ART Strategy for Treatment of Recurrent Pregnancy Loss: Isn’t It Better to Forget? 2 1 695 2 Recurrent pregnancy loss (RPL), recurrent miscarriage or habitual abortion is a multifactorial problem with exasperating and challenging aspects in reproductive medicine. It is defined as two or more consecutive loss of clinical pregnancies. However, the incidence of RPL is less than 5% in pregnant women but its etiology is diverse and varied and also for more than 50% of cases is not clearly defined (1). RPL is a challenging disorder in diagnosis and treatment for clinicians and a stressful problem with the psychological burden on the couples. RPL is a distressing incident. Occurrence of this traumatic experience leads to emotional distress such as anxiety, depression and indignation in most of these women. The psychological burden on the physicians and couples leads to massive efforts in any possible way for a successful pregnancy followed by a successful and healthy live birth. Therefore, one of alternative treatment options suggested by physicians or requested by the couples is assisted reproductive technology (ART). Now the question is whether ART has any position in the treatment of these couples? Whether it can increase their chances for having a live birth or it can decrease their waiting time for a successful pregnancy? The literature review on ART and RPL revealed that ART is not very efficient for having a live birth compared to expectant management. However, all of the studies used ART for couples with approved chromosomal abnormalities as the cause of RPL and also for women diagnosed with unexplained RPL. In these cases, ART with PGS is used for selection of embryos free of chromosomal anomalies. In spite of the wide application of PGS and ART in treatment of PRL, its clinical outcomes and cost-effectiveness in the procedures are unclear (2). The first generation of PGS method was FISH-based screening on blastomeres of cleavage-stage embryos. FISH-based procedure for screening aneuploid embryos has a significant rate of misdiagnosis and also in vitro fertilized embryos have high level of mosaicism, therefore many of the euploid embryos are misdiagnosed with aneuploid. Several randomized controlled trials on RPL showed that FISH-based PGS cannot improve the live birth rate. The second generation of PGS includes more accurate methods such as CGH-microarray, SNP microarray and NGS which significantly improve the efficiency and efficacy of screening for genetic anomalies. Despite serious improvement in ART and PGS procedures, the new generation of PGS also cannot increase live birth rate in comparison with expectant management as a standard treatment of RPL (3). ART–PGS is an expensive strategy for reducing repeated miscarriages without improvement in the chance of live birth rate. A large number of PGS cycles failed to lead to embryo transfer due to failure of finding euoploid embryos. According to studies’ results, live birth rate of IVF/PGS cycles is about 50%; however, live-birth rate of expectant management is about 70% over time, while the IVF/PGS approach is 100-fold more expensive than expectant management (4). Therefore, if ART-GPS was the first choice for reducing the waiting time for the birth of a living child, its success rate would be higher than 90%. Therefore, it will have the priority over expectant management for treatment of RPL. Unfortunately, despite all improvements and efforts, the method is not very successful. So, until achieving this level of success rate, ART-PGS should be suggested for RPL with more precaution. In addition, appropriate counseling of couples regarding the conditions, success rate and cost of ART-PGS will help them to choose the method with more awareness. 191 192 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 695.pdf Diejomaoh MF. Recurrent spontaneous miscarriage is still a challenging diagnostic and therapeutic quagmire. Med Princ Pract. 2015;24 Suppl 1:38-55.##Kaandorp SP, van Mens TE, Middeldorp S, Hutten BA, Hof MH, van der Post JA, et al. Time to conception and time to live birth in women with unexplained recurrent miscarriage. Hum Reprod. 2014;29(6):1146-52.##Gleicher N, Kushnir VA, Barad DH. Preimplantation genetic screening (PGS) still in search of a clinical application: a systematic review. Reprod Biol Endocrinol. 2014;12:22.##Murugappan G, Ohno MS, Lathi RB. Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss. Fertil Steril. 2015;103(5):1215-20.##

Cyclic Variation of Cellular Clock Proteins in the Mouse Estrous Ovary 2 1 676 2 Background: The mammalian ovary is controlled by a number of biological rhythms, which regulate the recruitment and release of mature oocytes. The main objective of this study was to investigate the role of cellular clock proteins during follicle maturation in the mouse estrous ovary. Methods: Immunohistochemical (IHC) studies were performed on ovaries from 50 estrous staged mice culled at two time points of 09:00 [day] and 01:00 [mid-point of the dark cycle]. Six antibodies were used to identify the expression of core cellular clock proteins (BMAL1, CLOCK, CRY1, CRY2, PER1 and PER2) within the ovary and four follicle stages, primordial, primary, antral and corpus lutea. IHC data was scored using the Allred protocol and significance determined by Mann-Whitney tests. Differences were considered significant at p<0.05. Results: All four follicle stages presented greater BMAL1 and CLOCK protein scores during the day and up regulation of CRY1-2 and PER1-2 at night. In primordial follicles, BMAL1 and CLOCK increases were significant (p<0.05) and CRY-1 and PER-1 were highly significant (p<0.001), and CRY-2 did not reach significance. Primary follicles demonstrated a similar response with BMAL1 and CLOCK, and CRY-1, PER-1-2 all reaching significant expression (p<0.05; p<0.001; p<0.001 respectively). CRY-2 expression was not significant. Antral follicles did not show significant BMAL1 or CLOCK expression, CRY-1 and PER-1 were highly significant (p<0.001) and CRY-2 had a small but significant increase (p<0.05). Corpus lutea demonstrated significant BMAL1 increase but CLOCK had no significant variation. CRY-1, PER1-2 increases were highly significant (p<0.001) and CRY-2 was up regulated but failed to reach significance. Conclusion: The ovary demonstrated a cellular clock response to the light: dark cycle and in addition, as the ovarian follicles mature changes in the positive and negative arms of both clock responsive proteins were observed. 192 199 George G Wiggins Department of Biochemistry, University of Otago Department of Biochemistry, University of Otago New Zealand Michael M Legge Department of Biochemistry, University of Otago Department of Biochemistry, University of Otago New Zealand mike.legge@otago.ac.nz Cellular clockOvarian folliclesOvary 676.pdf Baker TG. A quantative and cytological study of germ cells in human ovaries. Proc R Soc Lond B Biol Sci. 1963;158:417-33.##Marieb E, Hoehn K. Human Anatomy and Physiology. 7th ed. San Francisco: Pearson Benjamin Cummings; 2007. Chapter 27, The Reproductive System; p. 1091-101.##McGee EA, Hsueh AJ. Initial and cyclic recruitment of ovarian follicles. Endocr Rev. 2000;21(2):200-14.##Bristol-Gould SK, Kreeger PK, Selkirk CG, Kilen SM, Mayo KE, Shea LD, et al. Fate of the initial follicle pool: empirical and mathematical evidence supporting its sufficiency for adult fertility. Dev Biol. 2006;298(1):149-54.##Macnaughton M, Govan A. Clinics in Obstetrics and Gynaecology. Eastbourne, England: W.B Saunders Company Ltd; 1976. Chapter 2, The ovary; p. 15-22.##Ferin M. Neuroendocrine control of ovarian function in the primate. J Reprod Fertil. 1983;69(1):369-81.##Richards JS, Pangas SA. The ovary: basic biology and clinical implications. J Clin Invest. 2010;120(4):963-72.##Roche JF. Control and regulation of folliculogenesis--a symposium in perspective. Rev Reprod. 1996;1(1):19-27.##Alleva JJ, Waleski MV, Alleva FR, Umberger EJ. Synchronizing effect of photoperiodicity on ovulation in hamsters. Endocrinology. 1968;82(6):1227-35.##Lawton IE, Schwartz NB. Pituitary-ovarian function in rats exposed to constant light: a chronological study. Endocrinology. 1967;81(3):497-508.##Mahoney MM. Shift work, jet lag, and female reproduction. Int J Endocrinol. 2010;2010:813764.##Morse D, Cermakian N, Brancorsini S, Parvinen M, Sassone-Corsi P. No circadian rhythms in testis: Period1 expression is clock independent and developmentally regulated in the mouse. Mol Endocrinol. 2003;17(1):141-51.##Karman BN, Tischkau SA. Circadian clock gene expression in the ovary: Effects of luteinizing hormone. Biol Reprod. 2006;75(4):624-32.##Shimizu T, Hirai Y, Murayama C, Miyamoto A, Miyazaki H, Miyazaki K. Circadian Clock genes Per2 and clock regulate steroid production, cell proliferation, and luteinizing hormone receptor transcription in ovarian granulosa cells. Biochem Biophys Res Commun. 2011;412(1):132-5.##Hastings MH, Herzog ED. Clock genes, oscillators, and cellular networks in the suprachiasmatic nuclei. J Biol Rhythms. 2004;19(5):400-13.##Reppert SM, Weaver DR. Coordination of circadian timing in mammals. Nature. 2002;418(6901):935-41.##Reppert SM. A clockwork explosion! Neuron. 1998;21(1):1-4.##Ko CH, Takahashi JS. Molecular components of the mammalian circadian clock. Hum Mol Genet. 2006;15 Spec No 2:R271-7.##Gekakis N, Staknis D, Nguyen HB, Davis FC, Wilsbacher LD, King DP, et al. Role of the CLOCK protein in the mammalian circadian mechanism. Science. 1998;280(5369):1564-9.##Rutter J, Reick M, Wu LC, McKnight SL. Regulation of clock and NPAS2 DNA binding by the redox state of NAD cofactors. Science. 2001;293(5529):510-4.##Vilmar A, Garcia-Foncillas J, Huarriz M, Santoni-Rugiu E, Sorensen JB. RT-PCR versus immunohistochemistry for correlation and quantification of ERCC1, BRCA1, TUBB3 and RRM1 in NSCLC. Lung Cancer. 2012;75(3):306-12.##Van der Salm L, Legge M. A re-evaluation of methods for determining the oestrous cycle in the mouse. Animal Technol. 1994;45:43-5.##Allred DC, Harvey JM, Berardo M, Clark GM. Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Mod Pathol. 1998;11(2):155-68.##Makris A, Allred DC, Powles TJ, Dowsett M, Fernando IN, Trott PA, et al. Cytological evaluation of biological prognostic markers from primary breast carcinomas. Breast Cancer Res Treat. 1997;44(1):65-74.##Adhikari D, Liu K. Molecular mechanisms underlying the activation of mammalian primordial follicles. Endocr Rev. 2009;30(5):438-64.##Edson MA, Nagaraja AK, Matzuk MM. The mammalian ovary from genesis to revelation. Endocr Rev. 2009;30(6):624-712.##Fragouli E, Lalioti MD, Wells D. The transcriptome of follicular cells: biological insights and clinical implications for the treatment of infertility. Hum Reprod Update. 2014;20(1):1-11.##Durlinger AL, Kramer P, Karels B, de Jong FH, Uilenbroek JT, Grootegoed JA, et al. Control of primordial follicle recruitment by anti-Müllerian hormone in the mouse ovary. Endocrinology. 1999;140(12):5789-96.##Nakamura TJ, Moriya T, Inoue S, Shimazoe T, Watanabe S, Ebihara S, et al. Estrogen differentially regulates expression of Per1 and Per2 genes between central and peripheral clocks and between reproductive and nonreproductive tissues in female rats. J Neurosci Res. 2005;82(5):622-30.##Nakamura TJ, Sellix MT, Menaker M, Block GD. Estrogen directly modulates circadian rhythms of PER2 expression in the uterus. Am J Physiol Endocrinol Metab. 2008;295(5):E1025-31.##Gachon F, Nagoshi E, Brown SA, Ripperger J, Schibler U. The mammalian circadian timing system: from gene expression to physiology. Chromosoma. 2004;113(3):103-12.##Rudic RD, McNamara P, Curtis AM, Boston RC, Panda S, Hogenesch JB, et al. BMAL1 and CLOCK, two essential components of the circadian clock, are involved in glucose homeostasis. PLoS Biol. 2004;2(11):e377.##Rutter J, Reick M, McKnight SL. Metabolism and the control of circadian rhythms. Annu Rev Biochem. 2002;71:307-31.##Sassone-Corsi P. Commentary: the year in circadian rhythms. Mol Endocrinol. 2010;24(11):2081-7.##Zhang EE, Liu Y, Dentin R, Pongsawakul PY, Liu AC, Hirota T, et al. Cryptochrome mediates circadian regulation of cAMP signaling and hepatic gluconeogenesis. Nat Med. 2010;16(10):1152-6.##

Short Term Organ Culture of Mouse Ovary in the Medium Supplemented with Bone Morphogenetic Protein 15 and Follicle Stimulating Hormone: A Morphological, Hormonal and Molecular Study 2 1 686 2 Background: Bone morphogenetic protein 15 (BMP15) is a growth factor derived from oocyte and is essential for in vivo ovarian follicular growth and in this study, its effects on the improvement of growth and development of follicles during in vitro culture of neonatal mouse ovaries was investigated. Methods: Two week old mice were cultured for 7 days in the basic culture media with or without follicle stimulating hormone (FSH) and BMP15 as four experimental groups; FSH-/BMP15-, FSH+/BMP15-, FSH-/BMP15+ and FSH+/BMP15+. The ovarian follicles at different developmental stages in paraffin embedding sections of cultured and non-cultured ovaries were counted and compared. The 17-β estradiol (E2) and progesterone (P4) levels were analyzed in collected culture media. The expression ratio of developmental genes (PCNA, BMPR-IB, BMPR-II, FSH-R, CYP17 and ZP3) to housekeeping gene (GAPDH) was analyzed by real time PCR (RT-PCR) in comparison with non-cultured control ovaries. The data was compared by independent t-test and one-way ANOVA (with Tukey’s Post Hoc test). The p<0.05 was considered significant. Results: The percentage of antral follicles, ovarian size, concentration of E2 and P4 and the expression ratio of PCNA and ZP3 genes in the ovaries cultured in medium supplemented with BMP15 and FSH increased significantly in comparison with other cultured groups (p<0.05). The BMPR-IB, BMPR-II and FSH-R mRNA level was significantly lower (p<0.05) and CYP 17 mRNA level did not change in the FSH+/BMP15+ group than other cultured groups. Conclusion: This study demonstrated a favorable effect of BMP15 in combination with FSH on in vitro development of small size mouse follicles to antral stage. 199 208 Mojdeh M Salehnia مژده صالح نیا Department of Anatomy, Faculty of Medical Sciences, Tarbiat Modares University Department of Anatomy, Faculty of Medical Sciences, Tarbiat Modares University Iran salehnim@modares.ac.ir, mogdeh@dr.com Mojdeh M Pajokh Department of Anatomy, Faculty of Medical Sciences, Tarbiat Modares University Department of Anatomy, Faculty of Medical Sciences, Tarbiat Modares University Iran Nassim N Ghorbanmehr Department of Biotechnology, Faculty of Biological Sciences, Alzahra University Department of Biotechnology, Faculty of Biological Sciences, Alzahra University Iran Bone morphogenetic protein 15Follicle stimulating hormoneGene expressionOrgan cultureOvary 686.pdf Mester B, Ritter LJ, Pitman JL, Bibby AH, Gilchrist RB, McNatty KP, et al. Oocyte expression, secretion and somatic cell interaction of mouse bone morphogenetic protein 15 during the peri-ovulatory period. Reprod Fertil Dev. 2015;27(5):801-11.##Fenwick MA, Mora JM, Mansour YT, Baithun C, Franks S, Hardy K. Investigations of TGF-β signaling in preantral follicles of female mice reveal differential roles for bone morphogenetic protein 15. Endocrinology. 2013;154(9):3423-36.##Paulini F, Melo EO. The role of oocyte-secreted factors GDF9 and BMP15 in follicular development and oogenesis. Reprod Domest Anim. 2011;46(2):354-61.##Juengel JL, Bodensteiner KJ, Heath DA, Hudson NL, Moeller CL, Smith P, et al. Physiology of GDF9 and BMP15 signalling molecules. Anim Reprod Sci. 2004;82-83:447-60##Gasperin BG, Ferreira R, Rovani MT, Bordignon V, Duggavathi R, Buratini J. Expression of receptors for BMP15 is differentially regulated in dominant and subordinate follicles during follicle deviation in cattle. Anim Reprod Sci. 2014;144(3-4):72-8.##McNatty KP, Juengel JL, Reader KL, Lun S, Myllymaa S, Lawrence SB, et al. Bone morphogenetic protein 15 and growth differentiation factor 9 co-operate to regulate granulosa cell function. Reproduction. 2005;129(4):473-80.##de Resende LO, Vireque AA, Santana LF, Moreno DA, de Sa Rosa e Silva AC, Ferriani RA, et al. Single-cell expression analysis of BMP15 and GDF9 in mature oocytes and BMPR2 in cumulus cells of women with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation. J Assist Reprod Genet. 2012;29(10):1057-65.##Mery L, Lefevre A, Benchaib M, Demirci B, Salle B, Guerin JF, et al. Follicular growth in vitro: detection of growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15) during in vitro culture of ovine cortical slices. Mol Reprod Dev. 2007;74(6):767-74.##Otsuka F, McTavish KJ, Shimasaki S. Integral role of GDF-9 and BMP-15 in ovarian function. Mol Reprod Dev. 2011;78(1):9-21.##Guéripel X, Brun V, Gougeon A. Oocyte bone morphogenetic protein 15, but not growth differentiation factor 9, is increased during gonadotropin-induced follicular development in the immature mouse and is associated with cumulus oophorus expansion. Biol Reprod. 2006;75(6):836-43.##Lima IM, Brito IR, Rossetto R, Duarte AB, Rodrigues GQ, Saraiva MV, et al. BMPRIB and BMPRII mRNA expression levels in goat ovarian follicles and the in vitro effects of BMP-15 on preantral follicle development. Cell Tissue Res. 2012;348(1):225-38.##Hreinsson JG, Scott JE, Rasmussen C, Swahn ML, Hsueh AJ, Hovatta O. Growth differentiation factor-9 promotes the growth, development, and survival of human ovarian follicles in organ culture. J Clin Endocrinol Metab. 2002;87(1):316-21.##Kedem A, Fisch B, Garor R, Ben-Zaken A, Gizunterman T, Felz C, et al. Growth differentiating factor 9 (GDF9) and bone morphogenetic protein 15 both activate development of human primordial follicles in vitro, with seemingly more beneficial effects of GDF9. J Clin Endocrinol Metab. 2011;96(8):E1246-54.##Zhai B, Liu H, Li X, Dai L, Gao Y, Li C, et al. BMP15 prevents cumulus cell apoptosis through CCL2 and FBN1 in porcine ovaries. Cell Physiol Biochem. 2013;32(2):264-78.##Otsuka F, Yao Z, Lee T, Yamamoto S, Erickson GF, Shimasaki S. Bone morphogenetic protein-15. Identification of target cells and biological functions. J Biol Chem. 2000;275(50):39523-8.##Hussein TS, Froiland DA, Amato F, Thompson JG, Gilchrist RB. Oocytes prevent cumulus cell apoptosis by maintaining a morphogenic paracrine gradient of bone morphogenetic proteins. J Cell Sci. 2005;118(Pt 22):5257-68.##Wu YT, Tang L, Cai J, Lu XE, Xu J, Zhu XM, et al. High bone morphogenetic protein-15 level in follicular fluid is associated with high quality oocyte and subsequent embryonic development. Hum Reprod. 2007;22(6):1526-31.##Gode F, Gulekli B, Dogan E, Korhan P, Dogan S, Bige O, et al. Influence of follicular fluid GDF9 and BMP15 on embryo quality. Fertil Steril. 2011;95(7):2274-8.##Passos MJ, Vasconcelos GL, Silva AW, Brito IR, Saraiva MV, Magalhaes DM, et al. Accelerated growth of bovine preantral follicles in vitro after stimulation with both FSH and BMP-15 is accompanied by ultrastructural changes and increased atresia. Theriogenology. 2013;79(9):1269-77.##Celestino JJ, Lima-Verde IB, Bruno JB, Matos MH, Chaves RN, Saraiva MV, et al. Steady-state level of bone morphogenetic protein-15 in goat ovaries and its influence on in vitro development and survival of preantral follicles. Mol Cell Endocrinol. 2011;338(1-2):1-9.##Rossi RO, Costa JJ, Silva AW, Saraiva MV, Van den Hurk R, Silva JR. The bone morphogenetic protein system and the regulation of ovarian follicle development in mammals. Zygote. 2016;24(1):1-17.##Avella MA, Xiong B, Dean J. The molecular basis of gamete recognition in mice and humans. Mol Hum Reprod. 2013;19(5):279-89.##Gupta SK, Bhandari B, Shrestha A, Biswal BK, Palaniappan C, Malhotra SS, et al. Mammalian zona pellucida glycoproteins: structure and function during fertilization. Cell Tissue Res. 2012;349(3):665-78.##Picut CA, Swanson CL, Scully KL, Roseman VC, Parker RF, Remick AK. Ovarian follicle counts using proliferating cell nuclear antigen (PCNA) and semi-automated image analysis in rats. Toxicol Pathol. 2008;36(5):674-9.##Muskhelishvili L, Wingard SK, Latendresse JR. Proliferating cell nuclear antigen--a marker for ovarian follicle counts. Toxicol Pathol. 2005;33(3):365-8.##Zhang Z, Shen B, Wang Y, Chen Y, Wang G, Lin P, et al. Molecular cloning of proliferating cell nuclear antigen and its differential expression analysis in the developing ovary and testis of penaeid shrimp Marsupenaeus japonicus. DNA Cell Biol. 2010;29(4):163-70.##Oktay K, Schenken RS, Nelson JF. Proliferating cell nuclear antigen marks the initiation of follicular growth in the rat. Biol Reprod. 1995;53(2):295-301.##Rowe E, Van Horn A, Rockwell LC. CYP17 genotype modifies the impact of anthropometric variation on salivary estradiol in healthy women. Am J Phys Anthropol. 2015;156(4):665-70.##Marcondes RR, Carvalho KC, Duarte DC, Garcia N, Amaral VC, Simões MJ, et al. Differences in neonatal exposure to estradiol or testosterone on ovarian function and hormonal levels. Gen Comp Endocrinol. 2015;212:28-33.##Kempisty B, Ziółkowska A, Ciesiółka S, Piotrowska H, Antosik P, Bukowska D, et al. Association between the expression of LHR, FSHR and CYP19 genes, cellular distribution of encoded proteins and proliferation of porcine granulosa cells in real-time. J Biol Regul Homeost Agents. 2014;28(3):419-31.##Scarlet D, Walter I, Hlavaty J, Aurich C. Expression and immunolocalisation of follicle-stimulating hormone receptors in gonads of newborn and adult female horses. 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Frequency of Y Chromosome Microdeletions Among Iranian Infertile Men with Azoospermia and Severe Oligozoospermia: A Meta-analysis 2 1 679 2 Background: While multiple factors can contribute to male infertility, genetic factors, such as chromosomal disorders or Y-chromosome microdeletion, are responsible for about 10% of male infertility. Considering the role of Y-chromosome microdeletions in men with oligozoospermia who volunteer for in vitro fertilization (IVF), the prevalence of such microdeletions in each particular community needs to be exactly determined. Hence, the present study attempted to analyze the available literature on the frequency of chromosome microdeletion among Iranian infertile men. Methods: In the first stage, a systematic search was performed on international and Iranian databases including PubMed, Scopus, Web of Science, IranMedex, MEDLIB, and Scientific Information Database in order to extract all relevant studies published until December 1, 2014. Results: According to the literature review and meta-analysis process, Y chromosome microdeletions were present in about 12.1% (95% CI, 6.5-21.5) of Iranian infertile men with azoospermia and severe oligozoospermia. Conclusion: Because of the presence of Y-chromosome microdeletion in at least 12% of Iranian infertile men, it is necessary all the IVF centers, implement this Y-chromosome microdeletion screening tests in the work-up of male infertility. 208 213 Ehsan E Yousefi-Razin Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Mohammad Javad MJ Nasiri Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Mir Davood MD Omrani Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences Iran davood_omrani@sbmu.ac.ir AzoospermiaMicrodeletionsOligoastenospermiaSTR markersY-Chromosome 679.pdf Elfateh F, Rulin D, Xin Y, Linlin L, Haibo Z, Liu RZ. Prevalence and patterns of Y chromosome microdeletion in infertile men with azoospermia and oligzoospermia in Northeast China. Iran J Reprod Med. 2014;12(6):383-8.##Ambulkar PS, Sigh R, Reddy M, Varma PS, Gupta DO, Shende MR, et al. Genetic risk of azoospermia factor (AZF) microdeletions in idiopathic cases of azoospermia and oligozoospermia in central indian population. J Clin Diagn Res. 2014;8(3):88-91.##Zaimy MA, Kalantar SM, Sheikhha MH, Jahaninejad T, Pashaiefar H, Ghasemzadeh J, et al. The frequency of Yq microdeletion in azoospermic and oligospermic Iranian infertile men. Iran J Reprod Med. 2013;11(6):453-8.##Khabour OF, Fararjeh AS, Alfaouri AA. Genetic screening for AZF Y chromosome microdeletions in Jordanian azoospermic infertile men. Int J Mol Epidemiol Genet. 2014;5(1):47-50.##Hamada AJ, Esteves SC, Agarwal A. A comprehensive review of genetics and genetic testing in azoospermia. Clinics (Sao Paulo). 2013;68 Suppl 1:39-60.##Wong WY, Thomas CM, Merkus JM, Zielhuis GA, Steegers-Theunissen RP. male factor subfertility: possible causes and the impact of nutritional factors. Fertil Steril. 2000;73(3):435-42.##Elghezal H, Hidar S, Braham R, Denguezli W, Ajina M, Saâd A. Chromosome abnormalities in one thousand infertile males with nonobstructive sperm disorders. Fertil Steril. 2006;86(6):1792-5.##Fu L, Xiong DK, Ding XP, Li C, Zhang LY, Ding M, et al. Genetic screening for chromosomal abnormalities and Y chromosome microdeletions in Chinese infertile men. J Assist Reprod Genet. 2012;29(6):521-7.##Vogt PH. Genomic heterogeneity and instability of the AZF locus on the human Y chromosome. Mol Cell Endocrinol. 2004;224(1-2):1-9.##Totonchi M, Mohseni Meybodi A, Borjian Boroujeni P, Sedighi Gilani M, Almadani N, Gourabi H. Clinical data for 185 infertile Iranian men with Y-chromosome microdeletion. J Assist Reprod Genet. 2012;29(8):847-53.##Mirfakhraie R, Mirzajani F, Kalantar SM, Montazeri M, Salsabili N, Pourmand GR, et al. High prevalence of AZFb microdeletion in Iranian patients with idiopathic non-obstructive azoospermia. Indian J Med Res. 2010;132:265-70.##Nasiri MJ, Farnia P. Prevalence of rapidly growing mycobacteria (RGM) in Iran: Systematic review and meta-analysis. Int J Mycobacteriol. 2015;4(Suppl 1):145.##Saliminejad K, Sadeghi MR, Kamali K, Amirjannati N, Soltanghoraee H, Khorram Khorshid HR. Discrepancy in the frequency of Y chromosome microdeletions among Iranian infertile men with azoospermia and severe oligozoospermia. Genet Test Mol Biomarkers. 2012;16(8):931-4.##Malekasgar AM, Mombaini H. Screening of 'Y' chromosome microdeletions in Iranian infertile males. J Hum Reprod Sci. 2008;1(1):2-9.##Khatami SR, Galehdari H, Rasekh A, Mombeini H, Konar E. Assessment of Correlation between Androgen Receptor CAG Repeat Length and Infertility in Infertile Men Living in Khuzestan, Iran. Int J Fertil Steril. 2015;9(2):189-96.##Torfeh M, Sakhinia E, Hasani H, Ahmadi Asre Badr Y, Nourizadeh D, Heshmat Y, et al. Molecular analysis and comparison of Y chromosome microdeletions in Tabriz and Kashan infertile men with azospermia and severe oligospermia. Iran J Obstet Gynecol Infertil. 2012;15(2):23-30.##Omrani MD, Samadzadae S, Bagheri M, Attar K. Y chromosome microdeletions in idiopathic infertile men from West Azarbaijan. Urol J. 2006;3(1):38-43.##Sheikhha MH, Zaimy MA, Soleimanian S, Kalantar SM, Rasti A, Golzade M, et al. Multiplex PCR Screening of Y-chromosome microdeletions in azoospermic ICSI candidate men. Iran J Reprod Med. 2013;11(4):335-8.##Asbagh FA, Sina A, Najmabadi H, Akbari MT, Pourm ATG. Prevalence of Y chromosome microdeletions in Iranian infertile men. Acta Med Iran. 2003;41(3):164-70.##Akbarzadeh-Khiavi M, Rahmani SA, Akbarzadeh-Khiavi T, Safary A, Nikzad H, Jalili A. Molecular screening of Y chromosome microdeletions in AZFc and AZFd regions of the non-obstructive azoospermic patients referred to Alzahra hospital in Tabriz. Jokull J. 2013;63(10):44-53.##Etemadi K, Amiri I. Y chromosome microdeletion study in idiopathic infertile men in Hamadan Fatemieh hospital with multiplex PCR method. Sci J Hamadan Univ Med Sci. 2013;19(4):48-56##Kalantar SM, Dehghani M, Zaimy A, Soleimanian S. Screening of Y-chromosome microdeletion in Iranian infertile men. Int J Reprod BioMed. 2011;9(2):61.##Keshvari Shirvan M, Taghavi Razavizadeh R, Ashraf H. Evaluating Y chromosome microdeletions in infertile men with severe oligozoospermia or azoospermia at Imam Reza hospital in Meshad. J Reprod Infertil. 2010;11(4):259-67.##Poongothai J, Gopenath TS, Manonayaki S. Genetics of human male infertility. 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Distress in Infertile Males in Manipal-India: A Clinic Based Study 2 1 680 2 Background: Being infertile comes as an overwhelming realization for couples trying to conceive. In consideration of rising rates of infertility worldwide, clinicians in India have also begun exploring this field for new possibilities, development and research. The purpose of this study was to estimate the proportion and predictors of infertility specific stress in males diagnosed with primary infertility. Methods: This cross-sectional research was conducted in an assisted reproduction center, Manipal, India, on 300 infertile married males. The tools were "semi-structured questionnaire" compiled by the authors, "ICD-10 Classification of Mental and Behavioural Disorders (Clinical Descriptions and Diagnostic Guidelines) and" Psychological Evaluation Test for infertility. Multiple logistic regression analysis was carried out on data with p-value fixed as 0.05. Results: The presence of stress was reported in 72% of male participants. The predictors of stress were nature and severity of their infertility diagnosis, sperm defects, urological condition and experience of corrective surgery undergone for it. Psychological stress in men was also predicted by present and past history of significant psychiatric morbidity and coping difficulties associated with it. Conclusion: The stress is both a common experience and at times a clinical condition associated with deteriorating mental and physical health in men seeking fertility treatments. As a prerequisite, Indian fertility clinics need to treat stress as an identifiable condition and devise ways of addressing it at all stages of assisted conception and reproductive treatments. 213 221 Ansha A Patel Department of Psychiatry, Kasturba Medical College, Manipal University Department of Psychiatry, Kasturba Medical College, Manipal University India ansha_patel@yahoo.co.in Podila PS Venkata Narasimha Sharma Department of Psychiatry, Kasturba Medical College, Manipal University Department of Psychiatry, Kasturba Medical College, Manipal University India Pratapkumar P Narayan Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University India Binu BV Sreekumaran Nair Department of Statistics, Manipal University Department of Statistics, Manipal University India Dinesh D Narayanakurup Department of Clinical Psychology, School of Allied Health Sciences, Manipal University Department of Clinical Psychology, School of Allied Health Sciences, Manipal University India Praveena P Pai Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University India Cross-sectional studyIndiaInfertilityMaleMorbidityPsychological factorsStress 680.pdf Dunkel-Schetter C, Stanton AL, editors. Infertility: Perspectives from stress and coping research. 1st ed. New York: Plenum; 1991. Chapter 10, Psychological adjustment to infertility: Future directions in research and application; p. 197-222.##Read J. Counselling for Fertility Problems. London: Sage Publications Ltd; 1985.##Diamond R, Kezur D, Meyers M, Scharf CN, Weinschel M. Couple therapy for infertility. 1st ed. New York: Guilford Press; 1999. 243 p.##Ulbrich PM, Coyle AT, Llabre MM. Involuntary childlessness and marital adjustment: his and hers. J Sex Marital Ther. 1990;16(3):147-58.##Wright J, Duchesne C, Sabourin S, Bissonnette F, Benoit J, Girard Y. Psychosocial distress and infertility: men and women respond differently. Fertil Steril. 1991;55(1):100-8.##Harvey JH. Disenfranchised grief: New directions, challenges, and strategies for practice. 1st ed. Champaign, IL: Research Press; 2002. p.17-22.##Guerra D, Llobera A, Veiga A, Barri PN. Psychiatric morbidity in couples attending a fertility service. Hum Reprod. 1998;13(6):1733-6.##Volgsten H, Skoog Svanberg A, Ekselius L, Lundkvist O, Sundström Poromaa I. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 2008;23(9):2056-63.##Berger DM. Impotence following the discovery of azoospermia. Fertil Steril. 1980;34(2):154-6.##Feuer GS. The psychological impact of infertility on the lives of men. Diss Abstr Int. 1983;44(3-A):706-7.##Rogstad KE. The psychological effects of vasectomy. Sex Marital Ther. 1996;11(3):265-72.##Burns LH, Covington SN. Infertility Counseling: A Comprehensive Handbook for Clinicians. 1st ed. New York: Parthenon; 1999. Chapter 18, Recipient counselling for donor insemination; p. 325-44.##Irvine S, Cawood E. Male infertility and its effect on male sexuality. Sex Marital Ther. 1996;11(3):273-80.##Dhillon R, Cumming CE, Cumming DC. Psychological well-being and coping patterns in infertile men. 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Geneva: World Health Organization; 2004. p. 65-135.##Franco JG Jr, Razera Baruffi RL, Mauri AL, Petersen CG, Felipe V, Garbellini E. Psychological evaluation test for infertile couples. J Assist Reprod Genet. 2002;19(6):269-73.##Wiersema NJ, Drukker AJ, Mai BT, Giang HN, Nguyen TN, Lambalk CB. Consequences of infertility in developing countries: results of a questionnaire and interview survey in the South of Vietnam. J Transl Med. 2006;4:54.##Olshansky EF. Infertility and its influence on women's career identities. Health Care Women Int. 1987;8(2-3):185-96.##Leon IG. Understanding and treating infertility: psychoanalytic considerations. J Am Acad Psychoanal Dyn Psychiatry. 2010;38(1):47-75.##Kikendall KA. Self-discrepancy as an important factor in addressing women's emotional reactions to infertility. Prof Psychol: Res Pract. 1994;25(3):214-20.##Gerrity DA. A biopsychosocial theory of infertility. Fam J. 2001;9(2):151-8.##Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007;21(2):293-308.##Webb RE, Daniluk JC. The end of the line infertile men's experiences of being unable to produce a child. Men Masc. 1999;2(1):6-25.##Freeman EW, Boxer AS, Rickels K, Tureck R, Mastroianni L Jr. Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil Steril. 1985;43(1):48-53.##Berger DM. Couples' reactions to male infertility and donor insemination. Am J Psychiatry. 1980;137(9):1047-9.##Gannon K, Glover L, Abel P. Masculinity, infertility, stigma and media reports. Soc Sci Med. 2004;59(6):1169-75.##Becker G, Nachtigall RD. Eager for medicalisation: the social production of infertility as a disease. Sociol Health Illn. 1992;14(4):456-71.##Beutel M, Kupfer J, Kirchmeyer P, Kehde S, Köhn FM, Schroeder-Printzen I, et al. Treatment-related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI. Andrologia. 1999;31(1):27-35.##Wichman CL, Ehlers SL, Wichman SE, Weaver AL, Coddington C. Comparison of multiple psychological distress measures between men and women preparing for in vitro fertilization. Fertil Steril. 2011;95(2):717-21.##Daniluk J. Helping patients cope with infertility. Clin Obstet Gynecol. 1997;40(3):661-72.##McGrady AV. Effects of psychological stress on male reproduction: a review. Arch Androl. 1984;13(1):1-7.##Lenzi A, Lombardo F, Salacone P, Gandini L, Jannini EA. Stress, sexual dysfunctions, and male infertility. J Endocrinol Invest. 2003;26(3 Suppl):72-6.##Nene UA, Coyaji K, Apte H. Infertility: a label of choice in the case of sexually dysfunctional couples. Patient Educ Couns. 2005;59(3):234-8.##Bharadwaj A. Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities. Soc Sci Med. 2003;56(9):1867-80.##Jejeebhoy SJ. Infertility in India-levels, patterns and consequences: Priorities for social science research. J Fam Welf. 1998;44(2):15-24.##Thara R, Ramachandran V, Hassan PP. Psychological aspects of infertility. Indian J Psychiatry. 1986;28(4):329-34.##Tao P, Coates R, Maycock B. The impact of infertility on sexuality: A literature review. Australas Med J. 2011;4(11):620-7.##Collodel G, Moretti E, Fontani V, Rinaldi S, Aravagli L, Saragò G, et al. Effect of emotional stress on sperm quality. Indian J Med Res. 2008;128(3):254-61.##

The Relation Between Marital Adjustment and Posttraumatic Growth in Infertile Couples: The Mediatory Role of Religious Coping Strategies 2 1 682 2 Background: Infertility as a crisis can both lead to negative reactions and stress in infertile couples and bring about positive reactions and growth, to which henceforth posttraumatic growth is referred. This study was conducted to model the relation between martial adjustment and posttraumatic growth through the mediation of religious coping strategies in infertile couples. Methods: This correlation-based study was performed on 250 couples at the infertility center of Shariati hospital, Tehran, Iran, selected via convenience sampling. They answered to the Marital Adjustment Scale, the Posttraumatic Growth Inventory, and the Religious Coping Strategies Inventory. This study used Structural Equation Modeling. Results: The results showed significant positive relationships between marital adjustment and both positive religious coping strategies and posttraumatic growth. A significant positive relationship between positive religious coping strategies and posttraumatic growth was also detected. Positive religious coping strategies were observed to play a mediatory role between marital adjustment and posttraumatic growth. This was the case while attributing such a mediatory role to negative coping strategies was not possible. Conclusion: Based on the results, this study can be seen as further evidence showing the necessity of focusing on the role of positive religious coping strategies in marital adjustment and posttraumatic growth in infertile couples. 221 230 Seyyedeh Fatemeh SF Ghafouri Department of Counseling, Faculty of Psychology and Education, Shahid Beheshti University Department of Counseling, Faculty of Psychology and Education, Shahid Beheshti University Iran Saeed S Ghanbari Department of Counseling, Faculty of Psychology and Education, Shahid Beheshti University Department of Counseling, Faculty of Psychology and Education, Shahid Beheshti University Iran ghanbari-sbu@yahoo.com Hajar H Fallahzadeh Department of Counseling, Faculty of Psychology and Education, Shahid Beheshti University Department of Counseling, Faculty of Psychology and Education, Shahid Beheshti University Iran Omid O Shokri Department of Psychology, Faculty of Psychology and Education, Shahid Beheshti University Department of Psychology, Faculty of Psychology and Education, Shahid Beheshti University Iran Coping strategiesInfertile coupleMarital adjusmentPosttraumatic GrowthReligion 682.pdf Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril. 2008;90(5 Suppl):S60.##Gibson DM, Myers JE. Gender and infertility: a relational approach to counseling women. J Couns Dev. 2000:78(40):400-10.##Herrmann D, Scherg H, Verres R, von Hagens C, Strowitzki T, Wischmann T. Resilience in infertile couples acts as a protective factor against infertility-specific distress and impaired quality of life. J Assist Reprod Genet. 2011;28(11):1111-7.##Bradow A. Primary and secondary infertility and post traumatic stress disorder: experiential differences between type of infertility and symptom characteristics. US: Spalding University, Louisville, KY; 2012; 125 p.##Paul MS, Berger R, Berlow N, Rovner-Ferguson H, Figlerski L, Gardner S, et al. Posttraumatic growth and social support in individuals with infertility. Hum Reprod. 2010;25(1):133-41.##Galhardo A, Pinto-Gouveia J, Cunha M, Matos M. The impact of shame and self-judgment on psychopathology in infertile patients. Hum Reprod. 2011;26(9):2408-14.##Anderson KM, Sharpe M, Rattray A, Irvine DS. Distress and concerns in couples referred to a specialist infertility clinic. J Psychosom Res. 2003;54(4):353-5.##Tamannayi Far MR. [A comparative study of mental health, marital adjustment and coping responses among fertile-infertile women]. Clin Psychol Personal. 2011;2(4):51-60. Persian.##Rasouli R, Etemadi A, Shafi’abadi A, Delavar A. [Comparing effectiveness of individual and marital emotionally focused intervention based on decreasing relationship distress of couples with chronically ill children]. Fam Rese. 2007;3(11):683-96. Persian.##Choadhari NP, Patel HJ. A study about marital adjustment among female of urban & rural mehsana (Gujarat). personal Clin stud. 2009;1(2):70-5.##Fredrickson BL. How Does Religion Benefit Health and Well-Being? Are Positive Emotions Active Ingredients? Relig Psycholog. 2002;13(3):209-13.##Fredrickson BL. What good are positive emotions? Rev Gen Psychol. 1998;2(3):300-19.##Greef AP. Characteristics of families that function well. Fam Issues. 2000;21(8):948-62.##Rasouli R, Soltanegerd S. [The comparison and relationship between religious orientation and practical commitment to religious beliefs with marital adjustment in seminary scholars and university students]. Fam Res. 2013;8(32), 427-39. Persian.##Peterson-Post KM, Rhoades GK, Stanley SM, Markman HJ. Perceived criticism and marital adjustment predict depressive symptoms in a community sample. Behav Ther. 2014;45(4):564-75.##Qadir F, Khalid A, Haqqani S, Zill-e-Huma, Medhin G. The association of marital relationship and perceived social support with mental health of women in Pakistan. BMC Public Health. 2013;13(1):1150.##Sayers SL, Kohn CS, Fresco DM. Marital conflict and depression in the context of marital discord. Cognit Ther Res. 2001;25(6):713-32.##Peterson BD, Newton CR, Rosen KH, Schulman RS. Dyadic coping processes of men and women in infertile couples and their relationship to infertility stress, marital adjustment, and depression. Fertil Stril. 2004;82(2):S104.##Mollayinejad M, Jafarpour M, Jahanfar S, Jamshidi R. [The relationship between marital adjustment and the stress caused by infertility in women in Isfahan center for infertility treatment]. Fertil Infertil. 2000;2(5):26-39. Persian.##Repokari L, Punamäki RL, Unkila-Kallio L, Vilska S, Poikkeus P, Sinkkonen J, et al. Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls. Hum Reprod. 2007;22(5):1481-91.##Tedeschi RG, Park CL, Calhoun GL. Posttraumatic Growth: Positive Changes in the Aftermath of Crisis. New Jersey: Taylor & Francis e-Library; 2009. Chapter 5, The context for posttraumatic growth: Life crises, individual and social resources, and coping; p. 99-124.##Ho SM, Chan CL, Ho RT. Posttraumatic growth in Chinese cancer survivors. Psychooncology. 2004;13(6):377-89.##Bellizzi KM. Expressions of generativity and posttraumatic growth in adult cancer survivors. Int J Aging Hum Dev. 2004;58(4):267-87.##Cadell S, Regehr C, Hemsworth D. Factors contributing to posttraumatic growth: a proposed structural equation model. Am J Orthopsychiatry. 2003;73(3):279-87.##Calhoun LG, Cann A, Tedeschi RG, McMillan J. A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. J Trauma Stress. 2000;13(3):521-7.##Tedeschi RG, Calhoun LG. Posttraumatic growth: Conceptual foundations and empirical evidence. Psychol Inq. 2004;15(1):1-18.##Park CL, Cohen LH, Murch RL. Assessment and prediction of stress-related growth. J Pers. 1996;64(1):71-105.##Moussavi P. [The relationship between general and religious coping strategies with distress and posttraumatic growth] [master’s thesis]. [Tehran]: Tarbiat Modarres University; 2008. 208 p. Persian.##Collings RL, Taylor SE, Skokan LA. A better world or a shattered vision? Changes in life perspectives following victimization. Soc Cogn. 1990;8(3):263-85.##Spanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Marriage Fam. 1976;38(1):15-28.##Spanier GB, Thompson L. A confirmatory analysis of the dyadic adjustment scale. Marriage Fam. 1982;44(3):731-8.##Mollazadeh J. [The relationship between marital adjustment with personality factors and coping style in control children]. [dissertation]. [Tehran]: Tarbiat Modarres University. 2002. 188 p. Persian.##Sanaee B. [Family and Marriage Scales Compiled]. Tehran: Be’sat; 2008. 240 p. Persian.##Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-71.##Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol. 2000;56(4):519-43.##Ghiami Z. The relationship between attachment modes with religious coping methods. Psychol Educ. 2005;35(1):221-33.##Schmidt SD, Holstein B, Christensen U, Boivin J. Does infertility marital benefit? Patient Educ Couns. 2005;59(3):244-51.##Biringer E, Howard LM, Kessler U, Stewart R, Mykletun A. Is infertility really associated with higher levels of mental distress in the female population? Results from the North-Trondelag Health Study and the Medical Birth Registry of Norway. J Psychosom Obstet Gynaecol. 2015;36(2):38-45.##Kormi Nouri R, Akhondi MM, Behjati Ardakani Z. Psychosocial aspects of infertility from viewpoint of infertility treating physicians. J Reprod Infertil. 2001;2(3):13-26.##Schmidt SD, Blank TO, Bellizzi KM, Park CL. The relationship of coping strategies, social support, and attachment style with posttraumatic growth in cancer survivors. J Health Psychol. 2012;17(7):1033-40.##Büyükaşik-Colak C, Gündoğdu-Aktürk E, Bozo O. 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Intention for Cesarean Section Versus Vaginal Delivery Among Pregnant Women in Isfahan: Correlates and Determinants 2 1 685 2 Background: Iran has the second highest rate of cesarean section in the world. the corresponding rate in the third metropolitan city of Iran, Isfahan, is even higher. This paper aimed to assess correlates and determinants of intention for cesarean section versus normal vaginal delivery (NVD) among pregnant women in Isfahan. Methods: A study was conducted among 400 pregnant women aged 18-38 years, with gestational age of 24-40 weeks who attended labor clinics of nine hospitals in Isfahan during June and July 2014. Probability proportional to size was used to estimate the number of cases required to be selected for each hospital. T-test, chi-square and logistic regression analysis were employed to analyze the data. Results: Mean age of women was 26.6±4.4 years. Multivariate analysis identified selected factors as determinants of intention for CS. These were "the role of physician" (OR=1.33, p<0.001), "subjective norms" (OR=1.19, p<0.01) and "body Image" (OR=1.46, p<0.001) upon control of education, income and intended fertility (number of children intended). Moreover, path analysis showed that "attitude towards cesarean section" and "individualism" influence CS decision through subjective norm. Conclusion: Choosing cesarean section voluntarily is a multifaceted decision which is shaped by various factors; hence, comprehensive interventions are suggested to discourage voluntary cesarean section. These interventions need to encompass changes in physicians’ role, social norms, body image and correcting misperceptions among women towards CS and NVD during prenatal courses. 230 240 Zahra Z Shams-Ghahfarokhi Department of Demography, Allameh Tabatabaie University Department of Demography, Allameh Tabatabaie University Iran Farideh F Khalajabadi-Farahani National Institute for Population Studies and Comprehensive Management National Institute for Population Studies and Comprehensive Management Iran faridehfarahani2@gmail.com Cesarean sectionDeterminantsIranVaginal delivery 685.pdf Garmaroudi GR, Eftekhar H, Batebi A. [Factors that affect cesarean among pregnant women]. Payesh J. 2002;1(2):45-9. Persian.##Gibbons L, Belizán JM, Lauer JA, Betran AP, Merialdi M, Althabe F. The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. Geneva, Switzerland: World Health Organization; 2010. 32 p. Report No.:30.##Zhao Y, Chen S. Psychosocial factors for women requesting cesarean section. Int J Clin Med. 2013;4(9):395-9.##Miri Farahani L, Abbasi Shavazi MJ. [Cesarean section change trends in Iran and some demographic factors associated with in them in the past three decades]. Fasa Univ Med Sci Mag. 2012;2(3):127-34. Persian.##Baigi M, Rahimi EA. [The effect of Caesarean section on bringing about secondry infertility]. Sci J Kurdistan Univ Med Sci. 2005;9(2):40-4. Persian.##Saraei H. [Second demographic transition with a glance at the Iran]. J Popul Assoc Iran. 1999;6:118-40. Persian.##Abassi-Shavazi MJ. Below replacement- level fertility in Iran: Progress and prospect. Paper presented at: IUSSP Seminar on international perspective on low fertility; trends, theories and policies; 2001 Mar 21-23; Tokyo, Japan.##Ministry of Health and Medical Education. Ministry of Health and Medical Education Performance In the eleven government, Annual Report. 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Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. J Appl Soc Psychol. 2002;32(4):665-83.##Conrad P. The medicalization of society: On the transformation of human conditions into treatable disorders. 1st ed. Baltimore: Johns Hopkins University Press; 2007. p. 4.##Hosseini L, Iran-Pour E, Safarinejad MR. Sexual function of primiparous women after elective cesarean section and normal vaginal delivery. Urol J. 2012;9(2):498-504.##Wagner M. Choosing caesarean section. Lancet. 2000;356(9242):1677-80.##Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom J. Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol. 2004;104(6):1397-402.##Safarinejad MR, Kolahi AA, Hosseini L. The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands. J Sex Med. 2009;6(6):1645-67.##Sharifirad GHR, Fathian Z, Tirani M, Mahaki B. [Study on behavioral intention model (BIM) to the attitude of pregnant women toward normal delivery and cesarean section in province of Esfahan-Khomeiny Shahr-1385]. J Ilam Univ Med Sci. 2007;15(1):19-23. Persian.##Mirzaei H, Vosogh M. [Individualism: Reflection on the dimensions and indicators]. J Soci Sci lett. 2008;16(34):117-42. Persian.##Ghiasvand A. Application of statistics and SPSS software for data analysis. 1st ed. Tehran: Teesa; 2013. 213 p.##Bolbol Haghighi N, Ebrahimi H, Ajami ME. [Comparison of frequency of vaginal delivery with cesarean section and its causes in Shahroud (2000)]. J Reprod Infertil. 2002;3(2):50-8. Persian.##Khalajabadi Farahani F, Saraie H. [Intention for single child and it's determinants amongst men and women owned one child under five in Tehran]. J Popul Assoc Iran. 2012;7(13):118-48. Persian.##Penna L, Arulkumaran S. Cesarean section for non-medical reasons. Int J Gynaecol Obstet. 2003;82(3):399-409.##Anderson GM, Lomas J. Explaining variations in cesarean section rates: patients, facilities or policies? Can Med Assoc J. 1985;132(3):253-6, 259.##Faraji Darkhaneh R, Zahiri Sooroori Z, Farjad Bastani F. [A survey of knowledge and attitudes of pregnant women about delivery methods]. J Guilan Univ Med Sci. 2003;12(46):69-75. Persian.##Hopkins K. Are Brazilian women really choosing to deliver by cesarean? Soc Sci Med. 2000;51(5):725-40.##Rashman GB, Davies NJ, Cashman JN. Lee's Synopsis of Anesthesia. 12th ed. Boston: ButterWorth-Heinemann; 1999. p. 522-51.##Ahmadi F, Siahbazi S, Akhbari F. Incomplete cesarean scar rupture. J Reprod Infertil. 2013;14(1):43-5.##Yamasmit W, Chaithongwongwatthana S. Attitude and preference of Thai pregnant women towards mode of delivery. J Med Assoc Thai. 2012;95(5):619-24.##

Thyroid Function and Autoimmunity Versus Number of Pregnancies 2 1 681 2 Background: Thyroid autoimmunity may be linked to infertility, in both thyrotropin (TSH)-dependent and TSH-independent fashion. The aim of the present study was to assess this presumed reciprocal relationship of thyroid autoimmunity and pregnancy. Methods: TSH and antithyroid peroxidase autoantibodies (anti-TPO) were evaluated retrospectively over an eight-year period in 444 Greek women who had previously none or at least one pregnancy (>28 weeks). Statistics were done with analysis of covariance (ANCOVA) and the Chi square test. Results: Thyrotropin was higher in women with one pregnancy and lower in those with two or more pregnancies compared to women with no pregnancies. Furthermore, significantly more women with no pregnancies were anti-TPO (+), compared to women with one or those with at least two pregnancies. Conclusion: Because pregnancy might contribute to the development of thyroid autoimmunity, women should be monitored for development of thyroid autoimmunity long after their pregnancies, even after an uneventful first conception, pregnancy and delivery of a live infant. 240 243 Dimitrios B Boufas Department of Endocrinology, Hellenic Red Cross Hospital Department of Endocrinology, Hellenic Red Cross Hospital Greece Andromachi A Vryonidou Department of Endocrinology, Hellenic Red Cross Hospital Department of Endocrinology, Hellenic Red Cross Hospital Greece Georgios G Mastorkos Endocrine Unit, Department of Obstetrics and Gynecology, Athens University Medical School, Aretaieion University Hospital Endocrine Unit, Department of Obstetrics and Gynecology, Athens University Medical School, Aretaieion University Hospital Greece Ioannis I Ilias Department of Endocrinology, Elena Venizelou Hospital Department of Endocrinology, Elena Venizelou Hospital Greece iiliasmd@yahoo.com FertilityPregnancyThyroidThyrotropin 681.pdf Twig G, Shina A, Amital H, Shoenfeld Y. Pathogenesis of infertility and recurrent pregnancy loss in thyroid autoimmunity. J Autoimmun. 2012;38(2-3):J275-81.##Carp HJ, Selmi C, Shoenfeld Y. The autoimmune bases of infertility and pregnancy loss. J Autoimmun. 2012;38(2-3):J266-74.##Binita G, Suprava P, Mainak C, Koner BC, Alpana S. Correlation of prolactin and thyroid hormone concentration with menstrual patterns in infertile women. J Reprod Infertil. 2009;10(3):207-12.##Walsh JP, Bremner AP, Bulsara MK, O'Leary P, Leedman PJ, Feddema P, et al. Parity and the risk of autoimmune thyroid disease: a community-based study. J Clin Endocrinol Metab. 2005;90(9):5309-12.##Bülow Pedersen I, Laurberg P, Knudsen N, Jorgensen T, Perrild H, Ovesen L, et al. Lack of association between thyroid autoantibodies and parity in a population study argues against microchimerism as a trigger of thyroid autoimmunity. Eur J Endocrinol. 2006;154(1):39-45.##Phillips DI, Lazarus JH, Butland BK. The influence of pregnancy and reproductive span on the occurrence of autoimmune thyroiditis. Clin Endocrinol (Oxf). 1990;32(3):301-6.##McCanlies E, O'Leary LA, Foley TP, Kramer MK, Burke JP, Libman A, et al. Hashimoto's thyroiditis and insulin-dependent diabetes mellitus: differences among individuals with and without abnormal thyroid function. J Clin Endocrinol Metab. 1998;83 (5):1548-51.##Cohen J. A power primer. Psychol Bull. 1992;112 (1):155-9.##Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.##Colicchia M, Campagnolo L, Baldini E, Ulisse S, Valensise H, Moretti C. Molecular basis of thyrotropin and thyroid hormone action during implantation and early development. Hum Reprod Update. 2014;20(6):884-904.##van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17(5):605-19.##Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril. 2015;104(3):545-53.##Medenica S, Nedeljkovic O, Radojevic N, Stojkovic M, Trbojevic B, Pajovic B. Thyroid dysfunction and thyroid autoimmunity in euthyroid women in achieving fertility. Eur Rev Med Pharmacol Sci. 2015;19(6):977-87.##Vissenberg R, Manders VD, Mastenbroek S, Fliers E, Afink GB, Ris-Stalpers C, et al. Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update. 2015;21(3):378-87.##Weiss RV, Clapauch R. Female infertility of endocrine origin. Arq Bras Endocrinol Metabol. 2014;58(2):144-52.##Sgarbi JA, Kasamatsu TS, Matsumura LK, Maciel RM. Parity is not related to autoimmune thyroid disease in a population-based study of Japanese-Brazilians. Thyroid. 2010;20(10):1151-6.##Greer LG, Casey BM, Halvorson LM, Spong CY, McIntire DD, Cunningham FG. Antithyroid antibodies and parity: further evidence for microchimerism in autoimmune thyroid disease. Am J Obstet Gynecol. 2011;205(5):471.e1-4.##

A Rare Case of Gestational Gigantomastia with Hypercalcemia: The Challenges of Management and Follow up 2 1 689 2 Background: Gigantomastia is a breast disorder marked by exaggerated rapid growth of the breasts, generally bilaterally. Since this disorder is very rare and has been reported only in sparse case reports its etiology has yet to be fully established. Treatment is aimed at improving the clinical and psychological symptoms and reducing the treatment side effects; however, the best therapeutic option varies from case to case. Case Presentation: The present report described a case of gestational gigantomastia in a 30-year-old woman, gravida 2, parity 1, 17 week pregnant admitted to Pars Hospital, Tehran, Iran, on may 2014. The patient was admitted to hospital at week 17 of pregnancy, although her breasts initially had begun to enlarge from the first trimester. The patient developed hypercalcemia in her 32nd week of pregnancy. The present report followed this patient from diagnosis until the completion of treatment. Conclusion: Although gestational gigantomastia is a rare condition, its timely prognosis and careful examination of some conditions like hyperprolactinemia and hypercalcemia is essential in successful management of this condition. 243 247 Bahram B Moazzami Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences Iran Shahla Sh Chaichian Shahla Chaichian Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University Iran shchaichian@gmail.com Mohammad Reza MR Farahvash Department of Plastic Surgery, Faculty of Medicine, Tehran University of Medical Sciences Department of Plastic Surgery, Faculty of Medicine, Tehran University of Medical Sciences Iran Saeedeh S Taheri Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences Iran Seyed Ali SA Ahmadi Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences Iran Majid M Mokhtari Department of Medicine, Pulmonary and Critical Care Medicine, Shahid Beheshti University of Medical Sciences Department of Medicine, Pulmonary and Critical Care Medicine, Shahid Beheshti University of Medical Sciences Iran Kourosh K Sheibani Clinical Research and Development Center, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences Clinical Research and Development Center, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences Iran BreastDiagnosisGestational ageGigantomastiaHypercalcemiaIranTherapeutics 689.pdf Ezem BU, Osuagwu CC, Opara KA. Gestational gigantomastia with complete resolution in a Nigerian woman. BMJ Case Rep. 2011;2011.##Vidaeff AC, Ross PJ, Livingston CK, Parks DH. Gigantomastia complicating mirror syndrome in pregnancy. Obstet Gynecol. 2003;101(5 Pt 2):1139-42.##Antevski BM, Smilevski DA, Stojovski MZ, Filipovski VA, Banev SG. Extreme gigantomastia in pregnancy: case report and review of literature. Arch Gynecol Obstet. 2007;275(2):149-53.##Zargar AH, Laway BA, Masoodi SR, Shah NA, Darzi MA, Wani AH. Gestational macromastia not responding to termination of pregnancy. Postgrad Med J. 1995;71(832):124-5.##Williams PC. Massive hypertrophy of the breasts and axillary breasts in successive pregnancies. Am J Obstet Gynecol. 1957;74(6):1326-9.##Zargar AH, Laway BA, Masoodi SR, Chowdri NA, Bashir MI, Wani AI. Unilateral gestational macromastia--an unusual presentation of a rare disorder. Postgrad Med J. 1999;75(880):101-3.##Lafreniere R, Temple W, Ketcham A. Gestational macromastia. Am J Surg. 1984;148(3):413-8.##Eler Dos Reis P, Blunck Santos NQ, Barbosa Pagio FA, Chambo F, Chambo D, Chambo Filho A. Management and follow-up of a case of gestational gigantomastia in a brazilian hospital. Case Rep Obstet Gynecol. 2014;2014:610363.##Agarwal AA, Sonkar AA, Kushwaha JK, Singh S. Gestational hypertrophy of the breast. BMJ Case Rep. 2013;2013.##van Wingerden JJ. Gigantomastia--definition and association with hypercalcaemia. J Plast Reconstr Aesthet Surg. 2009;62(1):112-4.##Bloom SA, Nahabedian MY. Gestational macromastia: a medical and surgical challenge. Breast J. 2008;14(5):492-5.##Van Heerden JA, Gharib H, Jackson IT. Pseudohyperparathyroidism secondary to gigantic mammary hypertrophy. Arch Surg. 1988;123(1):80-2.##Amaya Garcia M, Acosta Feria M, Soto Moreno A, Dios Fuentes E, Navarro Gonzalez E, Quijada Thong D, et al. Primary hyperparathyroidism in pregnancy. Gynecol Endocrinol. 2004;19(2):111-4.##Lapid O. Breast reconstruction after mastectomy for gestational gigantomastia. Aesthetic Plast Surg. 2013;37(2):388-91.##Rinker B, Thornton BP. Skin-sparing mastectomy and immediate tissue expander breast reconstruction in patients with macromastia using the Passot breast reduction pattern. Ann Plast Surg. 2014;72(6):S158-64.##Rahman GA, Adigun IA, Yusuf IF. Macromastia: a review of presentation and management. Niger Postgrad Med J. 2010;17(1):45-9.##Karagulle E, Turk E, Erinanc OH, Moray G. Giant fibroadenoma growing rapidly during pregnancy. Iran Red Crescent Med J. 2014;16(8):e9531.##

Primary Tuberculosis of Cervix: A Coincidental Finding 2 1 673 2 Background: 95% of Tuberculosis (TB) of the female genital tract (FGT) is located in tissues other than the cervix. A rare case of primary TB of the cervix which was diagnosed coincidently in a patient of endometrioma was reported in this study. Case Presentation: A 34 year old nullipara, a diagnosed case of endometrioma had a small cervical growth. Pap smear and biopsy was taken and sent for histopathological examination. Her histopathological examination revealed multiple epitheloid cell granuloma and langerhans type giant cell caeseation. Ziehl neelsen staining was positive for acid fast bacilli (AFB). The patient was started on antituberculosis under directly observed therapy along with oral contraceptive pills. Patient was on regular follow-up and clinically she was doing well. Conclusion: Although cervical tuberculosis is very rare but for an abnormal looking cervix, cervical tuberculosis should be considered in the differential diagnosis in woman of all the age groups especially in areas where tuberculosis is rampant since these cases are potentially curable with medical therapy. Many of these patients are in reproductive age group. In young women, early diagnosis prevents further damage in reproductive tract and can improve their reproductive potential. 247 250 Nalini N Sharma Department of Obstetrics and Gynaecology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong Department of Obstetrics and Gynaecology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong India Srmsims_sharma@rediffmail.com Ahanthem A Singh Department of Obstetrics and Gynaecology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong Department of Obstetrics and Gynaecology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong India Yookarin Y Khonglah Department of Pathology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong Department of Pathology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong India Jaya J Mishra Department of Pathology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong Department of Pathology, North Eastern Indira, Gandhi Regional Institute of Health and Medical Sciences, Shillong India CervixGenital tuberculosisTuberculosis 673.pdf Agarwal J, Gupta JK. Female genital tuberculosis--a retrospective clinico-pathologic study of 501 cases. Indian J Pathol Microbiol. 1993;36(4):389-97.##Lamba H, Byrne M, Goldin R, Jenkins C. Tuberculosis of the cervix: case presentation and a review of the literature. Sex Transm Infect. 2002;78(1):62-3.##Elkattan E, Abdeibadei M, Hettow H, Hussein E, Assaad J. Tuberculosis cervicitis mimicking cancer cervix: A case study. Middle East Fertil Soc J. 2014;19(1):75-7.##Barmon D, Kataki AC, Sharma JD, Gharpholia D. A case of cervical tuberculosis mimicking cervical carcinoma. J Obstet Gynaecol India. 2013;63(4):285-7.##Ahmed S, Oguntayo A, Odogwu K, Abdullahi K. Tuberculous cervicitis: A case report. Niger Med J. 2011;52(1):64-5.##Chowdhury NN. Overview of tuberculosis of the female genital tract. J Indian Med Assoc. 1996;94(9):345-6, 361.##Paprikar M, Biswas M, Bhattacharyav S, Sodih B, Mukhopadhyay I. Tuberculosis of cervix. Med J Armed Forces India. 2008;64(4):297-8.##Mukerji S, Moncur L, Sanders B, Currie A, Watson A, Leeman K. Difficulties in diagnosing tuberculosis of the cervix in a post menopausal woman: Case report and literature review. Australas Med J. 2013;6(7):367-70.##Joshi PS, Shankar V, Sinha P. An unusual case of cervical tuberculosis. Online J Health Allied Scs. 2011;10(1):1-2.##Seth A, Kudesia M, Gupta K, Pant L, Mathur A. Cytodiagnosis and pitfalls of genital tuberculosis: A report of two cases. J Cytol. 2011;28(3):141-3.##