Access to Infertility Services in Middle East 2 1 663 2 In the new millennium, health promotion and reducing mortality from infectious diseases in developing and developed countries necessitates more focus to other various aspects of human health, such as sexual and reproductive health. Over the past two decades, more attention has been paid to the prevention of infertility and providing equitable access to effective and safe infertility treatment technologies at global scale. Despite the efforts of international organizations, governments, regional institutions and non-governmental organization, currently about 25 percent of infertile couples have access to infertility treatment in developed and developing countries. However, the condition in South of Africa is much worse that in some countries only one or two centers in the capital provide minimal services of infertility treatment (1). Assessment of infertility treatments in different countries shows that development of IVF clinic in Middle East region is faster than the rest of the world and even more than European and North American countries. The first centers in this region were established a few years after the ones in European countries. For example, more than 70 centers are active in Iran that more than 25 centers of them are in capital or more than 110 centers are active in Turkey and also Emirates, Egypt, Jordan, and Saudi Arabia have the same situation. The development of infertility treatment and increased numbers of IVF centers in this region depend on numerous factors. The most important factors are governmental support, partial or full insurance coverage of treatment cost, social and religious values of childbearing and the role of children in family stability. The increase in number of IVF clinics in private and governmental sections was a positive competition and increased the quantity and quality of treatment services in these countries. Another benefit of this development was the decrease in cost of infertility treatment services in Middle East region. So that the cost of one cycle of assisted reproductive technology (ART) treatment on average is less than 2000 dollars (about 1000 dollars for diagnostic and imaging tests, drugs and stimulation protocols and about 1000 dollars for operation, ovum pickup, fertilization, embryo culture and transfer and also cryopreservation of extra embryos) in Iran compared to more than 20000 dollars in UK and United States. Although this cost may be relatively high for people compared to annual income of people in these countries, accessibility to infertility service is easier and more convenient in the Middle East. As a result, quick and easy access of people to health services, as well as infertility treatment as one of the development goals of world health organization is somewhat available in this region (2). Iran is typically considered a developing country. Iran's population increased dramatically during the latter half of the 20th century. Recently, however, Iran's birth rate has significantly declined. But Iran's rate of population growth will continue gradually to stabilize above 90 million in 2050. Presently, more than half of the people are under the age of 24, one quarter being 15 years of age or younger (3). Therefore, the need for reproductive health service and infertility treatment will increase in future. The number of IVF clinics will be doubled very soon in future years to provide infertility services for young population. Alongside providing infertility services to Iranian couples due to great comparative advantage of Iran compared to other Middle East countries on low cost of traveling, hotels, transportation, living, infertility treatment and diversity of health services (ART, PGD, third-party reproduction, donor services), Iran is a good destination for health tourism of infertile couples. In fact, recently, infertile couples form neighboring countries especially Iraq and Afghanistan received their treatment from Iranian centers; regarding recent changes in the world policy to engage with Iran, Iran will be the host of foreign infertile couples specially Muslims to receive infertility treatment services in near future. 179 180 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@avicenna.ac.ir No Keyword 663.pdf Ombelet W. 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Allele, Genotype and Haplotype Structures of Functional Polymorphic Variants in Endothelial Nitric Oxide Synthase (eNOS), Angiotensinogen (ACE) and Aldosterone Synthase (CYP11B2) Genes in Healthy Pregnant Women of Indian Ethnicity 2 1 632 2 Background: Variants in the candidate genes eNOS, CYP11B2 and ACE have been implicated as liable biomarkers that can predict complications like hypertension and preeclampsia. Studies on the impact and distribution of these variants on healthy pregnancy have not been done so far in south Indian or in any of the native Indian population. Examining these variants could lay a strong basis in understanding the genetic aspects of preeclampsia and further offer effective means in early risk assessment in a preeclampsia. Methods: Genotyping for 303 unrelated healthy women of Tamilian origin who underwent uncomplicated term pregnancies was executed by PCR-RFLP for eNOS, CYP11B2 and ACE variants. Haplotype assessment and pairwise linkage disequilibrium (LD) investigation were performed by Haploview software. Results: The prevalence of eNOS variants (-786T>C, Glu298Asp and intron 4 VNTR) was 12%, 21.6% and 21.1%, respectively. The incidence of CYP11B2 (-344C>T) and ACE (287 bp Alu I/D) variants was found to be 43.8% and 42.7%. The observed frequencies of the studied polymorphisms did not diverge from the HWE (p>0.05). Significant LD was observed between 3 eNOS gene polymorphisms. Six different haplotype structures with a frequency of >1% were generated from three eNOS variants. Among the haplotypes generated, the haplotype T-4b-G was the most common with the frequency of 64.4%. There was a statistically significant inconsistency in the study population in comparison to other global races. Conclusion: The outcome of this study could be used for investigating future therapeutic value of the variants in a preeclamptic set-up which could pose a credible diagnostic potential for primary risk assessment of women susceptible to preeclampsia/other pregnancy related complications. 180 193 Anichavezhi A Devendran Department of Pharmacology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Department of Pharmacology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) India anich.deva@gmail.com Sreekala S Nampoothiri Department of Biotechnology and Biochemical Engineering, Sree Buddha College of Engineering, Alappuzha Department of Biotechnology and Biochemical Engineering, Sree Buddha College of Engineering, Alappuzha India Deepak D Shewade Department of Pharmacology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Department of Pharmacology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) India Suvro S Chatterjee Vascular Biology Division, AU-KBC Research Centre, Madras Institute of Technology (M.I.T), Anna University, Chrompet Vascular Biology Division, AU-KBC Research Centre, Madras Institute of Technology (M.I.T), Anna University, Chrompet India Balachandar B Jayaraman Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) India Adithan A Chandrasekharan Department of Pharmacology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Department of Pharmacology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) India CYP11B2eNOSHaplotypesHypertensionPreeclampsia 632.pdf Vallance P, Collier J, Moncada S. 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Haplotypic analyses of the aldosterone synthase gene CYP11B2 associated with stage-2 hypertension in northern Han Chinese. Clin Genet. 2004;66(5): 409-16.##Tsukada K, Ishimitsu T, Teranishi M, Saitoh M, Yoshii M, Inada H, et al. Positive association of CYP11B2 gene polymorphism with genetic predisposition to essential hypertension. J Hum Hypertens. 2002;16(11):789-93.##Yan G, Wang Y. Association of CYP11B2 gene polymorphism with ischemic stroke in the north Chinese Han population. Neurol India. 2012;60(5):504-9.##NCBI: dbSNP Short Genetic Variations [Internet]. HapMap CYP11B2 [cited 2014 Sept 20]. Available from: http://www.ncbi.nlm.nih.gov /projects/SNP/snp_ref.cgi?rs=1799998.##Davies E, Holloway CD, Ingram MC, Inglis GC, Friel EC, Morrison C, et al. Aldosterone excretion rate and blood pressure in essential hypertension are related to polymorphic differences in the aldosterone synthase gene CYP11B2. Hypertension. 1999;33(2):703-7.##Jaganmohan P, Narayana Rao SVL, Sambasiva Rao KRS. 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Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms in Male Partners of Recurrent Miscarriage Couples 2 1 634 2 Background: Methylenetetrahydrofolate reductase (MTHFR) single-nucleotide polymorphisms (SNPs) C677T and A1298C have been described as strong risk factors for idiopathic recurrent miscarriage (RM). However, very few studies have investigated the association of paternal MTHFR SNPs with RM. The aim of the present study was to evaluate the prevalence of paternal C677T and A1298C SNPs among Iranian RM couples. Methods: The study subjects comprised 225 couples with more than three consecutive pregnancy losses, and 100 control couples with no history of pregnancy complications. All females in the case group had MTHFR polymorphisms; and genotype SNPs were analyzed by PCR-RFLP. Groups were statistically compared using Mann Whitney U-test and Chi-square statistical tests. The p<0.05 were considered significant. Results: Statistically significant difference was detected in the frequency of MTHFR SNPs in male partners of the two groups (p=0.019). Combined heterozygosity of MTHFR polymorphisms was a common phenomenon in the males; 52 (23.1%) and 14 (14%) of males in RM and control groups, respectively. Absence of combined homozygosity for both SNPs in all studied groups/genders was observed. Conclusion: The MTHFR gene composition of male partners of RM couples may contribute to increased risk of miscarriage. 193 199 Somayeh-Sadat S Tara Department of Genetics, Science and Research Branch, Islamic Azad University Department of Genetics, Science and Research Branch, Islamic Azad University Iran Fatemeh F Ghaemimanesh Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR Iran Saeed S Zarei سعید زارعی Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR Iran Fakhreddin F Reihani-Sabet Avicenna Infertility Clinic, Avicenna Research Institute, ACECR Avicenna Infertility Clinic, Avicenna Research Institute, ACECR Iran Zhamak Z Pahlevanzadeh Avicenna Infertility Clinic, Avicenna Research Institute, ACECR Avicenna Infertility Clinic, Avicenna Research Institute, ACECR Iran Mohammad Hossein MH Modarresi محمدحسین مدرسی Department of Medical Genetics, Tehran University of Medical Sciences Department of Medical Genetics, 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 mahjed@avicenna.ac.ir; mahjed@yahoo.com Male partnersMethylenetetrahydrofolate reductasePolymorphismRecurrent miscarriageThrombophilia 634.pdf Stirling Y, Woolf L, North WR, Seghatchian MJ, Meade TW. 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A common mutation in the 5,10-methylenetetrahydrofolate reductase gene affects genomic DNA methylation through an interaction with folate status. Proc Natl Acad Sci USA. 2002;99(8):5606-11.##Jacob RA, Gretz DM, Taylor PC, James SJ, Pogribny IP, Miller BJ, et al. Moderate folate depletion increases plasma homocysteine and decreases lymphocyte DNA methylation in postmenopausal women. J Nutr. 1998;128(7):1204-12.##Stern LL, Mason JB, Selhub J, Choi SW. Genomic DNA hypomethylation, a characteristic of most cancers, is present in peripheral leukocytes of individuals who are homozygous for the C677T polymorphism in the methylenetetrahydrofolate reductase gene. Cancer Epidemiol Biomarkers Prev. 2000;9(8):849-53.##Kang SS, Wong PW, Susmano A, Sora J, Norusis M, Ruggie N. Thermolabile methylenetetrahydrofolate reductase: an inherited risk factor for coronary artery disease. Am J Hum Genet. 1991;48(3):536-45.##van der Put NM, Gabreels F, Stevens EM, Smeitink JA, Trijbels FJ, Eskes TK, et al. A second common mutation in the methylenetetrahydrofolate reductase gene: an additional risk factor for neural-tube defects? Am J Hum Genet. 1998;62(5):1044-51.##Altmae S, Stavreus-Evers A, Ruiz JR, Laanpere M, Syvanen T, Yngve A, et al. Variations in folate pathway genes are associated with unexplained female infertility. Fertil Steril. 2010;94(1):130-7.##Govindaiah V, Naushad SM, Prabhakara K, Krishna PC, Radha Rama Devi A. Association of parental hyperhomocysteinemia and C677T Methylene tetrahydrofolate reductase (MTHFR) polymorphism with recurrent pregnancy loss. Clin Biochem. 2009;42(4-5):380-6.##Jeddi-Tehrani M, Torabi R, Zarnani AH, Mohammadzadeh A, Arefi S, Zeraati H, et al. Analysis of plasminogen activator inhibitor-1, integrin beta3, beta fibrinogen, and methylenetetrahydrofolate reductase polymorphisms in Iranian women with recurrent pregnancy loss. Am J Reprod Immunol. 2011;66(2):149-56.##Jivraj S, Rai R, Underwood J, Regan L. Genetic thrombophilic mutations among couples with recurrent miscarriage. Hum Reprod. 2006;21(5):1161-5.##Toth B, Vocke F, Rogenhofer N, Friese K, Thaler CJ, Lohse P. Paternal thrombophilic gene mutations are not associated with recurrent miscarriage. Am J Reprod Immunol. 2008;60(4):325-32.##Miranda-Vilela AL, Lordelo GS, Akimoto AK, Alves PC, Pereira LC, Klautau-Guimaraes Mde N, et al. Genetic polymorphisms influence runners' responses to the dietary ingestion of antioxidant supplementation based on pequi oil (Caryocar brasiliense Camb.): a before-after study. Genes Nutr. 2011;6(4):369-95.##Rotondo JC, Bosi S, Bazzan E, Di Domenico M, De Mattei M, Selvatici R, et al. Methylenetetrahydrofolate reductase gene promoter hypermethylation in semen samples of infertile couples correlates with recurrent spontaneous abortion. Hum Reprod. 2012;27(12):3632-8.##Rajender S, Avery K, Agarwal A. Epigenetics, spermatogenesis and male infertility. Mutat Res. 2011;727(3):62-71.##Piedrahita JA. The role of imprinted genes in fetal growth abnormalities. Birth Defects Res A Clin Mol Teratol. 2011;91(8):682-92.##Diplas AI, Lambertini L, Lee MJ, Sperling R, Lee YL, Wetmur J, et al. Differential expression of imprinted genes in normal and IUGR human placentas. Epigenetics. 2009;4(4):235-40.##Georgiades P, Watkins M, Burton GJ, Ferguson-Smith AC. Roles for genomic imprinting and the zygotic genome in placental development. Proc Natl Acad Sci USA. 2001;98(8):4522-7.##Lim AL, Ferguson-Smith AC. Genomic imprinting effects in a compromised in utero environment: implications for a healthy pregnancy. Semin Cell Dev Biol. 2010;21(2):201-8.##Serman L, Vlahovic M, Sijan M, Bulic-Jakus F, Serman A, Sincic N, et al. The impact of 5-azacytidine on placental weight, glycoprotein pattern and proliferating cell nuclear antigen expression in rat placenta. Placenta. 2007;28(8-9):803-11.##Vilain A, Vogt N, Dutrillaux B, Malfoy B. DNA methylation and chromosome instability in breast cancer cell lines. FEBS Lett. 1999;460(2):231-4.##Hobbs CA, Sherman SL, Yi P, Hopkins SE, Torfs CP, Hine RJ, et al. Polymorphisms in genes involved in folate metabolism as maternal risk factors for Down syndrome. Am J Hum Genet. 2000;67(3):623-30.##Robberecht C, Pexsters A, Deprest J, Fryns JP, D'Hooghe T, Vermeesch JR. Cytogenetic and morphological analysis of early products of conception following hystero-embryoscopy from couples with recurrent pregnancy loss. Prenat Diagn. 2012;32(10):933-42.##Stangler Herodez S, Zagradisnik B, Erjavec Skerget A, Zagorac A, Takac I, Vlaisavljevic V, et al. MTHFR C677T and A1298C Genotypes and Haplotypes in Slovenian Couples with Unexplained Infertility Problems and in Embryonic Tissues from Spontaneous Abortions. Balkan J Med Genet. 2013;16(1):31-40.##

Allergy and Uterine Leiomyomas: Cooperative Interaction with ACP1 Genetic Polymorphism 2 1 635 2 Background: The possible association between allergy and neoplastic disorders has been the subject of many investigations but no general relationship has been determined. Little attention, however, has been paid to the possible role of allergy in the clinical manifestations of these diseases. In this study, the role of allergy in the susceptibility to uterine leiomyomas and in their growth was investigated. Interaction with ACP1, a genetic polymorphism associated with the growth of leiomyomas, has been also considered. Methods: Two hundred and three White woman from the population of Rome hospitalized for symptomatic leiomyomas requiring surgical intervention have been studied. One hundred thirty eight healthy women have been considered as controls. Allergy has been evaluated by prick test. T-test for equality of means, analysis of variance and linear correlation analysis has been performed. The level of statistical significance was set at 0.05. Results: The frequency of allergic manifestations in women with leiomyomas does not differ from healthy women. The dimension of leiomyomas is lower in allergic than in non allergic women (p=0.004). The ACP1 *B/*B genotype and allergy cooperate in lowering the dimension of leiomyomas; the proportion of woman with small leiomyomas (<10 percentile) is much higher in allergic women carrying the *B/*B genotype as compared to other women (p<0.001). About 8% of variance of leiomyomas dimension is attributable to the joint effect of ACP1 and allergy. Conclusion: Allergic women with high concentration of ACP1 f isoform (*B/*B genotype) are protected from excessive leyomioma growth. If confirmed in other clinical settings, our observation may have practical importance in identifying women at risk of more severe clinical manifestations. 199 203 Fulvia F Gloria-Bottini Department of Biomedicine and Prevention, University of Rome Tor Vergata Department of Biomedicine and Prevention, University of Rome Tor Vergata Italy gloria@med.uniroma2.it Maria M Ammendola Department of Obstetrics and Gynecology, P. Colombo Hospital Department of Obstetrics and Gynecology, P. Colombo Hospital Italy Patrizia P Saccucci Department of Biomedicine and Prevention, University of Rome Tor Vergata Department of Biomedicine and Prevention, University of Rome Tor Vergata Italy Adalgisa A Pietropolli Department of Biomedicine and Prevention, University of Rome Tor Vergata Department of Biomedicine and Prevention, University of Rome Tor Vergata Italy Anna A Neri Department of Biomedicine and Prevention, University of Rome Tor Vergata Department of Biomedicine and Prevention, University of Rome Tor Vergata Italy Andrea A Magrini Department of Biomedicine and Prevention, University of Rome Tor Vergata Department of Biomedicine and Prevention, University of Rome Tor Vergata Italy Egidio E Bottini Department of Biomedicine and Prevention, University of Rome Tor Vergata Department of Biomedicine and Prevention, University of Rome Tor Vergata Italy Acid phosphatase locus 1AllergyUterine Leiomyomas 635.pdf Engkilde K, Thyssen JP, Menne T, Johansen JD. Association between cancer and contact allergy: a linkage study. BMJ Open. 2011;1(1):e000084.##Roncarolo F, Infante-Rivard C. Asthma and risk of brain cancer in children. Cancer Causes Control. 2012;23(4):617-23.##Rittmeyer D, Lorentz A. Relationship between allergy and cancer: an overview. Int Arch Allergy Immunol. 2012;159(3):216-25.##Stott-Miller M, Chen C, Doody DR, Carter JL, Galloway DA, Madeleine MM, et al. A history of allergies is associated with reduced risk of oral squamous cell carcinoma. Cancer Causes Control. 2012;23(12):1911-9.##Chae YK, Neagu S, Kim J, Smyrlis A, Gooptu M, Tester W. Association between common allergic symptoms and cancer in the NHANES III female cohort. PLoS One. 2012;7(9):e42896.##Ammendola ML, Pietropolli A, Lista F, Saccucci P, Piccione E, Bottini E, et al. Is there an association between uterine leiomyomas and acid phosphatase locus 1 polymorphism? Am J Obstet Gynecol. 2009;200(1):110.e1-5.##Bottini N, Bottini E, Gloria-Bottini F, Mustelin T. Low-molecular-weight protein tyrosine phosphatase and human disease: in search of biochemical mechanisms. Arch Immunol Ther Exp (Warsz). 2002;50(2):95-104.##Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725-36.##Stefani M, Caselli A, Bucciantini M, Pazzagli L, Dolfi F, Camici G, et al. Dephosphorylation of tyrosine phosphorylated synthetic peptides by rat liver phosphotyrosine protein phosphatase isoenzymes. FEBS Lett. 1993;326(1-3):131-4.##

HbA1c in Patients with Polycystic Ovary Syndrome: A Potential Marker of Inflammation 2 1 646 2 Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is associated with increased inflammation, insulin resistance, and elevated risk of metabolic complications. hs-CRP is the most reliable marker of inflammation in PCOS patients. When hs-CRP is elevated, it can indicate increased risk of cardiovascular disease. The purpose of the study was to determine if a certain value of HbA1c in PCOS patients should alert clinicians to increased inflammation (as defined by hs-CRP >2 mg/l), thus potentially be indicative of increased risk of cardiovascular disease. Methods: A cohort study was conducted on female patients between the ages of 20 to 45 years who fulfilled the National Institute of Health criteria for PCOS. De-identified data of 46 patients with PCOS were obtained. All clinical tests were conducted after a 12 hr overnight fast. hs-CRP was measured by latex-enhanced immunonephelometry. Logistic regression analysis was conducted to assess the association between hs-CRP and HbA1c. Results: When various HbA1c levels were considered, a cutoff of 5.3% correctly classified patients with hs-CRP >2 mg/l at 80.4%. Sensitivity was 83.3% and specificity was 75%. Conclusion: An HbA1c cut off of 5.3% may be appropriate to initiate efforts for early detection of increased inflammation as a potential sign of risk for cardiovascular disease. 203 207 Rami R Mortada Department of Internal Medicine, School of Medicine-Wichita, University of Kansas, Wichita Department of Internal Medicine, School of Medicine-Wichita, University of Kansas, Wichita USA Ken K Kallail Department of Internal Medicine, School of Medicine-Wichita, University of Kansas, Wichita Department of Internal Medicine, School of Medicine-Wichita, University of Kansas, Wichita USA kkallail@kumc.edu Frank F Dong Department of Preventive Medicine and Public Health, School of Medicine-Wichita, University of Kansas, Wichita Department of Preventive Medicine and Public Health, School of Medicine-Wichita, University of Kansas, Wichita USA Sidika S Karakas Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of California-Davis Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of California-Davis USA Cardiovasculer diseaseHbA1chs-CRPInflammationPolycystic ovary syndrome 646.pdf Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456-88.##National Institutes of Health [Internet]. Maryland: National Institutes of Health; 1986-2014. Evidence-based Methodology Workshop on Polycystic Ovary Syndrome; 2012 Dec 3 [cited 2014 Jan 3]; [about 8 screens]. Available from: http://prevention.nih.gov/workshops/2012/pcos/docs/FinalReport.pdf.##Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(4):1929-35.##Lo JC, Feigenbaum SL, Yang J, Pressman AR, Selby JV, Go AS. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91(4):1357-63.##Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22(1):141-6.##Gonzalez F, Rote NS, Minium J, Kirwan JP. Increased activation of nuclear factor kappaB triggers inflammation and insulin resistance in polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91(4):1508-12.##Boulman N, Levy Y, Leiba R, Shachar S, Linn R, Zinder O, et a. Increased C-reactive protein levels in the polycystic ovary syndrome: a marker of cardiovascular disease. J Clin Endocrinol Metab. 2004;89(5):2160-5.##Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107(3):363-9.##Escobar-Morreale HF, Luque-Ramirez M, Gonzalez F. Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis.Fertil Steril. 2011;95(3):1048-58.e1-2.##Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499-511.##Zacho J, Tybjaerg-Hansen A, Jensen JS, Grande P, Sillesen H, Nordestgaard BG. Genetically elevated C-reactive protein and ischemic vascular disease. N Engl J Med. 2008;359(18):1897-908.##Walter DH, Fichtlscherer S, Britten MB, Rosin P, Auch-Schwelk W, Schachinger V, et al. Statin therapy, inflammation and recurrent coronary events in patients following coronary stent implantation. J Am Coll Cardiol. 2001;38(7):2006-12.##Seshadri P, Iqbal N, Stern L, Williams M, Chicano KL, Daily DA, et al. A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity. Am J Med. 2004;117(6):398-405.##Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GR, editors. Polycystic Ovary Syndrome. Boston: Blackwell Scientific Publications; 1992. p. 377–84.##Mortada R, Comerford K, Kallail KJ, Karakas SE. Utility of hemoglobin-A1C in nondiabetic women with polycystic ovary syndrome. Endocr Pract. 2013;19(2):284-9.##Kushner I. The phenomenon of the acute phase response. Ann N Y Acad Sci. 1982;389:39-48.##Ouchi N, Kihara S, Funahashi T, Nakamura T, Nishida M, Kumada M, et al. Reciprocal association of C-reactive protein with adiponectin in blood stream and adipose tissue. Circulation. 2003;107(5):671-4.##Zwaka TP, Hombach V, Torzewski J. C-reactive protein-mediated low density lipoprotein uptake by macrophages: implications for atherosclerosis. Circulation. 2001;103(9):1194-7.##Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889-934.##Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, et al. Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab. 2007;92(7):2500-5.##Wander K, Brindle E, O'Connor KA. C-reactive protein across the menstrual cycle. Am J Phys Anthropol. 2008;136(2):138-46.##

The Effect of a Newly Designed Needle on the Pain and Bleeding of Patients During Oocyte Retrieval of a Single Follicle 2 1 656 2 Background: The purpose of this study was to evaluate the effect of needle type on pain and bleeding during oocyte pick-up (OPU). Methods: From May through November 2013, patients undergoing OPU from a single follicle without any analgesic treatment were including this study. Eligible patients (n=75) were randomized 1:1 to undergo the procedure with either a reduced needle (17 gauge body, 20 gauge tip; RN group) or a standard needle (19 gauge; SN group). Overall pain was assessed by patients using a visual analogue scale (VAS), and vaginal bleeding after the procedure was recorded. Fisher exact, t-test or Wilcoxon test were used, and p<0.05 was considered to be statistically significant. Results: The percentage of mature oocytes was 86.5% in the RN group and 91.7% in the SN group. Pain during OPU was significantly lower in the RN group than in the SN group (mean VAS score±SD: 3.2±2.0 cm vs. 4.9±2.2 cm, p<0.01; mean±SD). The frequency of bleeding in the RN group was also significantly lower than that in the SN group (26.3% vs. 48.6%; p<0.05). No significant differences were found between the two groups with regard to fertilization and pregnancy rates. Conclusion: The newly designed needle significantly reduced pain and vaginal bleeding associated with single-follicle OPU in patients receiving no analgesic treatment, in comparison with a standard needle. The RN had no adverse effect on the quality of retrieved oocytes. 207 212 Koji K Nakagawa Division of Reproductive Medicine, Sugiyama Clinic Division of Reproductive Medicine, Sugiyama Clinic Japan koji@sugiyama.or.jp Yayoi Y Nishi Division of Reproductive Medicine, Sugiyama Clinic Division of Reproductive Medicine, Sugiyama Clinic Japan Masayo M Kaneyama Division of Reproductive Medicine, Sugiyama Clinic Division of Reproductive Medicine, Sugiyama Clinic Japan Rie R Sugiyama Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi Japan Hiroshi H Motoyama Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi Japan Rikikazu R Sugiyama Division of Reproductive Medicine, Sugiyama Clinic Division of Reproductive Medicine, Sugiyama Clinic Japan Aspiration needleBleedingOocyte aspirationPain 656.pdf Wikland M, Enk L, Hamberger L. Transvesical and transvaginal approaches for the aspiration of follicles by use of ultrasound. Ann N Y Acad Sci. 1985;442:182-94.##Nakagawa K, Nishi Y, Sugiyama R, Jyuen H, Takahashi Ch, Ojiro Y, et al. A programmed schedule of oocyte retrieval using mild ovarian stimulation (clomiphene citrate and recombinant follicular stimulating hormone). Reprod Med Biol. 2012;11(2):85-9.##Sugiyama R, Nakagawa K, Nishi Y, Ojiro Y, Juen H, Sugiyama R, et al. Using a mild stimulation protocol combined with clomiphene citrate and recombinant follicle-stimulation hormone to determine the optimal number of oocytes needed to achieve pregnancy and reduce the concerns of patients. Reprod Med Biol. 2013; 12(3):105-10.##Wikland M, Blad S, Bungum L, Hillensjo T, Karlstrom PO, Nilsson S. A randomized controlled study comparing pain experience between a newly designed needle with a thin tip and a standard needle for oocyte aspiration. Hum Reprod. 2011;26(6):1377-83.##McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18(4):1007-19.##Nakagawa K, Shirai A, Nishi Y, Sugiyama R, Kuribayashi Y, Sugiyama R, et al. A study of an extremely low oxygen concentration on the development of human embryos in assisted reproductive technology. Reprod Med Biol. 2010;9(3):163-8.##Nakagawa K, Takahashi C, Nishi Y, Jyuen H, Sugiyama R, Kuribayashi Y, et al. Hyaluronan-enriched transfer medium improves outcome in patients with multiple embryo transfer failures. J Assist Reprod Genet. 2012;29(7):679-85.##Sugiyama R, Nakagawa K, Shirai A, Sugiyama R, Nishi Y, Kuribayashi Y, et al. Clinical outcomes resulting from the transfer of vitrified human embryos using a new device for cryopreservation (plastic blade). J Assist Reprod Genet. 2010;27(4):161-7.##Kwan I, Bhattacharya S, Knox F, McNeil A. Conscious sedation and analgesia for oocyte retrieval during IVF procedures: a Cochrane review. Hum Reprod. 2006;21(7):1672-9.##Bols PE, Van Soom A, Ysebaert MT, Vandenheede JM, de Kruif A. Effects of aspiration vacuum and needle diameter on cumulus oocyte complex morphology and developmental capacity of bovine oocytes. Theriogenology. 1996;45(5):1001-14.##Bols PE, Ysebaert MT, Van Soom A, de Kruif A. Effects of needle tip bevel and aspiration procedure on the morphology and developmental capacity of bovine compact cumulus oocyte complexes. Theriogenology. 1997;47(6):1221-36.##

Effect of Omega-3 Supplementation on Visfatin, Adiponectin, and Anthropometric Indices in Women with Polycystic Ovarian Syndrome 2 1 643 2 Background: Polycystic ovary syndrome (PCOS) is a multifactorial, metabolic disorder. Characteristics are chronic anovulation, polycystic ovaries and hyperandrogenism. The aim of this study was to determine the effect of omega-3 supplementation on visfatin, adiponectin, and anthropometric indices in PCOS women. Methods: The study was a randomized double blind placebo-controlled clinical trial. It was conducted on 84 women with polycystic ovary syndrome (26.92±5.05 years, BMI=31.69 Kg/m2) who referred to the fertility and infertility research center and Shahid Sadoughi hospital in Yazd. After the examination, evaluation and paramedical assessment by obstetrician, they were recruited. They took 3 capsules of omega-3 (each one contained 180 mg EPA and 120 mg DHA) or placebo (each contained 1 g paraffin) daily for 8 weeks. Statistical analysis was paired T-test and student T-test, and a p<0.05 was considered statistically significant. Results: After the intervention, visfatin concentration did not change in neither groups. But, at the end of the study, the mean of adiponectin concentration increased (p<0.001) in omega-3 group. Moreover, the mean of changes in this factor was significantly different between groups (p<0.005). FSH did not change in two groups of the study. However, the mean of LH decreased about 1.74 mlU/ml in omega-3 group (p<0.005). The mean of change of LH/FSH ratio between groups was significant (p<0.05). After the intervention, prolactin did not meaningfully change in both groups. Conclusion: Our results showed that 8 weeks of supplementation of omega-3 may have some beneficial effects on PCOS biochemical characteristics such as LH, LH/FSH, and adiponectin. 212 221 Azadeh A Nadjarzadeh Nutrition and Food Security Research Centre, Shahid Sadoughi University of Medical Sciences Nutrition and Food Security Research Centre, Shahid Sadoughi University of Medical Sciences Iran Razieh R Dehghani-Firouzabadi Razieh Dehghani-Firouzabadi Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Iran Hoorieh H Daneshbodi International Campus, Shahid Sadoughi University of Medical Sciences International Campus, Shahid Sadoughi University of Medical Sciences Iran h_daneshbodi@ssu.ac.ir Mohammad Hassan MH Lotfi Department of Biostatistics & Epidemiology, Faculty of Health, Shahid Sadoughi University of Medical Sciences Department of Biostatistics & Epidemiology, Faculty of Health, Shahid Sadoughi University of Medical Sciences Iran Niloofar N Vaziri International Campus, Shahid Sadoughi University of Medical Sciences International Campus, Shahid Sadoughi University of Medical Sciences Iran Hassan H Mozaffari-Khosravi Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences Iran AdiponectinFertilityFSHLHObesityOmega-3PCOSVisfatin 643.pdf Witchel SF. Puberty and polycystic ovary syndrome. Mol Cell Endocrinol. 2006;254-255:146-53.##Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011;(7):CD007506.##Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol. 2011;9:39.##Franks S, McCarthy MI, Hardy K. Development of polycystic ovary syndrome: involvement of genetic and environmental factors. Int J Androl. 2006;29(1):278-85.##Xita N, Georgiou I, Tsatsoulis A. The genetic basis of polycystic ovary syndrome. Eur J Endocrinol. 2002;147(6):717-25.##Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011;7(4):219-31.##Kwintkiewicz J, Spaczynski RZ, Foyouzi N, Pehlivan T, Duleba AJ. Insulin and oxidative stress modulate proliferation of rat ovarian theca-interstitial cells through diverse signal transduction pathways. Biol Reprod. 2006;74(6):1034-40.##Park S, Park Y. Effects of dietary fish oil and trans fat on rat aorta histopathology and cardiovascular risk markers. Nutr Res Pract. 2009;3(2):102-7.##Poudyal H, Panchal SK, Diwan V, Brown L. Omega-3 fatty acids and metabolic syndrome: effects and emerging mechanisms of action. Prog Lipid Res. 2011;50(4):372-87.##Gallagher ML. Krause’s food and nutrition therapy. 12th ed. St Louis, Missouri: Saunders Elsevier; 2008. Chapter 3, The nutrients and their metabolism; p. 39-143.##Allahbadia GN, Merchant R. Polycystic ovary syndrome and impact on health. Middle East Fertil Soc J. 2010;16(1):19-37.##Xita N, Tsatsoulis A. Review: Fetal programming of polycystic ovary syndrome by androgen excess: evidence from experimental, clinical, and genetic association studies. J Clin Endocrinol Metab. 2006;91(5):1660-6.##Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D. Anti-Mullerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: relationship with increased luteinizing hormone levels. Am J Physiol Endocrinol Metab. 2009;296(2):E238-43.##Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115(5):911-9.##Hainault I, Carlotti M, Hajduch E, Guichard C, Lavau M. Fish oil in a high lard diet prevents obesity, hyperlipemia, and adipocyte insulin resistance in rats. Ann N Y Acad Sci. 1993;683:98-101.##Belzung F, Raclot T, Groscolas R. Fish oil n-3 fatty acids selectively limit the hypertrophy of abdominal fat depots in growing rats fed high-fat diets. Am J Physiol. 1993;264(6 Pt 2):R1111-8.##Sara CC, Bello NT. Omega-3 Fatty Acids and Obesity. J Food Nutr Disord. 2012;1:2.##Stofkova A. Resistin and visfatin: regulators of insulin sensitivity, inflammation and immunity. Endocr Regul. 2010;44(1):25-36.##Plati E, Kouskouni E, Malamitsi-Puchner A, Boutsikou M, Kaparos G, Baka S. Visfatin and leptin levels in women with polycystic ovaries undergoing ovarian stimulation. Fertil Steril. 2010;94(4):1451-6.##Varma V, Yao-Borengasse A, Rasouli N, Bodles AM, Phanavanh B, Lee MJ, et al. Human visfatin expression: relationship to insulin sensitivity, intramyocellular lipids, and inflammation. J Clin Endocrinol Metab. 2007;92(2):666-72.##Chen MP, Chung FM, Chang DM, Tsai JC, Huang HF, Shin SJ, et al. Elevated plasma level of visfatin/pre-B cell colony-enhancing factor in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab. 2006;91(1):295-9.##Ozkaya M, Cakal E, Ustun Y, Engin-Ustun Y. Effect of metformin on serum visfatin levels in patients with polycystic ovary syndrome. Fertil Steril. 2010;93(3):880-4.##Sandeep S, Velmurugan K, Deepa R, Mohan V. Serum visfatin in relation to visceral fat, obesity, and type 2 diabetes mellitus in Asian Indians. Metabolism. 2007;56(4):565-70.##Kowalska I, Straczkowski M, Nikolajuk A, Adamska A, Karczewska-Kupczewska M, Otziomek E, et al. Serum visfatin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome. Hum Reprod. 2007;22(7):1824-9.##Rossi AS, Lombardo YB, Lacorte JM, Chicco AG, Rouault Ch, Slama G, et al. Dietary fish oil positively regulates plasma leptin and adiponectin levels in sucrose-fed, insulin-resistant rats. Am J Physiol Regul Integr Comp Physiol. 2005;289(2):R486-R494.##Hajianfar H, Hosseinzadeh MJ, Bahonar A, Mohammad K, Askari GR, Entezari MH, et al. The effect of omega-3 on the serum visfatin concentration in patients with type II diabetes. J Res Med Sci. 2011;16(4):490-5.##Mamaghani F, Zarghami N, Malekiet MJ, Pourhassan-Moghaddam M, Hosseinpanah F. Variation of adiponectin levels in normal and obese subjects: possible correlation with lipid profiles. Int J Endocrinol Metab. 2009;7(3):170-8.##Panidis D, Kourtis A, Farmakiotis D, Mouslech T, Rousso D, Koliakos G. Serum adiponectin levels in women with polycystic ovary syndrome. Hum Reprod. 2003;18(9):1790-6.##Escobar-Morreale HF, Villuendas G, Botella-Carretero JI, Alvarez-Blasco F, Sanchon R, Luque-Ramirez M, et al. Adiponectin and resistin in PCOS: a clinical, biochemical and molecular genetic study. Hum Reprod. 2006;21(9):2257-65.##Mohammadi E, Rafraf M, Farzadi L, Asghari-Jafarabadi M, Sabour S. Effects of omega-3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome. Asia Pac J Clin Nutr. 2012;21(4):511-8.##Barontini M, Garcia-Rudaz MC, Veldhuis JD. Mechanisms of hypothalamic-pituitary-gonadal disruption in polycystic ovarian syndrome. Arch Med Res. 2001;32(6):544-52.##Spritzer PM, Poy M, Wiltgen D, Mylius LS, Capp E. Leptin concentrations in hirsute women with polycystic ovary syndrome or idiopathic hirsutism: influence on LH and relationship with hormonal, metabolic, and anthropometric measurements. Hum Reprod. 2001;16(7):1340-6.##Banaszewska B, Spaczynski RZ, Pelesz M, Pawelczyk L. Incidence of elevated LH/FSH ratio in polycystic ovary syndrome women with normo- and hyperinsulinemia. Rocz Akad Med Bialymst. 2003;48:131-4.##Wang Y, Yu P. [Clinical significance and changes of serum visfatin, adiponectin and leptin levels in patients with polycystic ovarian syndrome]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009;34(1):72-5. Chinese.##Lydic M, Juturu V. Dietary approaches and alternative therapies for polycystic ovary syndrome. Curr Nutr Food Sci. 2008;4(4):265-81.##Kasim-Karakas SE, Almario RU, Gregory L, Wong R, Todd H, Lasley BL. Metabolic and endocrine effects of a polyunsaturated fatty acid-rich diet in polycystic ovary syndrome. J Clin Endocrinol Metab. 2004;89(2):615-20.##Kuzmanov AP. Do omega-3 fatty acids affect hormones related to polycystic ovary syndrome infertility? [master's thesis]. [United States]: University of Wyoming; 2010. 81 p.##Ebbesson SO, Risica PM, Ebbesson LO, Kennish JM, Tejero ME. Omega-3 fatty acids improve glucose tolerance and components of the metabolic syndrome in Alaskan Eskimos: the Alaska Siberia project. Int J Circumpolar Health. 2005;64(4):396-408.##Harris WS, Miller M, Tighe AP, Davidson MH, Schaefer EJ. Omega-3 fatty acids and coronary heart disease risk: clinical and mechanistic perspectives. Atherosclerosis. 2008;197(1):12-24.##Anil E. The impact of EPA and DHA on blood lipids and lipoprotein metabolism: influence of apoE genotype. Proc Nutr Soc. 2007;66(1):60-8.##Cussons AJ, Watts GF, Mori TA, Stuckey BG. Omega-3 fatty acid supplementation decreases liver fat content in polycystic ovary syndrome: a randomized controlled trial employing proton magnetic resonance spectroscopy. J Clin Endocrinol Metab. 2009;94(10):3842-8.##Rafraf M, Mohammadi E, Asghari-Jafarabadi M, Farzadi L. Omega-3 fatty acids improve glucose metabolism without effects on obesity values and serum visfatin levels in women with polycystic ovary syndrome. J Am Coll Nutr. 2012;31(5):361-8.##Vargas ML, Almario RU, Buchan W, Kim K, Karakas SE. Metabolic and endocrine effects of long-chain versus essential omega-3 polyunsaturated fatty acids in polycystic ovary syndrome. Metabolism. 2011;60(12):1711-8.##Flachs P, Mohamed-Ali V, Horakova O, Rossmeisl M, Hosseinzadeh-Attar MJ, Hensler M, et al. Polyunsaturated fatty acids of marine origin induce adiponectin in mice fed a high-fat diet. Diabetologia. 2006;49(2):394-7.##Nakatani T, Kim HJ, Kaburagi Y, Yasuda K, Ezaki O. A low fish oil inhibits SREBP-1 proteolytic cascade, while a high-fish-oil feeding decreases SREBP-1 mRNA in mice liver: relationship to anti-obesity. J Lipid Res. 2003;44(2):369-79.##Oh DY, Talukdar S, Bae EJ, Imamura T, Morinaga H, Fan W, et al. GPR120 is an omega-3 fatty acid receptor mediating potent anti-inflammatory and insulin-sensitizing effects. Cell. 2010;142(5):687-98.##Kondo K, Morino K, Nishio Y, Kondo M, Fuke T, Ugi S, et al. Effects of a fish-based diet on the serum adiponectin concentration in young, non-obese, healthy Japanese subjects. J Atheroscler Thromb. 2010;17(6):628-37.##Itoh M, Suganami T, Satoh N, Tanimoto-Koyama K, Yuan X, Tanaka M, et al. Increased adiponectin secretion by highly purified eicosapentaenoic acid in rodent models of obesity and human obese subjects. Arterioscler Thromb Vasc Biol. 2007;27(9):1918-25.##Duda MK, O'Shea KM, Lei B, Barrows BR, Azimzadeh AM, McElfresh TE, et al. Dietary supplementation with omega-3 PUFA increases adiponectin and attenuates ventricular remodeling and dysfunction with pressure overload. Cardiovasc Res. 2007;76(2):303-10.##Higuchi T, Shirai N, Saito M, Suzuki H, Kagawa Y. Levels of plasma insulin, leptin and adiponectin, and activities of key enzymes in carbohydrate metabolism in skeletal muscle and liver in fasted ICR mice fed dietary n-3 polyunsaturated fatty acids. J Nutr Biochem. 2008;19(9):577-86.##Nettleton JA, Katz R. n-3 long-chain polyunsaturated fatty acids in type 2 diabetes: a review. J Am Diet Assoc. 2005;105(3):428-40.##Phelan N, O'Connor A, Kyaw Tun T, Correia N, Boran G, Roche HM, et al. Hormonal and metabolic effects of polyunsaturated fatty acids in young women with polycystic ovary syndrome: results from a cross-sectional analysis and a randomized, placebo-controlled, crossover trial. Am J Clin Nutr. 2011;93(3):652-62.##Kuzmanov A, Broughton KS. Role of marine omega-3 fatty acids in PCOS cancer risk. Proceedings of the 13th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI); 2010 November 4-7; Berlin, Germany: Monduzzi Editore; c2010. p. 349-351.##

Experiences of Infertile Women Seeking Assisted Pregnancy in Iran: A Qualitative Study 2 1 629 2 Background: Assisted reproductive technologies (ARTs) are complicated and stressful techniques and the social and cultural norms are major obstacles against their use. Many qualitative studies have been done in the field of women's experiences of infertility, but less is known about the experiences of infertile women seeking assisted pregnancy. The aim of this study was to understand and describe the experience of women who have used assisted reproductive technologies for their current pregnancy. Methods: This qualitative study was conducted based on a content analysis approach. With purposive sampling, 12 pregnant women who were using ART were recruited from Avicenna Fertility Center in Tehran. Women were selected purposefully and with maximum variation. Interviews were performed after a positive test of pregnancy and women were introduced to researchers in their first visit of pregnancy in the prenatal clinic. Interviews were recorded, transcribed verbatim and analyzed concurrently. Semi-structured interviews were coded, categorized and the themes were also identified. Results: Four main themes were uncovered which included struggle to achieve pregnancy, fear and uncertainty, escape from stigma and the pursuit to achieve husband satisfaction. Conclusion: It is essential for these women to be counseled and prepared by their health care providers after the use of ARTs. Distress can be reduced for infertile women seeking assisted pregnancy when they are prepared for possible failures, empowered to deal with stigma, and have their partners’ involvement in counseling sessions. 221 229 Fahimeh F Ranjbar School of Nursing and Midwifery, Tehran University of Medical Sciences School of Nursing and Midwifery, Tehran University of Medical Sciences Iran Zahra Z Behboodi-Moghadam School of Nursing and Midwifery, Tehran University of Medical Sciences School of Nursing and Midwifery, Tehran University of Medical Sciences Iran Leili L Borimnejad School of Nursing and Midwifery, Iran University of Medical Sciences School of Nursing and Midwifery, Iran University of Medical Sciences Iran Saeed Reza SR Ghaffari 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 Assisted reproductive technologyCounselingInfertilityPregnancyQualitative research 629.pdf Macaluso M, Wright-Schnapp TJ, Chandra A, Johnson R, Satterwhite CL, Pulver A, et al. A public health focus on infertility prevention, detection, and management. Fertil Steril. 2010;93(1):16.e1-10.##Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.##Akhondi M, Kamali K, Ranjbar F, Shafeghati S, Ardakani ZB, Shirzad M, et al. Introducing a quantitative method to calculate the rate of primary infertility. Iran J Public Health. 2012;41(12):54-9.##Vahidi S, Ardalan A, Mohammad K. Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005. Asia Pac J Public Health. 2009;21(3):287-93.##Boyle KE, Vlahos N, Jarow JP. Assisted reproductive technology in the new millennium: part II. Urology. 2004;63(2):217-24.##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.##McManus J, McClure N. Complications of assisted reproduction. Obstet Gynaecol. 2002;4(3):124-9.##Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod. 2004;19(10):2313-8.##Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ. 2011;342:d223.##Lukse MP, Vacc NA. Grief, depression, and coping in women undergoing infertility treatment. Obstet Gynecol. 1999;93(2):245-51.##Olivius C, Friden B, Borg G, Bergh C. Why do couples discontinue in vitro fertilization treatment? A cohort study. Fertil Steril. 2004;81(2):258-61.##Sohrabvand F, Jafarabadi M. Knowledge and attitudes of infertile couples about assisted reproductive technology. Iran J Reprod Med. 2005;3(2):90-4.##Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update. 2008;14(6):605-21.##Wilson C, Leese B. Do nurses and midwives have a role in promoting the well-being of patients during their fertility journey? A review of the literature. Hum Fertil (Camb). 2013;16(1):2-7.##Dornelles LM, MacCallum F, Lopes RC, Piccinini CA, Passos EP. 'Living each week as unique': maternal fears in assisted reproductive technology pregnancies. Midwifery. 2014;30(3):e115-20.##Behboodi-Moghadam Z, Salsali M, Eftekhar-Ardabily H, Vaismoradi M, Ramezanzadeh F. Experiences of infertility through the lens of Iranian infertile women: a qualitative study. Jpn J Nurs Sci. 2013;10(1):41-6.##Mosalanejad L, Parandavar N, Gholami M, Abdollahifard S. Increasing and decreasing factors of hope in infertile women with failure in infertility treatment: A phenomenology study. Iran J Reprod Med. 2014;12(2):117-24.##Abbasi-Shavazi MJ, Inhorn MC, Razeghi-Nasrabad HB, Toloo G. The “Iranian ART Revolution”: Infertility, assisted reproductive technology, and third-party donation in the Islamic Republic of Iran. J Middle East Womens Stud. 2008;4(2):1-28.##Morshed-Behbahani B, Mossalanejad L, Shahsavari S, Dastpak M. The experiences of infertile women on assistant reproductive treatments: a phenomenological study. Iran Red Crescent Med J. 2012;14(6):382-3.##Khodakarami N, Hashemi S, Seddigh S, Hamdiyeh M, Taheripanah R. Life Experience with Infertility; a Phenomenological Study. J Reprod Infertil. 2010;10(4):287-98.##Tremayne S. The dilemma of assisted reproduction in Iran. Facts Views Vis Obgyn. 2012:70-4.##Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-15.##van Teijlingen E, Forrest K. The range of qualitative research methods in family planning and reproductive health care. J Fam Plann Reprod Health Care. 2004;30(3):171-3.##Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12.##Hammarberg K, Astbury J, Baker H. Women's experience of IVF: a follow-up study. Hum Reprod. 2001;16(2):374-83.##Akizuki Y, Kai I. Infertile Japanese women's perception of positive and negative social interactions within their social networks. Hum Reprod. 2008;23(12):2737-43.##Redshaw M, Hockley C, Davidson LL. A qualitative study of the experience of treatment for infertility among women who successfully became pregnant. Hum Reprod. 2007;22(1):295-304.##Gnoth C, Maxrath B, Skonieczny T, Friol K, Godehardt E, Tigges J. Final ART success rates: a 10 years survey. Hum Reprod. 2011;26(8):2239-46.##Sanders KA, Bruce NW. Psychosocial stress and treatment outcome following assisted reproductive technology. Hum Reprod. 1999;14(6):1656-62.##Hasanpoor-Azghdy SB, Simbar M, Vedadhir A. The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study. Iran J Reprod Med. 2014;12(2):131-8.##Guz H, Ozkan A, Sarisoy G, Yanik F, Yanik A. Psychiatric symptoms in Turkish infertile women. J Psychosom Obstet Gynaecol. 2003;24(4):267-71.##Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Kondo A, Makino T. Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress. Gen Hosp Psychiatry. 2004;26(5):398-404.##van Empel IW, Nelen WL, Tepe ET, van Laarhoven EA, Verhaak CM, Kremer JA. Weaknesses, strengths and needs in fertility care according to patients. Hum Reprod. 2010;25(1):142-9.##Slade P, O'Neill C, Simpson AJ, Lashen H. The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. Hum Reprod. 2007;22(8):2309-17.##Goffman E. Essays on the social situation of mental patients and other inmates. 1 st ed. Garden City, NY: Anchor Books; 1961. p. 1-386.##Goffman E. Stigma: notes on the management of spoiled identity. Reissue, reprint, New York: Simon & Schuster; 1963. p. 1-147.##Conrad P. Medicalization and social control. Annu Rev Sociol. 1992;18(1):209-32.##Whiteford LM, Gonzalez L. Stigma: the hidden burden of infertility. Soc Sci Med. 1995;40(1):27-36.##Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007;21(2):293-308.##

Reproductive Outcome of Patients with Asherman’s Syndrome: A SAIMS Experience 2 1 660 2 Background: The purpose of the study was to evaluate menstrual and reproductive outcome in patients diagnosed with Asherman’s syndrome on hysteroscopy and to assess the role of hysteroscopic adhesiolysis. Methods: A prospective study was performed for patients having intrauterine adhesion at a tertiary care teaching hospital, Indore, India for a period of 2 years. Findings at hysteroscopy, details of adhesiolysis, changes in menstrual pattern following adhesiolysis, need for repeat procedure and fertility outcome were prospectively collected. Data was analysed using SPSS software. A p-value of <0.05 was considered significant. Results: A total of 60 patients with a mean age of 30.1±5.5 years with Asherman’s syndrome were included. In 53.3% of them, no factors like post-partum curettage, uterine surgery or history of tuberculosis could be found in which the present intrauterine adhesions could be attributed to. Hypomenorrhoea was the most common (53.3%) menstrual pattern in patients diagnosed with Asherman’s syndrome. Thirty eight out of 60 (63.33%) required second look hysteroscopy. There was a significant change in endometrial lining and echo pattern after adhesiolysis (p<0.05). 45% of patients started having normal menstrual flow after adhesiolysis which was statistically significant. A total of 16 conceptions and 10 live births were reported in the present cohort. Pregnancy rate was higher in patients having mild Asherman’s syndrome (53.3%) as compared to moderate (26.9%) or severe type (9.5%), (p=0.0049). It was also higher in patients having normal endometrial pattern after adhesiolysis (p=0.0005). Conclusion: Women who underwent hysteroscopic adhesiolysis showed significant improvement in the menstrual pattern. Pregnancy rates were improved after hysteroscopic adhesiolysis. 229 236 Shilpa Sh Bhandari Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute India drshilpa.b@gmail.com Priya B Bhave Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute India Ishita I Ganguly Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute India Asha A Baxi Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute India Pallavi P Agarwal Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute Department of Reproductive Medicine, Sri Aurobindo Medical College and PG Institute India AdhesiolysisAsherman’s syndromeHysteroscopyMenstrual patternPregnancy 660.pdf ASHERMAN JG. Amenorrhoea traumatica (atretica). J Obstet Gynaecol Br Emp. 1948;55(1):23-30.##Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol. 2013;11:118.##Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril. 1982;37(5):593-610.##Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome--one century later. Fertil Steril. 2008;89(4):759-79.##Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome. Fertil Steril. 2008;89(3):715-22.##Capella-Allouc S, Morsad F, Rongieres-Bertrand C, Taylor S, Fernandez H. Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility. Hum Reprod. 1999;14(5):1230-3.##Preutthipan S, Linasmita V. Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi Hospital. J Med Assoc Thai. 2000;83(1):42-6.##Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G, Singh N. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome. Arch Gynecol Obstet. 2010;281(2):355-61.##Sharma JB, Roy KK, Pushparaj M, Gupta N, Jain SK, Malhotra N, et al. Genital tuberculosis: an important cause of Asherman's syndrome in India. Arch Gynecol Obstet. 2008;277(1):37-41.##Malhotra N, Bahadur A, Kalaivani M, Mittal S. Changes in endometrial receptivity in women with Asherman's syndrome undergoing hysteroscopic adhesiolysis. Arch Gynecol Obstet. 2012;286(2):525-30.##Bukulmez O, Yarali H, Gurgan T. Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechialysis. Hum Reprod. 1999;14(8):1960-1.##Wamsteker K, De Block S. Diagnostic hysteroscopy: technique and documentation. In: Sutton C, Diamond M, editors. Endoscopic Surgery for Gynecologists. London: WB Saunders; 1998. p. 511-24.##Yasmin H, Nasir A, Noorani KJ. Hystroscopic management of Ashermans syndrome. J Pak Med Assoc. 2007;57(11):553-5.##Zikopoulos KA, Kolibianakis EM, Platteau P, de Munck L, Tournaye H, Devroey P, et al. Live delivery rates in subfertile women with Asherman's syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system. Reprod Biomed Online. 2004;8(6):720-5.##Salma U, Xu D, Sheikh SA. Observational study of a new treatment proposal for severe intrauterine adhesions. Int J Biosci. 2011;1(1):43-56.##

Live Birth from ICSI-TESA into In Vitro Matured Oocytes: A Case Report 2 1 650 2 Background: Repeated in vitro Fertilization (IVF) failure together with Ovarian Hyperstimulation Syndrome (OHSS) is one of the distressing situations leading couples to search for alternative treatment options. For such patients with Polycystic Ovarian Syndrome (PCOS) who have experienced Ovarian Hyperstimulation Syndrome, mild ovarian stimulation with in vitro oocyte maturation could be a promising alternative. Testicular Sperm Aspiration (TESA) of spermatozoa from a known obstructive azoospermic patient is a limiting factor for IVM (in vitro maturation) but the couple reported here accepted mild IVF -IVM with TESA. Case Presentation: In the treatment of a 32-year old woman, 9 immature oocytes were retrieved, 5 in vitro matured oocytes (maturation rate 55%) and after fertilization by Intracytoplasmic Sperm Injection (ICSI), 3 oocytes (fertilization rate 60%) which had two pronuclei and two good quality embryos on day 2, were transferred. A live pregnancy was observed by ultrasound scan and healthy infant was delivered. Conclusion: Although the number of births from ICSI of immature oocytes injected with surgically derived sperm is quite low, the selection of this mode of therapy as an alternative to conventional IVF will overcome the limitations and provides a new option in IVF practice. 236 239 Şafak Ş Hatırnaz Clinart IVF Center Clinart IVF Center Turkey Ebru E Hatırnaz Clinart IVF Center Clinart IVF Center Turkey Murat M Bakacak Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University, School of Medicine Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University, School of Medicine Turkey muratbakacak46@gmail. com Mehmet MS Bostancı Department of Obstetrics and Gynecology, Sakarya University Research and Education Hospital Department of Obstetrics and Gynecology, Sakarya University Research and Education Hospital Turkey Melahat M Atasever Department of Obstetrics and Gynecology, Giresun University, School of Medicine Department of Obstetrics and Gynecology, Giresun University, School of Medicine Turkey In vitro maturationOocytePregnancyTesticular sperm aspiration 650.pdf Cha KY, Chian RC. Maturation in vitro of immature human oocytes for clinical use. Hum Reprod Update. 1998;4(2):103-20.##Chian RC, Tan SL. Maturational and developmental competence of cumulus-free immature human oocytes derived from stimulated and intracytoplasmic sperm injection cycles. Reprod Biomed Online. 2002;5(2):125-32.##Mikkelsen AL, Host E, Blaabjerg J, Lindenberg S. Maternal serum supplementation in culture medium benefits maturation of immature human oocytes. Reprod Biomed Online. 2001;3(2):112-6.##Fadini R, Colpi E, Mignini Renzini M, Coticchio G, Comi R, Mastrolilli M, et al. Outcome of cycles of oocyte in vitro maturation requiring testicular sperm extraction for nonobstructive azoospermia. Fertil Steril. 2011;96(2):321-3.##Son WY, Chung JT, Henderson S, Reinblatt S, Buckett W, Chan PT, et al. Fertilization and embryo development with spermatozoa obtained from testicular sperm extraction into oocytes generated from human chorionic gonadotropin-primed in vitro maturation cycles. Fertil Steril. 2013;100(4):989-93.##Trounson A, Wood C, Kausche A. In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients. Fertil Steril. 1994;62(2):353-62.##Abdul-Jalil AK, Child TJ, Phillips S, Dean N, Carrier S, Tan SL. Ongoing twin pregnancy after ICSI of PESA-retrieved spermatozoa into in-vitro matured oocytes: case report. Hum Reprod. 2001;16(7):1424-6.##Sauerbrun-Cutler MT, Vega M, Keltz M, McGovern PG. In vitro maturation and its role in clinical assisted reproductive technology. Obstet Gynecol Surv. 2015;70(1):45-57.##Walls ML, Hunter T, Ryan JP, Keelan JA, Nathan E, Hart RJ. In vitro maturation as an alternative to standard in vitro fertilization for patients diagnosed with polycystic ovaries: a comparative analysis of fresh, frozen and cumulative cycle outcomes. Hum Reprod. 2015;30(1):88-96.##