The New 2010 WHO Manual and the Need to Address some Related Dilemmas 2 1 567 2 Regarding the variations in the quality of semen analysis, several papers have critically reviewed the diverse semen analysis results from a large number of studies carried out in different races and geographical areas over a long period of time. Most of these studies indicate decreased semen quality, especially sperm concentration (counts to less than 50%) and morphology between the years 1940 – 1990 (1). Nevertheless, the major problem of these meta-analyses is the use of collected data from different regions done in different time intervals with a wide range of methods and different levels of standardization. Most of these studies have problems in their case inclusion criteria, number of cases, size of the study and the employed techniques for semen analysis, which could negatively affect the results severely. As an example, many companies that provide external quality control for andrology laboratories, such as UK-NEQAS, have shown that in spite of the current WHO guidelines for semen analysis, the evaluated laboratories, inside and outside UK, are using different procedures and criteria for semen analysis. For example, WHO has recommended the use of improved Neubauer or Makler chamber to determine sperm counts, however, the reported chambers used by laboratories include: 1- Burker-turk, 2- Fast Read, 3- Fuchs Rosenthar, 4- Horwell, 5- Improved Neubauer, 6- Ieja, 7- Makler, 8- Microcell, 9- SQA-A, 10- CASA, 12- Weber or other local chambers and even without any chamber that may severely influence the accuracy of the results and also the criteria for the evaluation of sperm morphology and motility. The major problems faced in semen analyses are both their interpretations that are prone to subjective judgment and the difficulty to standardize them in the absence of absolute quantitative values for each parameter. WHO published a manual to address the wide variations in procedures and results of semen analysis between individuals and laboratories. The WHO laboratory manual for semen analysis has remained as the Bible of andrology in both research and clinic. Despite being an imperfect tool in the work-up of infertile couples, it has a critical role in providing standards for andrology laboratories (2, 3). One of the most important roles of this manual is to provide a simplified method to determine sperm concentration, motility and morphology with high accuracy and precision in laboratories with minimum levels of facility and staff and with limited scientific or practical skills. Five editions of the manual have been published so far (1980, 1987, 1992, 1999 and 2010) and the new 2010 edition provides more specific guidelines for the analysis of sperm parameters and more detailed information on each parameter in comparison with previous editions. In this version, new tests for the evaluation of sperm functions have been included in a chapter titled “Research Procedures” (4). Application of new values in the 2010 WHO laboratory manual, especially for normal forms of sperm morphology, has been kept very low as they could severely change the clinical management of patients. Therefore, most cases that were categorized as male factor infertility in the past are now considered in the normal range with no need for further medical or clinical intervention except the time for a natural conception. In contrast to WHO 2010, the values in the previous versions were too high leading to irrelevant diagnosis and unnecessary treatment of healthy men who were falsely diagnosed as subfertile men. To obtain normal semen parameters for the new version, a large sample size (4500 men) was selected from 14 countries in 4 continents. Despite taking into account all the probable confounding factors in case selection, data analysis and statistical methods, the new version contains some values with several unspecified points that have to be outlined here. For example, one can not contently categorize fertile and infertile men based on the narrow difference in values for sperm normal morphology, respectively 4% and 2%, or the narrow difference between the values for abnormal forms, respectively 96% and 98%, to achieve normal pregnancy or to be a candidate for ART. Whether or not we can regard normal sperm morphologies greater than 3% as a tool for ruling out male factor infertility in such cases remains to be explored and similar concerns about the new 2010 version have to go through the test of time and further in-depth studies. 159 160 Mohammad Reza MR Sadeghi محمدرضا صادقی Editor-in-chief Editor-in-chief Iran No Keyword 567.pdf Merzenich H, Zeeb H, Blettner M. Decreasing sperm quality: a global problem? BMC Public Health. 2010;10:24.##Ford WC. Comments on the release of the 5th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen. Asian J Androl. 2010;12(1):59-63.##Barratt CL. Semen analysis is the cornerstone of investigation for male infertility. Practitioner. 2007;251(1690):8-10, 12, 15-7.##World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010.##Medpedia [Internet]. USA: Medpedia; 2007-2010. Sperm Morphology: New Guidelines Announced: 4% is Normal; 2010 Jul 01 [cited 2010 Sept 12]; [about 3 screens]. Available from: http://www.medpedia.com/news_analysis/64InfertilityBlog/entries/ 36039-Sperm-Morphology-New-Guidelines-Announced-4-is-Normal##

Macroprolactin; A Frequent Cause of Misdiagnosed Hyperprolactinemia in Clinical Practice 2 1 2 Introduction: Macroprolactin is a significant cause of misdiagnosis, unnecessary investigation, and inappropriate treatment in patients with hyperprolactinemia. Its frequency has not been clearly established due to technical difficulties in identifying it. Most laboratories and clinicians are unaware of macroprolactin interferences in prolactin assays. Materials and Methods: A comprehensive literature search was conducted on the websites of the National Library of Medicine (http://www.ncbl.nlm.nih.gov) and PubMed Central, the US National Library of Medicine’s digital archive of life sciences literature (http://www.pubmedcentral.nih.gov/). The data were also looked for in relevant books and journal. Results: Macroprolactin is a non-bioactive prolactin isoform usually composed of a prolactin monomer and an IgG molecule having a prolonged clearance rate similar to that of immunoglobulins. This isoform is clinically non-reactive but it interferes with immunological assays used for the detection of prolactin. Conclusion: There is a need to understand and explore the recent progress in the diagnosis and pathophysiology of macroprolactinemia for improving patient care. 161 169 Richa R Vaishya ریچار وایشا Guru Nanak Eye Center, New Delhi Guru Nanak Eye Center, New Delhi India Rahul R Gupta رائول جوپتا Department of Neurosurgery, G.B. Pant Hospital Department of Neurosurgery, G.B. Pant Hospital India Sarika S Arora ساریکا آرورا Department of Biochemistry, Lady Hardinge Medical College and S.S.K. Hospital Department of Biochemistry, Lady Hardinge Medical College and S.S.K. Hospital India sarikaarora08@rediffmail.com HyperprolactinemiaMacroprolactinPolyethylene glycol assayProlactin antibody 435.pdf Suh HK, Frantz AG. Size heterogeneity of human prolactin in plasma and pituitary extracts. J Clin Endocrinol Metab. 1974;39(5):928-35.##Rogol AD, Rosen SW. Prolactin of apparent large molecular size: the major immunoactive prolactin component in plasma of a patient with a pituitary tumor. J Clin Endocrinol Metab. 1974;38(4):714-7.##Whittaker PG, Wilcox T, Lind T. Maintained fertileity in a patient with hyperprolactinemia due to big, big prolactin. J Clin Endocrinol Metab. 1981;53(4): 863-6.##Andersen AN, Pedersen H, Djursing H, Andersen BN, Friesen HG. Bioactivity of prolactin in a woman with an excess of large molecular size prolactin, persistent hyperprolactinemia and spontaneous conception. Fertil Steril. 1982;38(5):625-8.##Jackson RD, Wortsman J, Malarkey WB. Macroprolactinemia presenting like a pituitary tumor. Am J Med. 1985;78(2):346-50.##Sluijmer AV, Lappöhn RE. Clinical history and outcome of 59 patients with idiopathic hyperprolactinemia. Fertil Steril. 1992;58(1):72-7.##Hattori N, Ishihara T, Ikekubo K, Moridera K, Hino M, Kurahachi H. Autoantibody to human prolactin in patients with idiopathic hyperprolactinemia. J Clin Endocrinol Metab. 1992;75(5):1226-9.##Leite V, Cosby H, Sobrinho LG, Fresnoza MA, Santos MA, Friesen HG. Characterization of big, big prolactin in patients with hyperprolactinaemia. Clin Endocrinol (Oxf). 1992;37(4):365-72.##Bonhoff A, Vuille JC, Gomez F, Gellersen B. Identification of macroprolactin in a patient with asymptomatic hyperprolactinemia as a stable PRL-IgG complex. Exp Clin Endocrinol Diabetes. 1995; 103(4):252-5.##Hattori N, Ikekubo K, Ishihara T, Moridera K, Hino M, Kurahachi H. Correlation of the antibody titers with serum prolactin levels and their clinical course in patients with anti-prolactin autoantibody. Eur J Endocrinol. 1994;130(5):438-45.##Cavaco B, Prazeres S, Santos MA, Sobrinho LG, Leite V. Hyperprolactinemia due to big big prolactin is differently detected by commercially available immunoassays. J Endocrinol Invest. 1999;22(3):203-8.##Jackson RD, Wortsman J, Malarkey WB. Persistence of large molecular weight prolactin secretion during pregnancy in women with macroprolactinemia and its presence in fetal cord blood. J Clin Endocrinol Metab. 1989;68(6):1046-50.##Suliman AM, Smith TP, Gibney J, McKenna TJ. Frequent misdiagnosis and mismanagement of hyperprolactinemic patients before the introduction of macroprolactin screening: application of a new strict laboratory definition of macroprolactinemia. Clin Chem. 2003;49(9):1504-9.##Carotenuto A, D'Ursi AM, Nardi E, Papini AM, Rovero P. Conformational analysis of a glycosylated human myelin oligodendrocyte glycoprotein peptide epitope able to detect antibody response in multiple sclerosis. J Med Chem. 2001;44 (14):2378-81.##Coudevylle N, Rokas D, Sakarellos-Daitsiotis M, Krikorian D, Panou-Pomonis E, Sakarellos C, et al. Phosphorylated and nonphosphorylated epitopes of the La/SSB autoantigen: comparison of their antigenic and conformational characteristics. Biopoly-mers. 2006;84(4):368-82.##Sinha YN. Structural variants of prolactin: occurrence and physiological significance. Endocr Rev. 1995;16(3):354-69.##Hattori N, Ikekubo K, Nakaya Y, Kitagawa K, Inagaki C. Immunoglobulin G subclasses and prolactin (PRL) isoforms in macroprolactinemia due to anti-PRL autoantibodies. J Clin Endocrinol Metab. 2005;90(5):3036-44.##Hattori N, Inagaki C. Anti-prolactin (PRL) auto-antibodies cause asymptomatic hyperprolactinemia: bioassay and clearance studies of PRLimmunoglobulin G complex. J Clin Endocrinol Metab. 1997;82(9):3107-10.##Cavaco B, Leite V, Santos MA, Arranhado E, Sobrinho LG. Some forms of big big prolactin behave as a complex of monomeric prolactin with an immunoglobulin G in patients with macroprolactinemia or prolactinoma. J Clin Endocrinol Metab. 1995;80(8):2342-6.##Kavanagh-Wright L, Smith TP, Gibney J, Mc Kenna TJ. Characterization of macroprolactin and assessment of markers of autoimmunity in macroprolactinaemic patients. Clin Endocrinol (Oxf). 2009;70(4):599-605.##Hattori N, Nakayama Y, Kitagawa K, Li T, Inagaki C. Development of anti-PRL (prolactin) autoantibodies by homologous PRL in rats: a model for macroprolactinemia. Endocrinology. 2007;148(5): 2465-70.##Fahie-Wilson MN, Ellis AR, Seth J. Macroprolactin-a major problem in immunoassays for prolactin. Clin Chem. 1999;45 Suppl:A83.##Hattori N. The frequency of macroprolactinemia in pregnant women and the heterogeneity of its etiologies. J Clin Endocrinol Metab. 1996;81(2): 586-90.##Vallette-Kasic S, Morange-Ramos I, Selim A, Gunz G, Morange S, Enjalbert A, et al. Macropro-lactinemia revisited: a study on 106 patients. J Clin Endocrinol Metab. 2002;87(2):581-8.##Leslie H, Courtney CH, Bell PM, Hadden DR, McCance DR, Ellis PK, et al. Laboratory and clinical experience in 55 patients with macroprolactinemia identified by a simple polyethylene glycol precipitation method. J Clin Endocrinol Metab. 2001;86(6):2743-6.##Olukoga AO, Kane JW. Macroprolactinaemia: validation and application of the polyethylene glycol precipitation test and clinical characterization of the condition. Clin Endocrinol (Oxf). 1999; 51(1):119-26.##Fahie-Wilson MN. Polyethylene glycol precipitation as a screening method for macroprolactinemia. Clin Chem. 1999;45(3):436-7.##Sandoval C, González B, Cheng S, Esquenazi Y, Mercado M. [Macroprolactinemia identification in patients with hyperprolactinemia]. Ginecol Obstet Mex. 2007;75(8):459-64. Spanish.##Dzeranova LK, Goncharov NP, Dobracheva AD, Kolesnikova GS, Giniiatullina EN, Mel'nichenko GA. [The diagnostic value of macroprolactin in hyperprolactinemia]. Klin Lab Diagn. 2007;(10): 16-9. Russian.##Ram S, Harris B, Fernando JJ, Gama R, FahieWilson M. False-positive polyethylene glycol precipitation tests for macroprolactin due to increased serum globulins. Ann Clin Biochem. 2008;45(Pt 3):256-9.##Donadio F, Barbieri A, Angioni R, Mantovani G, Beck-Peccoz P, Spada A, et al. Patients with macroprolactinaemia: clinical and radiological features. Eur J Clin Invest. 2007;37(7):552-7.##Taghavi M, Sedigheh F. Macroprolactinemia in patients presenting with hyperandrogenic symptoms and hyperprolactinemia. Int J Endocrinol Metab. 2008;6(3):140-3.##Taghavi M, Khadjeh Dalouie M. [Evaluating the prevalence of macroprolactinemia and hyperprolactinemia and comparing their clinical and radiological signs in infertile women]. J Reprod Infertil. 2007;8(2):182. Persian.##Hattori N, Nakayama Y, Kitagawa K, Ishihara T, Saiki Y, Inagaki C. Anti-prolactin (PRL) autoantibody-binding sites (epitopes) on PRL molecule in macroprolactinemia. J Endocrinol. 2006;190(2): 287-93.##Ahlquist JA, Fahie Wilson MN. On the origin and distribution of macroprolactin. J Endocrinol. 2000; 164 suppl:P34.##Olukoga AO. Macroprolactinemia is clinically important. J Clin Endocrinol Metab. 2002;87(10): 4833-4.##Alfonso A, Rieniets KI, Vigersky RA. Incidence and clinical significance of elevated macroprolactin levels in patients with hyperprolactinemia. Endocr Pract. 2006;12(3):275-80.##

Effects of Chamomile Extract on Biochemical and Clinical Parameters in a Rat Model of Polycystic Ovary Syndrome 2 1 2 Introduction: Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder associated with ovulatory dysfunction. Presently, little is known about the primary factors that initiate PCOS. Chamomile flowers are used in alternative medicine for its anti-spasmolytic and anti-inflammatory effects. Antispasmodic properties of chamomile ease menstrual cramps and lessen the possibility of premature labor. This medicinal herb also stimulates menstruation. In this study, we evaluated the effects of Chamomile alcoholic-extract on the biochemical and clinical parameters in a rat model of PCOS. Materials and Methods: Estrous cyclicity of 30 virgin adult cycling rats was monitored by vaginal smears obtained between 0800 and 1200 hours. After about 4 days, each rat received an i.m. injection of Estradiol Valerate (Aburaihan Co., Iran), 2 mg in 0.2 ml of corn oil, to induce PCO. Corn oil was injected to the rats in the control group. All the rats in the experimental group were evaluated for follicular cysts 60 days after the injection. Rats with PCOS were treated by multiple doses (25, 50, 75 mg/kg) of intraperitoneal injections of Chamomile alcoholic-extract for ten days. The data were statistically analyzed at a significance level of p < 0.05 by ANOVA, followed by the Student Newman-Keuls post hoc test. Results: The histological and hormonal results showed that Chamomile can decrease the signs of PCOS in the ovarian tissue and help LH secretion in rats (p < 0.05). Conclusion: The alcoholic-extract of dried Matricaria chamomilla L. flowers can not only induce recovery from a PCO induced state in rats, but also increase dominant follicles. Additionally better endometrial tissue arrangements can be regarded as another therapeutic effect of Chamomile. 169 175 Farideh F Zafari Zangeneh فریده ظفری زنگنه Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran zangeneh14@gmail.com Bagher B Minaie باقر مینایی Department of Histology, Faculty of Medicine, Tehran University of Medical Sciences Department of Histology, Faculty of Medicine, Tehran University of Medical Sciences Iran Ashraf A Amirzargar اشرف امیرزرگر Physiology Department, Faculty of Medicine, Ahwaz Medical Sciences University Physiology Department, Faculty of Medicine, Ahwaz Medical Sciences University Iran Akram A Ahangarpour اکرم آهنگرپور Physiology Department, Faculty of Medicine, Ahwaz Medical Sciences University Physiology Department, Faculty of Medicine, Ahwaz Medical Sciences University Iran Kazem K Mousavizadeh کاظم موسی‌زاده Research Institute for Islamic & Complementary Medicine, Iran University of Medical Sciences Research Institute for Islamic & Complementary Medicine, Iran University of Medical Sciences Iran AnovulationChamomileEstradiol valerate (EV)ExtractInfertilityPolycystic ovary syndromeRat 426.pdf Tsilchorozidou T, Overton C, Conway GS. The pathophysiology of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2004;60(1):1-17.##Norman RJ, Wu R, Stankiewicz MT. 4: Polycystic ovary syndrome. Med J Aust. 2004;180(3):132-7. Review.##Kannel WB. The Framingham Study: historical insight on the impact of cardiovascular risk factors in men versus women. J Gend Specif Med. 2002;5 (2):27-37.##Dahlgren E, Janson PO, Johansson S, Lapidus L, Lindstedt G, Tengborn L. Hemostatic and metabolic variables in women with polycystic ovary syndrome. Fertil Steril. 1994;61(3):455-60.##Dahlgren E, Janson PO, Johansson S, Lapidus L, Odén A. Polycystic ovary syndrome and risk for myocardial infarction. Evaluated from a risk factor model based on a prospective population study of women. Acta Obstet Gynecol Scand. 1992;71(8): 599-604.##Vrbíková J, Cífková R, Jirkovská A, Lánská V, Platilová H, Zamrazil V, et al. Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Hum Reprod. 2003;18(5):980-4.##Achard A, Thiers A. [The pilar insufficient glycolytic virilism and its association year I (Diabetes bearded women)]. Bull Acad Natl Med.1991;86:51-83. French.##Stein IF, Leventhal ML. Amenorrha associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181-91.##Brawer JR, Munoz M, Farookhi R. Development of the polycystic ovarian condition (PCO) in the estradiol valerate-treated rat. Biol Reprod. 1986;35 (3):647-55.##Maschi O, Cero ED, Galli GV, Caruso D, Bosisio E, Dell'Agli M. Inhibition of human cAMPphosphodiesterase as a mechanism of the spasmolytic effect of Matricaria recutita L. J Agric Food Chem. 2008;56(13):5015-20.##Ziyan L, Yongmei Z, Nan Z, Ning T, Baolin L. Evaluation of the anti-inflammatory activity of luteolin in experimental animal models. Planta Med. 2007;73(3):221-6.##Avallone R, Zanoli P, Puia G, Kleinschnitz M, Schreier P, Baraldi M. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol. 2000;59(11): 1387-94.##Brueggemeier RW, Gu X, Mobley JA, Joomprabutra S, Bhat AS, Whetstone JL. Effects of phytoestrogens and synthetic combinatorial libraries on aromatase, estrogen biosynthesis, and metabolism. Ann N Y Acad Sci. 2001;948:51-66.##Medina JH, Pena C, Levi de Stein M. Benzodiazepine-like molecules, as well as other ligands for the brain benzodiazepine receptors, are relatively common constituents of plants. J Biochem Biophys Res. 1989;165(2):547-53.##Zava DT, Duwe G. Estrogenic and antiproliferative properties of genistein and other flavonoids in human breast cancer cells in vitro. Nutr Cancer. 1997;27(1):31-40.##Szukiewicz D, Uilenbroek JT. Polycystic ovary syndrome--searching for an animal model. J Med. 1998;29(5-6):259-75.##Chrousos GP. Regulation and dysregulation of the hypothalamic-pituitary-adrenal axis. The corticotropin-releasing hormone perspective. Endocrinol Metab Clin North Am. 1992;21(4):833-58.##Malyala A, Kelly MJ, Rønnekleiv OK. Estrogen modulation of hypothalamic neurons: activation of multiple signaling pathways and gene expression changes. Steroids. 2005;70(5-7):397-406.##Demling J, Fuchs E, Baumert M, Wuttke W. Preoptic catecholamine, GABA, and glutamate release in ovariectomized and ovariectomized estrogenprimed rats utilizing a push-pull cannula technique. Neuroendocrinology. 1985;41(3):212-8.##Jarry H, Leonhardt S, Schwarze T, Wuttke W. Preoptic rather than mediobasal hypothalamic amino acid neurotransmitter release regulates GnRH secretion during the estrogen-induced LH surge in the ovariectomized rat. Neuroendocrinology. 1995;62(5):479-86.##Handa JR, Hayashi S, Terasawa E, Kawata M. Neuroplasticity, development, and steroid hormone action. USA: CRC Press; 2002. p. 173.##Scott CJ, Clarke IJ. Inhibition of luteinizing hormone secretion in ovariectomized ewes during the breeding season by gamma-aminobutyric acid (GABA) is mediated by GABA-A receptors, but not GABA-B receptors. Endocrinology. 1993;132 (4):1789-96.##Kimura F, Jinnai K. Bicuculline infusions advance the timing of luteinizing hormone surge in proestrous rats: comparisons with naloxone effects. Horm Behav. 1994;28(4):424-30.##Ciechanowska M, Lapot M, Malewski T, Mateusiak K, Misztal T, Przekop F. Effects of GABA(A) receptor modulation on the expression of GnRH gene and GnRH receptor (GnRH-R) gene in the hypothalamus and GnRH-R gene in the anterior pituitary gland of follicular-phase ewes. Anim Reprod Sci. 2009;111(2-4):235-48.##Wang F, Shing M, Huen Y, Tsang SY, Xue H. Neuroactive flavonoids interacting with GABAA receptor complex. Curr Drug Targets CNS Neurol Disord. 2005;4(5):575-85.##Kahnberg P, Lager E, Rosenberg C, Schougaard J, Camet L, Sterner O, et al. Refinement and evaluation of a pharmacophore model for flavone derivatives binding to the benzodiazepine site of the GABA(A) receptor. J Med Chem. 2002;45(19): 4188-201.##Svenningsen AB, Madsen KD, Liljefors T, Stafford GI, van Staden J, Jäger AK. Biflavones from Rhus species with affinity for the GABA(A)/ benzodiazepine receptor. J Ethnopharmacol. 2006; 103(2):276-80.##Julião LD, Leitão SG, Lotti C, Picinelli AL, Rastrelli L, Fernandes PD, et al. Flavones and phenylpropanoids from a sedative extract of Lantana trifolia L. Phytochemistry. 2010;71(2-3): 294-300.##

Chromosomal Abnormalities in Infertile Men Referred to Iran Blood Transfusion Organization Research Center 2 1 2 Introduction: The prevalence of somatic chromosomal abnormalities in infertile male individuals has been reported to vary in different literatures. The aim of this study was to investigate the frequency of chromosomal aberrations among infertile men referred to the Cytogenetic Laboratory of Iran Blood Transfusion Organization Research Centre (IBTO). Materials and Methods: Chromosomal analysis was performed on phytohemagglutinin (PHA)-stimulated peripheral lymphocyte cultures of 1052 infertile men using standard cytogenetic methods. The study took place during 1997 to 2007. Results: Total chromosome alterations were revealed in 161 (15.30%) infertile men. The most prevalent chromosomal abnormality in the infertile men was 47, XXY, that was seen in 94 (58.38%) men while one of them had a mosaic karyotype: mos 47, XX[54]/47,XXY[18]/46,XY[9]. In 37 (22.98%) cases, structural aberrations were detected. There were 30 (18.63%) cases of sex reversal. Conclusion: Cytogenetic studies of these patients showed increased chromosomal abnormalities in infertile men in comparison with that of the normal population, justifying the need for cytogenetic analysis of men with idiopathic infertility. 175 179 Frouzandeh F Mahjoubi فروزنده محجوبی Department of Cytogenetics, Iran Blood Transfusion Organization Research Center (IBTO) Department of Cytogenetics, Iran Blood Transfusion Organization Research Center (IBTO) Iran Frouz@nigeb.ac.ir Saeideh S Soleimani سعیده سلیمانی Department of Cytogenetics, Iran Blood Transfusion Organization Research Center (IBTO) Department of Cytogenetics, Iran Blood Transfusion Organization Research Center (IBTO) Iran Sanaz S Mantegy ساناز منطقی National Research Institute for Genetic Engineering and Biotechnology National Research Institute for Genetic Engineering and Biotechnology Iran Chromosomal abnormalitiesCytogeneticInfertilityKlinefelter’s syndromeMale infertilitySex reversal 428.pdf de Kretser DM. Male infertility. Lancet. 1997;349 (9054):787-90.##Retief AE, Van Zyl JA, Menkveld R, Fox MF, Kotze GM, Brusnicky J. Chromosome studies in 496 infertile males with a sperm count below 10 million/ml. Hum Genet. 1984;66(2-3):162-4.##Pandiyan N, Jequier AM. Mitotic chromosomal anomalies among 1210 infertile men. Hum Reprod. 1996;11(12):2604-8.##Gosden CM, Davidson C, Robertson M. Lymphocyte culture. In: Rooney DE, Czepulkowski BH, editors. Human Cytogenetics: A Practical Approach. Oxford, United Kingdom: IRL Press Ltd; 1992. p. 31-54.##Benn PA, Perle MA. Chromosome staining and banding techniques. In: Rooney DE, Czepulkowski BH, editors. Human Cytogenetics: A Practical Approach. Oxford, United Kingdom: IRL Press Ltd; 1992. p. 91-118.##Tuerlings JH, de France HF, Hamers A, Hordijk R, Van Hemel JO, Hansson K, et al. Chromosome studies in 1792 males prior to intra-cytoplasmic sperm injection: the Dutch experience. Eur J Hum Genet. 1998;6(3):194-200.##Mau UA, Bäckert IT, Kaiser P, Kiesel L. Chromosomal findings in 150 couples referred for genetic counselling prior to intracytoplasmic sperm injection. Hum Reprod. 1997;12(5):930-7.##Peschka B, Leygraaf J, Van der Ven K, Montag M, Schartmann B, Schubert R, et al. Type and frequency of chromosome aberrations in 781 couples undergoing intracytoplasmic sperm injection. Hum Reprod. 1999;14(9):2257-63.##Zhou H, Zhu JW, Li HG, Tang YP. [Genetic defect in Chinese azoospermic patients and their relationship with reproductive hormones]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2009;26(4):427-30. Chinese.##Ng PP, Tang MH, Lau ET, Ng LK, Ng EH, Tam PC, et al. Chromosomal anomalies and Y microdeletions among Chinese subfertile men in Hong Kong. Hong Kong Med J. 2009;15(1):31-8.##Akgul M, Ozkinay F, Ercal D, Cogulu O, Dogan O, Altay B, et al. Cytogenetic abnormalities in 179 cases with male infertility in Western Region of Turkey: report and review. J Assist Reprod Genet. 2009;26(2-3):119-22.##Gündüz G, Lüleci G, Baykara M. Cytogenetic study in 102 infertile men. Urol Int. 1998;61(1):32-4.##Tachdjian G, Frydman N, Morichon-Delvallez N, Dû AL, Fanchin R, Vekemans M, et al. Reproductive genetic counselling in non-mosaic 47,XXY patients: implications for preimplantation or prenatal diagnosis: Case report and review. Hum Reprod. 2003;18(2):271-5.##Nagvenkar P, Desai K, Hinduja I, Zaveri K. Chromosomal studies in infertile men with oligozoospermia & non-obstructive azoospermia. Indian J Med Res. 2005;122(1):34-42.##Van Assche E, Bonduelle M, Tournaye H, Joris H, Verheyen G, Devroey P, et al. Cytogenetics of infertile men. Hum Reprod. 1996;11 Suppl 4:1-24; discussion 25-6.##

Cytogenetic Results of Patients with Infertility in Middle Anatolia, Turkey: Do Heterochromatin Polymorphisms Affect Fertility? 2 1 2 Introduction: Infertility is a significant multifactorial disorder that can be caused by chromosomal abnormalities. In this study, we aimed to cytogenetically investigate male and female patients admitted to the Genetic Diagnostic Laboratory of Kayseri Educational Hospital in Kayseri, Turkey with varied clinical prediagnoses of infertility. Materials and Methods: Chromosomes from cultured peripheral blood lymphocytes of 274 patients and 427 individuals as the controls were analyzed using GiemsaTrypsin-Giemsa (GTG) banding. The individuals with sex chromosome aneuploidy or mosaicism were classified as carriers and with chromosomal polymorphism, respectively. The results of the two groups were compared statistically. Results: Pure sex chromosome aneuploidy was found in 29 (10.5%) patients and mosaic sex chromosome aneuploidy in 15 (5.5%) cases and the total rate of abnormalities was 16%. Karyotypes were composed of an overall polymorphism rate of 8% in the patient and 4% in the control groups with no statistically significant difference (p = 0.2 and p > 0.05, respectively). Conclusion: The present study shows that chromosomal polymorphisms are common among infertile patients. Chromosomal abnormalities and even heteromorphisms are significant etiologic factors leading to fertility problems. The overall high prevalence of chromosomal polymorphisms in infertile couples, compared to the normal population, needs to be confirmed with further investigations and larger study populations to delineate the role of “harmless” chromosomal aberrations in the etiology of infertility. 179 182 Ahmet Okay A Caglayan احمت اکی کاگلایان Department of Medical Genetics, Kayseri Education and Research Hospital Department of Medical Genetics, Kayseri Education and Research Hospital Turkey okaycaglayan@yahoo.com Isilay I Ozyazgan ایسیلای ازیازگان Department of Medical Genetics, Kayseri Education and Research Hospital Department of Medical Genetics, Kayseri Education and Research Hospital Turkey Fatma F Demiryilmaz فاطمه دمیرییلماز Department of Medical Genetics, Kayseri Education and Research Hospital Department of Medical Genetics, Kayseri Education and Research Hospital Turkey Munis M Dundar مونس دوندار Department of Medical Genetics, Faculty of Medicine, Erciyes University Department of Medical Genetics, Faculty of Medicine, Erciyes University Turkey Chromosomal AberrationCytogeneticInfertilityKaryotypePolymorphismSex chromosome aneuploidy 429.pdf de Kretser DM. Male infertility. Lancet. 1997;349 (9054):787-90. Review.##Kamel RM. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol. 2010;8:21.##Shah K, Sivapalan G, Gibbons N, Tempest H, Griffin DK. The genetic basis of infertility. Reproduction. 2003;126(1):13-25.##Cortés-Gutiérrez EI, Cerda-Flores RM, Dávila Rodríguez MI, Hernández-Herrera R, VargasVillarreal J, Leal-Garza CH. Chromosomal abnormalities and polymorphisms in Mexican infertile men. Arch Androl. 2004;50(4):261-5.##Nakamura Y, Kitamura M, Nishimura K, Koga M, Kondoh N, Takeyama M, et al. Chromosomal vari-ants among 1790 infertile men. Int J Urol. 2001;8 (2):49-52.##Lissitsina J, Mikelsaar R, Punab M. Cytogenetic analyses in infertile men. Arch Androl. 2006;52(2): 91-5.##International Standing Committee on Human Cytogenetic Nomenclature; Shaffer LG, Tommerup N. ISCN 2005: an international system for human cytogenetic nomenclature. 1st ed. Basel: Karger Publishers; 2005.##Caglayan AO, Ozyazgan I, Demiryilmaz F, Ozgun MT. Are heterochromatin polymorphisms associated with recurrent miscarriage? J Obstet Gynaecol Res. 2010;36(4):774-6.##Meschede D, Louwen F, Eiben B, Horst J. Intracytoplasmic sperm injection pregnancy with fetal trisomy 9p resulting from a balanced paternal translocation. Hum Reprod. 1997;12(9):1913-4.##Johnson MD. Genetic risks of intracytoplasmic sperm injection in the treatment of male infertility: recommendations for genetic counseling and screening. Fertil Steril. 1998;70(3):397-411.##Kumtepe Y, Beyazyurek C, Cinar C, Ozbey I, Ozkan S, Cetinkaya K, et al. A genetic survey of 1935 Turkish men with severe male factor infertility. Reprod Biomed Online. 2009;18(4):465-74.##Vicdan A, Vicdan K, Günalp S, Kence A, Akarsu C, Işik AZ, et al. Genetic aspects of human male infertility: the frequency of chromosomal abnormalities and Y chromosome microdeletions in severe male factor infertility. Eur J Obstet Gynecol Reprod Biol. 2004;117(1):49-54.##Yakin K, Balaban B, Urman B. Is there a possible correlation between chromosomal variants and spermatogenesis? Int J Urol. 2005;12(11):984-9.##Madon PF, Athalye AS, Parikh FR. Polymorphic variants on chromosomes probably play a significant role in infertility. Reprod Biomed Online. 2005;11(6):726-32. Review.##Dundar M, Caglayan AO, Saatci C, Batukan C, Basbug M, Ozkul Y. Can the classical euchromatic variants of 9q12/qh cause recurrent abortions? Genet Couns. 2008;19(3):281-6.##Caglayan AO, Ozgun MT, Demiryilmaz F, Ozyazgan I. Can heterochromatin polymorphism of chromosome 6 affect fertility? Genet Couns. 2009; 20(2):203-6.##

Comparing the Effects of Continuous Hormone Replacement Therapy and Tibolone on the Genital Tract of Menopausal Women; A Randomized Controlled Trial 2 1 2 Introduction: Many postmenopausal women who are on hormone replacement therapy discontinue medications due to vaginal bleeding. Tibolone, a synthetic steroid, has minimal stimulatory effect on the endometrium. The aim of this study was to assess the effects of continuous HRT regimen and tibolone on the onset of vaginal bleeding and vaginal maturation value. Materials and Methods: A total of 150 healthy women in postmenopausal period were randomly enrolled in this controlled clinical trial. Patients were randomly allocated into three groups, and were followed for six months. The first 50 women received 2.5 mg tibolone plus a Cal+D tablet (500 mg Calcium and 200 IU vitamin D) daily, the second 50 women received 0.625 mg conjugated equine estrogen and 2.5 mg medroxyprogesterone acetate (CEE/MPA) plus one Cal+D tablet daily, and the remaining 50 received only one Cal+D tablet per day and served as the control group. Symptoms were recorded using a questionnaire that assessed vaginal bleeding or spotting, vaginal dryness and intention to continue the medications. Vaginal maturation value was assessed by examining vaginal smears before and after the treatment. The results for the three groups were analyzed using statistical methods. Results: In comparison with the control group, CEE/MPA and tibolone increased vaginal maturation value and decreased the frequency of vaginal dryness (p < 0.01). Women in tibolone group were more likely to continue the treatment regimen than those in the CEE/MPA or the control groups (p < 0.01). Conclusion: Tibolone can serve as an appropriate choice for HRT as it has low rates of vaginal bleeding/ spotting episodes and high acceptance rate in postmenopausal women. 183 188 Saeideh S Ziaei سعیده ضیایی Midwifery Department, Faculty of Medical Sciences, Tarbiat Modares University Midwifery Department, Faculty of Medical Sciences, Tarbiat Modares University Iran ziaei_sa@modares.ac.ir Raziyeh R Masoumi راضیه معصومی Midwifery Department, Faculty of Medical Sciences, Tarbiat Modares University Midwifery Department, Faculty of Medical Sciences, Tarbiat Modares University Iran Soghrat S Faghihzadeh سقراط فقیه زاده Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Iran CalciumHormone replacement therapyMenopauseTiboloneVaginal bleedingVaginal maturation value 430.pdf Hickey M, Higham J, Sullivan M, Miles L, Fraser IS. Endometrial bleeding in hormone replacement therapy users: preliminary findings regarding the role of matrix metalloproteinase 9 (MMP-9) and tissue inhibitors of MMPs. Fertil Steril. 2001;75(2): 288-96.##Christodoulakos GE, Botsis DS, Lambrinoudaki IV, Papagianni VD, Panoulis CP, Creatsa MG, et al. A 5-year study on the effect of hormone therapy, tibolone and raloxifene on vaginal bleeding and endometrial thickness. Maturitas. 2006;53(4):413-23.##Mirkin S, Navarro F, Archer DF. Hormone therapy and endometrial angiogenesis. Climacteric. 2003;6 (4):273-7.##de Gooyer ME, Deckers GH, Schoonen WG, Verheul HA, Kloosterboer HJ. Receptor profiling and endocrine interactions of tibolone. Steroids. 2003;68(1):21-30.##Modelska K, Cummings S. Tibolone for postmenopausal women: systematic review of randomized trials. J Clin Endocrinol Metab. 2002;87(1):16-23. Review.##Lundström E, Christow A, Kersemaekers W, SvaneG, Azavedo E, Söderqvist G, et al. Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density. Am J Obstet Gynecol. 2002;186(4):717-22.##van de Ven J, Donker GH, Sprong M, Blankenstein MA, Thijssen JH. Effect of tibolone (Org OD14) and its metabolites on aromatase and estrone sulfatase activity in human breast adipose stromal cells and in MCF-7 and T47D breast cancer cells. J Steroid Biochem Mol Biol. 2002;81(3):237-47.##Schatz F, Kuczynski E, Kloosterbooer L, Krikun G, Buchwalder LF, Rahman M, et al. Tibolone exerts progestational inhibition of matrix metalloproteinase expression in human endometrial stromal cells. Steroids. 2006;71(9):768-75.##Bruhat M, Rudolf K, Vaheri R, Kainulainen P, Timonen U, Viitanen A. Effective bleeding control and symptom relief by lower dose regimens of continuous combined hormone replacement therapy: a randomized comparative dose-ranging study. Maturitas. 2001;40(3):259-71.##Huber J, Palacios S, Berglund L, Hänggi W, Sathanandan SM, Christau S, et al. Effects of tibolone and continuous combined hormone replacement therapy on bleeding rates, quality of life and tolerability in postmenopausal women. BJOG. 2002;109(8):886-93.##Langer RD, Landgren BM, Rymer J, Helmond FA; OPAL Investigators. Effects of tibolone and continuous combined conjugated equine estrogen/ medroxyprogesterone acetate on the endometrium and vaginal bleeding: results of the OPAL study. Am J Obstet Gynecol. 2006;195(5):1320-7.##Morris EP, Wilson PO, Robinson J, Rymer JM. Long term effects of tibolone on the genital tract in postmenopausal women. Br J Obstet Gynaecol. 1999;106(9):954-9.##Nijland EA, Weijmar Schultz WC, Davis SR. Effects of tibolone and raloxifene on health-related quality of life and sexual function. Maturitas. 2007; 58(2):164-73.##Ziaei S, Moghasemi M, Faghihzadeh S. Comparative effects of conventional hormone replacement therapy and tibolone on climacteric symptoms and sexual dysfunction in postmenopausal women. Climacteric. 2010;13(2):147-56.##Ziaei S, Moaya M, Faghihzadeh S. Comparative effects of continuous combined hormone therapy and tibolone on body composition in postmenpausal women. Climacteric. 2010;13(3).249-53.##

Knowledge and Attitudes of a Number of Iranian Policy-makers towards Abortion 2 1 2 Introduction: Unsafe and illegal abortions are the third leading cause of maternal death. It affects physical, emotional and social health of women and their families. Abortion is a multi-dimensional phenomenon with several social, legal, and religious implications. The views of policy-makers affect the approach to abortion in every society. Understanding the attitudes and knowledge of high-ranking decision makers towards abortion was the purpose of this study. Materials and Methods: A qualitative research was implemented by carrying out individual interviews with 29 out of a selection of 80 presidents of medical sciences universities, senior executive managers in the legal system, forensic medicine and decision-makers in the health system and a number of top Muslim clerics, using a semi-structured questionnaire for data gathering. Content analysis revealed the results. Results: There were considerable unwillingness and reluctance among the interview-ees to participate in the study. The majority of participants fairly knew about the prevalence of illegal abortions and their complications. There was strong agreement on abortion when health of the mother or the fetus was at risk. Abortion for reproductive health reasons was supported by a minority of the respondents. The majority of them disagreed with abortion when pregnancy was the result of a rape, temporary marriage or out of wedlock affairs. Making decision for abortion by the pregnant mother, as a matter of her right, did not gain too much approval. Conclusion: It seemed that physical health of the mother or the fetus was of more importance to the respondents than their mental or social health. The mother’s hardship was not any indication for induced abortion in the viewpoints of the interviewed policy-makers. Strengthening family planning programs, making appro-priate laws in lines with religious orders and advocacy programs targeting decision makers are determined as strategies for improving women's health rights. 189 196 Hourieh H Shamshiri-Milani حوریه شمشیری میلانی Department of Health & Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences Department of Health & Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences Iran hourieh_milani@yahoo.com Abolghasem A Pourreza ابوالقاسم پوررضا Department of Health Management Sciences and Economics, School of Public Health, Teheran University of Medical Sciences Department of Health Management Sciences and Economics, School of Public Health, Teheran University of Medical Sciences Iran Feizollah F Akbari فیض‌الله اکبری Department of Health Management Sciences and Economics, School of Public Health, Teheran University of Medical Sciences Department of Health Management Sciences and Economics, School of Public Health, Teheran University of Medical Sciences Iran AbortionAttitudeDecision makersFetusReproductive rightsSex preferenceWomen’s health 431.pdf World Health Organization [Internet]. Geneva: WHO. Facts and figures from the world health report; 2005 [cited 2010 Aug 9]; [6 screens]. Available from: www.who.int/whr/2005/media_ centre/facts_en.pdf##World Health Organization. Safe abortion: technical and policy guidance for health systems. 1st ed. Geneva: WHO; 2003. p. 10-4.##Agha Yari T, Mehryar A. Estimation of induced abortion rates in Iran: Application of proximate determinants model. J Popul Assoc Iran. 2007;2(3): 61-91. Persian.##Zare N, Dastoori P. [Estimating the proportion of illegal abortion in 15-49 year-old women by randomized response technique]. Med J Tabriz Univ Med Sci. 2004;(61):36-9. Persian.##Jalili Z, Rouhani AA, Mohammad Alizadeh S, Jafari S, Sharifi M. [Perceptions of gynecologists and general physicians about therapeutic (legal) abortion: A study from Kerman, Iran]. Payesh J. 2006;5 (3):169-75. Persian.##Fawcus SR. Maternal mortality and unsafe abortion. Best Pract Res Clin Obstet Gynaecol. 2008;22(3): 533-48.##Singh S. Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. Lancet. 2006;368(9550):1887-92.##Paxman JM, Rizo A, Brown L, Benson J. The clandestine epidemic: the practice of unsafe abortion in Latin America. Stud Fam Plann. 1993;24(4):205-26.##IPPF: International Planned Parenthood Federation [Internet]. London: International Planned Parenthood Federation (IPPF); 2010. Death and Denial, Unsafe abortion and Poverty; 2009 Nov 18 [cited 2010 Aug 9]; [about 2 screens]. Available from: http://www.ippf.org/en/Resources/Reports-reviews/ Death and Denial.htm##World Health Organization. Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 [Internet]. Geneva: WHO; 2007 Sep [cited 2010 Apr 14]. 44p. Available from: http://whqlibdoc. who.int/publications/2007/9789241596121_eng.pdf##Serour GI. Medical and socio-cultural aspects of infertility in the Middle East. ESHRE Monogr. 2008;1:34-41.##Fine-Davis M. The psychological effect of abortion on women: a review of the literatures. Dublin: Crisis Pregnancy Agency; 2008. 49 p. Report No.: 20.##Glasier A, Gebbie A, Loudon N. Handbook of family planning and reproductive healthcare. 4th ed. London: Churchill Livingstone; 2000.##Briozzo L, Vidiella G, Rodríguez F, Gorgoroso M, Faúndes A, Pons JE. A risk reduction strategy to prevent maternal deaths associated with unsafe abortion. Int J Gynaecol Obstet. 2006;95(2):221-6.##Saeedi MR, Vaziri S, Jamshidpour M, Najafi F, Leghaei Z, Mahjoub P, et al. [Assessment of abortion and its causes and consequences during 15 last years in Kermanshah]. In: Comprehensive Study on Abortion in Iran; 2003 Feb 26-27; Kermanshah. Tehran: Avicenna Research Institute; 2003. p. 98-9. Persian.##Ahmadnia Sh, Mehriar AH. [Unwanted pregnancy and some related factors in Iran]. In: Comprehensive Study on Abortion in Iran; 2003 Feb 26-27; Kermanshah. Tehran: Avicenna Research Institute; 2003. p. 100-1. Persian.##Chinichian M, Holakoei Naeini K, Refaei Shirpak Kh. [A qualitative study on reasons of intended abortion in Iran]. Payesh J. 2007;6(3):219-32. Persian.##Chinichian M, Poorreza A. [Anthropological study of the beliefs and behaviors of women about abortion in Azarbayejan neighborhood in an area in downtown Tehran]. J Sch Public Health Inst Public Health Res. 2004;2(1):1-2. Persian.##Katiraei M. [Az Khesht ta Khesht]. 1st ed. Tehran: Institute of social research and studies; 1969. p. 7. Persian.##PCF: Pro choice forum [Internet]. London: IPPF; 1997-2010. Abortion law; 2002 Feb [cited 2010 Aug 8]; [about 20 screens]. Available from: www. prochoiceforum.org.uk/al12.php##IPPF: International Planned Parenthood Federation [Internet]. London: IPPF; 1952-2010. Respects women’s rights; 2008 Jan 21 [cited 2010 Aug 8]; [about 3 screens]. Available from: http://www.ippf. org/en/News/Intl news/Respect womens rights.htm##Hojati Ashrafi Gh. [Islamic punishment law book]. 4th ed. Tehran: Ganje Danesh; 2002. p. 96-132. Persian.##Rezaei J. [Abortion]. J Teb Tazkieh. 2004;52:74-84. Persian.##Shamshiri Milani H. [Health, it's dimensions and status of abortion related to health]. In: Compre-hensive Study on Abortion in Iran; 2003 Feb 26-27; Kermanshah. Tehran: Avicenna Research Institute; 2003. p. 104. Persian.##International Planned Parenthood Federation (IPPF). Medical and service delivery guidelines for sexual and reproductive health services. 3rd ed. London: IPPF; 2004. p. 281.##Sadr Sh, Abedi MH, Ghadaiani MH, Abedi M. [Assessment of abortion official permissions of Iranian forensic medicine organization during one year]. Forensic Med J. 2005;11(4):198-200. Persian.##Shamshiri Milani H. [Intended abortion]. J Res Med Sci. 2006;30(4):263-5. Persian.##Bazmi Sh, Behnoush B, Kiani M, Bazmi E. Comparative study of therapeutic abortion permissions in central clinical department of Tehran legal medicine organization before and after approval of law on abortion. Iran J Pediatr. 2008;18(4):315-22.##Whittaker A. Reproducing inequalities: abortion policy and practice in Thailand. Women Health. 2002;35(4):101-19.##Okonofua FE, Hammed A, Nzeribe E, Saidu B, Abass T, Adeboye G, et al. Perceptions of policy-makers in Nigeria toward unsafe abortion and maternal mortality. Int Perspect Sex Reprod Health. 2009;35(4):194-202.##Eslami SH. [Ethical approaches to abortion; a case study]. J Reprod Infertil. 2005;6(4):321-42. Persian.##Mehrgan AH. [Abortion and human rights in the outlook of international laws]. J Reprod Infertil. 2005;6(4):410-40. Persian.##Haji Ali F. [Abortion reverence or permission]. J Maqalat Barrasiha. 2004;37(3):55-81. Persian.##Nobahar R. [Abortion in the mirror of “Nafie Haraj” rule, holistic assessment of abortion in Iran]. In: Comprehensive Study on Abortion in Iran; 2003 Feb 26-27; Kermanshah. Tehran: Avicenna Research Institute; 2003. p. 85. Persian.##Nematti A. [Abortion in the views of Contemporary Islamic Jurisprudence]. J Reprod Infertil. 2005; 6(4):369-74. Persian.##The Grand Ayatollah Makarem Shirazi' s Office website [Internet]. Qom: Imam Hossein's (a.s.) school. Abortion; [cited 2010 Aug 8]; [about 7 screens]. Available from: http://english.makarem. ir/estefta/?it=807&mit##The Grand Ayatollah Rohani' s office website [Internet]. Qom: Ayatollah Rohani SM. 2004 Feb 25 [cited 2010 Mar 16]; [about 1 screen]. Available from: http://www.rohani.ir/estefta/search.php. Persian.##The Grand Ayatollah Hosseini Shahroudi' s office website [Internet]. Qom: Ayatollah Hosseini Shahroudi SM; [Estefta'at abortion]; [cited 2010 Aug 8]; [about 5 screens]. Available from: http:// www.shahroudi.com/Portal.aspx?pid=71243&Cultcure=Persian&CaseID=34314&PageIndex=0&Query=سقط جنین . Persian.##The Official Website of Grand Ayatollah Sistani [Internet]. Qom: Grand Ayatollah Sistani. [Questions and Answers: abortion]; [cited 2010 Aug 8]; [about 3 screens]. Available from: http://www. sistani.org/local.php?modules=nav&nid=5&cid=914. Persian.##Mousavi Ardebili A. Laws book. 19th ed. Qom: Nejat; 2009. p. 559-60. Persian.##The Grand Ayatollah Gerami' s office website [Internet]. Qom: Ayatollah Gerami; 2006-2010.[Questions and answers, answer No: 3192]; 2006 Jul 10 [cited 2010 Mar 16]; [about 1 screens]. Available from: http://www.gerami.org/modules. php?name=Content&pa=showpage&pid=6 . Persian.##The website of the office of Grand Ayatullah Saanei [Internet]. Qom: Grand Ayatullah Saanei; [Esteftaat: intended abortion prior to insufflation of holy spirit] ; [cited 2010 Aug 8]; [about 2 screens]. Available from: http://saanei.org/?view=01,05,13, 246,0. Persian.##Tabibi Jebelli M. [Review of abortion permit theory in view of the Imamieh Jurisprudents]. Name Mofid J. 2003; 9(37):75-96. Persian.##Haji Ali F. [Abortion therapy and its social path-ology]. Womens Stud. 2005;2(6):61-98. Persian.##Rezaei J. [Abortion]. J Teb Tazkieh. 2004;52:74-84. 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A Robertsonian Translocation rob (14;15) (q10:q10) in a Patient with Recurrent Abortions: A Case Report 2 1 2 Introduction: Robertsonian translocation is one of the major chromosomal rearrangements with a prevalence rate of 0.1% of the general population and 1% of the infertile population. In this report, we present a nonhomologous Robertsonian translocation in a female patient with a history of repeated abortions. Case Presentation: A couple with the complaint of repeated abortions was admitted in the Institute of Genetics and Hospital for Genetic Diseases in Begumpet, Hyderabad, India for cytogenetic evaluation. Chromosomal analysis of the couple revealed an abnormal karyotype in the female partner with 45, XX, rob (14, 15) (q10; q10) chromosomal constitution, while the male partner showed normal 46, XY karyotype. Conclusion: The cytogenetic analysis of couples with repeated abortions is mandatory to identify any probable chromosomal aberrations. Prenatal diagnosis should be offered to couples with repeated abortions in the case of future pregnancies. 197 201 Ananthapur A Venkateshwari Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India venkateshwari@yahoo.com Avvari A Srilekha Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India Tella T Sunitha تلا سونیتا Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India Nallari N Pratibha نالاری پراتیبها Department of Genetics, Osmania University Department of Genetics, Osmania University India Akka A Jyothy Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India Chromosomal AberrationCytogenetic analysisGenetic counselingRecurrent abortionRobertsonian translocations 433.pdf Sullivan AE, Silver RM, LaCoursiere DY, Porter TF, Branch DW. Recurrent fetal aneuploidy and recurrent miscarriage. Obstet Gynecol. 2004;104(4): 784-8.##Nielsen J, Wohlert M. Chromosome abnormalities found among 34,910 newborn children: results from a 13-year incidence study in Arhus, Denmark. Hum Genet. 1991;87(1):81-3.##Scriven PN, Flinter FA, Braude PR, Ogilvie CM. Robertsonian translocations--reproductive risks and indications for preimplantation genetic diagnosis. Hum Reprod. 2001;16(11):2267-73.##Jacobs PA. Mutation rates of structural chromosome rearrangements in man. Am J Hum Genet. 1981;33 (1):44-54.##Gilgenkrantz S. Robertsonian translocations and abnormal phenotypes. Groupe de Cytogénéticiens Français. Ann Genet. 1989;32(1):5-9.##Moorhead PS, Nowell PC, Mellman WJ, Battips DM, Hungerford DA. Chromosome preparations of leukocytes cultured from human peripheral blood. Exp Cell Res. 1960;20:613-6.##Seabright M. A rapid banding technique for human chromosomes. Lancet. 1971;2(7731):971-2.##Standing Committee on Human Cytogenetic Nomenclature; Mitelman F. ISCN 1995: an international system for human cytogenetic nomenclature (1995). 1st ed. New York: Karger Publishers; 1995. 67-72.##Warburton D, Dallaire L, Thangavelu M, Ross L, Levin B, Kline J. Trisomy recurrence: a reconsideration based on North American data. Am J Hum Genet. 2004;75(3):376-85.##Bianco K, Caughey AB, Shaffer BL, Davis R, Norton ME. History of miscarriage and increased incidence of fetal aneuploidy in subsequent pregnancy. Obstet Gynecol. 2006;107(5):1098-102.##Celep F, Karagüzel A, Ozeren M, Bozkaya H. The frequency of chromosomal abnormalities in patients with reproductive failure. Eur J Obstet Gynecol Reprod Biol. 2006;127(1):106-9.##Franssen MT, Korevaar JC, Leschot NJ, Bossuyt PM, Knegt AC, Gerssen-Schoorl KB, et al. [Risk factors for structural chromosomal abnormality in > or = 2 miscarriages, as an instrument for selective karyotyping]. Ned Tijdschr Geneeskd. 2007; 151(15):863-7. Dutch.##Gardner RJM, Sutherland GR. Chromosome abnormalities and genetic counseling. 4th ed. Oxford: Oxford University Press; 2004:122-37.##

Ectopic Molar Pregnancy: A Rare Entity 2 1 2 Introduction: Ectopic molar pregnancy is a rare occurrence and consequently not often considered as a diagnostic possibility. In this article, an attempt was made to stress on the need for histopathological examination and follow up of every case of ectopic pregnancy. This was substantiated with the help of a case report. Case Presentation: A 30-year-old gravida 4, para 3, pregnant woman with a 7-week history of amenorrhea attended hospital with abdominal pain. Per vaginal examination revealed a tender left adnexal mass measuring 4x4 cm and on ultrasonography there was a live fetus corresponding to a 7-week and 6 days gestation with free fluid in the pelvic cavity. Laparotomy, revealed a ruptured left tubal ectopic pregnancy and histopathological examination was suggestive of a molar pregnancy. Conclusion: Although rare, molar changes can occur at any site of an ectopic pregnancy. Clinical diagnosis of a molar pregnancy is difficult but histopathology is the gold standard for diagnosis. 201 204 Tulon T Borah تولون بوراه Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong India borahtulon@gmail.com Vandana V Raphael واندانا رافائل Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong India Subrat S Panda سوبرت پاندا Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong India Pallab P Saharia پالاب سارهاریا Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong India Ectopic molar pregnancyEctopic pregnancyHistopathologyHuman chorionic gonadotropinMolar pregnancy 434.pdf Sebire NJ, Lindsay I, Fisher RA, Savage P, Seckl MJ. Overdiagnosis of complete and partial hydatidiform mole in tubal ectopic pregnancies. Int J Gynecol Pathol. 2005;24(3):260-4.##Abdul MA, Randawa AJ, Shehu SM. Ectopic (tubal) molar gestation: report of two cases. Niger J Clin Pract. 2008;11(4):392-3.##Chauhan S, Diamond MP, Johns DA. A case of molar ectopic pregnancy. Fertil Steril. 2004;81(4): 1140-1.##Wee HY, Tay EH, Soong Y, Loh SF. Cervical hydatidiform molar pregnancy. Aust N Z J Obstet Gynaecol. 2003;43(6):473-4.##Aytan H, Caliskan AC, Demirturk F, Koseoglu RD, Acu B. Cervical partial hydatidiform molar pregnancy. Gynecol Obstet Invest. 2008;66(2):142-4.##Chauhan MB, Chaudhary P, Dahiya P, Sangwan K, Sen J. Molar cornual ectopic pregnancy. Acta Obstet Gynecol Scand. 2006;85(5):625-7.##Zite NB, Lipscomb GH, Merrill K. Molar cornual ectopic pregnancy. Obstet Gynecol. 2002;99(5 Pt 2):891-2.##Church E, Hanna L, New F, Uku A, Awad H, Watson AJ. Ovarian molar pregnancy. J Obstet Gynaecol. 2008;28(6):660-1.##Leung F, Terzibachian JJ, Chung Fat B, Lassabe C, Knoepffler F, Maillet R, et al. [Heterotopic ovarian hydatidiform mole. A case report]. Gynecol Obstet Fertil. 2009;37(9):749-51. French.##Snyman LC. Case report of an intra-uterine pregnancy complicated by an ectopic invasive molar pregnancy. Southern Afr J Gynae Oncol. 2009;1 (2):69-70.##Rotas M, Khulpateea N, Binder D. Gestational choriocarcinoma arising from a cornual ectopic pregnancy: a case report and review of the literature. Arch Gynecol Obstet. 2007;276(6):645-7.##Bakri YN, Amri A, Mulla J. Gestational choriocarcinoma in a tubal ectopic pregnancy. Acta Obstet Gynecol Scand. 1992;71(1):67-8.##Kagel T, Lemburg SP, Müller KM, Laczkovics A, Nicolas V, Heyer CM. [Mediastinal metastasis of a tubal choriocarcinoma following ectopic pregnancy as a rare cause of thoracic pain]. Zentralbl Gynakol. 2006;128(2):90-4. German.##Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol. 2006;27(1):56-60.##Burton JL, Lidbury EA, Gillespie AM, Tidy JA, Smith O, Lawry J, et al. Over-diagnosis of hydatidiform mole in early tubal ectopic pregnancy. Histopathology. 2001;38(5):409-17.##