2009 10 2 39 62

ترشح فاكتور رشد اندوتليال رگي (VEGF) در كشت سه بعدي بافت اندومتریوم انسان: یک مدل اندومتریوز خارج از بدن Secretion of Vascular Endothelial Growth Factor in a Three-Dimensional Culture of Human Endometrium; an In-Vitro Model for Endometriosis 2 1 زمینه و هدف: اندومتريوز بيماري است كه طي آن غدد و عروق رحمي در بيرون از حفرة رحمي به صورت نابجا رشد مي‌كنند. اين بيماري در حدود 10% از زنان در سن باروري و در حدود 50% از زنان نابارور ديده مي‌شود. عمل جراحي يكي از درمان‌هاي رايج اين بيماري است كه البته بعد از عمل جراحي، بيماري مي‌تواند دوباره عود كند. فاكتور رشد اندوتليال رگي (VEGF)، از فاکتورهای مؤثر در ایجاد بیماری به شمار می‌آید. هدف از تحقيق حاضر، تعيين ميزان ترشح فاكتور رشد اندوتليال رگي (VEGF) در اندومتريوم كشت شده در محيط كشت سه بعدي با ماتریکس فیبرینی مي‌باشد.روش بررسي: نمونه‌ها از اندومتريوم تنة رحم 10 زن كه در روزهاي 24-19 سيكل رحمي بودند و جهت درمان ناباروري، كيست‌هاي تخمداني و ساير علل غير رحمي مراجعه كننده به مركز تكنولوژي توليدمثل نوين تورنتو، تهيه شد. هر نمونه بافت آندومتريوم به 10 قطعه جهت كشت در چاهك‌هاي پليت كشت تقسيم شد (جمعاً 100 چاهك). نمونه‌ها با استفاده از روش كشت سه بعدي بافت، كشت داده شدند و مايع بالايي هر نمونه از كشت، جهت اندازه‌گيري سطح VEGF جمع‌آوري شد؛ سپس نمونه‌های اندومتریوم کشت داده شده جهت شناسایی رگزایی به روش ايمونوهيستوشيميايي بوسیله آنتی‌بادیAnti-Cox2 رنگ‌آمیزی شدند. لازم به ذکر است که داده‌های مربوط به درصد تکثیر سلولها و درصد رگزایی، با استفاده از آناليز آماري 2 و داده‌های مربوط به میزان ترشح VEGF، با استفاده از آزمون t داده‌پردازي شدند.نتايج: سطح VEGF در مايع رويي كشت سه بعدي موجود در چاهك‌‌هايي كه رگ‌زايي در آنها ديده شده بود (11/3±492)، افزايش معني‌داري (05/0p<) را نسبت به چاهك‌هاي فاقد رگ‌زايي (13/2±183) نشان داد. نتايج نشان‌دهندة تكثير سلولها در 91% از چاهكها بود و همچنين رگ‌زايي در 51 چاهك (56%) از چاهك‌‌های داراي تكثير سلولی مشاهده گردید. نتيجه‌گيري: ترشح VEGF، داراي نقش مهمي در ايجاد رگزايي و احتمالاً رشد و تكثير سلول‌هاي بافت اندومتريوم مي‌باشد؛ لذا احتمالاً ترشح VEGF می‌تواند در ايجاد بيماري اندومتريوز تأثير داشته باشد. در ضمن پیشنهاد می‌گردد رابطه بین تکثیر سلولها و میزان ترشح VEGF نیز توسط محققان دیگر مورد بررسی قرار گیرد. 2 Introduction: Endometriosis is the presence of endometrial glandular and stromal cells outside the uterine cavity. The disease is prevalent in about 10% of women of reproductive age and in up to 50% of infertile women. Surgery continues to be the first line of treatment in eradicating endometriotic lesions but recurrence of the condition is seen in up to 47% of the cases. VEGF is an effective factor in the establishment of endometriosis. The aim of the present study was to determine VEGF levels in a three-dimensional (3D) fibrin matrix culture of human endometrial tissue.Materials and Methods: Endometrial biopsies were obtained from the uterine fundus of 10 ovulating (at 19th to 24th day of menstruation cycle) premenopausal women attending the Toronto Center for Advanced Reproductive Technology (TCART) for the treatment of infertility, ovarian cysts or non-endometrial complaints. Each tissue fragment was divided into ten segments for culture in a total of 100 wells. The samples were cultured on three-dimensional fibrin matrices and the supernatant fluid was collected from each endometrial sample for the assessment of VEGF levels. The endometrial samples were stained by anti-Cox-2 antibody (anti-cyclooxygenase -2) for immunohistochemical evaluation of angiogenesis.Results: VEGF levels in the supernatant fluid of wells with angiogenesis was significantly higher (p<0.05) than wells with no signs of the phenomenon (492±3.11 and 183±13.2, respectively). The results were indicative of cell proliferation in 91% of the wells and angiogenesis was observed in 51 wells (56%) with cell proliferation.Conclusion: It seems that VEGF secretion plays an important role in promoting neovasculariza-tion and cell proliferation of endometrial cells. Therefore, VEGF secretion seems to be involved in the establishment of endometriosis. Seeking the relationship between cell proliferation and VEGF secretion rates is suggested. 095 101 Jafar Ai جعفر آی Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences Iran jafar_ai@tums.ac.ir Navid N Esfandiari نوید اسفندیاری Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Toronto Centre for Advanced Reproductive Technology (TCART),University of Toronto, Samuel Lunenfeld Research Institute Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Toronto Centre for Advanced Reproductive Technology (TCART),University of Toronto, Samuel Lunenfeld Research Institute Canada Robert R Casper رابرت کاسپر Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Toronto Centre for Advanced Reproductive Technology (TCART),University of Toronto, Samuel Lunenfeld Research Institute Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Toronto Centre for Advanced Reproductive Technology (TCART),University of Toronto, Samuel Lunenfeld Research Institute Canada AngiogenesisEndometriosisEndometriumFemale infertilityThree-dimensional tissue cultureVEGF 370.pdf Strathy JH, Molgaard CA, Coulam CB, Melton LJ 3rd. Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril. 1982;38(6):667-72.##Adamson GD, Nelson HP. Surgical treatment of endometriosis. Obstet Gynecol Clin North Am. 1997; 24(2):375-409. Review.##Kettel LM, Hummel WP. Modern medical management of endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):361-73. Review.##Rogers PA, Abberton KM, Susil B. Endothelial cell migratory signal produced by human endometrium during the menstrual cycle. Hum Reprod. 1992;7(8): 1061-6.##Lebovic DI, Bentzien F, Chao VA, Garrett EN, Meng YG, Taylor RN. Induction of an angiogenic phenotype in endometriotic stromal cell cultures by interleukin-1beta. Mol Hum Reprod. 2000;6(3):269-75.##Fasciani A, Bocci G, Xu J, Bielecki R, Greenblatt E,Leyland N, et al. Three-dimensional in vitro culture of endometrial explants mimics the early stages of endometriosis. Fertil Steril. 2003;80(5):1137-43.##Halme J, Hammond MG, Hulka JF, Raj SG, Talbert LM. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol. 1984;64 (2):151-4.##Oral E, Arici A. Pathogenesis of endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):219-33. Review.##Lamb K, Hoffmann RG, Nichols TR. Family trait analysis: a case-control study of 43 women with endometriosis and their best friends. Am J Obstet Gynecol. 1986;154(3):596-601.##Esfandiari N, Ai J, Nazemian Z, Javed MH, Gotlieb L, Casper RF. Expression of glycodelin and cyclo-oxygenase-2 in human endometrial tissue following three-dimensional culture. Am J Reprod Immunol. 2007;57(1):49-54.##Esfandiari N, Khazaei M, Ai J, Bielecki R, Gotlieb L, Ryan E, et al. Effect of a statin on an in vitro model of endometriosis. Fertil Steril. 2007;87(2):257-62.##Becker CM, Bartley J, Mechsner S, Ebert AD. [Angiogenesis and endometriose] Zentralbl Gynakol. 2004;126(4):252-8. German.##Ferrara N, Davis-Smyth T. The biology of vascular endothelial growth factor. Endocr Rev. 1997;18(1):4-25. Review.##Kieser A, Weich HA, Brandner G, Marmé D, Kolch W. Mutant p53 potentiates protein kinase C induction of vascular endothelial growth factor expression. Oncogene. 1994;9(3):963-9.##Yoo SA, Kwok SK, Kim WU. Proinflammatory role of vascular endothelial growth factor in the pathogenesis of rheumatoid arthritis: prospects for therapeutic intervention. Mediators Inflamm. 2008; 2008:129873. Review.##Lieb W, Safa R, Benjamin EJ, Xanthakis V, Yin X, Sullivan LM, et al. Vascular endothelial growth factor, its soluble receptor, and hepatocyte growth factor: clinical and genetic correlates and association with vascular function. Eur Heart J. 2009;30(9):1121-7.##Donnez J, Smoes P, Gillerot S, Casanas-Roux F, Nisolle M. Vascular endothelial growth factor (VEGF) in endometriosis. Hum Reprod. 1998;13(6):1686-90.##Rogers PA, Donoghue JF, Walter LM, Girling JE. Endometrial angiogenesis, vascular maturation, and lymphangiogenesis. Reprod Sci. 2009;16(2):147-51.##Cosin R, Gilabert-Estelles J, Ramon LA, Espana F, Gilabert J, Romeu A, et al. Vascular endothelial growth factor polymorphisms (-460C/T, 405G/C, and 936C/T) and endometriosis: their influence on vascular endothelial growth factor expression. Fertil Steril. 2008 Oct 16. [Epub ahead of print].##Godo G, Sas M, Falkay G. Bromocryptine therapy in luteal insufficiency. Acta Med Acad Sci Hung. 1980;37 (3):283-8.##Cunha-Filho JS, Gross JL, Lemos NA, Brandelli A, Castillos M, Passos EP. Hyperprolactinemia and luteal insufficiency in infertile patients with mild and minimal endometriosis. Horm Metab Res. 2001;33(4): 216-20.##Ferté C, Massard C, Moldovan C, Desruennes E, Loriot Y, Soria JC. Wound healing delay after central venous access following DCF/VEGF-trap therapy. Invest New Drugs. 2009 Feb 17. [Epub ahead of print].##Esfandiari N, Ai J, Khazaei M, Nazemian Z, Jolly A, Casper RF .Angiogenesis following three-dimensional culture of isolated human endometrial stromal cells. Int J Fertil Steril. 2008;2(1):19-22.##Fujii EY, Nakayama M, Nakagawa A. Concentra-tions of receptor for advanced glycation end products, VEGF and CML in plasma, follicular fluid, and peritoneal fluid in women with and without endometriosis. Reprod Sci. 2008;15(10):1066-74.##

بررسی اثرات اسيد لينولئيك مزدوج بر فاكتورها و هورمون‌هاي مؤثر در فرايند تخمك‌گذاري در موش‌هاي آزمايشگاهي Effects of Conjugated Linoleic Acid (CLA) on Hormones and Factors Involved in Murine Ovulation 2 1 زمينه و هدف: فرآیند تخمک‌گذاری واکنشي فیزیولوژیک- التهابی و وابسته به هماهنگی فعالیت گنادوتروپینها و هورمون‌های استروئیدی است. علاوه بر آن میانجی‌های درگیر در واکنش‌های التهابی همچون سایتوکینها، پروستاگلاندینها، لپتین، نیتریک اکساید و... در آن دخیلند. اسیدلینولئیک مزدوج (CLA) گروهی از اسیدهای چرب غیر اشباع با زنجیره بلند بیش از یک پیوند دوگانه هستند که در محصولات لبنی، گوشت گاو و گوسفند یافت می‌شوند. براساس شواهد موجود، CLA خوراكي بر میانجی‌هاي درگیر در فرایند تخمک‌گذاری اثر می‌گذارد. هدف از این مطالعه تعیین اثرات دوزهای مختلف CLA در رژیم غذایی بر هورمونها و عوامل سیستمیک و موضعی است که بر تخمک‌گذاری اثر می‌گذارند.روش بررسي: در این مطالعه 80 سر موش ماده سفید (سوری) با سن 250 روز در چهار گروه به طور تصادفی تقسیم شدند (گروه شاهد C و گروه‌های تیمار 1T، 2T و3T). هر گروه واجد 4 تکرار و در هر تکرار 5 موش (واحد آزمایشی) قرار داشت (مجموعاً 20 موش در هر گروه). موشها برای مدت 120 روز در گروه کنترل دریافت کننده جیره فاقد اسیدلینولئیک مزدوج و در گروه‌های تیمار دریافت کننده جیره g/kg1/0، g/kg3/0 و g/kg5/0 اسید لینولئیک مزدوج بودند که جایگزین روغن ذرت جیره شده بود. 120 روز پس از شروع آزمایش از ده موش در هر گروه که علایم فحلی داشتند بوسیله قطع دم خونگیری شد و غلظت‌های سرمی استرادیول، پروژسترون، LH، FSH، نیتریک اکساید، لپتین و TNFα اندازه‌گیری شدند. همچنین اثر CLA بر تولید پروستاگلاندینها و نیتریک اکساید تخمدانی بررسی شد. داده‌ها توسط نرم افزار SAS با تشکیل جدول ANOVA و آزمون مقایسه بین میانگین‌های دانکن آنالیز شد. احتمال کمتر از 05/0 معنی‌دار در نظر گرفته شد.نتایج: اسيدلينولئيك مزدوج به طور معنی‌داری باعث كاهش سطوح سرمی FSH (05/0p<)، استرادیول، LH، نیتریک اکساید، لپتین و TNFα گرديد (01/0p<). همچنین CLA سطح پروژسترون سرم را کاهش داد، اما این کاهش معنی‌دار نبود. اثر منفی CLA بر كاهش ميزان PGE2 و PGF2α تولیدی تخمدان به طور معني‌داري دیده شد (01/0p<).نتیجه‌گیری: بر اساس نتایج حاصل می‌توان عنوان کرد CLA دارای اثری معنی‌دار بر تولیدمثل حیوان ماده است. همچنین واجد یک اثر بازدارنده بر هورمون‌های سیستمیک و موضعی مؤثر بر تخمک‌گذاری است. بنابراین ممکن است CLA نقش اثرگذار بر کاهش نرخ تخمک‌گذاری در موش داشته باشد. 2 Introduction: Ovulation is a physiologic process with an inflammatory response that depends on a coordinated activity of gonadotropins and steroid hormones, as well as inflammatory mediators such as cytokines, prostaglandins, leptin, nitric oxide (NO), etc. Conjugated linoleic acid (CLA) is composed of polyunsaturated fatty acids (PUFA) found in dairy products, beef and lamb. There is strong evidence that dietary CLA affects mediators involved in ovulation. The aim of this study was to determine the effects of different doses of dietary CLA on systemic and local hormones and factors involved in ovulation.Materials and Methods: In this case-control study, 80 (50±2-day old) female mice were randomly divided into four groups (C as the controls and T1, T2 and T3 as the treatment groups). There were four replicates in each group and there were five mice in every replicate (20 mice, in total). The mice in the control group were fed with no CLA in their diet but the ones in the treatment group received 0.1, 0.3 and 0.5g/kg of CLA (replacing corn oil in the diet), respectively for 120 days. Later on, blood samples were obtained from the tails of animals that displayed estrus signs and estradiol (E2), progesterone (P4), LH, FSH, NO, leptin and TNFα were measured. Furthermore, the effects of CLA on the ovarian production of prostaglandins (PGs) and NO were investigated. The data were analyzed by SAS software. Results: CLA significantly decreased serum levels of FSH (p<0.05), LH, estradiol, NO, leptin and TNFα (p<0.01). In addition, CLA decreased progesterone levels but this effect was statistically insignificant. The significantly negative effects of CLA were seen on the ovarian production of PGE2 and PGF2α (p<0.01). 101 109 Hamid Reza HR Khodaei حمیدرضا خدایی Department of Animal Physiology, Faculty of Agriculture, Islamic Azad University, Research and Science Branch Department of Animal Physiology, Faculty of Agriculture, Islamic Azad University, Research and Science Branch Iran khodaei@khuisf.ac.ir Mohammad M Chamani محمد چمنی Department of Animal Physiology, Faculty of Agriculture, Islamic Azad University, Research and Science Branch Department of Animal Physiology, Faculty of Agriculture, Islamic Azad University, Research and Science Branch Iran Aliasghar A Sadeghi علی‌اصغر صادقی Department of Animal Physiology, Faculty of Agriculture, Islamic Azad University, Research and Science Branch Department of Animal Physiology, Faculty of Agriculture, Islamic Azad University, Research and Science Branch Iran Hossein H Hejazi سیدحسین حجازی Department of Parasitology, Faculty of Medicine, Isfahan University of Medical Sciences Department of Parasitology, Faculty of Medicine, Isfahan University of Medical Sciences Iran Conjugated linoleic acidNitric oxideOvaryOvulationProstaglandinGonadotropin 371.pdf Squires EJ. Applied animal endocrinology.1st ed. Cambridge: CABI; 2003. 233 p.##Espey LL. Ovulation as an inflammatory reaction--a hypothesis. Biol Reprod. 1980;22(1):73-106. Review.##Espey LL. Current status of the hypothesis that mam-malian ovulation is comparable to an inflammatory reaction. Biol Reprod. 1994;50(2):233-8.##Tokuyama O, Nakamura Y, Muso A, Honda K, Ishiko O, Ogita S. Expression and distribution of cyclo-oxygenase-2 in human periovulatory ovary. Int J Mol Med. 2001;8(6):603-6.##Staud R. Comparing COX-2 inhibitors with traditional NSAIDs. Emerg Med. 2000;23:1-6.##Wu YL, Wiltbank MC. Transcriptional regulation of cyclooxygenase-2 gene in ovine large luteal cells. Biol Reprod. 2001;65(5):1565-72.##Espey LL. Comparison of the effect of nonsteroidal and steroidal antiinflammatory agents on prostaglandin production during ovulation in the rabbit. Prostaglan-dins. 1983;26(1):71-8.##Nagao K, Yanagita T. Bioactive lipids in metabolic syndrome. Prog Lipid Res.2008;47(2):127-46. Review.##Ferguson EM, Leese HJ. Triglyceride content of bovine oocytes and early embryos. J Reprod Fertil. 1999;116(2):373-8.##Aydin R. Conjugated linoleic acid: chemical structure, sources andbiological properties. Turk J Vet Anim Sci. 2005;29:189-95.##Pariza MW, Park Y, Cook ME. The biologically active isomers of conjugated linoleic acid. Prog Lipid Res. 2001;40(4):283-98. Review.##Fritsche S, Fritsche J. Occurrence of CLA isomers in beef. J Am Oil Chem Soc. 1998;75:1449–51.##Collomb M, Schmid A, Sieber R, Wechsler D, Ryhanen E. Conjugated linoleic acids in milk fat:Variation and physiological effects. Inter Dairy J. 2006;16(11):1347-61.##Schmid A, Collomb M, Sieber R, Bee G. Conjugated linoleic acid in meat and meat products: A review. Meat Sci. 2006;73(1):29-41.##Nagao K, Yanagita T. Conjugated fatty acids in food and their health benefits. J Biosci Bioeng. 2005;100(2): 152-7.##Bhattacharya A, Banu J, Rahman M, Causey J, Fernandes G. Biological effects of conjugated linoleic acids in health and disease. J Nutr Biochem. 2006;17 (12):789-810. Review.##Rahman MM, Bhattacharya A, Banu J, Fernandes G. Conjugated linoleic acid protects against age-associated bone loss in C57BL/6 female mice. J Nutr Biochem. 2007;18(7):467-74.##Harris MA, Hansen RA, Vidsudhiphan P, Koslo JL, Thomas JB, Watkins BA, et al. Effects of conjugated linoleic acids and docosahexaenoic acid on rat liver and reproductive tissue fatty acids, prostaglandins and matrix metalloproteinase production. Prostaglandins Leukot Essent Fatty Acids. 2001;65(1):23-9.##Akahoshi A, Koba K, Ohkura-Kaku S, Kaneda N, Goto C, Sano H, et al. Metabolic effects of dietary conjugated linoleic acid (CLA) isomers in rats. Nutr Res. 2003;23(12):1691-701.##Yamasaki M, Ikeda A, Oji M, Tanaka Y, Hirao A, Kasai M, et al. Modulation of body fat and serum leptin levels by dietary conjugated linoleic acid in Sprague-Dawley rats fed various fat-level diets. Nutrition. 2003;19(1):30-5.##Khodaei HR, Ghoreishi SM, Hejazi SH. [The relation-ship between size of normal and cystic bovine ovarian follicles with follicular fluid levels of nitric oxide and estradiol]. J Reprod Infertil. 2007;8(1):17-22. Persian.##SAS Institute. SAS/STAT Software: Changes and Enhancements for Release 6.12. New York: SAS Institute Inc; 1997. 158 p.##Chatterjee S, Collins TJ, Yallampalli C. Inhibition of nitric oxide facilitates LH release from rat pituitaries. Life Sci. 1997;61(1):45-50.##Tamanini C, Basini G, Grasselli F, Tirelli M. Nitric oxide and the ovary. J Anim Sci. 2003;81(E. Suppl. 2):E1–E7.##Flint AP, Sheldrick EL, Fisher PA. Ligand-independ-ent activation of steroid receptors. Domest Anim Endocrinol. 2002;23(1-2):13-24.##Derecka K, Sheldrick EL, Wathes DC, Abayasekara DR, Flint AP. A PPAR-independent pathway to PUFA-induced COX-2 expression. Mol Cell Endocrinol. 2008;287(1-2):65-71.##Estévez A, Motta AB, Fernandez de Gimeno M. [Role of nitric oxide in the synthesis of prostaglandin F2 alpha and progesterone during luteolysis in the rat]. Medicina (B Aires). 1999;59(5 Pt 1):463-5. Spanish.##Luongo D, Bergamo P, Rossi M. Effects of conjug-ated linoleic acid on growth and cytokine expression in Jurkat T cells. Immunol Lett. 2003;90(2-3):195-201.##Castro N, Acosta F, Capote J, Argüello A. Effect of dietary conjugated linoleic acid on serum levels of N2O5 and l-citrulline in goat kids. Small Rumin Res. 2007;68(3):233-42.##Castaneda-Gutiérrez E, Benefield BC, de Veth MJ, Santos NR, Gilbert RO, Butler WR, et al. Evaluation of the mechanism of action of conjugated linoleic acid isomers on reproduction in dairy cows. J Dairy Sci. 2007;90(9):4253-64.##Pereira RM, Marques CC, Baptista MC, Vasques MI, Horta AEM. Influence of supplementation of arachido-nic acid and cyclooxygenase/lipoxygenase inhibition on the development of early bovine embryos. Rev Bras Zool. 2006;35:1-6.##Parent J, Villeneuve C, Fortier MA. Evaluation of the contribution of cyclooxygenase 1 and cyclooxygenase 2 to the production of PGE2 and PGF2 alpha in epi-thelial cells from bovine endometrium. Reproduction. 2003;126(4):539-47.##Fuentes MC, Calsamiglia S, Sanchez C, Gonzalez A, Newbold JR, Santos JEP, et al. Effect of extruded linseed on productive and reproductive performance of lactating dairy cows. Livest Sci. 2008;113(2-3):144-54.##Castaneda-Gutiérrez E, Pelton SH, Gilbert RO, Butler WR. Effect of peripartum dietary energy supplementa-tion of dairy cows on metabolites, liver function and reproductive variables. Anim Reprod Sci. 2009;112(3-4):301-15.##

مقایسه دو روش تحریک تخمک‌گذاری [لتروزول+HMG] و [کلومیفن+HMG] در زنان نابارور دارای تخمدان پلی‌کیستیک و تحت درمان با روش تلقيح داخل رحمي اسپرم Comparing the Effects of Clomiphene-HMG and Letrozole-HMG on Ovulation Induction in Infertile Women 2 1 زمينه و هدف: کلومیفن اگرچه از داروهای مؤثر در درمان ناباروری می‌باشد؛ لیکن دارای عوارضی نظیر گرگرفتگی، کاهش موکوس سرویکس و اختلال در تست پس از مقاربت (PCT) و کاهش رشد و ضخامت اندومتر و بارداري چندقلويی است. از طرف ديگر لتروزول داروی جدیدتری است که مزایای آن شامل افزایش موکوس سرویکس، افزایش ضخامت اندومتر و کاهش خطر بارداري چندقلوئی است؛ لذا هدف از این مطالعه مقایسه این دو دارو در بیماران مبتلا به تخمدان پلی‌کیستیک (PCO) به روش كمك باروري تلقيح داخل رحمي اسپرم (IUI) بود.روش بررسی: مطالعه از نوع کارآزمایی بالینی بود. این طرح در سال 1382 در شورای پژوهشی گروه مطرح و تصویب شد. سپس100 نفر از زنان نابارور مبتلا به PCO در محدودة سني 35-20 سال واجد شرایط IUIبا اخذ رضایت‌نامه آگاهانه در مرکز ناباروری ولی‌عصر (عج) در سالهای 85-82 به صورت تصادفی ساده به 2 گروه تقسیم شدند و در هر يك از گروه‌ها داروي کلومیفن يا لتروزول به همراه HMG در فاصله روز 7-3 سیکل قاعدگی تجویز شد. متغیرهای ضخامت اندومتر، تعداد فولیکول بالغ، میزان بارداري، سقط و چند قلویی براي شركت كنندگان در هر دو گروه ثبت گرديد. اختلاف در مورد متغیرهای پیوسته توسط t-test و متغیرهای کیفی توسط تست 2 و دقيق فيشر مورد تجزیه و تحلیل قرار گرفت. 05/0p≤ معنی‌دار تلقی شد.نتایج: تعداد فولیکول بالغ، خطر تحريك بيش از حد تخمدان (40% در مقابل 14%) و تعداد سقط (5/37% در مقابل 11/11%) در گروه کلومیفن به طور معنی‌داری بیشتر بود (به ترتيب 000/0p=، 003/0p=، 048/0p=). ضخامت اندومتر و میزان بارداري (8 نفر در گروه کلومیفن در مقابل 9 نفر در گروه لتروزول) در دو گروه از نظر آماری معنی‌دار نبود.نتیجه‌گیری: در صورت احتمال خطر تحريك بيش از حد تخمدان و یا سقط همچنین مواردی نظیر عدم تحمل یا شکست کلومیفن انتخاب لتروزول به جای کلومیفن منطقی می‌باشد؛ لیکن استفاده از این دارو به عنوان خط اول درمان نیاز به مطالعه بیشتری دارد. 2 Introduction: Clomiphene Citrate has been one of the effective medications in the treatment of infertility but it has undesirable side effects, such as flushing, decreased cervical mucus production, impaired postcoital test (PCT) and multiple pregnancies. Letrozole is a newer drug and it improves cervical mucus production, increases endometrial thickness and reduces the risk for multiple pregnancies. Comparing the efficacy of clomiphene citrate versus letrozole for ovulation induction in patients with Polycystic Ovarian Disease (PCOD) was the objective of this study.Materials and Methods: This clinical trial study was done on 100 infertile, 20-35 year-old women with PCOD attending Vali-e-Asr Infertility Clinic from April 2003 to April 2007. The cases were candidates for intrauterine insemination (IUI) and signed a consent form to participate in the study. The cases were assigned to two groups through simple random sampling, the first group receiving clomiphen citrate plus HMG and the second one Letrozole plus HMG. Endometrial thickness, number of mature follicles, pregnancy rates, history of abortion and multiple pregnancies were recorded and compared in the two groups.Results: Comparing the two groups, the number of mature follicles (p=0.000), the risk for ovarian hyperstimulation (40% versus 14%, p=0.003) and abortions rates (37.5% versus 11.11%, p=0.048) were significantly higher in the clomiphene group. Differences in endometrial thickness and pregnancy rates (eight subjects in the clomiphene versus nine in the letrozole group) were of no statistical significance in the two groups.Conclusion: It seems that letrozole is a good substitute for clomiphene citrate, especially in patients at risk of abortion or ovarian hyperstimulation syndrome (OHSS), or in those who cannot tolerate clomiphene citrate. Further studies are needed to be done to fully suggest letrozole as the first line treatment for controlled ovarian hyperstimulation syndrome. 109 115 Shirin Sh Ghazizadeh شیرین قاضی‌زاده Department of Gynecology and Obstetrics ,Faculty of Medicine, Tehran University of Medical Sciences Department of Gynecology and Obstetrics ,Faculty of Medicine, Tehran University of Medical Sciences Iran shirin_ghazizadeh@yahoo.com Mehran M Amooei مهران عموئی خانعباسی Faculty of Medical Tehran University of Medical Sciences Faculty of Medical Tehran University of Medical Sciences Iran 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 Maryam M Ghelichkhani مریم قلیچ خانی 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 HCGHuman menopausal genadotropinIntra uterine inseminationLetrozoleOvarian hyperstimulation syndromeOvulation inductionPCODClomiphene citrate 372.pdf Speroff L, Fritz MA. Clinical gynecologic endocrine-ology and infertility. 7th ed. Philadelphia: Lippincott Williams & Wilkins; c2005. Chapter 30, Parturition; p. 1097-132.##Sohrabvand F, Ansari Sh, Bagheri M. Efficacy of combined metformin-letrozole in comparison with metformin-clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease. Hum Reprod. 2006;21(6):1432-5.##Sh Tehrani Nejad E, Abediasl Z, Rashidi BH, Azimi Nekoo E, Shariat M, Amirchaghmaghi E. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphen citrate gonadotropins in controlled ovarian hyperstimulation: a prospective, simply randomized, clinical trial. J Assist Reprod Genet. 2008;25(5):187-90.##Ekerhovd E. [Ovulation induction by means of letrozole]. Tidsskr Nor Laegeforen. 2009;129(5):412-5. Norwegian.##Casper RF. Letrozole versus clomiphene citrate: which is better for ovulation induction? Fertil Steril. 2007. [Epub ahead of print]##Bao SH, Sheng SL, Peng YF, Lin QD. Effects of letrozole and clomiphene citrate on the expression of HOXA10 and integrin alpha v beta 3 in uterine epithelium of rats. Fertil Steril. 2009;91(1):244-8.##Topipat C, Choktanasiri W, Jultanmas R, Weerakiet S, Wongkularb A, Rojanasakul A. A comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on superovulation in Asian women with normal ovulatory cycles. Gynecol Endocrinol. 2008;24(3):145-50.##Jee BC, Ku SY, Suh CS, Kim KC, Lee WD, Kim SH. Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles: a pilot study. Fertil Steril. 2006;85(6):1774-7.##Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil Steril. 2006;85(2):277-84.##Atay V, Cam C, Muhcu M, Cam M, Karateke A. Comparison of letrozole and clomiphene citrate in women with polycystic ovaries undergoing ovarian stimulation. J Int Med Res. 2006;34(1):73-6.##Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril. 2002;78(2):280-5.##Fatemi HM, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate versus letrozole for ovarian stimulation: a pilot study. Reprod Biomed Online. 2003;7(5):543-6.##Novak E, Berek JS, Hillard PA, Adashi EY. Novak`s Gynecology. 13th ed. Philadelphia: Lippincott Williams & Wilkins; 2002. Chapter 25, Parturition; p. 871-930.##Danforth DN, Scott JR, Gibbs RS, Karlan BY, Haney AF. Danforth`s Obstetrics and Gynecology. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003. Chapter 38, Parturition; p. 685-96.##Cortinez A, De Carvalho I, Vantman D, Gabler F, Iniguez G, Vega M. Hormonal profile and endometrial morphology in letrozole-controlled ovarian hyper stimulation in ovulatory infertile patients. Fertil Steril. 2005;83(1):110-5.##Gregoriou O, Vlahos NF, Konidaris S, Papadias K, Botsis D, Creatsas GK. Randomized controlled trial comparing superovulation with letrozole versus recombinant follicle-stimulating hormone combined with intrauterine insemination for couples with unex-plained infertility who had failed clomiphene citrate stimulation and intrauterine insemination. Fertil Steril. 2008;90(3):678-83.##Al-Fozan H, Al-Khadouri M, Tan SL, Tulandi T. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril. 2004;82(6):1561-3.##Barroso G, Menocal G, Felix H, Rojas-Ruiz JC, Arslan M, Oehninger S. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hor-mone in controlled ovarian hyperstimulation: a pro-spective, randomized, blinded clinical trial. Fertil Steril. 2006;86(5):1428-31.##Begum MR, Ferdous J, Begum A, Quadir E. Comparison of efficacy of aromatase inhibitor and clomiphene citrate in induction of ovulation in polycys-tic ovarian syndrome. Fertil Steril. 2008 Jan 3. [Epub ahead of print].##Mitwally MF, Casper RF. Use of an aromatase inhibi-tor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril. 2001;75(2):305-9.##Sohrabvand F, Ansari Sh, Bagheri M. Efficacy of combined metformin-letrozole in comparison with metformin-clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease. Hum Reprod. 2006;21(6):1432-5.##

بررسي مقايسه‌اي آزمايش ادرار قبل و بعد از آزمايش مني در مردان Urine Indices before and after Semen Sampling 2 1 زمينه و هدف: در كلينيك‌هاي ناباروري عده زيادي از مردان پس از نمونه‌گيري مايع مني اقدام به انجام آزمايش ادرار مي‌نمايند. در آزمايشگاه‌هاي تشخيص طبي نيز روزانه تعداد زيادي نمونه ادرار جمع‌آوري مي‌گردد كه در مورد هر يك سئوالاتي از بيماران در زمينه‌هاي مختلف پرسيده مي‌شود؛ اما هرگز در مورد داشتن نزديكي (یا انزال) در چند ساعت گذشته از آنها سئوال نمي‌شود. با توجه به افزايش واضح پروتئين در ادرار پس از آزمايش مني و امکان تاثیر آن بر پارامترهای آزمایش کامل ادرار، اين مطالعه به منظور مقايسه شاخص‌هاي آناليز ادرار قبل و بعد از نمونه‌گيري مايع مني، انجام گرفت. روش بررسی: در اين بررسي از 220 مرد مراجعه كننده به كلينيك ناباروري مركز درمان ناباروري و سقط مكرر ابن‌سينا براي انجام آناليز مايع مني (S/A)، در دو نوبت قبل و بعد از دريافت مايع مني، نمونه ادرار گرفته شد تا تفاوت‌هاي ايجاد شده در آزمايش ادرار به سبب وجود مني در مجراي ادراري با استفاده از نوار ادراری و روش‌های نیمه کمی بررسي شود. كليه يافته‌ها با نرم افزار آماري SPSS ويرايش 5/11 و با استفاده از آزمون‌های آماری t زوج، ویلکاکسون، محاسبه ضریب همبستگی اسپیرمن و ضریب توافق کاپا بررسي و سطح معني‌داري از نظر آماري 05/0p< در نظر گرفته شد. نتايج: نتايج آناليز ادرار نشان داد كه رنگ ادرار، خون، ‌اسيدآسكوربيك، ‌اوروبیلینوژن،‌ بیلی روبین، نیتریت، کتون، قند و وزن مخصوص پس از S/A تغييري ندارند؛‌ در حالي كه کدورت و پروتئين ادرار پس از S/A افزايش معنی‌دار (001/0p<) داشته و pHنيز کاهش مي‌يابد اما معني‌دار نیست (46/0p=).نتیجه‌گیری: در آزمايشگاه به جز سئوالات مرسوم قبل از انجام آزمايش ادرار، بايد در مورد احتمال نزديكي يا هر نوع انزال به ويژه در مواردي كه نمونه از نظر وجود پروتئين مورد بررسي قرار مي‌گيرد از مردان سئوال شود تا از اضطراب و نگراني بي‌مورد بيمار و انجام آزمايش‌هاي اضافي و پرهزينه‌تر پيشگيري شود. 2 Introduction: In fertility clinics and diagnostic laboratories, a great number of male subjects undergo urinary sampling for urine analysis (U/A) after semen sampling.Despite taking thorough medical histories in these centers, questions on intercourses or ejaculations prior to the sampling are occasionally neglected. Due to the noticeable increases in urinary protein upon S/A and the possibilities for U/A parameters distortion, this study was undertaken to compare urinary indices before and after semen sampling.Materials and Methods: Urine samples were obtained from 220 men attending Avicenna Infertility Clinic in Tehran, Iran, before and after semen sampling and two urinalyses were done for each patient. Eventually, the findings were statistically compared and analyzed.Results: Biochemical and physical characteristics of urine samples, including color, blood, ascorbic acid, urobilinogen, bilirubin, nitrite, ketone, glucose and specific gravity did not undergo significant changes after semen sampling, while turbidity and protein were increased (p<0.001) and urine pH was decreased but with no statistical significance (p=0.46).Conclusion: It is recommended to ask about ejaculation or prior intercourses before urine sampling for urinalysis, especially at times when urinary protein is of importance. This will avoid unnecessary, additional diagnostic testing, which in turn will prevent psychological distress and save money and time. 115 120 Haleh H Soltanghoraee هاله سلطان قرایی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Hooman H Sadri-Ardekani هومن صدری‌اردکانی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadri@avicenna.ac.ir Ali A Sadeghi Tabar علی صادقی‌تبار Avicenna Infertility Clinic, Avicenna Research Institute (ACECR) Avicenna Infertility Clinic, 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 Leili L Chamani Tabriz لیلی چمنی تبریز Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Hojjat H Zeraati حجت زراعتی Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Iran Tahereh T Kashi طاهره کاشی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran DipstickEjaculationProteinuriaSemen analysisUrinalysis 373.pdf McPherson RA, Pincus MR, Henry JB. Henry`s clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders Elsevier; 2007. p. 367-88.##Mazouz B, Almagor M. False-positive microhematuria in dipsticks urinalysis caused by the presence of semen in urine. Clin Biochemis. 2003;36(3):229-31.##World Health Organization. WHO laboratory manual for the examination of human semen and sperm- cervical mucus interaction. 4th ed. Cambridge University Press; 1999. p. 57-62.##Domachevsky L, Grupper M, Shochat T, Adir Y. Proteinuria on dipstick urine analysis after sexual intercourse. BJU Int. 2006;97(1):146-8.##Verit A. Proteinuria on dipstick urine analysis after sexual intercourse. BJU Int. 2006;97(5):1122.##Kumar R, Kesarwani P, Shrivastava DN, Hemal AK. Post coital hematuria: presentation of an uncommon case. J Postgraduate medicine. 2004;50(4):312-3.##Harris NM, Yardley I, Basketter V, Holmes SA. Is sexual intercourse a significant cause of haematuria? BJU Int. 2002;89(4):344-6.##

فراواني، پيامد و عوامل خطر عفونت کلاميديا تراکوماتيس در زنان باردار Chlamydia trachomatis Infection in Pregnant Women 2 1 زمينه و هدف: عفونت‌هاي كلاميديايي، يكي از شايع‌ترين و پرضايعه‌ترين بيماري‌هاي منتقله از راه جنسي در جوامع مختلف است. كلاميديا تراكوماتيس در ايجاد پارگي زودرس كيسة آب، زايمان زودرس، سقط، وزن کم نوزاد، مرگ نوزادي و بسياري از اختلالات ديگر در دوران بارداري نقش مهمي دارد و از مشكلات موجود، كنترل عفونت كلاميديايي و عوارض آن می‌باشد؛ لذا اين پژوهش به منظور تعيين فراواني، پيامد و عوامل خطر عفونت‌هاي كلاميديايي در شهر تهران انجام شد. روش بررسي: مطالعه مقطعي، توصيفي‌ـ تحليلي و نمونه‌هاي مورد بررسي 1114 زن باردار در هفته 32-11 بارداري مراجعه‌كننده به بيمارستان‌هاي دانشگاه علوم پزشكي شهر تهران در سال 1385-1387 بودند که پس از جمع‌آوري سابقه و اطلاعات مربوط به بارداري، از آنها نمونه خون دريافت و با روش اليزا، آنتي‌بادي کلاميديا (IgG) در نمونه‌ها بررسي و همراه با اطلاعات پرسشنامه در نرم افزار SPSS V.13 ثبت گرديد. جهت آناليز داده‌ها از آزمون‌هاي آماري کاي دو، تي تست، نسبت شانس و رگرسيون لجستيک، با سطح معني‌داري 5% استفاده شد. نتايج: نتايج بررسي حضور آنتي‌بادي IgG عليه كلاميديا تراكوماتيس نشان داد كه فراواني عفونت‌هاي كلاميديايي 9/2% بود. شانس ابتلا به عفونت کلاميديايي در زنان باردار با سابقه زايمان قبلي 3/2 برابر شانس ابتلا در زنان بدون سابقه زايمان به دست آمد (با فاصله اطمينان 95%، 8/4-1/1). در زنان با عفونت قديمي کلاميديا (IgG مثبت) بروز کوريوآمنيوتيت 7/4 برابر (027/0p=) و مرگ نوزاد 6/11 برابر (008/0p=) بيشتر از زنان بدون عفونت بود.نتيجه‌گيري: مطالعه حاضر مي‌تواند نشان‌دهنده فراوانی کم عفونت کلاميديايي در جمعيت مورد بررسي باشد؛ با توجه به آنکه مطالعه در بیمارستان‌های دولتی انجام شده است، مطالعات آينده در جمعيت‌هاي متفاوتي از زنان باردار مراجعه‌کننده به بخش‌هاي خصوصي توصيه مي‌شود تا بتوان در مورد غربالگري کلاميديا در دوران بارداري و پيشگيري از پيامدهاي احتمالي در جامعه زنان باردار ايراني نظر قطعي داد. 2 Introduction: Chlamydial infections are the most common sexually transmitted diseases with highest rates of morbidity in different societies. Chlamydia trachomatis is a known causative agent for premature rapture of membranes (PROM), preterm labor, miscarriage, low birth weight and neonatal death, and forms a copious burden of disease in many countries. This study aims to evaluate the prevalence, outcome and risk factors of chlamydial infections.Materials and Methods: This cross-sectional, descriptive-analytical study was done on 1114 pregnant women in their 11th to 32nd week of gestation who attended the hospitals affiliated to Tehran University of Medical Sciences during March 2007 to March 2009. Serum levels of IgG anti-chlamydial antibody were measured by ELIZA method, upon taking a thorough medical history.Results: Positive results for chlamydia IgG were seen in 2.9% of the cases. Chlamydia infection was 2.3 times greater in multiparous women compared to primigravids, (95% CI, 1.1- 4.8). Chorioamnionitis and neonatal death were respectively 4.7 (p=0.027) and 11.6 (p=0.008) times more prevalent in IgG-positive group compared to women without the infection.Conclusion: A relatively low prevalence of chlamydial infection was observed in the studied population. Further studies in different groups of pregnant women, especially in cases attending private health sector, are recommended to be done in order to justify the necessity of routine Chlamydia screening in pregnancy and the obligation for preventive care measurements in Iranian pregnant women. 121 129 Soghra S Khezerdoust صغری خظردوست 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 Samin S Roostaie ثمین روستایی Imam Khomeini Complex Hospital, Tehran University of Medical Sciences Imam Khomeini Complex Hospital, Tehran University of Medical Sciences Iran Naser N Badami ناصر بادامی Faculty of Public Health, Tehran University of Medical Sciences Faculty of Public Health, Tehran University of Medical Sciences Iran Mohammad Mehdi MM Naghizadeh محمدمهدی نقی زاده 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 Chlamydia trachomatisComplicationsNeonatal deathPregnancySerologySexually transmitted infection 374.pdf Paavonen J, Eggert-Kruse W. Chlamydia trachomatis: impact on human reproduction. Hum Reprod Update. 1999;5(5):433-47.##Centers for Disease Control and Prevention, Workows-ki KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006;55(RR-11):1-94.##Gerbase AC, Rowley JT, Heymann DH, Berkley SF, Piot P. Global prevalence and incidence estimates of selected curable STDs. Sex Transm Infect. 1998;74 Suppl 1:S12-6.##Centers for Disease Control and Prevention (CDC). Chlamydia screening among sexually active young female enrollees of health plans--United States, 2000-2007. MMWR Morb Mortal Wkly Rep. 2009;58(14): 362-5.##Chamani-Tabriz L, Tehrani MJ, Akhondi MM, Mosavi-Jarrahi A, Zeraati H, Ghasemi J, et al. Chlamydia trachomatis prevalence in Iranian women attending obstetrics and gynaecology clinics. Pak J Biol Sci. 2007;10(24):4490-4.##Bakhtiari A, Firoozjahi A. Chlamydia trachomatis infection in women attending health centres in Babol: prevalence and risk factors. East Mediterr Health J. 2007;13(5):1124-31.##Fallah F, Kazemi B, Goudarzi H, Badami N, Doostdar F, Ehteda A, et al. Detection of Chlamydia trachomatis from urine specimens by PCR in women with cervicitis. Iran J Public Health. 2005;34(2):20-6.##Salari MH, Badami N. The rate of Chlamydia tracho-matis, Mycoplasma hominis and Ureaplasma urealyti-cum in females with habitual abortion and its compari-son with control group. Acta Med Iran. 2002;40(2):73-8.##Zaeimi Yazdi J, Khorramizadeh MR, Badami N, Kaze-mi B, Aminharati F, Eftekhar Z, et al. Comparative assessment of Chlamydia trachomatis infection in Iranian women with cervicitis: A cross-sectional study. Iran J Public Health. 2006;35(2):69-75.##Low N, Bender N, Nartey L, Shang A, Stephenson JM. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol. 2009;38(2):435-48.##Jeddi Tehrani M. [Diagnosis methods of Clamydia trachomatis]. J Reprod Infertil. 1999;1(1):36-43. Persian.##de la Torre E, Mulla MJ, Yu AG, Lee SJ, Kavathas PB, Abrahams VM. Chlamydia trachomatis infection modulates trophoblast cytokine/chemokine production. J Immunol. 2009;182(6):3735-45.##Euroimmun AG. Infections during pregnancy: new decision support tools from the serological laboratory [Internet]. Lübeck: Euroimmun AG; 1987 Sept [updated 2009 April 16]. Available from: http://www. euroimmun.com/index.php.##Chen MY, Fairley CK, De Guingand D, Hocking J, Tabrizi S, Wallace EM, et al. Screening pregnant women for chlamydia: what are the predictors of infection? Sex Transm Infect. 2009;85(1):31-5.##Chamani Tabriz L, Jeddi Tehrani M, Zeraati H, Asgari S, Moini M, Rabbani H, et al. [Prevalence of Chlamydia trachomatis infection in women reffered to obstetrics & gyneocologic clinic in Tehran. Iran J Infect Dis Trop Med. 2008;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.##Kirk E, Bora S, Van Calster B, Condous G, Van Huffel S, Timmerman D, et al. Chlamydia trachomatis infection in patients attending an Early Pregnancy Unit: prevalence, symptoms, pregnancy location and via-bility. Acta Obstet Gynecol Scand. 2008;87(6):601-7.##Sullivan EA, Abel M, Tabrizi S, Garland SM, Grice A, Poumerol G, et al. Prevalence of sexually trans-mitted infections among antenatal women in Vanuatu, 1999-2000. Sex Transm Dis. 2003;30(4):362-6.##Shankar M, Dutta R, Gkaras A, Tan B, Kadir RA, Economides D. Prevalence of Chlamydia trachomatis and bacterial vaginosis in women presenting to the early pregnancy unit. J Obstet Gynaecol. 2006;26(1): 15-9.##Shimano S, Nishikawa A, Sonoda T, Kudo R. Analy-sis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan. J Obstet Gynaecol Res. 2004;30(3):230-6.##Geisler WM, James AB. Chlamydial and gonococcal infections in women seeking pregnancy testing at family-planning clinics. Am J Obstet Gynecol. 2008; 198(5):502.##Yasodhara P, Ramalakshmi BA, Naidu AN, Raman L. Prevalence of specific IGM due to toxoplasma, rubella, CMV and c.trachomatis infections during pregnancy. Indian J Med Microbiol. 2001;19(2):52-6.##Sawhney MP, Batra RB. Chlamydia trachomatis seropositivity during pregnancy. Indian J Dermatol Venereol Leprol. 2003;69(6):394-5.##Behroozi R, Badami N. [The prevalence of Chla-mydia infection among pregnant women referred to prenatal clinics of Tehran University of Medical Sciences in the year 1994: a pilot study]. J Mazandaran Med Sci. 1999;9:26-31. Persian.##Pawlowska A, Niemiec KT, Filipp E, El Midaoui A, Scholz A, Marianowska S, et al. Chlamydia tracho-matis infection in pregnant women hospitalised in the Institute of Mother and Child in Warsaw, Poland. Med Wieku Rozwoj. 2005;9(1):21-6.##Kucinskiene V, Sutaite I, Valiukeviciene S, Milasaus-kiene Z, Domeika M. Prevalence and risk factors of genital Chlamydia trachomatis infection. Medicina (Kaunas). 2006;42(11):885-94.##Hiltunen-Back E, Haikala O, Kautiainen H, Paavonen J, Reunala T. A nationwide sentinel clinic survey of Chlamydia trachomatis infection in Finland. Sex Transm Dis. 2001;28(5):252-8.##Cliffe SJ, Tabrizi S, Sullivan EA. Chlamydia in the Pacific region, the silent epidemic. Sex Transm Dis. 2008;35(9):801-6.##Leszczy?ska-Gorzelak B, Darmochwal-Kolarz D, Borowiec-Blinowska A, Oleszczuk J. The prevalence of Chlamydia trachomatis infection in pregnant women. Med Wieku Rozwoj. 2005;9(1):27-35.##Rastogi S, Das B, Mittal A. Serum IgM to Chlamydia trachomatis in pregnancy: its usefulness for screening. Br J Biomed Sci. 2002;59(1):30-4.##Chamani Tabriz L, Jeddi Tehrani M, Mosavi-Jarrahi A, Zeraati H, Ghasemi J, Asgari S, et al. [The prevalence of Chlamydia trachomatis infection by molecular analysis of urine samples in women attending OB & GYN clinics in Tehran]. J Reprod Infertil. 2006;7(3):234-242. Persian.##Mikhova M, Ivanov S, Nikolov A, Mitov I, Iordanov D, Uzunova V, et al. [Cervicovaginal infections during pregnancy as a risk factor for preterm delivery]. Akush Ginekol (Sofiia). 2007;46(9):27-31. Bulgarian.##Ostaszewska-Puchalska I, Wilkowska-Trojniel M, Zdrodowska-Stefanow B, Knapp P. Chlamydia trachomatis infections in women with adverse pregnancy outcome. Med Wieku Rozwoj. 2005;9(1): 49-56.##Mitsui M, Tsukahara Y. [STD and mother to child transmission]. Nippon Rinsho. 2009;67(1):177-84. Japanese.##Blas MM, Canchihuaman FA, Alva IE, Hawes SE. Pregnancy outcomes in women infected with Chla-mydia trachomatis: a population-based cohort study in Washington State. Sex Transm Infect. 2007;83(4):314-8.##Mardh PA. Influence of infection with Chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring. Best Pract Res Clin Obstet Gynaecol. 2002;16(6):847-64. Review.##Sheiner E, Katz M. Chlamydial infections in obstet-rics and gynaecology in Israel. Med Wieku Rozwoj. 2005;9(1):37-42. Review.##Ryan GM Jr, Abdella TN, McNeeley SG, Baselski VS, Drummond DE. Chlamydia trachomatis infection in pregnancy and effect of treatment on outcome. Am J Obstet Gynecol. Am J Obstet Gynecol. 1990;162(1): 34-9.##Martin DH, Koutsky L, Eschenbach DA, Daling JR, Alexander ER, Benedetti JK, et al. Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydia trachomatis infections. JAMA. 1982;247(11):1585-8.##Zhang C, Zhu D, Guo X. [A study on ways of intrauterine infection of chlamydia trachomatis]. Zhonghua Fu Chan Ke Za Zhi. 2002;37(3):149-51. Chinese.##Djukic S, Nedeljkovic M, Pervulov M, Ljubic A, Radunovic N, Lazarevic B. Intra-amniotic Chlamydia trachomatis infection. Gynecol Obstet Invest. 1996;42 (2):109-12.##Bax CJ, Mutsaers JA, Jansen CL, Trimbos JB, D?rr PJ, Oostvogel PM. Comparison of serological assays for detection of Chlamydia trachomatis antibodies in different groups of obstetrical and gynecological patients. Clin Diagn Lab Immunol. 2003;10(1):174-6.##Morré SA, Munk C, Persson K, Krüger-Kjaer S, van Dijk R, Meijer CJ, et al. Comparison of three commercially available peptide-based immunoglobulin G (IgG) and IgA assays to microimmunofluorescence assay for detection of Chlamydia trachomatis antibodies. J Clin Microbiol. 2002;40(2):584-7.##Numazaki K. Serological tests for Chlamydia tracho-matis infections. Clin Microbiol Rev. 1998;11(1):228-9.##Honey E, Augood C, Templeton A, Russell I, Paavonen J, Mardh PA, et al. Cost effectiveness of screening for Chlamydia trachomatis: a review of published studies. Sex Transm Infect. 2002;78(6):406-12.##

ارزيابي كيفيت زندگي در زنان مبتلا به اندومتريوز Quality of Life in Patients with Endometriosis 2 1 زمينه و هدف: اندومتريوز، بيماري مزمني است كه ميزان شيوع آن در سنين باروري زنان حدود 10% مي‌باشد. علائم شاخص اين بيماري شامل: درد مزمن لگني،‌ مقاربت دردناك و كاهش قدرت باروري مي‌باشد كه اين علائم تأثير منفي جدي بر پارمترهاي رواني‌ـ اجتماعي بيماران گذاشته و مي‌تواند باعث كاهش مشخص در كيفيت زندگي زنان مبتلا شود. كيفيت زندگي، يك مفهوم پويا و چند بعدي است كه در برگيرنده جنبه‌هاي فيزيكي،روانشناختي و اجتماعي زندگي مي‌باشد. هدف اين مطالعه،‌ ارزيابي كيفيت زندگي در زنان مبتلا به اندومتريوز است.روش بررسي: اين مطالعه به طور مقطعي روي 40 زن مبتلا به اندومتريوز مراجعه‌كننده به مراكز درمان ناباروري ابن‌‌سينا و دانشگاه علوم پزشكي شهید بهشتي انجام گرفت. ابزار تحقيق،‌ پرسشنامه EHP-5 بود و توسط يك آزمونگر، از بيماران با تشخيص قطعي اندومتريوز تكميل مي‌گرديد كه تمام اين افراد حاضر به شركت در طرح بودند. نتايج: سن افراد مورد بررسي، 48-22 سال با ميانگين 3/87/35 سال و مدت زمان شروع علائم تا تشخيص، 84-6 ماه با ميانگين 32 ماه بود. تمام بيماران نابارور بوده و 75% از مقاربت دردناك و 32% از درد به هنگام راه رفتن شكايت داشتند. زندگي 92% بيماران، متأثر از علائم بيماري بوده و 62%، افت عملكرد شغلی نشان مي‌دادند. 55% نوسانات خلقي، 37% احساس افسردگي و 34% احساس تغيير شكل ظاهري مي‌نمودند. 73% اعتقاد داشتند كه ساير مردم و 41% معتقد بودند حتی پزشكان معالج وخامت بيماري آنها را درك نمي‌كنند و 29% نيز از عدم كارايي درمان‌هاي موجود مأيوس و نااميد بودند.نتيجه‌گيري: اندومتريوز كيفيت زندگي را بويژه در حوزه‌هاي درد،‌ عملكرد جسمي و عملكرد رواني تهديد مي‌نمايد. اندومتريوز با نقائص عمده‌اي از قبيل درد، افت عملكرد رواني و افت عملكرد اجتماعي همراه مي‌باشد. هر چند درمان‌هاي داروئي و جراحي بيماري باعث بهبود عملكرد فيزيكي و رواني،‌ سطح انرژي و كاهش سطح درد بيماران مي‌شوند؛ اما پرداختن به كيفيت زندگي بيماران با استفاده از روان‌درماني و دارودرماني مناسب در كنار درمان‌هاي جسمي موجود، ضروري و با اهميت بنظر مي‌رسد. 2 Introduction: Endometriosis is a chronic gynaecological disease with a prevalence of about 10% in women of reproductive age. The typical symptoms of this disease include chronic pelvic pain, dyspareunia and infertility with an overall negative impact on the psychosocial parameters in the subjects, leading to a significant reduction of quality of life. Health-Related Quality of Life (HRQL) is a multi-dimensional, dynamic concept that encompasses physical, psychological and social aspects of individuals. The aim of this study was to evaluate quality of life in patients with endometriosis. Materials and Methods: This descriptive, cross-sectional study was performed on forty 22–28 year-old women with endometriosis, attending Avicenna Infertility Clinic and Shahid Beheshti University of Medical Sciences. Endometriosis Health Profile-5 (EHP-5) questionnaire was used in interviews to collect data from individuals willing to participate in the study. Results: The mean age of participants was 35.7±8.3 years with an average duration of the disease of 32 months (6 to 84 months). All the patients were infertile, 75% suffered from dyspareunia and 32% had painful walking. Functional impairment was seen in 62% of the individuals and 92% felt as though symptoms were ruling their lives. Mood swing was seen in 55% of the patients, 37% felt depressed and 34% thought their general appearance had been affected. About 73% believed that healthy individuals and 41% believed that even medical doctors did not realize the gravity of their disease, while 29% felt hopeless because of treatment effectiveness.Conclusion: Endometriosis impairs quality of life, specially in the domains of pain, psychological and functional abilities. Although, medical and surgical measurements improve physical and psychological functions, increase energy levels and lessen pain but psychotherapy and appropriate pharmacotherapy seem to be essential in the management of endometriosis. 129 136 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 Farhad F Yaghmaie فرهاد یغمایی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Chronic pelvic painDyspareuniaEHP-5 questionnaireEndometriosisInfertilityQuality of life 375.pdf Olive DL, Schwartz LB. Endometriosis. N Engl J Med. 1993;328(24):1759-69.##Jones G, Jenkinson C, Taylor N, Mills A, Kennedy S. Measuring quality of life in women with endometrio-sis: tests of data quality, score reliability, response rate and scaling assumptions of the Endometriosis Health Profile Questionnaire. Hum Reprod. 2006;21(10): 2686-93.##Winkel CA. Evaluation and management of women with endometriosis. Obstet Gynecol. 2003;102(2):397-408. Review.##Gazvani R, Templeton A. New considerations for the pathogenesis of endometriosis. Int J Gynaecol Obstet. 2002;76(2):117-26. Review.##Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817-21.##Missmer SA, Cramer DW. The epidemiology of endo-metriosis. Obstet Gynecol Clin North Am. 2003; 30(1): 1-19. Review.##Coste J, Guillemin F, Pouchot J, Fermanian J. Method-ological approaches to shortening composite measure-ment scales. J Clin Epidemiol. 1997;50(3):247-52.##Zondervan K, Barlow DH. Epidemiology of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(3):403-14. Review.##Low WY, Edelmann RJ, Sutton C. A psychological profile of endometriosis patients in comparison to patients with pelvic pain of other origins. J Psychosom Res. 1993;37(2):111-6.##Gambone JC, Mittman BS, Munro MG, Scialli AR, Winkel CA, Chronic Pelvic Pain/Endometriosis Work-ing Group. Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process. Fertil Steril. 2002; 78(5):961-72.##Levine S. The changing terrains in medical sociology: emergent concern with quality of life. J Health Soc Behav. 1987;28(1):1-6.##Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273(1):59-65.##Jones G, Jenkinson C, Kennedy S. Evaluating the responsiveness of the Endometriosis Health Profile Questionnaire: the EHP-30. Qual Life Res. 2004;13(3): 705-13.##Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life and economic correlates. Obstet Gynecol. 1996;87(3):321-7.##Peveler R, Edwards J, Daddow J, Thomas E. Psy-chosocial factors and chronic pelvic pain: a comparison of women with endometriosis and with unexplained pain. J Psychosom Res. 1996;40(3):305-15.##Denny E. Women`s experience of endometriosis. J Adv Nurs. 2004;46(6):641-8.##Talor EM. The stress of infertility. Hum Ecol. 2002;95 (1):12.##Colwell HH, Mathias SD, Pasta DJ, Henning JM, Steege JF. A health-related quality-of-life instrument for symptomatic patients with endometriosis: a valid-ation study. Am J Obstet Gynecol. 1998;179(1):47-55.##Jones G, Kennedy S, Barnard A, Wong J, Jenkinson C. Development of an endometriosis quality-of-life instrument: The Endometriosis Health Profile-30. Obstet Gynecol. 2001;98(2):258-64.##Gao X, Yeh YC, Outley J, Simon J, Botteman M, Spalding J. Health-related quality of life burden of women with endometriosis: a literature review. Curr Med Res Opin. 2006;22(9):1787-97. Review.##Jones G, Jenkinson C, Kennedy S. Development of the Short Form Endometriosis Health Profile Ques-tionnaire: the EHP-5. Qual Life Res. 2004;13(3):695-704.##Ballweg ML. Impact of endometriosis on women`s health: comparative historical data show that the earlier the onset, the more severe the disease. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):201-18.##Denny E. Women`s experience of endometriosis. J Adv Nurs. 2004;46(6):641-8.##Ferrero S, Abbamonte LH, Parisi M, Ragni N, Remor-gida V. Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and post-operative administration of triptorelin. Fertil Steril. 2007;87(1):227-9.##Ferrero S, Abbamonte LH, Giordano M, Ragni N, Remorgida V. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod. 2007;22(4):1142-8.##Denny E, Mann CH. Endometriosis-associated dys-pareunia: the impact on women`s lives. J Fam Plann Reprod Health Care. 2007;33(3):189-93.##Jones G, Jenkinson C, Kennedy S. The impact of endometriosis upon quality of life: a qualitative analy-sis. J Psychosom Obstet Gynaecol. 2004;25(2):123-33##Marques A, Bahamondes L, Aldrighi JM, Petta CA. Quality of life in Brazilian women with endometriosis assessed through a medical outcome questionnaire. J Reprod Med. 2004;49(2):115-20.##

طراحی و روان‌‌سنجی "پرسشنامه كيفيت زندگی زوجهای نابارور" Developing “Quality of Life in Infertile Couples Questionnaire” and Measuring its Psychometric Properties 2 1 زمينه و هدف: مطالعات نشان می‌دهد که میزان ناباروری رو به افزايش است. زوجین نابارور مشکلات بسیاری را در زندگی خود تجربه می‌کنند. اندازه‌گیری کیفیت زندگی سبب می‌شود تا مسئولین بهداشتی با آگاهی از نیازهای آنان، بتوانند خدمات بهتری را به ايشان ارائه دهند. اندازه‌گیری کیفیت زندگی زوجین نابارور، به‌خصوص در ایران نیاز به پرسشنامه‌ای معتبر و پایا دارد. هدف از انجام اين پژوهش، طراحي پرسشنامه‌ای معتبر و پايا جهت اندازه‌گيري كيفيت زندگي زوج‌هاي نابارور مي‌باشد.روش بررسي: پژوهش حاضر، يك مطالعه اکتشافی است. در ابتدا، با مروری بر مطالعات و مصاحبه‌ها، مفهوم و ابعاد كيفيت زندگي زوج‌هاي نابارور تعریف و پرسشنامه کیفیت زندگی زوجین نابارور با 95 عبارت طراحی گردید. سپس شاخص اعتبار محتواي پرسشنامه با نظرات 10 متخصص در زمینه ناباروری و کیفیت زندگی و 10 زوج نابارور، مربوط بودن، واضح بودن و ساده بودن، بر اساس یک معیار 4 درجه‌ای تعیین گردید. اعتبار صوری پرسشنامه با نظرخواهی از 20 متخصص و زوج نابارور بررسی شد. اعتبار سازه (تحلیل عاملی)، با توزیع پرسشنامه طراحی شده در ميان 150 زن و مرد نابارور اندازه‌گیری شد. برای اندازه‌گیری پایایی، از روش همسانی درونی (آلفای کرونباخ) و آزمون مجدد استفاده گرديد.نتایج: در بررسی اعتبار محتوا، عباراتي كه شاخص اعتبار محتواي آنها بیشتر از 79% بود در پرسشنامه حفظ گردید، لذا تعداد عبارات پرسشنامه به 79 عدد کاهش یافت. نتایج تحلیل عاملی، 7 عامل را در پرسشنامه نشان داد. به‌علاوه یافته‌ها، پایایی همساني درونی (آلفای کرونباخ) عبارات را 95/0-71/0 و آزمون مجدد را 94/0-81/0، برای 7 عامل پرسشنامه نشان داد. در مراحل فوق 7 عبارت به علت کاهش بار عاملی و به دليل تكراري بودن، حذف گرديد و لذا عبارات پرسشنامه به 72 عدد رسید.نتیجه‌گیری: نتایج پژوهش حاضر نشان داد که پرسشنامه کیفیت زندگی زوجین نابارور با 72 عبارت از نوع لایکرت معتبر و پایا می‌باشد. با توجه به کمبود پرسشنامه معتبر و پايا جهت اندازه‌گیری کیفیت زندگی زنان و مردان نا بارور در جامعه ایران، بکارگیری این پرسشنامه می تواند مفید یاشد. با توجه به اهمیت این پرسشنامه، اندازه‌گیری سایر انواع اعتبار مانند اعتبار ممیزی و همزمان پيشنهاد می‌شود. 2 Introduction: Numerous studies point to the increasing prevalence of infertility around the world. This entity has usually taken its toll on infertile couples and has left them prone to psychosocial problems. Measuring quality of life of infertile couples can help health policy makers provide services tailored to the needs of this group of people. The purpose of this study was to develop a questionnaire to measure the quality of life of infertile couples and test its validity and reliability.Materials and Methods: In this exploratory study, we defined and determined the dimensions of quality of life in infertile couples by reviewing the literature and interviewing infertile couples. Finally, Quality of Life in Infertile Couples Questionnaire (QOLICQ) with 95 Likert-type items was developed.Results: In analyzing the content validity index, items with more than 79% validity were kept and the number of items was reduced to 79 in the questionnaire. Factor analysis showed seven factors in the questionnaire. An internal consistency of 0.71- 0.95 and a test-retest reliability of 0.81 - 0.04 were calculated for the seven factors. Therefore, the seven previously mentioned factors were omitted because of decreased value in factor analysis and redundancy, leaving 72 items in the questionnaire. Content validity index (CVI) of the questionnaire was measured by a panel of 10 experts and 10 infertile couples based on its "relevance", "clarity" and "simplicity" on a four-point scale. Then, construct validity (factor analysis) was measured by 150 infertile subjects. To determine reliability, internal consistency and test-retest reliability were measured. Conclusion: The Quality of Life in Infertile Couples Questionnaire (QOLICQ), which includes 72 Likert-type items, is a valid and reliable tool for measuring quality of life of infertile couples. Measuring other types of validity, such as discriminate and concurrent validity are recommended. 137 144 Farideh F Yaghmaei فریده یغمایی Department of Public Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Department of Public Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran farideh_y2002@yahoo.com Shamaneh Sh Mohammadi شمعانه محمدی Department of Internal Medicine and Surgery, Nasibeh Faculty of Nursing and Midwifery Department of Internal Medicine and Surgery, Nasibeh Faculty of Nursing and Midwifery Iran Hamid H Alavimajd حمید علوی‌مجد Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences Iran InfertilityPsychometric analysisQuality of lifeQuestionnaire 376.pdf Macduff C. Respondent-generated quality of life meas-ures: useful tools for nursing or more fool`s gold? J Adv Nurs. 2000;32(2):375-82. Review.##Khayata GM, Rizk DE, Hasan MY, Ghazal-Aswad S, Asaad MA. Factors influencing the quality of life of infertile women in United Arab Emirates. Int J Gynaecol Obstet. 2003;80(2):183-8.##Monga M, Alexandrescu B, Katz SE, Stein M, Ganiats T. Impact of infertility on quality of life, marital adjust-ment and sexual function. Urology. 2004;63(1):126-30.##Ramezanzadeh F, Aghssa MM, Abedinia N, Zayeri F, Khanafshar N, Shariat M, et al. A survey of relation-ship between anxiety, depression and duration of infer-tility. BMC Womens Health. 2004;4(1):9.##Spiroff L, Fritz MA. Clinical gynecology endocrine-ology and infertility. 17th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. 12 p.##Berek JS, Novak E. Berek & Novak`s gynecology. 14th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. 506 p.##Rebarsolzekey H. [Infertility and treatment]. 1st ed. Karimzadeh Maybodi K, Translator. Yazd: Yazad publisher; 1996. 28 p. Persian.##Cwikel J, Gidron Y, Sheiner E. Psychological inter-actions with infertility among women. Eur J Obstet Gynecol Reprod Biol. 2004;117(2):126-31. Review.##Schneider Z, Elliot D, LoBiondo-Wood G, Beanland C, Haber J. Nursing research: methods, critical appraisal and utilization. 2nd ed. Sydney: Mosby-Elsevier; 2004. 487 p.##Diamond R, Kezur D, Meyers M, Scharf CN, Wein-shel M. Couple therapy for infertility. New York: Gilford Press; 1999. 34 p.##Mohammadi MR, Khalaj Abadi Farahani F. [Emo-tional and psychological problems of infertility and strategies to overcome them]. J Reprod Infertil. 2001;2 (4):33-9. Persian.##Wischmann T, Stammer H, Scherg H, Gerhard I, Ver-res R. Psychosocial characteristics of infertile couples: a study by the Heidelberg Fertility Consultation Service. Hum Reprod. 2001;16(8):1753-61.##Mazaheri MA, Kayghobadi F, Faghihi Imani Z, Gha-shang N, Pato M. [Problem solving strategies and marital adjustment in infertile and fertile couples]. J Reprod Infertil. 2001;2(4):22-32. Persian.##Lowedermilk D, Perry S. Maternity and women`s health care. 8th ed. United States: Mosby; 2004.1274 p.##Pazandeh F, Sharghi N. [Comparing wellbeing of fertile and infertile women referring to health centers at Shaheed Beheshti Universty of Medical Sciences and Health Services and Infertile Centers at Tehran 2002]. Fac Nurs Midwifery Q. 2004;44:4-10. Persian.##Macnee C. Understanding nursing research: reading and using research in practice. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2003. 190 p.##Strombegy M, Olsen S. Instruments for clinical health care research. 3rd ed. Boston: Jones and Batlett Publisher; 2004. 128 p.##Nejat SN, Montazeri A, Holakhouei Naeini K, Mohammad K, Majdzadeh SR. [The World Health Organization Quality of Life (WHOQOL-BREF) ques-tionnaire: translation and validation study of the Iranian version]. J Sch Public Health Inst Public Health. 2007;4(4):1-12. Persian.##Rashidi B, Montazeri A, Ramezanzadeh F, Shariat M, Abedinia N, Ashrafi M. Health-related quality of life in infertile couples receiving IVF or ICSI treatment. BMC Health Serv Res. 2008;8:186.##Drosdzol A, Skrzypulec V. Quality of life and sexual functioning of Polish infertile couples. Eur J Contra-cept Reprod Health Care. 2008;13(3):271-81.##Yaghmaei F. [Measuring behavior in research by valid and reliable instruments]. 1st ed. Tehran: Shaheed Beheshti University of Medical Sciences and Health Services; 2007. 58 p. Persian.##Nilforooshan P, Latifi Z, Abedi MR, Ahmadi SA. [Quality of life and its different domains in fertile and infertile women]. J Res Behav Sci. 2006;4(1, 2):70-7. Persian.##Chachamovich JR, Chachamovich E, Zachia S, Knauth D, Passos EP. What variables predict generic and health-related quality of life in a sample of Brazilian women experiencing infertility? Hum Reprod. 2007;22 (7):1946-52.##Ragni G, Mosconi P, Baldini MP, Somigliana E, Vegetti W, Caliari I, et al. Health-related quality of life and need for IVF in 1000 Italian infertile couples. Hum Reprod. 2005;20(5):1286-91.##Lau JT, Wang Q, Cheng Y, Kim JH, Yang X, Tsui HY. Infertility-related perceptions and responses and their associations with quality of life among rural chinese infertile couples. J Sex Marital Ther. 2008;34 (3):248-67.##

اندومتريوز لگني در بيمار مبتلا به آمنوره اوليه Pelvic Endometriosis in a Patient with Primary Amenorrhea 2 1 زمينه و هدف: اندومتریوز بیماری است که در آن غدد و استرومای اندومتر در خارج از رحم یافت می‌شود. بیماری معمولاً در سن باروری زنان و در مناطق تحتانی لگن ایجاد می‌شود. به همین دلیل اکثر محققین فرضیه کاشته شدن نابجای بافت اندومتر، به دنبال برگشت خون قاعدگی از لوله‌ها به لگن را برای توضیح علت آن مطرح کرده‌اند. با اینحال از آنجا که بیماری به طور نادر در مردان، دختران قبل از قاعدگی، یا در مناطق غیرمعمول بدن یافت شده است سایر فرضیه‌ها مانند متاپلازی اپيتليوم سلومیک نيز مطرح شده است؛ اما از آنجا که اینگونه موارد بسیار نادر هستند، این فرضیه‌ها به طور کامل مورد قبول واقع نشده‌اند. این مقاله گزارش یک مورد اندومتریوز لگنی در بیمار مبتلا به آمنوره اولیه است که با هدف تأیید فرضیه متاپلازی سلومیک یا تئوری القاء گزارش شده است.معرفی مورد: بیمار دختر 19 ساله‌ای بود که با شکایت آمنوره اولیه و توده شکمی مراجعه کرده بود. او با دریافت ترکیب استروژن و پروژسترون قاعده نشده بود. همچنین وي 10 سال قبل به دلیل سل روده تحت عمل جراحی قرار گرفته بود که می‌توانست توجیه‌‌کننده آمنوره وی باشد. در معاینه، رشد موهای جنسی، پستانها و سیستم تناسلی خارجی طبیعی بود. از طرف دیگر در لمس شکم یک توده بزرگ لگنی تا حد ناف لمس می‌شد که در IVP سبب فشار دو طرفه بر حالبها شده بود. به دنبال عمل جراحی یک توده چسبنده بزرگ در سمت راست رحم مشاهده شد که قابل افتراق از آدنکس راست و رحم نبود. توده حذف شده و عدم انسداد سیستم خروجی از طریق رحم اثبات شد. توده حاوی مایع شکلاتی رنگی بود که آندومتریوما و یا لوب فرعی رحم همراه با هماتومترا را مطرح می‌کرد. در بررسی آسیب‌شناسی وجود اندومتریوما همراه با لوله فالوپ گزارش شد.نتیجه‌گیری: این گزارش نشان می‌دهد که اندومتریوز در دختر مبتلا به آمنوره اولیه و عدم انسداد سیستم خروجی قویاً مطرح‌کننده این مسئله است که بیماری می‌تواند از طرق دیگری به جز کاشته شدن نابجای اندومتر ایجاد شود. بعضی از این فرضيه‌ها متاپلازی سلومیک و تئوری القا مي‌باشند. 2 Introduction: Endometriosis is a disease defined by extra-uterine extension of endometrial glands and stroma. It usually occurs in women of reproductive age and in dependent sites of the pelvis. Theoretically, it is believed that the ectopic implantation of endometrial tissue occurs following retrograde menstruation. However, as the disease has rarely been seen in men, prepubertal girls or in unusual sites of body, other theories like coelomic metaplasia have been suggested. However, the very low prevalence rates of such cases have prevented those theories of being fully accepted. This is a case report of pelvic endometriosis in a patient with primary amenorrhea, presented as a proof for coelomic metaplasia or induction theory.Case Presentation: A 19-year old virgin girl was referred to Imam Reza Hospital in Mashad with complaints of primary amenorrhea and an abdominal mass. She had not experienced menstrual bleeding upon receiving a combination of estrogen and progesterone. Her past medical history was not noticeable except for the operation she had underwent for intestinal tuberculosis 10 years earlier, which could explain the reason for her amenorrhea. She had a normal pattern of sexual hair growth, breast development and external genitalia on examination. She also had a large pelvic mass at the level of umbilicus, which had caused compression of both ureters as demonstrated by an intravenous pyelogram (IVP). During operation, a huge adhesive mass was observed at the right side of uterus, which could not be differentiated from the right adnexal tissue and the uterus itself. The mass was excised and the normal outflow tract of the uterus was confirmed. The mass consisted of a chocolate-colored liquid that could suggest the diagnosis of endometrioma or an accessory uterine lobe with hematometra. “Endometrioma accompanied by fallopian tube” was reported upon pathological examination.Conclusion: Endometriosis in a subject with primary amenorrhea and absence of outflow tract obstruction, can strongly suggest ways other than endometrial cell implantation. One of these causes could be coelomic metaplasia, as an example of induction theory. 145 151 Fatemeh F Tavasoli فاطمه توسلی Department of Obs. &amp; Gyn, Faculty of Medicine, Mashad University of Medical Sciences Department of Obs. & Gyn, Faculty of Medicine, Mashad University of Medical Sciences Iran Leili L Hafizi لیلی حفیظی Department of Obs. &amp; Gyn, Faculty of Medicine, Mashad University of Medical Sciences Department of Obs. & Gyn, Faculty of Medicine, Mashad University of Medical Sciences Iran hafizil@mums.ac.ir Mahboobeh M Aalami محبوبه اعلمی Department of Midwifery, Faculty of Nursing and Midwifery, Mashad University of Medical Sciences Department of Midwifery, Faculty of Nursing and Midwifery, Mashad University of Medical Sciences Iran AmenorrheaCoelomic metaplasiaEndometriomaEndometriosisInduction theoryMetaplasiaPelvic mass 377.pdf D` Hooghe TM, Hill JA, editors. Endometriosis. Philadelphia: Williams and Wilkins; 2007. 1137 p. (Berek JS, editor. Novak`s Gynecology; vol. 29).##Speroff L, Fritz MA, editors. Clinical gynecologic endocrinology and infertility. 7th ed. Vol. 29,Endometriosis. Philadelphia: Lippincott Williams & Wilkins; 2005. 1103 p.##Gibbs RS, Karlan BY, Haney AF, Nygaard IE. Danforth`s Obstetrics and Gynecology. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. 713 p.##Canavan TP, Radosh L. Managing endometriosis. Strategies to minimize pain and damage. Postgrad Med. 2000;107(3):213-6, 222-4.##Laufer MR, Sanfilippo J, Rose G. Adolescent endometriosis: diagnosis and treatment approaches. J Pediatr Adolesc Gynecol. 2003;16(3 Suppl):S3-11.##Cramer DW, Missmer SA. The epidemiology of endometriosis. Ann N Y Acad Sci. 2002;955:11-22.##Laufer MR, Sanfilippo J, Rose G. Adolescent endo-metriosis: diagnosis and treatment approaches. J Pediatr Adolesc Gynecol. 2003;16(3 Suppl):s3-11.##Edmonds DK, Dewhurst J. Dewhurst`s textbook of obstetrics and gynaecology for postgraduates.6th rev.ed. London: Wiley-Blackwell; 1999. 420 p.##Hesla JS, Rock JA, editors. Endometriosis. Philadel-phia: Lippincott Williams & Wilkins; 2008. 438 p. Rock J.A, Jones H.W, editors. TeLinde`s Operative Gynecology; vol. 29).##Seidel G, Grabner D. [Generalized endometriosis]. Zentralbl Gynakol. 1988;110(7):465-8. German.##Nunley WC Jr, Kitchin JD 3rd. Congenital atresia of the uterine cervix with pelvic endometriosis. Arch Surg. 1980;115(6):757-8.##Lazovic G, Spremovic S, Cmiljic I, Vilendacic Z, Milicevic S. Endometriosis in a woman with mosaic Turner`s syndrome: case report. Int J Fertil Womens Med. 2006;51(4):160-2.##Kourounis G, Fotopoulos A, Decavalas G, Michail G. Endometriosis and ovarian dysgenesis: a case report. Clin Exp Obstet Gynecol. 2004;31(4):311-2.##Nakamura Y, Suehiro Y, Sugino N, Sasaki K, Kato H. A case of 46,X,der(X)(pter-->q21::p21-->pter) with gonadal dysgenesis, tall stature, and endometriosis. Fertil Steril. 2001;75(6):1224-5.##