2009 10 1 38 75

خصوصیات سلول هاي مزانشیمی ماتريکس بند ناف انسان Biological and Biochemical Characteristics of Human Umbilical Cord Mesenchymal Cells 2 1 زمینه و هدف: در سال‌های اخیر، سلول درمانی بعنوان روشی سودمند در درمان بیماری‌های مختلف به ویژه بیماری‌های مضمحل‌کننده دژنراتیو پیشنهاد شده است. سلول‌های مزانشیمی ماتریکس بند ناف، در زمره سلول‌های بنیادی هستند که اخیراً مورد توجه قرار گرفته‌اند. در مطالعه حاضر، ضمن معرفی شرایط کشت این سلولها، پاره‌ای ویژگیها از قبیل بیان آنزیم آلکالین فسفاتاز، توان تولید کلنی در قطره معلق و میزان رشد در تراکم‌های مختلف در این سلولها بررسی شده است.روش بررسي: در اين مطالعة تجربی، بند ناف نوزاد تازه متولد شده به روش سزارین از بیمارستان افضلی‌پور کرمان تهیه شد و در شرایط استریل به آزمایشگاه منتقل و به روش کشت قطعه بافت، در محیط کشت مناسب کشت داده شد. پس از رسیدن رشد سلولها به تراکم بیش از 80%، سلولها پاساژ داده شدند و به تعداد 1061 سلول در پلیت‌های مخصوص کشت داده شدند و ویژگی‌های رشد این سلولها بررسی شد. پس از تشکیل کلنی، کلنی‌های سلولی با کیت آلکالین فسفاتاز رنگ‌آمیزی شدند. همچنین تعداد 1051 سلول در قطرات معلق قرار گرفته و پس از 48 ساعت از نظر تشکیل کلنی و بیان آنزیم آلکالین فسفاتاز بررسی شدند. همچنین سلولها به تعداد 125، 250، 500، و 1000 سلول در l100 محیط کشت بمدت 48 ساعت کشت داده شدند و میزان فعالیت میتوکندری سلولها در گروه‌های مختلف با کیت Wst-1 بررسی شد.نتایج: سلول‌های مزانشیمی ماتریکس بند ناف انسان در محیط کشت، پس از 8 تا 10 روز کلنی‌های سلولی تشکیل دادند که آلکالین فسفاتاز مثبت بودند. کشت سلولها در قطرات معلق نیز به تولید کلنی‌های آلکالین فسفاتاز مثبت منجر شد. افزایش تراکم سلولی در ابتدای کشت، باعث ازدیاد میزان فعالیت میتوکندری سلولها پس از 48 ساعت نگهداری در انکوباتور شد.نتیجه‌گیری: یافته‌های مطالعه حاضر نشان می‌دهد که سلول‌‌های مزانشیمی ماتریکس بند ناف انسان قادرند در محیط کشت علاوه بر تک لایه سلولی، کلنی‌هاي آلکالین فسفاتاز مثبت تشكيل دهند. از سوی ديگر سلول‌های مزانشیمی بند ناف قادرند در قطره معلق رشد کرده و کلنی‌های آلکالین فسفاتاز مثبت تشکیل دهند؛ این سلولها در تراکم بالاتر، رشد بیشتری دارند. بنظر می‌رسد این سلولها از نظر مرحله تمایز، به سلول‌های بنیادی جنینی نزدیکتر باشند. 2 Introduction: Stem-cell therapy has recently been proposed as a useful technique in the treatment of various illnesses, particularly degenerative diseases.Human Umbilical Cord Mesenchymal cells (hUCM) are among the stem cells which have received more attention in recent years.The current study was designed to investigate the culture conditions of these cells and to study some biological and biochemical properties of these cells, such as alkaline phosphatase activity, colony formation properties in hanging drops culture and the growth rate in various cell concentrations.Materials and Methods: Human umbilical cord was collected following a healthy cesarean section at the operation room of Afzalipour Educational Hospital. Matrix fragments were cultured by organ explant method. The attached cells at confluence of >80% were sub-cultured in new culture dishes and were seeded at a 1×106 density for morphologic evaluations. Upon colony formation of the cells, they were further stained to detect alkaline phosphatase enzyme activity. Furthermore, cells at a 1×105 density were cultured in hanging drops for 48 hours and subsequently alkaline phosphatase activity was evaluated in the resultant colonies. In addition, cells were seeded at various densities in 96-well culture plates and cell activity was measured by Wst-1 cell proliferation assay kit following 48 hours of culture incubation.Results: HUCM cells formed alkaline phosphatase positive colonies in culture, as well as in hanging drops. Cell activity was correlated with cell population at the start of cell cultivation. Increased concentration of cells at the beginning of culture led to increased cell activity upon 48 hours of incubation.Conclusion: HUCM cells expressed alkaline phosphatase enzyme in vitro and constituted colonies in hanging drops. In addition, hUCM cells showed higher activity when cultured in larger populations. It seems that hUCM cells resemble both embryonic and some adult stem cells. Therefore, further study on the characteristics of these cells could provide a basis for their application in regenerative medicine. 07 16 Seyed Noureddin SN Nematollahi-Mahani سید نورالدین نعمت‌اللهی ماهانی Department of Anatomy, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences Department of Anatomy, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences Iran nnematollahi@kmu.ac.ir Mohammad M Rezazadehkermani محمد رضازاده‌کرمانی Medical Students Research Center, Kerman University of Medical Sciences Medical Students Research Center, Kerman University of Medical Sciences Iran Mostafa M Latifpour مصطفی لطیف‌پور Department of Anatomy, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences Department of Anatomy, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences Iran Parvin P Salehinejad پروین صالحی‌نژاد Nursery School, Kerman University of Medical Sciences Nursery School, Kerman University of Medical Sciences Iran Alkaline phosphataseCell proliferationCell therapyMesenchymal stem cellsPluripotent stem cellsUmbilical cord 353.pdf K?rbling M, Estrov Z. Adult stem cells for tissue repair - a new therapeutic concept? N Engl J Med. 2003;349 (6):570-82.##McElreavey KD, Irvine AI, Ennis KT, McLean WH. Isolation, culture and characterisation of fibroblast-like cells derived from the Whartons jelly portion of human umbilical cord. Biochem Soc Trans. 1991;19(1):29S.##Mitchell KE, Weiss ML, Mitchell BM, Martin P, Davis D, Morales L, et al. Matrix cells from Whartons jelly form neurons and glia. Stem Cells. 2003;21(1):50-60.##Kobayashi K, Kubota T, Aso T. Study on myofibro-blast differentiation in the stromal cells of Whartons jelly: expression and localization of alpha-smooth muscle actin. Early Hum Dev. 1998;51(3):223-33.##Kadner A, Hoerstrup SP, Tracy J, Breymann C, Maurus CF, Melnitchouk S, et al. Human umbilical cord cells: a new cell source for cardiovascular tissue engineering. Ann Thorac Surg. 2002;74(4):S1422-8.##Bailey MM, Wang L, Bode CJ, Mitchell KE, Detamore MS. A comparison of human umbilical cord matrix stem cells and temporomandibular joint condylar chondrocytes for tissue engineering temporoman-dibular joint condylar cartilage. Tissue Eng. 2007;13 (8):2003-10.##Medicetty S, Bledsoe AR, Fahrenholtz CB, Troyer D, Weiss ML. Transplantation of pig stem cells into rat brain: proliferation during the first 8 weeks. Exp Neurol. 2004;190(1):32-41.##Wang HS, Hung SC, Peng ST, Huang CC, Wei HM, Guo YJ, et al. Mesenchymal stem cells in the Whar-tons jelly of the human umbilical cord. Stem Cells. 2004;22(7):1330-7.##Weiss ML, Medicetty S, Bledsoe AR, Rachakatla RS, Choi M, Merchav S, et al. Human umbilical cord matrix stem cells: preliminary characterization and effect of transplantation in a rodent model of Parkin-sons disease. Stem Cells. 2006;24(3):781-92.##Carlin R, Davis D, Weiss M, Schultz B, Troyer D. Expression of early transcription factors Oct-4, Sox-2 and Nanog by porcine umbilical cord (PUC) matrix cells. Reprod Biol Endocrinol. 2006;4:8.##Jomura S, Uy M, Mitchell K, Dallasen R, Bode CJ, Xu Y. Potential treatment of cerebral global ischemia with Oct-4 umbilical cord matrix cells. Stem Cells. 2007;25(1):98-106.##Hoynowski SM, Fry MM, Gardner BM, Leming MT, Tucker JR, Black L, et al. Characterization and differ-entiation of equine umbilical cord-derived matrix cells. Biochem Biophys Res Commun. 2007;362(2):347-53.##Tian X, Fu R, Deng L. [Method and conditions of isolation and proliferation of multipotent mesenchymal stem cells]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007;21(1):81-5. Chinese.##Troyer DL, Weiss ML. Whartons jelly-derived cells are a primitive stromal cell population. Stem Cells. 2008;26(3):591-9.##Cho PS, Messina DJ, Hirsh EL, Chi N, Goldman SN, Lo DP, et al. Immunogenicity of umbilical cord tissue derived cells. Blood. 2008;111(1):430-8.##Raio L, Cromi A, Ghezzi F, Passi A, Karousou E, Viola M, et al. Hyaluronan content of Whartons jelly in healthy and Down syndrome fetuses. Matrix Biol. 2005;24(2):166-74.##Sobolewski K, Ma?kowski A, Ba?kowski E, Jaworski S. Wharton s jelly as a reservoir of peptide growth factors. Placenta. 2005;26(10):747-52.##Karahuseyinoglu S, Cinar O, Kilic E, Kara F, Akay GG, Demiralp DO, et al. Biology of stem cells in human umbilical cord stroma: in situ and in vitro sur-veys. Stem Cells. 2007;25(2):319-31.##Yu X, Jin G, Yin X, Cho S, Jeon J, Lee S, et al. Isolation and characterization of embryonic stem-like cells derived from in vivo-produced cat blastocysts. Mol Reprod Dev. 2008;75(9):1426-32.##Guo Y, Mantel C, Hromas RA, Broxmeyer HE. Oct-4 is critical for survival/antiapoptosis of murine embry-onic stem cells subjected to stress: effects associated with Stat3/ survivin. Stem Cells. 2008;26(1):30-4.##Takechi K, Kuwabara Y, Mizuno M. Ultrastructural and immunohistochemical studies of Wharton s jelly umbilical cord cells. Placenta. 1993;14(2):235-45.##

اثرات داروی اسپيرونولاکتون روی هورمون‌هاي محور هيپوفيز- گناد در موشهای صحرايی ماده Effects of Spironolactone on Pituitary-Gonadal Axis Hormones in Adult Female Rats 2 1 زمينه و هدف: اسپيرونولاکتون به عنوان یک داروی دیورتیک و آنتاگونيست آلدوسترون در درمان فشار خون بالا، اختلالات کبدی، کلیوی و قلبی و همچنين پرمويي در زنان مصرف می‌گردد. از اثرات جانبی این دارو، کاهش میل جنسی و اختلال درقاعدگی گزارش شده است. با توجه به عدم بررسي اثرات اسپیرونولاکتون روی هورمون‌های محور هیپوفیزـ گنادها، اين تحقيق با هدف بررسی اثرات احتمالی اين دارو بر هورمون‌هاي اين محور انجام گرفت.روش بررسي: پژوهش حاضر روي پنج گروه موش صحرايی بالغ، هر گروه شامل نه سر موش انجام شد. گروه کنترل هيچ دارويی دريافت نکردند. گروه شم حلال داروی اسپيرونولاکتون (سرم فيزيولوژی) و گروه‌های تيمار 1 تا 3 به ترتيب غلظت‌هاي 25 و50 و mg/kgBW100 اسپيرونولاكتون را به صورت دهانی‌ـ حلقی (خوراکی) و به مدت 14 روز دريافت کردند. پس از طی اين مدت هورمون‌هاي LH, FSH ،استروژن و پروژسترون به روش راديوايمونواسي (RIA) مورد سنجش قرار گرفت و نتايج حاصل بين گروه كنترل و ساير گروهها مورد مقايسه قرار گرفت. 05/0p< به عنوان سطح معني‌داري در نظر گرفته شد. نتايج: میانگین غلظت هورمون‌ FSH در گروه‌های تیمار 1 تا 3 و گروه‌هاي شم و کنترل (به صورت MSEM)به ترتیب 01/±11/0، 02/±14/0، 06/±38/0، 02/0±16/0 و 03/±18/0 بود که فقط در گروه تیمار 3 افزایش معنی‌داری را نسبت به گروه کنترل نشان داد. مقدار هورمون LH نيز به ترتیب 01/±13/0، 02/±19/0، 02/±14/0، 02/±13/0 و 02/±12/0 بود که فقط در دوز mg/kg B.W.50 نسبت به گروه کنترل تغییرات معنی‌داری ديده شد. کلیه مقادیر LH, FSH بر حسب mIU/mL می‌باشد. مقادير هورمون است روژن بر حسب pg/mL به ترتیب 03/21±9/99، 5/22±7/143، 01/32±1/139، 04/32±9/131 و 37/46±2/125 و همچنين مقادیر هورمون پروژسترون بر حسب pMol/mL به ترتیب 9/24±2/100، 09/15±6/72، 7/19±4/79، 02/26±1/62 و 6/27±5/66 بود که در هیچ یک از گروه‌های تجربی و شم نسبت به گروه کنترل اختلاف معنی‌داری مشاهده نشد.نتيجه‌گيری: نتایج مطالعه حاضر نشانگر تاثیر معنی‌دار و وابسته به دوز داروی اسپيرونولاکتون بر هورمون‌های LH وFSH می‌باشد. همچنین بیانگر این است که این دارو تاثیری بر غلظت هورمون‌های جنسی ندارد و بنابراین مصرف آن باعث اختلالات هورمونی نمی‌گردد. 2 Introduction: Spironolactone is a diuretic drug with aldosterone-antagonistic properties, used in the treatment of hypertension, congestive heart failure, cirrhosis, kidney disorders, and hirsutism. Some studies have reported decreased libido and menstrual disorders as the side-effects of this medication. The present study was done to investigate the effects of spironolactone on pituitary-gonadal axis hormones.Materials and Methods: Five groups of rats, each including nine adult females and with an average weight of 180 – 200gr, were selected. The control group received no drugs, while the sham group received spironolactone solvent (Normal saline), and the three experimental groups were put on oral spironolactone 25, 50 and 100mg/kg of the total body weight for 14 days. Hormonal measurements, including luteinizing hormone (LH), follicle stimulating hormone (FSH) and progesterone were performed by radioimmunoassay (RIA) after the test interval.Results: The mean values for FSH (mIU/ml) were 0.11±0.01, 0.14±0.02, 0.38±0.06, 0.16±0.02 and 0.18±0.03 for the three experimental (at 25, 50 and 100mg/kg doses of spironolactone), sham and the control groups, respectively with significant increase in the third experimental group in comparison to the controls. LH concentrations (mIU/ml) were 0.130.01, 0.190.02, 0.140.02, 0.130.02 and 0.120.02 respectively with significant increases at 50mg/kg spironolactone intake. Estrogen concentrations (pg/ml) were 99.921.03, 143.722.5, 139.132.01, 131.932.04 and 125.246.37, whilst progesterone concentrations (pMol/ml) were 100.224.9, 72.615.09, 79.419.7, 62.126.02 and 66.527.6 respectively with no significant changes in the experimental, sham or the control groups. Conclusion: Spironolactone had significant and dose-dependent effects on LH and FSH hormones. However, the medication neither had any negative effects on the concentration or production of sex steroids nor on the function of the gonads. Therefore, its intake does not interfere with hormonal and subsequently gonadal functions. 16 25 Farhad F Moradi فرهاد مرادی Department of Biology, Faculty of Science, Azad Islamic University Department of Biology, Faculty of Science, Azad Islamic University Iran Akbar A Zeraatpishe اکبر زراعت پیشه Department of Biology, Faculty of Science, Azad Islamic University Department of Biology, Faculty of Science, Azad Islamic University Iran a.zeraatpishe@yahoo.com Mehrdad M Shariati مهرداد شریعتی Department of Biology, Islamic Azad University Department of Biology, Islamic Azad University Iran Mokhtar M Mokhtari مختار مختاری Department of Biology, Islamic Azad University Department of Biology, Islamic Azad University Iran Female fertilityGonadal axisGonadotropinPituitarySex hormoneSex steroidSexual functionSpironolactone 354.pdf Katzung BG. Basic and clinical pharmacology. 10th ed. Toronto: McGraw-Hill; 2006. Chapter 15, Diurtic agents; p. 246-52.##Katzung BG. Basic and clinical pharmacology. 10th ed. Toronto: McGraw-Hill; 2006. Chapter 39, Adreno-corticosteroids & Adrenocorticalantagonists; p. 650.##Katzung BG. Basic and clinical pharmacology. 10th ed. Toronto: McGraw-Hill; 2006. Chapter 41, The gonadal hormones & inhibitors; p. 678-80.##Preston RA, Norris PM, Alonso AB, Ni P, Hanes V, Karara AH. Randomized, placebo-controlled trial of the effects of drospirenone-estradiol on blood pressure and potassium balance in hypertensive postmenopausal women receiving hydrochlorothiazide. Menopause. 2007;14(3 Pt 1):408-14.##Rapkin AJ, Winer SA. Drospirenone: a novel progestin. Expert Opin Pharmacother. 2007;8(7):989-99. Review.##Hauben M, Reich L, Gerrits CM, Madigan D. Detec-tion of spironolactone-associated hyperkalaemia fol-lowing the Randomized Aldactone Evaluation Study (RALES). Drug Saf. 2007;30(12):1143-9.##Baumann M, Megens R, Bartholome R, Dolff S, van Zandvoort MA, Smits JF, et al. Prehypertensive renin-angiotensin-aldosterone system blockade in spontan-eously hypertensive rats ameliorates the loss of long-term vascular function. Hypertens Res. 2007;30(9): 853-61.##Vacher C, Ferrière F, Marmignon MH, Pellegrini E, Saligaut C. Dopamine D2 receptors and secretion of FSH and LH: role of sexual steroids on the pituitary of the female rainbow trout. Gen Comp Endocrinol. 2002; 127(2):198-206.##Frances JH, Decruz S, William FJ, Serroni N. Prolactin, LH, FSH and TSH responses to a dopamine antagonist Crowly. J Clin Endocrinol Metab. 2003;86 (1):53-58.##Shevchenko IuL, Vetshev PS, Podzolkov VI, Ippoli-tov LI, Rodionov AV, Polunin GV. [Current aspects of diagnosis and treatment of symptomatic arterial hypertension of adrenal genesis]. Ter Arkh. 2003;75 (4):8-15. Russian.##Ebeid TA, Eid YZ, El-Abd EA, El-Habbak MM. Effects of catecholamines on ovary morphology, blood concentrations of estradiol-17beta, progesterone, zinc, triglycerides and rate of ovulation in domestic hens. Theriogenology. 2008;69(7):870-6.##Zouboulis CC, Chen WC, Thornton MJ, Qin K, Rosenfield R. Sexual hormones in human skin. Horm Metab Res. 2007;39(2):85-95.##De Berardis D, Serroni N, Salerno RM, Ferro FM. Treatment of premenstrual dysphoric disorder (PMDD) with a novel formulation of drospirenone and ethinyl estradiol. Ther Clin Risk Manag. 2007;3(4):585-90.##Pétra PH, Stanczyk FZ, Namkung PC, Fritz MA, Novy MJ. Direct effect of sex steroid-binding protein (SBP) of plasma on the metabolic clearance rate of testosterone in the rhesus macaque. J Steroid Biochem. 1985;22(6):739-46.##Knüttgen D, Wappler F. [Anaesthesia for patients with adrenal gland diseases]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2007;42(3):170-8. German.##Corbould A. Effects of spironolactone on glucose transport and interleukin-6 secretion in adipose cells of women. Horm Metab Res. 2007;39(12):915-8.##Ganie MA, Khurana ML, Eunice M, Gupta N, Gulati M, Dwivedi SN, et al. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab. 2004;89(6):2756-62.##B?ckstr?m T, Andreen L, Birzniece V, Bj?rn I, Johansson IM, Nordenstam-Haghjo M, et al. The role of hormones and hormonal treatments in premenstrual syndrome. CNS Drugs. 2003;17(5):325-42.##Wu KM, Farrelly JG. Preclinical development of new drugs that enhance thyroid hormone metabolism and clearance: inadequacy of using rats as an animal model for predicting human risks in an IND and NDA. Am J Ther. 2006;13(2):141-4. Review.##Buss SJ, Backs J, Kreusser MN, Hardt SE, Maser-Gluth C, Katus HA, et al. Spironolactone preserves cardiac norepinephrine re-uptake in salt- sensitive Dahl rats. Endocrinology. 2006;147(5):252-34.##Adriaens I, Jacquet P, Cortvrindt R, Janssen K, Smitz J. Melatonin has dose-dependent effects on folliculo-genesis, oocyte maturation capacity and steroidogen-esis. Toxicology. 2006;228(2-3):333-43.##Watts BA 3rd, George T, Good DW. Aldosterone inhibits apical NHE3 and HCO3- absorption via a nongenomic ERK-dependent pathway in medullary thick ascending limb. Am J Physiol Renal Physiol. 2006;291(5):F1005-13.##Sabbieti MG, Marchetti L, Menghi G, Yamamoto K, Kikuyama S, Vaudry H, et al. Occurrence of beta-endorphin binding sites in the pituitary of the frog Rana esculenta: effect of beta-endorphin on luteinizing hormone secretion. Gen Comp Endocrinol. 2003;132 (3):391-8.##Takebayashi K, Matsumoto S, Aso Y, Inukai T. Aldosterone blockade attenuates urinary monocyte chemoattractant protein-1 and oxidative stress in patients with type 2 diabetes complicated by diabetic nephropathy. J Clin Endocrinol Metab. 2006;91(6): 2214-7.##Swaminathan K, Davies J, George J, Rajendra NS, Morris AD, Struthers AD. Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, gly-caemic control and hormonal profiles. Diabetologia. 2008;51(5):762-8.##Sainsbury A, Herzog H. Inhibitory effects of central neuropeptide Y on the somatotropic and gonadotropic axes in male rats are independent of adrenal hormones. Peptids. 2001;22(3):467-71.##Karram T, Abbasi A, Keidar S, Golomb E, Hochberg I, Winaver J, et al. The role of mineralocoticoid recap-tors in the circadian activity of the human hypo-thalamus-pituitary- adrenal system: effect of age. Neurobiol Aging. 2000;21(4):585-9.##Ferreira R, Oliveira JF, Fernandes R, Moraes JF, Goncalves PB. The role of angiotensin II in the early stages of bovine ovulation. Reproduction. 2007;134(5): 713-9.##Ito O, Omata K, Ito S, Hoagland KM, Roman RJ. Effects of converting enzyme inhibitors on renal P-450 metabolism of arachidonic acid. Am J Physiol Regul Integr Comp Physiol. 2001;280(3):R822-830.##Fernandez MD, Carter GD, Palmer TN. The interact-tion of canrenone with oestrogen and progesterone receptors in human uterine cytosol. Br J Clin Pharmacol. 1983;15(1):95-101.##Iranzo A, Santamar?a J, Vilaseca I, de Osaba MJ. Absence of alterations in serum sex hormone levels in idiopathic REM sleep behavior disorder. Sleep. 2007 ;30(6):803-6.##

تأثیر تحریک تخمک‌گذاری و پانکچر تخمدانها روی میزان CRP سرم Effects of Ovulation Induction and Ovarian Puncture on CRP Levels in Subjects Undergoing IVF/ICSI 2 1 زمينه و هدف: تحریک تخمک‌گذاری، از فاکتورهای مهم در موفقیت روش‌هاي لقاح خارج رحمي محسوب می‌شود. CRP یک مارکر بیولوژیک نشان‌دهنده التهاب سیستمیک می‌باشد که با تحریک هورمونی افزایش مي‌یابد. تغییرات CRP به عنوان یک مارکر التهابی می‌تواند روی موفقیت IVF/ICSI مؤثر باشد. هدف از این مطالعه، بررسی اثر مصرف داروهای هورمونی و تحریک تخمک‌گذاری و همچنین دريافت تخمك از تخمدانها (پانكچر)، در میزان CRP سرم در بیماران داوطلب IVF/ICSI می‌باشد.روش بررسي: اين مطالعه از نوع مشاهده‌اي، توصيفي‌ـ تحليلي بود و روی 70 بیمار نابارور داوطلب IVF/ICSI که با پروتکل استاندارد Long در مرکز فوق تخصصی ابن‌سینا تحت تحریک تخمک‌گذاری قرار گرفته‌اند، طي سال‌هاي 1386-1385 انجام شده است. CRP خون بیماران در 4 نوبت اندازه‌گیری شد، روز شروع سیکل، روز تزریق HCG، روز پانکچر و روز انتقال جنین. همچنین روز پانکچر از هر بیمار تحت بررسی، یک نمونه مایع فولیکولی شفاف نیز جمع‌آوري شد. میزان CRP در سرم و مایع فولیکولی با استفاده از روش الایزای رقابتی بررسی شد. نتایج حاصل با استفاده از آزمون‌های t زوجي، من‌ـ ويتني، ويلكسون و فريدمن آنالیز شد و سطح معني‌داري، 05/0p< در نظر گرفته شد.نتایج: بررسي نشان داد که CRP سرم در تمامی بیماران، از زمان شروع سیکل تا پس از تزریق HCG و در 2/82% بیماران پس از پانکچر (به ترتیب µg/ml00/197/3، µg/ml26/254/5، µg/ml16/461/6)، افزایش معنی‌دار را نشان مي‌دهد (001/0p<). همچنین بین تغییرات CRP و میزان استرادیول سرم در روز تزریق HCG، ارتباط معنی‌داری وجود نداشت.نتیجه‌گیری: تحریک تخمک‌گذاری و همچنین پانکچر تخمدانها، باعث تحریک و التهاب سیستمیک می‌شود.CRP در طول سیکل تحریک تخمک‌گذاری و همچنین پس از تزریق HCG، و بخش عمده‌اي از بیماران پس از پانکچر، افزایش می‌یابد که احتمالاً این تغییرات می‌تواند روی نتایج بعدیIVF/ICSI اثرگذار باشد. 2 Introduction: Controlled ovarian hyperstimulation (COH) is an important factor in IVF/ICSI success rates. CRP is a serological marker for systemic inflammation and it increases following hormonal stimulation. Probable inflammation following ovulation induction and ovarian puncture, in regards to CRP changes, might affect the outcomes of IVF programs. The present study was conducted to determine the effects of ovulation induction and puncture of ovaries on serum CRP levels in IVF/ICSI candidates. Materials and Methods: This observational, descriptive-analytical study was performed at Avicenna Infertility Clinic during 2006 – 2007. COH was performed on 70 infertile patients who were candidates for IVF/ICSI, using standard long GnRH agonist protocol. Peripheral blood was drawn four times during the treatment cycle on the first day of stimulation and the days of HCG injection, ovary puncture, and embryo transfer. Non-serosanguinous follicular fluid samples were taken at the time of ovum pick up from each individual too. CRP levels were measured in follicular fluid and serum using competitive ELISA methods.Results: Serum CRP levels increased along with the stimulation cycle, from the first day of the procedure to the day of HCG injection but significant increases were seen in 82.2% of the cases following ovary puncture (respectively, 3.97±1.00g/ml, 5.54±2.26g/ml and 6.61±4.16g/ml; p<0.001). There were no significant correlations between serum estradiol and CRP levels.Conclusion: Controlled ovarian hyperstimulation and ovarian puncture potentiate systemic inflammation. Serum CRP levels increase during ovulation induction cycle and also after HCG injection, but not in all patients undergoing ovarian puncture. These inflammatory reactions may affect IVF/ICSI outcomes. 25 32 Soheila S Arefi سهیلا عارفی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad M Babashamsi محمد بابا‌شمسی Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR) Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR) Iran babashams@avicenna.ac.ir Pouneh P Shariatpanahi پونه شریعت‌پناهی Payam-e-Noor University, Tehran branch Payam-e-Noor University, Tehran branch Iran Elham E Savadi-Shiraz Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Controlled ovarian hyperstimulationC-reactive proteinInfertilityInflammationIntracytoplasmic sperm injection<i>In Vitro</i> fertilizationOvarian punctureAssisted Reproductive Techniques 355.pdf Kluft C, Leuven JA, Helmerhorst FM, Krans HM. Pro-inflammatory effects of oestrogens during use of oral contraceptives and hormone replacement treatment. Vascul Pharmacol. 2002;39(3):149-54.##Trevisanuto D, Doglioni N, Altinier S, Zaninotto M, Plebani M, Zanardo V. High-sensitivity C-reactive pro-tein in umbilical cord of small-for-gestational-age neo-nates. Neonatology. 2007;91(3):186-9.##Lohsoonthorn V, Qiu C, Williams MA. Maternal serum C-reactive protein concentrations in early pregnancy and subsequent risk of preterm delivery. Clin Biochem. 2007;40(5-6):330-5.##Garc?a RG, Celed?n J, Sierra-Laguado J, Alarc?n MA, Luengas C, Silva F, et al. Raised C-reactive protein and impaired flow-mediated vasodilation precede the de-velopment of preeclampsia. Am J Hypertens. 2007;20 (1):98-103.##Coussons-Read ME, Okun ML, Nettles CD. Psycho-social stress increases inflammatory markers and alters cytokine production across pregnancy. Brain Behav Immun. 2007;21(3):343-50.##de Maat MP, Madsen JS, Langdahl B, Bladbjerg EM, Tofteng CL, Abrahamsen B, et al. Genetic variation in estrogen receptor, C-reactive protein and fibrinogen does not predict the plasma levels of inflammation markers after longterm hormone replacement therapy. Thromb Haemost. 2007;97(2):234-9.##Meier-Ewert HK, Ridker PM, Rifai N, Price N, Dinges DF, Mullington JM. Absence of diurnal variation of C-reactive protein concentrations in healthy human sub-jects. Clin Chem. 2001;47(3):426-30.##Orvieto R, Chen R, Ashkenazi J, Ben-Haroush A, Bar J, Fisch B. C-reactive protein levels in patients under-going controlled ovarian hyperstimulation for IVF cycle. Hum Reprod. 2004;19(2):357-9.##Wood WG, Lüdemann J, Mitusch R, Heinrich J, Maass R, Frick U. Evaluation of a sensitive immunolumino-metric assay for the determination of C-reactive protein (CRP) in serum and plasma and the establishment of reference ranges for different groups of subjects. Clin Lab. 2000;46(3-4):131-40.##St?rk S, Bots ML, Grobbee DE, van der Schouw YT. Endogenous sex hormones and C-reactive protein in healthy postmenopausal women. J Intern Med. 2008; 264(3):245-53.##Wunder DM, Kretschmer R, Bersinger NA. Concen-trations of leptin and C-reactive protein in serum and follicular fluid during assisted reproductive cycles. Hum Reprod. 2005;20(5):1266-71.##Orvieto R, Schwartz A, Bar-Hava I, Abir R, Ashke-nazi J, La-Marca A, et al. Controlled ovarian hyper-stimulation--a state of endothelial activation. Am J Reprod Immunol. 2000;44(5):257-60.##Levin I, Gamzu R, Pauzner D, Rogowski O, Shapira I, Maslovitz S, et al. Elevated levels of CRP in ovarian hyperstimulation syndrome: an unrecognised potential hazard? BJOG. 2005;112(7):952-5.##

فراواني عفونت با کلامیدیا تراکوماتیس در زنان نابارور و بارور با دو روش سرولوژی و مولکولی Prevalence of Chlamydia trachomatis Infection in Fertile and Infertile Women; A Molecular and Serological Study 2 1 زمينه و هدف: کلامیدیا تراکوماتیس، یکی از شایع‌ترین عوامل باکتریايي بیماری‌های مقاربتی در جهان می‌باشد و شواهد گسترده‌اي مبنی بر بسته شدن لوله‌ها، متعاقب ابتلا به عفونت‌های کلامیدیایی وجود دارد. حدود 80% زنان مبتلا به عفونت اين باكتري بدون علامت بوده؛ ولی عفونت‌های بالا رونده به‌صورت PID و متعاقب آن، ناباروري در خانم‌های مبتلا به کلامیدیا شایع مي‌باشد. با توجه به نقش اساسی عفونت کلامیدیا تراکوماتيس ‌در زمینه ناباروري لوله‌ای و دردهای مزمن لگنی، مطالعه حاضر طراحي شد تا با توجه به فراوانی اين عفونت در زنان نابارور و مقايسه آن با زنان باردار، اهميت غربالگري عفونت در انواع مختلف ناباروري ارزيابي شده و بعلاوه دو تست سرولوژي و الايزا از نظر تشخيص عفونت كلاميديايي مورد مقايسه قرار گيرند. روش بررسي: در مطالعه حاضر، 233 زن نابارور مراجعه‌کننده به درمانگاه ناباروري بيمارستان وليعصر (عج) و 225 زن باردار مراجعه‌کننده به درمانگاه پره‌ناتال بیمارستان امام خمینی (ره) و اورژانس زایمان، انتخاب شدند. از هر داوطلب شركت در مطالعه، پس از تكميل پرسشنامه، ml2 نمونه خون جهت بررسی آنتی‌بادی کلامیدیا روش (الایزا) و ml15 نمونه اول ادرار جهت انجام PCR، جمع‌آوري شد. اطلاعات پرسشنامه‌ها همراه با نتايج آزمايشات PCR و الايزا، مورد ارزيابي و مقايسه قرار گرفت. جهت آناليز داده‌ها، از آزمون‌هاي آماري 2، تست دقيق فيشر، تي مستقل و رگرسيون لجستيك چندگانه، با سطح معني‌داري 5% استفاده شد.نتايج: آزمايش PCR، در 29 مورد (8/13%) از افراد نابارور و 19 مورد (1/11%) از زنان باردار، مثبت گزارش شده است که این اختلاف معنی‌دار نبود. موارد مثبت وجود IgG عليه كلاميديا به روش الایزا، در زنان نابارور20 مورد (6/8%) و در زنان باردار 11 مورد (9/4%) و افزايش IgM 2 مورد در زنان نابارور (9/0%) و 4 مورد در زنان باردار (8/1%) مشاهده شد که ميزان تيتر مثبت براي دو گروه عليه كلاميديا و نيز بين سرم و ادرار اختلاف معني‌داري نداشت.نتيجه‌گيري: به‌نظر مي‌رسد فراواني عفونت با کلامیدیا (برمبنای IgM، IgGو آزمايش PCR) در زنان نابارور و باردار، از نظر آماری یکسان می‌باشد. نتایج حاکی از آن است که به واسطه حساسیت و ویژگی بالای روش‌هاي مولكولي تشخيص عوامل بيماري‌هاي عفوني می‌توان به آسانی از نمونه ادرار به عنوان یک روش غیرتهاجمی، به جاي نمونه خون كه يك روش تهاجمي است، برای غربالگری گونه‌های کلامیدیا به ویژه کلامیدیا تراکوماتیس استفاده نمود. 2 Introduction: Chlamydia trachomatis is one of the most common sexually transmitted infections (STIs) in the world. About 80% of the infected women are asymptomatic, while ascending infections such as pelvic inflammatory disease (PID) and the resultant infertility due to fallopian tube occlusion are common manifestations. Due to the higher prevalence of C. trachomatis infection in infertile than fertile women and the importance of screening for this infection in different types of infertility, this study was undertaken to compare two serologic and ELISA methods for the diagnosis of the bacteria in the two groups.Materials and Methods: In this cross-sectional study, the participants included 233 infertile women attending Vali-e-Asr Infertility Clinic and 225 fertile women attending the Prenatal Clinic and Emergency Labor of Imam Khomeini Hospital. Each participant completed a researcher-devised questionnaire and subsequently 2 mls of peripheral blood for serological studies and 15 ml of the first catch urine (FCU) for molecular detection of the germ through Polymerase Chain Reaction (PCR) method were obtained.Results: PCR results showed C. trachomatis infection in 29 (13.8%) infertile and 19 (11.1%) pregnant participants with no significant statistical differences. Serological results showed presence of Chlamydia IgG in 20 (8.6%) infertile and 11 (4.9%) fertile participants and Chlamydia IgM was observed in 2 (0.9%) infertile and 4 (1.8%) fertile participants with no significant differences.Conclusion: The prevalence of C. trachomatis infection among fertile and infertile women by serological and molecular methods was not significantly different. However, considering the high specificity and sensitivity of PCR, it could be used as a noninvasive screening technique for C. trachomatis, compared to the invasive method of blood sampling. 32 42 Batool B Hossein Rashidi بتول حسین رشیدی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Leili L Chamani Tabriz لیلی چمنی تبریز Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran lchamani@avicenna.ac.ir Fedyeh F Haghollahi فدیه حق‌اللهی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Fatemeh F Ramezanzadeh فاطمه رمضان زاده Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Mamak M Shariat مامک شریعت Maternal-Fetal-Neonatal Health Research Center, Tehran University of Medical Sciences Maternal-Fetal-Neonatal Health Research Center, Tehran University of Medical Sciences Iran Abbas A Rahimi Foroushani عباس رحیمی فروشانی Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Iran Faezeh F Daneshjoo فائزه دانشجو Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology 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 Soheila S Asgari سهیلا عسگری Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Chlamydia trachomatisInfertilityPolymerase chain reactionPregnancySerologySexually transmitted infectionTubal occlusion 356.pdf Stamm WE, Jones RB, Batteiger BE, editors. Chla-mydia trachomatis (Trachoma, perinatal infections, lymphogranuloma venereum, and other genital infec-tions). Philadelphia: Elsevier Churchill Livingstone; 2005: 2239 p. (Mandell GL, Dolin R, Bennette JE, editors. Principles and practice of infectious diseases; vol. 2).##Sciarra JJ. Sexually transmitted diseases: global import-ance. Int J Gynaecol Obstet. 1997;58(1):107-19.##Workowski KA, Levine WC, Wasserheit JN; Centers for Disease Control and Prevention, Atlanta, Georgia. US Centers for Disease Control and Prevention guide-lines for the treatment of sexually transmitted diseases: an opportunity to unify clinical and public health prac-tice. Ann Intern Med. 2002;137(4):255-62.##McGregor JA, French JI. Chlamydia trachomatis infec-tion during pregnancy. Am J Obstet Gynecol. 1991;164 (6 Pt 2): 1782-9. Review.##Sambrook J, Russell DW, editors. Molecular cloning: A laboratory manual. 3rd ed. Vol. 6, Preparation and analysis of eukaryotic genomic DNA. New York: Cold Spring Harbor Laboratory Press; 2001. 237 p.##Chaudhry U, Saluja D. Detection of Neisseria gonor-rhoeae by PCR using orf1 gene as target. Sex Transm Infect. 2002;78(1):72.##Marushko IuV, Desiatnyk DH, Bychkova NH, Marush-ko TV, Iehipko HV. [Characteristics of modern diagno-sis of diseases caused by Chlamydia bacteria]. Lik Sprava. 2002;(7):3-6. Ukrainian.##Hacker NF, Moore JG. Essentials of obstetrics and gy-necology. 3rd ed. Philadelphia: WB Saunders Com-pany; 1998: p. 507-37.##Sharma M, Sethi S, Daftari S, Malhotra S. Evidence of chlamydial infection in infertile women with fallopian tube obstruction. Indian J Pathol Microbiol. 2003;46 (4):680-3.##Practice Committee of American Society for Repro-ductive Medicine. Definitions of infertility and recur-rent pregnancy loss. Fertil Steril. 2008;90(5 Suppl): S60.##Debattista J, Gazzard CM, Wood RN, Allan JA, Allan JM, Scarman A, et al. Interaction of microbiology and pathology in women undergoing investigations for infertility. Infect Dis Obstet Gynecol. 2004;12(3-4): 135-45.##Siemer J, Theile O, Larbi Y, Fasching PA, Danso KA, Kreienberg R, et al. Chlamydia trachomatis infection as a risk factor for infertility among women in Ghana, West Africa. Am J Trop Med Hyg. 2008;78(2):323-7.##Rampersad J, Wang X, Gayadeen H, Ramsewak S, Ammons D. In-house polymerase chain reaction for affordable and sustainable Chlamydia trachomatis detection in Trinidad and Tobago. Rev Panam Salud Publica. 2007;22(5):317-22.##Badami N, Salari MH. Rate of Chlamydia tracho-matis, Mycoplasma hominis and Ureaplasma urea-lyticum in infertile females and control group. Iran J Public Health. 2001;30(1-2):57-60.##Chamani-Tabriz L, Tehrani M J, Zeraati H, Asgari S, Moini M, Rabbani H, et al. [A Molecular survey on prevalence of Chlamydia trachomatis infection in pregnant woman attending OB&GY clinics of Tehran]. Iran J Infect Dis Trop Med. 2007;13(41):45-50.Persian.##Chen XS, Yin YP, Chen LP, Thuy NT, Zhang GY, Shi MQ, et al. Sexually transmitted infections among pregnant women attending an antenatal clinic in Fuzhou, China. Sex Transm Dis. 2006;33(5):296-301.##Tukur J, Shittu SO, Abdul AM. A case control study of active genital Chlamydia trachomatis infection among patients with tubal infertility in northern Nigeria. Trop Doct. 2006;36(1):14-6.##S?nmez S, S?nmez E, Yasar L, Aydin F, Coskun A, Süt N. Can screening Chlamydia trachomatis by sero-logical tests predict tubal damage in infertile patients? New Microbiol. 2008;31(1):75-9.##Omo-Aghoja LO, Okonofua FE, Onemu SO, Larsen U, Bergstrom S. Association of Chlamydia trachomatis serology with tubal infertility in Nigerian women. J Obstet Gynaecol Res. 2007;33(5):688-95.##Idahl A, Boman J, Kumlin U, Olofsson JI. Demonstra-tion of Chlamydia trachomatis IgG antibodies in the male partner of the infertile couple is correlated with a reduced likelihood of achieving pregnancy. Hum Reprod. 2004;19(5):1121-6.##Land JA, den Hartog JE. Chlamydia antibody testing in subfertile women. Drugs Today (Barc). 2006;42 Suppl A:35-42. Review.##Thomas K, Coughlin L, Mannion PT, Haddad NG. The value of Chlamydia trachomatis antibody testing as part of routine infertility investigations. Hum Reprod. 2000;15(5):1079-82.##Chamani-Tabriz L, Tehrani MJ, Akhondi MM, Mosavi-Jarrahi A, Zeraati H, Ghasemi J, et al. Chla-mydia trachomatis prevalence in Iranian women attending obstetrics and gynaecology clinics. Pak J Biol Sci. 2007;10(24):4490-4.##Chamani-Tabriz L, Tehrani MJ, Zeraati H, Asgari S, Tarahomi M, Moini M, et al. [A molecular survey of Chlamydia trachomatis infection in married women: a cross sectional study on 991 women]. Tehran Univ Med J. 2008;66(7):485-91. Persian.##Malik A, Jain S, Rizvi M, Shukla I, Hakim S. Chla-mydia trachomatis infection in women with secondary infertility. Fertil Steril. 2009;91(1):91-5.##Hvid M, Baczynska A, Deleuran B, Fedder J, Knud-sen HJ, Christiansen G, et al. Interleukin-1 is the initi-ator of fallopian tube destruction during Chlamydia trachomatis infection. Cell Microbiol. 2007;9(12): 2795-803.##Cravioto Mdel C, Matamoros O, Villalobos-Zapata Y, Pe?a O, Garc?a-Lara E, Mart?nez M, et al. [Prevalence of anti-Chlamydia trachomatis and anti-Neisseria gonorrhoeae antibodies in Mexican populations]. Salud Publica Mex. 2003;45(5 Suppl):S681-9. Review. Spanish.##Den Hartog JE, Land JA, Stassen FR, Slobbe-van Drunen ME, Kessels AG, Bruggeman CA. The role of chlamydia genus-specific and species-specific IgG antibody testing in predicting tubal disease in subfertile women. Hum Reprod. 2004;19(6):1380-4.##Wallace LA, Scoular A, Hart G, Reid M, Wilson P, Goldberg DJ. What is the excess risk of infertility in women after genital chlamydia infection? A systematic review of the evidence. Sex Transm Infect. 2008;84(3): 171-5.##Kanayama A, Fujihara E, Saika T, Kobayashi I, Onoye Y. [Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine samples of males and females by the strand displacement amplification (SDA) method]. Kansenshogaku Zasshi. 2008;82(3): 182-6. Japanese.##Fedorova VA, Bannikova VA, Alikberov ShA, Eli-seev IuIu, Grashkin VA. [Comparative efficiency of detection of the causative agent of urogenital chla-mydiasis by immunofluorescence, polymerase chain reaction, and dot immunoassay]. Klin Lab Diagn. 2007;7:30-5. Russian.##

عملكرد جنسي و هورمونی مردان نابارور مبتلا به آزواسپرمي غيرانسدادی Sexual and Hormonal Profiles of Infertile Subjects with Non-Obstructive Azoospermia 2 1 زمینه و هدف: طي سال‌هاي اخير پيشرفت‌هاي شگفت‌‌انگيزي در پي بردن به علل آزواسپرمي، اساس ژنتيكي آن و غلبه بر ناباروري اين افراد به كمك روش‌هاي كمك باروري صورت گرفته است، اما كيفيت زندگي اين افراد به‌طور عام و عملكرد جنسي آنها به‌طور خاص، كمتر بررسي شده است. عملكرد جنسي، از جنبه‌هاي مختلف یعنی وضعيت نعوظ آلت تناسلي، وضعيت انزال مايع مني، تمايل جنسي و فواصل نزديكي جنسی كه هركدام به تنهايي يا با همديگر ممكن است در يك فرد دچار اختلال شوند، قابل بررسی است. در اين مطالعه ضمن ارائه تابلوي باليني و هورموني افراد با آزواسپرمي غيرانسدادي مراجعه كننده بدليل ناباروري عملكرد جنسي، اين افراد مورد بررسي قرار خواهد گرفت. روش‌ بررسی: در اين مطالعه توصيفي، بيش از 300 بيمار با ناباروري مردانه و با تشخیص آزواسپرمي غير انسدادي مراجعه‌كننده به مركز درمان ناباروري ابن‌سينا طي دورة زماني مهرماه 1383 تا آذرماه 1385، وارد مطالعه شدند. براساس پرسشنامه مندرج در ‌پرونده ‌پزشکی بیماران كه شامل متغيرهاي ميل جنسي، نعوظ آلت تناسلي،‌ انزال مايع مني، مدت زمان تا وقوع انزال، اوج لذت جنسي و دفعات مقاربت جنسي مي‌باشد، عملکرد جنسي هر بيمار قبل از هرگونه اقدام تشخيصي‌ـ درماني مورد بررسی قرار گرفت. معاينه باليني به منظور بررسي تظاهرات كاهش آندروژن انجام شد. آزمايش اسپرموگرام مطابق معيارهاي WHO بعمل آمد. سنجش هورموني شامل LH، FSH و PRL به روش IRMA انجام شد و سطح سرمي تستوسترون با راديوايمونواسي اندازه‌گيري شد. در تمامی این بیماران آزمایش عدم اعتیاد درخواست گردید كه در صورت مثبت بودن تست مورفين يا سابقه سوء مصرف و وابستگي به هر نوع ماده مخدر، محرك يا مصرف طولاني مدت هر نوع دارو، از مطالعه كنار گذاشته شدند. در نهايت پس از اخذ رضايت‌نامه كتبي از مراجعين و با كنار گذاشتن افراد مصرف كننده مواد يا دارو، 279 نفر وارد مطالعه شدند. بيوپسي بيضه تحت بي‌حسي موضعي و با تكنيك استاندارد انجام گرفت. نتایج: تمايل جنسي در 90% بيماران طبيعی بود؛ در حاليكه در 10% بيماران، كاهش خفيف تمايل جنسي ديده شد. عملكرد نعوظ در 80% طبيعي، با قابليت انجام مقاربت طبيعي و تنها 20% مردان نعوظ كاهش يافته به هنگام دخول در واژن داشتند. در خصوص انزال، در 75% مردان حجم مايع مني طبيعي بود؛ در حاليكه 25% كاهش حجم مني داشتند. مدت زمان صرف شده تا انجام انزال، در 5/42% طبيعي و زود يا دير انزالي شديد در 10% مردان گزارش شد. اوج لذت جنسي (ارگاسم) در 80% طبيعي، كاهش مختصر در 15% و كاهش شديد در 5% اعلام شد. 8/54%‌ اين بيماران داراي بيضه‌هاي كوچك بودند. نرموگنادوتروپيسم، هيپرگنادوتروپيسم و هيپوگنادوتروپيسم به ترتيب در 125 (8/44%)، 139 (8/49%) و 15 نفر (3/5%) مشاهده شد. مقادير متوسط FSH، LH، تستوسترون و پرولاكتين به ترتيب mIU/ml4/25±5/24، mIU/ml2/7±9، ng/ml4/4±1/6 و ng/ml224±284 بود. در بيوپسي بيضه 42 بيمار (15%) كاهش اسپرماتوژنز به همراه وجود اسپرم بالغ گزارش گرديد. آتروفي بيضه در 8/21%، توقف بلوغ در 2/22%، سندرم سلول سرتولي تنها در 8/40% و هيپرپلازي سلول‌هاي لايديگ در 8/11% گزارش شد. نتيجه‌گيري: شيوع اختلالات جنسي در بيماران با آزواسپرمي غيرانسدادي، در حد شيوع اختلالات جنسي در جمعيت عمومي مي‌باشد؛ اما به دليل غالب بودن مشكل ناباروري در بيماران آزواسپرم، به اختلال عملكرد جنسي آنها كمتر توجه مي‌شود. توجه خاص به اين مشكلات به هنگام دنبال نمودن درمان ناباروري علاوه بر بهبود كيفيت زندگي،‌ در برخي موارد درمان ناباروري را نيز اثر بخش‌تر خواهد كرد. 2 Introduction: Recent advances in the field of male infertility has led to a better understanding about the etiologies and genetic basis of azoospermia, as well as the availability of surgical sperm retrieval methods and intracytoplasmic sperm injection (ICSI) for its treatment. Nevertheless, the quality of life of these patients in general, and sexual function in particular, have not been explored adequately. The aim of this study was to evaluate the sexual function of infertile patients with non-obstructive azoospermia.Materials and Methods: In this descriptive study, as much as 300 infertile men with non-obstructive azoospermia, who referred to Avicenna Infertility Clinic, in Tehran, Iran, were enrolled into the study during October 2004 to November 2006. Afterwards, 21 men were eliminated from the study because they met the exclusion criteria. At first, sexual functions of the patients were evaluated by a questionnaire, including questions on libido, penile erection, seminal ejaculation, inter intromission interval, orgasm and frequency of sexual intercourse. Physical examination was carried out to evaluate signs of androgenic deficiency. Semen samples were analyzed according to the current World Health Organization laboratory manual. Serum luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin (PRL) concentrations were measured by immunoradiometric assays (IRMA) and serum testosterone measurement was done by radioimmunoassay (RIA). Conventional testicular biopsy by standard procedure was performed on both testes under local anesthesia for the candidates.Results: On the whole, 90% of the cases had normal sexual desire. Erectile function with the ability to engage in normal intercourse was normal in 80%. Normal ejaculate volume was seen in 75% of the cases. Inter intromission interval was normal in 42.5%, but it was very premature or very late in 10%. Orgasm was normal in 80% and slightly or significantly decreased in 15% and 5% of the cases, respectively. Patients with small testicles comprised 54.8% of the cases, whilst 125 (44.8%), 139 (49.8%) and 15 (5.3%) of the patients were normogonadotropic, hypergonadotropic and hypogonadotropic, respectively. Mean values for FSH, LH, Testosterone and PRL were 24.5±25.4mIU/ml, 9±7.2mIU/ml, 6.1±4.4ng/ml and 284±224ng/ml, respectively. Hypospermatogenesis with mature sperm was seen in 42 (15%) of the subjects upon testis biopsy. Histological examination showed testicular atrophy in 21.8%, maturation arrest in 22.2%, sertoli cell only syndrome in 40.8% and hyperplasia of Leydig cells in 11.8% of the cases.Conclusion: Sexual dysfunction in infertile patients with non-obstructive azoospermia is as more prevalent as the general population. In azoospermia, sexual dysfunction is not taken into account due to the dominant picture of infertility in these patients. However, special attention to sexual dysfunction will improve quality of life and effectiveness of infertility treatments. 42 51 Naser N Amirjannati ناصر امیرجنتی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Behzad B Ghorbani بهزاد قربانی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran ghorbani@avicenna.ac.ir Mohammad Mehdi MM Akhondi محمدمهدی آخوندی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology 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 Haleh H Soltanghoraee هاله سلطان قرایی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran AzoospermiaEjaculationErectile dysfunctionMale infertilitySexual dysfunctionSexual health 357.pdf Irvine DS. Epidemiology and aetiology of male infertility. Hum Reprod. 1998;13(1 Suppl):33-44. Review.##Stanwell-Smith RE, Hendry WF. The prognosis of male subfertility: a survey of 1025 men referred to a fertility clinic. Br J Urol. 1984;56(4):422-8.##Prins GS, Dolgina R, Studney P, Kaplan B, Ross L, Niederberger C. Quality of cryopreserved testicular sperm in patients with obstructive and nonobstructive azoospermia. J Urol. 1999;161(5):1504-8.##Ezeh UI, Moore HD, Cooke ID. Correlation of testicular sperm extraction with morphological, bio-physical and endocrine profiles in men with azoo-spermia due to primary gonadal failure. Hum Reprod. 1998;13(11):3066-74.##Mak V, Jarvi KA. The genetics of male infertility. J Urol. 1996;156(4):1245-56. Review.##Silber SJ, Nagy ZP, Liu J, Godoy H, Devroey P, Van Steirteghem AC. Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod. 1994;9(9):1705-9.##Montague DK, Barada JH, Belker AM, Levine LA, Nadig PW, Roehrborn CG, et al. Clinical guidelines panel on erectile dysfunction: summary report on the treatment of organic erectile dysfunction. J Urol. 1996; 156(6):2007-11.##Cha KY, Oum KB, Kim HJ. Approaches for obtaining sperm in patients with male factor infertility. Fertil Steril. 1997;67(6):985-95. Review.##Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psycho-social correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61.##Glasser D, Sweeney M. The prevalence of erectile dysfunction in four countries: Italy, Brazil, Malaysia, and Japan. Cross-National Study Group. Paper present-ed at: International Consultation on Erectile Dysfunc-tion; 1999 Jul 1–3; Paris, France.##Rosen RC. Prevalence and risk factors of sexual dys-function in men and women. Curr Psychiatry Rep. 2000;2(3):189-95. Review.##Waldinger MD. The neurobiological approach to premature ejaculation. J Urol. 2002;168(6):2359-67. Review.##Grenier G, Byers ES. Rapid ejaculation: a review of conceptual, etiological, and treatment issues. Arch Sex Behav. 1995;24(4):447-72. Review.##Immerman RS, Mackey WC. A biocultural analysis of circumcision. Soc Biol. 1997;44(3-4):265-75.##Behre HM, Yeung CH, Holstein AF, Weinbauer GF, Gassner P, Nieschlag E, editors. Diagnosis of male infertility and hypogonadism. 2nd ed. Heidelberg: Springer; 2001. 90 p. (Nieschlag E, Behre HM, editors. Andrology: male reproductive health and dysfunction; vol. 6).##World Health Organization (WHO). WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 3rd ed. Cambridge: Cambridge University Press; 1992. 107 p.##Tournaye H, Staessen C, Liebaers I, Van Assche E, Devroey P, Bonduelle M, et al. Testicular sperm recov-ery in nine 47, XXY Klinefelter patients. Hum Reprod. 1996;11(8):1644-9.##Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin North Am. 1995;22(4):699-709. Review.##Schiavi RC, Segraves RT. The biology of sexual func-tion. Psychiatr Clin North Am. 1995;18(1):7-23.##American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Washington DC: American Psychiatric Pub; 2000. 943 p.##Rosen RC, Leiblum SR. Treatment of sexual disorders in the 1990s: an integrated approach. J Consult Clin Psychol. 1995;63(6):877-90. Review.##Matsumiya K, Namiki M, Takahara S, Kondoh N, Takada S, Kiyohara H, et al. Clinical study of azoo-spermia. Int J Androl. 1994;17(3):140-2.##Safarinejad MR. Prevalence and risk factors for erectile dysfunction in a population-based study in Iran. Int J Impot Res. 2003;15(4):246-52.##Gruenewald DA, Matsumoto AM. Testosterone sup-plementation therapy for older men: potential benefits and risks. J Am Geriatr Soc. 2003;51(1):101-15.##Wright J, Allard M, Lecours A, Sabourin S. Psycho-social distress and infertility: a review of controlled research. Int J Fertil. 1989;34(2):126-42. Review.##Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Sci Med. 1997;45 (11):1679-704.##Fassino S, Pier? A, Boggio S, Piccioni V, Garzaro L. Anxiety, depression and anger suppression in infertile couples: a controlled study. Hum Reprod. 2002;17(11): 2986-94.##Boivin J, Takefman JE, Tulandi T, Brender W. Reac-tions to infertility based on extent of treatment failure. Fertil Steril. 1995;63(4):801-7.##Andrews FM, Abbey A, Halman LJ. Stress from infertility, marriage factors, and subjective well-being of wives and husbands. J Health Soc Behav. 1991;32 (3):238-53.##Müller MJ, Schilling G, Haidl G. Sexual satisfaction in male infertility. Arch Androl. 1999;42(3):137-43.##Barrett-Connor E, Von Mühlen DG, Kritz-Silverstein D. Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study. J Clin Endo-crinol Metab. 1999;84(2):573-7.##Wang C, Alexander G, Berman N, Salehian B, David-son T, McDonald V, et al. Testosterone replacement therapy improves mood in hypogonadal men--a clinical research center study. J Clin Endocrinol Metab. 1996; 81(10):3578-83.##Lamberts SW, van den Beld AW, van der Lely AJ. The endocrinology of aging. Science. 1997;278(5337): 419-24. Review.##Alexander GM, Swerdloff RS, Wang C, Davidson T, McDonald V, Steiner B, et al. Androgen-behavior cor-relations in hypogonadal men and eugonadal men. II. Cognitive abilities. Horm Behav. 1998;33(2):85-94.##Rhoden EL, Tel?ken C, Sogari PR, Souto CA. The relationship of serum testosterone to erectile function in normal aging men. J Urol. 2002;167(4):1745-8.##Morales A, Johnston B, Heaton JP, Lundie M. Testos-terone supplementation for hypogonadal impotence: assessment of biochemical measures and therapeutic outcomes. J Urol. 1997;157(3):849-54.##Fugl-Meyer AR, Lodnert G, Br?nholm IB, Fugl-Meyer KS. On life satisfaction in male erectile dys-function. Int J Impot Res. 1997;9(3):141-8.##Nielsen J, Pelsen B, S?rensen K. Follow-up of 30 Klinefelter males treated with testosterone. Clin Genet. 1988;33(4):262-9.##Kübler A, Schulz G, Cordes U, Beyer J, Krause U. The influence of testosterone substitution on bone mineral density in patients with Klinefelter s syndrome. Exp Clin Endocrinol. 1992;100(3):129-32.##

نگرش زنان و مردان ساکن شهر شیراز نسبت به درمان از طریق اهدای تخمک Attitude of Male and Female Subjects towards Oocyte Donation in Shiraz 2 1 زمینه و هدف: اهدای تخمك، یکی از روش‌‌های درمانی برای زنان تحت درمان سرطان، زنان با تخمدان‌های نابالغ و نارسائي زودرس تخمدان، زنان پس از دوران یائسگي یا مبتلايان به بیماری‌های ژنتیکی جدی وابسته به جنس و اتوزومی مي‌باشد. استفاده از تخمک اهدایی برای زناني توصیه می‌شود که دارای رحم سالم با قابليت نگهداري جنين مي‌باشند. اما تخمدان‌های اين افراد تخمک‌های مناسبی تولید نمی‌کنند. هدف از پژوهش حاضر، بررسی نگرش زنان و مردان نسبت به درمان از طریق اهدای تخمك و عوامل مؤثر بر آن بود.روش بررسی: پژوهش حاضر، از نوع توصیفی‌ـ همبستگی بوده است كه در بهار سال 1387 در شهر شیراز انجام شد. نمونه‌هاي مورد بررسی، 206 نفر (102 زن و 104 مرد) ساکن شهر شیراز اعم از مجرد و متأهل، با و بدون فرزند و بارور و نابارور بودند که با پر کردن پرسشنامه محقق ساخته، در این پژوهش شرکت کردند. پرسشنامه شامل مشخصات عمومي افراد، سئوالات مربوط به نگرش نسبت به اهداي تخمك و اعلام شرايطي كه افراد در آن شرايط حاضر به درمان از طريق اهداي تخمك مي‌باشند، بود. نتايج مطالعه با استفاده از آزمون 2، من‌ـ ویتنی و کروسکال والیس مورد تجزیه و تحلیل آماري قرار گرفت. در این پژوهش مقدار 01/0p< به عنوان سطح معني‌داري در نظر گرفته شده است. نتایج: نتایج نشان داد که بین جنسیت و نگرش نسبت به درمان از طریق اهدای تخمك، تفاوت معنی‌داری وجود ندارد. همچنین میزان نگرش افراد نسبت به درمان از طریق اهدای تخمك، به سطح تحصیلات بستگی داشت. در بین زنان و مردان تفاوت معنی‌داری از لحاظ وجود شرايط پزشكي و حاضر بودن به انجام اين درمان گزارش شد (01/0p<)؛ به نحوي که در صورت وجود علت زنانه براي ناباروري، زنان بیشتر از مردان حاضر به انجام این نوع درمان بودند و مردان بيشتر از زنان اظهار كردند كه در هيچ شرايطي حاضر به انجام اين نوع درمان نيستند. اما در موارد ناباروري به علت افزايش سن، داشتن كودك ناتوان يا وجود مشكلات ارثي در خانواده، تفاوت معنی‌داري بين زنان و مردان وجود نداشت.نتیجه‌گیری: با توجه به لزوم استفاده از روش درماني تخمك اهدايي براي برخي از دلايل ناباروري و لزوم پذيرش اين روش توسط هر دوي زوجين، مراكز درماني بايد با فراهم آوردن زمينة مشاوره مناسب جهت ارائه اطلاعات صحيح در خصوص نحوه انجام روش درماني و مسائل حقوقي و شرعي فرا روي زوجين، آنها را در پذيرش يا رد اين روش كمك نمايند. 2 Introduction: Oocyte donation is an infertility treatment method in women undergoing cancer treatment, in premature ovarian failure, and menopause or in women who are known carriers for a serious autosomal recessive or X-linked disorder. Recipients of donated oocytes should have intact uterus to support embryo implantation and normal ongoing pregnancy. The objectives of this study were to evaluate attitude of male and female subjects towards oocyte donation and factors affecting these variables such as gender and education.Materials and Methods: This descriptive-correlative study was carried out in Shiraz, Iran, during spring 2008. The cases included 206 subjects (102 females and 104 males), single and married, with and without offspring and fertile and infertile subjects who filled a researcher-devised questionnaire, including questions on demography, attitude toward oocyte donation and conditions in which they might consider this kind of assisted treatment.Results: There were no statistically significant relationships between gender and attitude towards infertility treatment by oocyte donation. There was a relationship between attitude regarding oocyte donation and educational levels of the participants. There were significant differences between female and male subjects regarding medical conditions and conditions requiring this kind of assisted treatment (p<0.01); in conditions with female infertility, female subjects were more open to accept the procedure than men and men were reported to be more against any kind of treatment under any circumstances. There were no differences between women and men in cases of infertility due to age, parenting a disabled child or presence of inherited medical conditions in the family.Conclusion: Regarding the need for oocyte donation in some types of infertility, and the need to submit to the method by both couples, health centers should prepare the ground for proper consultations to provide correct information on the procedure and its legal aspects to help them accept or reject the method. 51 58 Shapour Sh Fereydouni شاپور فریدونی Department of Educational Psychology, College of Humanity, Islamic Azad University Department of Educational Psychology, College of Humanity, Islamic Azad University Iran shapour.fereydouni@gmail.com Bentolhoda B Fereydouni بنت‌الهدی فریدونی دشمن‌زیاری Department of Biology, College of Sciences, Shiraz University Department of Biology, College of Sciences, Shiraz University Iran Hamideh H Solimani حمیده سلیمانی Department of Special children, College of Humanity, Shiraz University Department of Special children, College of Humanity, Shiraz University Iran AttitudeEducationFemale infertilityMenopauseOocyte donationPremature ovarian failure 358.pdf Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet. 1978;2(8085):366.##Klein J, Sauer MV. Oocyte donation. Best Pract Res Clin Obstet Gynaecol. 2002;16(3):277-91. Review.##Lutjen P, Trounson A, Leeton J, Findlay J, Wood C, Renou P. The establishment and maintenance of preg-nancy using in vitro fertilization and embryo donation in a patient with primary ovarian failure. Nature. 1984; 307(5947):174-5.##Stolwijk AM, Zielhuis GA, Sauer MV, Hamilton CJ, Paulson RJ. The impact of the woman s age on the success of standard and donor in vitro fertilization. Fertil Steril. 1997;67(4):702-10.##Coulam CB, Adamson SC, Annegers JF. Incidence of premature ovarian failure. Obstet Gynecol. 1986;67(4): 604-6.##Coulam CB. Premature gonadal failure. Fertil Steril. 1982;38(6):645-55.##Rosenwaks Z. Donor eggs: their application in modern reproductive technologies. Fertil Steril. 1987;47(6): 895-909.##Cohen MA, Lindheim SR, Sauer MV. Donor age is paramount to success in oocyte donation. Hum Reprod. 1999;14(11):2755-8.##Sauer MV, editor. Principles of oocyte and embryo donation. 1th ed. Vol. 5, Genetic aspects of donor selection. New York: Springer. 1998. 53 p.##Baird PA, Anderson TW, Newcombe HB, Lowry RB. Genetic disorders in children and young adults: a population study. Am J Hum Genet. 1988;42(5):677-93.##Abbasi Shavazi MJ, Razeghi Nasrabad HB, Behjati Ardakani Z, Akhondi MM. [Attitudes of infertile women towards gamete donation: a case study in Tehran]. J Reprod Infertil. 2006;7(2):139-48. Persian.##Inhorn MC. Middle Eastern masculinities in the age of new reproductive technologies: male infertility and stigma in Egypt and Lebanon. Med Anthropol Q. 2004; 18(2):162-82.##Svanberg AS, Lampic C, Bergh T, Lundkvist O. Pub-lic opinion regarding oocyte donation in Sweden. Hum Reprod. 2003;18(5):1107-14.##Kazem R, Thompson LA, Hamilton MP, Templeton A. Current attitudes towards egg donation among men and women. Hum Reprod. 1995;10(6):1543-8.##Lessor R, Reitz K, Balmaceda J, Asch R. A survey of public attitudes toward oocyte donation between sis-ters. Hum Reprod. 1990;5(7):889-92.##Sheibani S. [Whither Kinship? New assisted reproduc-tion technology practices, Authoritative Knowledge and Relatedness case: studies from Iran]. Payesh. 2007; 7(4):299-306. Persian.##Diamond R, Kezur D, Meyers M. Couple therapy for infertility. 1th ed?. New York: Guilford Press; 1999. 237 p.##Chandra PS, Chaturvedi SK, Isaac MK, et al. Marital life among infertile spouse, the wife s perspective and its implication in therapy. Fam Ther. 1991;18:145-54.##Golombok S, Fivush R. Gender development. 1th ed. New York?: Cambridge University Press; 1994. 275 p.##

بررسی تأثیر بكارگیری الگوی بهینه شده SBC بر رفتارهای صحیح مصرف قرص‌های خوراكی پیشگیری از بارداری The Influence of Modified Steps to Behavior Change Model on Oral Contraceptive Use 2 1 زمینه و هدف: کنترل جمعیت یکی از اهداف مهم در جهان امروز به حساب می‌آید و برنامه‌ریزی خانواده‌ها در استفاده از روش‌های پیشگیری مناسب، دارای اهمیت ویژه‌ای می‌باشد. سرمایه‌گذاری در آموزش بهداشت در زمینه استفاده بهتر و مناسب‌تر از امکانات موجود، می‌تواند در این امر کمک‌کننده باشد. مدل تغییر رفتار مرحله‌ای (SBC)، که طی پنج مرحله به وقوع می‌پیوندد، می‌تواند مدلی مناسب در توسعه و ارزشیابی برنامه‌های تنظیم خانواده، برای افراد و گروهها باشد. مطالعه حاضر، با هدف تعیین تأثیر آموزش با استفاده از الگوی بهینه شده SBC در جهت کاهش حاملگی‌های ناخواسته، در زنان مصرف كنندۀ قرص‌های خوراكی پیشگیری از بارداری صورت گرفته است.روش بررسي: این پژوهش، یك كارآزمایی بالینی است که بر اساس الگوی بهینه شده SBC، در مصرف کنندگان قرص‌های پیشگیری از بارداری، در مراكز بهداشتی‌ـ درمانی شهر مشهد انجام شد. ابتدا اطلاعات با استفاده از پرسشنامه و به روش مصاحبه با290 نفر از زنان مصرف‌کنندۀ قرص‌های خوراكی پیشگیری از بارداری كه به طور تصادفی از مراکز بهداشتی انتخاب گردیدند، جمع‌آوری شد؛ سپس بطور تصادفی به دو گروه آزمون و شاهد تقسیم و براساس الگوی بهینه شده، مداخلۀ آموزشی بر روی گروه آزمون اجرا گردید و در فواصل زمانی مشخص (3 و 6 ماه)، پس آزمون انجام شد تا میزان تأثیر بكارگیری الگوی بهینه شده در افزایش رفتارهای صحیح مصرف قرص در نمونه‌های مورد پژوهش مشخص شود. از آزمون‌های غیر پارامتریك نظیر 2، من‌ـ ویتنی، ویلكاكسون و فریدمن براي تجزيه و تحليل اطلاعات استفاده شد و 05/0p< به عنوان سطح معني‌داري در نظر گرفته شده است.نتایج: بين دو گروه آزمون و شاهد قبل از مداخله، تفاوت معني‌داری وجود نداشت؛ اما پس از مداخله، اختلاف معني‌داری در نمرات كسب شده در متغيرهای آگاهی، تأیید و تصویب، قصد رفتاری، عملكرد، حمایت درك شده، خودكارآمدی عمومی و خودكارآمدی تنظیم خانواده، در گروه آزمون مشاهده شد (01/0p<)؛ همچنین عوارض جانبی و حاملگی‌های ناخواسته در گروه آزمون نسبت به گروه شاهد کاهش نشان داده است.نتیجه‌گیری: با توجه به نتایج مداخلات آموزشی در بهبود رفتارهای صحیح مصرف قرص‌های خوراكی پیشگیری از بارداری و در نتیجه حصول دو هدف عمده یعنی كاهش عوارض جانبی و كاهش حاملگی ناخواسته، توصیه می‌گردد ضمن فراهم نمودن تسهیلات بهداشتی برای خانواده‌ها، به توانایی آنان در زمینه خودكارآمدی، به منظور بهره‌گیری هرچه بیشتر از امكانات توجه شود؛ زیرا آموزش با در نظر گرفتن عامل خودكارآمدی، می‌تواند در كاهش هزینه‌های مربوط به بارداری‌های ناخواسته و مصرف نابجا و نامرتب روش‌های تنظیم خانواده و به وی‍‍ژه قرص‌های پیشگیری از بارداری، مؤثر باشد. 2 Introduction: Family planning and birth control are the main goals of governments worldwide for population growth control and appropriate contraceptive use is a measure to reach these goals. Investing in health education for better contraceptive use and more reasonable allocation of existing resources are of great help in materializing the goals. Steps to Behavior Change (SBC) can be a good model to develop and evaluate family-planning programs. The aim of this study was to investigate the influence of family-planning education through modified SBC model on the reduction of unwanted pregnancies in oral contraceptive (OC) users. Materials & Methods: This clinical trial study was carried out at Mashad Urban Health Centers. Data gathering was done through interviews and completion of a researcher-devised questionnaire for 290 randomly chosen women from the aforementioned centers. The subjects were randomly divided into two case and control groups. The intervention was done based on modified SBC model and post-tests were given three and six months after the introduction of the model.Results: There were no significant differences between the two groups prior to the intervention, but significant differences in the mean values of knowledge, approval, intention, practice and advocacy were seen in the experimental group compared to the controls (p<0.001). Additionally, significant reduction in oral contraceptive side-effects and unwanted pregnancies were seen in the experimental group following the intervention. Conclusion: Following the success of modified SBC model in this study, it is suggested that attempts be made to improve the individuals’ self-efficacy to more competently use the provided health services. Developing self-efficacy in these subjects for better contraceptive use, can be effective in decreasing the cost related to unwanted pregnancies and misuse of contraceptive methods especially OCPs. 58 71 Noushin N Peyman نوشین پیمان Department of Public Health, School of Public Health, Mashad University of Medical Sciences Department of Public Health, School of Public Health, Mashad University of Medical Sciences Iran Ali A Heidarnia علیرضا حیدرنیا Department of Health Education, School of Medical Sciences, Tarbiat Modares University Department of Health Education, School of Medical Sciences, Tarbiat Modares University Iran Hidarnia@modares.ac.ir Fazlollah F Ghofranipour فضل الله غفرانی پور Department of Health Education, School of Medical Sciences, Tarbiat Modares University Department of Health Education, School of Medical Sciences, Tarbiat 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 Farkhondeh F Amin Shokravi Department of Health Education, School of Medical Sciences, Tarbiat Modares University Department of Health Education, School of Medical Sciences, Tarbiat Modares University Iran Family planningHealth educationModified Steps of Behavior Change (SBC)Oral contraceptiveSelf-efficacyUnwanted pregnancy 359.pdf Family and Population Health Department. [Iran Integrate Monitoring Evaluation Survey (IMES)]. Tehran: Ministry of Health and Medical Education; 2005. 135 p. Report No.: 1. Persian.##Statistical Centre of Iran & Ministry of Health and Medical Education. [Iran Demographic and Health Survey (IDHS)]. Tehran: Ministry of Health and Med-ical Education; 2000. 191 p. Report No.: 1. Persian.##Peyman N, Hidarnia A, Ghofrani Poor F, Kazemnejad A, Amin Shokravi F, Khodaee Gh. [The relationship between perceived self-efficacy and contraceptive behaviors among Iranian women referring to health centers in Mashhad]. J Reprod Infertil. 2007;8(1):78-90. Persian.##Center for Communication Programs. Philippines com-munication outreach accelerates family planning use in 1993-1996 [Internet]. Maryland: Johns Hopkins School of Public Health; 1998 Aug. Available from: http:// www.jhuccp.org/pubs/ci/3/index.shtml##Center for communication programs (CCP) [Internet]. Maryland: Johns Hopkins School of Public Health; 2005. Steps to Behavior Change; Available from:##Storey JD, Boulay M. Improving family planning use and quality of services in Nepal through the Entertainment-Education Strategy. Maryland: Johns Hopkins School of Public Health (Center for Commu-nication Programs, Population Communication Ser-vices); 2001. 16 p. Report No.: CCP-A-00-96-90001-00.##Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: risk indicators for poor pill taking and discontinuation. Contraception. 1995;51 (5):283-8.##Deijen JB. The influence of type of information, somatization, and locus of control on attitude, know-ledge, and compliance with respect to the triphasic oral contraceptive Tri-Minulet. Contraception. 1997;56(1): 31-41.##Butler JT. Principles of health education and health promotion. 3rd ed. USA: Wadsworth; 2000. 400 p.##Lundy KS, Janes Sh. Community health nursing:Caring for the Public s health. Boston: Jones and Bartlett Publishing; 2001. 1018 p.##Strecher VJ, DeVellis BM, Becker MH, Rosenstock IM. The role of self-efficacy in achieving health behavior change. Health Educ Q. 1986;13(1):73-92.##Lawrance L, McLeroy KR. Self-efficacy and health education. J Sch Health. 1986;56(8):317-21. Review.##Peyman N. [Modifying and evaluating of Steps of Behavior Change (SBC) model integrated with Self efficacy theory in order to decrease unwanted preg-nancy] [dissertation]. [Tehran]: Department of Health Education, School of Medical Sciences, Tarbiat Modares University; 2007. 161 p. Persian.##Kaufman DM. Applying educational theory in prac-tice. BMJ. 2003;326(7382):213-6.##Knowles MS. Informal adult education: A guide for administrators, leaders, and teachers. California: Asso-ciation Press; 1950. 272 p.##Knowles MS. The making of an adult educator: An autobiographical journey. San Francisco: Jossey-Bass; 1989.211 p.##Finger WR. Using oral contraceptives correctly: pro-gress on package instructions. Network. 1991;12(2): 14-7, 27.##Knowles MS. Andragogy in action: Applying modern principles of adult learning. San Francisco: Jossey-Bass; 1984. 444 p.##G?mez de Le?n J, Hern?ndez D. [Poverty and contra-ceptive use in rural Mexico]. Paper presented at: The seminar of poverty, fertility and family planning; 1998 June 2-4; Mexico City, Mexico. Spanish.##Zavala AS, Perez-Gonzales M, Miller P, Welsh M, Wilkens LR, Potts M. Reproductive risks in a community-based distribution program of oral contra-ceptives, Matamoros, Mexico. Stud Fam Plann. 1987; 18(5):284-90.##Vural B, Vural F, Diker J, Yücesoy I. Factors affect-ing contraceptive use and behavior in Kocaeli, Turkey. Adv Contracept. 1999;15(4):325-36.##Khan MA, Trottier DA, Islam MA. Inconsistent use of oral contraceptives in rural Bangladesh. Contraception. 2002;65(6):429-33.##Bailey J, Jimenez RA, Warren CW. Effect of supply source on oral contraceptive use in Mexico. Stud Fam Plann. 1982;13(11):343-9.##Potter JE, Mojarro O, Nu?ez L. The influence of health care on contraceptive acceptance in rural Mexico. Stud Fam Plann. 1987;18(3):144-56.##Karavus M, Cali S, Kalaca S, Cebeci D. Attitudes of married individuals towards oral contraceptives: a qualitative study in Istanbul, Turkey. J Fam Plann Reprod Health Care. 2004;30(2):95-8.##Romero-Gutiérrez G, Garcia-Vazquez MG, Huerta-Vargas LF, Ponce-Ponce de Leon AL. Postpartum contraceptive acceptance in Le?n, Mexico: a multi-variate analysis. Eur J Contracept Reprod Health Care. 2003;8(4):210-6.##Oddens BJ. Determinants of contraceptive use among women of reproductive age in Great Britain and Germany. II: Psychological factors. J Biosoc Sci. 1997; 29(4):437-70.##

بررسي نگرش اهداء كنندگان و گيرندگان تخمك به مسائل اخلاقي آن Attitudes of Donors and Recipients toward Ethical Issues in Oocyte Donation 2 1 زمينه و هدف: عدم آگاهي اهداءکنندگان و گيرندگان از مسائل اخلاقي و حقوقي آن، مي‌تواند اثرات جبران‌ناپذير بر آينده کودکان حاصل از اين روش درماني، داشته باشد. لذا اين مطالعه با هدف بررسي نگرش در دو گروه گيرندگان و دهندگان تخمک انجام شد تا با توجه به تمايلات و اعتقادات اين گروه درماني با برنامه‌ريزي بهتر، موجب بهبود اثرات اجتماعي و اخلاقي اهداء تخمک باشيم.روش بررسي: در اين مطالعه توصيفي، 52 اهداءكننده و 53 گيرنده تخمك مراجعه‌كننده به مركز بهداشت باروري وليعصر (عج) بودند در صورت تمايل و رضايت آنان توسط پرسشگر، پرسشنامه طراحي شده ODQ در دو گروه گيرنده و دهنده تخمک و در دو بخش سئوالات دموگرافيک و نظرسنجي، تكميل گرديد. داده‌ها به‌صورت فراواني و درصد گزارش شد. نتايج: 3/47% از گيرندگان و 4/40% از اهداءکنندگان تخمک، موافق رازداري و محرمانه بودن اين روند درماني به صورت ناشناخته بودن فرد گيرنده و دهنده نسبت به هم بودند. 21/94% از گيرندگان و 9/56% از اهداکنندگان تخمک، موافق دادن پاداش به اهداء کنندگان و 64 % از گیرندگان و 30 % از اهداکنندگان مخالف آگاه نمودن فرزند از روند اهدای تخمک هستند. نتیجه‌گیری: در فرايند اهداء تخمک، بايستي ابعاد حقوقي، قانوني و اخلاقي براساس دستورالعملها و قوانين، مدون و مشخص شده و با انجام جلسات مشاوره ابعاد دقيق قانوني، احکام شرعي و عوارض پزشکي آن براي دهندگان و گيرندگان پيش از انجام اقدامات درماني کاملاً بيان شود. جهت تعميم نتايج، مطالعه وسيعتري در زمينه موارد مربوط با محرمانه بودن فرآيند مطابق نظر اهداءکنندگان و گيرندگان انجام گردد. 2 Introduction: Oocyte donation is a routine procedure in the treatment of some types of female infertilities in most infertility clinics worldwide. Donors and recipients awareness about legal and ethical issues governing donation plays a significant role on the future of couples and resultant babies. This study aimed to assess the attitudes of oocyte donors and recipients with attention to their belief and desires on the premises to adopt better policies and make improvements in social and ethical impacts of oocyte donation. Materials and Methods: This descriptive study was conducted on 52 donors and 53 recipients of oocyte in Vali-e-Asr Reproductive Health Research Center. If the subjects were willing to participate in the study, interviews were carried out to collect demographic data and explore the opinion of the participants through oocyte donation questionnaire (ODQ).Results: Totally, 47% of the recipients and 40.4% of the donors requested their identity to be kept confidential and anonymous to the counterparting party. As much as 94.2% of the recipients and 56.9% of the donors were in favor of giving financial rewards to the donors. Sixty-four percent of the recipients and 30% of the donors were against informing the baby about the oocyte donation procedure.Conclusion: The legal, civil and ethical issues of oocyte donation should be clearly anticipated according to the registered guidelines. The precise dimensions of legal, religious and medical side-effects of the procedure should be clearly explained through counseling the donors and recipients before initiating the cycles. More extensive studies on donors and recipients attitudes on legal, religious, and social aspects of oocyte donation are suggested. 71 81 Fatemeh F Ramezanzadeh فاطمه رمضان زاده Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Fedyeh F Haghollahi فدیه حق‌اللهی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran fedyeh_hagh@yahoo.com Maryam M Bagheri مریم باقری Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Masoomeh M Masoomi معصومه معصومی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Nasrin N Abedi-Nia نسرین عابدی نیا Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Mina M Jafarabadi مینا جعفرآبادی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran ConfidentialityEthical issuesFemale infertilityGamete donationOocyte donationOocyte recipients 360.pdf Inhorn MC. Making Muslim babies: IVF and gamete donation in Sunni versus Shi a Islam. Cult Med Psychiatry. 2006;30(4):427-50.##Isikoglu M, Senol Y, Berkkanoglu M, Ozgur K, Donmez L, Stones-Abbasi A. Public opinion regarding oocyte donation in Turkey: first data from a secular population among the Islamic world. Hum Reprod. 2006;21(1):318-23.##Practice Committee of American Society for Reproduc-tive Medicine. Repetitive oocyte donation. Fertil Steril. 2008;90(5 Suppl):S194-5. Review.##Eggs shared, given, and sold. Lancet. 2003;362(9382):413.##Ahuja KK, Mostyn BJ, Simons EG. Egg sharing and egg donation: attitudes of British egg donors and recipients. Hum Reprod. 1997;12(12):2845-52.##Yee S, Hitkari JA, Greenblatt EM. A follow-up study of women who donated oocytes to known recipient couples for altruistic reasons. Hum Reprod. 2007;22 (7):2040-50.##Berg JW. Risky business: evaluating oocyte donation. Am J Bioeth. 2001;1(4):18.##Baetens P, Devroey P, Camus M, Van Steirteghem AC, Ponjaert-Kristoffersen I. Counselling couples and donors for oocyte donation: the decision to use either known or anonymous oocytes. Hum Reprod. 2000;15 (2):476-84.##Safaie SH. [Essay on gamete & embryo donation in infertility treatment, from medical, theological, legal, ethical, psychological and sociological approaches]. 1th ed. Tehran: Samt Publishing; 2004. 170 p. Persian.##McLaughlin EA, Day J, Harrison S, Mitchell J, Pros-ser C, Hull M. Recruitment of gamete donors and pay-ment of expenses. Hum Reprod. 1998;13(5):1130-2.##Bromwich P. Oocyte donation. BMJ. 1990;300(6741): 1671-2. Review.##Lyall H, Gould GW, Cameron IT. Should sperm donors be paid? A survey of the attitudes of the general public. Hum Reprod. 1998;13(3):771-5.##Partrick M, Smith AL, Meyer WR, Bashford RA. Anonymous oocyte donation: a follow-up question-naire. Fertil Steril. 2001;75(5):1034-6.##Behjati Ardakani Z, Akhondi MA, Milanifar A, Modabery Y, Chamani L, Moeini M, et al. [Counsel-ing, evaluation and screening of donor and recipient in third party reproduction and the matching process]. Payesh. 2007;6(4):443-51. Persian.##American Society for Reproductive Medicine. 2002 guidelines for gamete and embryo donation: a practice committee report: guidelines and minimum standards. Fertil Steril. 2004;82 Suppl 1:S8.##Frith L. Gamete donation and anonymity: the ethical and legal debate. Hum Reprod. 2001;16(5):818-24. Review.##S?derstr?m-Anttila V. Follow-up study of Finnish volunteer oocyte donors concerning their attitudes to oocyte donation. Hum Reprod. 1995;10(11):3073-6.##Klock SC, Greenfeld DA. Parents knowledge about the donors and their attitudes toward disclosure in oocyte donation. Hum Reprod. 2004;19(7):1575-9.##Abbasi Shavazi MJ, Akhondi MM, Razeghi Nasrabad HB, Behjati Ardekani Z. [Attitudes of infertile women towards gamete donation: a case study in Tehran]. J Reprod Infertil. 2006;7(2):139-48. Persian.##Ghorbani B, Behjati Ardekani Z. [Openness about a child s origins in surrogacy in comparison with adoption & ART]. J Reprod Infertil. 2008;9(2):130-36. Persian.##Hahn SJ, Craft-Rosenberg M. The disclosure deci-sions of parents who conceive children using donor eggs. J Obstet Gynecol Neonatal Nurs. 2002;31(3): 283-93.##Greenfeld DA. The impact of disclosure on donor gamete participants: donors, intended parents and off-spring. Curr Opin Obstet Gynecol. 2008;20(3):265-8. Review.##Mac Dougall K, Becker G, Scheib JE, Nachtigall RD. Strategies for disclosure: how parents approach telling their children that they were conceived with donor gametes. Fertil Steril. 2007;87(3):524-33.##Golombok S, Jadva V, Lycett E, Murray C, Mac-callum F. Families created by gamete donation: follow-up at age 2. Hum Reprod. 2005;20(1):286-93.##Cook R, Vatev I, Michova Z, Golombok S. The European study of assisted reproduction families: a comparison of family functioning and child develop-ment between Eastern and Western Europe. J Psycho-som Obstet Gynaecol. 1997;18(3):203-12.##Brewaeys A. Donor insemination, the impact on family and child development. J Psychosom Obstet Gynaecol. 1996;17(1):1-13. Review.##Englert Y, Serena E, Philippe R, Fabienne D, Chantal L, Anne D. Sperm and oocyte donation: gamete donor issues. Int Congr Ser. 2004;1266:303-10.##Greenfeld DA, Klock SC. Disclosure decisions among known and anonymous oocyte donation recipients. Fertil Steril. 2004;81(6):1565-71.##Greenfeld DA. The impact of disclosure on donor gamete participants: donors, intended parents and off-spring. Curr Opin Obstet Gynecol. 2008;20(3):265-8.##Fox D. Paying for particulars in people-to-be: comer-cialisation, commodification and commensurability in human reproduction. J Med Ethics. 2008;34(3):162-6.##