It Is the Time to Treat Endometriosis Based on Pathophysiology 2 1 2 According to the literature, endometriosis was first explained in Egyptian scrolls in the sixteenth century BC (1). But the disease remained unknown in many human societies and patients underwent inappropriate treatment from incomplete drowning to even burning at the shadow of this belief that Satan has conquered their soles. Although Carl Freiherr von Rokitansky described the scientific and histological aspects of endometriosis in 1860 (2), the disease was considered as an ambiguous disorder along with unclear pathology till about 1.5 century later (1). Despite this astonishing description, mismanagement of the endometriosis, continued to the extent that even Freud misdiagnosed the individuals with the disorder as hysteric patients and tried to treat them by hypnosis in the last decades of 19 th and the first decades of the 20 th century. For the first time, the term "endometriosis" was issued by Sampson in 1925 (3-5). With the continuation of his studies, his brilliant paper based on retrograde menstruation theory as a cause of peritoneal endometriosis was published in 1927 (5). He also noticed the higher incidence of endometrioid and clear cell carcinoma in the endometrioma (1). It seems that the number of individuals with the risk of ovarian cancer approaches to 7 times greater than the normal population for these isolated types. So far according to Nezhat, the disease can be considered as a kind of screening tool for ovarian cancer (6). Georg Kelling carried out the first laparoscopic surgery on dogs in 1902. In addition, Hans Christian Jacobaeus applied the approach to operate on a human being in 1910. However, the procedure was modified and popularized by some pioneer people during the next couple of decades (7, 8). At that time, surgeons were performing many kinds of surgeries on these women especially oophorectomy in the hope of overcoming symptoms, and reducing the risk of infertility and ovarian cancer. Over time and in the shadow of technical and instrumental progress in laparoscopy, this technique turned to the gold standard manner for the treatment of endometriosis. As the time passed, it was cleared that, laparoscopic surgery is not the final solution for all endometriosis patients, and even worse, in some cases induces premature ovarian insufficiency and/or poor response to ART techniques. This is far beyond internal complications and hazards every surgery carries. Simultaneously, our insight into the pathophysiology of endometriosis were deerened through large unmber of studies. Based on the current evidence, various etiopathological factors such as genetic, epigenetic, environmental, immunological, stem cells and/or endocrine processes are involved. So far, no specific susceptibility genes have been identified. Endometriosis is indeed a benign disorder (9). The hormonal aspect of endometriosis for many years has helped physicians to treat endometriosis. However, these numerous products have their own complications and restrictions, especially at the time of pregnancy desire and in menopausal patients. In recent years, researchers have founded more sophisticated etiopathogeneses for the disease. According to a recent study, extrauterine stem cells originating from bone marrow are able to differentiate into endometriotic tissues. Despite confirmation of the role of molecular medicine as a new method for clarifying the pathogenesis of endometriosis, Sampson’s implantation theory has never been discarded (1). Jones in 1998 indicated that the women with endometriosis reveal upregulation of the antiapoptotic gene BCL-2 in eutopic and ectopic endometrium. Moreover, he postulated that genetic alterations of endometrial cells which impact their tendency to implant may be hereditary (10). Linkage analysis done by Treloar in 2005 has revealed candidate genes with biological plausibility, as well (11). The hypothesis of endometriosis as a pelvic inflammatory condition is accepted. In these patients, the peritoneal fluid and the number of activated macrophages are increased significantly. There is also a great variation in the cytokine/chemokine profile. Macrophages can produce and secrete various biologically active elements (i.e. cytokines, plasma proteins, coagulation and fibrinolytic agents, enzymes components of complement, and lipids). A unique protein similar to haptoglobin has been discovered by proteomics method in the peritoneal fluid of endometriosis patients (12). This protein decreases macrophage phagocytic activities after bounding process and enhances production of IL-6. Macrophage migration inhibitory factor, TNF-α, IL-1β, IL-6, and IL-8, and monocytes are in the peritoneal fluid of endometriosis patients (1). Integrin and E-cadherin and MMPs namely ICAM (Intracellular adhesion molecules) have been discovered in cells of menstrual effluent, endometrium, peritoneal fluid, peritoneum, and endometriotic cells (13). Langendonckt in 2002 showed a significant role of hemoglobin in the pathogenesis of peritoneal endometriosis. This hypothesis confirms that, after RBC lysis, the resultant released hemoglobin in the peritoneal cavity induces activation of cell adhesion molecules, cytokine production, cell proliferation, and neovas-cularization. Hemoglobin molecules degradation to its product, heme, Iron, biliverdin and bilirubin may lead to oxidativ stress (14). Despite these and other progresses in understanding the pathophysiology of this enigmatic disease and many compounds that their effectiveness has been postulated in several clinical trials, some, as gynecologic laparoscopists are continuing to transfer their habitual concepts that laparoscopy is the best treatment for endometriosis. With regard to ACOG guideline and much more scientific evidence, now it is the time to treat this malefic disease based on these causative etiologies and reserve surgery for the most important occasion during patient’s lifetime. 01 3 Shahla Sh Chaichian Shahla Chaichian Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University Iran shchaichian@gmail.com No Keyword 40044.pdf Harada, T., Endometriosis: pathogenesis and treatment. 2014: Springer.##von Rokitansky KF. Ueber uterusdrüsen-neubildung in uterus-und ovarial-sarcomen. Druck von Carl Ueberreuter; 1860. 6 p.##Sampson JA. Perforating hemorrhagic (chocolate) cysts of the ovary: their importance and especially their relation to pelvic adenomas of endometrial type. Arch Surg. 1921;3(2):245-323.##Sampson JA. Inguinal endometriosis (often reported as endometrial tissue in the groin, adenomyoma in the groin, and adenomyoma of the round ligament). Am J Obstet Gynecol. 1925;10(4):462-503.##Sampson JA. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1927;14(4):422-69.##Pearce CL, Templeman C, Rossing MA, Lee A, Near AM, Webb PM, et al. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol. 2012;13(4):385-94.##Stellato TA. History of laparoscopic surgery. Surg Clin North Am. 1992;72(5):997-1002.##Hatzinger M, Kwon ST, Langbein S, Kamp S, Häcker A, Alken P. Hans christian jacobaeus: inventor of human laparoscopy and thoracoscopy. J Endourol. 2006;20(11):848-50.##Varma R, Rollason T, Gupta JK, Maher ER. Endometriosis and the neoplastic process. Reproduction. 2004;127(3):293-304.##Jones RK, Searle RF, Bulmer JN. Apoptosis and bcl-2 expression in normal human endometrium, endometriosis and adenomyosis. Hum Reprod. 1998;13(12):3496-502.##Treloar SA, Wicks J, Nyholt DR, Montgomery GW, Bahlo M, Smith V, et al. Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am J Hum Genet. 2005;77(3):365-76.##Sharpe-Timms KL, Piva M, Ricke EA, Surewicz K, Zhang YL, Zimmer RL. Endometriotic lesions synthesize and secrete a haptoglobin-like protein. Biol Reprod. 1998;58(4):988-94.##van der Linden PJ, de Goeij AF, Dunselman GA, van der Linden EP, Ramaekers FC, Evers JL. Expression of integrins E-cadherin in cells from menstrual effluent, endometrium, peritoneal fluid, peritoneum, endometriosis. Fertil Steril. 1994;61(1):85-90.##Van Langendonckt A, Casanas-Roux F, Dolmans MM, Donnez J. Potential involvement of hemoglobin and heme in the pathogenesis of peritoneal endometriosis. Fertil Steril. 2002;77(3):561-70.##

Effect of Artificial Oocyte Activation on Intra-Cytoplasmic Sperm Injection Outcomes in Patients with Lower Percentage of Sperm Containing Phospholipase Cζ: A Randomized Clinical Trial 2 1 2 Background: Artificial oocyte activation (AOA) is a specialized method in assisted reproductive technique (ART). According to increasing concern about using AOA, it is necessary to evaluate sperm-borne oocyte activating factors (SOAFs) including phospholipase C zeta (PLCζ). In this study, PLCζ before AOA was evaluated first and then the impact of AOA on pre-implantation embryo development was investigated. Methods: This prospective clinical trial enrolled couples subjected to ICSI. By evaluating PLCζ, semen samples were categorized into two groups; I (Control) and II (PLCζ deficient). Retrieved oocytes from partners were put into three categories: control group (Injected with sperm from group I, n=113), group without AOA (Injected with sperm from group II and no exposure to AOA, n=106), and group AOA (Injected with sperm from group II and exposure to AOA, n=114). Finally, fertilization results were compared via Kruskal-Wallis followed by Dunn’s multiple comparison test. The p<0.05 was considered statistically significant. Results: Fertilization rate was significantly lower in the group without AOA compared to control group (41.9±6.3 vs. 78.1±4.7, p<0.001). AOA improved fertilization rate in group AOA compared to the group without AOA (69.5±3.9 vs. 41.9±6.3, p<0.01); however, cleavage (91.7±2.8, 90.9±4.6, and 95.2±3.4, respectively) and embryo quality (2.5±0.1, 2.3±0.2, and 2.4±0.2, respectively) scores were not substantially different between groups of control, with and without AOA. Conclusion: We showed that PLCζ can be considered as a good biomarker in evaluation of oocyte activation capability. Further studies are required to establish the best use of PLCζ as a biomarker in clinics. 03 10 Hamid H Nazarian Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Nahid N Azad Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Leila L Nazari Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences Iran Abbas A Piryaei Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Mohammad Hassan MH Heidari Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Reza R Masteri Farahani Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Maryam M Karimi Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences Iran Marefat M Ghaffari Novin Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences Iran mghaffarin@yahoo.com, mghaffarin@sbmu.ac.ir Artificial oocyte activationBiomarkerIntra-cytoplasmic sperm injectionPhospholipase C zetaSperm 30046.pdf Tosti E, Menezo Y. Gamete activation: basic knowledge and clinical applications. Hum Reprod Update. 2016;22(4):420-39.##Amdani SN, Yeste M, Jones C, Coward K. Sperm factors and oocyte activation: current controversies and considerations. Biol Reprod. 2015;93(2):50.##Vadnais ML, Gerton GL. From PAWP to "Pop": opening up new pathways to fatherhood. Asian J Androl. 2015;17(3):443-4.##Swann K, Lai FA. PLCzeta and the initiation of Ca(2 ) oscillations in fertilizing mammalian eggs. Cell Calcium. 2013;53(1):55-62.##Ramadan WM, Kashir J, Jones C, Coward K. Oocyte activation and phospholipase C zeta (PLCzeta): diagnostic and therapeutic implications for assisted reproductive technology. Cell Commun Signal. 2012;10(1):12.##Yoon SY, Jellerette T, Salicioni AM, Lee HC, Yoo MS, Coward K, et al. Human sperm devoid of PLC, zeta 1 fail to induce Ca(2 ) release and are unable to initiate the first step of embryo development. J Clin Invest. 2008;118(11):3671-81.##Heytens E, Parrington J, Coward K, Young C, Lambrecht S, Yoon SY, et al. Reduced amounts and abnormal forms of phospholipase C zeta (PLCzeta) in spermatozoa from infertile men. Hum Reprod. 2009;24(10):2417-28.##Kashir J, Jones C, Mounce G, Ramadan WM, Lemmon B, Heindryckx B, et al. Variance in total levels of phospholipase C zeta (PLC-zeta) in human sperm may limit the applicability of quantitative immunofluorescent analysis as a diagnostic indicator of oocyte activation capability. Fertil Steril. 2013;99(1):107-17.##Nomikos M, Yu Y, Elgmati K, Theodoridou M, Campbell K, Vassilakopoulou V, et al. Phospholipase Cζ rescues failed oocyte activation in a prototype of male factor infertility. Fertil Steril. 2013;99(1):76-85.##Vanden Meerschaut F, Nikiforaki D, Heindryckx B, De Sutter P. Assisted oocyte activation following ICSI fertilization failure. Reprod Biomed Online. 2014;28(5):560-71.##Vanden Meerschaut F, Leybaert L, Nikiforaki D, Qian C, Heindryckx B, De Sutter P. Diagnostic and prognostic value of calcium oscillatory pattern analysis for patients with ICSI fertilization failure. Hum Reprod. 2013;28(1):87-98.##Vanden Meerschaut F, Nikiforaki D, De Gheselle S, Dullaerts V, Van den Abbeel E, Gerris J, et al. Assisted oocyte activation is not beneficial for all patients with a suspected oocyte-related activation deficiency. Hum Reprod. 2012;27(7):1977-84.##Vanden Meerschaut F, D’Haeseleer E, Gysels H, Thienpont Y, Dewitte G, Heindryckx B, et al. Neonatal and neurodevelopmental outcome of children aged 3-5 years born following assisted oocyte activation. Reprod Biomed Online. 28(1):54-63.##Santella L, Dale B. Assisted yes, but where do we draw the line? Reprod Biomed Online. 2015;31(4):476-8.##Nasr-Esfahani MH, Deemeh MR, Tavalaee M. Artificial oocyte activation and intracytoplasmic sperm injection. Fertil Steril. 2010;94(2):520-6.##Amdani SN, Jones C, Coward K. Phospholipase C zeta (PL Cζ): oocyte activation and clinical links to male factor infertility. Adv Biol Regul. 2013;53(3):292-308.##van Blerkom J, Cohen J, Johnson M. A plea for caution and more research in the 'experimental' use of ionophores in ICSI. Reprod Biomed Online. 2015;30(4):323-4.##Kashir J, Heindryckx B, Jones C, De Sutter P, Parrington J, Coward K. Oocyte activation, phospholipase C zeta and human infertility. Hum Reprod Update. 2010;16(6):690-703.##Yelumalai S, Yeste M, Jones C, Amdani SN, Kashir J, Mounce G, et al. Total levels, localization patterns, and proportions of sperm exhibiting phospholipase C zeta are significantly correlated with fertilization rates after intracytoplasmic sperm injection. Fertil Steril. 2015;104(3):561-8.4.##Tavalaee M, Kiani-Esfahani A, Nasr-Esfahani MH. Relationship between potential sperm factors involved in oocyte activation and sperm DNA fragmentation with intra-cytoplasmic sperm injection clinical outcomes. Cell J. 2017;18(4):588-96.##Azad N, Nazarian H, Nazari L, Ghaffari Novin M, Piryaei A, Heidari MH, et al. Evaluation of PAWP and PLC? expression in infertile men with previous ICSI fertilization failure. Urol J. 2018;15(3):116-21.##World Health Organisation. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization Press; 2010. 307 p.##Kruger TF, Menkveld R, Stander FS, Lombard CJ, Van der Merwe JP, van Zyl JA, et al. Sperm morphologic features as a prognostic factor in in vitro fertilization. Fertil Steril. 1986;46(6):1118-23.##Grasa P, Coward K, Young C, Parrington J. The pattern of localization of the putative oocyte activation factor, phospholipase Czeta, in uncapacitated, capacitated, and ionophore-treated human spermatozoa. Hum Reprod. 2008;23(11):2513-22.##Montag M, Koster M, van der Ven K, Bohlen U, van der Ven H. The benefit of artificial oocyte activation is dependent on the fertilization rate in a previous treatment cycle. Reprod Biomed Online. 2012;24(5):521-6.##Nasr-Esfahani MH, Salehi M, Razavi S, Mardani M, Bahramian H, Steger K, et al. Effect of protamine-2 deficiency on ICSI outcome. Reprod Biomed Online. 2004;9(6):652-8.##Sheikhi A, Jalali M, Gholamian M, Jafarzadeh A, Jannati S, Mousavifar N. Elimination of apoptotic spermatozoa by magnetic-activated cell sorting improves the fertilization rate of couples treated with ICSI procedure. Andrology. 2013;1(6):845-9.##Saunders CM, Larman MG, Parrington J, Cox LJ, Royse J, Blayney LM, et al. PLC zeta: a sperm-specific trigger of Ca(2 ) oscillations in eggs and embryo development. Development. 2002;129(15):3533-44.##Ozil JP, Banrezes B, Toth S, Pan H, Schultz RM. Ca2 oscillatory pattern in fertilized mouse eggs affects gene expression and development to term. Dev Biol. 2006;300(2):534-44.##Ferrer-Vaquer A, Barragan M, Freour T, Vernaeve V, Vassena R. PLCζ sequence, protein levels, and distribution in human sperm do not correlate with semen characteristics and fertilization rates after ICSI. J Assist Reprod Genet. 2016;33(6):747-56.##Heindryckx B, De Gheselle S, Gerris J, Dhont M, De Sutter P. Efficiency of assisted oocyte activation as a solution for failed intracytoplasmic sperm injection. Reprod Biomed Online. 2008;17(5):662-8.##Tavalaee M, Nasr-Esfahani MH. Expression profile of PLCζ, PAWP, and TR-KIT in association with fertilization potential, embryo development, and pregnancy outcomes in globozoospermic candidates for intra-cytoplasmic sperm injection and artificial oocyte activation. Andrology. 2016;4(5):850-6.##Taylor SL, Yoon SY, Morshedi MS, Lacey DR, Jellerette T, Fissore RA, et al. Complete globozoospermia associated with PLCzeta deficiency treated with calcium ionophore and ICSI results in pregnancy. Reprod Biomed Online. 2010;20(4):559-64.##Eftekhar M, Janati S, Rahsepar M, Aflatoonian A. Effect of oocyte activation with calcium ionophore on ICSI outcomes in teratospermia: a randomized clinical trial. Iran J Reprod Med. 2013;11(11):875-82.##Nasr-Esfahani MH, Razavi S, Javdan Z, Tavalaee M. Artificial oocyte activation in severe teratozoospermia undergoing intracytoplasmic sperm injection. Fertil Steril. 2008;90(6):2231-7.##Ebner T, Koster M, Shebl O, Moser M, Van der Ven H, Tews G, et al. Application of a ready-to-use calcium ionophore increases rates of fertilization and pregnancy in severe male factor infertility. Fertil Steril. 2012;98(6):1432-7.##Chithiwala ZH, Lee HC, Hill DL, Jellerette-Nolan T, Fissore R, Grow D, et al. Phospholipase C-zeta deficiency as a cause for repetitive oocyte fertilization failure during ovarian stimulation for in vitro fertilization with ICSI: a case report. J Assisted Reprod Genet. 2015;32(9):1415-9.##Heytens E, Schmitt-John T, Moser JM, Jensen NM, Soleimani R, Young C, et al. Reduced fertilization after ICSI and abnormal phospholipase C zeta presence in spermatozoa from the wobbler mouse. Reprod Biomed Online. 2010;21(6):742-9.##Vanden Meerschaut F, Nikiforaki D, De Roo C, Lierman S, Qian C, Schmitt-John T, et al. Comparison of pre- and post-implantation development following the application of three artificial activating stimuli in a mouse model with round-headed sperm cells deficient for oocyte activation. Hum Reprod. 2013;28(5):1190-8.##Ozil JP, Huneau D. Activation of rabbit oocytes: the impact of the Ca2 signal regime on development. Development. 2001;128(6):917-28.##

Effects of Tamoxifen on DNA Integrity in Mice 2 1 2 Background: Tamoxifen (TX) is widely used to treat idiopathic infertility in men. Using TX has been shown to produce sperm in patients with oligospermia and azoospermia and improve male fertility. The aim of this study was to evaluate the effects of TX on DNA and chromatin quality in mice regarding the importance of chromatin quality and sperm DNA at all stages of reproduction. Methods: 24 male NMRI mice were divided into 3 groups including dose 0.4 mg/kg/day that received basal diet and TX, dose 0.6 mg/kg/day that received basal diet and TX, and group 3 that received vehicle for 35 days as the control. After that, epididymal spermatozoa were analyzed for nuclear DNA quality. One-way ANOVA was performed with a Tukey test to compare sperm DNA fragmentation at different times. The p<0.05 was considered significant. Results: The use of different doses of TX may have detrimental effects on sperm chromatin protamination and DNA integrity in mice. According to Acridine Orange (AO) staining, the rate of increased single-stranded DNA damage was observed at 0/6 mg/kg/day TX dose (p<0.05). Conclusion: The use of different studied TX doses in the animal sample was found to increase the amount of protamine deficiency and DNA defect in treated mice. 10 16 Sepideh S Sadeghi Department of Biology and Anatomical Sciences, Shahid Sadoughi University of Medical Sciences Department of Biology and Anatomical Sciences, Shahid Sadoughi University of Medical Sciences Iran Alireza A Talebi علیرضا طالبی Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Iran prof_talebi@ssu.ac.ir Abbas A Shahedi Department of Biology and Anatomical Sciences, Shahid Sadoughi University of Medical Sciences Department of Biology and Anatomical Sciences, Shahid Sadoughi University of Medical Sciences Iran Mohammad Reza MR Moein Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Iran Abolghasem A Abbasi-sarcheshmeh Department of Biology and Anatomical Sciences, Shahid Sadoughi University of Medical Sciences Department of Biology and Anatomical Sciences, Shahid Sadoughi University of Medical Sciences Iran DNAMiceSpermTamoxifen 30041.pdf Xu ZP, Sun HX, Zhang NY. [Sperm DNA damage and assisted reproductive technology]. Zhonghua Nan Ke Xue. 2008;14(3):259-63. Chinese.##Talebi AR, Sarcheshmeh AA, Khalili MA, Tabibnejad N. Effects of ethanol consumption on chromatin condensation and DNA integrity of epididymal spermatozoa in rat. Alcohol. 2011;45(4):403-9.##AinMelk Y, Belisle S, Carmel M, Jean-Pierre T. Tamoxifen citrate therapy in male infertility. Fertil Steril. 1987;48(1):113-7.##Traub A, Thompson W. The effect of tamoxifen on spermatogenesis in subfertile men. Andrologia. 1981;13(5):486-90.##Moein MR, Tabibnejad N, Ghasemzadeh J. Beneficial effect of tamoxifen on sperm recovery in infertile men with nonobstructive azoospermia. Andrologia. 2012;44 Suppl 1:194-8.##Patankar SS, Kaore SB, Sawaneh MV, Mishra NV, Deshkari AM. Short communication effect of clomiphene citrate on sperm density in male partners of infertile couples. Indian J Physiol Pharmacol. 2007;51(2):195-8.##Ko SC, Kim DG, Han CH, Lee YJ, Lee JK, Byun HG, et al. Nitric oxide-mediated vasorelaxation effects of anti-angiotensin I-converting enzyme (ACE) peptide from Styela clava flesh tissue and its anti-hypertensive effect in spontaneously hypertensive rats. Food Chem. 2012;134(2):1141-5.##Richthoff J, Spano M, Giwercman YL, Frohm B, Jepson K, Malm J, et al. The impact of testicular and accessory sex gland function on sperm chromatin integrity as assessed by the sperm chromatin structure assay (SCSA). Hum Reprod. 2002;17(12):3162-9.##Oosterhuis GJ, Mulder AB, Kalsbeek-Batenburg E, Lambalk CB, Schoemaker J, Vermes I. Measuring apoptosis in human spermatozoa: a biological assay for semen quality? Fertil Steril. 2000;74(2):245-50.##Suda T, Takahashi T, Golstein P, Nagata S. Molecular cloning and expression of the Fas ligand, a novel member of the tumor necrosis factor family. Cell. 1993;75(6):1169-78.##Carrell DT, Liu L. Altered protamine 2 expression is uncommon in donors of known fertility, but common among men with poor fertilizing capacity, and may reflect other abnormalities of spermiogenesis. J Androl. 2001;22(4):604-10.##Agarwal A, Said TM. Role of sperm chromatin abnormalities and DNA damage in male infertility. Hum Reprod Update. 2003;9(4):331-45.##Virant-Klun I, Tomazevic T, Meden-Vrtovec H. Sperm single-stranded DNA, detected by acridine orange staining, reduces fertilization and quality of ICSI-derived embryos. J Assist Reprod Genet. 2002;19(7):319-28.##Talebi A, Moein M, Tabibnejad N, Ghasemzadeh J. Effect of varicocele on chromatin condensation and DNA integrity of ejaculated spermatozoa using cytochemical tests. Andrologia. 2008;40(4):245-51.##Kazerooni T, Asadi N, Jadid L, Kazerooni M, Ghanadi A, Ghaffarpasand F, et al. Evaluation of sperm's chromatin quality with acridine orange test, chromomycin A3 and aniline blue staining in couples with unexplained recurrent abortion. J Assist Reprod Genet. 2009;26(11-12):591-6.##Saleh RA, Agarwal A, Sharma RK, Said TM, Sikka SC, Thomas AJ Jr. Evaluation of nuclear DNA damage in spermatozoa from infertile men with varicocele. Fertil Steril. 2003;80(6):1431-6.##Talebi A, Vahidi S, Aflatoonian A, Ghasemi N, Ghasemzadeh J, Firoozabadi R, et al. Cytochemical evaluation of sperm chromatin and DNA integrity in couples with unexplained recurrent spontaneous abortions. Andrologia. 2012;44 Suppl 1:462-70.##Simões R, Feitosa WB, Mendes CM, Marques MG, Nicacio AC, de Barros FR, et al. Use of chromomycin A3 staining in bovine sperm cells for detection of protamine deficiency. Biotech Histochem. 2009;84(3):79-83.##Nasr-Esfahani MH, Razavi S, Mardani M. Relation between different human sperm nuclear maturity tests and in vitro fertilization. J Assist Reprod Genet. 2001;18(4):219-25.##Agarwal A, Said TM. Role of sperm chromatin abnormalities and DNA damage in male infertility. Human Reproduction. 2003;9(4):331-45.##Ramezani M, Khalili MA, Adib M. Effect of vitrification on apoptosis and some of parameter of sperm in infertile men. Feyz. 2010;14(1):18-25.##Duran EH, Morshidi M, Taylor S, Oehninger S. Sperm DNA quality predicts intrauterine insemination outcome: a prospective cohort study. Hum Reprod. 2002;17(12):3122-8.##Nasr-Esfahani MH, Razavi Sh, Moradi M. Relation between different human sperm nuclear maturity tests & in vitro fertilization. J Assist Reprod Genet. 2001;18(4):219-25.##Dehghani Ashkezari M, Kalantar SM, Parivar K, Aflatoonian A. The correlation between sperm DNA integrity and IVF success rate in infertile couples. J Reprod Infertil. 2006;6(5):505-12.##Oryan Sh, Parivar K, Asle rousta M. Effect of tamoxifen on histological structure of testis in adult male Wistar rats. Med Sci J Islam Azad Univ Tehran Med Branch. 2008;18(2):81-4.##Motrich RD, Ponce AA, Rivero VE. Effect of tamoxifen treatment on the semen quality and fertility of the male rat. Fertil Steril. 2007;88(2):452-61.##Nada EA, El Taieb M, Ibrahim HM, Al Saied AE. Efficacy of tamoxifen and l‐carnitine on sperm ultrastructure and seminal oxidative stress in patients with idiopathic oligoasthenoteratozoospermia. Andrologia. 2015;47(7):801-10.##Chua M, Escusa KG, Luna S, Tapia LC, Dofitas B, Morales M. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta‐analysis. Andrology. 2013;1(5):749-57.##Pathak S, Kedia-Mokashi N, Saxena M, D'Souza R, Maitra A, Parte P, et al. Effect of tamoxifen treatment on global and insulin-like growth factor 2-H19 locus-specific DNA methylation in rat spermatozoa and its association with embryo loss. Fertil Steril. 2009;91(5 Suppl):2253-63.##Oakes C, La Salle S, Smiraglia DJ, Robaire B, Trasler JM. Developmental acquisition of genome-wide DNA methylation occurs prior to meiosis in male germ cells. Dev Biol. 2007;307(2):368-79.##Burns JL, Hassan AB. Cell survival and proliferation are modified by insulin-like growth factor 2 between days 9 and 10 of mouse gestation. Development. 2001;128(19):3819-30.##Kobayashi H, Sato A, Otsu E, Hiura H, Tomatsu C, Utsunomiya T, et al. Aberrant DNA methylation of imprinted loci in sperm from oligospermic patients. Hum Mol Genet. 2007;16(21):2542-51.##Marques CJ, Costa P, Vaz B, Carvalho F, Fernandes S, Barros A, et al. Abnormal methylation of imprinted genes in human sperm is associated with oligozoospermia. Mol Hum Reprod. 2008;14(2):67-74.##Aleem M, Padwal V, Choudhari J, Balasinor N, Parte P, Gill‐Sharma M. Effects of tamoxifen citrate on gene expression during nuclear chromatin condensation in male rats. Asian J Androl. 2005;7(3):311-21.##

The Effect of Behavioral Couple Therapy on the Improvement of Mental Health and Reduction of Marital Conflict in Infertile Couples in Kermanshah: A Randomized Controlled Trial (RCT) 2 1 2 Background: Infertility is a common disorder, exposing couples to complication such as the loss of mental health and the increase of marital conflicts. The aim of this study was to evaluate the effect of behavioral couple therapy on the enhancement of mental health and reduction of marital conflicts. Methods: In this clinical trial, 24 couples were selected using convenience sampling and were divided randomly into control (12 couples) and experimental (12 couples) groups. Mental Health Questionnaire (GHQ-28) and Kansas Marital Conflict Scale (KMCS) were used to collect data. These questionnaires were filled and pretest, posttest and followup were done in two months. Data were analyzed by Repeated Measures Analysis of Variance, chi-square, independent sample T test, and Bonferroni tests using SPSS-16 software. The significant level of the test was 0.05. Results: The results of the data analysis between experimental and control groups of females in the marital conflict variable showed that the effect of time (p=0.002) and time and group interactional effect (p=0.001) were significant. Moreover, in both experimental and control groups of males, time effect was significant (p=0.01), but time and group interactional effect was not significant (p=0.14). Also, the results of the data analysis between experimental and control groups of females in the mental health and time effect was significant (p=0.001) and time and group interactional effect was significant as well (p=0.001). But in both experimental and control groups of males, time effect (p=0.71) and time and group interactional effect were not significant (p=0.60). Conclusion: Behavioral couple therapy can be used in the treatment of infertile couples, especially in women. 16 24 Seyed Mojtaba SM Ahmadi Department of clinical psychology, School of Medicine, Shahid Beheshti University of Medical Sciences Department of clinical psychology, School of Medicine, Shahid Beheshti University of Medical Sciences Iran Jamile J Shahverdi Department of Psychology, Faculty of Medicine, Kermanshah University of Medical Sciences Department of Psychology, Faculty of Medicine, Kermanshah University of Medical Sciences Iran Shahverdi.jamile@yahoo.com Mansour M Rezaei منصور رضایی Department of Biostatistics and Epidemiology, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences Department of Biostatistics and Epidemiology, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences Iran Mitra M Bakhtiari Department of Anatomy and Biology, Faculty of Medicine, Kermanshah University of Medical Science Department of Anatomy and Biology, Faculty of Medicine, Kermanshah University of Medical Science Iran Kheirollah Kh Sadeghi خیراله صادقی Department of Psychology, Faculty of Medicine, Kermanshah University of Medical Sciences Department of Psychology, Faculty of Medicine, Kermanshah University of Medical Sciences Iran Fateme F Veisy Gene targeting Lab, John Curtin School of Medical Research, The Australian National University Gene targeting Lab, John Curtin School of Medical Research, The Australian National University Iran Maryam M Shahverdi Department of Information Technology, Payame Noor University Tehran West Department of Information Technology, Payame Noor University Tehran West Iran Behavioral couple therapyInfertilityMarital conflictMental health 30040.pdf Pazandeh F,Sharghi Someeh N, Karami Nory R, Alavimajd H. [The relationship between infertility with well-being and marital satisfaction]. Pejouhandeh. 2005:9(42):355-60. Persian.##Faal Kalkhoran L, Bahrami H, Farrokhi NA, Zeraati H, Tarahomi M. [Comparing Anxiety, Depression and Sexual Life Satisfaction in Two Groups of Fertile and Infertile Women in Tehran]. J Reprod Infertil. 2011;12(2):157-62. Persian.##Direkvand Moghaddam A, Delpisheh A, K Sayemiri. The prevalence of infertility in Iran, a systematic review. Iran J Obstet Gynecol Infertil. 2013;16(81):1-7.##Behdani F, Erfanian M, Hebrani P, Hojat SK. [Prevalence of depression and related factors in infertile women]. J Fundam Ment Health. 2004-2005;6(23-24):141-6. Persian.##De Berardis D, Mazza M, Marini S, Del Nibletto L, Serroni N, Pino MC, et al. Psychopathology, emotional aspects and psychological counselling in infertility: a review. Clin Ter. 2014;165(3):163-9.##Hesam AA, Taghipour L, Rasekhi S, Fallahi S, Hesam Z. Investigating the multiple aspects of mental health in infertile women. Int J Ment Health Addict. 2017;15(4):928-32.##Masoumi SZ, Poorolajal J, Keramati A, Moosavi SA. Prevalence of depression among infertile couples in Iran: a meta-analysis study. Iran J Public Health. 2013;42(5):458-66.##Van Horn AS, Reed SA. Medical of psychological aspects of infertility and assisted reproductive technology for the primary care provider. Mil Med. 2001;166(11):1018-22.##Tamanay far M.R. Comparison of mental health, adjustment and coping responses in fertile and in-fertile women. Scientific-Research. J Shahed Univ. 2011;4:51-60.##Saeedi L, Bahrami F, atemady O. The effectiveness of a short-term solution focused couples therapy to reduce conflicts between spouses city of Isfahan, Khomeini. News Res Serv. 2008;5(20):39-52.##Hasani F, Navabinezhad SH, Noranipoor R. A comparison of effectiveness of two couple therapies, CBCT and EFT, on depression in infertile male-factor pairs. Women Dev Polit. 2008;6(3):61-83.##Sharifi V, Asaadi SM, Mohammadi MM, Amini H, Kaviyani H, Semnani Y, et al. The reliability and execution of the persian version of the diagnostic DSM-IV structured interpretation (SCID). J New Cogn Sci. 2004;1(2):10-22.##Eggeman K, Moxley V, Schumm WR. (1985). Assessing spouses' perceptions of Gottman's temporal form in marital conflict. Psychol Rep. 1985;57(1):171-81.##Behjati Ardakani Z, Akhondi MM, Kamali K, Fazli Khalaf Z, Eskandari Sh, Ghorbani B, et al. [Mental Health Status of Patients Attending Avicenna Infertility Clinic]. J Reprod Infertil. 2010;11(4):319-24. Persian.##Sodani M, Nazarifar M, Mehrabizadeh Honarmand M. The effectiveness of bornstein behavioral-communication couple therapy on marital conflicts. J Clin Psychol. 2011;8(4):1-8.##Vizheh M, Pakgohar M, Babaei G, Ramezanzadeh F. Effect of counseling on quality of marital relationship of infertile couples: a randomizd, controlled (RCT) study. Arch Gynecol Obstet. 2013;287(3):583-9.##Soleimani AA, Najafi M, Ahmadi K, Javidi N, Hoseini Kamkar E, Mahboubi M. The effectiveness of emotionally focused couples therapy on sexual satisfaction and marital adjustment of infertile couples with marital conflicts international. J Fertil Steril. 2015;9(3):393-402.##Mirahmadi L, Ahmadi A, Bahrami F. Short-term effectiveness of marital therapy to self-regulation practices of happiness and mental health. New Find Psychol. 2012;22:33-43.##Alipour A, Rahimi A, Zare H. [The relationship between mental health and marital satisfaction of married students, payame noor university of Tehran]. J Urmia Univ Med Sci. 2013;24(7):557-65. Persian.##Frederiksen Y, Farver-Vestergaard I, Skovgård NG, Ingerslev HJ, Zachariae R. Efﬁcacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. 2015;5(1):e006592.##Mirahmadi I, Seyed ahmadi A, Bahrami F. Short-term efficacy of couple therapy on mental health self-regulatory approach depression and marriage. J Appl Psychol. 2011;5(3):99-111.##Abdulqader HG. Effect of psychological intervention on marital satisfaction rate of infertile couples. Int J Educ Pol Res Rev. 2014;1(3):28-36.##Khalatbari J, Ghorbanshirodi Sh, Akhshabi M, Hamzehpour T, Eslamipour M. The effectiveness of the behavioral- cognitive therapy on the reduction of the rate of the depression and anxiety of the infertile women of the Rasht city Indian J Sci Technol. 2011;4(11):1578-82.##Soltani M, Shairi MR, Roshan R, Rahimi CR. The impact of emotionally focused therapy on emotional distress in infertile couples. Int J Fertil Steril. 2014;7(4):337-44.##Hasani F. The comparison of effectiveness between two couple therapies, CBCT and EFT on marital satisfaction in infertile male factor pairs. Andisheh va Raftar. 2008;4(14):77-88.##Nazari V, Mohammadkhani P, Dolat shahi B. Comparative efficacy of cognitive-behavioral marital therapy and enhanced behavioral marital therapy combined increase in marital satisfaction. Mod J Psychol. 2011;6(22):149-75.##

The Impact of Infertility on Daily Occupations and Roles 2 1 2 Background: Infertility impacts approximately 16% of couples in the United States- roughly five million individuals. Experiencing infertility takes a physical and psychological toll on the infertile individual, as well as his/her partner. The goal of the current study was to explore and provide better insight into how infertility affects the roles and daily occupations (Such as self-care and work related tasks) of females. This information can better assist health care providers in providing quality care to such clients. Methods: 21 participants, females ranging in age from 20 to 46 years and experiencing infertility, participated in this qualitative, phenomenological research study. They partook in two telephone interviews aimed at exploring how infertility has impacted their roles and daily occupations. Inductive content data analysis was utilized to analyze the data. Results: Findings resulted in three main themes. Quotes from participants were used to title the themes. They are "when you’re dealing with infertility, every aspect of your life is impacted by it", "infertility impacted my areas of interest in life" and "infertility is very lonely". Conclusion: Infertility has the potential to impact every area of a female’s life. The emotional impact infertility may have on women, in addition to the physical and time constraints involved with pursuing fertility treatments, frequently resulted in decreased occupational engagement and fulfillment of roles as spouse or friend. Those experiencing infertility need more resources and support to navigate their journey. 24 35 Megan ME Collins Occupational Therapy Department, Winston-Salem State University Occupational Therapy Department, Winston-Salem State University USA edwardsme@wssu.edu InfertilityRolesSelf-care 30043.pdf Parry DC, Shinew KJ. The constraining impact of infertility on women’s leisure lifestyles. Leisure Sci. 2004;26(3):295-308.##Klock SC. Psychological issues related to infertility [Internet]. UK: Global Library of Women’s Medicine. 2011. Available from: http://www.glowm.com/section_view/heading/Psychological Issues Related to Infertility/item/412.##Soltani M, Shairi MR, Roshan R, Rahimi CR. The impact of emotionally focused therapy on emotional distress in infertile couples. Int J Fertil Steril. 2014;7(4):337-44.##Tao D, Coates R, Maycock B. The impact of infertility of sexuality: a literature review. Australas Med J. 2011;4(11):620-7.##Mahlstedt PP. The psychological component of infertility. Fertil Steril. 1985;43(3):335-46.##American Occupational Therapy Association. Occupational therapy practice framework: Domain and process. Am J Occup Ther. 2014;68(Suppl 1):S1-48.##Lester S. An introduction to phenomenological research [Internet]. Taunton UK: Stan Lester Developments; 1999 Jan 01. Available from: https://www.researchgate.net/publication/255647619##Lewis S. Qualitative inquiry and research design: choosing among 5 approaches. Health Promot Pract. 2015;16(4):473-5.##Avrech Bar M, Rubin V, Gavrieal-Tyjchman G, Jarus T. The validity and reliability of the modified version of the role checklist (M-RCL). Scand J Occup Ther. 2013;20(6):454-62.##Lin CS. Revealing the “essence” of things: Using phenomenology in LIS research. Qual Quant Methods Libr. 2013;4:469-78.##Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: a review of recent literature. Sociol Health Illn. 2010;32(1):140-62.##Burns LH, Covington SN. Infertility counseling: a comprehensive handbook for clinicians. 2nd ed. UK: Cambridge University Press; 2006. 658 P.##Abbey A, Frank MA, Halman LJ. Infertility and subjective well-being: the mediating roles of self-esteem, internal control, and interpersonal conflict. J Marriage Fam. 1992;54(2):408-17.##Fourquet J, Gao X, Zavala D, Orengo JC, Abac S, Ruiz A, et al. Patients’ report on how endometriosis affects health, work, and daily life. Fertil Steril. 2010;93(7):2424-8.##Wirtberg I, Möller A, Tronstad SE, Lalos A. Life 20 years after unsuccessful infertility treatment. Hum Reprod. 2007;22(2):598-604.##Daniluk JC, Tench E. Long term adjustment of infertile couples following unsuccessful medical intervention. J Couns Dev. 2007;85(1):89-100.##McCarthy MP. Women’s lived experience of infertility after unsuccessful medical intervention. J Midwifery Womens Health. 2008;53(4):319-24.##Abbey A, Andrews FM, Halman LJ. Gender’s role in responses to infertility. Psychol Women Q. 1991;15(2):295-316.##

Comparing the Impact of Autologous Platelet-rich Plasma and Granulocyte Colony Stimulating Factor on Pregnancy Outcome in Patients with Repeated Implantation Failure 2 1 2 Background: Despite the advancements in assisted reproductive technologies, repeated implantation failure (RIF) still remains a challenging problem for patients and clinicians. The aim of the present study was to compare the impact of intrauterine infusion of autologous platelet-rich plasma (PRP) and systemic administration of granulocyte colony stimulating factor (GCSF) on pregnancy outcome in patients with repeated implantation failure. Methods: The present retrospective cohort study included 123 patients with history of more than two repeated failed embryo transfers. Cycles were divided into two groups of intrauterine infusion of PRP (n=67) and systemic administration of GCSF (n=56). Pregnancy outcome was compared between two groups. The p-value less than 0.05 was considered statistically significant. Results: The clinical pregnancy rate was significantly higher in PRP group than GCSF group (40.3% versus 21.4%, p=0.025). The crud and adjusted odds ratios (95% confidence interval (CI)) were 2.5 and 2.6 (p=0.025, CI: 1.11-5.53 and p=0.03, CI: 1.10-6.15), respectively. Conclusion: It seems that intrauterine infusion of PRP can positively affect pregnancy outcome in RIF patients in comparison with systemic administration of GCSF and more studies need to be designed to conclude the effectiveness of this method. 35 42 Marzieh M Mehrafza مرضیه مهرافزا Mehr Fertility Research Center, Guilan University of Medical Science Mehr Fertility Research Center, Guilan University of Medical Science Iran marzieh.mehrafza@gmail.com Roya R Kabodmehri Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, Guilan University of Medical Sciences Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, Guilan University of Medical Sciences Iran Zahra Z Nikpouri Mehr Fertility Research Center, Guilan University of Medical Science Mehr Fertility Research Center, Guilan University of Medical Science Iran Gholamreza GhR Pourseify Mehr Fertility Research Center, Guilan University of Medical Science Mehr Fertility Research Center, Guilan University of Medical Science Iran Azadeh A Raoufi Mehr Fertility Research Center, Guilan University of Medical Science Mehr Fertility Research Center, Guilan University of Medical Science Iran Azadeh A Eftekhari Mehr Fertility Research Center, Guilan University of Medical Science Mehr Fertility Research Center, Guilan University of Medical Science Iran Sajedeh S Samadnia Mehr Fertility Research Center, Guilan University of Medical Science Mehr Fertility Research Center, Guilan University of Medical Science Iran Ahmad A Hosseini Mehr Fertility Research Center, Guilan University of Medical Science Mehr Fertility Research Center, Guilan University of Medical Science Iran Granulocyte colony-stimulating factorPlatelet-rich plasmaRepeated implantation failure 30044.pdf Coughlan C, Ledger W, Wang Q, Liu F, Demirol A, Gurgan T, et al. Recurrent implantation failure: definition and management. Reprod Biomed Online. 2014;28(1):14-38.##Rinehart J. Recurrent implantation failure: definition. J Assist Reprod Genet. 2007;24(7):284-7.##Polanski LT, Baumgarten MN, Quenby S, Brosens J, Campbell BK, Raine-Fenning NJ. What exactly do we mean by ‘recurrent implantation failure’? A systematic review and opinion. Reprod Biomed Online. 2014;28(4):409-23.##Papanikolaou EG, Kolibianakis EM, Tournaye H, Venetis CA, Fatemi H, Tarlatzis B, et al. Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in IVF. a systematic review and meta-analysis. Hum Reprod. 2007;23(1):91-9.##Practice committee of the society for assisted reproductive technology; practice committee of the smerican society for reproductive medicine. The role of assisted hatching in in vitro fertilization: a review of the literature. a committee opinion. Fertil Steril. 2006;85(2):544-6.##Caglar GS, Asimakopoulos B, Nikolettos N, Diedrich K, Al-Hasani S. Preimplantation genetic diagnosis for aneuploidy screening in repeated implantation failure. Reprod Biomed Online. 2005;10(3):381-8.##Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online. 2004;8(5):590-4.##Simon A, Laufer N. Assessment and treatment of repeated implantation failure (RIF). J Assist Reprod Genet. 2012;29(11):1227-39.##Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis. Reprod Biomed Online. 2012;25(6):561-71.##Chang Y, Li J, Chen Y, Wei L, Yang X, Shi Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med. 2015;8(1):1286-90.##Zadehmodarres S, Salehpour S, Saharkhiz N, Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist Reprod. 2017;21(1):54-6.##Nazari L, Salehpour S, Hoseini S, Zadehmodarres S, Ajori L. Effects of autologous platelet-rich plasma on implantation and pregnancy in repeated implantation failure: a pilot study. Int J Reprod Biomed (Yazd). 2016;14(10):625-8.##Krüger JP, Freymann U, Vetterlein S, Neumann K, Endres M, Kaps C. Bioactive factors in platelet-rich plasma obtained by apheresis. Transfus Med Hemother. 2013;40(6):432-40.##Rahmati M, Petitbarat M, Dubanchet S, Bensussan A, Chaouat G, Ledee N. Granulocyte-colony stimulating factor related pathways tested on an endometrial ex-vivo model. PLoS One. 2014;9(9):e102286.##Uzumaki H, Okabe T, Sasaki N, Hagiwara K, Takaku F, Tobita M, et al. Identification and characterization of receptors for granulocyte colony-stimulating factor on human placenta and trophoblastic cells. Proc Natl Acad Sci USA. 1989;86(23):9323-6.##Saito S, Fukunaga R, Ichijo M, Nagata S. Expression of granulocyte colony-stimulating factor and its receptor at the fetomaternal interface in murine and human pregnancy. Growth Factors. 1994;10(2):135-43.##Barad DH, Yu Y, Kushnir VA, Shohat-Tal A, Lazzaroni E, Lee HJ, et al. A randomized clinical trial of endometrial perfusion with granulocyte colony-stimulating factor in in vitro fertilization cycles: impact on endometrial thickness and clinical pregnancy rates. Fertil Steril. 2014;101(3):710-5.##Li Y, Pan P, Chen X, Li L, Li Y, Yang D. Granulocyte colony-stimulating factor administration for infertile women with thin endometrium in frozen embryo transfer program. Reprod Sci. 2014;21(3):381-5.##Eftekhar M, Miraj S, Mojtahedi MF, Neghab N. Efficacy of intrauterine infusion of granulocyte colony stimulating factor on patients with history of implantation failure: a randomized control trial. Int J Reprod Biomed (Yazd). 2016;14(11):687-90.##Bos-Mikich A, de Oliveira R, Frantz N. Platelet-rich plasma therapy and reproductive medicine. J Assist Reprod Genet. 2018;35(5):753-6.##Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte-and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009;27(3):158-67.##Aghajanova L, Cedars M, Huddleston H. Platelet-rich plasma in the management of Asherman syndrome: case report. J Assist Reprod Genet. 2018;35(5):771-5.##Castellani D, Valloni A, Piccirilli A, Galatioto GP, Vicentini C. An innovative approach to treating vaginal mesh exposure after abdominal sacral colpopexy: endoscopic resection of mesh and platelet-rich plasma; initial experience in three women. Int Urogynecol J. 2017;28(2):325-7.##Tehranian A, Esfehani-Mehr B, Pirjani R, Rezaei N, Heidary SS, Sepidarkish M. Application of autologous platelet-rich plasma (PRP) on wound healing after caesarean section in high-risk patients. Iran Red Crescent Med J. 2016;18(7):e34449.##Sills ES, Rickers NS, Li X, Palermo GD. First data on in vitro fertilization and blastocyst formation after intraovarian injection of calcium gluconate-activated autologous platelet rich plasma. Gynecol Endocrinol. 2018;34(9):756-60.##Srivastava A, Sengupta J, Kriplani A, Roy KK, Ghosh D. Profiles of cytokines secreted by isolated human endometrial cells under the influence of chorionic gonadotropin during the window of embryo implantation. Reprod Biol Endocrinol. 2013;11:116.##Dimitriadis E, White CA, Jones RL, Salamonsen LA. Cytokines, chemokines and growth factors in endometrium related to implantation. Hum Reprod Update. 2005;11(6):613-30.##Liang PY, Diao LH, Huang CY, Lian RC, Chen X, Li GG, et al. The pro-inflammatory and anti-inflammatory cytokine profile in peripheral blood of women with recurrent implantation failure. Reprod Biomed Online. 2015;31(6):823-6.##Bendinelli P, Matteucci E, Dogliotti G, Corsi MM, Banfi G, Maroni P, et al. Molecular basis of anti‐inflammatory action of platelet‐rich plasma on human chondrocytes: Mechanisms of NF‐κB inhibition via HGF. J Cellular Physiol. 2010;225(3):757-66.##Sak M, Gul T, Evsen M, Soydinc H, Sak S, Ozler A, et al. Fibroblast growth factor-1 expression in the endometrium of patients with repeated implantation failure after in vitro fertilization. Eur Rev Med Pharmacol Sci. 2013;17(3):398-402.##Boudjenah R, Molina-Gomes D, Wainer R, de Mazancourt P, Selva J, Vialard F. The vascular endothelial growth factor (VEGF) 405 G/C polymorphism and its relationship with recurrent implantation failure in women in an IVF programme with ICSI. J Assist Reprod Genet. 2012;29(12):1415-20.##Lédée N, Petitbarat M, Chevrier L, Vitoux D, Vezmar K, Rahmati M, et al. The uterine immune profile may help women with repeated unexplained embryo implantation failure after in vitro fertilization. Am J Reprod Immunol. 2016;75(3):388-401.##Makrigiannakis A, BenKhalifa M, Vrekoussis T, Mahjub S, Kalantaridou SN, Gurgan T. Repeated implantation failure: a new potential treatment option. Eur J Clin Invest. 2015;45(4):380-4.##Madkour A, Bouamoud N, Louanjli N, Kaarouch I, Copin H, Benkhalifa M, et al. Intrauterine insemination of cultured peripheral blood mononuclear cells prior to embryo transfer improves clinical outcome for patients with repeated implantation failures. Zygote. 2016;24(1):58-69.##Obidniak D, Gzgzyan A, Feoktistov A, Niauri D. Randomized controlled trial evaluating efficacy of autologous platelet-rich plasma therapy for patients with recurrent implantation failure. 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Relationship Between Unintended Pregnancy and Antenatal Care Use During Pregnancy in Hadiya Zone, Southern Ethiopia 2 1 2 Background: Unintended pregnancy has direct relation with poor utilization of maternal health care services and also associated with unhealthy behaviors during pregnancy. Few studies have examined the association between unintended pregnancy and maternal health behaviors during pregnancy in developing countries including Ethiopia. The purpose of the study was to determine the association of unintended pregnancy with use of antenatal care during pregnancy among pregnant women in Hadiya zone, southern Ethiopia. Methods: Community based cross sectional study design was employed in Hadiya zone, southern Ethiopia in 2017. 748 pregnant mothers were included using single population proportion. Study participants were selected by simple random sampling technique. A structured interviewer administered questionnaire was used to collect data. Descriptive, bivariate and multivariate logistic regression was employed to identify the independent effect of unintended pregnancy on the outcomes of interest. The level of significance was confirmed if p-value was less than 0.05. Results: More than one third (36.2%) of women reported unintended pregnancy. Unintended pregnancy was significantly associated with use of antenatal care. Women with unintended pregnancy were 69% less likely to receive ANC (AOR=0.31, 95% CI; 0.21–0.46) and were four times more likely to have late ANC initiation (AOR=4.40, 95% CI; 1.70–11.40) during pregnancy as compared to counterparts. Conclusion: This study finding showed an association between unintended pregnancy and ANC use during pregnancy. Women with unintended pregnancy were less likely to use antenatal care and more likely to delay initiation of antenatal care. Longitudinal studies are recommended on relationship between unintended pregnancy and ANC use. 42 52 Desta DE Abame Haramaya University, College of Health and Medical Sciences, School of Public Health Haramaya University, College of Health and Medical Sciences, School of Public Health Ethiopia Abera A Muluembet Jimma University, Institute of Health, Faculty of Public Health Jimma University, Institute of Health, Faculty of Public Health Ethiopia Amanuel A Tesfay Jimma University, Institute of Health, Faculty of Public Health Jimma University, Institute of Health, Faculty of Public Health Ethiopia amanuelpraise@gmail.com Yonas Y Yohannes East Badawacho, District Health Office East Badawacho, District Health Office Ethiopia Dejene D Ermias East Badawacho, District Health Office East Badawacho, District Health Office Ethiopia dj.ermi2005@gmail.com Terefe T Markos Wolaeta Sodo University, College of Health Sciences Wolaeta Sodo University, College of Health Sciences Ethiopia Gelila G Goba Department of Obstetrics and Gynecology, University of Illinois at Chicago Department of Obstetrics and Gynecology, University of Illinois at Chicago USA Antenatal careEthiopiaHadiyaUnintended pregnancy 30045.pdf Santelli BJ, Rochat R, Hatfield-Timajchy K, Gilbert BC, Curtis K, Cabral R, et al. The measurement and meaning of unintended pregnancy. Perspect Sex Reprod Health. 2003;35(2):94-101.##Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann. 2014;45(3):301-14.##Guttmacher Institute. Induced abortion and post abortion care in Ethiopia. New York: Guttmacher Institute 2016; 2 p.##Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462-74.##Central Statistical Agency (CSA). 2016 Ethiopia Demographic and Health Survey (2016 EDHS). Addis Ababa, Ethiopia: Central Statistical Agency of Ethiopia; 2017 July. 616 p.##United Nations. The Sustainable Development Goals Report 2016. New York: United Nations; 2016. 52 p.##Department of reproductive health and research, world health organization. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. 6th ed. Geneva: World Health Organisation. 2011; 56 p.##Karim RA. Reproductive health, including adolescent reproductive health: progress and challenges in Asia-Pacific. Asian Pac Popul J. 2009;24(1):153-96.##Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008;39(1):18-38.##World health organisation. Standards for maternal and neonatal Care. 1st ed. World Health Organisation: Geneva:World Health Organisation. 2007; 72 p.##Dott M, Rasmussen SA, Hogue CJ, Reefhuis J, National Birth Defects Prevention Study. Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, national birth defects prevention study, 1997-2002. Matern Child Heal J. 2010;14(3):373-81.##Wado YD, Afework MF, Hindin MJ. Unintended pregnancies and the use of maternal health services in southwestern Ethiopia. BMC Int Health Hum Rights. 2013;13:36.##Dibaba Y, Fantahun M, Hindin MJ.. The effects of pregnancy intention on the use of antenatal care services: systematic review and meta-analysis. Reprod Health. 2013;10:50.##Cheng D, Schwarz EB, Douglas E, Horon I. Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception. 2009;79(3):194-8.##Khajehpour M, Simbar M, Jannesari S, Ramezani-Tehrani F, Majd HA. Health status of women with intended and unintended pregnancies. Public Health. 2012;127(1):58-64.##Stern J, Salih Joelsson L, Tydén T, Berglund A, Ekstrand M, Hegaard H, et al. Is pregnancy planning associated with background characteristics and pregnancy-planning behavior? Acta Obstet Gynecol Scand. 2016;95(2):182-9.##Hadiya Zone Health Department. Annual report of Hadiya Zone. Hadiya zone, Southern Ethiopia; 2016.##Rutstein SO, Johnson K. The DHS wealth index. Calverton, Maryland: ORC Macro; 2004; No. 6.##Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459-68.##Mekonnen A, Asrese K. Household decision making status of women in dabat district, north west Ethiopia, 2009. Sci J Public Health. 2014;2(2):111-8.##Nigatu D, Gebremariam A, Abera M, Setegn T, Deribe K. Factors associated with women’s autonomy regarding maternal and child health care utilization in Bale Zone: a community based cross-sectional study. BMC Womens Health. 2014;14(1):79.##Hamdela B, Abebe G, Tilahun T. Unwanted pregnancy and associated factors among pregnant married women in Hosanna town, southern Ethiopia. PLoS One. 2012;7(6):e39074.##Kibret A, Bayu H, Merga M. Prevalence of unintended pregnancy and associated factors among pregnant women attending antenatal clinics in debre-markos town, north west Ethiopia. J Womens Health Care. 2015;4(3):1-6.##Getachew FD. Level of unintended pregnancy and its associated factors among currently pregnant women in Duguna Fango district, Wolaita zone, southern Ethiopia. Malaysian J Med Biol Res. 2015;2(2):75-88.##Mohammed F, Musa A, Amano A. Prevalence and determinants of unintended pregnancy among pregnant woman attending ANC at Gelemso general hospital, Oromiya region, east Ethiopia: a facility based cross-sectional study. BMC Womens Health. 2016;16(1):56.##Terfasa TG, Afework MF, Berhe FT. Antenatal care utilization and it’s associated factors in east Wollega zone, Ethiopia. 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Trends of Patients' Preferences in the Management of First and Early Second Trimester Pregnancy Loss Towards the Choice of Medical or Surgical Termination of Pregnancy in a Tertiary Care Center in Oman 2 1 2 Background: This study aimed to find out the patients preference towards the managementof pregnancy loss to either Misoprostol or dilatation and evacuation or curettage (D&C) in two different study periods. Methods: Retrospective chart review study included a total of 411 patients. The first study period was January to December 2010 and the second study period was January to December 2014. All patients were managed in Sultan Qaboos University Hospital of Oman. Results: Misoprostol was more preferable than dilatation and curettage D&C in both 2010 and 2014, with percentages of 79.30% and 69.57%, respectively. There was a slight increase in the preference toward D&C in 2014. There was a slight increase in the preference toward D&C with older age group as well as in patients with history of miscarriages. Conclusion: In comparison between 2010 and 2014 data, there was no significant change in patients’ preference. There was a slight increase in the preference toward D&C in the older age group and in patients with previous history of abortion in both years. 52 57 Tamima T Al-Dughaishi Sultan Qaboos University and Hospital Sultan Qaboos University and Hospital Oman Mussab MH Hamed Al-Jabri Sultan Qaboos University and Hospital Sultan Qaboos University and Hospital Oman Amjad AA Al-Haddabi Sultan Qaboos University and Hospital Sultan Qaboos University and Hospital Oman Vaidyanathan V Gowri Vaidyanathan Gowri Sultan Qaboos University and Hospital Sultan Qaboos University and Hospital Oman gowrie61@hormail.com AbortionMiscarriageMisoprostolParityTrends 30039.pdf Kolte AM, Bernardi LA, Christiansen OB, Quenby S, Farquharson RG, Goddijn M, et al. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod. 2015;30(3):495-8.##Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. New Engl J Med. 1988;319(4):189-94.##Symonds IM, Arulkumaran S, Symonds EM. 5th ed. Essential obstetrics and gynecology. London: Edinburgh: Churchill Livingstone/Elsevier; 2013. p. 277-82.##Niinimäki M, Karinen P, Hartikainen AL, Pouta A. Treating miscarriages: a randomised study of cost-effectiveness in medical or surgical choice. BJOG. 2009;116(7):984-90.##World Health Organization (WHO) [Internet]. Geneva: WHO headquarters; c 2019. WHO Model List of Essential Medicines; 2017 [cited 2018 Jun 12]. Available from: http://www.who.int/medicines/publications/essentialmedicines/en/.##Rausch M, Lorch S, Chung K, Frederick M, Zhang J, Barnhart K. A cost- effectiveness analysis of surgical versus medical management of early pregnancy loss. Fertil Steril. 2012;97(2):355-60.##Tang J, Kapp N, Dragoman M, de Souza JP. WHO recommendations for misoprostol use for obstetric and gynaecologic indications. Int J Gynecol Obstet. 2013;121(2):186-9.##Kong G, Lok I, Yiu A, Hui A, Lai B, Chung T. Clinical and psychological impact after surgical, medical or expectant management of first-trimester miscarriage--a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2013;53(2):170-7.##Shokry M, Fathalla M, Hussien M, Ashraf AE. Vaginal misoprostol versus vaginal surgical evacuation of first trimester incomplete abortion: Comparative study. Middle East Fertil Soc J. 2014;19(2):96-101.##Molnar AM, Oliver LM, Geyman JP. Patient preferences for management of first-trimester incomplete spontaneous abortion. J Am Board Fam Pract. 200;13(5):333-7.##Prasad S, Kumar A, Divya A. Early termination of pregnancy by single-dose 800 microg misoprostol compared with surgical evacuation. Fertil Steril. 2009;91(1):28-31.##Ankum WM, Wieringa-De Waard M, Bindels PJ. Management of spontaneous miscarriage in the first trimester: an example of putting informed shared decision making into practice. BMJ. 2001;322(7298):1343-6.##Trinder J, Brocklehurst P, Porter R, Read M, Vyas S, Smith L. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ. 2006;332(7552):1235-40.##Lemmers M, Verschoor MA, Oude Rengerink K, Naaktgeboren C, Opmeer BC, Bossuyt PM, et al. MisoREST: surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial. Hum Reprod. 2016;31(11):2421-7.##Reed Johnson F, Lancsar E, Marshall D, Kilambi V, Mühlbacher, Regier DA, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force. Value Health. 2013;16(1):3-13.##

The First ongoing Pregnancy Following Comprehensive Aneuploidy Assessment Using a Combined Blastocenetesis, Cell Free DNA and Trophectoderm Biopsy Strategy 2 1 2 Background: The exact origin of cell-free DNA found in spent culture media or blastocoel fluid is currently unknown but with the potential to become an improved source of DNA for chromosomal analysis than trophectoderm biopsy samples, it provides a superior representation of the fetal genetic status. However, the genetic material contained within the blastocoel cavity may be more reliable to assessment of embryo euploidy in a clinical context than trophectoderm of cell-free DNA. Case Presentation: This is the first UK case report where all three sources of DNA were analyzed in a clinical setting on 29 th January 2018 at the Centre for Reproductive and Genetic Health, London, leading to an ongoing clinical pregnancy. Conclusion: The experience from this case report suggests that removal of blasto-coel fluid, sampling of spent culture media and trophectoderm biopsy can be carried out in parallel. Gathering genetic information from two to three independent samples of embryo DNA may provide enhanced diagnostic accuracy and may clarify cytogenetic status of mosaic embryos. 57 63 Jara J Ben-Nagi Clinical Department, The Centre for Reproductive and Genetic Health Clinical Department, The Centre for Reproductive and Genetic Health UK jara.bennagi@crgh.co.uk Rabi R Odia Embryology Department, The Centre for Reproductive and Genetic Health Embryology Department, The Centre for Reproductive and Genetic Health UK Xavier XV Gonzalez Embryology Department, The Centre for Reproductive and Genetic Health Embryology Department, The Centre for Reproductive and Genetic Health UK Carleen C Heath Embryology Department, The Centre for Reproductive and Genetic Health Embryology Department, The Centre for Reproductive and Genetic Health UK Dhruti D Babariya Cooper Genomics Cooper Genomics UK Sioban S SenGupta Institute of Women’s Health, University College London Institute of Women’s Health, University College London UK Paul P Serhal Clinical Department, The Centre for Reproductive and Genetic Health Clinical Department, The Centre for Reproductive and Genetic Health UK Dagan D Wells Department of Women’s and Reproductive Health, University of Oxford Department of Women’s and Reproductive Health, University of Oxford UK BiopsyBlastocentesisCell free DNA 40045.pdf Yang Z, Liu J, Collins GS, Salem SA, Liu X, Lyle SS, et al. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Mol Cytogenet. 2012;5(1):24.##Scott RT Jr, Upham KM, Forman EJ, Zhao T, Treff NR. Cleavage-stage biopsy significantly impairs human embry-onic implantation potential while blastocyst biopsy does not: a randomized and paired clinical trial. Fertil Steril. 2013;100(3):624-30.##Forman EJ, Hong KH, Ferry KM, Tao X, Taylor D, Levy B, et al. In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial. Fertil Steril. 2013;100(1):100-7.e1.##Chen M, Wei S, Hu J, Quan S. Can comprehensive chromosome screening technology improve IVF/ ICSI outcomes? a meta-analysis. PLoS One. 2015;10(10):e0140779.##Dahdouh EM, Balayla J, García-Velasco JA. Comprehensive chromosome screening improves embryo selection: a meta-analysis. Fertil Steril. 104(6):1503-12.##Mastenbroek S, Twisk M, van der Veen F. Repping S. Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Hum Reprod Update. 2011;17(4):454-66.##Gleicher N, Orvieto R. Is the hypothesis of preimplantation genetic screening (PGS) still supportable? a review. J Ovarian Res. 2017;10(1):21.##Fragouli E, Wells D. Current status and future prospects of noninvasive preimplantation genetic testing for aneu-ploidy. Fertil Steril. 2018;110(3):408-9.##Rienzi L, Capalbo A, Stoppa M, Romano S, Maggiulli R, Albricci L, et al. No evidence of association between blastocyst aneuploidy and morphokinetic assessment in a selected population of poor-prognosis patients: a longitudinal cohort study. Reprod Biomed Online. 2015;30(1):57-66.##Minasi MG, Colasante A, Riccio T, Ruberti A, Casciani V, Scarselli F, et al. Correlation between aneuploidy, standard morphology evaluation and morphokinetic development in 1730 biopsied blastocysts: a consecutive case series study. Hum Reprod. 2016;31(10):2245-54.##Palini S, Galluzzi L, De Stefani S, Bianchi M, Wells D, Magnani M, et al. Genomic DNA in human blastocoele fluid. Reprod Biomed Online. 2013;26(6):603-10.##Magli MC, Pomante A, Cafueri G, Valerio M, Crip-pa A, Ferraretti AP, et al. Preimplantation genetic testing: polar bodies, blastomeres, trophectoderm cells, or blastocoelic fluid? Fertil Steril. 2016;105(3):676-83.e5.##Stigliani S, Anserini P, Venturini PL, Scaruffi P. Mitochondrial DNA content in embryo culture medium is signifi-cantly associated with human em-bryo fragmentation. Hum Reprod. 2013;28(10):2652-60.##Wu H, Ding C, Shen X, Wang J, Li R, Cai B, et al. Medium-based noninvasive preimplantation genetic diagnosis for human alpha-thalassemias-SEA. Medicine (Baltimore). 2015;94(12):e669.##Gianaroli L, Magli MC, Pomante A, Crivello AM, Cafueri G, Valerio M, et al. Blastocentesis: a source of DNA for preimplantation genetic testing. Results from a pilot study. Fertil Steril. 2014;102(6):1692-9.e6.##Tobler KJ, Zhao Y, Ross R, Benner AT, Xu X, Du L, et al. Blastocoel fluid from differentiated blastocysts harbors embryonic genomic material capable of a whole-genome deoxyribonucleic acid amplification and comprehensive chromosome microarray analysis. Fertil Steril. 2015;104(2):418-25.##Xu J, Fang R, Chen L, Chen D, Xiao JP, Yang W, et al. Noninvasive chromosome screening of human embryos by genome sequencing of embryo culture medium for in vitro fertilization. Proc Natl Acad Sci USA. 2016;113(42):11907-12.##Kuznyetsov V, Madjunkova S, Antes R, Abramov R, Motamedi G, Ibarrientos Z, et al. Evaluation of a novel non-invasive preimplantation genetic scre-ening approach. PLoS One. 2018;13(5):e0197262.##Vera-Rodriguez M, Diez-Juan A, Jimenez-Alma-zan J, Martinez S, Navarro R, Peinado V, et al. Origin and composition of cell-free DNA in spent medium from human embryo culture during preimplantation development. Hum Reprod. 2018;33 (4):745-56.##Gosden R. Cryopreservation: a cold look at techno-logy for fertility preservation. Fertil Steril. 2011;96 (2):264-8.##Zhang Y, Li N, Wang L, Sun H, Ma M, Wang H, et al. Molecular analysis of DNA in blastocoele fluid using next-generation sequencing. J Assist Reprod Genet. 2016;33(5):637-45.##