Unmet Needs of Adolescent and Young People’s Sexual and Reproductive Health in Iran 2 1 653 2 More than one fourth of the total population in Iran are young people aged 10-24 (1). On the one hand, strong cultural and religious values surround sexuality before marriage and on the other hand, shifts towards greater interaction between young men and women are occurring in response to the spread of education among females, the postponement of marriage, and outside influences (2-4). Although illegal, satellite is widely accessible (5, 6). Spread of social networks and communication technology has been fast among young people. Even sexuality is reflected openly in some rap music which is illegally accessible among adolescents and young people. Despite the recognition that such social and communication changes make the interchange of information including those with sexual content easier and faster among people, facilitate interpersonal communication and relationships and in fact provide greater opportunity for premarital liaisons and sex, there is still no comprehensive policy and program that target unmarried youth to address values, abstinence as well as safe sex in this country. One important reason can be denial of premarital sex (7). It might be claimed that sex is supposed to be confined within marriage in Iran and premarital mandatory courses have been designed to youth who intend to marry. The answer is that, evidence shows that despite normative inappropriateness (8), and legal and religious prohibition, a significant minority of females and relatively greater proportion of young men, do not wait until marriage to initiate sex (9). Due to the fact there is no supportive services, sexually active youth are exposed to social and medical risks associated with premarital sex (such as STIs, HIV, unwanted pregnancy, unsafe abortion, violence, and suicide). Hence, these premarital counseling programs, only target youth who postpone sex until after marriage. How about the rest of young people? For any reason, whether they should be overlooked? In fact, in contrary to huge social pressure on young people for premarital sex, no formal education has been designed for them. Stigma on communication about sexuality (7), strong taboo and gender double standard in sexuality before marriage, make these outcomes unrecognized. Even most parents and teachers hesitate to communicate with young people about consequences of premarital sex, protection against risk before they get involved in such relations. One may claim that youth are not aware of sexuality and should not be communicated on sexuality issues until they marry. The answer is that today’s young people are in fact different from last generation. They are aware of sexuality, but their information and knowledge are not detailed and they have a lot of misperceptions and myths (10) because they received their information mainly from their peers and unreliable sources which are detached from values. Recent rise of sexual transmission of HIV has led to some degree of realization of the significance of addressing safe sex for young people in schools to protect them against HIV/AIDS. However, it focuses mainly on unsafe injection, not much of unsafe sex and safe sex. Addressing protection by condom is still difficult for unmarried young people in Iran. Most parents even do not know whether they should talk with their teenager or not, what topics do they need to address, when do they need to start and how? They lack the knowledge and the skills to do so. Teachers are also ill-prepared and lack information and skills. One significant barrier is the fear that such programs might have negative influences on young people. Robust scientific evidence approved positive outcome of such programs. They improved awareness of risk and knowledge of risk reduction strategies, increased self-effectiveness and intention to practice safer sex, and delayed the onset of sexual activity (11). In a systematic literature review conducted in 2005, Douglas Kirby analyzed 83 studies of curriculum based programs that were published in 1990 or later, employed experimental or quasi-experimental design, and had sample sizes of 100 or more, and he found that 72 percent of programs in developing countries had positive impacts on changing behavior (12). To achieve a healthy population, we need to have a healthy young generation who drive the development in the country. Hence, we need to invest now on adolescent sexual and reproductive health. The consequences of such ignorance would have devastating effects on young generation now and in coming decades. The school setting can be an appropriate place for such programs because of access to huge number of young people and their parents. These programs should be age appropriate, culturally sensitive, and bounded with values and cultural norms, and comprehensive. These programs need to address values surrounding relationships, protection, risks of STIs and HIV and pregnancy as well as physiology and anatomy. 121 123 Farideh F Khalajabadi-Farahani Department of Population, Health and Family Planning, National Institute for Population Research Department of Population, Health and Family Planning, National Institute for Population Research Iran faridehfarahani2@gmail.com No Keyword 653.pdf Statistical Centre of Iran [Internet]. Tehran: Statistical Centre of Iran; 2011 [cited 2015 may 25]; [about 2 screens]. available from: http://www.amar.org.ir/Default.aspx?tabid=1228##Asadi A. [Assessment of relationships between female and male college students in universities of Ardebil city]. J Ardabil Univ Med Sci. 2006;6(2):113-14. Persian.##Movahhed M, Abbasi Shavazi MT. [Association between socialisation and girls' attitudes towards traditional and modern values on premarital hetreosexual relationships]. J Womens Study. 2006;1:67-99. Persian.##Movahhed M, Abbasi Shavazi MT, Hashemi Nia Z. [Gender heterogeniety, and attitude towards premarital heterosexual relationships in universities]. Women's Strategic Studies (Majale Motaleaat -e Raahbordi Zanan). 2009. p. 44. Persian.##Mohammad K, Farahani FK, Mohammadi MR, Alikhani S, Zare M, Tehrani FR, et al. Sexual risk-taking behaviors among boys aged 15-18 years in Tehran. J Adolesc Health. 2007;41(4):407-14.##Khalajabadi Farahani F, Kazempiour S, Rahimi A. [The effect of premarital hetersosexual relationships on marriage age and marital propensity among college students in Tehran]. J Fam Study. 2011;9(11):7-28. Persian.##Latifnejad Roudsari R, Javadnoori M, Hasanpour M, Hazavehei SM, Taghipour A. Socio-cultural challenges to sexual health education for female adolescents in Iran. Iran J Reprod Med. 2013;11(2):101-10.##Khalajabadi Farahani F, Cleland J. Perceived norms of premarital heterosexual relationships and sexuality among female college students in Tehran. Cult Health Sex. 2015;17(6):700-17.##Khalajabadi Farahani F. A meta analysis of sexuality before marriage among young people in Iran. Tehran: National Institute for Population Studies Tehran; 2015. 60 p.##Tavoosi A, Zaferani A, Enzevaei A, Tajik P, Ahmadinezhad Z. Knowledge and attitude towards HIV/AIDS among Iranian students. BMC Public Health. 2004;4:17.##Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, et al. Sexual behaviour in context: a global perspective. Lancet. 2006;368(9548):1706-28.##Kirby D, Laris BA, Rolleri L. Sex and HIV education programs for youth: their impact and important characteristics. USA: ETR Associates; 2006. 77 p.##

Impact of Inflammation on Male Reproductive Tract 2 1 631 2 Fertility in the male is dependent on the proper production of sperm cells. This process, called spermatogenesis is very complex and involves the synchronization of numerous factors. The presence of pro–inflammatory cytokines, tumor necrosis factor-alpha (TNF–α), interleukin–1 alpha (IL–1 α) and interleukin 1 beta (IL–1 β) cytokines in the male reproductive tract (testis, epididymis and sperm) may have certain physiological functions. However, when the levels of these cytokines are higher than normal, as seen in conditions of inflammation, they become very harmful to sperm production. Moreover, inflammation is also associated with oxidative stress and the latter is well known to impair sperm function. Epidemiological studies regarding male infertility have revealed that more and more infertile men suffer from acute or chronic inflammation of the genitourinary tract, which often occurs without any symptoms. The inflammatory reactions within the male genital tract are inevitably connected with oxidative stress. Oxidative stress, especially in sperm, is harmful because it damages sperm DNA and causes apoptosis in sperm. This article reviewed the suggested mechanisms and contribution of inflammation to male infertility. In addition, the review was further strengthened by discussing how inflammation affects both fertility and assisted reproductive technologies (ART). 123 130 Alfred A Azenabor Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Idi-Araba Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Idi-Araba Nigeria Ayodele AO Ekun Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Idi-Araba Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Idi-Araba Nigeria Oluyemi O Akinloye Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Idi-Araba Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Idi-Araba Nigeria oakinloye@unilag.ng.edu, oluyemiakinloye@hotmail.com CytokinesFertilityInfertilityInflammationSpermatogenesis 631.pdf Song N, Liu J, An S, Nishino T, Hishikawa Y, Koji T. Immunohistochemical Analysis of Histone H3 Modifications in Germ Cells during Mouse Spermatogenesis. Acta Histochem Cytochem. 2011;44(4):183-90.##Sharlip ID, Jarow JP, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. Fertil Steril. 2002;77(5):873-82.##Belsey MA. The epidemiology of infertility: a review with particular reference to sub-Saharan Africa. Bull World Health Organ. 1976;54(3):319-41.##Chukudebelu WO, Esege N, Megafu U. Etiological factors in infertility in Enugu, Nigeria. Infertility. 1979;2(2):193-200.##Nwofor AME, Ugezu AI. The difficulties encountered in the management of male infertility in Nnewi, Nigeria. Niger Med J. 2003;45(1):56-9.##Ikechebelu JI, Adinma JI, Orie EF, Ikegwuonu SO. High prevalence of male infertility in southeastern Nigeria. J Obstet Gynaecol. 2003;23(6):657-9.##Poongothai J, Gopenath TS, Manonayaki S. Genetics of human male infertility. Singapore Med J. 2009;50(4):336-47.##World Health Organisation. WHO Laboratory manual for the examination of human semen-cervical mucus interaction. 4th ed. Cambridge: Cambridge University Press; 1999. p. 1-86.##Akinloye O, Arowojolu AO, Shittu OB, Anetor JI. Cadmium toxicity: a possible cause of male infertility in Nigeria. Reprod Biol. 2006;6(1):17-30.##Akinloye O, Akintunde CO, Banjoko SO, Adaramoye AO, Adeleye AO. An assessment of the oestrogenic effect of soyprotein on female rabbits. Food Chem. 2002;77(1):67-9.##Akinloye O, Arowojolu AO, Shittu OB, Adejuwon CA, Osotimehin B. Selenium status of idiopathic infertile Nigerian males. Biol Trace Elem Res. 2005;104(1):9-18.##Akinloye O, Gromoll J, Callies C, Nieschlag E, Simoni M. Mutation analysis of the X-chromosome linked, testis-specific TAF7L gene in spermatogenic failure. Andrologia. 2007;39(5):190-5.##Akinloye O, Gromoll J, Nieschlag E, Simoni M. Androgen receptor gene CAG and GGN polymorphisms in infertile Nigerian men. J Endocrinol Invest. 2009;32(10):797-804.##Choudhury SR, Knapp LA. Human reproductive failure I: immunological factors. Hum Reprod Update. 2001;7(2):113-34.##Oladokun A, Arulogun O, Oladokun R, Morhason-Bello IO, Bamgboye EA, Adewole IF, et al. Acceptability of child adoption as management option for infertility in Nigeria: evidence from focus group discussions. Afr J Reprod Health. 2009;13(1):79-91.##Dhont N, van de Wijgert J, Luchters S, Muvunyi C, Vyankandondera J, Temmerman M. Sexual violence, HSV-2 and HIV are important predictors for infertility in Rwanda. Hum Reprod. 2010;25(10):2507-15.##Dohle GR, Smit M, Weber RF. Androgens and male fertility. World J Urol. 2003;21(5):341-5.##Mitchell RN, Cotran RS, editors. Acute and chronic inflammation. Philadelphia: Saunders Press; 2003. 33 p. (Kumar V, Cotran RS, Robbins SL, editors. Robbins Basic Pathology; vol. 127).##DePalma AF, Rothman RH, Lewinnek GE, Canale ST. Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet. 1972;134(5):755-8.##Purvis K, Christiansen E. Infection in the male reproductive tract. Impact, diagnosis and treatment in relation to male infertility. Int J Androl. 1993;16(1):1-13.##Comhaire FH, Mahmoud AM, Depuydt CE, Zalata AA, Christophe AB. Mechanisms and effects of male genital tract infection on sperm quality and fertilizing potential: the andrologist's viewpoint. Hum Reprod Update. 1999;5(5):393-8.##Hales DB, Diemer T, Hales KH. Role of cytokines in testicular function. Endocrine. 1999;10(3):201-17.##Soder O, Sultana T, Jonsson C, Wahlgren A, Petersen C, Holst M. The interleukin-1 system in the testis. Andrologia. 2000;32(1):52-5.##Diemer T, Hales DB, Weidner W. Immune endocrine interactions and Leydig cell function: the role of cytokines. Andrologia. 2003;35(1):55-63.##Maegawa M, Kamada M, Irahara M, Yamamoto S, Yoshikawa S, Kasai Y, et al. A repertoire of cytokines in human seminal plasma. J Reprod Immunol. 2002;54(1-2):33-42.##Cudicini C, Lejeune H, Gomez E, Bosmans E, Ballet F, Saez J, et al. Human Leydig cells and Sertoli cells are producers of interleukins-1 and -6. J Clin Endocrinol Metab. 1997;82(5):1426-33.##Male D, Brostoff J, Roth DB, Roit I. Mechanism of innate immunity in Immunology. 7th ed. Canada: Elsevier; 2006. 127 p.##Keck C, Gerber-Schafer C, Clad A, Wilhelm C, Breckwoldt M. Seminal tract infections: impact on male fertility and treatment options. Hum Reprod Update. 1998;4(6):891-903.##Potts JM, Sharma R, Pasqualotto F, Nelson D, Hall G, Agarwal A. Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia. J Urol. 2000;163(6):1775-8.##Warren JS, Johnson KJ, Ward PA. Oxygen radicals in cell injury and cell death. Pathol Immunopathol Res. 1987;6(5-6):301-15.##Agarwal A, Saleh RA, Bedaiwy MA. Role of reactive oxygen species in the pathophysiology of human reproduction. Fertil Steril. 2003;79(4):829-43.##Sharma RK, Said T, Agarwal A. Sperm DNA damage and its clinical relevance in assessing reproductive outcome. Asian J Androl. 2004;6(2):139-48.##Sikka SC. Relative impact of oxidative stress on male reproductive function. Curr Med Chem. 2001;8(7):851-62.##Naz RK, Evans L. Presence and modulation of interleukin-12 in seminal plasma of fertile and infertile men. J Androl. 1998;19(3):302-7.##Gruschwitz MS, Brezinschek R, Brezinschek HP. Cytokine levels in the seminal plasma of infertile males. J Androl. 1996;17(2):158-63.##Sanocka D, Jedrzejczak P, Szumała-Kaekol A, Fraczek M, Kurpisz M. Male genital tract inflammation: the role of selected interleukins in regulation of pro-oxidant and antioxidant enzymatic substances in seminal plasma. J Androl. 2003;24(3):448-55.##Kocak I, Yenisey C, Dundar M, Okyay P, Serter M. Relationship between seminal plasma interleukin-6 and tumor necrosis factor alpha levels with semen parameters in fertile and infertile men. Urol Res. 2002;30(4):263-7.##Shimoya K, Matsuzaki N, Tsutsui T, Taniguchi T, Saji F, Tanizawa O. Detection of interleukin-8 (IL-8) in seminal plasma and elevated IL-8 in seminal plasma of infertile patients with leukospermia. Fertil Steril. 1993;59(4):885-8.##Depuydt CE, Bosmans E, Zalata A, Schoonjans F, Comhaire FH. The relation between reactive oxygen species and cytokines in andrological patients with or without male accessory gland infection. J Androl. 1996;17(6):699-707.##Wolff H, Politch JA, Martinez A, Haimovici F, Hill JA, Anderson DJ. Leukocytospermia is associated with poor semen quality. Fertil Steril. 1990;53(3):528-36.##Thomas J, Fishel SB, Hall JA, Green S, Newton TA, Thornton SJ. Increased polymorphonuclear granulocytes in seminal plasma in relation to sperm morphology. Hum Reprod. 1997;12(11):2418-21.##Close CE, Roberts PL, Berger RE. Cigarettes, alcohol and marijuana are related to pyospermia in infertile men. J Urol. 1990;144(4):900-3.##Blackwell JM, Zaneveld LJ. Effect of abstinence on sperm acrosin, hypoosmotic swelling, and other semen variables. Fertil Steril. 1992;58(4):798-802.##Eggert-Kruse W, Kiefer I, Beck C, Demirakca T, Strowitzki T. Role for tumor necrosis factor alpha (TNF-alpha) and interleukin 1-beta (IL-1beta) determination in seminal plasma during infertility investigation. Fertil Steril. 2007;87(4):810-23.##Agarwal A, Nallella KP, Allamaneni SS, Said TM. Role of antioxidants in treatment of male infertility: an overview of the literature. Reprod Biomed Online. 2004;8(6):616-27.##Gharagozloo P, Aitken RJ. The role of sperm oxidative stress in male infertility and the significance of oral antioxidant therapy. Hum Reprod. 2011;26(7):1628-40.##Akinloye O, Abbiyesuku FM, Oguntibeju OO, Arowojolu AO, Truter EJ. The impact of blood and seminal plasma zinc and copper concentrations on spermogram and hormonal changes in infertile Nigerian men. Reprod Biol. 2011;11(2):83-98.##Sies H. Oxidative stress: oxidants and antioxidants. Exp Physiol. 1997;82(2):291-5.##Nakabeppu Y, Sakumi K, Sakamoto K, Tsuchimoto D, Tsuzuki T, Nakatsu Y. Mutagenesis and carcinogenesis caused by the oxidation of nucleic acids. Biol Chem. 2006;387(4):373-9.##Valko M, Leibfritz D, Moncol J, Cronin MT, Mazur M, Telser J. Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol. 2007;39(1):44-84.##Stadtman ER. Protein oxidation and aging. Science. 1992;257(5074):1220-4.##Twigg J, Fulton N, Gomez E, Irvine DS, Aitken RJ. Analysis of the impact of intracellular reactive oxygen species generation on the structural and functional integrity of human spermatozoa: lipid peroxidation, DNA fragmentation and effectiveness of antioxidants. Hum Reprod. 1998;13(6):1429-36.##Aitken RJ, Baker MA, Sawyer D. Oxidative stress in the male germ line and its role in the aetiology of male infertility and genetic disease. Reprod Biomed Online. 2003;7(1):65-70.##Agarwal A, Said TM. Role of sperm chromatin abnormalities and DNA damage in male infertility. Hum Reprod Update. 2003;9(4):331-45.##Sikka SC. Role of oxidative stress and antioxidants in andrology and assisted reproductive technology. J Androl. 2004;25(1):5-18.##Agarwal A, Sekhon LH. The role of antioxidant therapy in the treatment of male infertility. Hum Fertil (Camb). 2010;13(4):217-25.##Ursini F, Heim S, Kiess M, Maurine M, Roveri A, Wissing J, et al. Dual function of the selenoprotein PHGPx during sperm maturation. Science. 1999;285(5432):1393-6.##Kodama H, Yamaguchi R, Fukuda J, Kasai H, Tanaka T. Increased oxidative deoxyribonucleic acid damage in the spermatozoa of infertile male patients. Fertil Steril. 1997;68(3):519-24.##Carrell DT, Wilcox AL, Lowy L, Peterson CM, Jones KP, Erickson L, et al. Elevated sperm chromosome aneuploidy and apoptosis in patients with unexplained recurrent pregnancy loss. Obstet Gynecol. 2003;101(6):1229-35.##Steele EK, McClure N, Maxwell RJ, Lewis SE. A comparison of DNA damage in testicular and proximal epididymal spermatozoa in obstructive azoospermia. Mol Hum Reprod. 1999;5(9):831-5.##

Embryo Donation in Iranian Legal System: A Critical Review 2 1 622 2 Recent developments and newly-discovered methods for infertility treatment including in vitro fertilization and third party reproduction raise many questions and challenges with different ethical, legal, sociological and psychological dimensions. In Islamic countries, despite great developments in using this technology, the questions concerned with recognition of IVF methods and third party reproduction and legalization of this method are still the challenging ones. The approach of a few Shiite clerics to this issue has facilitated the legalisation of infertility treatment in Iran. The Iranian Parliament, with reference to Shiite clerics’ opinions (Fatwa), enacted the Act concerning Embryo Donation to Infertile Couples and its bylaw which can be considered as a successful example of legalization of third party reproduction in an Islamic country. The aforementioned Act permits embryo donation through artificial insemination from legally married couples to infertile couples. However, many of the legal aspects of this event are not specified in this Act and in many cases it added several uncertainties. This uncertainty, especially regarding the rights and duties of recipients and the child, causes important problems which generate more concerns. This article aimed to review the advantages and flaws of the Act. It is believed that the enactment of the aforementioned Act is an important step but an insufficient measure in this field. Important issues have been left unanswered and unclear in this Act which should be considered by legislators in any future revision of it. 130 138 Zohreh Z Behjati Ardakani Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Taghi MT Karoubi Department of law, Science and Culture University Department of law, Science and Culture University Iran Ali Reza A Milanifar Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Roudabeh R Masrouri Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Mehdi MM Akhondi محمدمهدی آخوندی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran akhondi@avicenna.ac.ir Embryo donationInfertility treatmentIslamic lawlegislationThird party reproduction 622.pdf Edwards RG, editor. The Beginnings of Human in vitro Fertilization. United Kingdom: forma Healthcare; 2009. Xvii p. (Gardner DK, Weissman A, Howles CH, Shoham Z, editors. Textbook of Assisted Reproduction Technologies; Introduction).##Akhondi MA, Behjati Ardakani Z, Arefi S, editors. [Natural fertilization, In Vitro fertilization and the importance of third party reproduction in infertility treatment]. Tehran: Avicenna Research Institute & SAMT Publications; 2006. 9 p. (Group authors, editor. Essays on gamete and embryo donation in infertility treatment; vol. 1). Persian.##Patki A, Saxena SG, Parikh FR, editors. Oocyte Donation. New Delhi: Jaypee Brothes Medical Publishers (P) Ltd; 2004. 382 p. (Rao KA, Brinsden PR, Sathananthan AH, editors. The infertility manual; vol. 38).##Lindheim SR, Sauer MV. Embryo donation: a programmed approach. Fertil Steril. 1999;72(5):940-1.##Khodaparast AH, Sharifi S, Milanifar AR, Behjati Ardakani Z. The moral problem of embryo donation. J Reprod Infertil. 2011;12(2):131-43.##Vayena E, Rowe PJ, Griffin P. Current practices and controversies in assisted reproduction: Report of a WHO meeting on medical, ethical and social aspects of assisted reproduction. Geneva: World Health Organization; 2002. 404 p.##Brazier M. Regulating the reproduction business? Med Law Rev. 1999;7(2):166-93.##Doi AR. Sharia: The Islamic law. 1st ed. London: Taha Publishers; 1984. p. 21-2.##Ramadan S. Islamic law: Its scope and equity. 1st ed. London: Macmillan; 1970. 42 p.##Austin RWJ, editor. The prophet of Islam. London: Islamic Council of Europe; 1978. 68 p. (Gauhar A, editor. The challenge of Islam; vol. 3).##Wesinck AJ. The importance of tradition for the study of Islam. Muslim World. 2007;11(3);239-45.##Khomeini SR. [Tahrir Alvasileh]. Qom: DAROLELM Publication; 2000. 621 p. Persian.##Islamic Parliament Research Center [Internet]. Tehran: Islamic Parliament Research Center. [The act concerning embryo donation to infertile couples]; 2003 July 20 [cited 2014 Jul 16]; [about 1 screen]. Available from: http://rc.majlis.ir/fa/law/show/93943. Persian.##Islamic Parliament Research Center [Internet]. Tehran: Islamic Parliament Research Center. [The bylaw for the act concerning embryo donation to infertile couples (hereinafter bylaw) adopted by Council of Ministers]; 2005 Mar 9 [cited 2014 Jul 16]; [about 1 screen]. Available from: http://rc.majlis.ir/fa/law/show/125235. Persian.##Golpayegani SMR. [Majma Almasael]. Qom: Darolqoran Alkarim Institute; 1993. p. 490-6. Persian.##Makarem Shirazi N. [Esteftaat Jadid]. Qom: Madrese Ali Ebne Abitaleb Publication; 2002. 608 p. Persian.##Safi Golpayegani L. [Jame Alahkam]. Qom: The office for publication of Ayatollah Safi Golpayegani’s works; 2003. 51 p. Persian.##Khamenei SA. [Resale Ojoube Alesteftaat]. 3rd ed. Tehran: HODA Publication; 2003. 282 p. Persian.##Yazdi M. [Artificial fertilization and its jurisprudential status]. Feghhe Ahle Beit. 1996:5(6);105. Persian.##Bojnordi SM. [Esteftaat and opinions]. Rahnemoun Magazine. 1992:2-3;225. Persian.##Milanifar AR, Shahbazi MH, Akhondi MM, Behjati Ardakani Z, editors. [Addressing court permission subject of the article 2 of the Act of legal aspects of Embryo Donation to the infertile couple]. Tehran: Avicenna Research Institute & SAMT Publications; 2006. 251 p. (Group authors, editor. Essays on gamete and embryo donation in infertility treatment; vol. 16). Persian.##Serour GI. Islamic perspectives in human reproduction. Reprod Biomed Online. 2008;17 Suppl 3:34-8.##Sadeghi Moghaddam MH. [The Iranian law of "How to grant embryo to infertile spouses": A view from Islamic law]. NAMEH-YE-MOFID. 2005:10(6);31-60. Persian.##American Society for Reproductive Medicine. Appendix A: minimal genetic screening for gamete donors. Fertil Steril. 2004;82 Suppl 1:S22-3.##Frith L. Gamete donation and anonymity: the ethical and legal debate. Hum Reprod. 2001;16(5):818-24.##Ramezan Zadeh F, Jafar Abadi M, editors. [Indications for gamete and embryo donation]. Tehran: Avicenna Research Institute & SAMT Publications; 2006. 77 p. (Group authors, editor. Essays on gamete and embryo donation in infertility treatment; vol. 3). Persian.##Safaiee SH. [Failures of IRI "Embryo Donation Act" based on a comparative study]. Payesh. 2007:6(4); 323-9. Persian.##Emamhadi MA, editor. [Hard-to-cure diseases and incurable diseases: medical and legal issues]. Tehran: Avicenna Research Institute & SAMT Publications; 2006. 53 p. (Group authors, editor. Essays on gamete and embryo donation in infertility treatment; vol. 3). Persian.##Gheblei Kh. [A study on the inheritance of children born through donor gamete (Sperm, ovum, or both)]. Payesh. 2007:6(4);365-71. Persian.##

Ultrastructural and Morphalogical Changes of Mouse Ovarian Tissues Following Direct Cover Vitrification with Different Cryoprotectants 2 1 619 2 Background: Cryopreservation of mammalian ovaries has been reported with different levels of success. Cryopreservation of ovarian tissue may be a potential alternative for treatment of infertility and many attempts have been done to improve the efficiency of ovarian cryopreservation. The objective of the present study was to compare the direct cover vitrification (DCV) with ethylene glycol (EG), dimethyl sulfoxide (DMSO) and EG plus DMSO. Methods: Eighty five mice were sacrificed by cervical dislocation and their ovaries were cryopreserved in the presence of 5% EG or DMSO alone or as mixture, 10% EG or DMSO alone or as mixture and a group with ascending concentrations of cryoprotectants. After toxicity testing and vitrification warming, the ovaries were fixed for histological and ultrastructural studies. In addition, the viability of mechanically isolated follicles was studied by trypan blue staining. All data were compared by ANOVA (p<0.05). Results: Ovarian tissues frozen in EG plus DMSO in ascending concentrations retained a higher percentage of morphologically normal and or viable follicles than tissues frozen in 10 M EG plus DMSO or in either concentration of EG and DMSO alone (p<0.001). Ultrastructural analysis of ovarian tissues frozen in ascending concentrations of EG plus DMSO showed that these follicles were well preserved and it was very similar to the control group. Conclusion: Cryopreservation of ovarian tissue in EG plus DMSO is the most effective method for preserving the structural integrity of follicles within the ovary. 138 148 Maryam M Ghavami Department of Anatomical Sciences, Tabriz University of Medical Sciences Department of Anatomical Sciences, Tabriz University of Medical Sciences Iran Daryoush D Mohammadnejad Drug Applied Research Center, Tabriz University of Medical Science Drug Applied Research Center, Tabriz University of Medical Science Iran Rahim R Beheshti Department of Veterinary, Shabestar Branch, Islamic Azad University Department of Veterinary, Shabestar Branch, Islamic Azad University Iran Jafar J Solmani-rad Department of Anatomical Sciences, Tabriz University of Medical Sciences Department of Anatomical Sciences, Tabriz University of Medical Sciences Iran Ali A Abedelahi Department of Anatomical Sciences, Tabriz University of Medical Sciences Department of Anatomical Sciences, Tabriz University of Medical Sciences Iran abedelahia@yahoo.com CryopreservationDirect cover vitrificationOvarian tissue 619.pdf Kuleshova LL, Lopata A. Vitrification can be more favorable than slow cooling. Fertil Steril. 2002;78(3):449-54.##Courbiere B, Odagescu V, Baudot A, Massardier J, Mazoyer C, Salle B, et al. Cryopreservation of the ovary by vitrification as an alternative to slow-cooling protocols. Fertil Steril. 2006;86(4 Suppl):1243-51.##Li YB, Zhou CQ, Yang GF, Wang Q, Dong Y. Modified vitrification method for cryopreservation of human ovarian tissues. Chin Med J. 2007;120(2):110-4.##Hani T, Tachibe T, Shingai S, Kamada N, Ueda O, Jishage K. Fertility of mice receiving vitrified adult mouse ovaries. Reproduction. 2006;131(4):681-7.##Hasegawa A, Mochida N, Ogasawara T, Koyama K. Pup birth from mouse oocytes in preantral follicles derived from vitrified and warmed ovaries followed by in vitro growth, in vitro maturation, and in vitro fertilization. Fertil Steril. 2006;86(4 Suppl):1182-92.##Newton H, Illingworth P. In-vitro growth of murine pre-antral follicles after isolation from cryopreserved ovarian tissue. Hum Reprod. 2001;16(3):423-9.##Xu M, Banc A, Woodruff TK, Shea LD. Secondary follicle growth and oocyte maturation by culture in alginate hydrogel following cryopreservation of the ovary or individual follicles. Biotechnol Bioeng. 2009;103(2):378-86.##Abdollahi M, Salehnia M, Salehpour S, Ghorbanmehr N. Human ovarian tissue vitrification/warming has minor effect on the expression of apoptosis-related genes. Iran Biomed J. 2013;17(4):179-86.##Salehnia M, Abbasian Moghadam E, Rezazadeh Velojerdi M. Ultrastructure of follicles after vitrification of mouse ovarian tissue. Fertil Steril. 2002;78(3):644-5.##Choi WJ, Yeo HJ, Shin JK, Lee SA, Lee JH, Paik WY. Effect of vitrification method on survivability, follicular growth and ovulation of preantral follicles in mice. J Obstet Gynaecol Res. 2007;33(2):128-33.##Boonkusol D, Faisaikarm T, Dinnyes A, Kitiyanant Y. Effects of vitrification procedures on subsequent development and ultrastructure of in vitro-matured swamp buffalo (Bubalus bubalis) oocytes. Reprod Fertil Dev. 2007;19(2):383-91.##Vajta G, Holm P, Kuwayama M, Booth PJ, Jacobsen H, Greve T, et al. Open Pulled Straw (OPS) vitrification: a new way to reduce cryoinjuries of bovine ova and embryos. Mol Reprod Dev. 1998;51(1):53-8.##Wani NA, Maurya SN, Misra AK, Saxena VB, Lakhchaura BD. Effect of cryoprotectants and their concentration on in vitro development of vitrified-warmed immature oocytes in buffalo (Bubalus bubalis). Theriogenology. 2004;61(5):831-42.##Schiewe MC, Rall WF, Stuart LD, Wildt DE. Analysis of cryoprotectant, cooling rate and in situ dilution using conventional freezing or vitrification for cryopreserving sheep embryos. Theriogenology. 1991;36(2):279-93.##Isachenko E, Isachenko V, Rahimi G, Nawroth F. Cryopreservation of human ovarian tissue by direct plunging into liquid nitrogen. Eur J Obstet Gynecol Reprod Biol. 2003;108(2):186-93.##Chen SU, Chien CL, Wu MY, Chen TH, Lai SM, Lin CW, et al. Novel direct cover vitrification for cryopreservation of ovarian tissues increases follicle viability and pregnancy capability in mice. Hum Reprod. 2006;21(11):2794-800.##Huang LS, Tan SQ, Qu QH. [Morphology and celluar proliferation of follicles from cryopreserved human ovarian tissues]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2010;41(2):261-4. Chinese.##Tan X, Song E, Liu X, Liu G, Cheng H, Wan F. Successful vitrification of mouse ovaries using less-concentrated cryoprotectants with Supercool X-1000 supplementation. In Vitro Cell Dev Biol Anim. 2012;48(2):69-74.##Abedelahi A, Salehnia M, Abdolamir A, Hajizadeh E. Comparison of ultrastructure and morphology of mouse ovarian follicles after conventional and direct cover vitrification using different concentrations of ethylene glycol. Iran J Reprod Med. 2009;7(2):45-52.##Abedelahi A, Salehnia M, Allameh AA, Davoodi D. Sodium selenite improves the in vitro follicular development by reducing the reactive oxygen species level and increasing the total antioxidant capacity and glutathione peroxide activity. Hum Reprod. 2010;25(4):977-85.##Fathi R, Valojerdi MR, Salehnia M. Effects of different cryoprotectant combinations on primordial follicle survivability and apoptosis incidence after vitrification of whole rat ovary. Cryo Letters. 2013;34(3):228-38.##Sheikhi M, Hultenby K, Niklasson B, Lundqvist M, Hovatta O. Preservation of human ovarian follicles within tissue frozen by vitrification in a xeno-free closed system using only ethylene glycol as a permeating cryoprotectant. Fertil Steril. 2013;100(1):170-7.##Faheem MS, Carvalhais I, Baron E, Moreira da Silva F. Effect of bovine ovarian tissue vitrification on the structural preservation of antral follicles. Reprod Domest Anim. 2013;48(5):774-80.##Nagano M, Atabay EP, Atabay EC, Hishinuma M, Katagiri S, Takahashi Y. Effects of isolation method and pre-treatment with ethylene glycol or raffinose before vitrification on in vitro viability of mouse preantral follicles. Biomed Res. 2007;28(3):153-60.##Isachenko V, Isachenko E, Rahimi G, Krivokharchenko A, Alabart JL, Nawroth F. Cryopreservation of human ovarian tissue by direct plunging into liquid nitrogen: negative effect of disaccharides in vitrification solution. Cryo Letters. 2002;23(5):333-44.##Chi HJ, Koo JJ, Kim MY, Joo JY, Chang SS, Chung KS. Cryopreservation of human embryos using ethylene glycol in controlled slow freezing. Hum Reprod. 2002;17(8):2146-51.##Rodrigues AP, Amorim CA, Costa SH, Matos MH, Santos RR, Lucci CM, et al. Cryopreservation of caprine ovarian tissue using glycerol and ethylene glycol. Theriogenology. 2004;61(6):1009-24.##Santos RR, Rodrigues AP, Costa SH, Silva JR, Matos MH, Lucci CM, et al. Histological and ultrastructural analysis of cryopreserved sheep preantral follicles. Anim Reprod Sci. 2006;91(3-4):249-63.##Celestino JJ, dos Santos RR, Lopes CA, Martins FS, Matos MH, Melo MA, et al. Preservation of bovine preantral follicle viability and ultra-structure after cooling and freezing of ovarian tissue. Anim Reprod Sci. 2008;108(3-4):309-18.##Yamada C, Caetano HV, Simoes R, Nicacio AC, Feitosa WB, Assumpcao ME, et al. Immature bovine oocyte cryopreservation: comparison of different associations with ethylene glycol, glycerol and dimethylsulfoxide. Anim Reprod Sci. 2007;99(3-4):384-8.##Begin I, Bhatia B, Baldassarre H, Dinnyes A, Keefer CL. Cryopreservation of goat oocytes and in vivo derived 2- to 4-cell embryos using the cryoloop (CLV) and solid-surface vitrification (SSV) methods. Theriogenology. 2003;59(8):1839-50.##Abedelahi A, Salehnia M, Allameh AA. The effects of different concentrations of sodium selenite on the in vitro maturation of preantral follicles in serum-free and serum supplemented media. J Assist Reprod Genet. 2008;25(9-10):483-8.##Choi J, Lee JY, Lee E, Yoon BK, Bae D, Choi D. Cryopreservation of the mouse ovary inhibits the onset of primordial follicle development. Cryobiology. 2007;54(1):55-62.##Kim SS, Yang HW, Kang HG, Lee HH, Lee HC, Ko DS, et al. Quantitative assessment of ischemic tissue damage in ovarian cortical tissue with or without antioxidant (ascorbic acid) treatment. Fertil Steril. 2004;82(3):679-85.##Cecconi S, Capacchietti G, Russo V, Berardinelli P, Mattioli M, Barboni B. In vitro growth of preantral follicles isolated from cryopreserved ovine ovarian tissue. Biol Reprod. 2004;70(1):12-7.##Luz VB, Santos RR, Pinto LC, Soares AA, Celestino JJ, Mafezoli J, et al. Dimethyl sulfoxide perfusion in caprine ovarian tissue and its relationship with follicular viability after cryopreservation. Fertil Steril. 2009;91(4 Suppl):1513-5.##Rho GJ, Kim S, Yoo JG, Balasubramanian S, Lee HJ, Choe SY. Microtubulin configuration and mitochondrial distribution after ultra-rapid cooling of bovine oocytes. Mol Reprod Dev. 2002;63(4):464-70.##Van Blerkom J. Microtubule mediation of cytoplasmic and nuclear maturation during the early stages of resumed meiosis in cultured mouse oocytes. Proc Natl Acad Sci U S A. 1991;88(11):5031-5.##Liu L, Hammar K, Smith PJ, Inoue S, Keefe DL. Mitochondrial modulation of calcium signaling at the initiation of development. Cell Calcium. 2001;30(6):423-33.##

ART Outcomes in GnRH Antagonist Protocol (Flexible) and Long GnRH Agonist Protocol during Early Follicular Phase in Patients with Polycystic Ovary Syndrome: A Randomized Clinical Trial 2 1 645 2 Background: Since increased LH in the early follicular phase in PCOS patients especially in GnRH antagonist protocol could be associated with reduced oocyte quality and pregnancy and impared implantation. The current study was conducted to determine ART outcomes in GnRH antagonist protocol (flexible) and long GnRH agonist protocol and compare them with adding GnRH antagonist in GnRH antagonist (flexible) protocol during early follicular phase in patients with polycystic ovary syndrome undergoing ICSI. Methods: In this randomized clinical trial, 150 patients with polycystic ovary syndrome undergoing ICSI were enrolled from 2012 to 2014 and randomly assigned to receive either GnRH antagonist protocol during early and late follicular phase or GnRH antagonist protocol (flexible) or long GnRH agonist protocol. The clinical and laboratory pregnancy in three groups was determined and compared. In this context, the chi-square and Fisher's exact test and ANOVA were used for data analysis. Statistical significance was defined as p<0.05. Results: There was no statistically significant difference with respect to chemical pregnancy and clinical pregnancy between the three groups. Also, other indices such as number and quality of oocytes and embryos were alike. Conclusion: Totally, according to our results, GnRH antagonist protocol during early and late follicular phase and GnRH antagonist protocol (flexible) and long GnRH agonist protocol in patients with polycystic ovary syndrome undergoing ICSI are similarly effective and use of each one based on patients’ condition and physicians’ opinion could be considered. 148 155 Sara S Mokhtar Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Mehdi MM Akhondi محمدمهدی آخوندی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Simin S Zafardoust 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 Fattane F Nazari Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology 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 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 ARTGnRH agonistGnRH antagonistInfertilityPCOS 645.pdf Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333(13):853-61.##Sheehan MT. Polycystic ovarian syndrome: diagnosis and management. Clin Med Res. 2004;2(1):13-27.##Homburg R, Berkowitz D, Levy T, Feldberg D, Ashkenazi J, Ben-Rafael Z. In vitro fertilization and embryo transfer for the treatment of infertility associated with polycystic ovary syndrome. Fertil Steril. 1993;60(5):858-63.##Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008;89(3):505-22.##Lainas TG, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas GT, Alexopoulou E, et al. Flexible GnRH antagonist protocol versus GnRH agonist long protocol in patients with polycystic ovary syndrome treated for IVF: a prospective randomised controlled trial (RCT). Hum Reprod. 2010;25(3):683-9.##Kurzawa R, Ciepiela P, Baczkowski T, Safranow K, Brelik P. Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH agonist protocols for in vitro fertilization in PCOS non-obese patients. A prospective randomized study. J Assist Reprod Genet. 2008;25(8):365-74.##Stadtmauer LA, Sarhan A, Duran EH, Beydoun H, Bocca S, Pultz B, et al. The impact of a gonadotropin-releasing hormone antagonist on gonadotropin ovulation induction cycles in women with polycystic ovary syndrome: a prospective randomized study. Fertil Steril. 2011;95(1):216-20.##Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception: a Cochrane review. Reprod Biomed Online. 2007;14(5):640-9.##Singh N, Naha M, Malhotra N, Lata K, Vanamail P, Tiwari A. Comparison of gonadotropin-releasing hormone agonist with GnRH antagonist in polycystic ovary syndrome patients undergoing in vitro fertilization cycle: Retrospective analysis from a tertiary center and review of literature. J Hum Reprod Sci. 2014;7(1):52-7.##Kolibianakis EM, Collins J, Tarlatzis BC, Devroey P, Diedrich K, Griesinger G. Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used? A systematic review and meta-analysis. Hum Reprod Update. 2006;12(6):651-71.##Lainas TG, Petsas GK, Zorzovilis IZ, Iliadis GS, Lainas GT, Cazlaris HE, et al. Initiation of GnRH antagonist on Day 1 of stimulation as compared to the long agonist protocol in PCOS patients. A randomized controlled trial: effect on hormonal levels and follicular development. Hum Reprod. 2007;22(6):1540-6.##Agha Hosseini M, Aleyasin A, Mahdavi A, Mokhtar S, Safdarian L, Fallahi P. Relationship between anti-mullerian hormone and assisted reproductive technique outcome in patients with polycystic ovary syndrome. Iran J Reprod Med. 2010;8(4):161-6.##Golan A, Weissman A. Symposium: Update on prediction and management of OHSS. A modern classification of OHSS. Reprod Biomed Online. 2009;19(1):28-32.##Kolibianakis EM, Zikopoulos K, Smitz J, Camus M, Tournaye H, Van Steirteghem AC, et al. Administration of gonadotropin-releasing hormone antagonist from day 1 of stimulation in in vitro fertilization. Fertil Steril. 2004;82(1):223-6.##Kolibianakis EM, Albano C, Kahn J, Camus M, Tournaye H, Van Steirteghem AC, et al. Exposure to high levels of luteinizing hormone and estradiol in the early follicular phase of gonadotropin-releasing hormone antagonist cycles is associated with a reduced chance of pregnancy. Fertil Steril. 2003;79(4):873-80.##Kim CH, Moon JW, Kang HJ, Ahn JW, Kim SH, Chae HD, et al. Effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase compared with GnRH agonist long protocol in non-obese and obese patients with polycystic ovary syndrome undergoing IVF/ICSI. Clin Exp Reprod Med. 2012;39(1):22-7.##Kdous M, Chaker A, Bouyahia M, Zhioua F, Zhioua A. [Increased risk of early pregnancy loss and lower live birth rate with GNRH antagonist vs. long GNRH agonist protocol in PCOS women undergoing controlled ovarian hyperstimulation]. Tunis Med. 2009;87(12):834-42. French.##Minaretzis D, Alper MM, Oskowitz SP, Lobel SM, Mortola JF, Pavlou SN. Gonadotropin-releasing hormone antagonist versus agonist administration in women undergoing controlled ovarian hyperstimulation: cycle performance and in vitro steroidogenesis of granulosa-lutein cells. Am J Obstet Gynecol. 1995;172(5):1518-25.##Xiao JS, Su CM, Zeng XT. Comparisons of GnRH antagonist versus GnRH agonist protocol in supposed normal ovarian responders undergoing IVF: a systematic review and meta-analysis. PLoS One. 2014;9(9):e106854.##Ashrafi M, Moini A, Mohammadzadeh A, Ezabadi Z, Zafarani F, Baghestani AR. A comparative study of GnRH antagonist and GnRH agonist in PCO patients undergoing IVF/ICSI cycles. Iran J Reprod Med. 2005;3(1):14-8.##Abuzeid MI, Mitwally M, Abuzeid YM, Bokhari HA, Ashraf M, Diamond MP. Early initiation of gonadotropin-releasing hormone antagonist in polycystic ovarian syndrome patients undergoing assisted reproduction: randomized controlled trial ISRCTN69937179. J Assist Reprod Genet. 2012;29(11):1193-202.##Lin H, Li Y, Li L, Wang W, Yang D, Zhang Q. Is a GnRH antagonist protocol better in PCOS patients? A meta-analysis of RCTs. PLoS One. 2014;9(3):e91796.##Choi MH, Lee SH, Kim HO, Cha SH, Kim JY, Yang KM, et al. Comparison of assisted reproductive technology outcomes in infertile women with polycystic ovary syndrome: In vitro maturation, GnRH agonist, and GnRH antagonist cycles. Clin Exp Reprod Med. 2012;39(4):166-71.##

Progesterone/Estradiol Ratio as a Predictor in the ART Cycles with Premature Progesterone Elevation on the Day of hCG Trigger 2 1 627 2 Background: The purpose of the study was to evaluate the role of Progesterone/ Estradiol (P4/E2) ratio as a predictive tool for clinical pregnancy in ART cycles with a premature progesterone rise of >1.5 ng/ml on the day of human chorionic gonadotropin (hCG) trigger. Methods: Retrospective analysis was done on 569 fresh embryo transfer cycles from January 2011 to December 2012 at the infertility unit of a tertiary care hospital. Age, BMI, number of cycles and number of clinical pregnancies have been considered. Results: The overall clinical pregnancy rate per embryo transfer was 42.8% (244/569). The clinical pregnancy rate in the 36 cycles with progesterone (P4) level >1.5 ng/ml was significantly lower than the 533 cycles with normal p4 ≤1.5 ng/ml (22.2% vs. 44.2%; p=0.0092). The 36 cycles with progesterone level >1.5 ng/ml were divided into subgroups of P4/E2 >1 (n=20) and P4/E2 ≤1 (n=16). The 20 cycles with P4/E2 >1 and P4 >1.5 ng/ml had a significantly lower pregnancy rate than the cycles with P4 ≤1.5 ng/ml (15% vs. 42.8%; p=0.0103). The 15 cycles with P4/E2 ≤1 and P4 >1.5 ng/ml had a similar pregnancy rate as the cycles with P4 ≤1.5 ng/ml. Conclusion: A premature progesterone elevation in ART cycles is possibly associated with lower clinical pregnancy rates; this adverse impact of elevated progesterone seems to be limited mainly to a subgroup with an elevated P4/E2 ratio >1. 155 162 Mariano M Mascarenhas Reproductive Medicine Unit, Christian Medical College Reproductive Medicine Unit, Christian Medical College India Mohan MSh Kamath Reproductive Medicine Unit, Christian Medical College Reproductive Medicine Unit, Christian Medical College India dockamz@gmail.com Achamma A Chandy Reproductive Medicine Unit, Christian Medical College Reproductive Medicine Unit, Christian Medical College India Aleyamma AT Kunjummen Reproductive Medicine Unit, Christian Medical College Reproductive Medicine Unit, Christian Medical College India ARTPregnancyPremature progesterone elevation 627.pdf Fatemi HM, Popovic-Todorovic B. Implantation in assisted reproduction: a look at endometrial receptivity. Reprod Biomed Online. 2013;27(5):530-8.##Al-Azemi M, Kyrou D, Kolibianakis EM, Humaidan P, Van Vaerenbergh I, Devroey P, et al. Elevated progesterone during ovarian stimulation for IVF. Reprod Biomed Online. 2012;24(4):381-8.##Fleming R, Jenkins J. The source and implications of progesterone rise during the follicular phase of assisted reproduction cycles. Reprod Biomed Online. 2010;21(4):446-9.##Li MQ, Jin LP. Ovarian stimulation for in vitro fertilization alters the protein profile expression in endometrial secretion. Int J Clin Exp Pathol. 2013;6(10):1964-71.##Garrido-Gomez T, Dominguez F, Simon C. Proteomics of embryonic implantation. Handb Exp Pharmacol. 2010;(198):67-78.##Samborski A, Graf A, Krebs S, Kessler B, Reichenbach M, Reichenbach HD, et al. Transcriptome changes in the porcine endometrium during the preattachment phase. Biol Reprod. 2013;89(6):134.##Altmae S, Esteban FJ, Stavreus-Evers A, Simon C, Giudice L, Lessey BA, et al. Guidelines for the design, analysis and interpretation of 'omics' data: focus on human endometrium. Hum Reprod Update. 2014;20(1):12-28.##Edgell TA, Rombauts LJ, Salamonsen LA. Assessing receptivity in the endometrium: the need for a rapid, non-invasive test. Reprod Biomed Online. 2013;27(5):486-96.##Kolibianakis EM, Bourgain C, Papanikolaou EG, Camus M, Tournaye H, Van Steirteghem AC, et al. Prolongation of follicular phase by delaying hCG administration results in a higher incidence of endometrial advancement on the day of oocyte retrieval in GnRH antagonist cycles. Hum Reprod. 2005;20(9):2453-6.##Elnashar AM. Progesterone rise on the day of HCG administration (premature luteinization) in IVF: an overdue update. J Assist Reprod Genet. 2010;27(4):149-55.##Edelstein MC, Seltman HJ, Cox BJ, Robinson SM, Shaw RA, Muasher SJ. Progesterone levels on the day of human chorionic gonadotropin administration in cycles with gonadotropin-releasing hormone agonist suppression are not predictive of pregnancy outcome. Fertil Steril. 1990;54(5):853-7.##Givens CR, Schriock ED, Dandekar PV, Martin MC. Elevated serum progesterone levels on the day of human chorionic gonadotropin administration do not predict outcome in assisted reproduction cycles. Fertil Steril. 1994;62(5):1011-7.##Hofmann GE, Bentzien F, Bergh PA, Garrisi GJ, Williams MC, Guzman I, et al. Premature luteinization in controlled ovarian hyperstimulation has no adverse effect on oocyte and embryo quality. Fertil Steril. 1993;60(4):675-9.##Silverberg KM, Burns WN, Olive DL, Riehl RM, Schenken RS. Serum progesterone levels predict success of in vitro fertilization/embryo transfer in patients stimulated with leuprolide acetate and human menopausal gonadotropins. J Clin Endocrinol Metab. 1991;73(4):797-803.##Ubaldi F, Smitz J, Wisanto A, Joris H, Schiettecatte J, Derde MP, et al. Oocyte and embryo quality as well as pregnancy rate in intracytoplasmic sperm injection are not affected by high follicular phase serum progesterone. Hum Reprod. 1995;10(12):3091-6.##Van Vaerenbergh I, Van Lommel L, Ghislain V, In't Veld P, Schuit F, Fatemi HM, et al. In GnRH antagonist/rec-FSH stimulated cycles, advanced endometrial maturation on the day of oocyte retrieval correlates with altered gene expression. Hum Reprod. 2009;24(5):1085-91.##Labarta E, Martinez-Conejero JA, Alama P, Horcajadas JA, Pellicer A, Simon C, et al. Endometrial receptivity is affected in women with high circulating progesterone levels at the end of the follicular phase: a functional genomics analysis. Hum Reprod. 2011;26(7):1813-25.##Griesinger G, Mannaerts B, Andersen CY, Witjes H, Kolibianakis EM, Gordon K. Progesterone elevation does not compromise pregnancy rates in high responders: a pooled analysis of in vitro fertilization patients treated with recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in six trials. Fertil Steril. 2013;100(6):1622-8.e1-3.##Keltz MD, Stein DE, Berin I, Skorupski J. Elevated progesterone-to-estradiol ratio versus serum progesterone alone for predicting poor cycle outcome within vitro fertilization. J Reprod Med. 2012;57(1-2):9-12.##Cetinkaya ES, Berker B, Aytac R, Atabekoglu C, Sonmezer M, Ozmen B. The value of the progesterone-to-estradiol ratio on the day of hCG administration in predicting ongoing pregnancy and live birth rates in normoresponders undergoing GnRH antagonist cycles. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):452-7.##Lai TH, Lee FK, Lin TK, Horng SG, Chen SC, Chen YH, et al. An increased serum progesterone-to-estradiol ratio on the day of human chorionic gonadotropin administration does not have a negative impact on clinical pregnancy rate in women with normal ovarian reserve treated with along gonadotropin releasing hormone agonist protocol. Fertil Steril. 2009;92(2):508-14.##COBAS® 4000 platform [Internet]. Dehli: Hoffmann-La Roche Ltd; 1996 [updated 2015; cited 2013 Dec 30]. Available from: http://www.roche-diagnosics.co.in/Products/Pages/COBAS4000platform.aspx##Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009. Hum Reprod. 2009;24(11):2683-7.##SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc##Achache H, Revel A. Endometrial receptivity markers, the journey to successful embryo implantation. Hum Reprod Update. 2006;12(6):731-46.##Van Vaerenbergh I, McIntire R, Van Lommel L, Devroey P, Giudice L, Bourgain C. Gene expression during successful implantation in a natural cycle. Fertil Steril. 2010;93(1):268.e15-8.##Legro RS, Ary BA, Paulson RJ, Stanczyk FZ, Sauer MV. Premature luteinization as detected by elevated serum progesterone is associated with a higher pregnancy rate in donor oocyte in-vitro fertilization. Hum Reprod. 1993;8(9):1506-11.##Melo MA, Meseguer M, Garrido N, Bosch E, Pellicer A, Remohi J. The significance of premature luteinization in an oocyte-donation programme. Hum Reprod. 2006;21(6):1503-7.##Bustillo M, Stern JJ, Coulam CB. Serum progesterone at the time of human chorionic gonadotrophin does not predict pregnancy in in-vitro fertilization and embryo transfer. Hum Reprod. 1995;10(11):2862-7.##Urman B, Alatas C, Aksoy S, Mercan R, Isiklar A, Balaban B. Elevated serum progesterone level on the day of human chorionic gonadotropin administration does not adversely affect implantation rates after intracytoplasmic sperm injection and embryo transfer. Fertil Steril. 1999;72(6):975-9.##Levi Setti PE, De Cesare R, Sacchi L, Vaiarelli A, Drovanti A, Patrizio P. Elevated progesterone levels on the day of hCG administration have no influence on pregnancy and implantation rates: retrospective analysis of 5,258 cycles. Fertil Steril. 2013;100(3):S465–S465.##Bosch E, Valencia I, Escudero E, Crespo J, Simon C, Remohi J, et al. Premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome. Fertil Steril. 2003;80(6):1444-9.##Bosch E, Labarta E, Crespo J, Simon C, Remohi J, Jenkins J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod. 2010;25(8):2092-100.##Fanchin R, de Ziegler D, Taieb J, Hazout A, Frydman R. Premature elevation of plasma progesterone alters pregnancy rates of in vitro fertilization and embryo transfer. Fertil Steril. 1993;59(5):1090-4.##Hamori M, Stuckensen JA, Rumpf D, Kniewald T, Kniewald A, Kurz CS. Premature luteinization of follicles during ovarian stimulation for in-vitro fertilization. Hum Reprod. 1987;2(8):639-43.##Venetis CA, Kolibianakis EM, Papanikolaou E, Bontis J, Devroey P, Tarlatzis BC. Is progesterone elevation on the day of human chorionic gonadotrophin administration associated with the probability of pregnancy in in vitro fertilization? A systematic review and meta-analysis. Hum Reprod Update. 2007;13(4):343-55.##Kolibianakis EM, Venetis CA, Bontis J, Tarlatzis BC. Significantly lower pregnancy rates in the presence of progesterone elevation in patients treated with GnRH antagonists and gonadotrophins: a systematic review and meta-analysis. Curr Pharm Biotechnol. 2012;13(3):464-70.##Venetis CA, Kolibianakis EM, Bosdou JK, Tarlatzis BC. Progesterone elevation and probability of pregnancy after IVF: a systematic review and meta-analysis of over 60 000 cycles. Hum Reprod Update. 2013;19(5):433-57.##Papanikolaou EG, Pados G, Grimbizis G, Bili E, Kyriazi L, Polyzos NP, et al. GnRH-agonist versus GnRH-antagonist IVF cycles: is the reproductive outcome affected by the incidence of progesterone elevation on the day of HCG triggering? A randomized prospective study. Hum Reprod. 2012;27(6):1822-8.##Hofmann GE, Khoury J, Johnson CA, Thie J, Scott RT Jr. Premature luteinization during controlled ovarian hyperstimulation for in vitro fertilization-embryo transfer has no impact on pregnancy outcome. Fertil Steril. 1996;66(6):980-6.##Younis JS, Haddad S, Matilsky M, Ben-Ami M. Premature luteinization: could it be an early manifestation of low ovarian reserve? Fertil Steril. 1998;69(3):461-5.##Younis JS, Matilsky M, Radin O, Ben-Ami M. Increased progesterone/estradiol ratio in the late follicular phase could be related to low ovarian reserve in in vitro fertilization-embryo transfer cycles with a long gonadotropin-releasing hormone agonist. Fertil Steril. 2001;76(2):294-9.##Lee FK, Lai TH, Lin TK, Horng SG, Chen SC. Relationship of progesterone/estradiol ratio on day of hCG administration and pregnancy outcomes in high responders undergoing in vitro fertilization. Fertil Steril. 2009;92(4):1284-9.##Abuelghar WM, Elsaeed MM, Tamara TF, Ellaithy MI, Ali MS. Measurement of serum estradiol/progesterone ratio on the day of embryo transfer to predict clinical pregnancies in intracytoplasmic sperm injection (ICSI) cycles. Is this of real clinical value? Middle East Fertil Soc J. 2013;18(1):31–7##Xu B, Li Z, Zhang H, Jin L, Li Y, Ai J, et al. Serum progesterone level effects on the outcome of in vitro fertilization in patients with different ovarian response: an analysis of more than 10,000 cycles. Fertil Steril. 2012;97(6):1321-7.e1-4.##

Cervical Priming by Misoprostol before Diagnostic Dilatation and Curettage: A Randomized Clinical Trial 2 1 598 2 Background: Difficulty in cervical dilatation is a hard situation during the procedure of diagnostic dilatation and curettage in some cases. This study was performed to evaluate the effect of vaginal misoprostol for cervical priming before diagnostic dilatation and curettage. Methods: In this study 56 women were selected as the candidates for dilatation and curettage. The study was double blind and was performed for two parallel groups. One misoprostol tablet (200 μg) was administered in posterior fornix of vagina 2-4 hr before operation in 28 patients whereas in other 28 patients, placebo (VitB6) was used. Then, the two groups were compared according to the patency of the cervix measured by No. 5 Hegar dilators and the duration of dilatation and curettage procedure as well. Chi-square test, t-test, and Mann-Whitney U test were used for comparing two groups, and a p-value less than 0.05 was considered as statistically significant. Results: Before the procedure of dilatation and curettage, the patency of the cervix was measured by passing Hegar dilator number 5 through the cervical canal in fifteen (53.6%) patients in the misoprostol group and 8 patients (28.6%) in the placebo group (p=0.05) which their difference was statistically significant. The effect of misoprostol was not significant in nulliparous women and postmenopausal period either. Conclusion: Vaginal misoprostol is a useful drug for ripening and dilating the cervix. It also facilitates the procedure of dilatation and curettage in premenopausal and multiparous women. Misoprostol was less effective in nulliparous women and in postmenopausal period. 162 167 Shima Sh Mohammadian Department of Obstetrics and Gynecology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences Department of Obstetrics and Gynecology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences Iran Anahita A Tavana Department of Natural Sciences, University of Texas at Austin Department of Natural Sciences, University of Texas at Austin USA Shahrzad Sh Tavana Department of Natural Sciences, University of Texas at Austin Department of Natural Sciences, University of Texas at Austin USA Aida A Mohammadian Qazvin University of Medical Sciences Qazvin University of Medical Sciences Iran Masoumeh M Fallahian معصومه فلاحیان Department of Obstetrics and Gynecology, Infertility and Reproductive Health Research Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences Department of Obstetrics and Gynecology, Infertility and Reproductive Health Research Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences Iran m_fallahian@yahoo.com Cervical ripeningCurettageDilatationMisoprostol 598.pdf Bonnar J, Sheppard BL. Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid. BMJ. 1996;313(7057):579-82.##Fernandez H, Alby JD, Tournoux C, Chauveaud-Lambling A, DeTayrac R, Frydman R, et al. Vaginal misoprostol for cervical ripening before operative hysteroscopy in pre-menopausal women: a double-blind, placebo-controlled trial with three dose regimens. Hum Reprod. 2004;19(7):1618-21.##Areerak W, Manotaya S. Vaginal misoprostol prior to curettage for cervical dilatation in premenopausal women: A randomized controlled trial. Thai J Obstet Gynecol. 2003;15(4):245-8.##Sharifzade F, Kashanian M, Assadollahi Dabbagh Z. Effect of vaginal misoprostol on cervical priming in diagnostic Dilatation and Curettage. IJOGI. 2010;13 (3):25-30.##Valadan M, Rezaee Z, Mohammad pour J, Moghadam Tabrizi N. Vaginal misoprostal for cervical priming before hysteroscopy. Tehran Univ Med J. 2008;66(8):599-603.##Briggs GG, Wan SR. Drug therapy during labor and delivery, part 2. Am J Health Syst Pharm. 2006;63 (12):1131-9.##Allen R, O'Brien BM. Uses of misoprostol in obstetrics and gynecology. Rev Obstet Gynecol. 2009;2 (3):159-68.##Ho PC, Ngai SW, Liu KL, Wong GC, Lee SW. Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy. Obstet Gynecol. 1997;90(5):735-8.##Darwish AM, Ahmad AM, Mohammad AM. Cervical priming prior to operative hysteroscopy: a randomized comparison of laminaria versus misoprostol. Hum Reprod. 2004;19(10):2391-4.##Singh N, Ghosh B, Naha M, Mittal S. Vaginal misoprostol for cervical priming prior to diagnostic hysteroscopy--efficacy, safety and patient satisfaction: a randomized controlled trial. Arch Gynecol Obstet. 2009;279(1):37-40.##Yassaee F, Mostafaee L. The role of cervical cerclage in pregnancy outcome in women with uterine anomaly. J Reprod Infertil. 2011;12(4):277-9.##Mathlouthi N, Saodi O, Ben Temime R, Makhlouf T, Attia L, Chachia A. [Sublingual Misoprostol for cervical ripening before diagnostic hysteroscopy: a randomized and prospective study about 108 cases]. Tunis Med. 2011;89(11):825-9. French.##Polyzos NP, Zavos A, Valachis A, Dragamestianos C, Blockeel C, Stoop D, et al. Misoprostol prior to hysteroscopy in premenopausal and postmenopausal women: A systematic review and meta-analysis. Hum Reprod Update. 2012;18(4):393-404.##Fung TM, Lam MH, Wong SF, Ho LC. A randomized placebo-controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women. BJOG. 2002;109(5):561-5.##Oppegaard KS, Nesheim BI, Istre O, Qvigstad E. Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design. BJOG. 2008;115(5):663, e1-9.##Bisharah M, Al-Fozan H, Tulandi T. A randomized trial of sublingual misoprostol for cervical priming before hysteroscopy. J Am Assoc Gynecol Laparosc. 2003;10(3):390-1.##

The Reproductive Behavior of Families with Thalassemic Children in Hormozgan 2 1 617 2 Background: Thalassemic disorders are the most prevalent monogenic hereditary diseases around the world caused by decreased and altered synthesis or agenesis in one or more globin chains. Families who have a child with thalassemia major face a myriad of significant problems. Hormozgan province ranks second with thalassemic patients in Iran. Therefore, current research is aimed to analyze the reproductive behavior of such families in the southern province of Iran. Methods: In this descriptive study 190 mothers of patients suffering from thalassemia major were included. The reproductive behavior of mothers was investigated by a questionnaire regarding the number of thalassemic infants born after their first child with thalassemia major. Results: About 23% of these mothers had more than 1 child with major thalassemia. The findings showed that the reasons for conception among these mothers were to have a healthy child (64.2%) and to have a boy (20%). In about 92.6% of mothers CVS test was not performed. Conclusion: This study showed that awaring mothers and families regarding the prevention of birth of afflicted infants and provision of accessible diagnostic facilities can reduce the number of children with thalassemia major. 167 171 Ali A Safari Moradabadi Health Promotion Research Center, Kermanshah University of Medical Sciences Health Promotion Research Center, Kermanshah University of Medical Sciences Iran Azin A Alavi Hormozgan Fertility and Infertility Research Center, Hormozgan University of Medical Sciences Hormozgan Fertility and Infertility Research Center, Hormozgan University of Medical Sciences Iran Tasnim T Eqbal Eftekhaari Cellular and Molecular Research Center, Hormozgan University of Medical Sciences Cellular and Molecular Research Center, Hormozgan University of Medical Sciences Iran Sakineh S dadipoor Hormozgan Fertility and Infertility Research Center, Hormozgan University of Medical Sciences Hormozgan Fertility and Infertility Research Center, Hormozgan University of Medical Sciences Iran mdadipoor@yahoo.com MothersReproductive behaviorThalassemia 617.pdf Weatherall DJ. The thalassaemias. BMJ. 1997;314(7095):1675-8.##Ghazanfari Z, Arab M, Forouzi M, Pouraboli B. Knowledge level and education needs of thalassemic childern's parents in Kerman. Iran J Crit Care Nurs. 2010;3(3):99-103.##Tahannejad-Asadi Z, Elahi A, Mohseni A, Talebi M, Khosravi M, Jalalifar MA. Screening and identifying of erythrocyte alloantibodies in patients with Thalassemia major referred to Ahvaz Shafa hospital. Feyz J Kashan Univ Med Sci. 2013;17(2):165-72.##Naderi M, Shamshiri H, Alizadeh S, Dorgalaleh A, Manafi R, Tabibian S. Cutaneous and mucosal manifestations in patients with beta major thalassemia. Dermatol Cosmet. 2013;4(1):27-33.##Long T. Whaley and Wong’s Nursing Care of Infants and Children. Nurse Educ Today. 2000;20(2):171-2.##Habibzadeh F, Yadollahie M, Roshanipoor M, Haghshenas M. Reproductive behaviour of mothers of children with beta-thalassaemia major. East Mediterr Health J. 2012;18(3):246-9.##Abbas Zadeh A, Rashidi nijad M, Borhani F. Evaluation of behavioral patients in mothers of Thalassemic children. J Med Sci and Health Serv. 2003;11(3):27.##Aguzzi S, Vullo C, Barrai I. Reproductive compensation in families segregating for Cooley's anaemia in Ferrara. Ann Hum Genet. 1978;42(2):153-60.##Rustamov RSh, Tokarev IuN. [Reproductive compensation in the mothers of patients with homozygous beta-thalassemia]. Genetika. 1983;19(9):1545-50. Russian.##Gamberini MR, Lucci M, Vullo C, Anderson B, Canella R, Barrai I. Reproductive behaviour of families segregating for Cooley's anaemia before and after the availability of prenatal diagnosis. J Med Genet. 1991;28(8):523-9.##Gamberini MR, Canella R, Lucci M, Vullo C, Barrai I. Reproductive behavior of thalassemic couples segregating for Cooley anemia. Am J Med Genet. 1991;38(1):103-6.##Ministry of Health and Medical Education [Internet]. Bandar Abbas: Hormozgan university medical science. 2013 [cited 2011 April 5]. Available from: http://fdo.behdasht.gov.ir/index.aspx?siteid=1&pageid=13391&newsview=33463.##Zeinalian M, Samavat A, Fadayee Nobari R, Azin S. Incidence rate of major beta-thalassemia and study of its causes after prevention and control program of thalassemia in Isfahan province. Sci J Iran Blood Transfus Organ. 2010;6(4):238-47.##Hossieni S, Yaghoubi E, Ghanbari M, Bijani A. Investigate Factors associated with the birth of children with thalassemia in Babylon. J Babol Univ Med Sci. 2007;9(6):44-9.##Samavat A, Modell B. Iranian national thalassaemia screening programme. BMJ. 2004;329(7475):1134-7.##Cowan J, Kerr C. Reproductive patterns and thalassaemia major. J Biosoc Sci. 1986;18(3):285-95.##Saxena A, Phadke SR. Thalassaemia control by carrier screening: The Indian scenario. Curr Sci. 2002;83(3):291-5.##Ghanei M, Adibi P, Movahedi M, Khami MA, Ghasemi RL, Azarm T, et al. Pre-marriage prevention of thalassaemia: report of a 100,000 case experience in Isfahan. Public Health. 1997;111(3):153-6.##Dyson SM, Fielder AV, Kirkham MJ. Midwives' and senior student midwives' knowledge of haemaglobinopathies in England. Midwifery. 1996;12(1):23-30.##

A Rare De Novo Balanced X; 1 Translocation in an Indian Female with Primary Amenorrhea 2 1 610 2 Background: Translocations involving X chromosome and an autosome are rather rare due to associated infertility in men and subfertility in women. X chromosome translocations are frequently associated with primary or secondary amenorrhea. In this report, a case of primary amenorrhea with a de novo balanced reciprocal translocation was presented between chromosomes X and 1. Case Presentation: A 24 year-old proposita with the complaint of primary amenorrhea was found to have hypoplastic uterus and streak gonads with a normal hormonal profile. Chromosomal analysis of the proband revealed a de novo translocation of 46, X, t(X; 1) (q21; p32) chromosomal constitution. Parental karyotypes of the proband showed normal karyotype. Conclusion: The observed translocation between chromosome X and 1 in the patient suggest either the disruption of a critical gene expression due to position effect or deletion of one or more essential genes in the disrupted long arm of the affected X chromosome. To the best of our knowledge, this is the first report from our ethnic group. 171 174 Ananthapur A Venkateshwari Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India venkateshwari@yahoo.com Avvari A Srilekha Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India Koka K Veena Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India Madireddy M Sujatha Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India Akka A Jyothy Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet India Abnormal karyotypeBalanced X autosome translocationGonadal dysgenesisPrimary amenorrhea 610.pdf Wong MS, Lam ST. Cytogenetic analysis of patients with primary and secondary amenorrhoea in Hong Kong: retrospective study. Hong Kong Med J. 2005;11(4):267-72.##Joseph A, Thomas IM. Cytogenetic investigations in 150 cases with complaints of sterility or primary amenorrhea. Hum Genet. 1982;61(2):105-9.##Sharp AJ, Spotswood HT, Robinson DO, Turner BM, Jacobs PA. Molecular and cytogenetic analysis of the spreading of X inactivation in X;autosome translocations. Hum Mol Genet. 2002;11(25):3145-56.##Moorhead PS, Nowell PC, Mellman WJ, Battips DM, Hungerford DA. Chromosome preparations of leukocytes cultured from human peripheral blood. Exp Cell Res. 1960;20:613-6.##Seabright M. A rapid banding technique for human chromosomes. Lancet. 1971;2(7731):971-2.##Mitelman F. An International System for Human Cytogenetic Nomenclature. Basel: S. Karger Publishers; 2013.##Fitch N, de Saint Victor J, Richer CL, Pinsky L, Sitahal S. Premature menopause due to a small deletion in the long arm of the X chromosome: a report of three cases and a review. Am J Obstet Gynecol. 1982;142(8):968-72.##Jost A. A new look at the mechanisms controlling sex differentiation in mammals. Johns Hopkins Med J. 1972;130(1):38-53.##Waters JJ, Campbell PL, Crocker AJ, Campbell CM. Phenotypic effects of balanced X-autosome translocations in females: a retrospective survey of 104 cases reported from UK laboratories. Hum Genet. 2001;108(4):318-27.##Vasu VR, Chandra N, Santhiya ST. X;7 translocation in an Indian woman with hypergonadotropic amenorrhea-a case report. Genet Test Mol Biomarkers. 2009;13(4):533-6.##Omrani MD, Saleh Gargari S, Azizi F. A de novo Reciprocal X; 9 Translocation in A Patient with Premature Ovarian Failure. Int J Fertil Steril. 2013;7(2):130-3.##Chen CP, Lin SP, Chern SR, Kuo YL, Wu PS, Chen YT, et al. Array CGH characterization of an unbalanced X-autosome translocation associated with Xq27.2-qter deletion, 11q24.3-qter duplication and Xq22.3-q27.1 duplication in a girl with primary amenorrhea and mental retardation. Gene. 2014;535(1):88-92.##Sills ES, Cotter PD, Marron KD, Shkrobot LV, Walsh HM, Salem RD. Ovarian dysgenesis associated with an unbalanced X;6 translocation: first characterisation of reproductive anatomy and cytogenetic evaluation in partial trisomy 6 with breakpoints at Xq22 and 6p23. Mol Med Rep. 2012;5(1):29-31.##Vitek WS, Pagidas K, Gu G, Pepperell JR, Simpson JL, Tantravahi U, et al. Xq;autosome translocation in POF: Xq27.2 deletion resulting in haploinsufficiency for SPANX. J Assist Reprod Genet. 2012;29(1):63-6.##

Cervical Cancer Along with Unknown Cirrhosis: A Misdiagnosed Case 2 1 611 2 Background: Cervical cancer is the second most common malignancy in women worldwide. Vaginal bleeding and vaginal discharge are the most common symptoms. Although ascites has been reported in cases with cervical cancer, it is due to other causes such as ovarian metastasis. Case Presentation: A 78-year-old diabetic woman who presented with ascites and abdominopelvic mass was misdiagnosed with ovarian cancer and treated with neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant radiotherapy. However, pathology confirmed locally advanced cervical cancer stage IV in this patient. She was discharged from the hospital three weeks after surgery with no serious complications. Discussion: Considering all signs and symptoms to reach a verdict would reduce such malpractices and consequently lead to select the best management and treatment. 174 178 Soheila S Aminimoghaddam Firoozgar Hospital, Iran University of Medical Sciencesy of Medical Sciences Firoozgar Hospital, Iran University of Medical Sciencesy of Medical Sciences Iran Dr_aminimoghaddam@ yahoo.com Fatemeh F Mahmoudzadeh Mazandaran University of Medical Sciences Mazandaran University of Medical Sciences Iran Andisheh A Maghsoudnia Tarbiat Modarres University Tarbiat Modarres University Iran Diabetes mellitusLiver cirrhosisMisdiagnosed caseOvarian neoplasmsUterine cervical neoplasms 611.pdf Solomon D, Breen N, McNeel T. Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines. CA Cancer J Clin. 2007;57(2):105-11.##International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer. 2007;120(4):885-91.##Zhan YS, Feng L, Tang SH, Li WG, Xu M, Liu TF, et al. Glucose metabolism disorders in cancer patients in a Chinese population. Med Oncol. 2010;27(2):177-84.##Kuriki K, Hirose K, Tajima K. Diabetes and cancer risk for all and specific sites among Japanese men and women. Eur J Cancer Prev. 2007;16(1):83-9.##Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM. Fasting serum glucose level and cancer risk in Korean men and women. JAMA. 2005;293(2):194-202.##Subramaniam A, Fauci JM, Schneider KE, Whitworth JM, Erickson BK, Kim K, et al. Invasive cervical cancer and screening: what are the rates of unscreened and underscreened women in the modern era? J Low Genit Tract Dis. 2011;15(2):110-3.##Nazari Z, Behtash N, Gilani MM, Ganjoei TA. Cervical carcinoma simulating advanced ovarian cancer. Eur J Surg Oncol. 2007;33(1):123-4.##Abdulhathi MB, Al-Salam S, Kassis A, Ghazal-Aswad S. Unusual presentation of cervical cancer as advanced ovarian cancer. Arch Gynecol Obstet. 2007;276(4):387-90.##Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis. Cochrane Database Syst Rev. 2010;(1):CD008285.##Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas, number 35, May 2002. Obstet Gynecol. 2002;99(5 Pt 1):855-67.##Yin M, Zhao F, Lou G, Zhang H, Sun M, Li C, et al. The long-term efficacy of neoadjuvant chemotherapy followed by radical hysterectomy compared with radical surgery alone or concurrent chemoradiotherapy on locally advanced-stage cervical cancer. Int J Gynecol Cancer. 2011;21(1):92-9.##Rose PG. Locally advanced cervical cancer. Curr Opin Obstet Gynecol. 2001 Feb;13(1):65-70.##Uddin MS, Hoque MI, Islam MB, Uddin MK, Haq I, Mondol G, et al. Serum-ascites albumin gradient in differential diagnosis of ascites. Mymensingh Med J. 2013;22(4):748-54.##Tempe A, Singh S, Wadhwa L, Garg A. Conventional and color Doppler sonography in preoperative assessment of ovarian tumors. Int J Gynaecol Obstet. 2006;92(1):64-8.##Skirnisdottir I, Garmo H, Holmberg L. Non-genital tract metastases to the ovaries presented as ovarian tumors in Sweden 1990-2003: occurrence, origin and survival compared to ovarian cancer. Gynecol Oncol. 2007;105(1):166-71.##Hewitt MJ, Anderson K, Hall GD, Weston M, Hutson R, Wilkinson N, et al. Women with peritoneal carcinomatosis of unknown origin: Efficacy of image-guided biopsy to determine site-specific diagnosis. BJOG. 2007;114(1):46-50.##Waggoner SE. Cervical cancer. Lancet. 2003;361(9376):2217-25.##Bailey J, Cymet TC. Planning for the HPV vaccine and its impact on cervical cancer prevention. Compr Ther. 2006;32(2):102-5.##Leary A, Pautier P, Tazi Y, Morice P, Duvillard P, Gouy S, et al. [The molecular biology of epithelial ovarian cancer]. Bull Cancer. 2012;99(12):1161-73. French.##Geisler JP, Linnemeier GC, Thomas AJ, Manahan KJ. Nutritional assessment using prealbumin as an objective criterion to determine whom should not undergo primary radical cytoreductive surgery for ovarian cancer. Gynecol Oncol. 2007;106(1):128-31.##

Retracted: Correlation of Sperm Associated Antigen 11 (SPAG11) and its Isoforms with Varicocele in Rats 2 1 654 2 The Editorial Board of the Journal of Reproduction and Infertility (JRI) has recently confirmed that the manuscript titled: "Correlation of Sperm Associated Antigen 11 (SPAG11) and its Isoforms with Varicocele in Rats", written by Hong Tian et al, published in volume 13, issue 4, pp. 241-247 has been published previously in Chinese. Therefore this paper is retracted, considering the fact that it is contrary to the journal’s policy. We regret the time that peer reviewers and others spent for evaluation of this paper and hope that there will be no repetition of this problems in the future. 178 179 No Keyword 654.pdf ####