفاده از مدل تئوری شناختی - اجتماعی، سال82-1381 Comparing the effect of peer-led versus adult-led AIDS education on knowledge, attitude and self-efficacy of female students in high schools in 4th region of education ministry in Tehran, using socio-cognitive theory, 2002-2003 2 1 مقدمه: ايران از جمله كشورهاي خاورميانه است كه با بحران ايدز مواجه مي‌باشد. حدود 17% موارد ايدز در بين نوجوانان 20 تا 29 ساله و حدود 35% در بين جوانان 30 تا 39 ساله اتفاق مي‌افتد. با توجه به دورة كمون طولاني (حدود 10 سال)، بديهي است كه درصد بسياري از موارد ابتلاء به عفونت ايدز در زمان نوجواني و جواني روي مي‌دهد. شروع برنامه‌های آموزش پیشگیری از ایدز در مدارس در بین نوجوانان از برنامه‌های مهم وزارت آموزش و پرورش و وزارت بهداشت، درمان و آموزش پزشكي در کشور ایران می‌باشد و مطالعه و شناخت موثرترین روش آموزشی در جهت ارتقاء آگاهی و بهبود نگرش و ارتقاء مهارت‌های زندگی در نوجوانان و رفتارهای پیشگیری از ایدز اولویت می‌یابد. اين مطالعه با هدف مقايسه تاثير دو نوع مداخله آموزشي پيشگيري از ايدز توسط گروه همسالان و گروه بزرگسالان (مشاورين مدرسه) بر آگاهي، نگرش و خود بسندگي دانش‌آموزان دختر دبیرستانی، پایه دوم رشته انساني، منطقه 4 آموزش و پرورش تهران در سال تحصیلی 82-1381 و به كارگيري نتايج تحقيق در طراحي برنامه‌هاي آموزش موثر پيشگيري از ايدز در مدارس انجام گرفت. مواد و روشها: مدل آموزشی استفاده شده در این بررسی مدل تئوري شناختي- اجتماعي بندورا مي‌باشد. با استفاده از نمونه‌گیری تصادفی خوشه‌ای تعداد 441 دانش‌آموز از 7 دبيرستان منطقه 4 وارد مطالعه شدند و براساس فرد آموزش دهنده به دو گروه آموزش توسط همسالان و آموزش توسط بزرگسالان (مشاورين مدرسه) و يك گروه کنترل تقسيم شدند. مطالب آموزشي شامل پيشگيري از ايدز، نگرش‌هاي صحيح مرتبط با آسيب پذيري نسبت به ايدز و عدم طرد بيماران مبتلا به ايدز و مهارت‌هاي خودبسندگي( تصميم گيري، حل مشكل و ابراز وجود) بود. پرسشنامه بدون نام پیش از مداخله و یک ماه پس از مداخله توسط دانش آموزان پاسخ داده شد. جهت تجزیه و تحلیل داده‌ها، نرم افزار SPSS-11 و مدل آنالیز واریانس، آزمون شفه و2 مورد استفاده قرار گرفت. نتایج: ميانگين نمره آگاهي در هر دو گروه مداخله، از پيش آزمون به پس آزمون در مقايسه با گروه كنترل به طور معني‌داري افزايش يافت (001/0P<)؛ ولي هيچ اختلاف معني‌داري ‌بين دو گروه مداخله همسالان و بزرگسالان ديده نشد. عليرغم يكسان بودن دو گروه مداخله از نظر ارتقاء آگاهي در پس آزمون، نوع اطلاعات در دو گروه به طورمعني‌داري متفاوت بود. با توجه به يكسان بودن مدل آموزشي در دو گروه به نظر مي‌رسد گروه همسالان بيشتر بر اساس نيازهاي اطلاعاتي همسالان (مثل نحوه انتقال) اطلاعات را منتقل كرده بودند. در حالي كه گروه بزرگسالان، اطلاعات ديگري (مثل نحوه درمان و واكسيناسيون) را بيشتر منتقل كرده بودند. در هیچ یک از دو گروه مداخله، تغییر معنی‌داری در نگرش آسيب‌پذيري نسبت به بیماری ایدز از پیش آزمون به پس آزمون مشاهده نشد؛ اما نگرش دانش‌آموزان نسبت به طرد بيماران مبتلا به ايدز در هر دو گروه مداخله همسالان و بزرگسالان از پيش‌آزمون تا پس‌آزمون به طور معنی‌داری نسبت به گروه کنترل بهبود يافت(0001/0p<). در حاليكه دو گروه مداخله در بهبود نگرش فوق از پيش آزمون به پس آزمون اختلاف معني‌داري ندارند. همچنين تنها گروه بزرگسالان در مقايسه با كنترل باعث ارتقاء معني‌داري در مهارت خودبسندگي در دانش آموزان گرديده است. درحالي‌كه در مقايسه دو به دو، گروه مشاورين مدرسه و گروه همسالان در بهبود نگرش فوق از پیش آزمون به پس آزمون اختلاف معنی‌داری ندارند. نتیجه‌گیری: بر اساس یافته‌های مطالعه حاضر، پیشنهاد می‌شود هر دو گروه همسالان و بزرگسالان براي برنامه‌های مداخله آموزشی در برنامه‌های آموزشی ایدز به کار گرفته شوند؛ به طوری‌که گروه همسالان در ارائه اطلاعات مورد نیاز گروه هدف و گروه بزرگسالان در ارائه مهارت‌های خودبسندگی کارآیی بیشتری دارند. هرچند مطالعات بیشتری با حجم نمونه بیشتر و مدت آموزشی طولانی‌تر جهت تائید نتایج فوق توصیه می‌گردد. 2 Introduction: Iran is one of the Middle East countries involved in AIDS crisis. Around 17% of cases are between 20-29 years old and 35% between 30-39. Considering the long incubation period (around 10 years), obviously a great percentage of cases have become involved in their adolescent ages. To address this issue, school based AIDS educational program for adolescents is being considered as an important strategy of the ministry of education and the ministry of health in Islamic Republic of Iran. Accordingly, studying and recognition of the most effective method of education which leads to increasing knowledge, improvement of attitude and enhancement of life skills related to prevention of AIDS among adolescents seems to be a priority. This study was designed to compare the effects of two educational interventions for prevention of AIDS, conducted by peers and adults (school counselors), on knowledge, attitude and self efficacy of female students in high schools of Tehran, studying in human science field, in 4th region of ministry of education in 2002-3. The objective was to found new initiatives in school based AIDS educational programs. Materials and Methods: The mode of education used in this survey was Bendora Socio- Cognitive theory. A total of 441 students from 7 high schools in 4th region of ministry of education, were recruited using random cluster sampling and were allocated based on the educator, to 2 intervention groups (peer-led and adult-led group) and one control group. The educational subjects included AIDS prevention and correct attitudes towards AIDS (vulnerability and rejecting patients) and self-efficacy skills (decision making, problem solving and assertiveness). Anonymous questionnaires were filled by the students before and 30 days after the intervention. Data analysis was done using SPSS-11, and statistical tests including Analysis of variance, and Chi-Square were used. Results: The mean score of knowledge significantly increased in both interventional groups compared to control group after intervention (p<0.0001), but no significant difference was detected between peer-led and adult-led groups in this regard. Despite the equality between two interventional groups in the rise in knowledge, the type of information imparted by them was significantly different. Concerning the unique mode of education used in both groups, it seems that peer-led group more likely imparted those information which were a matter of concern among their peers and friends (e.g. transmission mode) while adults (school counselors) imparted some other informations (e.g. treatment, vaccination). There was no significant improvement in the attitude of vulnerability towards AIDS among interventional groups from pre-intervention to post-intervention. Whereas the attitude of rejecting AIDS patients in both interventional groups has improved compared to control group (p<0.0001), no difference has been detected between the two interventional groups in this regard. The educational intervention only in adult-led group has led to enhancement of self-efficacy skills significantly compared to control group, from pretest to posttest, however, there was no significant difference between peer –led and adult-led group in this issue. Conclusion: we recommend both peer-led and adult- led programs to be employed in school-based AIDS education, particularly peers in imparting information according to their peer’s need and adults in training self efficacy skills. 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