Recurrent Pregnancy Loss through the Lens of Immunology 2 1 640 2 Evolutionary development of the immune system dates back to the emergence of life in the universe. Immune system emerges early in the course of embryogenesis; immune-restricted progenitor cells appear very early during development in the yolk sac and contribute later to the emergence of lymphoid and myeloid components of the immune system (1). Immune system consists of biological structures, entities, players and processes with a multiplex and intricate interaction with other body systems. It inspects and senses every subtle change in the expression level, stereochemical composition and conformation of the molecules and accordingly mounts regulatory responses. In physiological condition, immune system remains steady and delicately balanced; a small change in the normal physiological processes is concomitantly followed by immediate counter-regulatory mechanisms of the immune system leading to establishment of a new level of immunological balance. Pregnancy, as the most prominent physiological condition associated with a new level of immunological balance, is preceded by vaginal insemination. Seminal plasma contains large amounts of transforming growth factor β and prostaglandin E capable of induction of regulatory T cells (Treg). Seminal fluid initiates a series of events leading to induction of tolerogenic dendritic cells competent to prime Tregs (2). Treg deficiency is associated with such pregnancy-related complications as unexplained infertility, miscarriage, and pre-eclampsia. Within hours after fertilization and in order to adapt to such an immune-stimulatory condition as pregnancy, immune system deliberately creates early pregnancy factor (EPF) with potent immunomodulatory properties (3), a very early sign of pre-implantation immune adaptation to antigenically dissimilar embryo. For successful implantation, extensive modification of endometrium at the cellular and molecular levels and intricate bidirectional communication between implanting blastocyst and the endometrium are required. Such communication is orchestrated by a complex and multilayer network of immune cells, chemokines, cytokines, growth factors and adhesion molecules. In this context, a set of pro-inflammatory TH1 cytokines work in concert in a tightly-regulated manner to establish endometrial receptivity and window of implantation. Chemokines and adhesion molecules mediate blastocyst apposition and adhesion to endometrium. And finally decidual immune cells, mainly uterine natural killer cells (uNK), dendritic cells, TH1 and Treg cells play an eminent role not only in mediating immune tolerance, but also in vascular remodeling and decidual development (4). During pregnancy, the composition of decidual immune cells and cytokine profile gradually undergoes extensive modification and new functional synapses between fetal trophoblast and maternal immune cells are formed, supporting the fourth piece of conception. Plodding predominance of TH2 cytokines, stepwise decline in uNK cell and increase of Tregs population are among the hallmark of immune adaptation during pregnancy. Such complex modifications synergistically create a state of tolerance and form the basis of immunotrophism for embryo development (5). The final act of the performance is initiated around parturition by an extensive influx of neutrophils and macrophages and a re-balancing process of cytokine profile toward TH1, when a set of pro-inflammatory cytokines and mediators are released leading to cervical ripening and labor. As a matter of fact, a successful pregnancy is based, in essence, on highly harmonic spatiotemporal regulatory action of the immune network at the feto-maternal interface leading to endometrial receptivity and maternal tolerance. It is, thus, conceivable to imagine that immunologic disturbances not indemnified by the compensatory mechanisms are associated with reproductive failures during implantation and pregnancy. Initially, recurrent pregnancy loss (RPL) was attributed mostly to such maternal factors as anatomic abnormalities, endocrine dysfunction or chromosomal aberrations. Gradually during the last two decades, such opinion lost its validity and it became clear that these factors do not account for miscarriage in a large percentage of women suffering from RPL. It is now evident that about 95% of clinically lost embryos in RPL patients have a normal karyotype and a significant proportion of these abortions are associated with immune etiologies. In fact, a great number of immunological imbalances has been documented in which development of fetus and placenta is affected by maternal autoantibodies or autoreactive cells leading to infertility or RPL. Similarly, alloimmune rejection-type activity of maternal humoral or cellular immunity accounts for a great proportion of RPLs (6). Despite the undeniable impact of immune system in the course of pregnancy and great progresses that have been made over the recent years for documentation of immune etiology of a large percentage of RPL cases, most of the Iranian gynecologists still do not value reproductive immunology. This trend is also observed in Iranian scientific reproductive societies. Fortunately, global gynecologists’ attitude toward reproductive immunology is going to be overwhelmingly positive and this science has evolved from basic research experiments to clinical applications in most part of the world for management of RPL and repeated implantation failure (7). All in all, it is not imprudent to say that it is time to see recurrent pregnancy loss in the light of immunology. 059 61 Amir Hassan AH Zarnani امیرحسن زرنانی Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Iran zarnani@avicenna.ac.ir, zarnania@gmail.com No Keyword 640.pdf Boiers C, Carrelha J, Lutteropp M, Luc S, Green JC, Azzoni E, et al. Lymphomyeloid contribution of an immune-restricted progenitor emerging prior to definitive hematopoietic stem cells. Cell Stem Cell. 2013;13(5):535-48.##Robertson SA, Prins JR, Sharkey DJ, Moldenhauer LM. Seminal fluid and the generation of regulatory T cells for embryo implantation. Am J Reprod Immunol. 2013;69(4):315-30.##Orozco C, Perkins T, Clarke FM. Platelet-activating factor induces the expression of early pregnancy factor activity in female mice. J Reprod Fertil. 1986;78(2):549-55.##Chaouat G. Inflammation, NK cells and implantation: friend and foe (the good, the bad and the ugly?): replacing placental viviparity in an evolutionary perspective. J Reprod Immunol. 2013;97(1):2-13.##Erlebacher A. Immunology of the maternal-fetal interface. Annu Rev Immunol. 2013;31:387-411.##Varla-Leftherioti M. Recurrent pregnancy loss Causes, controversies and treatment. 2nd ed. New York: CRC press; 2015. Chapter 27, The Immunobiology of Recurrent Miscarriage; p. 233-48.##Kwak-Kim J, Han AR, Gilman-Sachs A, Fishel S, Leong M, Shoham Z. Current trends of reproductive immunology practices in in vitro fertilization (IVF) - a first world survey using IVF-Worldwide.com. Am J Reprod Immunol. 2013;69(1):12-20.##

Exploring the Human Seminal Plasma Proteome: An Unexplored Gold Mine of Biomarker for Male Infertility and Male Reproduction Disorder 2 1 618 2 Background: The human seminal fluid is a complex body fluid. It is not known how many proteins are expressed in the seminal plasma; however in analog with the blood it is possible up to 10,000 proteins are expressed in the seminal plasma. The human seminal fluid is a rich source of potential biomarkers for male infertility and reproduction disorder. Methods: In this review, the ongoing list of proteins identified from the human seminal fluid was collected. To date, 4188 redundant proteins of the seminal fluid are identified using different proteomics technology, including 2-DE, SDS-PAGE-LC-MS/MS, MudPIT. However, this was reduced to a database of 2168 non-redundant protein using UniProtKB/Swiss-Prot reviewed database. Results: The core concept of proteome were analyzed including pI, MW, Amino Acids, Chromosome and PTM distribution in the human seminal plasma proteome. Additionally, the biological process, molecular function and KEGG pathway were investigated using DAVID software. Finally, the biomarker identified in different male reproductive system disorder was investigated using proteomics platforms so far. Conclusion: In this study, an attempt was made to update the human seminal plasma proteome database. Our finding showed that human seminal plasma studies used to date seem to have converged on a set of proteins that are repeatedly identified in many studies and that represent only a small fraction of the entire human seminal plasma proteome. 061 72 Kambiz K Gilany کامبیز گیلانی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran k.gilany@avicenna.ac.ir Arash A Minai-Tehrani Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Iran Elham E Savadi-Shiraz Department of Urology, Pediatric Urology and Andrology, Section Molecular Andrology, Justus Liebig University Department of Urology, Pediatric Urology and Andrology, Section Molecular Andrology, Justus Liebig University Germany Hassan H Rezadoost Medicinal Plants and Drugs Research Institute, Shahid Beheshti University Medicinal Plants and Drugs Research Institute, Shahid Beheshti University Iran Niknam N Lakpour نیکنام لک‌پور Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran BiomarkerHuman seminal plasmaProteomeProteomics 618.pdf Brugh VM 3rd, Lipshultz LI. 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Proteomic analysis of seminal plasma from normal volunteers and post-vasectomy patients identifies over 2000 proteins and candidate biomarkers of the urogenital system. J Proteome Res. 2011;10(3):941-53.##Cross NL. Human seminal plasma prevents sperm from becoming acrosomally responsive to the agonist, progesterone: cholesterol is the major inhibitor. Biol Reprod. 1996;54(1):138-45.##Veveris-Lowe TL, Kruger SJ, Walsh T, Gardiner RA, Clements JA. Seminal fluid characterization for male fertility and prostate cancer: kallikrein-related serine proteases and whole proteome approaches. Semin Thromb Hemost. 2007;33(1):87-99.##Zylbersztejn DS, Andreoni C, Del Giudice PT, Spaine DM, Borsari L, Souza GH, et al. Proteomic analysis of seminal plasma in adolescents with and without varicocele. Fertil Steril. 2013;99(1):92-8.##Kagedan D, Lecker I, Batruch I, Smith C, Kaploun I, Lo K, et al. Characterization of the seminal plasma proteome in men with prostatitis by mass spectrometry. 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Development of narrow immobilized pH gradients covering one pH unit for human seminal plasma proteomic analysis. Proteomics. 2003;3(8):1611-9.##Fung KY, Glode LM, Green S, Duncan MW. A comprehensive characterization of the peptide and protein constituents of human seminal fluid. Prostate. 2004;61(2):171-81.##Kumar V, Hassan MI, Tomar AK, Kashav T, Nautiyal J, Singh S, et al. Proteomic analysis of heparin-binding proteins from human seminal plasma: a step towards identification of molecular markers of male fertility. J Biosci. 2009;34(6):899-908.##Poliakov A, Spilman M, Dokland T, Amling CL, Mobley JA. Structural heterogeneity and protein composition of exosome-like vesicles (prostasomes) in human semen. Prostate. 2009;69(2):159-67.##Thimon V, Frenette G, Saez F, Thabet M, Sullivan R. Protein composition of human epididymosomes collected during surgical vasectomy reversal: a proteomic and genomic approach. 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Lipopolysaccharide- and Lipoteichoic Acid-mediated Pro-inflammatory Cytokine Production and Modulation of TLR2, TLR4 and MyD88 Expression in Human Endometrial Cells 2 1 621 2 Background: Toll-like receptor (TLR)-mediated inflammatory processes are supposed to be involved in pathophysiology of spontaneous abortion and preterm labor. Here, we investigated functional responses of human endometrial stromal cells (ESCs) and whole endometrial cells (WECs) to lipopolysaccharide (LPS) and lipoteichoic acid (LTA). Methods: Endometrial tissues were obtained from 15 cycling women who underwent laparoscopic tubal ligation. Modulation of TLR2, TLR4 and MyD88 expression and pro-duction of pro-inflammatory cytokines by WECs and ESCs in response to LPS and LTA were assessed. Results: WECs and ESCs expressed significant levels of TLR4 and MyD88 transcripts but, unlike WECs, ESCs failed to express TLR2 gene. Regardless of positive results of Western blotting, ESCs did not express TLR4 at their surface as judged by flow cytometry. Immunofluorescent staining revealed intracellular localization of TLR4 with predominant perinuclear pattern. LPS stimulation marginally increased TLR4 gene ex-pression in both cell types, whereas such treatment significantly upregulated MyD88 gene expression after 8 hr (p<0.05). At the protein level, however, LPS activation significantly increased TLR4 expression by ESCs (p<0.05). LTA stimulation of WECs was accompanied with non-significant increase of TLR2 and MyD88 transcripts. LPS and LTA stimulation of WECs caused significant production of IL-6 and IL-8 in a dose-dependent manner (p<0.05). Similarly, ESCs produced significant amounts of IL-6, IL-8 and also TNF-α in response to LPS activation (p<0.05). Conclusion: Our results provided further evidence of initiation of inflammatory processes following endometrial TLR activation by bacterial components which could potentially be harmful to developing fetus. 072 82 Nesa N Rashidi Immunology Department, Faculty of Medicine, Tehran University of Medical Sciences Immunology Department, Faculty of Medicine, Tehran University of Medical Sciences Iran Mahroo M Mirahmadian Immunology Department, Faculty of Medicine, Tehran University of Medical Sciences Immunology Department, Faculty of Medicine, Tehran University of Medical Sciences Iran Mahmood M Jeddi-Tehrani محمود جدی‌تهرانی Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR Iran Simin S Rezania Biophysics Institute, Medical University of Graz Biophysics Institute, Medical University of Graz Austria Jamileh J Ghasemi جمیله قاسمی Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Iran Somaieh S Kazemnejad Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Ebrahim E Mirzadegan Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Iran Sedigheh S Vafaei Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Iran Maryam M Kashanian مریم کاشانیان Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Faculty of Medicine, Iran university of Medical Sciences Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Faculty of Medicine, Iran university of Medical Sciences Iran Zahra Z Rasoulzadeh Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences Iran Amir Hassan AH Zarnani امیرحسن زرنانی Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Iran zarnani@avicenna.ac.ir, zarnania@gmail.com CytokineEndometriumInflammationLPSLTAToll-like receptor 621.pdf Wira CR, Fahey JV, Sentman CL, Pioli PA, Shen L. 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Toll-like receptor 4 mediates the response of epithelial and stromal cells to lipopolysaccharide in the endometrium. PLoS One. 2010;5(9):e12906.##Tavakoli M, Jeddi-Tehrani M, Salek-Moghaddam A, Rajaei S, Mohammadzadeh A, Sheikhhasani S, et al. Effects of 1,25(OH)2 vitamin D3 on cytokine production by endometrial cells of women with recurrent spontaneous abortion. Fertil Steril. 2011;96(3):751-7.##Zarnani AH, Shahbazi M, Salek-Moghaddam A, Zareie M, Tavakoli M, Ghasemi J, et al. Vitamin D3 receptor is expressed in the endometrium of cycling mice throughout the estrous cycle. Fertil Steril. 2010;93(8):2738-43.##Shahbazi M, Jeddi-Tehrani M, Zareie M, Salek-Moghaddam A, Akhondi MM, Bahmanpoor M, et al. Expression profiling of vitamin D receptor in placenta, decidua and ovary of pregnant mice. Placenta. 2011;32(9):657-64.##Delbandi AA, Mahmoudi M, Shervin A, Akbari E, Jeddi-Tehrani M, Sankian M, et al. 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The localization of Toll-like receptor 2 (TLR2) in the endometrium and the cervix of dogs at different stages of the oestrous cycle and with pyometra. Reprod Domest Anim. 2012;47 Suppl 6:351-5.##Pioli PA, Amiel E, Schaefer TM, Connolly JE, Wira CR, Guyre PM. Differential expression of Toll-like receptors 2 and 4 in tissues of the human female reproductive tract. Infect Immun. 2004;72(10):5799-806.##Hornef MW, Normark BH, Vandewalle A, Normark S. Intracellular recognition of lipopolysaccharide by toll-like receptor 4 in intestinal epithelial cells. J Exp Med. 2003;198(8):1225-35.##Fahey JV, Schaefer TM, Channon JY, Wira CR. Secretion of cytokines and chemokines by polarized human epithelial cells from the female reproductive tract. Hum Reprod. 2005;20(6):1439-46.##Jacobsson B, Holst RM, Wennerholm UB, Andersson B, Lilja H, Hagberg H. Monocyte chemotactic protein-1 in cervical and amniotic fluid: relationship to microbial invasion of the amniotic cavity, intra-amniotic inflammation, and preterm delivery. Am J Obstet Gynecol. 2003;189(4):1161-7.##Matsuda Y, Kouno S, Nakano H. Effects of antibiotic treatment on the concentrations of interleukin-6 and interleukin-8 in cervicovaginal fluid. Fetal Diagn Ther. 2002;17(4):228-32.##Goepfert AR, Goldenberg RL, Andrews WW, Hauth JC, Mercer B, Iams J, et al. The Preterm Prediction Study: association between cervical interleukin 6 concentration and spontaneous preterm birth. Am J Obstet Gynecol. 2001;184(3):483-8.##Haider S, Knofler M. Human tumour necrosis factor: physiological and pathological roles in placenta and endometrium. Placenta. 2009;30(2):111-23.##Aboussahoud W, Aflatoonian R, Bruce C, Elliott S, Ward J, Newton S, et al. Expression and function of Toll-like receptors in human endometrial epithelial cell lines. J Reprod Immunol. 2010;84(1):41-51.##

Female Reproductive Hormones and Biomarkers of Oxidative Stress in Genital Chlamydia Infection in Tubal Factor Infertility 2 1 638 2 Background: Genital Chlamydia infection (GCI) and the associated pathologies have been implicated in tubal infertility. Though the actual pathologic mechanisms are still uncertain, oxidative stress and other factors have been implicated. The purpose of the study was to determine the possible contribution of female reproductive hormones and biomarkers of oxidative stress in genital Chlamydial infection to tubal occlusion. Methods: This prospective case control study was carried out by recruiting 150 age matched women grouped into infertile Chlamydia positive women (n=50), fertile Chlamydia positive women (n=50) and fertile Chlamydia negative women as controls (n=50). High vaginal swabs and endocervical swabs were collected for screening Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, Staphylococcus aureus, and Candida albicans. Sera were collected for estimation of Chlamydia trachomatis antibody, female reproductive hormones [Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Oestradiol (E2), Progesterone (P4), Prolactin (PRL)] and biomarkers of oxidative stress [Total Antioxidant Capacity (TAC) and 8-hydroxyl-2-deoxyguanosine (8-OHdG)] by enzyme immunoassay (EIA). Data were analyzed using chi square, analysis of variance and LSD Post hoc to determine mean differences at p=0.05. Results: Among women with GCI, higher levels of LH and 8-OHdG were observed in infertile Chlamydia positive women compared to fertile Chlamydia positive women (p<0.05). Higher levels of LH and 8-OHdG and lower TAC levels were observed in infertile Chlamydia positive women compared to fertile Chlamydia negative controls (p<0.05). Conclusion: Mechanisms including oxidative DNA damage and reduced antioxidant capacity may be involved in the pathology of Chlamydia induced tubal damage. 082 90 Augusta AC Nsonwu-Anyanwu Medical Lab., Science Department, College of Medical Sciences, University of Calabar Medical Lab., Science Department, College of Medical Sciences, University of Calabar Nigeria austadechic@yahoo.com Mabel MA Charles-Davies Department of Chemical Pathology, University of Ibadan Department of Chemical Pathology, University of Ibadan Nigeria Victor VO Taiwo Department of Veterinary Pathology, University of Ibadan Department of Veterinary Pathology, University of Ibadan Nigeria Bin B Li Unit of Molecular Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences Unit of Molecular Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences China Anthony AA Oni Department of Medical Microbiology & Parasitology, University of Ibadan Department of Medical Microbiology & Parasitology, University of Ibadan Nigeria Folashade FA Bello Department of Obstetrics and Gynaecology, University of Ibadan Department of Obstetrics and Gynaecology, University of Ibadan Nigeria Chlamydia trachomatisFemale infertilityHormoneOxidative stressTubal obstruction 638.pdf Hafner LM, Pelzer ES, editors. Tubal damage, infertility and tubal ectopic pregnancy: chlamydia trachomatis and other microbial aetiologies. Open access publisher: InTech; 2011. 13 p. (Kamrava M, editor. Ectopic Pregnancy-Modern Diagnosis and Management; vol. 2).##Den Hartog JE, Morre SA, Land JA. Chlamydia trachomatis associated tubal factor subfertility, immunogenetic factors and serological screening. Hum Reprod Update. 2006;12(6):719-30.##Horne AW, Stock SJ, King AE. Innate immunity and disorders of the female reproductive tract. Reproduction. 2008;135(6):739-49.##Agarwal T, Gupta R, Dutta R, Srivastava P, Bhengraj AR, Salhan S, et al. Protective or pathogenic immune response to genital chlamydial infection in women-A possible role of cytokine secretion profile of cervical mucosal cells. J Clin Immunol. 2009;130(3):347-54.##Beatty WL, Byrne GI, Morrison RP. Repeated and persistent infection with Chlamydia and the development of chronic inflammation and disease. 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Sex Transm Dis. 2006;33(3):137-42.##Abdul-Sater AA, Said-Sadier N, Lam VM, Singh B, Pettengill MA, Soares F, et al. Enhancement of reactive oxygen species production and chlamydial infection by the mitochondrial Nod-like family member NLRX1. J Biol Chem. 2010;285(53):41637-45.##Chandra A, Surti N, Kesavan Sh Agarwal A. Significance of oxidative stress in human reproduction. Arch Med Sci. 2009;5(1A):S28-S42.##Polak G, Koziol-Montewka M, Gogacz M, Blaszkowska I, Kotarski J. Total antioxidant status of peritoneal fluid in infertile women. Eur J Obstet Gynecol Reprod Biol. 2001;94(2):261-3.##Van Langendonckt A, Casanas-Roux F, Donnez J. Oxidative stress and peritoneal endometriosis. Fertil Steril. 2002;77(5):861-70.##Harma M, Harma M, Kocyigit A, Demir N. Role of plasma nitric oxide in complete hydatidiform mole. Eur J Gynaecol Oncol. 2004;25(3):333-5.##Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. 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Definition of "infertility". Fertil Steril. 2004;82 Suppl 1:S206.##National Collaborating Centre for Women’s and Children’s Health (UK). Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence: Guidance; 2004 Feb.##World Health Organization, Department of Reproductive Health and Research. Sexually transmitted and other reproductive tract infections: A guide to essential practice. Switzerland: WHO; 2005. 196 p.##Schachter J. Sexually transmitted chlamydia trachomatis infection: management of the most common venereal disease. Postgrad Med. 1982;72(4):60-2.##Evangelista AT, Beilstein HR. Laboratory diagnosis of gonorrhea. Washington DC: American Society for Microbiology; 1993. p. 78-89.##Ohlemeyer CL, Hornberger LL, Lynch DA, Swierkosz EM. Diagnosis of Trichomonas vaginalis in adolescent females: InPouch TV culture versus wet-mount microscopy. 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Stereological Analysis of Human Placenta in Cases of Placenta Previa in Comparison with Normally Implanted Controls 2 1 607 2 Background: placenta previa (PP) is an obstetric complication that can affect maternal and fetal morbidity and mortality. Its prevalence is rising due to cesarean sections. There is no quantitative data of placenta in PP. In this study, quantitative parameters of placenta in cases with PP in comparison with normally implanted controls were investigated. Methods: In this quasi experimental study, placentas from pregnancies with PP and normally implanted controls (n=10) were obtained from women who underwent cesarean section. Three full-thickness columns of each placenta were sampled using systematic uniform random sampling (SURS). Columns were cut into slices and slices were sectioned with 4 μm thickness. SURS selected sections were stained by Masson’s trichrome. Stereological analysis was done on 8-10 SURS microscopic fields of each section. Absolute volume and volume density of chorionic villi, intervillous space, syncytiotrophoblast, fibrin and blood vessels in chorionic villi were estimated in both groups. Statistical analysis was done using Mann Whitney-U test and significant level was set at p<0.05. Results: There was a significant reduction in total volume and volume density of fibrin deposits on the surface of chorionic villi (p<0.05), and a significant increment in total volume and volume density of chorionic villous blood vessels in PP group in comparison with C group (p<0.05). Conclusion: Results showed that impairment in situation of implantation in PP can cause significant changes in the structure of placenta. These changes probably can be influential on the evolution and survival of fetus. 090 96 Zahra Z Heidari Genetic of Non-communicable Diseases Research Center, Department of Histology, Faculty of Medicine, Zahedan University of Medical Sciences Genetic of Non-communicable Diseases Research Center, Department of Histology, Faculty of Medicine, Zahedan University of Medical Sciences Iran Nahid N Sakhavar Department of Obstetrics and Gynecology, Faculty of Medicine, Zahedan University of Medical Sciences Department of Obstetrics and Gynecology, Faculty of Medicine, Zahedan University of Medical Sciences Iran Hamidreza H Mahmoudzadeh-Sagheb Genetic of Non-communicable Diseases Research Center, Department of Histology, Faculty of Medicine, Zahedan University of Medical Sciences Genetic of Non-communicable Diseases Research Center, Department of Histology, Faculty of Medicine, Zahedan University of Medical Sciences Iran Tahmine T Ezazi-Bojnourdi Department of Obstetrics and Gynecology, Faculty of Medicine, Zahedan University of Medical Sciences Department of Obstetrics and Gynecology, Faculty of Medicine, Zahedan University of Medical Sciences Iran tahmine_ezazi@yahoo. com HistologyPlacenta previaPlacentaStereology 607.pdf Heidari Z, Mahmoudzadeh-Sagheb H, Zakeri Z, Nourzaei N. Stereological changes of human placenta in systemic lupus erythematosus compared with healthy controls. ZJRMS. 2013;15(7):50-4.##Zhang L, Wang Y, Liao AH. Quantitative abnormalities of fetal trophoblast cells in maternal circulation in preeclampsia. Prenat Diagn. 2008;28(12):1160-6.##Gilstrap III LC, Wenstrom KD, editors. Obstetrical Hemorrhage. New York: McGrow-Hill; 2010. 971 p. (Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, editor. Text book of Williams obstetrics; vol. 1).##Nyango DD, Mutihir JT, Kigbu JH. Risk factors for placenta praevia in Jos, north central Nigeria. Niger J Med. 2010;19(1):46-9.##Salihu HM, Li Q, Rouse DJ, Alexander GR. Placenta previa: neonatal death after live births in the United States. Am J Obstet Gynecol. 2003;188(5):1305-9.##Druzin ML. Packing of lower uterine segment for control of postcesarean bleeding in instances of placenta previa. Surg Gynecol Obstet. 1989;169(6):543-5.##Biswas R, Sawhney H, Dass R, Saran RK, Vasishta K. Histopathological study of placental bed biopsy in placenta previa. Acta Obstet Gynecol Scand. 1999;78(3):173-9.##Mayhew TM, Burton GJ. Stereology and its impact on our understanding of human placental functional morphology. Microsc Res Tech. 1997;38(1-2):195-205.##Gundersen HJ, Bendtsen TF, Korbo L, Marcussen N, Moller A, Nielsen K, et al. Some new, simple and efficient stereological methods and their use in pathological research and diagnosis. APMIS. 1988;96(5):379-94.##Weibel ER. Measuring through the microscope: development and evolution of stereological methods. J Microsc. 1989;155(Pt 3):393-403.##Heidari Z, Saberi EA, Mahmoudzadeh-Sagheb H, Farhad-Mollashahi N, Zadfatah F. Stereological analysis of the dental pulp in patients with advanced periodontitis. ZJRMS. 2013;15(7):44-9.##Heidari Z, Mahmoudzadeh-Sagheb H, Moudi B. A quantitative study of sodium tungstate protective effect on pancreatic beta cells in streptozotocin-induced diabetic rats. Micron. 2008;39(8):1300-5.##Mayhew TM. Placental stereology: spaning the levels from molecule to whole organ. Image Anal Stereol. 2009;28(3):121-7.##Mayhew TM. Thinning of the intervascular tissue layers of the human placenta is an adaptive response to passive diffusion in vivo and may help to predict the origins of fetal hypoxia. Eur J Obstet Gynecol Reprod Biol. 1998;81(1):101-9.##Ducray JF, Naicker T, Moodley J. Pilot study of comparative placental morphometry in preeclamptic and normotensive pregnancies suggests possible maladaptations of the fetal component of the placenta. Eur J Obstet Gynecol Reprod Biol. 2011;156(1):29-34.##Papinniemi M, Keski-Nisula L, Heinonen S. Placental ratio and risk of velamentous umbilical cord insertion are increased in women with placenta previa. Am J Perinatol. 2007;24(6):353-7.##Maly A, Goshen G, Sela J, Pinelis A, Stark M, Maly B. Histomorphometric study of placental villi vascular volume in toxemia and diabetes. Hum Pathol. 2005;36(10):1074-9.##Chaikitgosiyakul S, Rijken MJ, Muehlenbachs A, Lee SJ, Chaisri U, Viriyavejakul P, et al. A morphometric and histological study of placental malaria shows significant changes to villous architecture in both Plasmodium falciparum and Plasmodium vivax infection. Malar J. 2014;13:4.##Ishii T, Sawada K, Koyama S, Isobe A, Wakabayashi A, Takiuchi T, et al. Balloon tamponade during cesarean section is useful for severe post-partum hemorrhage due to placenta previa. J Obstet Gynaecol Res. 2012;38(1):102-7.##B-Lynch C, Keith L, Ladon A, Karoshi M. A Textbook of postpartum hemorrhage: A comprehensive guide to evaluation, management and surgical intervention. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2006. 67 p.##Hargitai B, Marton T, Cox PM. Best practice no 178. Examination of the human placenta. J Clin Pathol. 2004;57(8):785-92.##Sebire NJ, Backos M, Goldin RD, Regan L. Placental massive perivillous fibrin deposition associated with antiphospholipid antibody syndrome. BJOG. 2002;109(5):570-3.##Benirschke K, Kaufmann P. Pathology of the human placenta. 4th ed. New York: springer-verlag; 1999. 337 p.##Healthline networks [internet]. San Francisco: Healthline Networks; c 2005-2014. Asherman's Syndrome: Diagnosis, Treatment, and Prevention; 2014 Feb [cited 2014 May 15]; [1 screen]. Available from: http://www.healthline.com/health-blogs/fruit-womb/ashermans-syndrome-diagnosis-treatment-and-prevention#15.##Kanfer A, Bruch JF, Nguyen G, He CJ, Delarue F, Flahault A, et al. Increased placental antifibrinolytic potential and fibrin deposits in pregnancy-induced hypertension and preeclampsia. Lab Invest.1996;74(1):253-8.##The Foundation for Exxcellence in Women's Health Care [Internet]. Dallas: The Foundation for Exxcellence in Women's Health Care; c 2014. Etiology and Management of Placenta Accreta at 20 Weeks; 2011 Jul [cited 2014 May 15]; [1 screen]. Available from: http://www.exxcellence.org/pearls.php?id=35##Adam I, Haggaz AD, Mirghani OA, Elhassan EM. Placenta previa and pre-eclampsia: analyses of 1645 cases at medani maternity hospital, Sudan. Front Physiol. 2013;4:32.##

Effect of Administration of Single Dose GnRH Agonist in Luteal Phase on Outcome of ICSI-ET Cycles in Women with Previous History of IVF/ICSI Failure: A Randomized Controlled Trial 2 1 641 2 Background: GnRH agonist administration in the luteal phase has been suggested to beneficially affect the outcome of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles. This blind randomized controlled study evaluates the effect of GnRH (Gonadotropine Releasing Hormone) agonist administration on ICSI outcome in GnRH antagonist ovarian stimulation protocol in women with 2 or more previous IVF/ICSI-ET failures. Methods: One hundred IVF failure women who underwent ICSI cycles and stimulated with GnRH antagonist ovarian stimulation protocol, were included in the study. Women were randomly assigned to intervention (received a single dose injection of GnRH agonist (0.1 mg of Decapeptil) subcutaneously 6 days after oocyte retrieval) and control (did not receive GnRH agonist) groups. Implantation and clinical pregnancy rates were the primary outcome measures. Results: Although the age of women, the number of embryos transferred in the current cycle and the quality of the transferred embryos were similar in the two groups, there was a significantly higher rate of implantation (Mann Whitney test, p=0.041) and pregnancy (32.6% vs. 12.5%, p=0.030, OR=3.3, 95%CI, 1.08 to 10.4) in the intervention group. Conclusion: Our results suggested that, in addition to routine luteal phase support using progesterone, administration of 0.1 mg of Decapeptil 6 days after oocyte retrieval in women with previous history of 2 or more IVF/ICSI failures led to a significant improvement in implantation and pregnancy rates after ICSI following ovarian stimulation with GnRH antagonist protocol. 096 102 Simin S Zafardoust Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mahmood M Jeddi-Tehrani محمود جدی‌تهرانی Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Mehdi MM Akhondi محمدمهدی آخوندی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Iran Koorosh K Kamali Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Sara S Mokhtar Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Bita B Badehnoosh Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Farnaz F Fatemi فرناز فاطمی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Afsaneh A Mohammadzadeh افسانه محمدزاده Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran af85af@yahoo.com DecapeptilGnRH agonistGnRH antagonistICSIImplantation failureIntracytoplasmic sperm injectionIVF failureLuteal phase support 641.pdf Jindal UN, Verma S, editors. Luteal Phase Support. London-United Kingdom: Jaypee Brothers, Medical Publishers; 2013. 622 p. (Rao KA, Carp HJA, Fischer F. Textbook of In Vitro Fertilization; vol. 2).##Aflatoonian A, Asgharnia M, Alshohadaei FS. Comparison of progesterone administration before and after embryo transfer in ART cycles. J Reprod Infertil. 2004;5(1):44-51.##Smitz J, Devroey P, Camus M, Deschacht J, Khan I, Staessen C, et al. The luteal phase and early pregnancy after combined GnRH-agonist/HMG treatment for superovulation in IVF or GIFT. Hum Reprod. 1988;3(5):585-90.##Van Steirteghem AC, Smitz J, Camus M, Van Waesberghe L, Deschacht J, Khan I, et al. The luteal phase after in-vitro fertilization and related procedures. Hum Reprod. 1988;3(2):161-4.##Devroey P, Bourgain C, Macklon NS, Fauser BC. Reproductive biology and IVF: ovarian stimulation and endometrial receptivity. Trends Endocrinol Metab. 2004;15(2):84-90.##Garcia J, Jones GS, Acosta AA, Wright GL Jr. Corpus luteum function after follicle aspiration for oocyte retrieval. Fertil Steril. 1981;36(5):565-72.##Pritts EA, Atwood AK. Luteal phase support in infertility treatment: a meta-analysis of the randomized trials. Hum Reprod. 2002;17(9):2287-99.##van der Linden M, Buckingham K, Farquhar C, Kremer JA, Metwally M. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev. 2011;(10):CD009154.##Isik AZ, Caglar GS, Sozen E, Akarsu C, Tuncay G, Ozbicer T, et al. Single-dose GnRH agonist administration in the luteal phase of GnRH antagonist cycles: a prospective randomized study. Reprod Biomed Online. 2009;19(4):472-7.##Tesarik J, Hazout A, Mendoza-Tesarik R, Mendoza N, Mendoza C. Beneficial effect of luteal-phase GnRH agonist administration on embryo implantation after ICSI in both GnRH agonist- and antagonist-treated ovarian stimulation cycles. Hum Reprod. 2006;21(10):2572-9.##Oliveira JB, Baruffi R, Petersen CG, Mauri AL, Cavagna M, Franco JG Jr. Administration of single-dose GnRH agonist in the luteal phase in ICSI cycles: a meta-analysis. Reprod Biol Endocrinol. 2010;8:107.##Kyrou D, Kolibianakis EM, Fatemi HM, Tarlatzi TB, Devroey P, Tarlatzis BC. Increased live birth rates with GnRH agonist addition for luteal support in ICSI/IVF cycles: a systematic review and meta-analysis. Hum Reprod Update. 2011;17(6):734-40.##Razieh DF, Maryam AR, Nasim T. Beneficial effect of luteal-phase gonadotropin-releasing hormone agonist administration on implantation rate after intracytoplasmic sperm injection. Taiwan J Obstet Gynecol. 2009;48(3):245-8.##Sasaki K, Norwitz ER. Gonadotropin-releasing hormone/gonadotropin-releasing hormone receptor signaling in the placenta. Curr Opin Endocrinol Diabetes Obes. 2011;18(6):401-8.##Wu S, Wilson MD, Busby ER, Isaac ER, Sherwood NM. Disruption of the single copy gonadotropin-releasing hormone receptor in mice by gene trap: severe reduction of reproductive organs and functions in developing and adult mice. Endocrinology. 2010;151(3):1142-52.##Tesarik J, Greco E. The probability of abnormal preimplantation development can be predicted by a single static observation on pronuclear stage morphology. Hum Reprod. 1999;14(5):1318-23.##Balasch J, Martinez F, Jove I, Cabre L, Coroleu B, Barri PN, et al. Inadvertent gonadotrophin-releasing hormone agonist (GnRHa) administration in the luteal phase may improve fecundity in in-vitro fertilization patients. Hum Reprod. 1993;8(7):1148-51.##Elefant E, Biour B, Blumberg-Tick J, Roux C, Thomas F. Administration of a gonadotropin-releasing hormone agonist during pregnancy: follow-up of 28 pregnancies exposed to triptoreline. Fertil Steril. 1995;63(5):1111-3.##Uehara S, Sakahira H, Tamura M, Watanabe T, Yajima A. Normal outcome following administration of gonadotropin-releasing hormone (GnRH) agonist during early pregnancy. Congenit Anom. 1998;38(1):81-5.##Schroder AK, Katalinic A, Diedrich K, Ludwig M. Cumulative pregnancy rates and drop-out rates in a German IVF programme: 4102 cycles in 2130 patients. Reprod Biomed Online. 2004;8(5):600-6.##Petersen CG, Mauri AL, Baruffi RL, Oliveira JB, Massaro FC, Elder K, et al. Implantation failures: success of assisted hatching with quarter-laser zona thinning. Reprod Biomed Online. 2005;10(2):224-9.##

Comparison of Sexual Dysfunction in Women Using Depo-Medroxyprogesterone Acetate (DMPA) and Cyclofem 2 1 614 2 Background: Sexual affairs are one of the physiological needs affecting human health. Sexual functioning disorders can reduce individual’s capabilities and creativities. Sexual relations are in the center of women’s quality of life. The most important family planning is to prevent unintended pregnancies. Injectable contraceptives protect women exposed to many complications and mortality due to unintended pregnancies, with tolerable effects on other aspects of women’s life. An important aspect of women’s life is sexual health. This study aimed to compare sexual function of women using DMPA with women using Cyclofem presented to health centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran in 2013. Methods: This descriptive-comparative study was conducted on 240 women in health centers in Tehran, Iran. They were selected by multistage sampling. The data was collected using a questionnaire completed by interviewing. The questionnaire had 2 parts, demographic characteristic section and Female Sexual Function Index (FSFI). Data was analyzed by descriptive statistics, independent T-test, U-test, Chi-square, Fisher exact test. The p-value less than 0.05 were applied for all statistical tests as significance level. Results: The difference in sexual function between Cyclofem and DMPA groups was insignificant, but in terms of sexual desire in DMPA users better than and sexual pain them less than in Cyclofem users, the difference between the groups was significant (p<0.05). Conclusion: In introducing hormonal contraceptive methods, health workers should emphasize their adverse effects on sexual function. Women who use Cyclofem and DMPA should be aware that they may experience some changes in libido and sexual pain. 102 109 Giti G Ozgoli The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran Zohre Z Sheikhan The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran zsheikhan@Gmail.com Mahrokh M Dolatian ماهرخ دولتیان The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran Masumeh M Simbar معصومه سیمبر The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences The Research Centre for Safe Motherhood, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran Maryam M Bakhtyari Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences Iran Maliheh M Nasiri Department of Biostatics, Faculty of Paramedic, Shahid Beheshti University Department of Biostatics, Faculty of Paramedic, Shahid Beheshti University Iran CyclofemDMPASexual dysfunction 614.pdf Gonzalez M, Viafara G, Caba F, Molina E. Sexual function, menopause and hormone replacement therapy (HRT). Maturitas. 2004;48(4):411-20.##Korda JB. [Female sexual dysfunction]. Urologe A. 2008;47(1):77-89. German.##Oksuz E, Malhan S. Prevalence and risk factors for female sexual dysfunction in Turkish women. J Urol. 2006;175(2):654-8.##Ponholzer A, Roehlich M, Racz U, Temml C, Madersbacher S. Female sexual dysfunction in a healthy Austrian cohort: prevalence and risk factors. Eur Urol. 2005;47(3):366-74.##Panzer C, Wise S, Fantini G, Kang D, Munarriz R, Guay A, et al. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med. 2006;3(1):104-13.##Foroutan SK, Jadid Milani M. Prevalence of sexual dysfunction in patients referred to the Family Justice Center. Daneshvar J. 2008;16(78):39-44.##Nik-Azin A, Nainian MR, Zamani M, Bavojdan MR, Bavojdan MR, Motlagh MJ. Evaluation of sexual function, quality of life, and mental and physical health in pregnant women. J Family Reprod Health. 2013;7(4):171-6.##Bolhari J, Ramezanzadeh F, Abedininia N, Naghizadeh MM, Pahlavani H, Saberi M. The survey of divorce incidence in divorce applicants in Tehran. J Family Reprod Health. 2012;6(3):129-37.##Ojanlatva A, Makinen J, Helenius H, Korkeila K, Sundell J, Rautava P. Sexual activity and perceived health among Finnish middle-aged women. Health Qual Life Outcomes. 2006;4:29.##Biddle AK, West SL, D'Aloisio AA, Wheeler SB, Borisov NN, Thorp J. Hypoactive sexual desire disorder in postmenopausal women: quality of life and health burden. Value Health. 2009;12(5):763-72.##Sitruk-Ware R, Nath A, Mishell DR Jr. Contraception technology: past, present and future. Contraception. 2013;87(3):319-30.##Morroni C, Myer L, Moss M, Hoffman M. Preferences between injectable contraceptive methods among South African women. Contraception. 2006;73(6):598-601.##Canto de Cetina TE, Luna MO, Cetina Canto JA, Bassol S. Menstrual pattern and lipid profiles during use of medroxyprogesterone acetate and estradiol cypionate and NET-EN (200 mg) as contraceptive injections. Contraception. 2004;69(2):115-9.##Nathirojanakun P, Taneepanichskul S, Sappakitkumjorn N. Efficacy of a selective COX-2 inhibitor for controlling irregular uterine bleeding in DMPA users. Contraception. 2006;73(6):584-7.##Guazzelli CA, Jacobucci MS, Barbieri M, Araujo FF, Moron AF. Monthly injectable contraceptive use by adolescents in Brazil: evaluation of clinical aspects. Contraception. 2007;76(1):45-8.##Bortolotti de Mello Jacobucci MS, Guazzelli CA, Barbieri M, Araujo FF, Moron AF. Bleeding patterns of adolescents using a combination contraceptive injection for 1 year. Contraception. 2006;73(6):594-7.##Berek JS. Berek & Novak’s Gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; c2012. Chapter 11, Sexuality, sexual dysfunction and sexual assault; p. 270-305.##Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Schootman M, Peipert JF, Cottler LB, et al. Type of contraception method used at last intercourse and associations with health risk behaviors among US adolescents. Contraception. 2010;82(6):549-55.##Ruminjo JK, Sekadde-Kigondu CB, Karanja JG, Rivera R, Nasution M, Nutley T. Comparative acceptability of combined and progestin-only injectable contraceptives in Kenya. Contraception. 2005;72(2):138-45.##Wallwiener M, Wallwiener LM, Seeger H, Mueck AO, Zipfel S, Bitzer J, et al. Effects of sex hormones in oral contraceptives on the female sexual function score: a study in German female medical students. Contraception. 2010;82(2):155-9.##Davis AR, Castano PM. Oral contraceptives and libido in women. Annu Rev Sex Res. 2004;15:297-320.##Witting K, Santtila P, Jern P, Varjonen M, Wager I, Hoglund M, et al. Evaluation of the female sexual function index in a population based sample from Finland. Arch Sex Behav. 2008;37(6):912-24.##Schaffir J. Hormonal contraception and sexual desire: a critical review. J Sex Marital Ther. 2006;32(4):305-14.##Sanders SA, Graham CA, Bass JL, Bancroft J. A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation. Contraception. 2001;64(1):51-8.##Sabatini R, Cagiano R. Comparison profiles of cycle control, side effects and sexual satisfaction of three hormonal contraceptives. Contraception. 2006;74(3):220-3.##Hubacher D, Lopez L, Steiner MJ, Dorflinger L. Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons. Contraception. 2009;80(2):113-8.##Gold MA, Bachrach LK. Contraceptive use in teens: a threat to bone health? J Adolesc Health. 2004;35(6):427-9.##Schaffir JA, Isley MM, Woodward M. Oral contraceptives vs injectable progestin in their effect on sexual behavior. Am J Obstet Gynecol. 2010;203(6):545.e1-5.##Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208.##Hussein M, Mahran DG, Farouk OA, El-Assal MA, Fathallah MM, Romih MS. Bone mineral density in women of a low socioeconomic level using DMPA for contraception in rural Upper Egypt. Int J Gynaecol Obstet. 2010;110(1):31-4.##Clayton AH. Sexual function and dysfunction in women. Psychiatr Clin North Am. 2003;26(3):673-82.##Nijland EA, Weijmar Schultz WC, Nathorst-Boos J, Helmond FA, Van Lunsen RH, Palacios S, et al. Tibolone and transdermal E2/NETA for the treatment of female sexual dysfunction in naturally menopausal women: results of a randomized active-controlled trial. J Sex Med. 2008;5(3):646-56.##van Lunsen RH, Laan E. Genital vascular responsiveness and sexual feelings in midlife women: psychophysiologic, brain, and genital imaging studies. Menopause. 2004;11(6 Pt 2):741-8.##Modelska K, Litwack S, Ewing SK, Yaffe K. Endogenous estrogen levels affect sexual function in elderly post-menopausal women. Maturitas. 2004;49(2):124-33.##Barrientos JE, Paez D. Psychosocial variables of sexual satisfaction in Chile. J Sex Marital Ther. 2006;32(5):351-68.##Auslander BA, Rosenthal SL, Fortenberry JD, Biro FM, Bernstein DI, Zimet GD. Predictors of sexual satisfaction in an adolescent and college population. J Pediatr Adolesc Gynecol. 2007;20(1):25-8.##Asghari Roodsari A, Khademi A, Akbari D, Hamed E, Tabatabaiifar SL, Alleyassin A. Female sexual dysfunction in married medical students. Mcgill J Med. 2005;8(2):104-8.##Wiebe ER, Brotto LA, MacKay J. Characteristics of women who experience mood and sexual side effects with use of hormonal contraception. J Obstet Gynaecol Can. 2011;33(12):1234-40.##Basson R. Sexual desire and arousal disorders in women. N Engl J Med. 2006;354(14):1497-506.##Aladag N, Filiz M, Topsever P, Apaydin P, Gorpelioglu S. Satisfaction among women: differences between current users of barrier (male condom) and non-barrier methods. Eur J Contracept Reprod Health Care. 2006;11(2):81-8.##

An Association Study between INSR/NsiI (rs2059806) and INSR/PmlI (rs1799817) SNPs in Women with Polycystic Ovary Syndrome from West Azerbaijan Province, Iran 2 1 623 2 Background: It has been demonstrated that insulin signaling pathway related genes have important roles in polycystic ovary syndrome (PCOS) risk. The goal of present investigation was to assess the potential association between INSR/NsiI (rs2059806) and INSR/PmlI (rs1799817) SNPs and PCOS. Methods: 50 women with PCOS and 47 normal controls entered the study. NsiI and PmlI SNPs in the INSR gene were determined by RFLP-PCR. Results: INSR/NsiI (rs2059806) SNP GG, GA, AA, G and A genotypic and allelic frequencies were 45(90%), 5(10%), 0(0%), 95(95%) and 5(5%) in cases and 41(87.2%), 6(12.8%), 0(0%), 88(93.6%) and 6(6.38%) in controls, respectively. INSR/PmlI (rs1799817) SNPs resulted in three genotypes of CC, CT, and TT with C and T alleles. The frequencies of PmlI (rs1799817) SNPs in the INSR gene were 37(37%) and 63(63%) in cases, also 39(41.49%) and 55 (58.51%) in controls regarding T and C alleles. The frequencies of PmlI (rs1799817) SNPs in the INSR gene were 4(8%), 29(58%), and 17(34%) in cases, also 5(10.64%), 29(61.7%), and 13(27.66%) in controls regarding TT, TC, and CC genotypes, respectively. Conclusion: The present study as the first investigation of its own kind in Iranian Azeri Turkish women, reported no association between NsiI (rs2059806) and PmlI (rs1799817) SNPs in the INSR gene and PCOS risk. 109 113 Morteza M Bagheri Food and Beverages Safety Research Center, Urmia University of Medical Sciences Food and Beverages Safety Research Center, Urmia University of Medical Sciences Iran Isa I Abdi-Rad Food and Beverages Safety Research Center, Urmia University of Medical Sciences Food and Beverages Safety Research Center, Urmia University of Medical Sciences Iran isaabdirad@yahoo.com Nima N Hosseini-Jazani Food and Beverages Safety Research Center, Urmia University of Medical Sciences Food and Beverages Safety Research Center, Urmia University of Medical Sciences Iran Rasoul R Zarrin Food and Beverages Safety Research Center, Urmia University of Medical Sciences Food and Beverages Safety Research Center, Urmia University of Medical Sciences Iran Fariba F Nanbakhsh Reproductive Health Research Center, Department of Obstetrics and Gynecology, Urmia University of Medical Sciences Reproductive Health Research Center, Department of Obstetrics and Gynecology, Urmia University of Medical Sciences Iran Nauman N Mohammadzaie Cellular and Molecular Research Center, Urmia University of Medical Sciences Cellular and Molecular Research Center, Urmia University of Medical Sciences Iran Insulin/geneticsPolycystic ovary syndromePolymorphismReceptor 623.pdf Ranjzad F, Mahmoudi T, Irani Shemirani A, Mahban A, Nikzamir A, Vahedi M, et al. A common variant in the adiponectin gene and polycystic ovary syndrome risk. Mol Biol Rep. 2012;39(3):2313-9.##Mukherjee S, Shaikh N, Khavale S, Shinde G, Meherji P, Shah N, et al. Genetic variation in exon 17 of INSR is associated with insulin resistance and hyperandrogenemia among lean Indian women with polycystic ovary syndrome. Eur J Endocrinol. 2009;160(5):855-62.##Talbot JA, Bicknell EJ, Rajkhowa M, Krook A, O'Rahilly S, Clayton RN. Molecular scanning of the insulin receptor gene in women with polycystic ovarian syndrome. J Clin Endocrinol Metab. 1996;81(5):1979-83.##Chen ZJ, Shi YH, Zhao YR, Li Y, Tang R, Zhao LX, et al. [Correlation between single nucleotide polymorphism of insulin receptor gene with polycystic ovary syndrome]. Zhonghua Fu Chan Ke Za Zhi. 2004;39(9):582-5. Chinese.##Chen ZJ, Zhao H, He L, Shi Y, Qin Y, Shi Y, et al. Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16.3, 2p21 and 9q33.3. Nat Genet. 2011;43(1):55-9.##Lee EJ, Yoo KJ, Kim SJ, Lee SH, Cha KY, Baek KH. Single nucleotide polymorphism in exon 17 of the insulin receptor gene is not associated with polycystic ovary syndrome in a Korean population. Fertil Steril. 2006;86(2):380-4.##Jin L, Zhu XM, Luo Q, Qian Y, Jin F, Huang HF. A novel SNP at exon 17 of INSR is associated with decreased insulin sensitivity in Chinese women with PCOS. Mol Hum Reprod. 2006;12(3):151-5.##Siegel S, Futterweit W, Davies TF, Concepcion ES, Greenberg DA, Villanueva R, et al. A C/T single nucleotide polymorphism at the tyrosine kinase domain of the insulin receptor gene is associated with polycystic ovary syndrome. Fertil Steril. 2002;78(6):1240-3.##Xu X, Zhao H, Shi Y, You L, Bian Y, Zhao Y, et al. Family association study between INSR gene polymorphisms and PCOS in Han Chinese. Reprod Biol Endocrinol. 2011;9:76.##Ranjzad F, Mahban A, Shemirani AI, Mahmoudi T, Vahedi M, Nikzamir A, et al. Influence of gene variants related to calcium homeostasis on biochemical parameters of women with polycystic ovary syndrome. J Assist Reprod Genet. 2011;28(3):225-32.##Taylor SI, Kadowaki T, Kadowaki H, Accili D, Cama A, McKeon C. Mutations in insulin-receptor gene in insulin-resistant patients. Diabetes Care. 1990;13(3):257-79.##Dunaif A, Scott D, Finegood D, Quintana B, Whitcomb R. The insulin-sensitizing agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endocrinol Metab. 1996;81(9):3299-306.##Ott J, Wattar L, Kurz C, Seemann R, Huber JC, Mayerhofer K, et al. Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study. Eur J Endocrinol. 2012;166(5):897-902.##Farmakiotis D, Katsikis I, Panidis D. Calcium homeostasis and anovulatory infertility. Hum Reprod. 2007;22(12):3264.##Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.##Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Boston: Blackwell Scientific Publications; 1992. 377 p.##Miller SA, Dykes DD, Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res. 1988;16(3):1215.##Sagodi L, Kiss-Toth E, Barkai L. [Role of genetic and environmental factors in the development of polycystic ovary syndrome]. Orv Hetil. 2013;154(17):650-7. Hungarian.##Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774-800.##Stepto NK, Cassar S, Joham AE, Hutchison SK, Harrison CL, Goldstein RF, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod. 2013;28(3):777-84.##Barber TM, Franks S. The link between polycystic ovary syndrome and both Type 1 and Type 2 diabetes mellitus: what do we know today? Womens Health (Lond Engl). 2012;8(2):147-54.##Nestler JE. Role of hyperinsulinemia in the pathogenesis of the polycystic ovary syndrome, and its clinical implications. Semin Reprod Endocrinol. 1997;15(2):111-22.##Carmina E. Ovarian and adrenal hyperandrogenism. Ann N Y Acad Sci. 2006;1092:130-7.##Markopoulos MC, Rizos D, Valsamakis G, Deligeoroglou E, Grigoriou O, Chrousos GP, et al. Hyperandrogenism in women with polycystic ovary syndrome persists after menopause. J Clin Endocrinol Metab. 2011;96(3):623-31.##Sirmans SM, Weidman-Evans E, Everton V, Thompson D. Polycystic ovary syndrome and chronic inflammation: pharmacotherapeutic implications. Ann Pharmacother. 2012;46(3):403-18.##Schmidt J, Landin-Wilhelmsen K, Brannstrom M, Dahlgren E. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metab. 2011;96(12):3794-803.##Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol (Oxf). 2000;52(5):595-600.##Bentley-Lewis R, Seely E, Dunaif A. Ovarian hypertension: polycystic ovary syndrome. Endocrinol Metab Clin North Am. 2011;40(2):433-49.##Usadi RS, Legro RS. Reproductive impact of polycystic ovary syndrome. Curr Opin Endocrinol Diabetes Obes. 2012;19(6):505-11.##Bhattacharya SM. Insulin resistance and overweight-obese women with polycystic ovary syndrome. Gynecol Endocrinol. 2010;26(5):344-7.##Ramezani Tehrani F, Daneshpour M, Hashemi S, Zarkesh M, Azizi F. Relationship between polymorphism of insulin receptor gene, and adiponectin gene with PCOS. Iran J Reprod Med. 2013;11(3):185-94.##Unsal T, Konac E, Yesilkaya E, Yilmaz A, Bideci A, Ilke Onen H, et al. Genetic polymorphisms of FSHR, CYP17, CYP1A1, CAPN10, INSR, SERPINE1 genes in adolescent girls with polycystic ovary syndrome. J Assist Reprod Genet. 2009;26(4):205-16.##Urbanek M, Sam S, Legro RS, Dunaif A. Identification of a polycystic ovary syndrome susceptibility variant in fibrillin-3 and association with a metabolic phenotype. J Clin Endocrinol Metab. 2007;92(11):4191-8.##

Posterior Urethral Valve: An Unusual Cause of Primary Male Infertility 2 1 616 2 Background: Posterior urethral valve presenting in adulthood is uncommon. This can be an unusual cause of primary male infertility as a result of abnormalities in sexual function. Case Presentation: This report describes a 40 year old man who presented to us on account of inability to impregnate his wife after 2 years of marriage. History revealed poor stream of urine since childhood and passage of scanty ejaculate during intercourse. A micturating cystourethrogram revealed dilated posterior urethra in keeping with posterior urethral valves. Endoscopic valve ablation was done with subsequent improvement in ejaculate volume and urine stream. His spouse achieved pregnancy thereafter. Conclusion: In this report, it was found that adult posterior urethral valve though uncommon may be a cause of male infertility. Restoration of fertility potential can be achieved following valve ablation. 113 116 Jude JO Agbugui Department of Surgery, University of Benin Teaching Hospital Department of Surgery, University of Benin Teaching Hospital Nigeria orumuah@yahoo.com Oisamoren O Omokhudu Department of Surgery, University of Benin Teaching Hospital Department of Surgery, University of Benin Teaching Hospital Nigeria Male infertilityPosterior urethral valvesRetained ejaculate 616.pdf Krishnan A, de Souza A, Konijeti R, Baskin LS. The anatomy and embryology of posterior urethral valves. J Urol. 2006;175(4):1214-20.##Warren J, Pike JG, Leonard MP. Posterior urethral valves in Eastern Ontario - a 30 year perspective. Can J Urol. 2004;11(2):2210-5.##Atwell JD. Posterior urethral valves in the British Isles: a multicenter B.A.P.S. review. J Pediatr Surg. 1983;18(1):70-4.##Schober JM, Dulabon LM, Woodhouse CR. Outcome of valve ablation in late-presenting posterior urethral valves. BJU Int. 2004;94(4):616-9.##Maranya GA. Posterior urethral valves in the adult: report of two cases. East Afr Med J. 2004;81(8):430-2.##Culty T, Delongchamps NB, Dominique S, Servin F, Ravery V, Boccon-Gibod L. Posterior urethral valves in adult with Down syndrome. Urology. 2006;67(2):424.e1-424.e2.##Opsomer RJ, Wese FX, Dardenne AN, Van Cangh PJ. Posterior urethral valves in adult males. Urology. 1990;36(1):35-7.##Ikuerowo SO, Balogun BO, Akintomide TE, Ikuerowo AO, Akinola RA, Gbelee HO, et al. Clinical and radiological characteristics of Nigerian boys with posterior urethral valves. Pediatr Surg Int. 2008;24(7):825-9.##Ahmed A, Bello A, Mbibu NH, Maitama HY, Kalayi GD. Epidemiological and aetiological factors of male infertility in northern Nigeria. Niger J Clin Pract. 2010;13(2):205-9.##

A Successful Healthy Childbirth in a Case of Total Globozoospermia with Oocyte Activation by Calcium Ionophore 2 1 636 2 Background: Globozoospermia is a rare (incidence of 0.1% among andrological patients) and poorly understood condition, but a severe disorder in male infertility. This case report detailed the course of treatment and protocol of a patient with type 1 globozoospermia using Intracytoplasmic Sperm Injection (ICSI) and oocyte activation by calcium ionophore, which yielded conception and birth of a healthy baby after six previous unsuccessful attempts, using ICSI alone. Case Presentation: A 39-year-old male with normal findings on routine examination presented to TDV 29 Mayis Hospital, Assisted Reproduction Unit (ART) with his 37-year-old wife. Her examination was also within normal limits and ovulatory cycle was regular. The male’s diagnostic screening revealed normal karyotype (46, XY) and no Y-microdeletion. However, the spermogram was abnormal; sperm count of 14 million/ml with 35% active motility and 100% morphologically abnormal sperm, indicating globozoospermia. Ovarian stimulation was provided using classic long down-regulation protocol and 13 MII oocytes were collected. Next, calcium ionophore was applied following the ICSI procedure to improve the chances for fertilization. The case report compared quantitative procedural and diagnostic screening data, and fertilization rates. On day 5, two grade 1 blastcysts out of 5 embryos were transferred, yielding positive beta-human chorionic gonadotropin (beta hCG), and ultimately a healthy delivery. Conclusion: ICSI with assisted oocyte activation by calcium ionophore may overcome male infertility where there is total globozoospermia. 116 121 Nilay N Karaca TDV 29 Mayis Hospital, Department of Assisted Reproduction TDV 29 Mayis Hospital, Department of Assisted Reproduction Turkey karacanilay@hotmail.com Yasam YK Akpak Ankara Mevki Military Hospital, Department of Obstetrics and Gynecology Ankara Mevki Military Hospital, Department of Obstetrics and Gynecology Turkey Serkan S Oral LIV Hospital, Department of Assisted Reproduction LIV Hospital, Department of Assisted Reproduction Turkey Tugce T Durmus TDV 29 Mayis Hospital, Department of Assisted Reproduction TDV 29 Mayis Hospital, Department of Assisted Reproduction Turkey Rabiye R Yilmaz TDV 29 Mayis Hospital, Department of Assisted Reproduction TDV 29 Mayis Hospital, Department of Assisted Reproduction Turkey Calcium ionophoreGlobozoospermiaIntracytoplasmic sperm injection (ICSI)Morphologically abnormal sperm 636.pdf Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J, et al. 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