Endometriosis Classification-The Quest for the Holy Grail? 2 1 683 2 Endometriosis has baffled us for almost a century. Despite important advances, there is a constant struggle to confidently answer many fundamental questions regarding this enigmatic disease. Lack of a widely accepted classification system that accurately describes the extent and severity of the disease and takes into account various phenotypes-in particular deep infiltrative disease- is amongst factors that have hindered research in the field. Furthermore, comparison of surgical outcomes and complication rates requires a tool that accurately describes surgical complexity. Numerous systems for classification or staging of endometriosis have been proposed to date. The most commonly used is currently the revised American Society for Reproductive Medicine (rASRM) (1). rASRM has been criticized for its arbitrary point system, its poor reproducibility and lack of correlation with symptoms (2). Also, this system is unhelpful in describing deep infiltrative endometriosis. The Enzian system (3) attempts to address some of the above problems in more advanced diseases but has failed to gain wide acceptance, perhaps because of its complexity. Endometriosis Fertility Index (EFI) has shown promise in predicting pregnancy outcomes (4) and is the only system validated to predict a clinical outcome in endometriosis but is not designed to benchmark surgical complexity or to correlate with symptoms. Attempts to develop a better classification system are ongoing (2) but are we on the right track? The more we understand endometriosis, the clearer it becomes that the highly complex nature of the disease defies a single all-encompassing classification system. Perhaps a system that accurately describes the surgical findings, whilst correlating with symptoms and predicting fertility outcomes cannot exist as the pathophysiology of the disease and the ways it causes its multitude of symptoms are convoluted. The success of EFI is due to its narrow scope and the fact that it doesn’t aim to solve all the problems at the same time. Therefore, a similar approach is needed to devise a system that limits itself to describing the surgical findings; without attempting to correlate with symptoms or fertility outcomes. We have been working on such a system in the last two years. VNESS (Visual Numeric Endometriosis Surgical Staging) merely describes intra-operative findings using 8 numbers. Each number corresponds to a compartment in the pelvis, starting from the left adnexa, and going down to the pouch of Douglas and back up to the right adnexa. The disease severity in each compartment can be between 0 (No disease) to 4 (Visceral invasion). A "Complexity score" on a scale of 0-10 accompanies VNESS to assist in benchmarking for surgical outcome and complication rates. VNESS does not attempt to correlate with symptoms and only attempts to turn intraoperative findings into quantitative values. Results of validation studies using videotaped procedures with multiple scorers are encouraging, showing excellent intra-observer and inter-observer correlation (5, 6). A classification system is a language for communication and like languages, its survival depends on its simplicity, practicality, flexibility and the number of its users. We are forming an international collaborative group to refine this new language and we invite interested endometriosis surgeons to join us. 067 68 Shaheen Sh Khazali Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford and St. Peter’s Hospitals NHS Foundation Trust Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford and St. Peter’s Hospitals NHS Foundation Trust United Kingdom s.khazali@me.com No Keyword 683.pdf Revised american society for reproductive medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817-21.##Adamson GD. Endometriosis classification: an update. Curr Opin Obstet Gynecol. 2011;23(4):213-20.##Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, et al. [ENZIAN-score, a classification of deep infiltrating endometriosis]. Zentralbl Gynakol. 2005;127(5):275-81. German.##Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010;94(5):1609-15.##Abdalla A, Khazali S. Development and validation of a new Visual Numeric Endometriosis Surgical Score for assessment of pelvic endometriosis using videotaped laparoscopic procedures [thesis]. [UK]: University of Surrey; 2015. p. 56-87.##Padmehr R, Shadjoo K, Mohazzab A, Khazali S. Inter-observer and intra-observer validity of Visual Numeric Endometriosis Surgical Staging Sytem (VNESS), Enzian and r-ASRM using videotaped endometriosis procedures [dissertation]. [Tehran]: Academic Center for Education, Culture and Research (ACECR); 2015.120 p.##

Models predicting success of infertility treatment: A systematic review 2 1 678 2 Background: Infertile couples are faced with problems that affect their marital life. Infertility treatment is expensive and time consuming and occasionally isn’t simply possible. Prediction models for infertility treatment have been proposed and prediction of treatment success is a new field in infertility treatment. Because prediction of treatment success is a new need for infertile couples, this paper reviewed previous studies for catching a general concept in applicability of the models. Methods: This study was conducted as a systematic review at Avicenna Research Institute in 2015. Six data bases were searched based on WHO definitions and MESH key words. Papers about prediction models in infertility were evaluated. Results: Eighty one papers were eligible for the study. Papers covered years after 1986 and studies were designed retrospectively and prospectively. IVF prediction models have more shares in papers. Most common predictors were age, duration of infertility, ovarian and tubal problems. Conclusion: Prediction model can be clinically applied if the model can be statistically evaluated and has a good validation for treatment success. To achieve better results, the physician and the couples’ needs estimation for treatment success rate were based on history, the examination and clinical tests. Models must be checked for theoretical approach and appropriate validation. The privileges for applying the prediction models are the decrease in the cost and time, avoiding painful treatment of patients, assessment of treatment approach for physicians and decision making for health managers. The selection of the approach for designing and using these models is inevitable. 068 82 Alireza A Zarinara Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Hojjat H Zeraati حجت زراعتی Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, TUMS Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, TUMS Iran Koorosh K Kamali Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Kazem K Mohammad کاظم محمد Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, TUMS Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, TUMS Iran Parisa P Shahnazari 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 ARTInfertility treatmentPrediction modelTreatment success 678.pdf Gurunath S, Pandian Z, Anderson RA, Bhattacharya S. 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A case study of the applicability of a prediction model for the selection of patients undergoing in vitro fertilization for single embryo transfer in another center. Fertil Steril. 2007;87(6):1314-21.##Smeenk JM, Stolwijk AM, Kremer JA, Braat DD. External validation of the templeton model for predicting success after IVF. Hum Reprod. 2000;15(5):1065-8.##Erdem A, Erdem M, Atmaca S, Korucuoglu U, Karabacak O. Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online. 2008;17(2):199-206.##Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod. 1996;11(9):1892-6.##Steures P, van der Steeg JW, Mol BW, Eijkemans MJ, van der Veen F, Habbema JD, et al. Prediction of an ongoing pregnancy after intrauterine insemination. Fertil Steril. 2004;82(1):45-51.##Steures P, van der Steeg JW, Hompes PG, Habbema JD, Eijkemans MJ, Broekmans FJ, et al. Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet. 2006;368(9531):216-21.##Stolwijk AM, Wetzels AM, Braat DD. Cumulative probability of achieving an ongoing pregnancy after in-vitro fertilization and intracytoplasmic sperm injection according to a woman's age, subfertility diagnosis and primary or secondary subfertility. Hum Reprod. 2000;15(1):203-9.##Lintsen AM, Eijkemans MJ, Hunault CC, Bouwmans CA, Hakkaart L, Habbema JD, et al. Predicting ongoing pregnancy chances after IVF and ICSI: a national prospective study. Hum Reprod. 2007;22(9):2455-62.##Soria M, Pradillo G, Garcia J, Ramon P, Castillo A, Jordana C, et al. Pregnancy predictors after intrauterine insemination: analysis of 3012 cycles in 1201 couples. J Reprod Infertil. 2012;13(3):158-66.##Isa AM, Abu-Rafea B, Alasiri SA, Al-Mutawa J, Binsaleh S, Al-Saif S, et al. Accurate diagnosis as a prognostic factor in intrauterine insemination treatment of infertile saudi patients. J Reprod Infertil. 2014;15(4):184-9.##La Marca A, Nelson SM, Sighinolfi G, Manno M, Baraldi E, Roli L, et al. Anti-Mullerian hormone-based prediction model for a live birth in assisted reproduction. Reprod Biomed Online. 2011;22(4):341-9.##van Loendersloot LL, van Wely M, Repping S, Bossuyt PM, van der Veen F. Individualized decision-making in IVF: calculating the chances of pregnancy. Hum Reprod. 2013;28(11):2972-80.##Trimarchi JR, Hackett RJ, Pierce DJ, Keefe DL. Mathematical model predicts day 6 transfer outcomes. Fertil Steril. 2002;78(Suppl 1):S140.##Nayudu PL, Gook DA, Hepworth G, Lopata A, Johnston WI. Prediction of outcome in human in vitro fertilization based on follicular and stimulation response variables. 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Predictive value and clinical impact of Basal follicle-stimulating hormone in subfertile, ovulatory women. J Clin Endocrinol Metab. 2007;92(6):2163-8.##Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC. A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertil Steril. 2002;77(1):91-7.##Giwercman A, Lindstedt L, Larsson M, Bungum M, Spano M, Levine RJ, et al. Sperm chromatin structure assay as an independent predictor of fertility in vivo: a case-control study. Int J Androl. 2010;33(1):e221-7.##Ferlitsch K, Sator MO, Gruber DM, Rucklinger E, Gruber CJ, Huber JC. Body mass index, follicle-stimulating hormone and their predictive value in in vitro fertilization. J Assist Reprod Genet. 2004;21(12):431-6.##Bancsi LF, Huijs AM, den Ouden CT, Broekmans FJ, Looman CW, Blankenstein MA, et al. 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Acta Obstet Gynecol Scand. 1987;66(7):617-24.##Snick HK, Snick TS, Evers JL, Collins JA. The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study. Hum Reprod. 1997;12(7):1582-8.##Ottosen LD, Kesmodel U, Hindkjaer J, Ingerslev HJ. Pregnancy prediction models and eSET criteria for IVF patients--do we need more information? J Assist Reprod Genet. 2007;24(1):29-36.##Tjon-Kon-Fat RI, Lar DN, Steyerberg EW, Broekmans FJ, Hompes P, Mol BW, et al. Inter-clinic variation in the chances of natural conception of subfertile couples. Hum Reprod. 2013;28(5):1391-7.##Haan G, Bernardus RE, Hollanders JM, Leerentveld RA, Prak FM, Naaktgeboren N. Results of IVF from a prospective multicentre study. Hum Reprod. 1991;6(6):805-10.##Nachtigall RD. International disparities in access to infertility services. Fertil Steril. 2006;85(4):871-5.##Bonita R, Beaglehole R. Basic Epidemiology. 2nd ed. Geneva: World Health Organization; 2006. 207 p.##Shibahara H, Obara H, Ayustawati, Hirano Y, Suzuki T, Ohno A, et al. Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility. Int J Androl. 2004;27(2):63-8.##Wichmann L, Isola J, Tuohimaa P. Prognostic variables in predicting pregnancy. A prospective follow up study of 907 couples with an infertility problem. Hum Reprod. 1994;9(6):1102-8.##Mol BW, van Wely M, Steyerberg EW. Using prognostic models in clinical infertility. Hum Fertil (Camb). 2000;3(3):199-202.##Luke B, Brown MB, Wantman E, Stern JE, Baker VL, Widra E, et al. A prediction model for live birth and multiple births within the first three cycles of assisted reproductive technology. Fertil Steril. 2014;102(3):744-52.##Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. 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The Effects of Imatinib Mesylate on Cellular Viability, Platelet Derived Growth Factor and Stem Cell Factor in Mouse Testicular Normal Leydig Cells 2 1 658 2 Background: Growth factors play an essential role in the development of tumor and normal cells like testicular leydig cells. Treatment of cancer with anti-cancer agents like imatinib mesylate may interfere with normal leydig cell activity, growth and fertility through failure in growth factors’ production or their signaling pathways. The purpose of the study was to determine cellular viability and the levels of, platelet derived growth factor (PDGF) and stem cell factor (SCF) in normal mouse leydig cells exposed to imatinib, and addressing the effect of imatinib on fertility potential. Methods: The mouse TM3 leydig cells were treated with 0 (control), 2.5, 5, 10 and 20 μM imatinib for 2, 4 and 6 days. Each experiment was repeated three times (15 experiments in each day).The cellular viability and growth factors levels were assessed by MTT and ELISA methods, respectively. For statistical analysis, one-way ANOVA with Tukey's post hoc and Kruskal-Wallis test were performed. A p-value less than 0.05 was considered statistically significant. Results: With increasing drug concentration, cellular viability decreased significantly (p<0.05) and in contrast, PDGF levels increased (p<0.05). Different imatinib concentrations had no significant effect on SCF level. Increasing the duration of treatment from 2 to 6 days had no obvious effect on cellular viability, PDGF and SCF levels. Conclusion: Imatinib may reduce fertility potential especially at higher concentrations in patients treated with this drug by decreasing cellular viability. The effect of imatinib on leydig cells is associated with PDGF stimulation. Of course future studies can be helpful in exploring the long term effects of this drug. 082 88 Fatemeh F Kheradmand Department of Biochemistry, Cellular and Molecular Research Center, Urmia University of Medical Sciences Department of Biochemistry, Cellular and Molecular Research Center, Urmia University of Medical Sciences Iran Seyyed Mohammad Reza MR Hashemnia Department of Biochemistry, Urmia University of Medical Sciences Department of Biochemistry, Urmia University of Medical Sciences Iran Nasim N Valizadeh Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences Iran Shiva Sh Roshan-Milani Department of Physiology, Cellular and Molecular Research Center, Urmia University of Medical Sciences Department of Physiology, Cellular and Molecular Research Center, Urmia University of Medical Sciences Iran Shivamilani@umsu.ac.ir Cellular viabilityGrowth factorsImatinib mesylateLeydig cellPlatelet derived growth factorStem cell factor 658.pdf Lindberg N, Holland EC. PDGF in gliomas: more than just a growth factor? Ups J Med Sci. 2012;117(2):92-8.##Nurmio M, Kallio J, Toppari J, Jahnukainen K. Adult reproductive functions after early postnatal inhibition by imatinib of the two receptor tyrosine kinases, c-kit and PDGFR, in the rat testis. Reprod Toxicol. 2008;25(4):442-6.##Unni SK, Modi DN, Pathak SG, Dhabalia JV, Bhartiya D. Stage-specific localization and expression of c-kit in the adult human testis. J Histochem Cytochem. 2009;57(9):861-9.##Nurmio M, Toppari J, Zaman F, Andersson AM, Paranko J, Soder O, et al. Inhibition of tyrosine kinases PDGFR and C-Kit by imatinib mesylate interferes with postnatal testicular development in the rat. Int J Androl. 2007;30(4):366-76.##Bergeron F, Bagu ET, Tremblay JJ. Transcription of platelet-derived growth factor receptor α in Leydig cells involves specificity protein 1 and 3. J Mol Endocrinol. 2011;46(2):125-38.##Fitter S, Vandyke K, Gronthos S, Zannettino AC. Suppression of PDGF-induced PI3 kinase activity by imatinib promotes adipogenesis and adiponectin secretion. J Mol Endocrinol. 2012;48(3):229-40.##Turjap M, Jurica J, Demlova R. [Potential clinical benefit of therapeutic drug monitoring of imatinib in oncology]. Klin Onkol. 2015;28(2):105-11. Czech.##Al-Hadiya BM, Bakheit AH, Abd-Elgalil AA. Imatinib mesylate. Profiles Drug Subst Excip Relat Methodol. 2014;39:265-97.##Shu LL, Jiang QL, Meng FY, Yang M. [Molecular mechanism of imatinib-induced thrombocytopenia in treatment of patients with CML]. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2011;19(5):1314-8. Chinese.##Gnessi L, Basciani S, Mariani S, Arizzi M, Spera G, Wang C, et al. Leydig cell loss and spermatogenic arrest in platelet-derived growth factor (PDGF)-A-deficient mice. J Cell Biol. 2000;149(5):1019-26.##Mariani S, Basciani S, Arizzi M, Spera G, Gnessi L. PDGF and the testis. Trends Endocrinol Metab. 2002;13(1):11-7.##Heim C, Minniear K, Dann CT. Imatinib has deleterious effects on differentiating spermatogonia while sparing spermatogonial stem cell self renewal. Reprod Toxicol. 2011;31(4):454-63.##Prasad AM, Ramnarayan K, Nalini K, Bairy KL. Effect of imatinib on the biochemical parameters of the reproductive function in male Swiss albino mice. Indian J Pharmacol. 2011;43(4):389-92.##Ghalaut VS, Prakash G, Bansal P, Dahiya K, Dokwal S, Ghalaut PS, et al. Effect of imatinib on male reproductive hormones in BCR-ABL positive CML patients: A preliminary report. J Oncol Pharm Pract. 2013;20(4):243-8.##Schultheis B, Nijmeijer BA, Yin H, Gosden RG, Melo JV. Imatinib mesylate at therapeutic doses has no impact on folliculogenesis or spermatogenesis in a leukaemic mouse model. Leuk Res. 2012;36(3):271-4.##Ramasamy K, Hayden J, Lim Z, Mufti GJ, Ho AY. Successful pregnancies involving men with chronic myeloid leukaemia on imatinib therapy. Br J Haematol. 2007;137(4):374-5.##Soares PB, Jeremias TS, Alvarez-Silva M, Licinio MA, Santos-Silva MC, Vituri CL. In vitro inhibitory effects of imatinib mesylate on stromal cells and hematopoietic progenitors from bone marrow. Braz J Med Biol Res. 2013;46(1):39-51.##Wolff NC, Randle DE, Egorin MJ, Minna JD, Ilaria RL Jr. Imatinib mesylate efficiently achieves therapeutic intratumor concentrations in vivo but has limited activity in a xenograft model of small cell lung cancer. Clin Cancer Res. 2004;10(10):3528-34.##Basciani S, Mariani S, Arizzi M, Ulisse S, Rucci N, Jannini EA, et al. Expression of platelet-derived growth factor-A (PDGF-A), PDGF-B, and PDGF receptor-alpha and -beta during human testicular development and disease. J Clin Endocrinol Metab. 2002;87(5):2310-9.##Yan W, Kero J, Huhtaniemi I, Toppari J. Stem cell factor functions as a survival factor for mature Leydig cells and a growth factor for precursor Leydig cells after ethylene dimethane sulfonate treatment: implication of a role of the stem cell factor/c-Kit system in Leydig cell development. Dev Biol. 2000;227(1):169-82.##Brennan J, Tilmann C, Capel B. Pdgfr-alpha mediates testis cord organization and fetal Leydig cell development in the XY gonad. Genes Dev. 2003;17(6):800-10.##Figueira MI, Cardoso HJ, Correia S, Maia CJ, Socorro S. Hormonal regulation of c-KIT receptor and its ligand: implications for human infertility? Prog Histochem Cytochem. 2014;49(1-3):1-19.##Basciani S, Brama M, Mariani S, De Luca G, Arizzi M, Vesci L, et al. Imatinib mesylate inhibits Leydig cell tumor growth: evidence for in vitro and in vivo activity. Cancer Res. 2005;65(5):1897-903.##Hashemnia SMR, Kheradmand F, Noori F, Roshan-Milani Sh. [Inhibition of growth factor signaling pathways by Imatinib mesylate in mouse normal leyding cells]. Uremia Med J. 2013;24(9):711-8. Persian.##McGary EC, Onn A, Mills L, Heimberger A, Eton O, Thomas GW, et al. Imatinib mesylate inhibits platelet-derived growth factor receptor phosphorylation of melanoma cells but does not affect tumorigenicity in vivo. J Invest Dermatol. 2004;122(2):400-5.##Beppu K, Jaboine J, Merchant MS, Mackall CL, Thiele CJ. Effect of imatinib mesylate on neuroblastoma tumorigenesis and vascular endothelial growth factor expression. J Natl Cancer Inst. 2004;96(1):46-55.##Feng HL, Sandlow JI, Sparks AE, Sandra A, Zheng LJ. Decreased expression of the c-kit receptor is associated with increased apoptosis in subfertile human testes. Fertil Steril. 1999;71(1):85-9.##Capdeville R, Buchdunger E, Zimmermann J, Matter A. Glivec (STI571, imatinib), a rationally developed, targeted anticancer drug. Nat Rev Drug Discov. 2002;1(7):493-502.##Heinrich MC, Blanke CD, Druker BJ, Corless CL. Inhibition of KIT tyrosine kinase activity: a novel molecular approach to the treatment of KIT-positive malignancies. J Clin Oncol. 2002;20(6):1692-703.##Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM, et al. Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med. 2001;344(14):1031-7.##Hiraga T, Nakamura H. Imatinib mesylate suppresses bone metastases of breast cancer by inhibiting osteoclasts through the blockade of c-Fms signals. Int J Cancer. 2009;124(1):215-22.##Basciani S, Mariani S, Spera G, Gnessi L. Role of platelet-derived growth factors in the testis. Endocr Rev. 2010;31(6):916-39.##Baran Y, Zencir S, Cakir Z, Ozturk E, Topcu Z. Imatinib-induced apoptosis: a possible link to topoisomerase enzyme inhibition. J Clin Pharm Ther. 2011;36(6):673-9.##Ohishi K, Sawada H, Yoshida Y, Yokoi W, Hatano H, Aiyama R, et al. Inhibitory effects of N-(3,5-dimethoxy-4-n-octyloxycinnamoyl)-N'-(3,4-dimethylphenyl)piperazine (YIC-C8-434), an acyl-CoA:cholesterol O-acyltransferase inhibitor, on cholesterol esterification in the intestine and liver. Biol Pharm Bull. 2003;26(8):1125-8.##Uehara H, Kim SJ, Karashima T, Shepherd DL, Fan D, Tsan R, et al. Effects of blocking platelet-derived growth factor-receptor signaling in a mouse model of experimental prostate cancer bone metastases. J Natl Cancer Inst. 2003;95(6):458-70.##Hou Z, Zhu HL, Liu T. [Effects of imatinib mesylate on the levels of endocrine hormones]. Zhonghua Xue Ye Xue Za Zhi. 2013;34(9):762-6. Chinese.##Tanriverdi O, Unubol M, Taskin F, Meydan N, Sargin G, Guney E, et al. Imatinib-associated bilateral gynecomastia and unilateral testicular hydrocele in male patient with metastatic gastrointestinal stromal tumor: a literature review. J Oncol Pharm Pract. 2012;18(2):303-10.##

Effects of Ghrelin on Sexual Behavior and Luteinizing Hormone Beta-subunit Gene Expression in Male Rats 2 1 642 2 Background: The hormones of hypothalamo-pituitary-gonadal (HPG) axis have facilitative effects on reproductive behavior in mammals. Ghrelin as a starvation hormone has an inhibitory effect on HPG axis’ function. Hence, it is postulated that ghrelin may reduce the sexual behavior through inhibiting of HPG axis. The aim of this study was to examine the effects of ghrelin and its antagonist, [D-Lys3]-GHRP-6, on sexual behavior and LH beta-subunit gene expression in male rats. Methods: In this experimental study, 128 male Wistar rats were divided into two groups. Each group was further subdivided into eight subgroups (n=8 rats/subgroup) including the animals that received saline, ghrelin (2, 4 or 8 nmol), [D-Lys3]-GHRP-6 (5 or 10 nmol) or co-administration of ghrelin (4 nmol) and [D-Lys3]-GHRP-6 (5 or 10 nmol) through the stereotaxically implanted cannula into the third cerebral ventricle. The sexual behavior of male rats encountering with females and the hypophyseal LH beta-subunit gene expression were evaluated at two different groups. Data were analyzed by ANOVA and p<0.05 was considered statistically significant. Results: Ghrelin injection (4 and 8 nmol) significantly (p<0.01) increased the latencies to the first mount, intromission and ejaculation as well as the post-ejaculatory interval. Also, 4 and 8 nmol ghrelin significantly (p<0.05) increased the number of mount and decreased the number of ejaculation. In co-administrated groups, [D-Lys3]-GHRP-6 antagonized the effects of ghrelin. Ghrelin injection (4 and 8 nmol) reduced the LH beta-subunit gene expression while pretreatment with [D-Lys3]-GHRP-6 improved the gene expression. Conclusion: Ghrelin decreased the sexual behavior and LH beta-subunit gene expression in male rats, whereas [D-Lys3]-GHRP-6 antagonizes these effects. 088 97 Farrin F Babaei-Balderlou Department of Animal Sciences, Faculty of Biological Sciences, Shahid Beheshti University Department of Animal Sciences, Faculty of Biological Sciences, Shahid Beheshti University Iran Homayoun H Khazali Department of Animal Sciences, Faculty of Biological Sciences, Shahid Beheshti University Department of Animal Sciences, Faculty of Biological Sciences, Shahid Beheshti University Iran farrin_babaei@yahoo.com [D-Lys3]-GHRP-6GhrelinLuteinizing Hormone (LH)Male ratSexual behavior 642.pdf Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402(6762):656-60.##Kojima M, Hosoda H, Matsuo H, Kangawa K. Ghrelin: discovery of the natural endogenous ligand for the growth hormone secretagogue receptor. Trends Endocrinol Metab. 2001;12(3):118-22.##Lu S, Guan JL, Wang QP, Uehara K, Yamada S, Goto N, et al. Immunocytochemical observation of ghrelin-containing neurons in the rat arcuate nucleus. Neurosci Lett. 2002;321(3):157-60.##Cowley MA, Smith RG, Diano S, Tschop M, Pronchuk N, Grove KL, et al. The distribution and mechanism of action of ghrelin in the CNS demonstrates a novel hypothalamic circuit regulating energy homeostasis. Neuron. 2003;37(4):649-61.##Guan XM, Yu H, Palyha OC, McKee KK, Feighner SD, Sirinathsinghji DJ, et al. Distribution of mRNA encoding the growth hormone secretagogue receptor in brain and peripheral tissues. Brain Res Mol Brain Res. 1997;48(1):23-9.##Howard AD, Feighner SD, Cully DF, Arena JP, Liberator PA, Rosenblum CI, et al. A receptor in pituitary and hypothalamus that functions in growth hormone release. Science. 1996;273(5277):974-7.##McKee KK, Palyha OC, Feighner SD, Hreniuk DL, Tan CP, Phillips MS, et al. Molecular analysis of rat pituitary and hypothalamic growth hormone secretagogue receptors. Mol Endocrinol. 1997;11(4):415-23.##Miller DW, Harrison JL, Brown YA, Doyle U, Lindsay A, Adam CL, et al. Immunohistochemical evidence for an endocrine/paracrine role for ghrelin in the reproductive tissues of sheep. Reprod Biol Endocrinol. 2005;3:60.##Ogata R, Matsuzaki T, Iwasa T, Kiyokawa M, Tanaka N, Kuwahara A, et al. Hypothalamic Ghrelin suppresses pulsatile secretion of luteinizing hormone via beta-endorphin in ovariectomized rats. Neuroendocrinology. 2009;90(4):364-70.##Dupont J, Maillard V, Coyral-Castel S, Rame C, Froment P. Ghrelin in female and male reproduction. Int J Pept. 2010;2010. pii:158102.##Martini AC, Fernandez-Fernandez R, Tovar S, Navarro VM, Vigo E, Vazquez MJ, et al. Comparative analysis of the effects of ghrelin and unacylated ghrelin on luteinizing hormone secretion in male rats. Endocrinology. 2006;147(5):2374-82.##Wang L, Fang F, Li Y, Zhang Y, Pu Y, Zhang X. Role of ghrelin on testosterone secretion and the mRNA expression of androgen receptors in adult rat testis. Syst Biol Reprod Med. 2011;57(3):119-23.##Saito TR. Effects of LHRH on copulatory behavior and locomotor activity in sexually inexperienced male rats. Jikken Dobutsu. 1988;37(4):489-92.##Awoniyi CA, Reece MS, Hurst BS, Faber KA, Chandrashekar V, Schlaff WD. Maintenance of sexual function with testosterone in the gonadotropin-releasing hormone-immunized hypogonadotropic infertile male rat. Biol Reprod. 1993;49(6):1170-6.##Vignozzi L, Corona G, Petrone L, Filippi S, Morelli AM, Forti G, et al. Testosterone and sexual activity. J Endocrinol Invest. 2005;28(3 Suppl):39-44.##Davidson JM. Activation of the male rat's sexual behavior by intracerebral implantation of androgen. Endocrinology. 1966;79(4):783-94.##Garelick T, Swann J. Testosterone regulates the density of dendritic spines in the male preoptic area. Horm Behav. 2014;65(3):249-53.##Rissman EF. Behavioral regulation of gonadotropin-releasing hormone. Biol Reprod. 1996;54(2):413-9.##Asakawa A, Inui A, Kaga T, Katsuura G, Fujimiya M, Fujino MA, et al. Antagonism of ghrelin receptor reduces food intake and body weight gain in mice. Gut. 2003;52(7):947-52.##Beck B, Richy S, Stricker-Krongrad A. Feeding response to ghrelin agonist and antagonist in lean and obese Zucker rats. Life Sci. 2004;76(4):473-8.##Brzozowski T, Konturek PC, Sliwowski Z, Pajdo R, Drozdowicz D, Kwiecien S, et al. Prostaglandin/cyclooxygenase pathway in ghrelin-induced gastroprotection against ischemia-reperfusion injury. J Pharmacol Exp Ther. 2006;319(1):477-87.##Unniappan S, Peter RE. In vitro and in vivo effects of ghrelin on luteinizing hormone and growth hormone release in goldfish. Am J Physiol Regul Integr Comp Physiol. 2004;286(6):R1093-101.##Lewis MJ, Johnson DF, Waldman D, Leibowitz SF, Hoebel BG. Galanin microinjection in the third ventricle increases voluntary ethanol intake. Alcohol Clin Exp Res. 2004;28(12):1822-8.##Agmo A, Paredes R, Fernandez H. Differential effects of GABA transaminase inhibitors on sexual behavior, locomotor activity, and motor execution in the male rat. Pharmacol Biochem Behav. 1987;28(1):47-52.##Abilio VC, Vera JA Jr, Ferreira LS, Duarte CR, Martins CR, Torres-Leite D, et al. Effects of melatonin on behavioral dopaminergic supersensitivity. Life Sci. 2003;72(26):3003-15.##Bertoldi ML, Luque EM, Carlini VP, Vincenti LM, Stutz G, Santillan ME, et al. Inhibitory effects of ghrelin on sexual behavior: role of the peptide in the receptivity reduction induced by food restriction in mice. Horm Metab Res. 2011;43(7):494-9.##Agmo A. Sexual motivation--an inquiry into events determining the occurrence of sexual behavior. Behav Brain Res. 1999;105(1):129-50.##Jang JK, Kim WY, Cho BR, Lee JW, Kim JH. Microinjection of ghrelin in the nucleus accumbens core enhances locomotor activity induced by cocaine. Behav Brain Res. 2013;248:7-11.##Blum ID, Patterson Z, Khazall R, Lamont EW, Sleeman MW, Horvath TL, et al. Reduced anticipatory locomotor responses to scheduled meals in ghrelin receptor deficient mice. Neuroscience. 2009;164(2):351-9.##Yahashi S, Kang KS, Kaiya H, Matsuda K. GHRP-6 mimics ghrelin-induced stimulation of food intake and suppression of locomotor activity in goldfish. Peptides. 2012;34(2):324-8.##Yannielli PC, Molyneux PC, Harrington ME, Golombek DA. Ghrelin effects on the circadian system of mice. J Neurosci. 2007;27(11):2890-5.##Jerlhag E, Engel JA. Ghrelin receptor antagonism attenuates nicotine-induced locomotor stimulation, accumbal dopamine release and conditioned place preference in mice. 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Pharmacological characterization of the ghrelin receptor mediating its inhibitory action on inflammatory pain in rats. Amino Acids. 2012;43(4):1751-9.##Stoyanovitch AG, Johnson MA, Clifton DK, Steiner RA, Fraley GS. Galanin-like peptide rescues reproductive function in the diabetic rat. Diabetes. 2005;54(8):2471-6.##

A Comparison of the Effects of Transdermal Estradiol and Estradiol Valerate on Endometrial Receptivity in Frozen-thawed Embryo Transfer Cycles: A Randomized Clinical Trial 2 1 655 2 Background: The purpose of this study was to determine the optimal endometrial preparation protocol by comparing the clinical outcome of two methods of endometrial preparation in frozen-thawed embryo transfer (FET) cycles, including that is, oral estradiol and 17ß-estradiol transdermal patch. Methods: In this randomized controlled trial, women underwent either conventional IVF or intracytoplasmic sperm injection (ICSI) who had at least two top-quality embryos appropriate for cryopreservation and frozen embryos from previous cycles. In the study group (n=45), 17-B estradiol transdermal patches 100 µg were applied from the second day of the cycle and continued every other day. Then, each patch was removed after four days. In the control group (n=45), oral estradiol valerate 6 mg was started at the same time and continued daily. Results: There was a significant difference in estradiol level on the day of progesterone administration and the day of embryo transfer between the two groups (p=0.001 in both), but no significant difference was observed between them in biochemical and clinical pregnancy rates (32.6% vs. 33.3%, p=1.000 and 30.2% vs. 33.3%, p=0.810, respectively). Conclusion: It is suggested that estradiol transdermal patches be used instead of oral estradiol in FET cycles. Due to the reduced costs, drug dose, and emotional stress as well as the simplicity of the protocol for patients. 097 104 Robab R Davar 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 Sima S Janati Research and Clinical Center for Infertility, Dezful University of Medical Sciences Research and Clinical Center for Infertility, Dezful University of Medical Sciences Iran sjanati@dums.ac.ir Fereshteh F Mohseni 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 Mehdi M Khabazkhoob Department of Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences Department of Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences Iran Soheila S Asgari سهیلا عسگری Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Iran Frozen-thawed embryo transferTransdermal estradiol patchsEndometrial preparationPregnancy rate 655.pdf Aflatoonian A, Mansoori Moghaddam F, Mashayekhy M, Mohamadian F. Comparison of early pregnancy and neonatal outcomes after frozen and fresh embryo transfer in ART cycles. J Assist Reprod Genet. 2010;27(12):695-700.##Wang JX, Yap YY, Matthews CD. Frozen-thawed embryo transfer: influence of clinical factors on implantation rate and risk of multiple conception. Hum Reprod. 2001;16(11):2316-9.##Hancke K, More S, Kreienberg R, Weiss JM. Patients undergoing frozen-thawed embryo transfer have similar live birth rates in spontaneous and artificial cycles. J Assist Reprod Genet. 2012;29(5):403-7.##Kyrou D, Fatemi HM, Popovic-Todorovic B, Van den Abbeel E, Camus M, Devroey P. Vaginal progesterone supplementation has no effect on ongoing pregnancy rate in hCG-induced natural frozen-thawed embryo transfer cycles. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):175-9.##Salumets A, Suikkari AM, Makinen S, Karro H, Roos A, Tuuri T. Frozen embryo transfers: implications of clinical and embryological factors on the pregnancy outcome. Hum Reprod. 2006;21(9):2368-74.##Gelbaya TA, Nardo LG, Hunter HR, Fitzgerald CT, Horne G, Pease EE, et al. Cryopreserved-thawed embryo transfer in natural or down-regulated hormonally controlled cycles: a retrospective study. Fertil Steril. 2006;85(3):603-9.##Ma WG, Song H, Das SK, Paria BC, Dey SK. Estrogen is a critical determinant that specifies the duration of the window of uterine receptivity for implantation. Proc Natl Acad Sci USA. 2003;100(5):2963-8.##Yu Ng EH, Yeung WS, Yee Lan Lau E, So WW, Ho PC. High serum oestradiol concentrations in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent frozen-thawed embryo transfer cycles. Hum Reprod. 2000;15(2):250-5.##Lieberman BA, Troup SA, Matson PL. Cryopreservation of embryos and pregnancy rates after IVF. Lancet. 1992;340(8811):116.##Konc J, Kanyo K, Varga E, Kriston R, Cseh S. The effect of cycle regimen used for endometrium preparation on the outcome of day 3 frozen embryo transfer cycle. Fertil Steril. 2010;94(2):767-8.##Morozov V, Ruman J, Kenigsberg D, Moodie G, Brenner S. Natural cycle cryo-thaw transfer may improve pregnancy outcome. J Assist Reprod Genet. 2007;24(4):119-23.##Van Steirteghem AC, Van der Elst J, Van den Abbeel E, Joris H, Camus M, Devroey P. Cryopreservation of supernumerary multicellular human embryos obtained after intracytoplasmic sperm injection. Fertil Steril. 1994;62(4):775-80.##Salumets A, Tuuri T, Makinen S, Vilska S, Husu L, Tainio R, et al. Effect of developmental stage of embryo at freezing on pregnancy outcome of frozen-thawed embryo transfer. Hum Reprod. 2003;18(9):1890-5.##Schalkoff ME, Oskowitz SP, Powers RD. A multifactorial analysis of the pregnancy outcome in a successful embryo cryopreservation program. Fertil Steril. 1993;59(5):1070-4.##Edgar DH, Bourne H, Speirs AL, McBain JC. A quantitative analysis of the impact of cryopreservation on the implantation potential of human early cleavage stage embryos. Hum Reprod. 2000;15(1):175-9.##Van der Elst J, Van den Abbeel E, Vitrier S, Camus M, Devroey P, Van Steirteghem AC. Selective transfer of cryopreserved human embryos with further cleavage after thawing increases delivery and implantation rates. Hum Reprod. 1997;12(7):1513-21.##Moini A, Zadeh Modarress S, Amirchaghmaghi E, Mirghavam N, Khafri S, Reza Akhoond M, et al. The effect of adding oral oestradiol to progesterone as luteal phase support in ART cycles - a randomized controlled study. Arch Med Sci. 2011;7(1):112-6.##Roque M, Lattes K, Serra S, Sola I, Geber S, Carreras R, et al. Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles: a systematic review and meta-analysis. Fertil Steril. 2013;99(1):156-62.##Achache H, Revel A. Endometrial receptivity markers, the journey to successful embryo implantation. Hum Reprod Update. 2006;12(6):731-46.##Kuhl H. Pharmacokinetics of oestrogens and progestogens. Maturitas. 1990;12(3):171-97.##Krasnow JS, Lessey BA, Naus G, Hall LL, Guzick DS, Berga SL. Comparison of transdermal versus oral estradiol on endometrial receptivity. Fertil Steril. 1996;65(2):332-6.##Paulson RJ. Hormonal induction of endometrial receptivity. Fertil Steril. 2011;96(3):530-5.##Banz C, Katalinic A, Al-Hasani S, Seelig AS, Weiss JM, Diedrich K, et al. Preparation of cycles for cryopreservation transfers using estradiol patches and Crinone 8% vaginal gel is effective and does not need any monitoring. Eur J Obstet Gynecol Reprod Biol. 2002;103(1):43-7.##von Holst T, Salbach B. Efficacy and tolerability of a new 7-day transdermal estradiol patch versus placebo in hysterectomized women with postmenopausal complaints. Maturitas. 2000;34(2):143-53.##Davar R, Eftekhar M, Tayebi N. Transfer of Cryopreserved-Thawed Embryos in a Cycle Using Exogenous Steroids with or Without Prior Gonadotropihin-Releasing Hormone Agonist. J Med Sci. 2007;7:880-3.##Dal Prato L, Borini A, Cattoli M, Bonu MA, Sciajno R, Flamigni C. Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist. Fertil Steril. 2002;77(5):956-60.##Aflatoonian A, Oskouian H, Ahmadi S, Oskouian L. Can fresh embryo transfers be replaced by cryopreserved-thawed embryo transfers in assisted reproductive cycles? A randomized controlled trial. J Assist Reprod Genet. 2010;27(7):357-63.##Engmann L, DiLuigi A, Schmidt D, Benadiva C, Maier D, Nulsen J. The effect of luteal phase vaginal estradiol supplementation on the success of in vitro fertilization treatment: a prospective randomized study. Fertil Steril. 2008;89(3):554-61.##Jabbour HN, Kelly RW, Fraser HM, Critchley HO. Endocrine regulation of menstruation. Endocr Rev. 2006;27(1):17-46.##Navot D, Anderson TL, Droesch K, Scott RT, Kreiner D, Rosenwaks Z. Hormonal manipulation of endometrial maturation. J Clin Endocrinol Metab.1989;68(4):801-7.##

Laparoscopic Fimbrioplasty and Neosalpingostomy in Female Infertility: A Review of 402 Cases at the Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital in Yaoundé-Cameroon 2 1 661 2 Background: More than 70 million couples suffer from infertility worldwide. The aim of this study was to evaluate the fertility outcomes after laparoscopic fimbrioplasty and neosalpingostomy in female infertility. Methods: Laparoscopic distal tuboplasty was carried out for 402 cases at the Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital in Yaoundé-Cameroon in Central Africa from December 2002 to December 2007. Laparoscopic fimbrioplasty and neosalpingostomy were done using bipolar electrocoagulation and conventional endoscopic instruments. Log-rank test was used to compare cumulative rate curves of intrauterine pregnancy with respect to the tubal stages. P<0.05 was considered statistically significant. Results: The mean age of the patients was 31.6±5.45 years. Secondary infertility was the most frequent type of infertility (70.14%). The laparoscopic tubal surgery done consisted of fimbrioplasty in 185(46%) cases and neosalpingostomy in 217(54%) cases. Of 260 women followed up after tuboplasty, there were overall 74(28.48%) pregnancies; 68(26.1%) intrauterine pregnancies and 6(2.3%) ectopic pregnancies. Pregnancy rates were significantly associated to the tubal stage (63% in stage 1, 15% in stage 3 and 00% in stage 4; p<0.001) and the adnexal adhesion scores (73.91% in the absence of adnexal adhesions and 8.8% in the case of a severe adnexal adhesion score). Of the 68 intrauterine pregnancies, there were 60(88%) live births and 8(12%) spontaneous abortions. Conclusion: It is believed that laparoscopic fimbrioplasty and neosalpingostomy should be the preferred choice when faced with tubal distal occlusion in a context of female infertility. This implies that training in endoscopic surgery should be regarded as an important issue in developing countries. 104 110 Jean J Kasia Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Cameroon Jean J Ngowa Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Cameroon jdkemfang@yahoo.fr Yolande Y Mimboe Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Cameroon Michel M Toukam Laboratory of Clinical Biology, Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital Laboratory of Clinical Biology, Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital Cameroon Anny A Ngassam Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital Cameroon Claude C Noa Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Cameroon Etienne E Belinga Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I Cameroon Alexis A Medou Anesthesia Unit, Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital Anesthesia Unit, Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital Cameroon Adnexal adhesionFimbrioplastyInfertilityLaparoscopyNeosalpingostomyTubal stage 661.pdf 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.##Leke RJ, Oduma JA, Bassol-Mayagoitia S, Bacha AM, Grigor KM. Regional and geographical variations in infertility: effects of environmental, cultural, and socioeconomic factors. Environ Health Perspect. 1993;101 Suppl 2:73-80.##Bergstrom S. Reproductive failure as a health priority in the Third World: a review. East Afr Med J. 1992;69(4):174-80.##Daar AS, Merali Z. Infertility and social suffering: the case of ART in developing countries. In: Vayena E, Rowe PJ, Griffin PD, editors. Current Practices and Controversies in Assisted Reproduction. Geneva, Switzerland: World Health Organization; 2002. 396 p.##Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM. 'Men leave me as I cannot have children': women's experiences with involuntary childlessness. Hum Reprod. 2002;17(6):1663-8.##Umezulike AC, Efetie ER. The psychological trauma of infertility in Nigeria. Int J Gynaecol Obstet. 2004;84(2):178-80.##Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22(6):1506-12.##Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 2009;29(5):1353-70.##Donnez J, Casanas-Roux F. Prognostic factors of fimbrial microsurgery. Fertil Steril. 1986;46(2):200-4.##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.##Fathalla MF, Sinding SW, Rosenfield A, Fathalla MM. Sexual and reproductive health for all: a call for action. Lancet. 2006;368(9552):2095-100.##Okonofua FE, Essen UI, Nimalaraj T. Hysterosalpingography versus laparoscopy in tubal infertility: comparison based on findings at laparatomy. Int J Gynaecol Obstet. 1989;28(2):143-7.##Sharma S, Mittal S, Aggarwal P. Management of infertility in low resource countries. BJOG. 2009;116 Suppl 1:77-83.##Kasia JM, Raiga J, Doh AS, Biouele JM, Pouly JL, Kwiatkowski F, et al. Laparoscopic fimbrioplasty and neosalpingostomy. Experience of the Yaounde General Hospital, Cameroon (report of 194 cases). Eur J Obstet Gynecol Reprod Biol. 1997;73(1):71-7.##American Fertility Society. Classification of adnexal adhesions, distal tubal occlusions secondary to tubal ligation, tubal pregnancies, mullerian abnormalities and intra uterine adhesions. Fertil Steril. 1988;49(6):944-55.##Mage G, Pouly JL, de Joliniere JB, Chabrand S, Riouallon A, Bruhat MA. A preoperative classification to predict the intrauterine and ectopic pregnancy rates after distal tubal microsurgery. Fertil Steril. 1986;46(5):807-10.##De Cherney AH. Tubal disease: surgery and in vitro fertilization. In: Kase NG, Weingold AB, Gershenson DM, editors. Principles and Practice of Clinical Gynecology. London, England: Churchill Livingstone; 1990. p. 445-57.##El-Mowafi DM, Ngoh NN. Management of tubal obstructions. Surg Technol Int. 2005;14:199-212.##Berker B, Mahdavi A, Shahmohamady B, Nezhat C. Role of laparoscopic surgery in infertility. Middle East Fertil Soc J. 2005;10(2):94-104.##Bruhat MA, Mage G, Pouly JL, Manhes H, Canis M, Wattiez A. [Adhesions in operatory laparoscopy]. Paris: Medsi/McGraw-Hill; 1989. 215 p. French.##Madelenat P, Filoux Y, Hazout A, Palmer R. [Laparoscopic treatment of stenoses and phimosis of the ampulla of the tube. A critical study of the results (author's transl)]. J Gynecol Obstet Biol Reprod (Paris). 1979;8(5):445-50. French.##Canis M, Mage G, Pouly JL, Manhes H, Wattiez A, Bruhat MA. Laparoscopic distal tuboplasty: report of 87 cases and a 4-year experience. Fertil Steril. 1991;56(4):616-21.##Dubuisson JB, Bouquet de Joliniere J, Aubriot FX, Darai E, Foulot H, Mandelbrot L. Terminal tuboplasties by laparoscopy: 65 consecutive cases. Fertil Steril. 1990;54(3):401-3.##Larue L, Sedbon E, Crequat J, Madelenat P. [Per-celioscopic surgery of the distal fallopian tube in infertility]. J Gynecol Obstet Biol Reprod (Paris). 1990;19(3):343-7. French.##Ahmad G, Watson AJ, Metwally M. Laparoscopy or laparotomy for distal tubal surgery? A meta-analysis. Hum Fertil (Camb). 2007;10(1):43-7.##Dlugi AM, Reddy S, Saleh WA, Mersol-Barg MS, Jacobsen G. Pregnancy rates after operative endoscopic treatment of total (neosalpingostomy) or near total (salpingostomy) distal tubal occlusion. Fertil Steril. 1994;62(5):913-20.##Eyraud B, Erny R, Vergnet F. [Distal tubal surgery using laparoscopy]. J Gynecol Obstet Biol Reprod (Paris). 1993;22(1):9-14. French.##Audebert AJ, Pouly JL, Von Theobald P. Laparoscopic fimbrioplasty: an evaluation of 35 cases. 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The Relationship between Chlamydia trachomatis Genital Infection and Spontaneous Abortion 2 1 647 2 Background: Chlamydia trachomatis is the etiology of most of sexually transmitted diseases. Colonization of C. trachomatis in the genital tract during early gestation has been associated with preterm birth, and preterm premature rupture of the membranes. The role of C. trachomatis on spontaneous abortion has not yet been proved completely. The aim of this study was to evaluate the frequency of C. trachomatis infection among pregnant women and its association with spontaneous abortion. Methods: This case-control study was conducted from August 2012 until January 2013. Totally, 218 women were included; 109 women with spontaneous abortion with gestation age between 10-20 weeks (cases), and 109 women with normal pregnancy with gestation age between 20-30 weeks (controls) in Sanandaj, Iran. DNA was extracted from endocervical swabs and a PCR test was conducted for detection of C. trachomatis infection in women using specific primers. Independent T-test and Chi-square were used for comparison of quantitative and qualitative variables, respectively, and p<0.05 was considered significant. Results: The total prevalence of C. trachomatis infection was 38(17.43%) in endocervical swabs of women. However, the number of cases with C. trachomatis infections was 25 out of 109(22.9%) in the case group and 13 out of 109(11.9%) in control group, respectively. Association between chlamydia infection and spontaneous abortion was statistically significant (OR=2.198, CI 95%: 1.058-4.56). Conclusion: Our study showed that C. trachomatis infection was associated with spontaneous abortion. Thus, screening and treatment of pregnant women may prevent this adverse pregnancy outcome. 110 117 Amjad A Ahmadi Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences Iran Mazaher M Khodabandehloo Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences Iran mazaher-kh@muk.ac.ir Rashid R Ramazanzadeh Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences Iran Fariba F Farhadifar Department of Obstetrics and Gynecology, Social Determinant of Health Research Center Department of Obstetrics and Gynecology, Social Determinant of Health Research Center Iran Daem D Roshani Social Determinants of Health Research Center, Kurdistan University of Medical Sciences Social Determinants of Health Research Center, Kurdistan University of Medical Sciences Iran Ebrahim E Ghaderi Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences Iran Niloofar N Farhangi Be’sat Hospital, Faculty of Medicine, Kurdistan University of Medical Sciences Be’sat Hospital, Faculty of Medicine, Kurdistan University of Medical Sciences Iran Chlamydia trachomatisGenital infectionMiscarriagePregnancySpontaneous abortion 647.pdf Wilkowska-Trojniel M, Zdrodowska-Stefanow B, Ostaszewska-Puchalska I, Redzko S, Przepiesc J, Zdrodowski M. The influence of Chlamydia trachomatis infection on spontaneous abortions. Adv Med Sci. 2009;54(1):86-90.##Bekler C, Kultursay N, Ozacar T, Sayiner A, Yalaz M, Akisu M. Chlamydial infections in term and preterm neonates. Jpn J Infect Dis. 2012;65(1):1-6.##Rours GI, Duijts L, Moll HA, Arends LR, de Groot R, Jaddoe VW, et al. Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study. Eur J Epidemiol. 2011;26(6):493-502.##Choi SJ, Park SD, Jang IH, Uh Y, Lee A. The prevalence of vaginal microorganisms in pregnant women with preterm labor and preterm birth. Ann Lab Med. 2012;32(3):194-200.##Fatholahzadeh B, Bahador A, Haghighi Hasanabad M, Bazarjani F, Haghighi F. Comparative screening of Chlamydia trachomatis infection in women population in Tehran, Iran. Iran Red Crescent Med J. 2012;14(5):289-93.##Folger AT. 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English, Lithuanian.##Marashi SM, Moulana Z, Imani Fooladi AA, Mashhadi Karim M. Comparison of Genital Chlamydia trachomatis Infection Incidence Between Women With Infertility and Healthy Women in Iran Using PCR and Immunofluorescence Methods. Jundishapur J Microbiol. 2014;7(4):e9450.##Sotoodeh Jahromi A, Farjam M, Mogharrab F, Amiryan M, Jamshidi Makiani M, Madani A, et al. Chlamydia trachomatis and rubella antibodies in women with full-term deliveries and women with abortion. Am J Infect Dis. 2010;6(3):66-9.##Zahirnia Z, Eslami G, Goodarzi H, Taheri S, Fallah F, Taheripanah R, et al. [Evaluation of the prevalence of infection with Chlamydia trachomatis in spontaneous abortions, by Nested PCR method]. Pejouhesh. 2013;37(1):67-72. Persian.##Eslami G, Goudarzi H, Taheripanah R, Taheri S, Fallah F, Moazzami B, et al. Chlamydia trachomatis Detection by Nested-PCR Method on Females Referred to Medical Centers of Tehran, Iran. Arch Clin Infect Dis. 2012;7(4):124-7.##Michou IV, Constantoulakis P, Makarounis K, Georgoulias G, Kapetanios V, Tsilivakos V. Molecular investigation of menstrual tissue for the presence of Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis collected by women with a history of infertility. J Obstet Gynaecol Res. 2014;40(1):237-42.##Sattari M, Zeighami H, Peerayea S. Detection of Chlamydia trachomatis in Endocervical Smears of Women with Abortion. Res J Biol Sci. 2008;3(2):214-6.##Silveira MF, Erbelding EJ, Ghanem KG, Johnson HL, Burke AE, Zenilman JM. Risk of Chlamydia trachomatis infection during pregnancy: effectiveness of guidelines-based screening in identifying cases. Int J STD AIDS. 2010;21(5):367-70.##Hashemi FB, Pourakbari B, Yazdi JZ. Frequency of Chlamydia trachomatis in women with cervicitis in Tehran, Iran. Infect Dis Obstet Gynecol. 2009;2009:67014.##Taheri Beni B, Motamedi H, Ardakani MR. Genotyping of the prevalent Chlamydia trachomatis strains involved in cervical infections in women in Ahvaz, Iran. J Med Microbiol. 2010;59(Pt 9):1023-8.##Jenab A, Golbang N, Golbang P, Chamani-Tabriz L, Roghanian R. Diagnostic value of PCR and ELISA for Chlamydia trachomatis in a group of asymptomatic and symptomatic women in Isfahan, Iran. Int J Fertil Steril. 2009;2(4):193-8.##Zaeimi Yazdi J, Khorramizadeh MR, Badami N, Kazemi B, Aminharati F, Eftekhar Z, et al. Comparative assessment of Chlamydia trachomatis infection in Iranian women with Cervicitis: A cross-sectional study. Iran J Public Health. 2006;35(2):69-75.##Fallah F, Kazemi B, Goudarzi H, Badami N, Doostdar F, Ehteda A, et al. Detection of Chlamydia trachomatis from Urine Specimens by PCR in women with Cervicitis. Iran J Public Health. 2005;34(2):20-6.##Chamani-Tabriz L, Jeddi-Tehrani M, Zeraati H, Asgari S, Tarahomi M, Moini M, et al. 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Acta Med Iran. 2002;40(2):79-82.##Vigil P, Tapia A, Zacharias S, Riquelme R, Salgado AM, Varleta J. First-trimester pregnancy loss and active Chlamydia trachomatis infection: correlation and ultrastructural evidence. Andrologia. 2002;34(6):373-8.##Silveira MF, Ghanem KG, Erbelding EJ, Burke AE, Johnson HL, Singh RH, et al. Chlamydia trachomatis infection during pregnancy and the risk of preterm birth: a case-control study. Int J STD AIDS. 2009;20(7):465-9.##Sozio J, Ness RB. Chlamydial lower genital tract infection and spontaneous abortion. Infect Dis Obstet Gynecol. 1998;6(1):8-12.##Andrews WW, Klebanoff MA, Thom EA, Hauth JC, Carey JC, Meis PJ, et al. Midpregnancy genitourinary tract infection with Chlamydia trachomatis: association with subsequent preterm delivery in women with bacterial vaginosis and Trichomonas vaginalis. Am J Obstet Gynecol. 2006;194(2):493-500.##Abdul-Karim ET, Abdul-Muhymen N, Al-Saadie M. Chlamydia trachomatis and rubella antibodies in women with full-term deliveries and women with abortion in Baghdad. East Mediterr Health J. 2009;15(6):1407-11.##Ghazvini K, Ahmadnia H, Ghanaat J. Frequency of Chlamydia trachomatis among male patients with urethritis in northeast of Iran detected by polymerase chain reaction. Saudi J Kidney Dis Transpl. 2012;23(2):316-20.##Juhl CS, Christensen M, Bor IP. [No firm evidence for screening for Chlamydia in connection with spontaneous abortion]. Ugeskr Laeger. 2013;175(6):354-7. Danish.##Howie SE, Horner PJ, Horne AW. Chlamydia trachomatis infection during pregnancy: known unknowns. Discov Med. 2011;12(62):57-64.##

The Role of Religious Coping Strategies in Predicting Depression among a Sample of Women with Fertility Problems in Shiraz 2 1 659 2 Background: One of the most common mental health problems among women with infertility problems is depression. Research has shown that religious beliefs and practices can help people to cope with difficult situations. The purpose of this study was to explore the role of different religious coping strategies in predicting depression in a group of infertile women in Shiraz. Methods: A total of 72 women with fertility problems were recruited from several private infertility clinics in Shiraz using convenience sampling. The participants completed the research questionnaires including Beck Depression Inventory and Religious Coping Scale. The Religious Coping Scale consists of five dimensions including practice, active, passive, benevolent reappraisal and negative religious coping. Descriptive statistics (frequency percentage, mean and standard deviation), Pearson’s correlation and simultaneous multiple regression analysis were used for data analysis using SPSS version 16. A p-value less than 0.05 was considered statistically significant. Results: The present study showed that about 30% of women with fertility problems experienced the symptoms of depression. The findings also indicated that the most commonly used religious coping strategy was practice religious coping, while the least commonly used religious coping strategies were passive and negative religious coping. The findings also showed that active religious coping, practice religious coping and benevolent reappraisal coping predicted depression reduction. Conclusion: This study highlights the effect of religious coping on depression reduction of women with fertility problems. In other words, women who used religious coping strategies were less likely to experience depression symptoms. 117 123 Abdulaziz A Aflakseir Abdulaziz Aflakseir Department of Clinical Psychology, School of Education and Psychology, Shiraz University Department of Clinical Psychology, School of Education and Psychology, Shiraz University Iran aaflakseir@shirazu.ac.ir Mansoureh M Mahdiyar Department of Clinical Psychology, School of Education and Psychology, Shiraz University Department of Clinical Psychology, School of Education and Psychology, Shiraz University Iran Coping behaviorDepressionInfertilityReligious beliefsWomen 659.pdf Kazem M, Ali A. An overview of the epidemiology of primary infertility in Iran. J Reprod Infertil. 2009;10(3):213-6.##Quaas A, Dokras A. Diagnosis and treatment of unexplained infertility. Rev Obstet Gynecol. 2008;1(2):69-76.##Deka PK, Sarma S. Psychological aspects of infertility. BJMP. 2010;3(3):336-9.##Drosdzol A, Skrzypulec V. Depression and anxiety among Polish infertile couples--an evaluative prevalence study. J Psychosom Obstet Gynaecol. 2009;30(1):11-20.##Haririyan HR, Mohammadpour Y, Aghajanloo A. [Prevalence of depression and contributing factors of depression in the infertile women referred to Kosar infertility center, 2009]. Iran J Obstet, Gynaecol Infertil. 2010;13(2):45-9. Persian.##Behdani F, Erfanian M, Hbrani P, Hogat K. [Prevalence of depression and risk factors in infertile women referred to Montaserieh infertility clinic in Mashhad]. J Fundam Ment Health. 2004;6(23-24):141-6. Persian.##Faraji R, Milani F, Danesh M. Realative frequency of depression in infertile women, Rasht, Iran. Int J Gynecol Obstetr. 2009;107 suppl 2:S174-S5.##Peyvandi S, Hosseini SH, Daneshpoor SMM, Mohammadpour RA, Qolami N. [The prevalence of depression, anxiety and marital satisfaction and related factors in infertile women referred to infertility clinics of Sari city in 2008]. J Mazandaran Univ Med Sci. 2011;21(80):26-32. Persian.##Shahnooshi M, Karimi Z. [Social consequences of infertility in a group of infertile women in Isfahan]. Soc Sci J Azad Univ. 2010;4(11):171-98. Persian.##Pargament KI, Magyar-Russell GM, Murray-Swank NA. The sacred and the search for significance: Religion as a unique process. J Soc Issues. 2005;61:665-87.##Koenig HG, McCullough ME, Larson DB. Handbook of religion and health. 2nd ed. Oxford: Oxford University Press; 2001.236 p.##Abernethy AD, Chang HT, Seidlitz L, Evinger JS, Duberstein PR. Religious coping and depression among spouses of people with lung cancer. Psychosomatics. 2002;43(6):456-63.##Loewenthal KM, Cinnirella M, Evdoka G, Murphy P. Faith conquers all? Beliefs about the role of religious factors in coping with depression among different cultural-religious groups in the UK. Br J Med Psychol. 2001;74:293-303.##Smith TB, McCullough ME, Poll J. Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychol Bull. 2003;129(4):614-36.##Paloutzian RF. Handbook of the psychology of religion and spirituality. 2nd ed. London: Guilford Press; 2014. 431 p.##Emmons RA. The psychology of ultimate concerns: Motivation and spirituality in personality. 2nd ed. London: Guilford Press; 2003. 230 p.##King M, Marston L, McManus S, Brugha T, Meltzer H, Bebbington P. Religion, spirituality and mental health: results from a national study of English households. Br J Psychiatry. 2013;202(1):68-73.##Greenstreet W. Integrating spirituality in health and social care: perspective and practical approaches. 1st ed. Oxford: Radcliffe Publishing; 2006. 310 p.##Koenig HG, Dana EK, Verna BC. Handbook of religion and health. 2nd ed. New York: Oxford University Press; 2012. 421 p.##Pargament KI, Koenig HG, Tarakeshwar N, Hahn J. Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study. J Health Psychol. 2004;9(6):713-30.##National Youth Organization. [Survey on youth’s attitudes on religion and social issues]. 1st ed. Tehran: Youth Organization Press; 2005. 25 p. Persian.##Masoumi SZ, Poorolajal J, Keramat A, Moosavi SA. Prevalence of depression among infertile couples in Iran: A meta-analysis study. Iran J Public Health. 2013;42(5):458-66.##Nasseri M. Cultural similarities in psychological reactions to infertility. Psychol Rep. 2000;86(2):375-8.##Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. 1st ed. San Antonio, TX: Psychological Corporation; 1996. 18 p.##Poole H, Bramwell R, Murphy P. Factor Structure of the Beck Depression Inventory-II in patients with chronic pain. Clin J Pain. 2006;22(9):790-8.##Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21(4):185-92.##Aflakseir A, Coleman PG. Initial development of the Iranian religious coping scale. J Muslim Ment Health. 2011;6(1):44-61.##Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol. 2005;61(4):461-80.##Pargament K. APA handbook of psychology, religion, and spirituality. 1st ed. New York: American Psychological Association; 2013. 467 p.##Carpenter TP, Laney T, Mezulis A. Religious coping, stress, and depressive symptoms among adolescents: A prospective study. Psycholog Relig Spiritual. 2012;4(1):19-30.##Carleton RA, Esparza P, Thaxter PJ, Grant KE. Stress, religious coping resources, and depressive symptoms in an urban adolescent sample. J Sci Stud Relig. 2008;47(1):113-21.##Frazier P, Tashiro T, Berman M, Steger M, Long J. Correlates of levels and patterns of positive life changes following sexual assault. J Consult Clin Psychol. 2004;72(1):19-30.##George LK, Larson DB, Koenig HG, Mccullough ME. Spirituality and health: What we know, what we need to know. J Soc Clin Psychol. 2000;19(1):102-16.##Koenig HG. Religion and remission of depression in medical inpatients with heart failure/pulmonary disease. J Nerv Ment Dis. 2007;195(5):389-95.##Eliassen AH, Taylor J, Lloyd DA. Subjective religiosity and depression in the transition to adulthood. J Sci Stud Relig. 2005;44(2):187-99.##

Socio-Demographic Correlates of Women’s Infertility and Treatment Seeking Behavior in India 2 1 652 2 Background: Infertility is an emergent issue in India. Until recently, very few studies have understood the patterns and consequences of infertility in India. Family planning programs in India also viewed exclusively the patterns and determinants of overfertility rather than infertility. Furthermore, there is the lack of information about treatment seeking behavior of infertile couples. Therefore, this paper aimed to examine the extent of infertility and treatment seeking behavior among infertile women in India. An attempt was also made to evaluate the effects of socio-demographic factors on treatment seeking behavior. Methods: The study used the data from the District Level Household and Facility Survey carried out in India during 2007-08. Several statistical techniques such as chi-square test, proportional hazard model and binary logistic regression model were used for the analysis. Results: Approximately, 8% of currently married women suffered from infertility in India and most of them were secondary infertile (5.8%). Within India, women’s infertility rate was the highest in west Bengal (13.9 percent) and the lowest in Meghalaya (2.5 percent). About 80% of infertile women sought treatment but a substantial proportion (33%) received non-allopathic and traditional treatment due to expensive modern treatment and lack of awareness. Conclusion: In the context of policy response, it can be said that there is a need to improve the existing services and quality of care for infertile women. Treatment for infertility should be integrated into the larger reproductive health packages. 123 133 Sanjit S Sarkar International Institute for Population Sciences International Institute for Population Sciences India sanjitiips@gmail.com Pallavi P Gupta International Institute for Population Sciences International Institute for Population Sciences India AwarenessDeterminantsInfertilityPrimary infertilitySecondary infertilityTreatment seekingTreatment 652.pdf World Health Organization (WHO). Infertility: A Tabulation of Available Data on Prevalence of Primary and Secondary Infertility. WHO/MCH/91.9. Geneva: World Health Organization; 1999.##Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril. 2009;92(5):1520-4.##Larsen U. Childlessness, subfertility, and infertility in Tanzania. Stud Fam Plann. 1996;27(1):18-28.##World Health Organization. Infections, pregnancies, and infertility: perspectives on prevention. World Health Organization. Fertil Steril. 1987;47(6):964-8.##Parikh FR, Nadkarni SG, Kamat SA, Naik N, Soonawala SB, Parikh RM, et al. Genital tuberculosis--a major pelvic factor causing infertility in Indian women. Fertil Steril. 1997;67(3):497-500.##Yeboah ED, Wadhwani JM, Wilson JB. Etiological factors of male infertility in Africa. Int J Fertil. 1992;37(5):300-7.##Philippov OS, Radionchenko AA, Bolotova VP, Voronovskaya NI, Potemkina TV. Estimation of the prevalence and causes of infertility in western Siberia. Bull World Health Organ. 1998;76(2):183-7.##Sharon NC, Linda HB. Infertility counselling: A comprehensive handbook for clinicians. 2nd ed. USA: Cambridge University Press; 2006. 635 p.##Homan GF, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Hum Reprod Update. 2007;13(3):209-23.##Yilmaz N, Kilic S, Kanat-Pektas M, Gulerman C, Mollamahmutoglu L. The relationship between obesity and fecundity. J Womens Health (Larchmt). 2009;18(5):633-6.##Schmidt L, Sobotka T, Bentzen JG, Nyboe Andersen A. Demographic and medical consequences of the postponement of parenthood. Hum Reprod Update. 2012;18(1):29-43.##Ganguly S, Unisa S. Trends of infertility and childlessness in India: findings from NFHS data. Facts Views Vis Obgyn. 2010;2(2):131-8.##Rutstein SO, Iqbal HS. Infecundity, Infertility, and Childlessness in Developing Countries. Calverton, Maryland, USA: ORC Macro and the World Health Organization; 2004 Sept. 74 p. DHS Comparative Reports No.: 9.##Larsen U. Primary and secondary infertility in sub-Saharan Africa. Int J Epidemiol. 2000;29(2):285-91.##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.##Unisa S. Childlessness in andhra Pradesh, India: Treatment-seeking and consequences. Reprod Health Matters. 1999;7(13):54-64.##Ram U. Childlessness and its consequences in India: Levels, patterns and Differentials. Final Report. International Institute for Population Sciences, Mumbai, India; 2006 Sept. 308 p.##Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Sci Med. 1997;45(11):1679-704.##Bharadwaj A. Culture, infertility and gender–vignettes from South Asia and North Africa. Sex Health Exch. 2002;2:14-5.##Phipps S. Men and women react differently to infertility. South Africa Today. 1993;122(2581):14-7.##Desai S, Hazra M. Understanding the emotions of infertile couples. J Obstet Gynaecol India. 1992;42:498-503.##Patel T. Fertility behaviour: population and society in a Rajasthan village. 1st ed. New Delhi: Oxford University Press; 1994. 77 p.##Dhaliwal LK, Khera KR, Dhall GI. Evaluation and two-year follow-up of 455 infertile couples--pregnancy rate and outcome. Int J Fertil. 1991;36(4):222-6.##Kakar DN. Traditional healers in North India: a study. Nurs J India. 1983;74(3):61-3.##Mulgaonkar VB. A research and an intervention programme on women’s reproductive health in slums of Mumbai. 1st ed. Mumbai: Sujeevan Trust; 2001. 144 p.##International Institute for Population Sciences (IIPS), 2010. District Level Household and Facility Survey (DLHS-3), 2007-08, India. Mumbai: IIPS.##Statacrop. Stata Statistical Software: Release 10. College Station, TX: StataCrop LP; 2007.##Hormones and You: Patient Information Page [Internet]. The Hormone Foundation; 1998. Infertility and Women; 2005 April [cited 2011 Dec 21]. Available from: http://press.endocrine.org/doi/abs/10.1210/jcem.90.4.9997##

Ovarian Malignant Mixed Germ Cell Tumor: A Case of Unusual Presentation as Molar Pregnancy 2 1 665 2 Background: This research was conducted to introduce a patient with rare ovarian mixed germ cell tumor, presented as molar pregnancy. Case Presentation: The patient was a 16 year old woman admitted with diagnosis of molar pregnancy. Abdominal enlargement was the only complaint. She had a large pelvic mass in physical examination. The first diagnosis was molar pregnancy due to previous ultrasonic reports and positive βeta HCG. Urine pregnancy test was positive. As suction curettage was performed for her, surprisingly, the size of uterus was normal and no molar tissue was found in pathologic examination. At intraoperative ultrasound exam, an extra-uterine heterogeneous mass was found. Extra-uterine mass was confirmed by CT and MRI done after suction curettage. Mixed germ cell tumor was confirmed by histological examination after laparatomy and removing tumoral mass. Finally, she received Bleomycin, Etoposide and Cisplatin (BEP) regimen in four courses and Vincristine, Actinomycin D (Dactinomycin) and Cyclophosphamide (VAC) regimen in two courses and Diphereline for saving the other ovary. Conclusion: Some young patients misinterpret the early symptoms of an ovarian neoplasm as those of pregnancy which can lead to a delay in the diagnosis. 133 137 Soheila S Aminimoghaddam Gynecology Oncology Department, Iran University of Medical Sciences Gynecology Oncology Department, Iran University of Medical Sciences Iran Dr_aminimoghaddam@ yahoo.com Iman I Mohseni Gynecology Oncology Department, Iran University of Medical Sciences Gynecology Oncology Department, Iran University of Medical Sciences Iran Azadeh A Afzalzadeh Gynecology Oncology Department, Iran University of Medical Sciences Gynecology Oncology Department, Iran University of Medical Sciences Iran Shooka Sh Esmaeeli Gynecology Oncology Department, Iran University of Medical Sciences Gynecology Oncology Department, Iran University of Medical Sciences Iran BEPEmbryonal carcinomaGerm cell tumorMolar pregnancyTumor markerVACYolk sac tumor 665.pdf Berek JS, Hacker NF. Berek & Hacker’s Gynecologic Oncology. 5th ed. New York: Lippincott Williams & Wilkins; 2009. 912 p.##Goyal LD, Kaur S, Kawatra K. Malignant mixed germ cell tumour of ovary--an unusual combination and review of literature. J Ovarian Res. 2014;7:91.##DiSaia PhJ, Creasman WT. Clinical gynecologic oncology. 8th ed. Elsevier Health Sciences; 2012. 342 p.##Pagaro PM, Gore CR, Patil T, Chandanwale Sh. Mixed germ cell tumors: report of two cases. Med J of Dr. DY Patil Univ. 2013;6(3):298-301.##Kurman RJ, Norris HJ. Malignant mixed germ cell tumors of the ovary. A clinical and pathologic analysis of 30 cases. Obstet Gynecol. 1976;48(5):579-89.##DiSaia Ph J, Creasman WT. Clinical gynecologic oncology. 6th ed. US: Mosby; 2002. 675 p.##Igwegbe A, Eleje G. Hydatidiform mole: A Review of Management Outcomes in a Tertiary Hospital in South-East Nigeria. Ann Med Health Sci Res. 2013;3(2):210-4.##Lazarus E, Hulka C, Siewert B, Levine D. Sonographic appearance of early complete molar pregnancies. J Ultrasound Med. 1999;18(9):589-94.##Aoki Y, Kase H, Fujita K, Tanaka K. Dysgerminoma with a slightly elevated alpha-fetoprotein level diagnosed as a mixed germ cell tumor after recurrence. Gynecol Obstet Invest. 2003;55(1):58-60.##Ghaemmaghami F, Modares M, Arab M, Behtash N, Moosavi AZ, Khanafshar N, et al. EMA-EP regimen, as firstline multiple agent chemotherapy in high-risk GTT patients (stage II-IV). Int J Gynecol Cancer. 2004;14(2):360-5.##Berek JS, Hacker NF. Practical Gynecologic Oncology. 3rd ed. UK: Lippinkot Williams and Wilkins; 2000. Chapter 12, Non epithelial ovarian and fallopian tube cancers; p. 523-51.##Huser M, Crha I, Ventruba P, Hudecek R, Zakova J, Smardova L, et al. Prevention of ovarian function damage by a GnRH analogue during chemotherapy in Hodgkin lymphoma patients. Hum Reprod. 2008;23(4):863-8.##