The 40th Anniversary of IVF: Has ART's Success Reached Its Peak? 2 1 2 This year, 25th July will be the 40th anniversary for birth celebration of Louise Joy Brown, the first IVF baby; Consequently, IVF will be forty years old. Therefore, simple technology has been the architect of wonderful development and subsequently originator of stunning technologies in the field of biomedicine such as stem cell technology, regenerative medicine, cloning and transgenic technologies, preimplantation genetics screening/diagnosis and more recently gene-editing technology to knock out pathogenic gene mutations in human embryos. In addition, the prospect of this area is also very promising and can be the basis of amazing changes in the treatment of severe illnesses such as cancer, obesity, diabetes, cardiovascular and neurodegenarative diseases. Along with all these merits and advancements, it must be acknowledged that infertility treatment still faces numerous challenges and problems most notably the low success rate and the consequent repeated implantation failure. In essence, many factors can contribute to this problem, most of which are due to the nature of human reproduction and fertilization process, so the maximum chance of pregnancy per cycle is less than 20% in healthy couples. Another reason for this low success rate is related to in vitro performing of fertilization and embryo culture and the inability to accurately and consistently control many vital parameters for human gametes and embryo in accordance with the same in vivo condition. Are we really unable to accurately control these parameters? The fact is that technological advancement and the introduction of new equipment have facilitated optimal achievement in in vitro condition. In addition, quality control and continuous monitoring of the performance of equipment and staff and the quality of chemicals, reagents and plastic ware also help to achieve this propose. The subsequent question is whether IVF clinics have been successful in fulfilling these requirements and achieving maximum success rate. According to annual data published by European Society of Human Reproduction and Embryology (ESHRE) in Europe and the Centers for Disease Control and Prevention (CDC) in the US from large ART fertility treatment registries, success rate of IVF clinics shows wide variation. Few top clinics are reporting their success rate to be more than 40%, while the rate of few others is less than 10% and a large number of clinics are between these two ranges. Unfortunately, even in developed countries, the number of clinics with a low success rate is very high. These clinics waste a large part of the health budget from the public resources and pocket of patients (1). According to obtained data from Australia and New Zealand Assisted Reproduction Database (ANZARD) on success rates of IVF clinics, the qualified clinics (top 25th percentile) are spending about 2 million dollars of health resources to take home 100 live babies; however, low quality clinics (bottom 25th percentile) devote more than 6 million dollars for the same 100 live babies. This means that they spend three times more than qualified centers and also the patients in the lowest performing clinic must undergo seven IVF cycles more than the patients referring to the top clinic to achieve success. The failed couples provide a business for these poor-performing clinics since the patients have to resume their treatment due to inefficiency ofclinics and their extreme desire to leverage maximum benefits from the patients. Furthermore, most of low-performing clinics have no program for achieving better results. In general, community and health care providers in public and private sections have no idea who would provide good or bad IVF services (2). It is estimated more than 400,000 babies from 1.6 million ART cycles are born around the world every year. Due to the changes in lifestyle indifferent societies, especially postponding marriage, first pregnancy and childbearing after the fourth decade of life, the need for assisted reproductive techniques and subsequently the cost of infertility treatment are increasing worldwide. According to the report published by CDC, the total market cost of fertility services was up to $3.5 billion in the U.S. in 2012. Regarding the data published in1988, it increased more than fourfold during 24 years and it still continues to grow. Therefore, intensive and continuous monitoring of IVF clinics by governmental authorities and non- governmental agencies is necessary to maintain and improve the quality of infertility services and patients' rights (3). An effective tool for monitoring IVF clinics is the development of ART services registries. Inspection on the results of IVF clinics is a requirement for ART services which is accepted worldwide. Moreover, availability, efficiency, safety, and qualification of ART services are necessary for community, infertile couples, physicians and other professional members, and health policy makers to make universal trust on IVF clinics and ART outcomes. At recent, data reporting and IVF registry are performed in most of developed countries, so an international organization entitled the International Committee Monitoring ART (ICMART) has been established for this purpose. There was voluntarily collected data of 2184 clinics from 52 countries including the type of clinics, cycles and protocols, pregnancy rates, take-home babies, twin birth rates and pregnancy complications in the last report in 2004. Unfortunaly, most African and Asian countries do not report their data and even there is no national data registry for ART services in these countries (4). Another important factor for improving ART success rate is rigorous monitoring of IVF clinics and their procedures through quality control and quality assurance as total quality management (TQM). TQM is a prerequisite for successful management of an IVF clinic. Unfortunately, a large number of centers are neglecting the role of TQM and also there are no established performance indicators for ART laboratories. In most clinics running TQM, no peer-based external inspection was provisioned to supervise its excellence implementation. At recent, College of American Pathologists (CAP) in collaboration with the American Society for Reproductive Medicine (ASRM) designed an accreditation program regarding the needs of IVF laboratories. In Europian countries, ESHRE has developed a certification program for centers through a careful evaluation of defined standards and on site visit. Skilled inspectors will assess centres according to ESHRE standards to provide advice for continuous improvement. However, this certification program and systemic inspection is not performed in most Asian and African countries (5). In conclusion, it seems that expansion of national and international IVF registry and changing it from voluntary status to a mandatory duty and also monitoring the accuracy of reported data will be effective in efficiency promotion and performance transparency of IVF clinics. In addition, continuous monitoring and inspection of IVF clinics by authorities and strict enforcement on TQM implementation will definitely play a critical role in improvement of performance and protecting patients' rights. The future is bright, since rigorous efforts of scientists and scholars have always solved most of complications and improve ART outcomes. 067 69 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 .. 10023.pdf Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Systematic review of worldwide trends in assisted reproductive technology 2004-2013. Reprod Biol Endocrinol. 2017;15(1):6.##Health Report [Internet]. Sydny: ABC Online Services; 2011. Fertility clinic data kept from public, costing government millions. 2015 May 11 [cited 2018 Apr 12]; [about 3 Scressns]. Available from: http://www.abc.net.au/radionational/ programs/healthreport/fertility-clinic-data-kept-from-public,-costing-government/6459674##Thompson C. IVF global histories, USA: between rock and a marketplace. Reprod Biomed Soc Online. 2016;2:128-35.##Sullivan EA, Zegers-Hochschild F, Mansour R, Ishihara O, de Mouzon J, Nygren KG, et al. International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2004. Hum Reprod. 2013;28(5):1375-90.##Sandro Esteves, Ashok Agarwal. Ensuring that reproductive laboratories provide high-quality services. In: Fabiola Bento, Sandro Esteves, Ashok Agarwal, editors. Quality management in ART clinics: a practical guide. New York: Springer Science Business Media New York; 2013. p. 129-46.##

Zinc is an Essential Element for Male Fertility: A Review of Zn Roles in Men’s Health, Germination, Sperm Quality, and Fertilization 2 1 2 Zinc (Zn) is the second most abundant trace element in human, which can't be stored in the body, thus regular dietary intake is required. This review explained the physiological and pathogenesis roles of zinc in men's health and its potentials in germination, quality of sperm, and fertilization. Our investigation showed that Zn contained many unique properties in human, especially males. The antioxidant quality is one of them. Also, the increased reactive oxygen species levels in the seminal plasma of men who are both infertile and smokers influence the Zn content of seminal plasma in a way that physiology of spermatozoa can be affected as well. Moreover, Zn acts as a toxic repercussionagainst heavy metals and cigarette inflammatory agents. Zinc as a hormone balancer helps hormones such as testosterone, prostate and sexual healthand functions as an antibacterial agent in men’s urea system. It plays a role in epithelial integrity, showing that Zn is essential for maintaining the lining of the reproductive organs and may have a regulative role in the progress of capacitation and acrosome reaction. In contrast, Zn deficiency impedes spermatogenesis and is a reason for sperm abnormalities and has a negative effect on serum testosterone concentration. Based on these findings, Zn microelement is very essential for male fertility. It could be considered as a nutrient marker with many potentials in prevention, diagnosis, and treatment of male infertility. 069 80 Ali A Fallah Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran Iran Azadeh A Mohammad-Hasani Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran Iran Abasalt A Hosseinzadeh Colagar Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran Iran acolagar@yahoo.com; ahcolagar@umz.ac.ir GerminationMale fertilityMicroelementROSSperm ParametersZinc 10019.pdf Khosronezhad N, Hosseinzadeh Colagar A, Mortazavi SM. 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Review of Trichomonas vaginalis in Iran, Based on Epidemiological Situation 2 1 2 Trichomoniasis, which is caused by Trichomonas vaginalis, is the most common non-viral sexually transmitted infection (STI) in the world including Iran. There were roughly 250 million new cases all over the world in a year. T. vaginalis as an important disease has been associated with HIV (in terms of exposure to sexually transmitted infection, STI) which increases the number of high-risk members, and thus it is an important public health problem. Additionally, this pathogen has been associated with serious health consequences. For instance, it may cause a woman to deliver a low-birth-weight or premature infant, and increase chances of cervical cancer. Because little information is available about the prevalence of T. vaginalis infection in Iranian population, this review was carried out to determine the prevalence of T. vaginalis among Iranian population. For this systematic review, data about epidemiology of T. vaginalis in different parts of Iran with different populations were systematically collected from 1992 to 2017 through the international databases such as PubMed, Scirus, ISI Web of Science, Scopus, EMBASE, Science Direct and Google Scholar and Islamic World Science Citation Center (ISC). National database searching included Iran Medex, Iran Doc, Magiran and Scientific Information Database (SID). A total of 39 clinical and laboratory investigations about the prevalence of Trichomoniasis from different regions of Iran were analyzed. The overall prevalence rate of T. vaginalis infection in Iranian population was estimated to be minimally 0.4% and maximally 42%. The present review showed that T. vaginalis infection rate is relatively high among the Iranian population. The control strategies, including personal hygienic education, simultaneous couple treatment, the sensitivity of diagnostic methods, appropriate preventive tool (condom) in sexual contacts could lead to the disruption of transmission. 082 89 Mohsen M Arbabi Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Iran arbabi4.mohsen@yahoo.com Mahdi M Delavari Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Iran Zohreh Z Fakhrieh-Kashan Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Iran Hossein H Hooshyar Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Department of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences Iran EpidemiologyGeneral populationIranPrevalenceTrichomonas vaginalis 10021.pdf Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96.##Mao M, Liu HL. Genetic diversity of Trichomonas vaginalis clinical isolates from Henan province in central China. Pathog Glob Health. 2015;109(5):242-6.##Kashan ZF, Arbabi M, Delavari M, Hooshyar H, Taghizadeh M, Joneydy Z. Effect of Verbascum thapsus ethanol extract on induction of apoptosis in Trichomonas vaginalis in vitro. Infect Disord Drug Targets. 2015;15(2):125-30.##Menezes CB, Mello Mdos S, Tasca T. Comparsion of permanent staining methods for the laboratory diagnosis of trichomoniasis. Rev Inst Med Trop Sao Paulo. 2016;58:5.##Mahmoud A, Sherif NA, Abdella R, El-Genedy AR, El Kateb AY, Askalani AN. Prevalence of Trichomonas vaginalis infection among Egyptian women using culture and Latex agglutination: cross-sectional study. 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[An investigation on coincidence of Trichomoniasis and bacterial vaginosis and their effects on pregnant women referred to Shahid akbarabadi maternity hospital in Tehran during 2002-2003]. Razi J Med Sci. 2005;12(46):227-34. Persian.##Bakhshandehnosrat S, Qaemi E, Behnampoor N, Rezayayi M. [Determining the etiological agents in vaginal infections in women referring to Dezyani women hospital in Gorgan]. J Sabzevar Univ Med Sci. 2003;10(3):58-65. Persian.##Habibypour R, Amirkhani A, Matinnia N. Contamination rate of Trichomonas vaginalis in females referring to Taamin Ejtemayi hospitals in Hamedan in 2005. Zahedan J Res Med Sci. 2007;8(4):245-51.##Hazrati Kh, Mohammadzadeh H, Mostaghim M, Fereiduni J, Mehri E. [A comparative study sensitivity diagnostic of smear and Diamond culture methods for detection of Trichomonas vaginalis and the relationship between infection and clinical findings]. J Urmia Univ Med Sci. 2004;15:7-13. Persian.##Moshfe AA, Hosseini S. Comparison of clinical and microscopis diagnosis of Trichomoniasis refferred to the Yasouj Women Clinic. Armaghane Danesh. 2004;9(1):71-82.##Akhlaghi L, Falahati M, Jahani Abianeh M, Ourmazdi H, Amini M. [Study on the prevalence of Trichomonas vaginalis and Candida Albicans in women referred to Robat Karim medical center and a comparative evaluation of Loffler and Diluted Carbol Fuchsin Stains for rapid diagnosis of them]. Razi J Med Sci. 2005;12(48):75-87. Persian.##Sharbat Daran M, Shefaei Sh, Sami H, Haji Ahmadi M, Ramezan Pour R, Mersadi N, et al. Comparison of clinicalpresentations, wet smear, Papanicolaou smear with Dorset’sculture for diagnosis of Trichomonas vaginalis in doubtfulwomen to Trichomoniasis. J Babol Univ Med Sci. 2005;7(3):46-9.##Abdolali chalechale, Isaac karimi. The prevalence of Trichomonas vaginalis infection amang patients that presented to hospitals in the Kermanshah district of Iran in 2006 and 2007. Turk J Med Sci. 2010;40:971-5.##Jamali R, Zareikar B, Yousefee S, Ghazanchaei A. Comparison of direct microscopic examination and culture methods sensitivity for diagnosis of Trichomonas vaginalis in Tabriz health care centers visitors. Yafteh. 2007;8(4):63-8.##Etminan S, Bokaee M. Prevalence of trichomoniasis in women referring to health centers in Yazd. J Knowledge Health. 2007;2(3):14-20.##Gouya MM, Nabai S. [Prevalence of some sexually transmitted infections in a family planning service]. Razi J Med Sci. 2007;14(54):143-50. Persian.##Bulbul haghighi N, Ebrahimi H, Delvarian-Zade M, Hasani MR. [Evaluate and compare the clinical and laboratory diagnosis of candida vaginitis in women referred to health centers in the Shahrood city]. J Shahrekord Univ Med Sci. 2009;11(3):17-22. Persian.##Ziaei Hezarjaribi H, Dalimi A, Ghasemi M, Ghafari R, Esmaeili S, Armat S, et al. [Prevalence of comm on sexually transmitted diseases among women referring for Pap smear in Sari, Iran]. J Mazand Univ Med Sci. 2013;23(1):19-24. Persian.##Rezaeian M, Vatanshenassan M, Rezaie S, Mohebali M, Niromand N, Niyyati M, et al. Prevalence of Trichomonas vaginalis using parasitological methods in Tehran. Iran J Parasitol. 2009;4(4):43-7.##Badparva E, Papi OA, kheirandish F, Pornia Y, Azizi M. Sensitivity assessment of direct method for diagnosis of Trichomonas vaginalis in comparison with Dorset culture media. Yafteh. 2010;12(1):25-30.##Makvandi S, Zargar Shoushtari Sh. The relationship of cervicovaginal infections in Pap smear samples with some factors in Ahvaz, Iran; an epidemiological study. Jundishapur J Chronic Dis Care. 2011;1(1):55-61.##Baghchesaraie H, Salmani R, Amini B. Prevalence of Trichomonas vaginalis infection among women refered to laboratories in Zanjan, 2010. J Res Develop in Nurs Midwifery. 2012;9(1):69-75.##Nourian AA, Shabani N, Mousavinasab S, Rahmanpour H. Association of Trichomonas vaginalis with low birth weight. 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Analysis the prevalence of Trichomonas vaginalis in women clinics of Tehran city’s referents by PCR. Horizon Med Sci. 2015;20(4):223-9.##Habibi A, Nateghi Rostami M, Douraghi M, Dolati M, Hossein Rashidi B, Ahangari R. Frequency of genital infection with Trichomonas vaginalis in women referred to gynecology hospital of the city of Qom. J Dermatol Cosmet. 2015;6(4):190-219.##Van der Pol B. Trichomonas vaginalis infection: the most prevalent nonviral sexually transmitted infection receives the least public health attention. Clin Infect Dis. 2007;44(1):23-5.##Van Der Pol B, Kwok C, Pierre-Louis B, Rinaldi A, Salata RA, Chen PL, et al. Trichomonas vaginalis infection and HIV acquisition in African women. J Infect Dis. 2008;197(4):548-54.##Harp DF, Chowdhury I. Trichomoniasis: evaluation to execution. Eur J Obstet Gynecol Reprod Biol. 2011;157(1):3-9.##N Poole D, Mc Clelland RS. Global epidemiology of Trichomonas vaginalis. 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The prevalence of Trichomonas vaginalis in pap smear samples of women presented to Imam Reza hospital, Kermanshah, Iran from 2006-2012. Res J Med Sci. 2016;10(6):653-8.##Ahady MT, Safavi N, Jafari A, Mohamadi Z, Abed S, Pourasgar S. Prevalence of Trichomoniasis among 18-48 year-old women in northwest of Iran. Iran J Parasitol. 2016;11(4):580-4.##

Assessment of PGC1α-FNDC5 Axis in Granulosa Cells of PCOS Mouse Model 2 1 2 Background: Polycystic ovarian syndrome (PCOS) is a metabolic and endocrine disorder which is characterized by hyperandrogenism, anovulation or oligomenor-rhea and polycystic ovarian morphology. It is believed that modulation in metabolism of granulosa cells of PCOS patients may lead to infertility. One of the metabolic modulators is FNDC5 and its cleaved form, irisin. The axis of PGC1α- FNDC5 pathway is one of the main factors affecting cellular energy balance the purpose of this study was to evaluate this pathway in granulosa cells derived from PCOS mice model in comparison with control group. Methods: In the present study, PCOS mouse model was developed by injection of dehydroepiandrosterone (DHEA) hormone in 20 mice for a period of 20 days. Also, 20 uninjected mice were used as the control. Meanwhile, a vehicle group consisted of mice which received daily subcutaneous sesame oil injection (n=20). Relative expressions of PGC1α and FNDC5 in granulosa cells were evaluated by RT-qPCR. Analysis of gene expressions was calculated by the ΔΔCT method and the relative levels of mRNA were normalized to GAPDH transcript levels. Differences in genes expression among three groups were assessed using one-way ANOVA, Tukey's Post Hoc test. Results: Our results showed that expression of FNDC5 was significantly reduced in granulosa cells of DHEA-induced PCOS mice compared with control and vehicle groups (p<0.05), while there was no significant differences in PGC1α expression among different groups. Conclusion: Down regulation of FNDC5 transcript level may contribute in metabolic disturbance of granulosa cells derived from PCOS ovary apart from PGC1α levels which remained unchanged. 089 95 Shabnam Sh Bakhshalizadeh Department of Anatomy, School of Medicine, Zanjan University of Medical Sciences Department of Anatomy, School of Medicine, Zanjan University of Medical Sciences Iran Farzaneh F Rabiee Department of Cellular Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR Department of Cellular Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR Iran Reza R Shirazi Cellular and Molecular Research Center, Iran University of Medical Sciences Cellular and Molecular Research Center, Iran University of Medical Sciences Iran Kamran K Ghaedi Department of Cellular Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR Department of Cellular Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR Iran Fardin F Amidi Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences Iran famidi@sina.tums.ac.ir Mohammad Hossein MH Nasr-Esfahani Department of Cellular Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR Department of Cellular Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR Iran mh.nasr-esfahani@royaninstitute.org FNDC5Granulosa cellInfertilityMetabolic disorderPGC1αPolycystic ovarian syndrome 10015.pdf Diamanti-Kandarakis E. Polycystic ovarian syndrome: pathophysiology, molecular aspects and clinical implications. Expert Rev Mol Med. 2008;10:e3.##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.##Poretsky L, Cataldo NA, Rosenwaks Z, Giudice LC. The insulin-related ovarian regulatory system in health and disease. Endocr Rev. 1999;20(4):535-82.##Sacchi S, Marinaro F, Tondelli D, Lui J, Xella S, Marsella T, et al. Modulation of gonadotrophin induced steroidogenic enzymes in granulosa cells by d-chiroinositol. Reprod Biol Endocrinol. 2016;14(1):52.##Chang RJ. The reproductive phenotype in polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab. 2007;3(10):688-95.##Rahmanpour H, Jamal L, Mousavinasab SN, Esmailzadeh A, Azarkhish K. Association between polycystic ovarian syndrome, overweight, and metabolic syndrome in adolescents. J Pediatr Adolesc Gynecol. 2012;25(3):208-12.##Austin S, St-Pierre J. PGC1α and mitochondrial metabolism--emerging concepts and relevance in ageing and neurodegenerative disorders. J Cell Sci. 2012;125(Pt 21):4963-71.##Varela-Rodríguez BM, Pena-Bello L, Juiz-Valiña P, Vidal-Bretal B, Cordido F, Sangiao-Alvarellos S. FNDC5 expression and circulating irisin levels are modified by diet and hormonal conditions in hypothalamus, adipose tissue and muscle. Sci Rep. 2016;6:29898.##Perakakis N, Triantafyllou GA, Fernández-Real JM, Huh JY, Park KH, Seufert J, et al. Physiology and role of irisin in glucose homeostasis. Nat Rev Endocrinol. 2017;13(6):324-37.##Rizk FH, Elshweikh SA, Abd El-Naby AY. Irisin levels in relation to metabolic and liver functions in Egyptian patients with metabolic syndrome. Can J Physiol Pharmacol. 2016;94(4):359-62.##Albrecht E, Norheim F, Thiede B, Holen T, Ohashi T, Schering L, et al. Irisin – a myth rather than an exercise-inducible myokine. Sci Rep. 2015;5:8889.##Jedrychowski MP, Wrann CD, Paulo JA, Gerber KK, Szpyt J, Robinson MM, et al. Detection and quantitation of circulating human irisin by tandem mass spectrometry. Cell Metab. 2015;22(4):734-40.##Abali R, Temel Yuksel I, Yuksel MA, Bulut B, Imamoglu M, Emirdar V, et al. Implications of circulating irisin and Fabp4 levels in patients with polycystic ovary syndrome. J Obstet Gynaecol. 2016;36(7):897-901.##Acet M, Celik N, Acet T, Ilhan S, Yardim M, Aktun H, et al. Serum and follicular fluid irisin levels in poor and high responder women undergoing IVF/ICSI. Eur Rev Med Pharmacol Sci. 2016;20(10):1940-6.##Irving BA, Still CD, Argyropoulos G. Does IRISIN have a BRITE future as a therapeutic agent in humans? Curr Obes Rep. 2014;3:235-41.##Zügel M, Qiu S, Laszlo R, Bosnyák E, Weigt C, Müller D, et al. The role of sex, adiposity, and gonadectomy in the regulation of irisin secretion. Endocrine. 2016;54(1):101-10.##Rabiee F, Forouzanfar M, Ghazvini Zadegan F, Tanhaei S, Ghaedi K, Motovali Bashi M, et al. Induced expression of Fndc5 significantly increased cardiomyocyte differentiation rate of mouse embryonic stem cells. Gene. 2014;551(2):127-37.##Azizi R, Nestler JE, Dewailly D. Androgen excess disorders in women. 2nd ed. New Jersey: Humana Press. 2006. Chapter 18, Ovarian steroidogenic abnormalities in the polycystic ovary syndrome; p. 203-11.##Catteau-Jonard S, Dewailly D. Pathophysiology of polycystic ovary syndrome: the role of hyperandrogenism. Front Horm Res. 2013;40:22-7.##Adamska A, Karczewska-Kupczewska M, Lebkowska A, Milewski R, Górska M, Otziomek E, et al. Serum irisin and its regulation by hyperinsulinemia in women with polycystic ovary syndrome. Endocr J. 2016;63(12):1107-12.##Bostancı MS, Akdemir N, Cinemre B, Cevrioglu AS, Özden S, Ünal O. Serum irisin levels in patients with polycystic ovary syndrome. Eur Rev Med Pharmacol Sci. 2015;19(23):4462-8.##Li H, Xu X, Wang X, Liao X, Li L, Yang G, et al. Free androgen index and Irisin in polycystic ovary syndrome. J Endocrinol Invest. 2016;39(5):549-56.##

Angiotensin Type 2 Receptor Gene Polymorphisms and Susceptibility to Preeclampsia 2 1 2 Background: The purpose of the study was to determine the relationship between angiotensin II type 1 receptor at position+1166 (AT1R+1166A/C; rs5186) and angiotensin II type 2 receptor at position+1675 (AT2R+1675A/G; rs5194) gene polymorphisms with preeclampsia in an Iranian women population. Methods: 430 women were recruited in this study including 212 preeclamptics and 218 healthy women. PCR-RFLP method was used for genotyping the polymorphisms. Chi square and Fisher exact test were used for comparing case and control groups. The p<0.05 was considered statistically significant. Results: The frequency of genotypes of the AT1R gene and AT2R gene was similar in preeclampsia and normal pregnancy. There were no significant differences in genotype and also allele frequencies between preeclamptics and healthy women regarding the two studied polymorphisms. AT1R/AT2R genotypes combination study indicated that there was a statistically significant difference between preeclamptics and healthy women. AC/AG combination was significantly decreased, while CC/AA combination showed significant increase in patients compared with the healthy women (p<0.01). Conclusion: The present study showed that the genetic polymorphisms within AT1R and AT2R genes may be associated with susceptibility to preeclampsia in Iranian women. 095 100 Mohammad Sadegh MS Soltani-Zangbar Department of Immunology, School of Medicine, Shiraz University of Medical Sciences Department of Immunology, School of Medicine, Shiraz University of Medical Sciences Iran Behnoush B Pahlavani Islamic Azad University, Fars Science and Research Branch Islamic Azad University, Fars Science and Research Branch Iran Jaleh J Zolghadri Infertility Research Center, Shiraz University of Medical Sciences Infertility Research Center, Shiraz University of Medical Sciences Iran Behrouz B Gharesi-Fard Department of Immunology, School of Medicine, Shiraz University of Medical Sciences Department of Immunology, School of Medicine, Shiraz University of Medical Sciences Iran gharesifb@sums.ac.ir AT1RAT2RPolymorphismPreeclampsia 10016.pdf Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785-99.##Li H, Ma Y, Fu Q, Wang L. Angiotensin-converting enzyme insertion/deletion (ACE I/D) and angiotensin II type 1 receptor (AT1R) gene polymorphism and its association with preeclampsia in Chinese women. Hypertens Pregnancy. 2007;26(3):293-301.##Rochat RW, Koonin LM, Atrash HK, Jewett JF. Maternal mortality in the United States: report from the maternal mortality collaborative. Obstet Gynecol. 1988;72(1):91-7.##Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987-2004. Am J Hypertens. 2008;21(5):521-6.##Leeman L, Fontaine P. Hypertensive disorders of pregnancy. Am Fam physician. 2008;78(1):93-100.##Salimi S, Mokhtari M, Yaghmaei M, Jamshidi M, Naghavi A. Association of angiotensin-converting enzyme intron 16 insertion/deletion and angiotensin II type 1 receptor A1166C gene polymorphisms with preeclampsia in south east of Iran. J Biomed Biotechnol. 2011;2011:941515.##Demir C, Evruke C, Ozgunen FT, Urunsak IF, Candan E, Kadayifci O. Factors that influence morbidity and mortality in severe preeclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Saudi Med J. 2006;27(7):1015-8.##Akbar SA, Khawaja NP, Brown PR, Tayyeb R, Bamfo J, Nicolaides KH. Angiotensin II type 1 and 2 receptors gene polymorphisms in Preeclampsia and normal pregnancy in three different populations. Acta Obstet Gynecol Scand. 2009;88(5):606-11.##Jeunemaitre X, Soubrier F, Kotelevtsev YV, Lifton RP, Williams CS, Charru A, et al. Molecular basis of human hypertension: role of angiotensinogen. Cell. 1992;71(1):169-80.##Plummer S, Tower C, Alonso P, Morgan L, Baker P, Broughton‐Pipkin F, et al. Haplotypes of the angiotensin II receptor genes AGTR1 and AGTR2 in women with normotensive pregnancy and women with preeclampsia. Hum Mutat. 2004;24(1):14-20.##Bonnardeaux A, Davies E, Jeunemaitre X, Fery I, Charru A, Clauser E, et al. Angiotensin II type 1 receptor gene polymorphisms in human essential hypertension. Hypertension. 1994;24(1):63-9.##Berry C, Touyz R, Dominiczak A, Webb RC, Johns D. Angiotensin receptors: signaling, vascular pathophysiology, and interactions with ceramide. Am J Physiol Heart Circ Physiol. 2001;281(6):H2337-65.##Sethupathy P, Borel C, Gagnebin M, Grant GR, Deutsch S, Elton TS, et al. Human microRNA-155 on chromosome 21 differentially interacts with its polymorphic target in the AGTR1 3′ untranslated region: a mechanism for functional single-nucleotide polymorphisms related to phenotypes. Am J Hum Genet. 2007;81(2):405-13.##Erdmann J, Guse M, Kallisch H, Fleck E, Regitz-Zagrosek V. Novel intronic polymorphism ( 1675G/A) in the human angiotensin II subtype 2 receptor gene. Hum Mutat. 2000;15(5):487.##Jin JJ, Nakura J, Wu Z, Yamamoto M, Abe M, Chen Y, et al. Association of angiotensin II type 2 receptor gene variant with hypertension. Hypertens Res. 2003;26(7):547-52.##Behravan J, Naghibi M, Mazloomi MA, Hassany M. Polymorphism of angiotensin II type 1 receptor gene in essential hypertension in Iranian population. Daru. 2006;14(2):82-6.##Zhang L, Yang H, Qin H, Zhang K. Angiotensin II type I receptor A1166C polymorphism increases the risk of pregnancy hypertensive disorders: Evidence from a meta-analysis. J Renin Angiotensin Aldosterone Syst. 2014;15(2):131-8.##Perez-Sepulveda A, Torres MJ, Khoury M, Illanes SE. Innate immune system and preeclampsia. Front Immunol. 2014;5:244.##Smith CJ, Saftlas AF, Spracklen CN, Triche EW, Bjonnes A, Keating B, et al. Genetic risk score for essential hypertension and risk of preeclampsia. Am J Hypertens. 2016;29(1):17-24.##Staff AC, Johnsen GM, Dechend R, Redman CW. Preeclampsia and uteroplacental acute atherosis: immune and inflammatory factors. J Reprod Immunol. 2014;101-102:120-6.##Baudin B. Polymorphism in angiotensin II receptor genes and hypertension. Exp Physiol. 2005;90(3):277-82.##Alkanli N, Sipahi T, Kilic TO, Sener S. Lack of association between ACE I/D and AGTR1 A1166C gene polymorphisms and preeclampsia in Turkish pregnant women of Trakya region. J Gynecol Obstet. 2014;2(4):49-53.##Bouba I, Makrydimas G, Kalaitzidis R, Lolis DE, Siamopoulos KC, Georgiou I. Interaction between the polymorphisms of the renin–angiotensin system in preeclampsia. Eur J Obstet Gynecol Reprod Biol. 2003;110(1):8-11.##Kobashi G, Hata A, Ohta K, Yamada H, Kato EH, Minakami H, et al. A1166C variant of angiotensin II type 1 receptor gene is associated with severe hypertension in pregnancy independently of T235 variant of angiotensinogen gene. J Hum Genet. 2004;49(4):182-6.##Nałogowska-Głośnicka K, Łacka B, Zychma MJ, Grzeszczak W, Zukowska-Szczechowska E, Poreba R, et al. Angiotensin II type 1 receptor gene A1166C polymorphism is associated with the increased risk of pregnancy-induced hypertension. Med Sci Monit. 2000;6(3):523-9.##Zhou A, Dekker GA, Lumbers ER, Lee SY, Thompson SD, McCowan L, et al. The association of AGTR2 polymorphisms with preeclampsia and uterine artery bilateral notching is modulated by maternal BMI. Placenta. 2013;34(1):75-81.##

Decreased Expression of CDC25A in Azoospermia as the Etiology of Spermatogenesis Failure 2 1 2 Background: Spermatogenesis is a tightly regulated developmental process of male germ cells. The stages in spermatogenesis are mitosis, meiosis and spermiogenesis. One of the genes playing a role in meiosis is Cell Division Cycle 25A (CDC25A). Decreased expression of CDC25A is associated with failure of spermatogenesis and sperm retrieval. Infertility examination for azoospermia has been limited on histological examination. Hence, molecular research to find marker genes for infertility will improve the examination of testis biopsies. Methods: This research is a cross sectional study of 50 testicular biopsies with Johnsen scoring categories from scoring 2 to 8. Analysis of mRNA expression used qPCR and protein expression using immunohistochemistry. Statistical analysis with Spearman correlation was considered significant at p<0.05. Results: The result showed that transcript level and protein expression of CDC25A decreased in score 5 of Johnsen scoring categories. Moderate Spearman rho correlation (r=0.546) between mRNA relative expression and protein expression of CDC25A was significant at p<0.01. Conclusion: Decreased expression of CDC25A is associated with meiotic arrest as the etiology of spermatogenic failure in many azoospermic men. 100 109 Dwi DA Suryandari Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Indonesia Yurnadi YH Midoen Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Indonesia yurnadi.kes@ui.ac.id Luluk L Yunaini Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Indonesia Sari S Setyaningsih Master Program Biomedical Sciences, Faculty of Medicine, Universitas Indonesia Master Program Biomedical Sciences, Faculty of Medicine, Universitas Indonesia Indonesia Hans-Joachim HJ Freisleben Medical Research Unit, Faculty of Medicine, Universitas Indonesia Medical Research Unit, Faculty of Medicine, Universitas Indonesia Indonesia CDC25AInfertilityJohnsen scoringSpermatogenic failure 10022.pdf Mahanta R, Gogoi A, Roy S, Bhattacharyya IK, Sharma P. 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Metabolic Fingerprinting of Seminal Plasma from Non-obstructive Azoospermia Patients: Positive Versus Negative Sperm Retrieval 2 1 2 Background: Non-obstructive azoospermia (NOA) occurs in approximately 10% of infertile men. Retrieval of the spermatozoa from the testicle of NOA patients is an invasive approach. Seminal plasma is an excellent source for exploring to find the biomarkers for presence of spermatozoa in testicular tissue. The present discovery phase study aimed to use metabolic fingerprinting to detect spermatogenesis from seminal plasma in NOA patients as a non-invasive method. Methods: In this study, 20 men with NOA were identified based on histological analysis who had their first testicular biopsy in 2015 at Avicenna Fertility Center, Tehran, Iran. They were divided into two groups, a positive testicular sperm extraction (TESE(+)) and a negative testicular sperm extraction (TESE(-)). Seminal plasma of NOA patients was collected before they underwent testicular sperm extraction (TESE) operation. The metabolomic fingerprinting was evaluated by Raman spectrometer. Principal component analysis (PCA) and an unsupervised statistical method, was used to detect outliers and find the structure of the data. The PCA was analyzed by MATLAB software. Results: Metabolic fingerprinting of seminal plasma from NOA showed that TESE(+) versus TESE(-) patients were classified by PCA. Furthermore, a possible subdivision of TESE(-) group was observed. Additionally, TESE(-) patients were in extreme oxidative imbalance compared to TESE(+) patients. Conclusion: Metabolic fingerprinting of seminal plasma can be considered as a breakthrough, an easy and cheap method for prediction presence of spermatogenesis in NOA. 109 115 Kambiz K Gilany کامبیز گیلانی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran k.gilany@avicenna.ac.ir Naser N Jafarzadeh Department of Medical Physics, Tarbiat Modares University Department of Medical Physics, Tarbiat Modares University Iran Ahmad A Mani-Varnosfaderani Chemometrics and Chemoinformatics Laboratory, Department of Chemistry, Faculty of Sciences, Tarbiat Modares University Chemometrics and Chemoinformatics Laboratory, Department of Chemistry, Faculty of Sciences, Tarbiat Modares University Iran Arash A Minai-Tehrani Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Iran Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mahsa M Darbandi Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Sara S Darbandi Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Mehdi M Amini Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Babak B Arjmand Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences Iran Zhamak Zh Pahlevanzadeh Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Male infertilityMetabolic fingerprintingNon-obstructive azoospermiaSeminal plasmaTesticular sperm extraction 10020.pdf Thonneau P, Marchand S, Tallec A, Ferial M-L, Ducot B, Lansac J, et al. 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To What Extent Are Cryopreserved Sperm and Testicular Biopsy Samples Used in Assisted Reproduction? 2 1 2 Background: Testicular biopsies and ejaculated spermatozoa are routinely cryo-preserved in many units but the fate of these samples has not provoked large interest. This prompted us to review our data accumulated during a period of 20 years (1997 to 2016). Methods: For patients with biopsies (group 1) or ejaculated spermatozoa (group 2), an attempt was made to evaluate whether the samples stored, had been discarded with the patient’s consent or because the patient had died, or whether they had been transported to another laboratory. In each of these categories, a previous use in our program of assisted reproduction was assessed. Results: The total utilization rate in group 1 (n=95) was 53.7% and only 5.48% in group 2 (n=365). In both groups, deceased patients had not previously used their cryopreserved samples. In detail, the utilization rates for still banked, discarded and transferred samples were 84.2%, 50% and 27.3%, respectively in group 1 and 2.88%, 10.4% and 10%, respectively in group 2. Conclusion: The exact reasons for the low utilization rates of cryopreserved male gametes remain to be explored. A closer contact between sperm banking units and patients might be useful to discuss the need for further storage of the probes, their possible disposal or the prospects when a specific use for assisted reproduction is intended. 115 119 Bernd B Rosenbusch Department of Gynaecology and Obstetrics, Ulm University Department of Gynaecology and Obstetrics, Ulm University Germany bernd.rosenbusch@uniklinik-ulm.de Assisted reproductionCryopreservationMale fertility preservationSpermatozoaTesticular biopsy 10013.pdf Meirow D, Schenker JG. Cancer and male infertility. Hum Reprod. 1995;10(8):2017-22.##Pacey AA, Eiser C. Banking sperm is only the first of many decisions for men: What healthcare professionals and men need to know. Hum Fertil (Camb). 2011;14(4):208-17.##Tomlinson M, Meadows J, Kohut T, Haoula Z, Naeem A, Pooley K, et al. Review and follow-up of patients using a regional sperm cryopreservarion service: ensuring that resources are targeted to those patients most in need. Andrology. 2015;3(4):709-16.##Sanger WG, Olson JH, Sherman JK. Semen cryobanking for men with cancer--criteria change. Fertil Steril. 1992;58(5):1024-7.##Lass A, Akagbosu F, Abusheikha N, Hassouneh M, Blayney M, Avery S, et al. A programme of semen cryopreservation for patients with malignant disease in a tertiary infertility centre: lessons from 8 years’ experience. Hum Reprod. 1998;13(11):3256-61.##Sadeghi MR. It is time to pay more attention to sperm cryopreservation: now more than ever! J Reprod Infertil. 2016;17(1):1.##Zhang QF, Qiao J, Bai Q, Li M, Lian Y, Wu YQ, et al. [Outcome of intracytoplasmic sperm injection cycle: fresh compared to cryopreserved-thawed testicular and epididymal spermatozoa]. Zhonghua Fu Chan Ke Za Zhi. 2009;44(10):740-4. Chinese.##Botchan A, Karpol S, Lehavi O, Paz G, Kleiman SE, Yogev L, et al. Preservation of sperm of cancer patients: extent of use and pregnancy outcome in a tertiary infertility center. Asian J Androl. 2013;15(3):382-6.##Záková J, Lousová E, Ventruba P, Crha I, Pochopová H, Vinklárková J, et al. Sperm cryopreservation before testicular cancer treatment and its subsequent utilization for the treatment of infertility. ScientificWorldJournal. 2014;2014:575978.##Ferrari S, Paffoni A, Filippi F, Busnelli A, Vegetti W, Somigliana E. Sperm cryopreservation and reproductive outcome in male cancer patients: a systematic review. Reprod Biomed Online. 2016;33(1):29-38.##Ragni G, Somigliana E, Restelli L, Salvi R, Arnoldi M, Paffoni A. Sperm banking and rate of assisted reproduction treatment. Cancer. 2003;97(7):1624-9.##Kelleher S, Wishart SM, Liu PY, Turner L, Di Pierro I, Conway AJ, et al. Long-term outcomes of elective human sperm cryostorage. Hum Reprod. 2001;16(12):2632-9.##

Ebstein Anomaly with Pregnancy: A Rare Case 2 1 2 Background: Ebstein anomaly is an uncommon, complex congenital malformation of the heart with prevalence of 0.3-0.5%. It occurs in 1% of congenital heart disease cases. It is characterized by dysplastic abnormalities of tricuspid valve which involves both basal and free attachments of the tricuspid valve leaflets, with downward displacement and elongation of the septal and anterior cusp which resulting in tricuspid regurgitation, the proximal part of the right ventricle is "atrialised", becoming thin walled and poorly contractile, along with an enlarged right atrium. With this anomaly, fertility is usually unaffected, even in women with cyanosis. The average life expectancy at birth of patients with Ebstein anomaly is 25-30 years. Due to its rarity and varied clinical presentations associated with Ebstein anomaly during pregnancy, this case was presented in this paper. Case Presentation: A 24 year old G2A1 at 39 weeks 6 days gestation with a known case of Ebstein anomaly was referred to NEIGRIHMS in April 2017 for further management as our institute is having well equipped cardiac facilities. Her antepartum period was uneventful. Elective LSCS was done at 40 weeks 3 days and a healthy baby weighing 2.5 kg was delivered. Intra and postpartum period was uneventful. Conclusion: Due to varied clinical presentations associated with Ebstein anomaly during pregnancy, such women should undergo close surveillance with multidisciplinary approach during the antenatal period to be diagnosed in terms of complications and hence be treated accordingly. 119 123 Nalini N Sharma Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences India Nalinisharma100@rediffmail.com Thiek TJ Lalnunnem Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences India Megha M Nandwani Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences India Singh SS Ahanthem Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences India Baingen BW Synrang Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences India Ebstein anomalyMaternal outcomePregnancy 10.pdf Chatterjee S, Sengupta I, Mandal R, Sarkar R, Chakraborty PS, et al. Anaesthetic management of caesarean section in a patient with Ebstein’s anomaly. Indian J Anaesth. 2008;52(3):321-3.##Donnelly JE, Brown JM, Radford DJ. Pregnancy outcome and Ebstein’s anomaly. Br Heart J. 1991;66(5):368-71.##Dearani JA, Danielson GK. Surgical management of Ebstein’s anomaly in the adult. Semin Thorac Cardiovasc Surg. 2005;17(2):148-54.##Misa VS, Pan PH. Evidence-based case report for analgesic and anesthetic management of a parturient with Ebstein’s Anomaly and Wolff-Parkinson syndrome. Int J Obstet Anesth. 2007;16(1):77-81.##Groves ER, Groves BJ. Epidural analgesia for labour in a patient with Ebstein’s anomaly. Can J Anaesth. 1995;42(1):77-9.##Pinelli JM, Symington AJ, Cunningham KA, Paes BA. Case report and reviewer of the perinatal implication of maternal lithium use. Am J Obstet Gynecol. 2002;187(1):245-9.##Connolly HM, Warnes CA. Ebstein’s anomaly: outcome of pregnancy. 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Caesarean section using total intravenous anaesthesia in a patient with Ebstein’s anomaly complicated by supraventricular tachycardia. Int J Obstet Anesth. 2007;16(2):155-9.##Katsuragi S, Kamiya C, Yamanaka K, Neki R, Miyoshi T, Iwanaga N, et al. Risk factors for maternal and fetal outcome in pregnancy complicated by Ebstein anomaly. Am J obstet Gynecol. 2013;209(5):452-7.##Lima FV, Koutrolou-Sotiropoulou P, Yen TY, Stergiopoulos K. Clinical characteristics and outcomes in pregnant women with Ebstein anomaly at the time of delivery in the USA: 2003-2012. Arch Cardiovasc Dis. 2016;109(6-7):390-8.##