Fertility Preservation and Potential Future Treatment Options 2 1 582 2 In spite of large improvements in health care technologies and more access to reproductive health services during past decades, there are many reports on human fertility decline. The role of life style and environmental factors on human fertility has attracted more attention recently and is the subject of worldwide studies on causes of male and female factor infertility. The important factors such as aging and delayed parenthood, inappropriate diet and poor nutrition, obesity, lack of exercise or intense professional exercise, emotional stress, environmental and occupational chemical hazards, radiotherapy, chemotherapy, air pollution, smoking and drug addiction, heavy use of alcohol/caffeine and several reproductive disorders (e.g. endometriosis, uterine fibroids, surgery, genetic predisposition and sexually transmitted infections (STIs)) can negatively affect human fertility. However, several approaches to deal with these factors and to reduce their impact on fertility are recommended. One of such preventative care approaches is fertility preservation with beneficial outcomes for individuals at risk of losing their fertility (1). The field of fertility preservation has quickly evolved during the last two decades with the hope to invent new technologies and find protocols for all those at risk of fertility loss. Individuals at risk of damage to their reproductive function request rapid counseling for all options on fertility preservation and for an authentic clinic with multidisciplinary team of experts including oncologists, endocrinologists, andrologists, surgeons, psychiatrists, geneticists and embryologists. Unfortunately, a small number of candidates actually receive fertility preservation services prior to total loss of their fertility. Financial, educational, cultural and structural barriers exist for these candidates. At present, different options of fertility preservation are available for male and female candidates. The options for female candidates are pre-pubertal and post-pubertal ovarian tissue cryopreservation and oocyte and embryo freezing. The alternatives for male candidates are similar including pre-pubertal testicular tissue cryopreservation, post-pubertal ejaculated, epididymal or testicular sperm cryopreservation and embryo freezing for married cases. The priority for use of them depends on several factors, such as gender, age, marital status and several other factors. In spite of the list of options available for patients at risk of fertility loss, a large number of women with uterus failure cannot experience pregnancy and term child birth. They are mostly candidates of surrogacy and several legal, emotional, ethical and social issues are related to this practice (2). The exceptional and difficult work of Turkish and Swedish teams provides a new option for women with absolute uterine factor infertility. They performed uterine transplantation in a woman from the uterus of a brain-death donor. The report of the first successful transplantation in terms of organ survival after uterine transplantation and clinical pregnancy was published; however, the pregnancy ended in abortion. The uterus unlike the other transplanted organs requires huge vascular and nerves network, changes in the local immune system and many other changes in uterus regenerate during successful implantation and normal pregnancy (3). Therefore, a normal pregnancy and live birth is anticipated through this valuable initial work. Although many research works were done in the field of fertility preservation, still there are lots of challenges to be faced. In addition, the future research on fertility preservation along with restoring the fertility of people who have lost their ability should be focused on changes in lifestyle and treatment procedures, particularly in current protocols of cancer therapy which culminate in damage or loss of fertility. 061 62 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@avicenna.ac.ir No Keyword 582.pdf Barri P, Pellicer A. Fertility preservation: moving ahead faster than expected!. J Assist Reprod Genet. 2014;31(1):3-5.##Sharma R, Biedenharn KR, Fedor JM, Agarwal A. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol. 2013;11:66.##Ozkan O, Akar ME, Ozkan O, Erdogan O, Hadimioglu N, Yilmaz M, et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril. 2013;99(2):470-6.##

The Effect of Curcumin on Intracellular pH (pHi), Membrane Hyperpolarization and Sperm Motility 2 1 556 2 Background: Curcumin has shown to affect sperm motility and function in vitro and fertility in vivo. The molecular mechanism(s) by which curcumin affects sperm motility has not been delineated. Since modulation of intracellular pH (pHi) and plasma membrane polarization is involved in sperm motility, the present study was conducted to investigate the effect of curcumin on these sperm (human and murine) parameters. Methods: The effect of curcumin on sperm forward motility was examined by counting percentages of forward moving sperm. The effect of curcumin on intracellular pH (pHi) was measured by the fluorescent pH indicator 2,7-bicarboxyethyl-5,6-carboxyfluorescein-acetoxymethyl ester (BCECF-AM). The effect of curcumin on plasma membrane polarization was examined using the fluorescence sensitive dye bis (1,3-dibarbituric acid)-trimethine oxanol [DiBAC4(3)]. Results: Curcumin caused a concentration-dependent (p<0.05) decrease in forward motility of both human and mouse sperm. It also caused a concentration-dependent decrease in intracellular pH (pHi) in both human and mouse sperm. Curcumin induced significant (p<0.05) hyperpolarization of the plasma membrane in both human and mouse sperm. Conclusion: These findings indicate that curcumin inhibits sperm forward motility by intracellular acidification and hyperpolarization of sperm plasma membrane. This is the first study to our knowledge which examined the effect of curcumin on sperm pHi and membrane polarization that affect sperm forward motility. These exciting findings will have application in deciphering the signal transduction pathway involved in sperm motility and function and in development of a novel non-steroidal contraceptive for infertility. 062 71 Rajesh RK Naz Reproductive Immunology and Molecular Biology Laboratories, Department of Obstetrics and Gynecology, West Virginia University, School of Medicine, Morgantown Reproductive Immunology and Molecular Biology Laboratories, Department of Obstetrics and Gynecology, West Virginia University, School of Medicine, Morgantown USA Rnaz@hsc.wvu.edu ContraceptionCurcuminPolarizationSignal transductionSperm forward motilitySperm 556.pdf Tayyem RF, Heath DD, Al-Delaimy WK, Rock CL. Curcumin content of turmeric and curry powders. Nutr Cancer. 2006;55(2):126-31.##Singh S. From exotic spice to modern drug? Cell. 2007;130(5):765-8.##Sharma RA, Gescher AJ, Steward WP. Curcumin: the story so far. Eur J Cancer. 2005;41(13):1955-68.##Aggarwal BB, Sundaram C, Malani N, Ichikawa H. Curcumin: The Indian solid gold. Adv Exp Med Biol. 2007;595:1-75.##Corson TW, Crews CM. Molecular understanding and modern application of traditional medicines: Triumphs and trials. Cell. 2007;130(5):769-74.##Gupta SC, Patchva S, Koh W, Aggarwal BB. Discovery of curcumin, a component of the golden spice, and its miraculous biological activities. Clin Exp Pharmacol Physiol. 2013;39:283-99.##Yallapu MM, Ebeling MC, Jaggi M, Chauhan SC. Plasma proteins interaction with curcumin nanoparticles: implications in cancer therapeutics. Curr Drug Metab. 2013;14(4):504-15.##Yallapu MM, Jaggi M, Chauhan SC. Curcumin nanomedicine: a road to cancer therapeutics. Curr Pharm Des. 2013;19(11):1994-2010.##Naz RK. Can curcumin provide an ideal contraceptive? Mol Reprod Dev. 2011;78(2):116-23.##Garbers DL, Watkins HD, Hansbrough JR, Smith A, Misono KS. The amino acid sequence and chemical synthesis of speract and speract analogues. J Biol Chem. 1981;257(6):2734-7.##Babcock DF, Rufo GA Jr, Lardy HA. Potassium-dependent increases in cytosolic pH stimulate metabolism and motility of mammalian sperm. Proc Natl Acad Sci USA. 1983;80(5):1327-31.##Babcock DF, Pfeiffer DR. Independent elevation of cytosolic [Ca2 ] and pH of mammalian sperm by voltage-dependent and pH-sensitive mechanisms. J Biol Chem. 1987;262(31):15041-7.##Zeng Y, Oberdorf JA, Florman HM. pH regulation in mouse sperm: identification of Na( )-, Cl(-)-, and HCO3(-)-dependent and arylaminobenzoate-dependent regulatory mechanisms and characterization of their roles in sperm capacitation. Dev Biol. 1996;173(2):510-20.##Hamamah S, Gatti JL. Role of the ionic environment and internal pH on sperm activity. Hum Reprod. 1998 Dec;13 Suppl 4:20-30.##Darszon A, Iabarca P, Nishigaki T, Espinosa F. Ion channels in sperm physiology. Physiol Rev. 1999;79(2):481-510.##Naz RK, Rajesh PB. Role of tyrosine phosphorylation in sperm capacitation/acrosome reaction. Reprod Biol Endocrinol. 2004;2:75.##Gagnon C, de Lamirande E, editors. Controls of sperm motility. Cambridge: Cambridge University Press; 2006. 108 p. (Jonge CD, Barratt C, editors. The Sperm Cell).##Zeng XH, Yang C, Kim ST, Lingle CJ, Xia XM. Deletion of the Slo3 gene abolishes alkalization-activated K current in mouse spermatozoa. Proc Natl Acad Sci USA. 2011;108(14):5879-84.##De La Vega-Beltran JL, Sánchez-Cárdenas C, Krapf D, Hernandez-González EO, Wertheimer E, Treviño CL, et al. Mouse sperm membrane potential hyperpolarization is necessary and sufficient to prepare sperm for the acrosome reaction. J Biol Chem. 2012;287(53):44384-93.##Lishko PV, Kirichok Y, Ren D, Navarro B, Chung JJ, Clapham DE. The control of male fertility by spermatozoan ion channels. Ann Rev Physiol. 2012;74:453-75.##Chavez JC, de la Vega-Beltran JL, Escoffier J, Visconti PE, Trevino CL, Darszon A, et al. Ion permeabilities in mouse sperm reveal an external trigger for Slo3-dependent hyperpolarization. PLoS One. 2013;8(4):e60578.##Samuel AS, Naz RK. Isolation of human single chain variable fragment antibodies against specific sperm antigens for immunocontraceptive development. Hum Reprod. 2008;23(6):1324-37.##Hamamah S, Magnoux E, Royere D, Barthelemy C, Dacheux JL, Gatti JL. Internal pH of human spermatozoa: effect of ions, human follicular fluid and progesterone. Mol Hum Reprod. 1996;2(4):219-24.##Jain R, Jain A, Kumar R, Verma V, Mikhuri JP, Sharma VL, et al. Functional attenuation of human sperm by novel, non-surfactant spermicides: precise targeting of membrane physiology without affecting structure. Hum Reprod. 2010;25(5):1165-76.##Rossato M, Di Virgilio F, Rizzuto R, Galeazzi C, Foresta C. Intracellular calcium store depletion and acrosome reaction in human spermatozoa: role of calcium and plasma membrane potential. Mol Hum Reprod. 2001;7(2):119-28.##Wong PYD, Lee WM, Tsang AYF. The effects of extracellular sodium on acid release and motility initiation in rat caudal epididymal spermatozoa in vitro. Exp Cell Res. 1981;131(1):97-104.##Carr DW, Acott TS. Intracellular pH regulates bovine sperm motility and protein phosphorylation. Biol Reprod. 1989;41(5):907-20.##Gatti JL, Billard R, Christen R. Ionic regulation of the plasma membrane potential of rainbow trout (Salmo gairdneri) sperm: role in the inititation of motility. J Cell Physiol. 1990;143(3):546-54.##Setchell BP, Maddocks S, Brooks DE, editors. Anatomy, vasculature, innervation, and fluids of the male reproductive tract. New York: Raven Press; 1994. 1063 p. (Knobil E, Neill JD, editors. The Physiology of Reproduction, vol. 1).##Brewis IA, Morton IE, Mohammad SN, Browes CE, Moore HD. Measurement of intracellular calcium concentration and plasma membrane potential in human spermatozoa using flow cytometry. J Androl. 2000;21(2):238-49.##Patrat C, Serres C, Jouannet P. Induction of a sodium influx by progesterone in human spermatozoa. Biol Reprod. 2000;62(5):1380-6.##Patrat C, Serres C, Jouannet P. Progestrone induces hyperpolarization after a transient depolarization phase in human spermatozoa. Biol Reprod. 2002;66(6):1775-80.##Navarro B, Kirichok Y, Clapham DE. KSper, a pH-sensitive K current that controls sperm membrane potential. Proc Natl Acad Sci USA. 2007;104(18):7688-92.##Gresik M, Kolarova N, Farkas V. Hyperpolarization and intracellular acidification in Trichoderma viride as a response to illumination. J Gen Microbiol. 1991;137(11):2605-9.##Jaruga E, Salvioli S, Dobrucki J, Chrul S, Bandorowicz-Pikula J, Sikora E, et al. Apoptosis-like, reversible changes in plasma membrane asymmetry and permeability, and transient modifications in mitochondrial membrane potential induced by curcumin in rat thymocytes. FEBS Lett. 1998;433(3):287-93.##Bilmen JG, Khan S, Javed MH, Michelangeli F. Inhibition of the SERCA Ca2 pumps by curcumin. Curcumin putatively stabilizes the interaction between the nucleotide-binding and phosphorylation domains in the absence of ATP. Eur J Biochem. 2001;268(23):6318-27.##Cao J, Liu Y, Jia J, Zhou HM, Kong Y, Yang G, et al. Curcumin induces apoptosis through mitochondrial hyperpolarization and mtDNA damage in human hepatoma G2 cells. Free Radic Biol Med. 2007;43(6):968-75.##Schackmann RW, Chock PB. Alteration of intracellular [Ca2 ] in sea urchin sperm by the egg peptide speract. Evidence that increased intracellular Ca2 is coupled to Na entry and increased intracellular pH. J Biol Chem. 1986;261(19):8719-28.##Garcia MA, Meizel S. Regulation of intracellular pH in capacitated human spermatozoa by a Na /H exchanger. Mol Reprod Dev. 1999;52(2):189-95.##Morgan DJ, Weisenhaus M, Shum S, Su T, Zheng R, Zhang C, et al. Tissue speciﬁc PKA inhibition using a chemical genetic approach and its application to studies on sperm capacitation. Proc Natl Acad Sci USA. 2008;105(52):20740-5.##Escoffier J, Krapf D, Navarrete F, Darszon A, Visconti PE. Flow cytometry analysis reveals a decrease in intracellular sodium during sperm capacitation. J Cell Sci. 2012;125(Pt 2):473-85.##McPartlin LA, Visconti, PE, Bedford-Guaus SJ. Guaninenucleotide exchange factors (RAPGEF3/RAPGEF4) induce sperm membrane depolarization and acrosomal exocytosis in capacitated stallion sperm. Biol Reprod. 2011;85(1):179-88.##Ohl DA, Naz RK. Infertility due to antisperm antibodies. Urology. 1995;46(4):591-602.##Sikka SC. Role of oxidative stress and antioxidants in andrology and assisted reproductive technology. J Androl. 2004;25(1):5-18.##

The Effects of Glyceryl Trinitrate Patch on the Treatment of Preterm Labor: A Single-blind Randomized Clinical Trial 2 1 562 2 Background: Preterm labor (PTL) is one of the main causes of neonatal mortality and morbidity. PTL leads to serious complications especially in the gestational age prior to 24-26 weeks. The aim of this study was to investigate the effect of glyceryl trinitrate (GTN) patch on the treatment and complications of PTL. Methods: In this clinical trial, 84 singleton pregnant women with gestational age of 27-35 weeks were surveyed. PTL was clinically diagnosed and the patients were randomly divided into two groups who were treated with GTN or placebo for 48 hr. The consequences, complications and changes in some parameters in both groups were compared. Data were analyzed with chi square test, paired and unpaired t tests by SPSS software and p<0.05 was considered significant. Results: No significant difference was observed between two groups in terms of successful tocolysis, receiving full dose of corticosteroids and the mean prolongation of the pregnancy. However, delivery times in patients who delivered during the hospitalization were 31±4.4 and 18.3±2.2 hr (p=0.01), respectively. Headache was more severe in control group (p=0.007). The systolic and mean arterial blood pressure decrease (p<0.001) and maternal heart rate increase (p=0.01) were significant in GTN group. The changes of vital signs were not significant in placebo group. Conclusion: The effect of GTN in the treatment of PTL is similar to the placebo without any serious complication. However, GTN delays the delivery time in delivery during the primary hospitalization. Thus, further studies with larger sample size are needed to evaluate the exact effects of GTN on PTL. 071 78 Anisodowleh A Nankali Imam Reza Hospital, Kermanshah University of Medical Sciences Imam Reza Hospital, Kermanshah University of Medical Sciences Iran Parnian P Kord Jamshidi Imam Reza Hospital, Kermanshah University of Medical Sciences Imam Reza Hospital, Kermanshah University of Medical Sciences Iran Mansour M Rezaei منصور رضایی Biostatistics and Epidemiology Department, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences Biostatistics and Epidemiology Department, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences Iran rezaei@kums.ac.ir Glyceryl trinitrate patchObstetric laborPrematureTocolysis 562.pdf James D, Steer P, Weiner C, Gonik B, Crowther C, Robson S. High risk pregnancy management option. 4th ed. Philadelphia: Elsevier Saunders; 2011. p. 457-69.##Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics. 23rd ed. New York: McGraw Hill; 2009. p. 804-32.##Smith GN, Walker MC, Ohlsson A, O'Brien K, Windrim R. Randomized double-blind placebo controlled trial of transdermal nitroglycerin for preterm labor. Am J Obstet Gynecol. 2007;196(1):37.##Children’s Health [Internet]. US National library of medicine, NIH; 2007. Nitroglycerin patch show promise for premature labor; 2011 Jan 27 [cited 2013 Nov 11]; [about 3 screens]. Available from: http://health.Usnews.com/usnews/health/articles/070201/1health.earlylabor.htm.##Leszczynska-Gorzelak B, Laskowska M, Marciniak B, Oleszczuk J. Nitric oxide for treatment of threatened preterm labor. Int J Gynaecol Obstet. 2001;73(3):201-6.##Smith GN, Guo Y, Wen SW, Walker MC. Secondary analysis of the use of transdermal nitroglycerin for preterm labor. Am J Obstet Gynecol. 2010;203(6):565.##Perveen S, Araainuddin J, Naz S. Short term tocolytic efficacy of transdermal nitrogelycerine. Med Channel. 2010;16(1):152-4.##Schleussner E, Moller A, Gross W, Kahler C, Moller U, Richter S, et al. Maternal and fetal side effects of tocolysis using transdermal nitroglycerin or intravenous fenoterol combined with magnesium sulfate. Eur J Obstet Gynecol Reprod Biol. 2003;106(1):14-9.##Geneva foundation for medical education and research [Internet]. Cairo: Geneva Foundation for Medical Education and Research; 2006. Transdermal nitroglycerine patch for tocolysis - An experience; 2011 Feb 9 [cited 2013 Nov 11]; [about 11 screens]. Available from: http://www.gfmer.ch/IAMANEH_ESMANEH_Cairo_2006/pdf/Transdermal_nitroglycerine_Rai_2006.pdf##Lees C, Campbell S, Jauniaux E, Brown R, Ramsay B, Gibb D, et al. Arrest of preterm labour and prolongation of gestation with glyceryl trinitrate, a nitric oxide donor. Lancet. 1994;343(8909):1325-6.##Katzung B. Basic & clinical pharmacology: Lange Medical Books. 11th ed. London: McGraw Hill; 2001. p. 93-6.##Nitroglycerin Transdermal [Internet]. US FDA; 2011. Nitroglycerin Transdermal; 2011 Feb 9 [cited 2013 Nov 11]; [about 7 screens]. Available from: http://www.drugs.com/pro/nitroglycerin-transdermal.html##Gyetvai K, Hannah ME, Hodnett ED, Ohlsson A. Tocolytics for preterm labor: a systemic review. Obstet Gynecol. 1999;94(5 pt 2):869-77.##Bisits A, Madsen G, Knox M, Gill A, Smith R, Yeo G, et al. The Randomized Nitric Oxide Tocolysis Trial (RNOTT) for the treatment of preterm labor. Am J Obstet Gynecol. 2004;191(3):683-90.##Lees CC, Lojacono A, Thompson C, Danti L, Black RS, Tanzi P, et al. Glyceryl trinitrate and ritodrine in tocolysis: an international multicenter randomized study. Obstet Gynecol. 1999;94(3):403-8.##Schleussner E, Richter S, Gross W, Kahler C, Moller A, Moller U, Seewald HJ. [Nitroglycerin patch for tocolysis--a prospective randomized comparison with fenoterol by infusion]. Z Geburtshilfe Neonatol. 2001;205(5):189-94. German.##Duckitt K, Thornton S. Nitric oxide donors for the treatment of preterm labour. Cochrane Database Syst Rev. 2002;(3):CD002860.##

Relationship between Structural and Intermediary Determinants of Health and Preterm Delivery 2 1 583 2 Background: Preterm birth is a major health problem that leads to infant morbidity and mortality. The main goal of this study was to find the relationship between social determinants of health and preterm delivery. Methods: A prospective longitudinal cohort study was carried out on 500 pregnant women in their 24th to 28th gestational weeks in 2012. The pregnant women filled out a self-report questionnaire on the structural determinant, perceived stress, and perceived social support. The participants were followed up until labor and the data about mother and the newborn were collected after labor. The data were analyzed by SPSS 21 and Lisrel 8.8 software programs using pathway analysis. Results: The final path model fit well (CFI=0.96; RMSEA=0.060). Path analysis showed that among structural factors, income had a direct effect (β=0.06) and the factors of income (β=0.00594), number of children (family size) (β=-0.024), as well as mother’s education (β=-0.0084) had the greatest overall effect on gestational age at birth respectively. Also, the results showed that among intermediate factors of social determinants of health, stress in the direct path (β=-0.12) and among the overall effects, the perceived stress (β=-0.12) and perceived social support (β=0.0396) affected the gestational age at birth. Conclusion: The current study showed that some structural and intermediary determinants such as income and perceived stress had an effect on preterm labor. 078 87 Mahrokh M Dolatian ماهرخ دولتیان Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences Iran Arash A Mirabzadeh Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences Iran aramirab@uswr.ac.ir Ameneh A Setareh Forouzan Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences Iran Homeira H Sajjadi Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences 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 Zohreh Z Mahmoodi Department of Midwifery, Faculty of Nursing and Midwifery, Alborz University of Medical Sciences Department of Midwifery, Faculty of Nursing and Midwifery, Alborz University of Medical Sciences Iran Farnoosh F Moafi Department of Midwifery, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences Department of Midwifery, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences Iran Intermediary determinants of healthPerceived social supportPerceived stressStructural determinants of health 583.pdf Goldenberg RL, Culhane JF, Iams JD, Romero R. 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The effect of parental occupation on low birth weight [dissertation]. [Hong Kong]: University of Hong Kong; 2004. 58 p.##Doyal L. Gender and the 10/90 gap in health research. Bull World Health Organ. 2004;82(3):162.##Jansen PW, Tiemeier H, Jaddoe VW, Hofman A, Steegers EA, Verhulst FC, et al. Explaining educational inequalities in preterm birth: the generation r study. Arch Dis Child Fetal Neonatal Ed. 2009;94(1):F28-34.##Park MJ, Son M, Kim YJ, Paek D. Social inequality in birth outcomes in Korea, 1995-2008. J Korean Med Sci. 2013;28(1):25-35.##Chevalier A, O'Sullivan V. Mother's education and birth weight [discussion papers]. [Germany]: Royal Holloway University of London & London School of Economics and IZA; 2007. 43 p.##Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Production. Geneva: World Health Organization; 2010 Apr. 31 p.##Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). 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BMC Public Health. 2012;12:65.##Feldman PJ, Dunkel-Schetter C, Sandman CA, Wadhwa PD. Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosom Med. 2000;62(5):715-25.##Leal Mdo C, Pereira AP, Lamarca Gde A, Vettore MV. The relationship between social capital, social support and the adequate use of prenatal care. Cad Saude Publica. 2011;27 Suppl 2:S237-53.##Black KD. Stress, symptoms, self-monitoring confidence, well-being, and social support in the progression of preeclampsia/gestational hypertension. J Obstet Gynecol Neonatal Nurs. 2007;36(5):419-29.##

Impairment of Quality of Life in Symptomatic Reproductive Tract Infection and Sexually Transmitted Infection 2 1 584 2 Background: Reproductive tract infections (RTI) and sexually transmitted infections (STI) are often subclinical and remain undetected. The current study aimed to estimate the burden of RTI/STI, associated symptoms, risk factors and the impact of the condition on quality of life (QOL). Methods: A community based, cross sectional study was conducted. Married women aged 18 to 49 years were selected through systematic random sampling in a rural area. A semi-structured questionnaire was used to evaluate socio-demographic characteristics, symptoms, risk factors and knowledge regarding RTI/STI. A standardized instrument from the World Health Organization (WHO-BREF) was used to measure QOL. The chi square (2) and unpaired t tests were used for statistic evaluation of results. Results: In a sample of 464 women, 60 (13%) women were symptomatic and the commonest symptom was abnormal vaginal discharge (n=54). 24 of the women had sought treatment. Age (p=0.0006) and socio-economic status (p=0.0004) were significant for an outcome of RTI/STI. Significant risk factors included lack of use of barrier contraceptives (p<0.001), past history of infection (p<0.001), use of reusable cloth during menstruation (p<0.001) and presence of spousal symptoms (p<0.001). QOL scores were impacted on all domains with significant differences. The largest mean difference was in the social relations and sexual activity domain. Conclusion: In the current study, the obtained data was a 13% prevalence of RTI/STI symptoms with a significant lack of awareness regarding occurrence and prevention among women and significant impairment on all QOL domains. 087 94 Sameer S Valsangkar Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur India sameer_vg@yahoo.com Dhamodharan D Selvaraju Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur India Rohin R Rameswarapu Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur India Shivaprasad Sh Kamutapu Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur Department of Community Medicine, Prathima Institute of Medical Sciences, Nagnur India Quality of lifeReproductive tract infectionSexually transmitted infection 584.pdf Wilkinson D, Abdool Karim SS, Harrison A, Lurie M, Colvin M, Connolly C, et al. Unrecognized sexually transmitted infections in rural South African women: a hidden epidemic. Bull World Health Organ. 1999;77(1):22-8.##Samanta A, Ghosh S, Mukherjee S. Prevalence and health-seeking behavior of reproductive tract infection/sexually transmitted infections symptomatics: a cross-sectional study of a rural community in the Hooghly district of West Bengal. Indian J Public Health. 2011;55(1):38-41.##Population Council. Reproductive Tract Infections: An Introductory Overview [Internet]. New York; 2001 [cited 2011 Oct 15]. Available from: www.popcouncil.org/pdfs/RTIFacsheetsRev.pdf##Raj R, Sreenivas V, Mehta M, Gupta S. Health-related quality of life in Indian patients with three viral sexually transmitted infections: herpes simplex virus-2, genital human papilloma virus and HIV. Sex Transm Infect. 2011;87(3):216-20.##Woodhall SC, Jit M, Soldan K, Kinghorn G, Gilson R, Nathan M, et al. The impact of genital warts: loss of quality of life and cost of treatment in eight sexual health clinics in the UK. Sex Transm Infect. 2011;87(6):458-63.##Cai T, Mondaini N, Migno S, Meacci F, Boddi V, Gontero P, et al. Genital Chlamydia trachomatis infection is related to poor sexual quality of life in young sexually active women. J Sex Med. 2011;8(4):1131-7.##Choudhry S, Ramachandran VG, Das S, Bhattacharya SN, Mogha NS. Pattern of sexually transmitted infections and performance of syndromic management against etiological diagnosis in patients attending the sexually transmitted infection clinic of a tertiary care hospital. Indian J Sex Transm Dis. 2010;31(2):104-8.##Thappa D, Kaimal S. Sexually transmitted infections in India: current status (except human immunodeficiency virus/acquired immunodeficiency syndrome). Indian J Dermatol. 2007;52:78##Devi SA, Vetrichevvel TP, Pise GA, Thappa DM. Pattern of sexually transmitted infections in a tertiary care centre at Puducherry. Indian J Dermatol. 2009;54(4):347-9.##Mishra D, Singh HP. Kuppuswamy's socioeconomic status scale--a revision. Indian J Pediatr. 2003;70(3):273-4.##Valsangkar S, Bodhare T, Bele S, Sai S. An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women. J Hum Reprod Sci. 2011;4(2):80-5.##The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46(12):1569-85.##Madhivanan P, Bartman MT, Pasutti L, Krupp K, Arun A, Reingold AL, et al. Prevalence of Trichomonas vaginalis infection among young reproductive age women in India: implications for treatment and prevention. Sex Health. 2009;6(4): 339-44.##Setia MS, Jerajani HR, Brassard P, Boivin JF. Clinical and demographic trends in a sexually transmitted infection clinic in Mumbai (1994-2006): an epidemiologic analysis. Indian J Dermatol Venereol Leprol. 2010;76(4):387-92.##Cabada MM, Maldonado F, Bauer I, Verdonck K, Seas C, Gotuzzo E. Sexual behavior, knowledge of STI prevention, and prevalence of serum markers for STI among tour guides in Cuzco/Peru. J Travel Med. 2007;14(3):151-7.##McManus A, Dhar L. Study of knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex and sex education: (a cross sectional survey of urban adolescent school girls in South Delhi, India). BMC Womens Health. 2008;8:12.##

Sociodemographic Factors Associated with Pap Test Adherence and Cervical Dysplasia in Surgically Sterilized Women 2 1 557 2 Background: Routine dysplasia screening decreases the rates of cervical cancer. Since many women seek gynecological care to secure contraception, it was hypothesized that sterilized women will be less likely to undergo routine cervical cancer screening. Prior studies tried to evaluate this relationship, but results were conflicting. The study sought to further explore the sociodemographic and behavioral risk factors that might predispose sterilized women to be screening non-adherent and more likely to have cervical dysplasia. Methods: Secondary analysis of women (n=1688) enrolled in a cross-sectional study in North America and divided into screening (n=925) and diagnostic (n=763) groups was performed. Information about sociodemographic and behavioral risk factors, surgical sterilization and date of last Pap test were obtained from questionnaires. Cervical histology was obtained from pathology records. Univariable analyses identified differences in risk factors between groups. Multivariable logistic regression models were constructed to evaluate Pap adherence and cervical dysplasia. Results: Sterilized women were 39% more likely to be screening non-adherent (p≤0.05) especially if divorced, separated or widowed (OR=1.62), Hispanic (OR=1.57) and with a higher number of vaginal births (OR=2.00). Education was an effect measure modifier, significantly associated with non-adherence (OR=1.60). The association between sterilization and non-adherence remained significant when adjusted for confounders (AOR=1.47). Sterilization was associated with an 80% increased odds of cervical dysplasia in women over 40. Conclusion: Sterilized women with certain sociodemographic factors are more likely to be non-adherent with Pap screening and more prone to dysplasia. These findings may assist practitioners in counseling at-risk patients. 094 105 Katherine KC Whitehouse Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, USA Jane JR Montealegre Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston USA Michele M Follen Department of Obstetrics and Gynecology School of Medicine, Philadelphia Department of Obstetrics and Gynecology School of Medicine, Philadelphia USA Michael ME Scheurer Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston USA Kjersti K Aagaard Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, USA aagaardt@bcm.tmc.edu Cervical dysplasia screeningPap test cervical dysplasiaSterilizationTubal Ligation 557.pdf DiSaia P, Creasmen W. Clinical gynecologic oncology. 7th ed. Philadelphia, PA: Elsevier; 2007.##Mathew A, George PS. Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix--worldwide. Asian Pac J Cancer Prev. 2009;10(4):645-50.##American Cancer Society. What are the key statistics about cervical cancer? [Internet]. Atlanta, GA: American Cancer Society; 2014 [updated 2014; cited 2014 Feb 6]. Available from: http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics##Waggoner SE. Cervical cancer. Lancet. 2003;361(9376):2217-25.##American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2012 [Internet]. Atlanta, GA: American Cancer Society; 2012 [updated 2014; cited 2014 Feb 6]. Available from: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-033423.pdf.##Martin CK, Richardson LC, Berkman ND, Kuo TM, Yuen AN, Benard VB. Impact of the 2002 American society for Colposcopy and Cervical Pathology guidelines on cervical cancer diagnosis in a geographically diverse population of commercially insured women, 1999-2004. J Low Genit Tract Dis. 2011;15(1):25-32.##Stanley M. Pathology and epidemiology of HPV infection in females. Gynecol Oncol. 2010;117(2 Suppl):S5-10.##Speroff L, Darney P. A clinical guide for contraception. 4th ed. Philadelphia, PA: Lippincott, William & Wilkins; 2005.##Eggleston KS, Coker AL, Williams M, Tortolero-Luna G, Martin JB, Tortolero SR. Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995-2001. J Womens Health (Larchmt). 2006;15(8):941-51.##Cohen MM, Roos NP. Cervical cytology screening after tubal ligation. Am J Prev Med. 1986;2(4):220-5.##Kjaer SK, Mellemkjaer L, Brinton LA, Johansen C, Gridley G, Olsen JH. Tubal sterilization and risk of ovarian, endometrial and cervical cancer. A Danish population-based follow-up study of more than 65 000 sterilized women. Int J Epidemiol. 2004;33(3):596-602.##Li HQ, Thomas DB, Jin SK, Wu F. Tubal sterilization and use of an IUD and risk of cervical cancer. J Womens Health Gend Based Med. 2000;9(3):303-10.##Winkler HA, Anderson PS, Fields AL, Runowicz CD, DeVictoria C, Goldberg GL. Compliance with Papanicolaou smear screening following tubal ligation in women with cervical cancer. J Womens Health. 1999;8(1):103-7.##Mathews CA, Stoner JA, Wentzensen N, Moxley KM, Tenney ME, Tuller ER, et al. Tubal ligation frequency in Oklahoma women with cervical cancer. Gynecol Oncol. 2012;127(2):278-82.##Pham B, Rhodes H, Milbourne A, Adler-Storthz K, Follen M, Scheurer ME. Epidemiologic differentiation of diagnostic and screening populations for the assessment of cervical dysplasia using optical technologies. Gend Med. 2012;9(1 Suppl):S36-47.##Pruitt SL, Parker PA, Peterson SK, Le T, Follen M, Basen-Engquist K. Knowledge of cervical dysplasia and human papillomavirus among women seen in a colposcopy clinic. Gynecol Oncol. 2005;99(3 Suppl 1):S236-44.##Scheurer ME, Tortolero-Luna G, Guillaud M, Follen M, Chen Z, Dillon LM, et al. Correlation of human papillomavirus type 16 and human papillomavirus type 18 e7 messenger RNA levels with degree of cervical dysplasia. Cancer Epidemiol Biomarkers Prev. 2005;14(8):1948-52.##Coker AL, Desimone CP, Eggleston KS, White AL, Williams M. Ethnic disparities in cervical cancer survival among Texas women. J Womens Health (Larchmt). 2009;18(10):1577-83.##Garner EI. Cervical cancer: disparities in screening, treatment, and survival. Cancer Epidemiol Biomarkers Prev. 2003;12(3):242s-247s.##Ibfelt E, Kjær SK, Johansen C, Hogdall C, Steding-Jessen M, Frederiksen K, et al. Socioeconomic position and stage of cervical cancer in Danish women diagnosed 2005 to 2009. Cancer Epidemiol Biomarkers Prev. 2012 May;21(5):835-42.##MacLaughlan SD, Lachance JA, Gjelsvik A. Correlation between smoking status and cervical cancer screening: a cross-sectional study. J Low Genit Tract Dis. 2011;15(2):114-9.##Nelson W, Moser RP, Gaffey A, Waldron W. Adherence to cervical cancer screening guidelines for U.S. women aged 25-64: data from the 2005 Health Information National Trends Survey (HINTS). J Womens Health (Larchmt). 2009;18(11):1759-68.##Russo E, Kupek E, Zanine RM. Vaginal delivery and low immunity are strongly associated with high-grade cervical intraepithelial neoplasia in a high-risk population. J Low Genit Tract Dis. 2011;15(3):195-9.##Smith AM, Heywood W, Ryall R, Shelley JM, Pitts MK, Richters J, et al. Association between sexual behavior and cervical cancer screening. J Womens Health (Larchmt). 2011;20(7):1091-6.##U.S. Preventive Services Task Force. Screening for cervical cancer: recommendations and rationale. Am J Nurs. 2003;103(11):101-2, 105-6, 108-9.##International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S, et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet. 2007;370(9599):1609-21.##ACOG Committee on Practice Bulletins Gynecology. ACOG Practice Bulletin no. 109: Cervical cytology screening. Obstet Gynecol. 2009;114(6):1409-20.##ACOG committee opinion. Recommendations on frequency of Pap test screening. Number 152--March 1995. Committee on Gynecologic Practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1995;49(2):210-1.##Smith RA, Brooks D, Cokkinides V, Saslow D, Brawley OW. Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin. 2013;63(2):88-105.##Roland KB, Soman A, Benard VB, Saraiya M. Human papillomavirus and Papanicolaou tests screening interval recommendations in the United States. Am J Obstet Gynecol. 2011;205(5):447.e1-8.##Saraiya M, Berkowitz Z, Yabroff KR, Wideroff L, Kobrin S, Benard V. Cervical cancer screening with both human papillomavirus and Papanicolaou testing vs Papanicolaou testing alone: what screening intervals are physicians recommending?. Arch Intern Med. 2010;170(11):977-85.##Sirovich BE, Welch HG. The frequency of Pap smear screening in the United States. J Gen Intern Med. 2004;19(3):243-50.##Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol. 2007;197(4):340-5.##Canadian Task Force on Preventive Health Care, Pollock S, Dunfield L, Shane A, Kerner J, Bryant H, et al. Recommendations on screening for cervical cancer. CMAJ. 2013;185(1):35-45.##

Outpatient Follicle Monitoring: A Plea for Standardization in Ultrasound Based Follicle Monitoring and Data Transfer 2 1 558 2 Background: The complexity of assisted reproductive technology (ART) increased during the last decades. New scientific and medical findings as well as the statutory requirements for improving the safety and the outcome of ART were the main impetus for its development. While therapy planning is done and ART is used by the IVF centers, the medical support and monitoring of patients is conducted by referring gynecologists. Reported follicle measurements by the gynecologist allow the adoption of the therapy plan. Most notably, the crucial aspect is processing and interpretation of ultrasound scan (US). The results of the received US, the transfer of data between IVF center(s) and referred physician(s) as well as the subjective interpretation often culminate in interpretation and logistical problems. This might increase the error probability with considerable detriments for the patients and ART outcome. Methods: The follicle monitoring was performed using Voluson I ultrasound system combined with SonoAVC® software. Results were communicated via DICOM language to DynaMed® software, a medical program for managing an IVF center with seamless integration of all processes needed for an accurate and precise workflow. Results: In this study, no loss of data was detected. All data were integrated by DynaMed® software and were recallable in a fast and easy manner. Conclusion: The broad usage of Voluson I ultrasound SonoAVC® software and communication of the results via Picture Archiving and Communication System (PACS) server between the IVF center and local gynecologist would provide more assistance for the patients and consequently the ART outcomes can be improved. 105 109 Maximilian M Murtinger IVF Centers Prof Zech IVF Centers Prof Zech Austria m.murtinger@ivf.at Mathias MH Zech IVF Centers Prof Zech IVF Centers Prof Zech Austria Dietmar D Spitzer IVF Centers Prof Zech IVF Centers Prof Zech Austria Nicolas NH Zech IVF Centers Prof Zech IVF Centers Prof Zech Austria 3D ultrasoundData transferDICOM standardFollicle measurementIVFMedical standardizationUltrasound monitoring 558.pdf Forman RG, Robinson J, Yudkin P, Egan D, Reynolds K, Barlow DH. What is the true follicular diameter: an assessment of the reproducibility of transvaginal ultrasound monitoring in stimulated cycles. Fertil Steril. 1991;56(5):989-92.##Deutch TD, Joergner I, Matson DO, Oehninger S, Bocca S, Hoenigmann D, et al. Automated assessment of ovarian follicles using a novel three-dimensional ultrasound software. Fertil Steril. 2009;92(5):1562-8.##Murtinger M, Aburumieh A, Rubner P, Eichel V, Zech MH, Zech NH. Improved monitoring of ovarian stimulation using 3D transvaginal ultrasound plus automated volume count. Reprod Biomed Online. 2009;19(5):695-9.##Wittmaack FM, Kreger DO, Blasco L, Tureck RW, Mastroianni L Jr, Lessey BA. Effect of follicular size on oocyte retrieval, fertilization, cleavage, and embryo quality in in vitro fertilization cycles: a 6-year data collection. Fertil Steril. 1994;62(6):1205-10.##Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet. 1978;2(8085):366.##Olofsson JI, Banker MR, Sjoblom LP. Quality management systems for your in vitro fertilization clinic's laboratory: Why bother? J Hum Reprod Sci. 2013;6(1):3-8.##European commission. Commission directive 2003/94/EC of 8 October 2003 laying down the principles and guidelines of good manufacturing practice in respect of medicinal products for human use and investigational medicinal products for human use (2004/23/EC) [Internet]. Brussels (Belgium): Official Journal of the European Union; 2003 Oct 8 [cited 2013 Feb 12]. Available from: http://ec.europa.eu/health/files/eudralex/vol1/dir_2003_94/dir_2003_94_en.pdf##Raine-Fenning N, Jayaprakasan K, Deb S, Clewes J, Joergner I, Dehghani Bonaki S, et al. Automated follicle tracking improves measurement reliability in patients undergoing ovarian stimulation. Reprod Biomed Online. 2009;18(5):658-63.##Raine-Fenning N, Jayaprakasan K, Clewes J. Automated follicle tracking facilitates standardization and may improve work flow. Ultrasound Obstet Gynecol. 2007;30(7):1015-8.##Ata B, Seyhan A, Reinblatt SL, Shalom-Paz E, Krishnamurthy S, Tan SL. Comparison of automated and manual follicle monitoring in an unrestricted population of 100 women undergoing controlled ovarian stimulation for IVF. Hum Reprod. 2011;26(1):127-33.##Hains IM, Georgiou A, Westbrook JI. The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature. J Am Med Inform Assoc. 2012;19(4):506-13.##Alper MM; International Standards Organization. Experience with ISO quality control in assisted reproductive technology. Fertil Steril. 2013;100(6):1503-8.##

The Case of Sacrococcygeal Teratoma in an IVF Pregnancy: Is There any Association between Congenital Tumors and Assisted Reproduction Techniques? 2 1 560 2 Background: Sacrococcygeal teratoma (SCT) is a rare congenital tumor and its association with IVF pregnancy is not clear. There are limited reports of congenital tumors in IVF pregnancy. The exact embryogenesis of SCT is not known but a genetic etiology has been reported. Whether these congenital tumors have any association with assisted reproductive techniques remains obscure. Case Presentation: In this study, a case of SCT in an IVF pregnancy with donor oocytes was reported. IVF was performed for bilateral tubal blockade and poor ovarian reserve. It was diagnosed antenatally by ultrasonography. Successful surgical treatment was performed in postnatal period and six months follow-up remained uneventful. Conclusion: The purpose of reporting this case is to emphasize on the possibility of association of congenital tumors with assisted reproductive techniques and hence, the need for screening in these pregnancies. An association could not be detected based on few case reports and therefore, large population based studies are required to elucidate the effect of these reproductive techniques on occurrence of congenital tumors. 109 113 Anjali A Tempe Department of Obstetrics and Gynaecology, Maulana Azad Medical College Department of Obstetrics and Gynaecology, Maulana Azad Medical College India Nilanchali N Singh Department of Obstetrics and Gynaecology, Maulana Azad Medical College Department of Obstetrics and Gynaecology, Maulana Azad Medical College India nilanchalisingh@gmail.com Ila I Sharma Department of Obstetrics and Gynaecology, Maulana Azad Medical College Department of Obstetrics and Gynaecology, Maulana Azad Medical College India Satish S Agarwal Department of Paediatric Surgery, Maulana Azad Medical College Department of Paediatric Surgery, Maulana Azad Medical College India AssistedCongenital TumorsIVFReproduction TechniquesSacrococcygeal Teratoma 560.pdf Chambers GM, Wang YA, Chapman MG, Hoang VP, Sullivan EA, Abdalla HI, et al. What can we learn from a decade of promoting safe embryo transfer practices? A comparative analysis of policies and outcomes in the UK and Australia, 2001-2010. Hum Reprod. 2013;28(6):1679-86.##Kallen B, Finnstrom O, Lindam A, Nilsson E, Nygren KG, Otterblad PO. Congenital malformations in infants born after in vitro fertilization in Sweden. Birth Defects Res A Clin Mol Teratol. 2010;88(3):137-43.##Bonduelle M, Liebaers I, Deketelaere V, Derde MP, Camus M, Devroey P, et al. Neonatal data on a cohort of 2889 infants born after ICSI (1991-1999) and of 2995 infants born after IVF (1983-1999). Hum Reprod. 2002;17(3):671-94.##Ericson A1, Kallen B. Congenital malformations in infants born after IVF: a population-based study. Hum Reprod. 2001;16(3):504-9.##Chisholm CA, Heider AL, Kuller JA, von Allmen D, McMahon MJ, Chescheir NC. Prenatal diagnosis and perinatal management of fetal sacrococcygeal teratoma. Am J Perinatol. 1999;16(1):47-50.##Avery GB, Fletcher MA, McDonald ME. Neonatology: pathophysiology and management of newborn. Philadelphia: Lippincott; 1994. p. 1219-20.##Wee WW, Tagore S, Tan JV, Yeo GS. Foetal sacrococcygeal teratoma: extremes in clinical presentation. Singapore Med J. 2011;52(6):e118-23.##Rescorla FJ, Sawin RS, Coran AG, Dillon PW, Azizkhan RG. Long-term outcome for infants and children with sacrococcygeal teratoma: a report from the Childrens Cancer Group. J Pediatr Surg. 1998;33(2):171-6.##Villa JC, John V, Verghella V. Large foetal sacrococcygeal teratoma complicated by preterm premature rupture of membranes and maternal preeclampsia. Rev Colomb Obstet Ginecol. 2007;58(4):322-27.##Chervenak FA, Isaacson G, Touloukian R, Tortora M, Berkowitz RL, Hobbins JC. Diagnosis and management of fetal teratomas. Obstet Gynecol. 1985 Nov;66(5):666-71.##Manzoni C, Canali R, Narciso A, Nanni L, Pintus C. [Sacrococcygeal teratoma: single center experience and functional long-term follow-up]. Clin Ter. 2011;162(2):99-106. Italian.##Anthony S, Buitendijk SE, Dorrepaal CA, Lindner K, Braat DD, den Ouden AL. Congenital malformations in 4224 children conceived after IVF. Hum Reprod. 2002;17(8):2089-95.##Rizk T, Nabbout R, Koussa S, Akatcherian C. Congenital brain tumor in a neonate conceived by in vitro fertilization. Childs Nerv Syst. 2000;16(8):501-2.##White L, Giri N, Vowels MR, Lancaster PA. Neuroectodermal tumours in children born after assisted conception. Lancet. 1990;336(8730):1577.##Morof DF, Levine D, Stringer KF, Grable I, Folkerth R. Congenital glioblastoma multiforme: prenatal diagnosis on the basis of sonography and magnetic resonance imaging. J Ultrasound Med. 2001;20(12):1369-75.##Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AE, et al. In vitro fertilization is associated with an increase in major birth defects. Fertil Steril. 2005;84(5):1308-15.##

A Novel de novo Balanced Reciprocal Translocation t(18;22) Associated with Recurrent Miscarriages: A Case Report 2 1 563 2 Background: Recurrent miscarriage is a major concern in the couples with reproductive problems. The chromosomal abnormalities, mainly balanced rearrangements are reported in variable phenotypes and the prevalence of them is 2-8% in such couples. Case Presentation: In this study, the clinical, cytogenetic and molecular cytogenetic evaluations were performed on a couple with RM. The cytogenetic analysis of the husband revealed a balanced reciprocal translocation of t(18;22)(q21.1;q12) whereas wife had a normal karyotype of 46,XX. Further spectral karyotyping was performed to rule out the involvement of any other chromosomal aberrations present in the genome. Additional whole chromosome paint FISH (Fluorescence in situ hybridization) with paint probes 18 and 22 confirmed the translocation. Conclusion: To our knowledge, this is the first report of a novel (18;22) translocation with unique breakpoints and their association with RM. The reciprocal translocations provide a good opportunity for the identification of disease associated genes. However, in recurrent miscarriages, most of them do not disrupt any gene at the breakpoint but can lead to unbalanced gametes and hence poor reproductive outcome like RM or birth of a child with malformations and intellectual disability. The translocation breakpoints might be risk factors for RM. Moreover, the impact of the balanced translocations in association with RM is discussed in this report. 113 117 Usha UR Dutta Diagnostics Division, Center for DNA Fingerprinting and Diagnostics, Tuljaguda complex Diagnostics Division, Center for DNA Fingerprinting and Diagnostics, Tuljaguda complex India ushadutta@hotmail.com, usha@cdfd.org.in Rajitha R Ponnala Diagnostics Division, Center for DNA Fingerprinting and Diagnostics, Tuljaguda complex Diagnostics Division, Center for DNA Fingerprinting and Diagnostics, Tuljaguda complex India Ashwin A Dalal Diagnostics Division, Center for DNA Fingerprinting and Diagnostics, Tuljaguda complex Diagnostics Division, Center for DNA Fingerprinting and Diagnostics, Tuljaguda complex India Balanced translocationFISHGTG bandingRecurrent miscarriageSKY 563.pdf Royal College of Obstetricians and Gynecologists (RCOG). The management of recurrent miscarriage. London: Royal College of Obstetricians and Gynecologists; 1998.##Sierra S, Stephenson M. 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Medical and Surgical Management of Male Infertility 2 1 585 2 This article is the review of the book "Medical & Surgical Management of Male Infertility" edited by Botros RMB Rizk, Nabil Aziz, Ashok Agarwal and Edmund Sabanegh Jr. This book (hardcover) was published by Jaypee Brothers Medical Publishing, New Delhi.London.Philadelphia.Panama on September 2013 (1st edition). The contents of the book and its relevance to medical education are discussed in this invited review. 117 120 Hooman H Sadri-Ardekani هومن صدری‌اردکانی Wake Forest Institute for Regenerative Medicine (WFIRM), Wake Forest School of Medicine, Winston-Salem Wake Forest Institute for Regenerative Medicine (WFIRM), Wake Forest School of Medicine, Winston-Salem USA hsadri@wakehealth.edu AndrologyAssisted reproductionGeneticsMale infertilityMedical ethicsSpermSpermatogonial stem cellTestis 585.pdf Goldstein M, Schlegel PN. Surgical and medical management of male infertility. 1st ed. United Kingdom: Cambridge University Press; 2013. 361 p.##Lipshultz LI, Howards SS, Niederberger C. Infertility in the male. 4th ed. United Kingdom: Cambridge University Press; 2009. 688 p.##