Is It the Right Time for Routine Clinical Application of Stem Cells in Reproductive Medicine? 2 1 2 Infertility as a universal public health topic affects about %15 of couples in reproductive age of 18-45 world-wide. According to epidemiologic studies, it is steadily increasing in the industrialized countries due to envirnomental factors and habitual changes in human's lifestyle. WHO estimates that about 60-80 million of infertile couples require medical intervention to get pregnant every year. In spite of all the progress and development in the diagnosis and treatment of infertility, assissted reproductive technologies (ARTs) are able to help only less than 70% of them during the first 5 years of their attempt through assissted concieving using either their own gametes or the reproductive capacity of the third party (1). Despite the advances in using gametes and embryo donation for infertility treatment, a relatively large number of couples are unable to accept third party conception as the final option for their treatment. They request for gametes production from their own geneome through advances in stem cell biology and regenerative medicine. However, the exaggerating of media about priliminary results of scientific research is more than reality which tiggers the premature request of infertile couples. Stem cell biology and regenerative medicine is a new field of biomedicine and is going through its initial and introductory stages. The first human embryonic stem cells were created by the team of James Thomson, an American developmental biologist, in 1998. Stem cells are characterized as undifferentiated cells with the ability of proliferation, self-renewal, and differentiation almost into any of the over 200 cell types in the body. The stem cells application in translational research leads to enhancement and promotion in the field of regenerative medicine. Currently, stem cells provide massive promise for cell therapy, tissue engineering, and regenerative medicine as well as using for pharmaceutical and biotechnological purposes (2). The past decade developments were accompanied with extraordinary growth of experimental therapies of regenerative medicine, presented in clinical practice. The outcomes vary from clear positive clinical effects for a few irremediable diseases to relatively less or no effects for others. The causes of these inconsistent conse-quences are in the veil of ambiguity. Furthermore, experimental cell therapies on patients are more expensive. Although rich goverments and international companies financed these experimental therapies, there is no guarantee for returns of their investments. Therefore, the success of limited number of these therapies leads to more expensive treatment procedures that circumscribe their routine application for everyone at the beginning. In addition, these experimental therapies may expose the patients to unknown risks which are not predictable (3). Several experimental therapies of stem cell were performed in reproductive medicine with the aim of artifical gametes generation, endometrial reconstruction, erectile dysfunction restoration, and vaginal amendment. The unproven, untested and often unsafe stem cells treatments are ferquent in the field of reproductive biomedicine. Up to now, all of stem cell-based treatments in reproductive medicine are limited to clinical trials. Particularly, the stem cell based clinical experiments on in vitro or de novo generation of gametes failed to improve reproductive function of infertile cases (4). Stem cell-based technologies similar to large numbers of other technologies have been introduced and prematurely presented to infertile couples over the last 30 years and this process is not going to stop. However, before transferring a technology to reproductive medicine, its evaluation in terms of effectiveness, safety and cost effectiveness should be completed. Moreover, the appeal for introduction and using new technologies by the community is obvious regarding our lack of knowledge about infertility causes and its low success rate. It should be noted that we are all looking for advances in the field of ART and wish to provide the best possible treatment plan for our patients. But we must always look for the best practice in our clinics (5). Today, often public media publish incomplete early results of scientific research and report in congruent demands in the community. Therefore, patients often ask the physicians for their favorite choices and media propagates some issues or even some research results from websites which may be fake. In fact, financial profit, advertising of pharmaceutical and instrument companies or even emotional pressures of patients should not lead us to wrong directions. The precipitant in using new technology without validation through well designed numerouse clinical trials undoubtedly would be the reason for wasting the time and financial resources of patients and health systems, and may even exert irreparable damage on patient health. Therefore, with regard to the above mentioned facts, it is essential to prevent routine and broad application of stem cells in the treatment of infertility, and we need to pay more attention in the procedure of designing clinical trials for generalizability of the results. Nevertheless however, we believe that stem cells and regenerative medicine will play a significant and critical role in the future of medicine and human health. 01 3 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 10014.pdf Hendriks S, Dancet EA, van Pelt AM, Hamer G, Repping S. Artificial gametes: a systematic review of biological progress towards clinical application. Hum Reprod Update. 2015;21(3):285-96.##Elbuluk A, Einhorn TA, Iorio R. A comprehensive review of stem-cell therapy. JBJS Rev. 2017;5(8):e15.##Cossu G, Birchall M, Brown T, De Coppi P, Culme-Seymour E, Gibbon S, et al. Lancet commission: stem cells and regenerative medicine. Lancet. 2017. pii: S0140-6736(17)31366-1.##Vassena R, Eguizabal C, Heindryckx B, Sermon K, Simon C, van Pelt AM, et al. Stem cells in reproductive medicine: ready for the patient? Hum Reprod. 2015;30(9):2014-21.##Harper J, Magli MC, Lundin K, Barratt CL, Brison D. When and how should new technology be introduced into the IVF laboratory? Hum Reprod. 2012;27(2):303-13.##

CFTR Mutation Analysis in Western Iran: Identification of Two Novel Mutations 2 1 2 Background: Cystic fibrosis (CF) is one of the most common autosomal recessive disorders in Caucasian population. The incidence of disorder varies among different religious, ethnic and geographical isolates. The aim of this study was to identify the spectrum and the frequency of known and unknown disease-causing mutations in Iranian CF patients. Methods: Genomic DNA was extracted from peripheral whole blood with a QI-Aamp DNA Mini-Kit. Mutation analysis was done in the CFTR gene including complete coding region and intron/exon boundaries using a direct sequencing method. Results: In general, ten mutations were identified in 27 CF cases. Two out of 10 mutations, 754delT and GGTGGCdel/TTGins, were reported as novel mutations. The most common observed mutations in patients were R334W (40.74%), ΔF508 (18.5%), K710X (12.96%) and D110H (5.5%), 1897C>G (1.85%), R1162X (1.85%), S466X (1.85%) and T1036I (1.85%). Conclusion: The finding indicated a unique mutation panel which can be used in genetic counseling, prenatal diagnosis and future screening of CF in Iran. Although ΔF508 is the most common mutation in other populations including Caucasian, this mutation seem not to have an important role in Iranian CF patients. Findings suggest that a different approach in molecular genetics diagnostic strategies in Middle Eastern countries including Iran should be considered. 03 10 Nasibeh N Karimi Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz Iran nasb_kaerimi@tabrizu.ac.ir Reza R Alibakhshi Reza Alibakhshi Department of Biochemistry, School of Medicine, Kermanshah University of Medical Sciences Department of Biochemistry, School of Medicine, Kermanshah University of Medical Sciences Iran Shekoufeh Sh Almasi Department of Biology, Faculty of Life Science, Dalhousie University, Halifax Department of Biology, Faculty of Life Science, Dalhousie University, Halifax Canada CFTR geneCystic fibrosisIranMiddle EastR334W 9.pdf Rowntree RK, Harris A. The phenotypic consequences of CFTR mutations. Ann Hum Genet. 2003;67(Pt 5):471-85.##Vankeerberghen A, Cuppens H, Cassiman JJ. The cystic fibrosis transmembrane conductance regulator: an intriguing protein with pleiotropicfunctions. J Cyst Fibros. 2002;1(1):13-29.##Matsui H, Grubb BR, Tarran R, Randell SH, Gatzy JT, Davis CW, et al. Evidence for periciliary liquid layer depletion, not abnormal ion composition, in the pathogenesis of cystic fibrosis airways disease. Cell. 1998;95(7):1005-15.##Taylor CJ, Connolly S. Hepatobiliary disease in cystic fibrosis. Paediatrics and Child Health (Oxford). 2010;20(1):20-5.##Dawson KP, Frossard PM. The geographic distribution of cystic fibrosis mutations gives clues about population origins. Eur J Pediatr. 2000;159(7):496-9.##Castellani C, Cuppens H, Macek M Jr, Cassiman JJ, Kerem E, Durie P, et al. Consensus on the use and interpretation of cystic fibrosis mutation analysis in clinical practice. J Cyst Fibros. 2008;7(3):179-96.##Kabra SK, Kabra M, Lodha R, Shastri S. Cystic fibrosis in India. Pediatr Pulmonol. 2007;42(12):1087-94.##Desgeorges M, Mégarbané A, Guittard C, Carles S, Loiselet J, Demaille J, et al. Cystic fibrosis in Lebanon: distribution of CFTR mutations among Arab communities. Hum Genet. 1997;100(2):279-83.##Alibakhshi R, Zamani M. Mutation analysis of CFTR gene in 70 Iranian cystic fibrosis patients. Iran J Allergy Asthma Immunol. 2006;5(1):3-8.##Mehdizadeh Hakkak A, Keramatipour M, Talebi S, Brook A, Tavakol Afshari J, Raazi A, et al. Analysis of CFTR Gene Mutations in Children with Cystic Fibrosis, First Report from North-East of Iran. Iran J Basic Med Sci. 2013;16(8):917-21.##Elahi E, Khodadad A, Kupershmidt I, Ghasemi F, Alinasab B, Naghizadeh R, et al. A haplotype framework for cystic fibrosis mutations in Iran. J Mol Diagn. 2006;8(1):119-27.##Jalalirad M, Houshmand M, Mirfakhraie R, Goharbari MH, Mirzajani F. First study of CF mutations in the CFTR gene of Iranian patients: detection of DeltaF508, G542X, W1282X, A120T, R117H, and R347H mutations. J Trop Pediatr. 2004;50(6):359-61.##Shah U, Frossard P, Moatter T. Cystic fibrosis: defining a disease under-diagnosed in Pakistan. Trop Med Int Health. 2009;14(5):542-5.##Kilinç MO, Ninis VN, Dağli E, Demirkol M, Ozkinay F, Arikan Z, et al. Highest heterogeneity for cystic fibrosis: 36 mutations account for 75% of all CF chromosomes in Turkish patients. Am J Med Genet. 2002;113(3):250-7.##Kambouris M, Banjar H, Moggari I, Nazer H, Al-Hamed M, Meyer BF. Identification of novel mutations in Arabs with cystic fibrosis and their impact on the cystic fibrosis transmembrane regulator mutation detection rate in Arab populations. Eur J Pediatr. 2000;159(5):303-9.##Farra C, Menassa R, Awwad J, Morel Y, Salameh P, Yazbeck N, et al. Mutational spectrum of cystic fibrosis in the Lebanese population. J Cyst Fibros. 2010;9(6):406-10.##Frossard PM, Girodon E, Dawson KP, Ghanem N, Plassa F, Lestringant GG, et al. Identification of cystic fibrosis mutations in the United Arab Emirates. Mutations in brief no. 133. Online. Hum Mutat. 1998;11(5):412-3.##Alibakhshi R, Kianishirazi R, Cassiman JJ, Zamani M, Cuppens H. Analysis of the CFTR gene in Iranian cystic fibrosis patients: identification of eight novel mutations. J Cyst Fibros. 2008;7(2):102-9.##Estivill X, Bancells C, Ramos C. Geographic distribution and regional origin of 272 cystic fibrosis mutations in European populations. The Biomed CF Mutation Analysis Consortium. Hum Mutat. 1997;10(2):135-54.##Gómez-Llorente MA, Suarez A, Gómez-Llorente C, Muñoz A, Arauzo M, Antunez A, et al. Analysis of 31 CFTR mutations in 55 families from the South of Spain. Early Hum Dev. 2001;65 Suppl:S161-4.##des Georges M, Guittard C, Altiéri JP, Templin C, Sarles J, Sarda P, et al. High heterogeneity of CFTR mutations and unexpected low incidence of cystic fibrosis in the Mediterranean France. J Cyst Fibros. 2004;3(4):265-72.##Chevalier-Porst F, Bonardot AM, Gilly R, Chazalette JP, Mathieu M, Bozon D. Mutation analysis in 600 French cystic fibrosis patients. J Med Genet. 1994;31(7):541-4.##Lay-Son G, Puga A, Astudillo P, Repetto GM; Collaborative Group of the Chilean National Cystic Fibrosis Program. Cystic fibrosis in Chilean patients: Analysis of 36 common CFTR gene mutations. J Cyst Fibros. 2011;10(1):66-70.##Ziętkiewicz E, Rutkiewicz E, Pogorzelski A, Klimek B, Voelkel K, Witt M. CFTR mutations spectrum and the efficiency of molecular diagnostics in Polish cystic fibrosis patients. PLoS One. 2014;9(2):e89094.##Bernardino AL, Ferri A, Passos-Bueno MR, Kim CE, Nakaie CM, Gomes CE, et al. Molecular analysis in Brazilian cystic fibrosis patients reveals five novel mutations. Genet Test. 2000;4(1):69-74.##Collazo T, Bofill AM, Clark Y, Hernández Y, Gómez M, Rodríguez F, et al. Common mutations in Cuban cystic fibrosis patients. J Cyst Fibros. 2009;8(1):47-9.##Pérez MM, Luna MC, Pivetta OH, Keyeux G. CFTR gene analysis in Latin American CF patients: heterogeneous origin and distribution of mutations across the continent. J Cyst Fibros. 2007;6(3):194-208.##Akhavan-Niaki H, Derakhshandeh-Peykar P, Banihashemi A, Mostafazadeh A, Asghari B, Ahmadifard MR, et al. A comprehensive molecular characterization of beta thalassemia in a highly heterogeneous population. Blood Cells Mol Dis. 2011;47(1):29-32.##Alibakhshi R, Moradi K, Mohebbi Z, Ghadiri K. Mutation analysis of PAH gene in patients with PKU in western Iran and its association with polymorphisms: identification of four novel mutations. Metab Brain Dis. 2014;29(1):131-8.##Lao O, Andrés AM, Mateu E, Bertranpetit J, Calafell F. Spatial patterns of cystic fibrosis mutation spectra in European populations. Eur J Hum Genet. 2003;11(5):385-94.##Onay T, Zielenski J, Topaloglu O, Gokgoz N, Kayserili H, Apak MY, et al. Cystic fibrosis mutations and associated haplotypes in Turkish cystic fibrosis patients. 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The Efficacy and Safety of On-demand Tramadol and Paroxetine Use in Treatment of Life Long Premature Ejaculation: A Randomized Double-blind Placebo-controlled Clinical Trial 2 1 2 Background: Several medical therapies have been proposed for the treatment of premature ejaculation (PE). Paroxetine and tramadol were both reported to be effective in treatment of PE. In this study, the therapeutic effects of tramadol, paroxetine and placebo were compared in treatment of primary PE. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 150 patients were divided into 3 groups. One group was treated with tramadol 50 mg on- demand, the other group took paroxetine 20 mg on-demand and the third group was treated with placebo. Before starting treatment and after 12 weeks, patients were asked to measure their average intravaginal ejaculation latency time (IELT) and fill the PEP (Premature Ejaculation Profile) questionnaire. Results: At the end of the 12th week, the mean IELT and average of PEP scores improved in all 3 groups. The increase in tramadol group was significantly higher than the paroxetine and placebo groups (p<0.0001). There were no significant differences in terms of side effects between the 3 groups. Conclusion: The results showed that despite an increase in mean IELT and PEP scores in all 3 groups, the rate of improvement in tramadol group was significantly more than the others. Thus, tramadol may be considered as an appropriate alternative therapeutic option for lifelong PE. 10 16 Ali A Hamidi-Madani Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Iran Reza R Motiee Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Iran motiee.reza@yahoo.com Gholamreza G Mokhtari Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Iran Hamidreza H Nasseh Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Iran Samaneh S Esmaeili Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Iran Ehsan E Kazemnezhad Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Urology Research Center, School of Medicine, Razi hospital, Guilan University of Medical Sciences Iran IELTParoxetinePEPPremature ejaculationTramadol 10009.pdf Montorsi F. Prevalence of premature ejaculation: a global and regional perspective. J Sex Med. 2005;2 Suppl 2:96-102.##Raisi F, Farnia V, Ghanbarian N, Ghafuri Z. Effects of herbal vigRX on premature ejaculation: a random-ized, double-blind study. Iran J Psychiatry. 2010;5(1):4-6.##Symonds T, Roblin D, Hart K, Althof S. How does premature ejaculation impact a man s life? J Sex Marital Ther. 2003;29(5):361-70.##Serefoglu EC, Yaman O, Cayan S, Asci R, Orhan I, Usta MF, et al. Prevalence of the complaint of eja-culating prematurely and the four premature ejacul-ation syndromes: results from the Turkish society of andrology sexual health survey. J Sex Med. 2011;8(2):540-8.##Porst H, Montorsi F, Rosen RC, Gaynor L, Grupe S, Alexander J. The premature ejaculation prevalence and attitudes (PEPA) survey: prevalence, com-orbidities, and professional help-seeking. Eur Urol. 2007;51(3):816-23.##Mohee A, Eardley I. Medical therapy for premature ejaculation. Ther Adv Urol. 2011;3(5):211-22.##McMahon CG, Althof S, Waldinger MD, Porst H, Dean J, Sharlip I, et al. An evidence-based definition of lifelong premature ejaculation: report of the international society for sexual medicine ad hoc committee for the definition of premature ejaculation. BJU Int. 2008;102(3):338-50.##Gameel TA, Tawfik AM, Abou-Farha MO, Basta-wisy MG, El-Bendary MA, El-Gamasy Ael-N. On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: a randomised placebo-controlled clinical trial. Arab J Urol. 2013;11(4):392-7.##Cooper AJ, Cernovsky ZZ, Colussi K. Some clinical and psychometric characteistics of primary and se-condary premature ejaculations. J Sex Marital Ther. 1993;19(4):276-88.##Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the global study of sex-ual attitudes and behaviores. Int J Impot Res. 2005;17(1):39-57.##Patrick DL, Althof SE, Pryor JL, Rosen R, Row-land DL, Ho KF, et al. Premature ejaculation: an observational study of men and their partners. J Sex Med. 2005;2(3):358-67.##Wu T, Yue X, Duan X, Luo D, Cheng Y, Tian Y, et al. Efficacy and safety of tramadol for premature ejaculation: a systematic review and meta-analysis. Urology. 2012;80(3):618-24.##Ozcan L, Polat EC, Otunctemur A, Ozbek E. Dulo-xetine, dual serotonin and norepinephrine reuptake inhibitor, versus paroxetine, selective serotonin reuptake inhibitor, in the treatment for premature ejaculation. Int Urol Nephrol. 2015;47(2):283-7.##Kaynar M, Kilic O, Yurdakul T. On-demand tra-madol hydrochloride use in premature ejaculation treatment. Urology. 2012;79(1):145-9.##Pryor JL, Althof SE, Steidle C, Rosen RC, Hell-strom WJ, Shabsigh R, et al. Efficacy and toler-ability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet. 2006; 368(9539):929-37.##Waldinger MD, Hengeveld MW, Zwinderman AH, Olivier B. Effect of SSRI antidepressants on eja-culation: a double-blind, randomized, placebo-con-trolled study with fluoxetine, fluvoxamine, paroxe-tine, and sertraline. J Clin Psychopharmacol. 1998;18(4):274-81.##Roblin D. Premature ejaculation: diagnosis and pharmacotherapy. Int J Pharm Med. 2000;14(6):313-8.##Safarinejad MR. Once-daily high-dose pindolol for paroxetine-refractory premature ejaculation: a double-blind, placebo-controlled and randomized study. J Clin Psychopharmacol. 2008;28(1):39-44.##Safarinejad MR, Hosseini SY. Safety and efficacy of tramadol in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. J Clin Psychopharmacol. 2006;26(1):27-31.##Salem EA, Wilson SK, Bissada NK, Delk JR, Hel-lstrom WJ, Cleves MA. Tramadol HCL has promise in on-demand use to treat premature ejaculation. J Sex Med. 2008;5(1):188-93.##Bar-Or D, Salottolo KM, Orlando A, Winkler JV; Tramadol ODT Study Group. A randomized double-blind, placebo-controlled multicenter study to evalu-ate the efficacy and safety of two doses of the tramadol orally disintegrating tablet for the treat-ment of premature ejaculation within less than 2 minutes. Eur Urol. 2012;61(4):736-43.##Giuliano F, Clément P. Serotonin and premature ejaculation: from physiology to patient manage-ment. Eur Urol. 2006;50(3):454-66.##Giuliano FA. Tramadol for the treatment of pre-mature ejaculation. Eur Urol. 2012;61(4):744-5.##Waldinger MD, Zwinderman AH, Olivier B. On-demand treatment of premature ejaculation with clomipramine and paroxetine: a randomized, double blind fixed-dose study with stopwatch assessment. Eur Urol. 2004;46(4):510-6.##Marcou TA, Marque S, Mazoit JX, Benhamou D. The median effective dose of tramadol and mor-phine for postoperative patients: a study of inter-actions. 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Empty Follicle Syndrome Following GnRHa Trigger in PCOS Patients Undergoing IVF Cycles 2 1 2 Background: The objective of this study was to analyze the incidence and the underlying mechanisms of empty follicle syndrome (EFS) occurring in gonadotropin releasing hormone agonist (GnRHa) triggered in in vitro fertilization (IVF) cycles with GnRH antagonist protocol in women with polycystic ovary syndrome (PCOS) of Indian origin. The study also intended to evaluate the cycle outcome following a rescue trigger. Methods: Retrospective cohort analysis of data was extracted from the hospital database of 271 PCOS patients who underwent IVF in antagonist protocol triggered with GnRHa from August 2014 to December 2016. All cases with failure to obtain oocytes following retrieval were analyzed. Continuous variables were expressed as mean±SD using t-test and Chi-squared test for categorical variables. A p<0.05 was considered statistically significant. Results: Incidence of EFS following GnRHa trigger was found to be 3.3%. False empty follicle syndrome (FEFS) accounted for majority of the cases (8/9=88.8%). Of the nine EFS, six cases were salvaged with a rescue trigger, resulted in transfer of reasonably good quality embryos in a frozen-thawed embryo replacement cycle achieving clinical pregnancy in three cases (3/6=50%). Conclusion: Our experience with EFS cases following GnRHa, albeit small, given the rarity of its occurrence, suggests that majority of EFS are of false forms and can be effectively salvaged which results in reasonably favorable outcome. 16 26 Krishna K Deepika Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd India drkdipika@gmail.com Davuluri D Sindhuma Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd India Bijlani B Kiran Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd India Nair N Ravishankar Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd India Praneesh P Gautham Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd India Rao R Kamini Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd Department of Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd India GnRH antagonistEmpty follicle syndromeGonadotropin releasing hormone agonist triggerPolycystic ovary syndromeRescue trigger 10010.pdf Driscoll GL, Tyler JP, Knight DC, Cooke S, Kime L, Clark L, et al. Failure to collect oocytes in assisted reproductive technology: a retrospective. Hum Reprod. 1998;13(1):84-7.##Mesen TB, Yu B, Richter KS, Widra E, DeCherney AH, Segars JH. The prevalence of genuine empty follicle syndrome. Fertil Steril. 2011;96(6):1375-7.##Baum M, Machtinger R, Yerushalmi GM, Maman E, Seidman DS, Dor J, et al. Recurrence of empty follicle syndrome with stimulated IVF cycles. Gynecol Endocrinol. 2012;28(4):293-5.##Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertil Steril. 2010;94(2):389-400.##Fauser BC, de Jong D, Olivennes F, Wramsby H, Tay C, Itskovitz-Eldor J, et al. Endocrine profiles after triggering of final oocyte maturation with GnRH agonist after cotreatment with the GnRH antagonist ganirelix during ovarian hyperstimulation for in vitro fertilization. J Clin Endocrinol Metab. 2002;87(2):709-15.##Humaidan P, Kol S, Papanikolaou EG; Copenhagen GnRH Agonist Triggering Workshop Group. GnRH agonist for triggering of final oocyte maturation: time for a change of practice? Hum Reprod Update. 2011;17(4):510-24.##Yen SS, Llerena O, Little B, Pearson OH. Disappearance rates of endogenous luteinizing hormone and chorionic gonadotropin in man. J Clin Endocrinol Metab. 1968;28(12):1763-7.##Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.##ALPHA Scientists In Reproductive Medicine; ESHRE Special Interest Group Embryology. Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Reprod Biomed Online. 2011;22(6):632-46.##Coulam CB, Bustillo M, Schulman JD. Empty follicle syndrome. Fertil Steril. 1986;46:1153-5.##Engmann L, DiLuigi A, Schmidt D, Nulsen J, Maier D, Benadiva C. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril. 2008;89(1):84-91.##Türkgeldi E, Türkgeldi L, Seyhan A, Ata B. Gonadotropin-releasing hormone agonist triggering of oocyte maturation in assisted reproductive technology cycles. Turk J Obstet Gynecol. 2015;12(2):96-101.##Quintans CJ, Donaldson MJ, Blanco LA, Pasqualini RS. Empty follicle syndrome due to human errors: Its occurrence in an in vitro fertilization programme. Hum Reprod. 1998;13(10):2703-5.##Awonuga A, Govindbhai J, Zierke S, Schnauffer K. Continuing the debate on empty follicle syndrome: can it be associated with normal bioavailability of beta human chorionic gonadotrophin on the day of oocyte recovery? Hum Reprod. 1998;13(5):1281-4.##Ben-Shlomo I, Schiff E, Levran D, Ben Rafael Z, Mashiach S, Dor J. Failure of oocyte retrieval during in vitro fertilization: a sporadic event rather than a syndrome. Fertil Steril. 1991;55(2):324-7.##Castillo JC, Garcia-Velasco J, Humaidan P. Empty follicle syndrome after GnRHa triggering versus hCG triggering in COS. J Assist Reprod Genet. 2012;29(3):249-53.##Stevenson TL, Lashen H. Empty follicle syndrome: The reality of a controversial syndrome, a systematic review. Fertil Steril. 2008;90(3):691-8.##Orvieto R, Rabinson J, Meltzer S, Zohav E, Anteby E, Homburg R. Substituting HCG with GnRH agonist to trigger final follicular maturation--a retrospective comparison of three different ovarian stimulation protocols. Reprod Biomed Online. 2006;13(2):198-201.##Zegers-Hochschild F, Fernández E, Mackenna A, Fabres C, Altieri E, Lopez T. The empty follicle syndrome: a pharmaceutical industry syndrome. Hum Reprod. 1995;10(9):2262-5.##Aktas M, Beckers NG, van Inzen WG, Verhoeff A, de Jong D. Oocytes in the empty follicle: A controversial syndrome. Fertil Steril. 2005;84(6):1643-8.##Kummer NE, Feinn RS, Griffin DW, Nulsen JC, Benadiva CA, Engmann LL. Predicting successful induction of oocyte maturation after gonadotropin-releasing hormone agonist (GnRHa) trigger. Hum Reprod. 2013;28(1):152-9.##Peluso JJ. Role of the amplitude of the gonadotropin surge in the rat. Fertil Steril. 1990;53(1):150-4.##Itskovitz-Eldor J, Kol S, Mannaerts B. Use of a single bolus of GnRH agonist triptorelin to trigger ovulation after GnRH antagonist ganirelix treatment in women undergoing ovarian stimulation for assisted reproduction, with special reference to the prevention of ovarian hyperstimulation syndrome: preliminary report: short communication. Hum Reprod. 2000;15(9):1965-8.##Shapiro BS, Daneshmand ST, Restrepo H, Garner FC, Aguirre M, Hudson C. Efficacy of induced luteinizing hormone surge after "trigger" with gonadotropin-releasing hormone agonist. Fertil Steril. 2011;95(2):826-8.##Shapiro BS, Andersen CY. Major drawbacks and additional benefits of agonist trigger--not ovarian hyperstimulation syndrome related. Fertil Steril. 2015;103(4):874-8.##Inan MS, Al-Hassan S, Ozand P, Coskun S. Transcriptional profiling of granulosa cells from a patient with recurrent empty follicle syndrome. Reprod Biomed Online. 2006;13(4):481-91.##Yuan P, He Z, Zheng L, Wang W, Li Y, Zhao H, et al. Genetic evidence of ‘genuine’ empty follicle syndrome: a novel effective mutation in the LHCGR gene and review of the literature. Hum Reprod. 2017;32(4):944-53.##Madani T, Jahangiri N. Empty follicle syndrome: the possible cause of occurrence. Oman Med J. 2015;30(6):417-20.##Reichman DE, Hornstein MD, Jackson KV, Racowsky C. Empty follicle syndrome--does repeat administration of hCG really work? Fertil Steril. 2010;94(1):375-7.##Wang JG, Lobo RA. The complex relationship between hypothalamic amenorrhea and polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(4):1394-7.##Dunaif A, Givens JR, Haseltine FP. Polycystic Ovarian Syndrome. Boston: Blackwell Scientific Publications; 1992. 377 p.##Meyer L, Murphy LA, Gumer A, Reichman DE, Rosenwaks Z, Cholst IN. Risk factors for a suboptimal response to gonadotropin-releasing hormone agonist trigger during in vitro fertilization cycles. Fertil Steril. 2015;104(3):637-42.##Chang FE, Beall SA, Cox JM, Richter KS, DeCherney AH, Levy MJ. Assessing the adequacy of gonadotropin-releasing hormone agonist leuprolide to trigger oocyte maturation and management of inadequate response. Fertil Steril. 2016;106(5):1093-100.##Chevrier L, Guimiot F, de Roux N. GnRH receptor mutations in isolated gonadotropic deficiency. Mol Cell Endocrinol. 2011;346(1-2):21-8.##Beranova M, Oliveira LM, Bédécarrats GY, Schipani E, Vallejo M, Ammini AC, et al. Prevalence, phenotypic spectrum, and modes of inheritance of gonadotropin-releasing hormone receptor mutations in idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 2001;86(4):1580-8.##Alviggi C, Clarizia R, Pettersson K, Mollo A, Humaidan P, Strina I, et al. Suboptimal response to GnRHa long protocol is associated with a common LH polymorphism. Reprod Biomed Online. 2011;22 Suppl 1:S67-72.##Park JY, Su YQ, Ariga M, Law E, Jin SL, Conti M. EGF-like growth factors as mediators of LH action in the ovulatory follicle. Science. 2004;303(5658):682-4.##Ashkenazi H, Cao X, Motola S, Popliker M, Conti M, Tsafriri A. Epidermal growth factor family members: endogenous mediators of the ovulatory response. Endocrinology. 2005;146(1):77-84.##Ndukwe G, Thornton S, Fishel S, Dowell K, Aloum M, Green S. 'Curing' empty follicle syndrome. Hum Reprod. 1997;12(1):21-3.##Reichman DE, Greenwood E, Meyer L, Kligman I, Rosenwaks Z. Can in vitro fertilization cycles be salvaged by repeat administration of intramuscular human chorionic gonadotropin the day after failed injection? Fertil Steril. 2012;98(3):671-4.##Blazquez A, Guillén JJ, Colomé C, Coll O, Vassena R, Vernaeve V. Empty follicle syndrome prevalence and management in oocyte donors. Hum Reprod. 2014;29(10):2221-7.##Kim JH, Jee BC. Empty follicle syndrome. Clin Exp Reprod Med. 2012;39(4):132-7.##Lorusso F, Depalo R, Tsadilas S, Caradonna F, Di Gilio A, Capotorto MT, et al. Is the occurrence of the empty follicle syndrome a predictor that a subsequent stimulated cycle will be an unfavourable one? Reprod Biomed Online. 2005;10(5):571-4.##Coskun S, Madan S, Bukhari I, Al-Hassan S, Al-Rejjal R, Awartani K. Poor prognosis in cycles following "genuine" empty follicle syndrome. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):157-9.##

Performing IUI Simultaneously with hCG Administration Does Not Compromise Pregnancy Rate: A Retrospective Cohort Study 2 1 2 Background: The probability of conception occurs before ovulation in natural cycle, thus performing IUI before ovulation should not compromise the pregnancy outcomes. Methods: A retrospective cohort study was conducted at a university hospital during 2007 to 2015. The ovarian stimulation and monitoring were performed as usual. The total of 29 preovulatory IUI, and 221 postovulatory IUI couples were recruited. In postovulatory IUI, 5,000 IU of hCG was injected when dominant follicle reached 17 mm. The IUI was performed 36 to 40 hr afterward. In preovulatory IUI, hCG was injected and IUI was performed simultaneously when the dominant follicle reached the size. Data were compared using independent sample t test and Fisher’s exact test. A p-value of <0.05 was considered statistically significant. Results: The characteristics of both groups were comparable. The cumulative biochemical, clinical, and live birth rates were not different between prevulatory and postovulatory IUI groups (10.3% vs. 16.3%; p=0.407, 10.3% vs. 12.2%; p=0.77 and 10.3% vs. 11.3%; p=0.877, respectively). Conclusion: Performing IUI simultaneously with hCG administration does not compromise pregnancy rate. 26 32 Patsama P Vichinsartvichai Infertility Unit, Department of Obstetrics and Gynecology, Vajira Hospital, Faculty of Medicine, Navamindradhiraj University Infertility Unit, Department of Obstetrics and Gynecology, Vajira Hospital, Faculty of Medicine, Navamindradhiraj University Thailand patsama@nmu.ac.th Khanitta K Traipak Infertility Unit, Department of Obstetrics and Gynecology, Vajira Hospital, Faculty of Medicine, Navamindradhiraj University Infertility Unit, Department of Obstetrics and Gynecology, Vajira Hospital, Faculty of Medicine, Navamindradhiraj University Thailand Chirawattana C Manolerttherwan Infertility Unit, Department of Obstetrics and Gynecology, Vajira Hospital, Faculty of Medicine, Navamindradhiraj University Infertility Unit, Department of Obstetrics and Gynecology, Vajira Hospital, Faculty of Medicine, Navamindradhiraj University Thailand Artificial inseminationPostovulatory IUIPregnancy ratePreovulatory IUITiming of hCG 2.pdf Vichinsartvichai P, Siriphadung S, Traipak K, Promrungrueng P, Manolertthewan C, Ratchanon S. The influence of women age and successfulness of intrauterine insemination (IUI) cycles. J Med Assoc Thai. 2015;98(9):833-8.##Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril. 2010;93(1):79-88.##Azantee YW, Murad ZA, Roszaman R, Hayati MY, Norsina MA. Associated factors affecting the successful pregnancy rate of intrauterine insemination at International Islamic University Malaysia (IIUM) Fertility Centre. Med J Malaysia. 2011;66(3):195-8.##Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med. 1995;333(23):1517-21.##Aydin Y, Hassa H, Oge T, Tokgoz VY. A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):444-8.##Dehghani-Firouzabai R, Aflatoonian A, Davar R, Farid-Mojtahedi M. A comparison of pregnancy rate before and after the administration of HCG in intrauterine insemination. Arch Gynecol Obstet. 2014;289(2):429-32.##Järvelä IY, Tapanainen JS, Martikainen H. Improved pregnancy rate with administration of hCG after intrauterine insemination: a pilot study. Reprod Biol Endocrinol. 2010;8:18.##Mostafa MS, El Huseiny AM, Soliman BS, Mohammed MM. Effect of postponing hCG injection after intrauterine insemination on pregnancy rate. Middle East Fertil Soc J. 2014;19(3):183-6.##Propst AM, Thoppil JJ, Groll JM, Frattarelli JL, Robinson RD, Retzloff MG. A single pre-ovulatory IUI at 12 hours after hCG trigger is comparable to a traditional IUI at 36 hours. Fertil Steril. 2012;98(3):S85-S6.##Propst AM, Thoppil JJ, Groll JM, Frattarelli JL, Robinson RD, Retzloff MG. Pre-ovulatory vs. ovulatory intrauterine insemination in controlled ovarian hyperstimulation cycles. Fertil Steril. 2007;88 (Supplement 1):S172-S3.##Robb PA, Robins JC, Thomas MA. Timing of hCG administration does not affect pregnancy rates in couples undergoing intrauterine insemination using clomiphene citrate. J Natl Med Assoc. 2004;96(11):1431-3.##Wang YC, Chang YC, Chen IC, Cnien HH, Wu GJ. Comparison of timing of IUI in ovarian stimulated cycles. Arch Androl. 2006;52(5):371-4.##Rahman SM, Karmakar D, Malhotra N, Kumar S. Timing of intrauterine insemination: an attempt to unravel the enigma. Arch Gynecol Obstet. 2011;284(4):1023-7.##World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010. 341 p.##Temporal relationships between ovulation and defined changes in the concentration of plasma estradiol-17 beta, luteinizing hormone, follicle-stimulating hormone, and progesterone. I. Probit analysis. World Health Organization, Task Force on Methods for the Determination of the Fertile Period, Special Programme of Research, Development and Research Training in Human Reproduction. Am J Obstet Gynecol. 1980;138(4):383-90.##Edwards RG, Steptoe PC. Control of human ovulation, fertilization and implantation. Proc R Soc Med. 1974;67(9):932-6.##Testart J, Frydman R. Minimum time lapse between luteinizing hormone surge or human chorionic gonadotropin administration and follicular rupture. Fertil Steril. 1982;37(1):50-3.##Cantineau AE, Cohlen BJ; Dutch IUI Study Group. The prevalence and influence of luteinizing hormone surges in stimulated cycles combined with intrauterine insemination during a prospective cohort study. Fertil Steril. 2007;88(1):107-12.##Martinez AR, Bernardus RE, Kucharska D, Schoemaker J. Urinary luteinizing hormone testing and prediction of ovulation in spontaneous, clomiphene citrate and human menopausal gonadotropin-stimulated cycles. A clinical evaluation. Acta Endocrinol (Copenh). 1991;124(4):357-63.##Fuh KW, Wang X, Tai A, Wong I, Norman RJ. Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates. Hum Reprod. 1997;12(10):2162-6.##Shoham Z, Jacobs HS, Insler V. Luteinizing hormone: its role, mechanism of action, and detrimental effects when hypersecreted during the follicular phase. Fertil Steril. 1993;59(6):1153-61.##Isaksson R, Tiitinen A. Obstetric outcome in patients with unexplained infertility: comparison of treatment-related and spontaneous pregnancies. Acta Obstet Gynecol Scand. 1998;77(8):849-53.##Gelbaya TA, Potdar N, Jeve YB, Nardo LG. Definition and epidemiology of unexplained infertility. Obstet Gynecol Surv. 2014;69(2):109-15.##De Cicco S, Tagliaferri V, Selvaggi L, Romualdi D, Di Florio C, Immediata V, et al. Expectant management may reduce overtreatment in women affected by unexplained infertility confirmed by diagnostic laparoscopy. Arch Gynecol Obstet. 2017;295(2):427-33.##Dong Fl, Sun Yp, Su Yc, Guo Yh, Hu Ll, Wang F. Relationship between processed total motile sperm count of husband or donor semen and pregnancy outcome following intrauterine insemination. Syst Biol Reprod Med. 2011;57(5):251-5.##Vandekerckhove FW, De Croo I, Gerris J, Vanden Abbeel E, De Sutter P. Sperm Chromatin Dispersion Test before Sperm Preparation Is Predictive of Clinical Pregnancy in Cases of Unexplained Infertility Treated with Intrauterine Insemination and Induction with Clomiphene Citrate. Front Med (Lausanne). 2016;3:63.##Miller DC, Hollenbeck BK, Smith GD, Randolph JF, Christman GM, Smith YR, et al. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology. 2002;60(3):497-501.##Homburg R, Armar NA, Eshel A, Adams J, Jacobs HS. Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome. BMJ. 1988;297(6655):1024-6.##Goud P, Goud A, Van Oostveldt P, Van der Elst J, Dhont M. Fertilization abnormalities and pronucleus size asynchrony after intracytoplasmic sperm injection are related to oocyte postmaturity. Fertil Steril. 1999;72(2):245-52.##

Effect of Aromatherapy with Peppermint Oil on the Severity of Nausea and Vomiting in Pregnancy: A Single-blind, Randomized, Placebo-controlled trial 2 1 2 Background: Nausea and vomiting are common complaints in the first half of pregnancy. These symptoms can significantly affect a person's personal and professional life. Aromatherapy is one of the types of complementary medicine that is used in the treatment of nausea and vomiting. The objective of this study was to determine the effect of aromatherapy with peppermint oil on the severity of nausea and vomiting of pregnancy (NVP). Methods: This was a single-blind clinical trial that was conducted on 56 pregnant women with mild to moderate severity of NVP and 6 to 20 weeks of gestational age. After the determination of gestational age and base severity of NVP in each woman, they were randomly assigned to one of the two groups: peppermint oil (n=28) or placebo (n=28). Inhalation aromatherapy was done for four days and at the end of each day,they responded to the Pregnancy Unique Quantification of Emesis/Nausea questionnaire (PUQE). The data obtained were analyzed with Mann-Whitney test and ANOVA with repeated measures using SPSS software version 22. Also, the level of significance was p<0.05. Results: Although the severity of NVP in each intervention group significantly decreased (p<0.001), the comparison of the severity of NVP during the study period and at the end of it was not statistically significant between the placebo and intervention groups. Conclusion: According to the possibility of neurological mechanisms causing NVP, the effect of aromatherapy with peppermint oil and placebo were the same in this study. This similarity can be due to psychological impacts of intervention on pregnant women. 32 39 Narges N Joulaeerad Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran Giti G Ozgoli Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran g.ozgoli@gmail.com Homa H Hajimehdipoor Traditional Medicine and Materia Medica Research Center and Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences Traditional Medicine and Materia Medica Research Center and Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences Iran Erfan E Ghasemi Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences Iran Fatemeh F Salehimoghaddam Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences Iran AromatherapyInhalationMentha piperitaNauseaPregnancyVomiting 4.pdf Refuerzo JS, Smith JA, Ramin SM. Clinical features and evaluation of nausea and vomiting of pregnancy [Internet]. Waltham, MA: UpToDate Inc; 2015 April 25 [cited 2017 Jun 3]. Available from: https://www.uptodate.com/contents/clinical-features-and-evaluation-of-nausea-and-vomiting-of-pregnancy##Einarson T, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J Popul Ther Clin Pharmacol. 2012;20(2):171-83.##Herrell HE. Nausea and vomiting of pregnancy. Am Fam Physician. 2014;89(12):965-70.##Badell ML, Ramin SM, Smith JA. Treatment options for nausea and vomiting during pregnancy. Pharmacotherapy. 2006;26:1273-87.##Munch S, Korst LM, Hernandez GD, Romero R, Goodwin TM. Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context. J Perinatol. 2011;31(1):10-20.##Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011;40(2):309-34.##Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Eng J Med. 2010;363(16):1544-50.##Firouzbakht M, Nikpour M, Omidvar Sh, Kiapour A. Comparative Study of Effects of ginger with vit. B6 in treatment nausea and vomiting during pregnancy. J Fam Health. 1391;1(3):8-13.##Hollyer T, Boon H, Georgousis A, Smith M, Einarson A, et al. The use of CAM by women suffering from nausea and vomiting during pregnancy. BMC complement Altern Med. 2002;2:5.##Abedzadeh Kalahroudi M. Complementary and alternative medicine in midwifery. Nurs Midwifery Stud. 2014;3(2):e19449.##Ghani RMA, Ibrahim ATA. The effect of aromatherapy inhalation on nausea and vomiting in early pregnancy: a pilot randomized controlled trial. J Nat Sci Res. 2013;3(6):192-205.##Fundukian LJ. The gale encyclopedia of alternative medicine. 4th ed. United States of America: Thomson Gale; 2014. 2848 p.##Thomson F. PDR for herbal medicines. 4th ed. Montvale, New Jersey: Thomson; 2007. 1026 p.##World Health Organization. WHO monographs on medicinal plants commonly used in the newly independent states (NIS). 1st ed. Geneva: WHO Press; 2010. Aetheroleum menthae piperitae; p. 251-70.##Lawless J. The encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health and well being. 1st ed. San Francisco: Red Wheel Weiser; 2013. 224 p.##Mills SY, Bone K, Mills S, Bone K. The essential guide to herbal safety. 1st ed. United States of America: Elsevier Churchill Livingstone; 2005. 704 p.##Verma RS, Rahman L, Verma RK, Chauhan A, Yadav AK, Singh A. Essential oil composition of menthol mint (Mentha arvensis) and peppermint (Mentha piperita) cultivars at different stages of plant growth from Kumaon region of western Himalaya. Open Access J Med Aromat Plants. 2010;1(1):13-8.##Tisserand R, Young R. Essential oil safety: a guide for health care professionals. 2nd ed. Edinburg: Churchill Livingstone Elsevier; 2014. 780 p.##Heimes K, Hauk F, Verspohl EJ. Mode of action of peppermint oil and (-)-menthol with respect to 5‐HT3 receptor subtypes: binding studies, cation uptake by receptor channels and contraction of isolated rat ileum. Phytother Res. 2011;25(5):702-8.##US Food and Drug Administration [Internet]. Washington: US Department of Health and Human Services; C2014. Food additive status list. [cited 2014 Dec 23]; [about 60 screens]. Available from: http://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm091048.htm#ftnP##Hashem Dabaghian F. Knowledge of pregnant women about the efficacy and safety of herbal medicine and their practice during pregnancy. J Complement Med. 2012;2(3):246-56.##Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, et al. Validation studies of the pregnancy unique-quantification of emesis (PUQE) scores. J Obstet Gynecol. 2005;25(3):241-4.##Ebrahimi, N, Maltepe C, Bournissen FG, Koren G. Nausea and vomiting of pregnancy: using the 24-hour pregnancy-unique quantification of emesis (PUQE-24) scale. J Obstet Gynaecol. 2009;31(9):803-7.##National Association for Holistic Aromatherapy [Internet]. North Carolina: NAHA; C2014. Methods of application. [cited 2014 Apr 15]; [about 7 screens]. Available from: https://www.naha.org/explore-aromatherapy/about-aromatherapy/methods-of-application/##Pasha H, Behmanesh F, Mohsenzadeh F, Hajahmadi M, Moghadamnia AA. Study of the effect of mint oil on nausea and vomiting during pregnancy. Iran Red Crescent Med J. 2012;14(11):727-30.##Anderson LA, Gross JB. Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea. J Perianesth Nurs. 2004;19(1):29-35.##Sites DS, Johnson NT, Miller JA, Torbush PH, Hardin JS, Knowles SS, et al. Controlled breathing with or without peppermint aromatherapy for postoperative nausea and/or vomiting symptom relief: a randomized controlled trial. J Perianesth Nurs. 2014;29(1):12-9.##

Effect of Sexual Education on Sexual Function of Iranian Couples During Pregnancy: A Quasi Experimental Study 2 1 2 Background: The aim of this study was to evaluate the impact of husbands' participation in sexual education on sexual function during pregnancy. Methods: This quasi experimental study was conducted on 123 couples who were divided in two intervention (A: couples, B: pregnant women) and one control (C) groups. Group A couples received sex education, Group B women received sex education without their spouses, and Group C women received routine prenatal care without sex education. Sexual functions of couples were assessed by Female Sexual Function Index (FSFI) and International Index Erectile Function (IIEF) questionnaires, before sex education, four weeks after the intervention, at the end of the second trimester and at the end of the third trimester. Results: Mean total scores of FSFI and IIEF were not different at baseline in three groups. Repeated measure analysis showed significant differences between groups (A and B with C) in the mean total scores of FSFI and IIEF during the third trimester. The mean total scores of the two intervention groups of A and B were not significant. Conclusion: According to the results of the present study, promoting the sexual function of pregnant women needs to include the sex education on prenatal care. Whereas spouses’ participation was suggested to have a great role in the effectiveness and strengthening of the education in various studies, this study showed that the lack of spouses’ participation for whatever reasons may lead to the same results of previous studies which emphasized the necessity of spouses’ participation. 39 49 Masumeh M Heidari Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University Iran Farkhondeh F Aminshokravi Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University Iran aminsh_f@modares.ac.ir, heidari@shahed.ac.ir Farid F Zayeri Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences Iran Seyed Ali SA Azin Department of Health Promotion, Iranian Academic Center for Education, Culture and Research, ACECR Department of Health Promotion, Iranian Academic Center for Education, Culture and Research, ACECR Iran CouplePregnancySex educationSexual functionThird trimester 7.pdf Bartellas E, Crane JM, Daley M, Bennett KA, Hutchens D. Sexuality and sexual activity in pregnancy. BJOG. 2000;107(8):964-8.##Gałązka I, Drosdzol‐Cop A, Naworska B, Czajkowska M, Skrzypulec‐Plinta V. Changes in the sexual function during pregnancy. J Sex Med. 2015;12(2):445-54.##Pauleta JR, Pereira NM, Graça LM. Sexuality during pregnancy. J Sex Med. 2010;7(1pt1):136-42.##Pauls RN, Occhino JA, Dryfhout VL. Effects of pregnancy on female sexual function and body image: a prospective study. J Sex Med. 2008;5(8):1915-22.##Nourani Sh, Jonaidy E, Shakeri MT, Mokhber N. Sexual satisfaction in fertile and infertile women attending state clinics in Mashad. J Reprod Infertil. 2010;10(4):269-77.##Leite APL, Campos AA, Dias AR, Amed AM, De Souza E, Camano L. Prevalence of sexual dysfunction during pregnancy. Rev Assoc Med Bras. 2009;55(5):563-8.##Jamali S, Mosalanejad L. Sexual dysfnction in Iranian pregnant women. Iran J Reprod Med. 2013;11(6):479-86.##Bayrami R, Sattarzadeh N, Koochaksariie FR, Pezeshki MZ. Sexual dysfunction in couples and its related factors during pregnancy. J Reprod Infertil. 2008;9(3):271-82.##Ebrahimian A, Heydari M, Saberi Zafar Ghandi MB, Delavari S. Comparing Sexual dysfunctions in men before and during their wives' pregnancy. Iran J Obstet Gynecol Infertil. 2012;15(33):19-25.##Nakić Radoš S, Soljačić Vraneš H, Šunjić M. Sexuality during pregnancy: what is important for sexual satisfaction in expectant fathers? J Sex Marital Ther. 2015;41(3):282-93.##Masters WH, Johnson VE. Human sexual response. 1st ed. Boston: Little, Brown and company; 1976. 366 p.##Nichols FH, Humenick SS. Childbirth education: practice, research and theory. 1st ed. US: Saunders Company; 2000. 731 p.##Onah HE, Iloabachie GC, Obi SN, Ezugwu FO, Eze JN. Nigerian male sexual activity during pregnancy. Int J Gynecol Obstet. 2002;76(2):219-23.##Serati M, Salvatore S, Siesto G, Cattoni E, Zanirato M, Khullar V, et al. Female sexual function during pregnancy and after childbirth. J Sex Med. 2010;7(8):2782-90.##Regan PC, Lyle JL, Otto AL, Joshi A. Pregnancy and changes in female sexual desire: A review. Soc Behav Pers. 2003;31(6):603-11.##Aslan G, Aslan D, Kızılyar A, Ispahi C, Esen A. A prospective analysis of sexual functions during pregnancy. Int J Impot Res. 2005;17(2):154-7.##Malarewicz A, Szymkiewicz J, Rogala J. [Sexuality of pregnant women]. Ginekol Pol. 2006;77(9):733-9. Polish.##Jawed-Wessel S, Herbenick D, Schick V, Fortenberry JD, Cattelona GA, Reece M. Development and validation of the maternal and partner sex during pregnancy scales. J Sex Marital Ther. 2016;42(8):681-701.##Hassan ZR, Shafie K, Bashardoust N, Reihani M, Jaberi P. Study of the related factors in couples sexual relationship during pregnancy. J Qazvin Univ Med Sci. 2002;5(4):62-7.##Yeniel AO, Petri E. Pregnancy, childbirth, and sexual function: perceptions and facts. Int Urogynecol J. 2014;25(1):5-14.##Read J. Sexual problems associated with infertility, pregnancy, and ageing. 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Effective communication training on marital satisfaction in mothers of elementary school students in the city of Khorramabad. Educ Res. 2008;5:114-97.##Polomeno V. Sex and pregnancy: A perinatal educator's guide. J Perinat Educ. 2000;9(4):15-27.##Murtagh J. Female sexual function, dysfunction, and pregnancy: implications for practice. J Midwifery Womens Health. 2010;55(5):438-46.##Corbacioglu A, Bakir VL, Akbayir O, Cilesiz Goksedef BP, Akca A. The role of pregnancy awareness on female sexual function in early gestation. J Sex Med. 2012;9(7):1897-903.##Navidian A, Rigi SN, Soltani P. Effects of group sexual counseling on the traditional perceptions and attitudes of Iranian pregnant women. Int J Womens Health. 2016;8:203-11.##Liu HL, Hsu P, Chen KH. Sexual activity during pregnancy in Taiwan: a qualitative study. Sex Med. 2013;1(2):54-61.##de Pierrepont C, Polomeno V, Bouchard L, Reissing E. [What do we know about perinatal sexuality? a scoping review on sexoperinatality-part 1]. J Gynecol Obstet Biol Reprod (Paris). 2016;45(8):796-808. French.##

Yeast and Fertility: Effects of In Vitro Activity of Candida spp. on Sperm Quality 2 1 2 Background: Candida spp. causes semen candidiasis, the most important sexually transmitted fungal infection; this microorganism affects male fertility potential and could alter oocyte fertilization. The in vitro effects of the yeasts Candida albicans and Candida glabrata and their soluble factors of fungal metabolism on semen quality were studied. Methods: Candida strains (2, 0.5 and 0.05 McF) and their soluble factors were incubated for 3 hr with selected spermatozoa. Conventional (Viability and motility) and functional parameters (Mitochondrial membrane potential, membrane integrity, detection of reactive oxygen species and DNA fragmentation) were quantified in 35 semen samples. In addition, human spermatozoa were incubated under capacitating conditions with Candida spp. and soluble factors. Finally, spermatozoa were incubated with mannose before incubation with either yeast to block sperm and yeast interaction. Data was analyzed using Friedman test, and p<0.05 was considered significant. Results: The conventional sperm parameters were statistically affected by the two yeast strains after 3 hr and their effect was maintained until the 24 hr incubation. However, the functional parameters were altered, this change was not statistically significant. Pretreatment of spermatozoa with mannose decreased the effect of Candida spp. Conclusion: The presence of C. albicans or C. glabrata affects seminal parameters. The effect is related to incubation time and yeast concentration, it can be supposed that the yeast sperm interaction is mediated through the mannose sperm receptor. 49 56 Elizabeth EX Castrillón-Duque Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín Colombia Jennifer JP Suárez Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín Colombia Walter D. WD Cardona Maya Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín Colombia wdario.cardona@udea.edu.co Candida albicansCandida glabrataMale infertilitySemenSpermatozoa 8.pdf World Health Organization. World Health Organiza-tion laboratory manual for the examination and processing of human semen. 5th ed. Geneva, Swit-zerland: World Health Organization. 2010. p. 286.##Alsterholm M, Flytström I, Leifsdottir R, Faerge-mann J, Bergbrant IM. Frequency of bacteria, Candida and malassezia species in balanoposthitis. Acta Derm Venereol. 2008;88(4):331-6.##Puerta Suárez J, Villegas Castaño A, Serna Quintana GJ, Martínez A, Romero Palacio J, Giraldo M, et al. [Spermoculture: Bacterial growth in ejaculation and its relationship with the seminal parameters]. Rev Chil Obstet Ginecol. 2015;80(1):33-40. Spanish.##Cardona Maya WD, Du Plessis SS, Velilla PA. Semen as virus reservoir? J Assist Reprod Genet. 2016;33(9):1255-6.##Puerta Suárez J, Cardona Maya WD. [Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Ureaplasma urealyticum in semen samples: effects on sperm quality]. Urología Colomb. 2016;25(3):219-24. Spanish.##Ahmad G, du Plessis SS, Agarwal A. Sexually Transmitted Infections and Impact on Male Fertility. In: Gunasekaran K, Pandiyan N, editors. Male Infertility: A Clinical Approach. New Delhi: Springer India; 2017. p. 167-83.##Brown GD, Denning DW, Gow NA, Levitz SM, Netea MG, White TC. Hidden killers: human fungal infections. Sci Transl Med. 2012;4(165):165rv13.##Burrello N, Salmeri M, Perdichizzi A, Bellanca S, Pettinato G, D'Agata R, et al. Candida albicans experimental infection: effects on human sperm motility, mitochondrial membrane potential and apoptosis. Reprod Biomed Online. 2009;18(4):496-501.##Wise GJ, Talluri GS, Marella VK. Fungal infections of the genitourinary system: manifestations, diagnosis, and treatment. Urol Clin North Am. 1999;26(4):701-18, vii.##Aridogan IA, Izol V, Ilkit M. Superficial fungal infections of the male genitalia: a review. Crit Rev Microbiol. 2011;37(3):237-44.##Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010;23 (2):253-73.##Tuttle JP Jr, Bannister ER, Derrick FC. Interference of human spermatozoal motility and sperm-atozoal agglutina-tion by Candida albicans. J Urol. 1977;118(5):797-9.##Tian YH, Xiong JW, Hu L, Huang DH, Xiong CL. Candida albicans and filtrates interfere with human spermatozo-al motility and alter the ultrastructure of spermatozoa: an in vitro study. Int J Androl. 2007;30(5):421-9.##Burrello N, Calogero AE, Perdichizzi A, Salmeri M, D'Agata R, Vicari E. Inhibition of oocyte fertilization by as-sisted reproductive techniques and increased sperm DNA fragmentation in the presence of Candida albicans: a case report. Reprod Biomed Online. 2004;8(5):569-73.##Aitken RJ. Sperm function tests and fertility. Int J Androl. 2006;29(1):69-75.##Gil-Villa AM, Cardona-Maya W, Agarwal A, Shar-ma R, Cadavid A. Role of male factor in early recurrent embryo loss: do antioxidants have any effect? Fertil Steril. 2009;92(2):565-71.##Gil-Villa AM, Cardona-Maya W, Agarwal A, Shar-ma R, Cadavid A. Assessment of sperm factors possibly in-volved in early recurrent pregnancy loss. Fertil Steril. 2010;94(4):1465-72.##Rodríguez E, Gil-Villa AM, Aguirre-Acevedo DC, Cardona-Maya W, Cadavid AP. [Evaluation of atypical semen parameters in individuals whose couples had a history of early recurrent embryo death: in search for a reference value]. Biomedica. 2011;31(1):100-7. Spanish.##Mayorga-Torres BJ, Cardona-Maya W, Cadavid Á, Camargo M. [Evaluation of sperm functional parameters in normozoospermic infertile individuals]. Actas Urol Esp. 2013;37(4):221-7. Spanish.##Mayorga-Torres BJ, Camargo M, Agarwal A, du Plessis SS, Cadavid ÁP, Cardona Maya WD. Influence of ejacula-tion frequency on seminal parameters. Reprod Biol Endocrinol. 2015;13:47.##Lalinde-Acevedo PC, Mayorga-Torres BJM, Agar-wal A, du Plessis SS, Ahmad G, Cadavid ÁP, et al. Physically Active Men Show Better Semen Parameters than Their Sedentary Counterparts. Int J Fertil Steril. 2017;11(3):156-65.##Mayorga-Torres BJM, Camargo M, Cadavid ÁP, du Plessis SS, Cardona Maya WD. Are oxidative stress markers associated with unexplained male infertility? Andrologia. 2017;49(5).##Glander HJ, Schaller J. Binding of annexin V to plasma membranes of human spermatozoa: a rapid assay for detection of membrane changes after cryo-storage. Mol Hum Reprod. 1999;5(2):109-15.##Rennemeier C, Frambach T, Hennicke F, Dietl J, Staib P. Microbial quorum-sensing molecules induce acrosome loss and cell death in human spermatozoa. Infect Immun. 2009;77(11):4990-7.##Berktas M, Aydin S, Yilmaz Y, Cecen K, Bozkurt H. Sperm motility changes after coincubation with various uropathogenic microorganisms: an in vitro experimental study. Int Urol Nephrol. 2008;40(2):383-9.##Matsuura R, Takeuchi T, Yoshida A. Preparation and incubation conditions affect the DNA integrity of ejaculated human spermatozoa. Asian J Androl. 2010;12(5):753-9.##Nabi A, Khalili MA, Halvaei I, Roodbari F. Prolonged incubation of processed human spermatozoa will increase DNA fragmentation. Andrologia. 2014;46(4):374-9.##del Valle GM. Candida glabrata: un patógeno emergente. Biociencias. 2016;10(1):89-102.##Cardona-Maya WD, Cadavid AP. [Evaluation of the role of the monosaccharides, mannose and N-acetylglucosamine in the induction of the acrosome reaction in human spermatozoa]. Actas Urol Esp. 2005;29(7):676-84. Spanish.##Cardona-Maya W, Velilla P, Montoya CJ, Cadavid A, Rugeles MT. Presence of HIV-1 DNA in spermatozoa from HIV-positive patients: changes in the semen parameters. Curr HIV Res. 2009;7(4): 418-24.##Cardona-Maya W, Velilla PA, Montoya CJ, Cada-vid Á, Rugeles MT. In vitro human immunodeficiency virus and sperm cell interaction mediated by the mannose receptor. J Reprod Immunol. 2011;92 (1-2):1-7.##Cardona-Maya W, López-Herrera A, Velilla-Her-nández P, Rugeles MT, Cadavid AP. The role of mannose receptor on HIV-1 entry into human spermatozoa. Am J Reprod Immunol. 2006;55(4):241-5.##

A New Approach to an Old Concept for Reducing Shoulder Pain Caused by Gynecological Laparoscopy 2 1 2 Background: The purpose of this study was to introduce a technique to extract the remaining peritoneal gas in order to improve the post-laparoscopic shoulder pain. Methods: This study included 12 patients undergoing laparoscopic gynecologic procedures between February and March 2016 in Minimally Invasive Techniques Research Center, Pars Hospital, Tehran, Iran. For complete suction of the air from abdominal cavity, the air was first vacuumed from the pelvic cavity in Trendelenburg position and then the patients were put in anti-Trendelenburg position. In this position, as the remaining gas was shifting toward subdiaphragmatic area, the suction tube was shifted to a position next to the camera canal and the remaining air was suctioned. A 10 point visual analogue scale was used to measure the severity of patients’ post-operative shoulder pain. Results: The mean VAS for shoulder pain was 0.8±1.7 4 hr post-surgery. At 12 hr post-surgery, the mean VAS was 0.8±1.5. At 24 hr post-surgery, the mean VAS for shoulder pain was 0.3±0.8. Finally, 48 hr post-surgery, the VAS score for all patients was zero. Conclusion: Our approach for emptying the abdominal cavity from residual gas after laparoscopic procedures seems to be useful in preventing post-operative shoulder pain among patients undergoing gynecological laparoscopic surgeries. Further studies are suggested to compare the effect of our proposed method with other methods. 56 61 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 Bahram B Moazzami Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences Iran bahrammoazzami@gmail.com Ameneh A Haghgoo Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences Iran Kourosh K Sheibani Basir Research Center Basir Research Center Iran GynecologyIranLaparascopyPainShoulderSurgery 10012.pdf Readman E, Maher PJ, Ugoni AM, Gordon S. Intraperitoneal ropivacaine and a gas drain: effects on postoperative pain in laparoscopic surgery. J Am Assoc Gynecol Laparosc. 2004;11(4):486-91.##Shen CC, Wu MP, Lu CH, Kung FT, Huang FJ, Huang EY, et al. Effects of closed suction drainage in reducing pain after laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc. 2003;10(2):210-4.##Craciunas L, Stirbu L, Tsampras N. The use of a peritoneal gas drain following gynecological laparoscopy: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2014;179:224-8.##Kerimoglu OS, Yilmaz SA, Pekin A, İncesu F, Dogan NU, İlhan TT, et al. Effect of drainage on postoperative pain after laparoscopic ovarian cystectomy. J Obstet Gynaecol. 2015;35(3):287-9.##Jackson SA, Laurence AS, Hill JC. Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia. 1996;51(5):485-7.##Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg. 2000;87(9):1161-5.##Abbott J, Hawe J, Srivastava P, Hunter D, Garry R. Intraperitoneal gas drain to reduce pain after laparoscopy: randomized masked trial. Obstet Gynecol. 2001;98(1):97-100.##Sharami SH, Sharami MB, Abdollahzadeh M, Keyvan A. Randomised clinical trial of the influence of pulmonary recruitment manoeuvre on reducing shoulder pain after laparoscopy. J Obstet Gynaecol. 2010;30(5):505-10.##Phelps P, Cakmakkaya OS, Apfel CC, Radke OC. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol. 2008;111(5):1155-60.##Guido RS, Brooks K, McKenzie R, Gruss J, Krohn MA. A randomized, prospective comparison of pain after gasless laparoscopy and traditional laparoscopy. J Am Assoc Gynecol Laparosc. 1998;5(2):149-53.##Kaufman Y, Hirsch I, Ostrovsky L, Klein O, Shnaider I, Khoury E, et al. Pain relief by continuous intraperitoneal nebulization of ropivacaine during gynecologic laparoscopic surgery--a randomized study and review of the literature. J Minim Invasive Gynecol. 2008;15(5):554-8.##Kahokehr A, Sammour T, Srinivasa S, Hill AG. Systematic review and meta-analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures. Br J Surg. 2011;98(1):29-36.##Tsimoyiannis EC, Siakas P, Tassis A, Lekkas ET, Tzourou H, Kambili M. Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy. World J Surg. 1998(8):824-8.##Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013;27(7):2275-82.##Nursal TZ, Yildirim S, Tarim A, Noyan T, Poyraz P, Tuna N, et al. Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Arch Surg. 2003;388(2):95-100.##Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87(3):273-84.##Tsai HW, Wang PH, Yen MS, Chao KC, Hsu TF, Chen YJ. Prevention of postlaparoscopic shoulder and upper abdominal pain: a randomized controlled trial. Obstet Gynecol. 2013;121(3):526-31.##Raymond AP, Chan K, Deans R, Bradbury R, Vancaillie TG, Abbott JA. A comparative, single-blind, randomized trial of pain associated with suction or non-suction drains aftergynecologic laparoscopy. J Minim Invasive Gynecol. 2010;17(1):16-20.##Özdemir-van Brunschot DM, van Laarhoven KC, Scheffer GJ, Pouwels S, Wever KE, et al. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc. 2016;30(5):2049-65.##Nasajiyan N, Javaherfourosh F, Ghomeishi A, Akhondzadeh R, Pazyar F, Hamoonpou N. Comparison of low and standard pressure gas injection at abdominal cavity on postoperative nausea and vomiting in laparoscopic cholecystectomy. Pak J Med Sci. 2014;30(5):1083-7.##Haghgoo A, Chaichian S, Ghahremani M, Nooriardebili S, Akbaian A, Moazzami B. The Use of Peritoneal Suction Drainage to Reduce Shoulder Pain Caused by Gynecological Laparoscopy. Arch Iran Med. 2016;19(3):173-8.##Healey M, Maher P, Hill D, Gebert R, Wein P. Factors associated with pain following operative laparoscopy: a prospective observational study. Aust N Z J Obstet Gynaecol. 1998;38(1):80-4.##Georgiou C, Demetriou N, Pallaris T, Theodosopoulos T, Katsouyanni K, Polymeneas G. Is the routine use of drainage after elective laparoscopic cholecystectomy justified? A randomized trial. J Laparoendosc Adv Surg Tech A. 2011;21(2):119-23.##Alexander JI, Hull MG. Abdominal pain after laparoscopy: the value of a gas drain. Br J Obstet Gynaecol. 1987;94(3):267-9.##

De novo Balanced Robertsonian Translocation rob(22;22)(q10;q10) in a Woman with Recurrent Pregnancy Loss: A Rare Case 2 1 2 Background: Recurrent pregnancy loss (RPL), one of the most common complications of pregnancy, is responsible for significant emotional distress to the couple desiring to conceive. In almost 50% of the cases, the etiology remains unknown. The frequency of chromosomal structural rearrangements associated with a history of RPL in couples varies between 2% to 8%. Robertsonian translocations (ROBs) have an estimated incidence rate of 1/1000 births, making this type of rearrangement the most common structural chromosomal abnormalities seen in the general population. According to the literature, there are few RPL cases with rob (22; 22). Case Presentation: This case is a Syrian female offered to the Orient Hospital (Damascus, Syria), having RPL in the first trimester, no fetal malformations, and/or no neonatal death. She had a balanced chromosomal translocation involved the both short arms of chromosome 22. Banding cytogenetics, refined by array-proven multicolor banding (aMCB) revealed a rob (22; 22)(q10;q10). Her husband had a normal karyotype. Interestingly, chromosomal analysis was performed for her other family members and it revealed normal karyotype for all people, which indicates that translocation is of de novo origin. However, the couple did not have any living offspring after seven years of marriage. Conclusion: The present case was a case of RPL occurring due to rob (22;22). However, the rob(22;22)(q10;10) is the cause of recurrent abortions. Couples with the history of RPL should be suggested to do cytogenetic analysis in order to estimate whether they have chromosomal rearrangement. This diagnostic approach is of great significance to figure out what causes RPL. 61 67 Nawras N Alhalabi Faculty of Medicine, Syrian Private University Faculty of Medicine, Syrian Private University Syria nawras@me.com Walid W Al-Achkar Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission of Syria Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission of Syria Syria Abdulsamad A Wafa Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission of Syria Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission of Syria Syria Mazen M Kenj Assisted Reproduction Unit, Orient Hospital Assisted Reproduction Unit, Orient Hospital Syria Marwan M Alhalabi Assisted Reproduction Unit, Orient Hospital Assisted Reproduction Unit, Orient Hospital Syria Assisted Reproductive TechniquesRecurrent Pregnancy LossRobertsonian translocationsSyria 10011.pdf Roman E. 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