Implications of Assisted Human Reproduction During Coronavirus Disease 2019 (COVID-19) Pandemic 2 1 2 More than six months have been passed since the outbreak of coronavirus disease (Covid-19) and during this short period, the virus quickly and extensively has been spread worldwide. The human virus has been known since 1960s. But over the past half-century, little attention has been paid to the virus. At recent, more than 40 coronaviruses have been identified in this family that most of them infected animals. Few of them are causes of human diseases such as common cold (15% of cases), severe acute respiratory syndrome (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In spite of living with most of coronavirus family and their circulation among the human population for a very long time, we know very little about most members of this family especially the new coronavirus, Covid-19. Every day, there are reports of the Covid-19 disease with varying degrees of severity, from flu-like symptoms to death that have not been stated previously with other coronaviruses (1). The known coronavirus only leads to acute respiratory syndrome in human, but the new coronavirus is attached to ACE2 as its specific receptor. In addition to respiratory system, ACE2 is present in other tissues including kidney, gastrointestinal tract, and blood vessels (Arteries and veins). Therefore, pathogenesis of Covid-19 has occurred in organs other than the lungs. Due to the adverse effects and unknown behavior of coronavirus, from the beginning of Covid-19 outbreak, it was recommended to suspend the unnecessary and elective medical interventions, such as assisted reproductive technologies. ACE2 receptor has not been found on sperm and oocyte. Moreover, vertical transmission and severe prenatal complications of coronavirus on pregnant women have never been reported. However, the rate of preterm labor slightly increased which may be attributed to altering of immune privilege between mother-fetus and disturbance of normal pregnancy. Consequently, occurrence of natural pregnancy has not been prohibited during Covid-19 outbreak (2). In this issue, you will find a systematic review entitled "Coronavirus Disease 2019 (COVID-19): A Systematic Review of Pregnancy and the Possibility of Vertical Transmission" that represents all studies on this subject until now. However, due to the lack of knowledge about symptoms and pathogenesis of SARS-CoV-2 on the fetus, infants and children, infertility treatment was almost completely stopped following outbreaks. Some medical interventions to treat infertility require the transfer of gametes and embryos. Yet, there is the possibility of virus transmission to a healthy mother through in vitro fertilization wherein gametes and embryos journey a long way out of body. Although there is no evidence of couple’s infection with coronavirus, the application of such technologies is intermitted temporarily to discover more about the behavior of the virus (3). In addition, another concern is the direct effects of the virus on the reproductive system due to the unknown pathogenesis of Covid-19. Preliminary studies have showed the presence of ACE2 on reproductive cells and tissues which leads to impairment of female and male fertility. High levels of ACE2 is expressed in testis on spermatogonia (Spg), leydig cells (LC) and Sertoli cells (SC) as the potential route for coronavirus entry into these cells. However, several studies have not found SARS-CoV-2 in semen following acute infection, but elevated LH level as a sign of primary hypogonadism is reported. Future studies may show orchitis like consequences of SARS-CoV-2 infection on testis and spermatogenic cells. We may find similar consequences and pathogenesis in the female reproductive system in the future (4). Although infertility does not threaten the survival of infertile couples, it may have severe impact on their quality of life in future. Human fertility, especially in women, can be affected by a number of age-dependent factors. Most of pathophysiological effects on fertility potential are irreversible; therefore, appropriate actions at proper time can prevent irreversible childlessness of infertile couples. Recently, infertility treatment and assisted reproduction services were resumed along with protection guidelines for clients and health care providers following the transition of Covid-19 outbreak from the log phase to the decline phase and control of the disease in most countries. Therefore, at present, we should prevent the spread of the disease from symptomatic and asymptomatic patients to clinic’s staff, employees; to top it all off, rigorous screening for couples seeking infertility treatment is highly recommended. Currently, the best strategy is making an interval between implementation of assisted reproductive technology (ART) and start of pregnancy. Accordingly, controlled ovarian stimulation, ovum pickup, fertilization and cryopreservation of embryos can be performed without any delay; however, embryo transfer will be delayed till subsiding of the pandemic as the best policy for infertility clinics. 155 157 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@ari.ir No Keyword 80085.pdf Yang Y, Peng F, Wang R, Guan K, Jiang T, Xu G, et al. The deadly Coronaviruses: the 2003 SARS pandemic and the 2020 novel coronavirus epidemic in China. J Autoimmun. 2020;109:102434.##Liu H, Wang LL, Zhao SJ, Kwak-Kim J, Mor G, Liao AH. Why are pregnant women susceptible to COVID-19? an immunological viewpoint. J Reprod Immunol. 2020;139:103122.##Tesarik J. After Corona: There is life after the pandemic. Reprod Biomed Online. 2020;40(6):760-762.##Verma S, Saksena S, Sadri-Ardekani H. ACE2 receptor expression in testes: implications in COVID-19 pathogenesis. Biol Reprod. 2020;ioaa080.##

Coronavirus Disease 2019 (COVID-19): A Systematic Review of Pregnancy and the Possibility of Vertical Transmission 2 1 2 Background: There is a growing need for information regarding maternal and neonatal outcomes during coronavirus pandemic. In this study, a comprehensive investigation was done regarding the possibility of vertical transmission using the available data in the literature. Methods: A systematic search was conducted using electronic databases, including PubMed, Scopus, Web of Science, Embase, and Scholar. All studies containing infected COVID-19 pregnant women who had given birth were included, and the search was done up to April 14, 2020. Results: Overall, 21 articles were reviewed, and clinical characteristics of 90 pregnant patients and 92 neonates born to mothers infected with COVID-19 were reviewed. The most common symptoms included fever, cough, and dyspnea. The main laboratory findings included leukocytosis, lymphopenia, thrombocytopenia, and elevated C-reactive protein. The most commonly reported complications were preterm labor and fetal distress. Three mothers were admitted to ICU and required mechanical ventilation; among them, one died, and one was on extracorporeal membrane oxygenation. Overall, 86 neonates were tested for the possibility of vertical transmission and 82 cases were negative in RT-PCR, while 4 were positive. Out of 92 neonates, one died, and one was born dead. Nineteen patients reported having no symptoms, while breathing problems and pneumonia were reported as the most common neonatal complications. Conclusion: There were no differences in the clinical characteristics of pregnant women and non-pregnant COVID-19 patients. COVID-19 infection has caused higher incidence of fetal distress and premature labor in pregnant women. Although the possibility of vertical transmission in infected pregnant women is rare, four neonates’ test results for COVID-19 infection were positive in this review. 157 169 Mohammad Ali MA Ashraf Student Research Committee, Shiraz University of Medical Sciences Student Research Committee, Shiraz University of Medical Sciences Iran Pedram P Keshavarz Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences Iran Parisa P Hosseinpour School of Medicine, Islamic Azad University, Kazeroun branch School of Medicine, Islamic Azad University, Kazeroun branch Iran Amirhossein AH Erfani Student Research Committee, Shiraz University of Medical Sciences Student Research Committee, Shiraz University of Medical Sciences Iran Amirhossein AH Roshanshad Student Research Committee, Shiraz University of Medical Sciences Student Research Committee, Shiraz University of Medical Sciences Iran Alieh A Pourdast Department of infectious diseases, Tehran University of Medical Sciences Department of infectious diseases, Tehran University of Medical Sciences Iran Peyman NS Nowrouzi-sohrabi Department of Biochemistry, Student Research Committee, Shiraz University of Medical Sciences Department of Biochemistry, Student Research Committee, Shiraz University of Medical Sciences Iran Shahla Sh Chaichian Shahla Chaichian Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences Iran Tahereh T Poordast Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences Iran ta.poordast@yahoo.com Coronavirus disease 2019 (COVID-19)Vertical transmissionPregnancyNeonatal outcomesPregnant womenSARS-CoV-2Systematic review 80083.pdf Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.##World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Jun 8]; [about 5 screens]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-may-2020##Chen YH, Keller J, Wang IT, Lin CC, Lin HC. Pneumonia and pregnancy outcomes: a nationwide population-based study. Am J Obstet Gynecol. 2012;207(4):288.-e1-7.##Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;63(6):425-33.##Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7.##Centers for disease control and prevention. Coronavirus disease 2019 (COVID-19) [Internet]. Geneva: Centers for disease control and prevention. If you are pregnant, breastfeeding, or caring for young children. 2020, June 09 [cited 2020 Jun 10]; [about 10 screens]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html##Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.##Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018;23(2):60-3.##Gidlöf S, Savchenko J, Brune T, Josefsson H. COVID-19 in pregnancy with comorbidities: more liberal testing strategy is needed. Acta Obstet Gynecol Scand. 2020 Apr 6. [Epub ahead of print].##Huang JW, Zhou XY, Lu SJ, Xu Y, Hu JB, Huang ML, et al. Dialectical behavior therapy-based psychological intervention for woman in late pregnancy and early postpartum suffering from COVID-19: a case report. J Zhejiang Univ Sci B. 2020;21(5):394-9.##Iqbal SN, Overcash R, Mokhtari N, Saeed H, Gold S, Auguste T, et al. An uncomplicated delivery in a patient with COVID-19 in the United States. N Engl J Med. 2020;382(16):e34.##Kalafat E, Yaprak E, Cinar G, Varli B, Ozisik S, Uzun C, et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol. 2020;55(6):835-7.##Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed patient. Korean J Anesthesiol. 2020 Mar 31. [Epub ahead of print].##Liao X, Yang H, Kong J, Yang H. Chest CT findings in a pregnant patient with 2019 novel coronavirus disease. Balkan Med J. 2020;37(4):226-8.##Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020 Mar 4. [Epub ahead of print].##Li Y, Zhao R, Zheng S, Chen X, Wang J, Sheng X, et al. Early release-lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis. 2020;26(6):1335-6.##Khan S, Peng L, Siddique R, Nabi G, Xue M, Liu J, et al. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infect Control Hosp Epidemiol. 2020;41(6):748-50.##Liu W, Wang Q, Zhang Q, Chen L, Chen J, Zhang B, et al. Coronavirus disease 2019 (COVID-19) during pregnancy: a case series. Preprints 2020, 2020020373.##Khan S, Jun L, Siddique R, Li Y, Han G, Xue M, et al. Association of COVID-19 with pregnancy outcomes in health-care workers and general women. Clin Microbiol Infect. 2020;26(6):788-90.##Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-15.##Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants born to mothers with a new coronavirus (COVID-19). Front Pediatr. 2020 Mar 16;8:104.##Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020;67(6):655-63.##Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020;323(18):1846-8.##Xiong X, Wei H, Zhang Z, Chang J, Ma X, Gao X, et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID19. J Med Virol. 2020 Apr 10;10.1002/jmv.25857. [Epub ahead of print].##Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. 2020 Feb 28;ciaa200. [Epub ahead of print].##Wang S, Guo L, Chen L, Liu W, Cao Y, Zhang J, et al. A case report of neonatal 2019 coronavirus disease in China. Clin Infect Dis. 2020 Mar 12;cia225. [Epub ahead of print].##Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020;323(18):1848-9.##Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51-60.##Zamaniyan M, Ebadi A, Aghajanpoor Mir S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn. 2020 Apr 17;10.1002/pd.5713. [Epub ahead of print].##Ashraf MA, Shokouhi N, Shirali E, Davari-tanha F, Memar O, Kamalipour A, et al. COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes. medRxiv. 2020 Jan 1. [Epub ahead of print].##Mimouni F, Lakshminrusimha S, Pearlman SA, Raju T, Gallagher PG, Mendlovic J. Perinatal aspects on the covid-19 pandemic: a practical resource for perinatal–neonatal specialists. J Perinatol. 2020;40(5):820-6.##COVID-19 situation reports [Internet]. Who.int. 2020 [cited 8 June 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports##Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.##Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020;9(1):386-9.##Muhidin S, Moghadam ZB, Vizheh M. Analysis of maternal coronavirus infections and neonates born to mothers with 2019-nCoV; a systematic review. Arch Acad Emerg Med. 2020;8(1):e49.##Parazzini F, Bortolus R, Mauri PA, Favilli A, Gerli S, Ferrazzi E. Delivery in pregnant women infected with SARS-CoV-2: a fast review. Int J Gynecol Obstet. 2020;150(1):41-6.##Revel MP, Parkar AP, Prosch H, Silva M, Sverzellati N, Gleeson F, et al. COVID-19 patients and the radiology department–advice from the European society of radiology (ESR) and the european society of thoracic imaging (ESTI). Eur Radiol. 2020 Apr 20:1-7. [Epub ahead of print]. ##Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med. 2020 Mar 17. [Epub ahead of print].##Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei province]. Zhonghua Fu Chan Ke Za Zhi. 2020;55(3):166-71.##Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, et al. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med. 2020 Apr 17;NEJMc2009226. [Epub ahead of print].##Rasmussen SA, Kissin DM, Yeung LF, MacFarlane K, Chu SY, Turcios-Ruiz RM, et al. Preparing for influenza after 2009 H1N1: special considerations for pregnant women and newborns. Am J Obstet Gnecol. 2011;204(6 Suppl 1):S13-20.##Mirzadeh M, Khedmat L. Pregnant women in the exposure to COVID-19 infection outbreak: the unseen risk factors and preventive healthcare patterns. J Matern Fetal Neonatal Med. 2020 Apr 7:1-2. [Epub ahead of print].##Lam CM, Wong SF, Leung TN, Chow KM, Yu WC, Wong TY, et al. A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome. BJOG. 2004;111(8):771-4.##Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol. 2020;55(5):586-92.##Lu Q, Shi Y. Coronavirus disease (COVID-19) and neonate: what neonatologist need to know. J Med Virol. 2020 Mar 1;10.1002/jmv.25740. [Epub ahead of print].##Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol. 2020;39(3):246-250.##Panahi L, Amiri M, Pouy S. Risks of novel coronavirus disease (COVID-19) in pregnancy; a narrative review. Arch Acad Emerg Med. 2020;8(1):e34.##Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020 Apr 7;10.1111/aogs.13867. [Epub ahead of print].##Maleki Dana P, Kolahdooz F, Sadoughi F, Moazzami B, Chaichian S, Asemi Z. COVID-19 and pregnancy: a review of current knowledge. Infez Med. 2020;28(suppl 1):46-51.##Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, Arian SE, et al. Maternal death due to COVID-19. Am J Obstet Gynecol. 2020;S0002-9378(20)30516-0. [Epub ahead of print].##

The Anti-Inflammatory Effect of Octyl Gallate Through Inhibition of Nuclear Factor-κB (NF-κB) Pathway in Rat Endometriosis Model 2 1 2 Background: Endometriosis is a chronic inflammatory condition associated with an increased risk of epithelial ovarian cancer. Our previous studies found that the anti-inflammatory effect of octyl gallate in endometriosis cell culture was more effective than gallic acid and heptyl gallate. This study aimed to analyze the anti-inflammatory effect of octyl gallate in rat endometriosis model. Methods: Thirty female Wistar rats were randomly divided into three groups. Group I was the sham-operated group, group II was the surgically-induced group, whereas group III was the surgically-induced group and each rat was administered with 20 mg of octyl gallate dissolved in 1 ml Na-CMC via oral gavage once a day for 30 days. When all rats were euthanized, the endometrial tissue from group I and last two groups were collected for further analysis. TNF-α levels were measured using Luminex, while non-phosphorylated NF-κB and COX-2 levels were analyzed using ELISA. Results: The average of non-phosphorylated NF-κB levels in group III (4.970±0.971 pg/mgP) was significantly higher than group II (3.97±0.656 pg/mgP). Moreover, the proportion of rats with the high level of non-phosphorylated NF-κB in group III was 45.6% higher than group II (p<0.05). The proportion of rats with the high level of COX-2 in group III was 22.3% lower than group II (p<0.05). However, there was no significant difference in TNF-α levels between all groups. Conclusion: The anti-inflammatory effect of octyl gallate may has effects in NF-κB activation and reduction of COX-2 levels in rat endometriosis model. 169 176 Arleni A Bustami Integrated Laboratory of Medical Faculty, Universitas Indonesia Integrated Laboratory of Medical Faculty, Universitas Indonesia Indonesia arleni.ab@gmail.com Wahyu WP Lestari Master Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia Master Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia Indonesia Cicilia CF Hayuningrum Departement of Parasitology, Faculty of Medicine, Universitas Indonesia Departement of Parasitology, Faculty of Medicine, Universitas Indonesia Indonesia Heri H Wibowo Integrated Laboratory of Medical Faculty, Universitas Indonesia Integrated Laboratory of Medical Faculty, Universitas Indonesia Indonesia Puspita PE Wuyung Departement of Pathology Anatomy, Faculty of Medicine, Universitas Indonesia Departement of Pathology Anatomy, Faculty of Medicine, Universitas Indonesia Indonesia R. Muharam RM Natadisastra Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital Indonesia Chronic inflammationCOX-2EndometriosisNF-κBOctyl gallate 80077.pdf Sacco K, Portelli M, Pollaco J, Schembri-Wismayer P, Calleja-Agius J. The role of prostaglandin E2 in endometriosis. Gynecol Endocrinol. 2012;28(2):134-8.##Ahn SH, Monsanto SP, Miller C, Singh SS, Thomas R, Tayade C. Pathophysiology and immune dysfunction in endometriosis. Biomed Res Int. 2015:1-12.##De Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010;376(9742):730-8.##Stilley JA, Birt JA, Sharpe-Timms KL. Cellular and molecular basis for endometriosis-associated infertility. Cell Tissue Res. 2012;349(3):849-62.##Kalinski P. Regulation of immune response by prostaglandin E2. J Immunol. 2012;188(1):21-8.##Fujikawa M, Ibuki T, Matsumura K, Sawa T. Inflammatory hyperalgesia: the role of prostaglandin system in the spinal cord. Adv Neuroimmune Biol. 2012;3(2):197-207.##Das ND, Das A, Chai YG. The anti-oxidative and anti-inflammatory roles of gallic acid on transcriptional regulation. In: Thompson MA, Collins PB, editors. Handbook on gallic acid. New York: Nova Science Publishers, Inc.; 2013.##Bustami A, Dachniar H, Adyasa ZM, Nareswari SS, Sopiah P, Arsianti A, et al. The apoptotic effect of gallic acid and its derivatives on primary cultured endometriosis cells. Adv Sci Lett. 2017;23(7):6697-700.##Bustami A, Utami FS, Budiarti R, Wibowo H. Interleukin-1β and cyclooxygenase-2 proinflammation analysis and in silico docking nuclear factor kappa B on endometriosis cell culture given heptyl gallate and octyl gallate treatment. Asian J Pharm Clin Res. 2019;12(2):503-6.##Bustami A, Nareswari SS, Sopiah PP, Zoya MA, Ade A, Muharram R. Cell viability inhibition effect of gallic acid and it synthethic derivative forms on primary cultured endometriosis cells. Adv Sci Lett. 2017;23(7):6681-4.##Fischer OM, Kaufmann-Reiche U, Moeller C, Fuhrmann U. Effects of dienogest on surgically induced endometriosis in rats after repeated oral administration. Gynecol Obstet Invest. 2011;72(3):145-51.##Oeckinghaus A, Ghosh S. The NF-ĸB family of transcription factors and its regulation. Cold Spring Harb Perspect Biol. 2009;1(4):a000034.##Liu T, Zhang L, Joo D, Sun SC. NF-κB signalling in inflammation. Signal Transduct Target Ther. 2017;2, pii: 17023.##Kaponis A, Iwabe T, Taniguchi F, Ito M, Deura I, Decavalas G, et al. The role of NF-kappaB in endometriosis. Front Biosci (Schol Ed). 2012;4:1213-234.##McKinnon BD, Kocbek V, Nirgianakis K, Bersinger NA, Mueller MD. Kinase signalling pathways in endometriosis: potential targets for non-hormonal therapeutic. Hum Reprod Update. 2016;22(3):382-403.##Cho YJ, Lee SH, Par JW, Han M, Park MJ, Han SJ. Dysfunctional signaling underlying endometriosis: current state of knowledge. J Mol Endocrinol. 2018;60(3):R97-R113.##Yahfoufi N, Alsadi N, Jambi M, Matar C. The immunomudulatory and anti-inflammatory role of polyphenols. Nutrients. 2018;10(11). Pii: E1618.##Wei G, Wu Y, Gao Q, Shen C, Chen Z, Wang K, et al. Gallic acid attenuates postoperative intra-abdominal adhesion by inhibiting inflammatory reaction in a rat model. Med Sci Monit. 2018;24:827-38.##Karimi-Khouzani O, Heidarian E, Amini SA. Anti-inflmmatory and ameliorative effect of gallic acid on fluoxetine-induced oxidative stress and liver damage in rats. Pharmacol Reports. 2017;69(4):830-5.##Kim SH, Jun CD, Suk K, Choi BJ, Lim H, Park S, et al. Gallic acid inhibits histamine release and pro-inflammatory cytokine production in mast cells. Toxicol Sci. 2006;91(1):123-31.##Jiang DX, Zhang MH, Zhang Q, Chen YS, Ma WJ, Wu WP, et al. Influence of gallic acid on porcine neutrophils phosphodiesterase 4, IL-6, TNF-α and rat arthritis model. J Intgr Agr. 2015;14(4):758-64.##Mori T, Koyama N, Tan J, Segawa T, Maeda M, Town T. Combination therapy with octyl gallate and ferulic acid improves cognition and neurodegeneration in a transgenic mouse model of Alzheimer’s disease. J Biol Chem. 2017;292(27):11310-25.##

Embryo Banking with Mild Ovarian Stimulation for IVF: An Alternative Strategy for Poor Prognosis Patients 2 1 2 Background: Management of Poor Ovarian Reserve (POR) in in vitro fertilization remains a difficult challenge. The purpose of this retrospective cohort study was to compare the effectiveness of embryo banking strategy over a cohort of several mild stimulation cycles (Embryo Banking Strategy for Poor Prognosis/Embargo) to conventional full-dose antagonist protocol for IVF. Methods: Subjects identified as having poor ovarian response (POR) based on the Bologna criteria were recruited. In total, there were 113 subjects included in the analysis. Fifty-three subjects underwent embryo banking procedure (Embargo) protocol, and sixty subjects underwent the conventional full-dose antagonist protocol for IVF. The Chi-square test was used to compare the clinical pregnancy rate, miscarriage rate as well as live birth rate, while the Mann-Whitney U test was utilized to analyze the cost per clinical pregnancy between the two groups. A p<0.05 was considered statistically significant. Results: The two studied groups showed similar outcomes regarding clinical pregnancy rate, miscarriage rate, as well as live birth rate (p=0.966, p=0.310, and p=0.469, respectively). Cost analysis of subjects who underwent mild ovarian stimulation followed by Embargo revealed the high cost of the protocol compared to conventional full-dose antagonist protocol ($10.507±6.181 vs. $9.533±2.530, p=0.002). Conclusion: The clinical outcomes of both protocols were comparable. Embargo procedure was not efficient in improving the overall clinical outcomes in patients who were expected poor ovarian responders as the protocol costed more comparing with conventional full-dose antagonist protocol. A larger prospective randomized control trial is needed to evaluate this finding. 176 183 Ivan I Sini Morula IVF Jakarta Clinic Morula IVF Jakarta Clinic Indonesia ivansini@morulaivf.co.id Arie A AA Polim Morula IVF Jakarta Clinic Morula IVF Jakarta Clinic Indonesia Nining N Handayani Morula IVF Jakarta Clinic Morula IVF Jakarta Clinic Indonesia Adinda A Pratiwi Morula IVF Jakarta Clinic Morula IVF Jakarta Clinic Indonesia Rosalina R Thuffi Morula IVF Jakarta Clinic Morula IVF Jakarta Clinic Indonesia Nuraeni N Yusup Morula IVF Jakarta Clinic Morula IVF Jakarta Clinic Indonesia Arief A Boediono Morula IVF Jakarta Clinic Morula IVF Jakarta Clinic Indonesia Embryo freezingIn Vitro FertilizationMild ovarian stimulationPoor ovarian response 60083.pdf Reed BG, Babayev SN, Bukulmez O. Shifting paradigms in diminished ovarian reserve and advanced reproductive age in assisted reproduction: Customization instead of conformity. Semin Reprod Med. 2015;33(3):169-78.##Cobo A, Garrido N, Crespo J, José R, Pellicer A. Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod Biomed Online. 2012;24(4):424-32.##Ubaldi FM, Rienzi L, Ferrero S, Baroni E, Sapienza F, Cobellis L, et al. Management of poor responders in IVF. Reprod Biomed Online. 2005;10(2):235-46.##Loutradis D, Drakakis P, Vomvolaki E, Antsaklis A. Different ovarian stimulation protocols for women with diminished ovarian reserve. J Assist Reprod Genet. 2007;24(12):597-611.##Jirge PR. Poor ovarian reserve. J Hum Reprod Sci. 2016;9(2):63-9.##Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update. 2013;19(1):26-36.##van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update. 2010;16(6):577-89.##Revelli A, Chiadò A, Dalmasso P, Stabile V, Evangelista F, Basso G, et al. “Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial. J Assist Reprod Genet. 2014;31(7):809-15.##Tarlatzis BC, Zepiridis L, Grimbizis G, Bontis J. Clinical management of low ovarian response to stimulation for IVF: a systematic review. Hum Reprod Update. 2003;9(1):61-76.##Siristatidis C, Salamalekis G, Dafopoulos K, Basios G, Vogiatzi P, Papantoniou N. Mild versus conventional ovarian stimulation for poor responders undergoing IVF/ICSI. In Vivo. 2017;31(2):231-7.##Bastu E, Buyru F, Ozsurmeli M, Demiral I, Dogan M, Yeh J. A randomized, single-blind, prospective trial comparing three different gonadotropin doses with or without addition of letrozole during ovulation stimulation in patients with poor ovarian response. Eur J Obstet Gynecol Reprod Biol. 2016;203:30-4.##Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, et al. A randomized single-blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: a preliminary report. Hum Reprod. 2004;19(9):2031-5.##Deb S, Campbell BK, Clewes JS, Pincott-Allen C, Raine-Fenning NJ. Intracycle variation in number of antral follicles stratified by size and in endocrine markers of ovarian reserve in women with normal ovulatory menstrual cycles. Ultrasound Obstet Gynecol. 2013;41(2):216-22.##Alper MM, Fauser BC. Ovarian stimulation protocols for IVF: is more better than less? Reprod Biomed Online. 2017;34(4):345-53.##Racowsky C, Stern JE, Gibbons WE, Behr B, Pomeroy KO, Biggers JD. National collection of embryo morphology data into society for assisted reproductive technology clinic outcomes reporting system: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate. Fertil Steril. 2011;95(6):1985-9.##Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The international glossary on infertility and fertility care, 2017. Hum Reprod. 2017;32(9):1786-801.##Karande V, Gleicher N. A rational approach to the management of low responders in in-vitro fertilization. Hum Reprod. 1999;14(7):1744-8.##Shrestha D, La X, Feng HL. Comparison of different stimulation protocols used in in vitro fertilization: a review. Ann Transl Med. 2015;3 (10):137.##Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C. Clinical rationale for cryopreservation of entire embryo cohorts in lieu of fresh transfer. Fertil Steril. 2014;102(1):3-9.##Çelik S, Turgut NE, Cengiz Çelik D, Boynukalın K, Abalı R, Purisa S, et al. The effect of the pooling method on the live birth rate in poor ovarian responders according to the Bologna criteria. Turk J Obstet Gynecol. 2018;15(1):39-45.##

Distribution of Human Papillomavirus and Antisperm Antibody in Semen and Its Association with Semen Parameters Among Infertile Men 2 1 2 Background: Sexually transmitted infections (STIs) can be associated with infertility. Human papillomavirus (HPV) has been identified as a potential agent in male infertility. Also, anti-sperm antibodies (ASA) have been detected in men with infertility. The aim of this study was to investigate the prevalence and association of HPV and ASA in infected semen of infertile men. Methods: This cross-sectional study was performed on 96 infertile men referring to infertility treatment center of Kashan University of Medical Sciences during March 2017 till September 2017 in Iran. Semen analysis and diagnostic PCR test were performed for detection of HPV DNA. The semen parameters in HPV infected and ASA positive samples were compared with HPV non-infected and ASA negative samples. Chi square test was used to determine the correlation between variables and p<0.05 was considered statistically significant. Results: HPV DNA and ASA were detected in 17.4% and 15.2% of 96 semen samples, respectively. Semen volume, sperm count, sperm motility and the normal morphology rate were significantly decreased in HPV-positive subjects (p=0.004, p= 0.016, p<0.001, and p=0.017, respectively). Also, sperm motility was significantly decreased in ASA-positive subjects (p=0.002), also patients with HPV infection had a higher rate of ASA than the non-HPV group. In contrast to ASA, HPV infection had a significant correlation with education level (p=0.039). Conclusion: The findings suggest that asymptomatic seminal infection of HPV and ASA by adversely affecting sperm quality, in particular sperm motility and count, may play an important role in male infertility. 183 189 Ahmad A Piroozmand Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences Iran Seyed Dawood SD Mousavi Nasab Department of Research and Development, Production and Research Complex, Pasteur Institute of Iran Department of Research and Development, Production and Research Complex, Pasteur Institute of Iran Iran Mahzad M Erami Beheshti Hospital, Kashan University of Medical Sciences Beheshti Hospital, Kashan University of Medical Sciences Iran Seyed Mohammad Ali SMA Hashemi Department of Virology, School of Medicine, Golestan University of Medical Sciences Department of Virology, School of Medicine, Golestan University of Medical Sciences Iran Elnaz E Khodabakhsh Infertility Clinic, Shahid Beheshti Hospital, Kashan University of Medical Sciences Infertility Clinic, Shahid Beheshti Hospital, Kashan University of Medical Sciences Iran Nayebali N Ahmadi Proteomics Research Center, Shahid Beheshti University of Medical Sciences Proteomics Research Center, Shahid Beheshti University of Medical Sciences Iran Zahra Z Vahedpoor Obstetrics and Gynecology Department, Kashan University of Medical Sciences Obstetrics and Gynecology Department, Kashan University of Medical Sciences Iran zahravahedpoor@gmail.com Antisperm antibodyHPVMale infertilitySemen parameter 60078.pdf Murray KS, James A, McGeady JB, Reed ML, Kuang WW, Nangia AK. The effect of the new 2010 world health organization criteria for semen analyses on male infertility. Fertil Steril. 2012;98(6):1428-31.##Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World health organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231-45.##Chaudhury K, Das T, Chakravarty B, Bhattacharyya AK. Acrosin activity as a potential marker for sperm membrane characteristics in unexplained male infertility. Fertil Steril. 2005;83(1):104-9.##Ashrafi Hafez A, Ahmadi Vasmehjani A, Baharlou R, Mousavi Nasab SD, Davami MH, Najafi A, et al. Analytical assessment of interleukin- 23 and -27 cytokines in healthy people and patients with hepatitis C virus infection (genotype 1 and 3a). Hepat Mon. 2014;14(9):e21000.##Bezold G, Schuster-Grusser A, Lange M, Gall H, Wolff H, Peter RU. Prevalence of human herpesvirus types 1–8 in the semen of infertility patients and correlation with semen parameters. Fertil Steril. 2001;76(2):416-8.##Kapranos N, Petrakou E, Anastasiadou C, Kotronias D. Detection of herpes simplex virus, cytomegalovirus, and Epstein-Barr virus in the semen of men attending an infertility clinic. Fertil Steril. 2003;79 Suppl 3:1566-70.##Dejucq N, Jégou B. Viruses in the mammalian male genital tract and their effects on the reproductive system. Microbiol Mol Biol Rev. 2001;65(2):208-31.##Pekler VA, Robbins WA, Nyamathi A, Yashina TL, Leak B, Robins TA. Use of versant TMA and bDNA 3.0 assays to detect and quantify hepatitis C virus in semen. J Clin Lab Anal. 2003;17(6):264-70.##Neofytou E, Sourvinos G, Asmarianaki M, Spandidos DA, Makrigiannakis A. Prevalence of human herpes virus types 1-7 in the semenof men attending an infertility clinic and correlation with semen parameters. Fertil Steril. 2009;91(6):2487-94.##Pellati D, Mylonakis I, Bertoloni G, Fiore C, Andrisani A, Ambrosini G, et al. Genital tract infections and infertility. Eur J Obstet Gynecol Reprod Biol. 2008;140(1):3-11.##Mostafa T. Cigarette smoking and male infertility. J Adv Res. 2010;1(3):179-86.##Yang Y, Jia CW, Ma YM, Zhou LY, Wang SY. Correlation between HPV sperm infection and male infertility. Asian J Androl. 2013;15(4):529-32.##Garolla A, Pizzol D, Bertoldo A, De Toni L, Barzon L, Foresta C. Association, prevalence, and clearance of human papillomavirus and antisperm antibodies in infected semen samples from infertile patients. Fertil Steril. 2013;99(1):125-31.##World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge, UK: Cambridge University Press; 1999. 113 p.##Qu W, Jiang G, Cruz Y, Chang CJ, Ho GY, Klein RS, et al. PCR detection of human papillomavirus: comparison between MY09/MY11 and GP5 /GP6 primer systems. J Clin Microbiol. 1997;35(6):1304-10.##Piroozmand A, Mostafavi Zadeh SM, Madani A, Soleimani R, Nedaeinia R, Niakan M, et al. The association of high risk human papillomaviruses in patientswith cervical cancer: an evidence based study on patients with squamous cell dysplasia or carcinoma for evaluation of 23 human papilloma virus genotypes. Jundishapur J Microbiol. 2016;9(4):e32728.##Foresta C, Noventa M, De Toni L, Gizzo S, Garolla A. HPV-DNA sperm infection and infertility: from a systematicliterature review to a possible clinical management proposal. Andrology. 2015;3(2):163-73.##Nasseri S, Monavari SH, Keyvani H, Nikkhoo B, Vahabpour Roudsari R, Khazeni M. The prevalence of human papilloma virus (HPV) infection in theoligospermic and azoospermic men. Med J Islam Repub Iran. 2015;29:272.##Mostafavizadeh SM, Niakan M, Ahmadi A, Aghabozorgi S, Lak R, Azimi SA, et al. Frequency distribution of HPV18 based on the detection of E6 oncoprotein gene in cervix cancer samples. Feyz. 2013;17(3):287-93.##Flores-Sánchez I, Gutiérrez-Salinas J, Enriquez-Alvarado E, Hernández-Rodríguez S, Ramos-Barragán C, Salamanca-Ceciliano A, et al. [Detection of human papillomavirus types 16 and 18 in semen samples from patients in an assisted reproduction program]. Ginecol Obstet Mex. 2010;78(12):645-51. Spanish.##Ibrahim AI, Obeid MT, Jouma MJ, Moasis GA, Al-Richane WL, Kindermann I, et al. Detection of herpes simplex virus, cytomegalovirus and Epstein-Barr virus DNA in atherosclerotic plaques and in unaffected bypass grafts. J Clin Virol. 2005;32(1):29-32.##Luttmer R, Dijkstra MG, Snijders PJ, Jordanova ES, King AJ, Pronk DTM, et al. Presence of human papillomavirus in semen of healthy men is firmly associated with HPV infections of the penile epithelium. Fertil Steril. 2015;104(4):838-44.e8.##Moghimi M, Zabihi-Mahmoodabadi S, Kheirkhah-Vakilabad A, Kargar Z. Significant correlation between high-risk HPV DNA in semen and impairment of sperm quality in infertile men. Int J Fertil Steril. 2019;12(4):306-9.##Giuliano AR, Lazcano-Ponce E, Villa LL, Flores R, Salmeron J, Lee JH, et al. The human papillomavirus infection in men study: humanpapillomavirus prevalence and type distribution among men residing in Brazil, Mexico, and the United States. Cancer Epidemiol Biomarkers Prev. 2008;17(8):2036-43.##Lazcano-Ponce E, Herrero R, Muñoz N, Hernandez-Avila M, Salmerón J, Leyva A, et al. High prevalence of human papillomavirus infection in Mexican males: comparative study of penile-urethral swabs and urine samples. Sex Transm Dis. 2001;28(5):277-80.##Lajous M, Mueller N, Cruz-Valdéz A, Aguilar LV, Franceschi S, Hernández-Avila M, et al. Determinants of prevalence, acquisition, and persistence of human papillomavirus in healthy Mexican military men. Cancer Epidemiol Biomarkers Prev. 2005;14(7):1710-6.##Yang L, Xie S, Feng X, Chen Y, Zheng T, Dai M, et al. Worldwide prevalence of human papillomavirus and relative risk of prostate cancer: a meta-analysis. Sci Rep. 2015;5:14667.##Moscicki AB, Palefsky JM. Human papillomavirus in men: an update. J Low Genit Tarct Dis. 2011;15(3):231-4.##Luttmer R, Dijkstra MG, Snijders PJ, Hompes PG, Pronk DT, Hubeek I, et al. Presence of human papillomavirus in semen in relation to semen quality. Hum Reprod. 2016;31(2):280-6.##Cai T, Wagenlehner FM, Mondaini N, D'Elia C, Meacci F, Migno S, et al. Effect of human papillomavirus and C hlamydia trachomatis co‐infection on sperm quality in young heterosexual men with chronic prostatitis‐related symptoms. BJUI Int. 2014;113(2):281-7.##Gizzo S, Ferrari B, Noventa M, Ferrari E, Patrelli TS, Gangemi M, et al. Male and couple fertility impairment due to HPV-DNAsperm infection: update on molecular mechanism and clinical impact--systematic review. Biomed Res Int. 2014;2014:230263.##Brossfield JE, Chan PJ, Patton WC, King A. Tenacity of exogenous human papillomavirus DNA in sperm washing. J Assist Reprod Genet. 1999;16(6):325-8.##Garolla A, Pizzol D, Foresta C. The role of human papillomavirus on sperm function. Curr Opin Obstet Gynecol. 2011;23(4):232-7.##Rintala MA, Greénman SE, Pöllänen PP, Suominen JJ, Syrjänen SM. Detection of high-risk HPV DNA in semenand its association with the quality of semen. Int J STD AIDS. 2004;15(11):740-3.##Adeghe JH. Male subfertility due to sperm antibodies: a clinical overview. Obstet Gynecol Surv. 1992;48(1):1-8.##Ayvaliotis B, Bronson R, Rosenfeld D, Cooper G. Conception rates in couples where autoimmunity to sperm is detected. Fertil Steril. 1985;43(5):739-42.##Sinisi AA, Di Finizio B, Pasquali D, Scurini C, D'Apuzzo A, Bellastella A. Prevalence of antisperm antibodies by Sperm MAR test in subjects undergoing a routine sperm analysis for infertility. Int J Androl. 1993;16(5):311-4.##Mazumdar S, Levine AS. Antisperm antibodies: etiology, pathogenesis, diagnosis, and treatment. Fertil Steril. 1998;70(5):799-810.##Cui D, Han G, Shang Y, Liu C, Xia L, Li L, et al. Antisperm antibodies in infertile men and their effect on semen parameters: a systematic review and meta-analysis. Clin Chim Acta. 2015;444:29-36.##Perino A, Giovannelli L, Schillaci R, Ruvolo G, Fiorentino FP, Alimondi P, et al. Human papillomavirus infection in couples undergoing in vitro fertilization procedures: impact on reproductive outcomes. Fertil Steril. 2011;95(5):1845-8.##

Study of Relationship Between Mode of Conception and Non-Specific Psychological Distress in Women Undergoing Noninvasive Prenatal Testing 2 1 2 Background: Noninvasive prenatal testing (NIPT) has been performed worldwide to detect common fetal chromosomal aneuploidies. Methods: Pregnant women (n=3743) with advanced maternal age who visited Nagoya University for NIPT were enrolled in this study. The K6 mental stress scores, that is non-specific psychological distress scores were obtained by questionnaires which were administered pre-NIPT and postpartum. High K6 scores (10) indicate anxiety or depression. The K6 stress scores at pre-NIPT and postpartum were evaluated about the relationship between mode of conception and non-specific psychological distress using binomial logistic regression. Results: In general, 7.5% of pre-NIPT women (179/2393) and 5.1% of postpartum women (121/n) were found with high K6 scores. They also did not differ significantly based on maternal age, previous live birth, previous miscarriage, and mode of conception, i.e., natural conception, artificial insemination with husband (AIH), or assisted reproductive technology (ART). Moreover, the prenatal K6 scores were not significantly higher than those at postpartum. Conclusion: Our present data suggest that mental distress in women undergoing NIPT during pregnancy and after birth has no statistical relationship with maternal age, previous live birth, previous miscarriage, or infertility treatment, and continuous mental care may help reduce mental distress in the postpartum period. 189 194 Nobuhiro N Suzumori Department of Obstetrics and Gynecology, Nagoya City University Hospital Department of Obstetrics and Gynecology, Nagoya City University Hospital Japan og.n.suz@med.nagoyacu.ac.jp Eri E Takeda Department of Obstetrics and Gynecology, Nagoya City University Hospital Department of Obstetrics and Gynecology, Nagoya City University Hospital Japan Takeshi T Ebara Department of Occupational and Environmental Health, Nagoya City University Hospital Department of Occupational and Environmental Health, Nagoya City University Hospital Japan Kyoko K Kumagai Department of Obstetrics and Gynecology, Nagoya City University Hospital Department of Obstetrics and Gynecology, Nagoya City University Hospital Japan Yuki Y Sawada Department of Obstetrics and Gynecology, Nagoya City University Hospital Department of Obstetrics and Gynecology, Nagoya City University Hospital Japan Mayumi M Sugiura-Ogasawara Department of Obstetrics and Gynecology, Nagoya City University Hospital Department of Obstetrics and Gynecology, Nagoya City University Hospital Japan ARTDepressionInfertilityNIPTPrenatal diagnosis 80084.pdf Norton ME, Jacobsson B, Swamy GK, Laurent LC, Ranzini AC, Brar H, et al. Cell-free DNA analysis for noninvasive examination of trisomy. N Engl J Med. 2015;372(17):1589-97.##Bianchi DW, Chiu RWK. Sequencing of circulating cell-free DNA during pregnancy. N Engl J Med. 2018;379(5):464-73.##Abdalla O, Woods C, de Costa C. A clinical audit of combined first trimester screening and non-invasive prenatal testing offered to pregnant women in a regional Australian hospital. Aust N Z J Obstet Gynaecol. 2019;59(1):157-60.##Sago H, Sekizawa A, Japan NIPT Consortium. Nationwide demonstration project of next-generation sequencing of cell-free DNA in maternal plasma in Japan: 1-year experience. Prenat Diagn. 2015;35(4):331-6.##Samura O, Sekizawa A, Suzumori N, Sasaki A, Wada S, Hamanoue H, et al. Current status of noninvasive prenatal testing in Japan. J Obstet Gynecol Res. 2017;43(8):1245-55.##Suzumori N, Ebara T, Yamada T, Samura O, Yotsumoto J, Nishiyama M, et al. Fetal cell-free DNA fraction in maternal plasma is affected by fetal trisomy. J Hum Genet. 2016;61(7):647-52.##Suzumori N, Ebara T, Kumagai K, Goto S, Yamada Y, Kamijima M, et al. Non-specific psychological distress in woman undergoing noninvasive prenatal testing because of advanced maternal age. Prenat Diagn. 2014;34(11):1055-60.##Takeda E, Suzumori N, Ebara T, Yotsumoto J, Kumagai K, Oseto K, et al. Psychological distress in post-partum women after non-invasive prenatal testing (NIPT) in Japan. J Obstet Gynaecol Res. 2018;44(1):35-42.##Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959-76.##Stanhiser J, Steiner AZ. Psychosocial aspects of fertility and assisted reproductive Technology. Obstet Gynecol Clin North Am. 2018;45(3):563-74.##Hassold T, Hunt P. Maternal age and chromosomally abnormal pregnancies: what we know and what we wish we knew. Curr Opin Pediatr. 2009;21(6):703-8.##Allyse MA, Sayres LC, Havard M, King JS, Greely HT, Hudgins L, et al. Best ethical practices for clinicians and laboratories in the provision of noninvasive prenatal testing. Prenat Diagn. 2013;33(7):656-61.##Lo KK, Karampetsou E, Boustred C, McKay F, Mason S, Hill M, et al. Limited clinical utility of non-invasive prenatal testing for subchromosomal abnormalities. Am J Hum Genet. 2016;98(1):34-44.##Zhang J, Li J, Saucier JB, Feng Y, Jiang Y, Sinson J, et al. Non-invasive prenatal sequencing for multiple Mendelian monogenic disorders using circulating cell-free fetal DNA. Nat Med. 2019;25(3):439-47.##Ghaedrahmati M, Kazemi A, Kheirabadi G, Bahrami M, Ebrahimi A. Examining the relationship between mothers' prenatal mental health and demographic factors with postpartum depression. J Educ Health Promot. 2018;7:146.##Massarotti C, Gentile G, Ferreccio C, Scaruffi P, Remorgida V, Anserini P. Impact of infertility and infertility treatments on quality of life and levels of anxiety and depression in women undergoing in vitro fertilization. Gynecol Endocrinol. 2019;35(6):485-9.##

The Effect of Theory-Based HIV/AIDS Educational Program on Preventive Behaviors Among Female Adolescents in Tehran: A Randomized Controlled Trial 2 1 2 Background: Adolescents are increasingly at risks of HIV infection through high-risk sexual behaviors. This paper aimed to assess the effectiveness of a HIV/AIDS educational intervention among female adolescents in Tehran. Methods: A randomized controlled trial was conducted among high school girls aged 12-16 years studying in Tehran in 2016-17. The sample was selected using multistage random cluster sampling. Four schools per district were randomly selected using probability-proportional to size. Adolescents were randomly assigned to the experimental (n=289) and the control (n=289) groups. The theory of planned behavior (TPB) was the basis of both the intervention and the evaluation phase. Both experimental and control groups completed a questionnaire designed for HIV related behaviors for female adolescents (HBQFA) at baseline and after six months follow up. A theory-based educational program was implemented for the experimental group. Results: The mean age of participants was 14.1 years (SD=0.96). In the experimental group, significant improvements were shown in adolescents’ HIV knowledge (31.9%, 95% CI: 28.8-35.0), attitudes towards HIV (16.6%, 95% CI=14.4-18.8), subjective norm (16.8%, 95% CI=12.9-20.6) and perceived behavioral control (19.1%, 95% CI=16.2-22.1), perceived parental support (17%, 95% CI=13.8-20.2), behavioral intention to prevent HIV (19%, 95% CI=16.3-21.6), and HIV preventive behavior (17.3%, 95% CI=13.9-20.6) (p<0.001). Conclusion: Theory-based educational intervention on HIV/AIDS prevention can significantly protect adolescents from misconceptions, wrong attitudes and risky behaviors and unsupportive social environment that expose them to greater HIV risk. Health policy -makers are advised to consider effective training programs related to HIV/AIDS prevention behaviors in the school system. 194 207 Farideh F Khalajabadi Farahani Department of Population and Health, National Population Studies and Comprehensive Management Institute Department of Population and Health, National Population Studies and Comprehensive Management Institute Iran Fatemeh F Darabi Department of Public Health, Asadabad School of Medical Sciences Department of Public Health, Asadabad School of Medical Sciences Iran fatemedarabi43@yahoo.com Mehdi M Yaseri Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences Iran AdolescentsEducationHIV/AIDSTheory of planned behavior 80074.pdf Statistical center of Iran [Internet]. Iran: Statistical center of Iran; 2016. Population and housing censuses; 2016 [Cited 2020 Apr 20]; [about 1 screen]. Available from: https://www.amar.org.ir/english/Population-and-Housing-Censuses.##Islamic republic of Iran. Islamic Republic of Iran AIDS Progress report: On monitoring of the united nations general assembly special session on HIV and AIDS. Tehran: National AIDS committee secretariat, ministry of health and medical education. 2012 Mar. 72 p.##Adeomi AA, Adeoye OA, Asekun-Olarinmoye EO, Abodunrin OL, Olugbenga-Bello AI, Sabageh AO. Evaluation of the effectiveness of peer education in improving HIV knowledge, attitude, and sexual behaviours among in-school adolescents in Osun State, Nigeria. AIDS Res Treat. 2014;2014:131756.##Darabi F, Yaseri M, Kaveh MH, Khalajabadi Farahani F, Majlessi F, Shojaeizadeh D. The effect of a theory of planned behavior-based educational intervention on sexual and reproductive health in Iranian adolescent girls: a randomized controlled trial. J Res Health Sci. 2017;17(4):e00400.##Stueve A, O'Donnell LN. Early alcohol initiation and subsequent sexual and alcohol risk behaviors among urban youths. Am J Public Health. 2005;95(5):887-93.##Boonstra HD. Progressive and pragmatic: the national sexuality education standards for US public schools. Guttmacher Policy Rev.2012;15(2):2-7.##Emmanuel F, Salim M, Akhtar N, Arshad S, Reza TE. Second-generation surveillance for HIV/AIDS in Pakistan: results from the 4th round of integrated behavior and biological survey 2011-2012. Sex Transm Infect. 2013;89 Suppl 3:iii23-8.##Peter J, Valkenburg PM. Adolescents’ exposure to sexually explicit internet material and sexual satisfaction: a longitudinal study. Hum Commun Res. 2009;35(2):171-94.##World Health Organization. WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users 2012 revision. Geneva: World Health Organization. 2012; 112 p.##Khalajabadi Farahani F, Akhondi M, Shirzad M, Azin A. HIV/STI risk-taking sexual behaviours and risk perception among male university students in Tehran: implications for HIV prevention among youth. J Bioscoc Sci. 2018;50(1):86-101.##Mohammad K, Khalajabadi Farahani F, Mohammadi MR, Alikhani S, Zare M, Tehrani FR, et al. Sexual risk-taking behaviours among boys aged 15-18 years in Tehran. J Adolesc Health. 2007;41 (4):407-14.##Khalajabadi Farahani F, Akhondi MM, Abbasi M. Knowledge on HIV and sexual transmission of HIV among male college students. Payesh. 2018;6:687-702.##Panjalipoue S, Bostani Khalesi Z, Mirhaghjoo SN. Iranian female adolescents’ reproductive health needs: a systematic review. Int J Women’s Health Reprod Sci. 2018;6(3):226-32.##Shariati M, Babazadeh R, Mousavi SA, Najmabadi KM. Iranian adolescent girls’ barriers in accessing sexual and reproductive health information and services: a qualitative study. J Fam Plann Reprod Health Care. 2014;40(4):270-5.##Abedian K, Shahhosseini Z. University students’ point of views to facilitators and barriers to sexual and reproductive health services. Int J Adolesc Med Health. 2014;26(3):387-92.##Tan X, Pan J, Zhou D, Wang C, Xie C. HIV/AIDS knowledge, attitudes and behaviors assessment of Chinese students: a questionnaire study. Int J Environ Res Public Health. 2007;4(3):248-53.##Zakiei A, Khazaie H, Komasi S. A more understanding about aids: design and assessment of validity and reliability of several new scales. J Caring Sci. 2019;8(4):249-56.##Alimoradi Z, Kariman N, Simbar M, Ahmadi F. Contributing factors to high-risk sexual behaviors among Iranian adolescent girls: a systematic review. Int J Community Based Nurs Midwifery. 2017;5(1):2-12.##Khalajabadi Farahani F. Exposure to sexual explicit materials (Pornography) in internet & cyber space and its influences on sexual behavior and interpersonal relationships among adolescents in tehran. J Fam Res. 2019;15(1):127-53.##Khalajabadi Farahani F, Mansson SA, Cleland J. Engage in or refrain from? a qualitative exploration of premarital sexual relations among female college students in Tehran. J Sex Res. 2019;56(8): 1009-22.##National AIDS committee secretariat, Ministry of Health and Medical Education. Latest statistics on AIDS in the Islamic Republic of Iran by the end of 2017. Iran: Ministry of health and medical education, office of infectious disease management; 2017. 72 p.##Darabi F, Kaveh MH, Majlessi F, Farahani FKA, Yaseri M, Shojaeizadeh D. Effect of theory-based intervention to promote physical activity among adolescent girls: a randomized control trial. Electronic Physician. 2017;9(4):4238-47.##Schwartländer B, Stover J, Hallett T, Atun R, Avila C, Gouws E, et al. Towards an improved investment approach for an effective response to HIV/AIDS. Lancet. 2011;377(9782):2031-41.##Anderssen N, Jacobs DR Jr, Aas H, Jakobsen R. Do adolescents and parents report each other's physical activity accurately? Scand J Med Sci Sports. 1995;5(5):302-7.##Olfati F, Aligholi S. A study on educational needs of teenager girls regarding the reproductive health and determination of proper strategies in achieving the target goals in Qazvin. J Qazvin Univ Med Sci. 2008;12(2):80-2.##Mirzaei K, Olfati F. Educational needs of adolescent girls for reproductive health in teachers views. J Qazvin Univ Med Sci. 2014;18 (2):67-76.##Cleland J, Verrall J, Vaessen M. Preferences for the sex of children and their influence on repro-ductive behaviour. 1st ed. Voorburg: International statistical institute; 1983. 46 p.##Darabi F, Khalajabadi Farahani F, Yaseri M. Psychometric analysis of the HIV behaviors questionnaire for female adolescents (HBQFA) in Iran. J Psychiatry. 2018;20(421):2.##Harvey B, Stuart J, Swan T. Evaluation of a dramain-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial. Int J STD AIDS. 2000;11(2):105-11.##Kaveh MH, Darabi F, Khalajabadi-Farahani F, Yaseri M, Kaveh MH, Mohammadi MJ, et al. The impact of a tpb-based educational intervention on nutritional behaviors in iranian adolescent girls: a randomized controlled trial. Fresenius Environ Bull. 2018;27(6):4349-56.##Gańczak M, Barss P, Alfaresi F, Almazrouei S, Muraddad A, Al-Maskari F. Break the silence: HIV/AIDS knowledge, attitudes, and educational needs among Arab university students in United Arab Emirates. J Adolesc Health. 2007;40(6):572. e1-8.##Jones V, Modeste N, Hopp Marshak H, Fox C. The effect of HIV/AIDS education on adolescents in Trinidad and Tobago. ISRN Infect Dis. 2013;2013: 1-8.##Gao X, Wu Y, Zhang Y, Zhang N, Tang J, Qiu J, et al. Effectiveness of school-based education on HIV/AIDS knowledge, attitude, and behavior among secondary school students in Wuhan, China. PLoS One. 2012;7(9):e44881.##Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211.##Bisallah CI, Rampal L, Lye MS, Sidik SM, Ibrahim N, Iliyasu Z, et al. Effectiveness of health education intervention in improving knowledge, attitude, and practices regarding Tuberculosis among HIV patients in general hospital Minna, Nigeria–a randomized control trial. PloS One. 2018;13(2): e0192276.##Albarracin D, Johnson BT, Fishbein M, Mueller leile PA. Theories of reasoned action and planned behavior as models of condom use: a meta- analysis. Psychol Bull. 2001;127(1):142-61.##Lal P, Nath A, Badhan S, Ingle GK. A study of awareness about HIV/AIDS among senior secondary school children of Delhi. Indian J Community Med. 2008;33(3):190-2.##

The Experience of Dutch Women Using a Coping Intervention for Oocyte Retrieval: A Qualitative Study 2 1 2 Background: Many women experience oocyte retrieval during an IVF treatment as a stressful and emotionally difficult situation. Women fear the pain as associated with oocyte retrieval. Based on the existing literature, a coping intervention for oocyte retrieval (CIFOR) was developed to deal with the stress and pain during oocyte retrieval. The objective of this study was to explore the experiences of women using coping intervention for oocyte retrieval (CIFOR) while undergoing oocyte retrieval. Methods: For this generic qualitative study, a purposeful sample of fifteen women was gathered from a university clinic in the Netherlands and each participant was interviewed. Background information about the IVF treatment was collected from medical files. Semi-structured interviews were performed approximately 15 min after the OR procedure. Data were analyzed using the Qualitative Analysis Guide of Leuven and processed using MAXQDA. Results: Twenty-five women were approached for this study between January and May 2018. This study identified five themes that were important in the experiences of women using CIFOR: highly valuing the CIFOR, feasible in daily practice, need for information, sense of control and partner’s involvement. Conclusion: Women highly valued the tool. They found CIFOR feasible in daily practice and it fulfilled their needs for information. In addition, women had a sense of control using the intervention. Future research will involve performing a pilot study according to the Medical Research Council framework with outcomes based on the patient’s sense of control, ability to cope, coping strategies, anxiety and pain. 207 217 Henrietta D.L. HDL Ockhuijsen Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht Netherland h.d.l.ockhuysen@umcutrecht.nl Ida I Ophorst Department of Children, Princes Maxima Centre and University Medical Centre Utrecht Department of Children, Princes Maxima Centre and University Medical Centre Utrecht Netherland Agnes A Van Den Hoogen Department of Neonatology, Wilhelmina Children's Hospital and University Medical Centre Utrecht Department of Neonatology, Wilhelmina Children's Hospital and University Medical Centre Utrecht Netherland AnxietyEarly interventionFertilization in vitroOocyte retrievalPainPsychological adaptation 80078.pdf World Health Organization. Sexual and reproductive health. Geneva: World Health Organization. 2012. Global prevalence of infertility, infecundity and childlessness. [cited 2020]; [about 1 screen]. Available from: http://www.who.int/reproductivehealth/topics/infertility/burden/en.##Van Asselt KM, Hinloopen RJ, Silvius AM, Van der Linden PJQ, Van Oppen CCAN, Van Balen JAM. NHG-Standaard Subfertiliteit [Internet]. Nederland: Nederland huisartsen genootschap. 2010 [cited 2020]; [about 3screen]. Available from: https://richtlijnen.nhg.org/standaarden/subfertiliteit#volledige-tekst.##European society of human reproduction and embryology. Workshops, symposia and training courses. Grimbergen, Belgium: ESHRE publication. Available from: https://www.eshre.eu/Publications/Textbooks-and-lecture-handouts.aspx.##Frederiksen Y, Mehlsen MY, Matthiesen SMS, Zachariae R, Ingerslev HJ. Predictors of pain during oocyte retrieval. J Psychosom Obstet Gynaecol. 2017;38(1):21-9.##Gejervall AL, Stener-Victorin E, Cerne A, Borg K, Bergh C. Pain aspects in oocyte aspiration for IVF. Reprod Biomed Online. 2007;14(2):184-90.##Stener-Victorin E. The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials. Hum Reprod. 2005;20(2):339-49.##Kwan I, Wang R, Pearce E, Bhattacharya S. Pain relief for women undergoing oocyte retrieval for assisted reproduction. Cochrane Database Syst Rev. 2018;5(5):CD004829.##Cheung CWC, Yee AWW, Chan PS, Saravelos SH, Chung JPW, Cheung LP, et al. The impact of music therapy on pain and stress reduction during oocyte retrieval-a randomized controlled trial. Reprod Biomed Online. 2018;37(2):145-52.##Newton, CR. Assisting patients to manage oocyte retrieval: American Society for reproductive Medicine. Presentation Post graduate Program Denver; 2010.##Lazarus RS, Folkman S. Stress, appraisal, and coping. 1st ed. New York: Springer; 2006. 376 p.##Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, et al. Developing and evaluating complex interventions: the new medical research council guidance. BMJ. 2008;29;337:a1655.##Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new medical research council guidance. Int J Nurs Stud. 2013;50(5):587-92.##Bleijenberg N, de Man-van Ginkel JM, Trappenburg JCA, Ettema RGA, Sino CG, Heim N, et al. Increasing value and reducing waste by optimizing the development of complex interventions: enriching the development phase of the medical research council (MRC) framework. Int J Nurs Stud. 2018;79:86-93.##Kahlke RM. Generic qualitative approaches: Pitfalls and benefits of methodological mixology. Int J Qual Methods. 2014;13(1):37-52.##Merriam SB. Qualitative research, a guide to design and implementation. 2nd ed. USA: Jossey-Bass publisher; 2009. 237 p.##Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health Ment Health. 2015;42(5):533-44.##Fusch PI, Ness LR. Are we there yet? data saturation in qualitative research. Qual Rep. 2015;20(9):1408-16.##de C Williams AC, Craig KD. Updating the definition of pain. Pain. 2016;157(11):2420-3.##Dierckx de Casterle B, Gastmans C, Bryon E, Denier Y. QUAGOL: a guide for qualitative data analysis. Int J Nurs Stud. 2012;49(3):360-71.##Holloway I, Wheeler S. Qualitative research in nursing and healthcare. 3rd ed. 2010. UK: John wiley & sons; 2010. 351 p.##Eldridge S, Bond C, Campbell M, Lancaster G, Thabane L, Hopwell S. Definition and reporting of pilot and feasibility studies. Trials. 2013;14(Suppl 1):O18.##Miller SM. Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. implications for cancer screening and management. Cancer. 1995;76(2):167-77.##van Zuuren FJ, Grypdonck M, Crevits E, Vande Walle C, Defloor T. The effect of an information brochure on patients undergoing gastrointestinal endoscopy: a randomized controlled study. Patient Educ Couns. 2006;64(1-3):173-82.##Folkman S. The Oxford handbook of stress, health, and coping. 1st ed. Oxford; New York: Oxford University Press; 2011. 451 p.##Throsby K, Gill R. It’s different for men: Masculinity and IVF. Men Masc. 2004;6(4):330-48.##Herrera F. Men always adopt: Infertility and reproduction from a male perspective. J Fam Issues. 2013;34(8):1059-80.##Schick M, Rösner S, Toth B, Strowitzki T, Wischmann T. Exploring involuntary childlessness in men–a qualitative study assessing quality of life, role aspects and control beliefs in men’s perception of the fertility treatment process. Hum Fertil (Camb). 2016;19(1):32-42.##Ying LY, Wu LH, Loke AY. The experience of chinese couples undergoing in vitro fertilization treatment: Perception of the treatment process and partner support. PLoS One. 2015;10(10):e0139691.##

Suppressing HOXA-10 Gene Expression by MicroRNA 135b During the Window of Implantation in Infertile Women 2 1 2 Background: Implantation failure has long been identified as a common problem underlying low success rate of IVF. Currently, endometrial receptivity has gained expert attention as it is demonstrated to contribute to successful embryo implantation. MicroRNAs (miRNAs) is known to affect endometrial receptivity through post-transcriptional gene expression regulation. This study aimed to evaluate the expression of miRNA 135b and HOXA-10 during the implantation window in endometrial tissue of infertile women. Methods: A total of 14 patients diagnosed with infertility in the gynaecology clinic of Cipto Mangunkusumo and Daya Medika hospitals Jakart, Indonesia were selected as the observed group, and 9 fertile patients were enrolled in the control group. Total RNA was isolated from endometrial tissues collected at the secretory phase of the menstrual cycle. The miRNA 135b and HOXA-10 mRNA expression were measured using quantitative real-time PCR (qPCR). The correlation between these variables was then determined using Pearson’s correlation coefficient. Results: The expression of miRNA 135b in the infertile group was significantly higher by 1.81-fold compared to the control group (p<0.01), whereas, expression of HOXA-10 mRNA was significantly lower in the infertile group compared to the controls (p=0.047). Significant negative correlation was observed between the expression of miRNA 135b and HOXA-10 mRNA in infertile women (p=0.021; r=-0.607). Conclusion: Taken together, this study provides that alteration of miRNA expression is involved in regulating the implantation process partly via modulation of the expression of gene required for implantation. 217 222 Aida A Riyanti Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Indonesia Ririn RR Febri Human Reproductive, Infertility, and Family Planning Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia Human Reproductive, Infertility, and Family Planning Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia Indonesia Sarah SC Zakirah Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Indonesia Achmad AK Harzif Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Indonesia Rajjudin R Rajjudin Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala Indonesia Raden R Muharam Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Indonesia A A Asmarinah Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Department of Medical Biology, Faculty of Medicine, Universitas Indonesia Indonesia Budi B Wiweko Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia Indonesia budiwiweko@gmail.com EndometriumHOXA-10InfertilitymiRNA 135bWindow of implantation 80076.pdf Inhorn MC, Patrizio P. Infertility around the globe : new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update. 2015;21(4):411-26.##Liang J, Wang S, Wang Z. Role of microRNAs in embryo implantation. Reprod Biol Endocrinol. 2017;15(1):90.##Shi C, Shen H, Fan LJ, Guan J, Zheng XB, Chen X, et al. Endometrial microRNA signature during the window of implantation changed in patients with repeated implantation failure. Chin Med J (Engl). 2017;130(5):566-73.##Paulson RJ. Introduction : endometrial receptivity: evaluation, induction and inhibition. Fertil Steril. 2019;111(4):609-10.##Patel B, Elguero S, Thakore S, Dahoud W, Bedaiwy M, Mesiano S. Role of nuclear progesterone receptor isoforms in uterine pathophysiology. Hum Reprod Update. 2015;21(2):155-73.##Zanatta A, Pereira RM, Rocha AM, Cogliati B, Baracat EC, Taylor HS, et al. The relationship among HOXA10, estrogen receptor, progesterone receptor, and progesterone receptor B proteins in rectosigmoid endometriosis: a tissue microarray study. Reprod Sci. 2015;22(1):31-7.##Li Y, Adur MK, Kannan A, Davila J, Zhao Y, Nowak RA, et al. Progesterone alleviates endometriosis via inhibition of uterine cell proliferation, inflammation and angiogenesis in an immunocompetent mouse model. Plos One. 2016;11(10):e0165347.##Salamonsen LA, Evans J, Nguyen HP, Edgell TA. The microenvironment of human implantation: determinant of reproductive success. Am J Reprod Immunol. 2016;75(3):218-25.##Vidigal JA, Ventura A. The biological functions of miRNAs : lessons from in vivo studies. Trends Cell Biol. 2015;25(3):137-47.##Kuokkanen S, Chen B, Ojalvo L, Benard L, Santoro N, Pollard JW. Genomic profiling of microRNAs and messenger RNAs reveals hormonal regulation in microRNA expression in human endometrium. Biol Reprod. 2010;82(4):791-801.##Petracco R, Grechukhina O, Popkhadze S, Massasa E, Zhou Y, Taylor HS. MicroRNA 135 regulates HOXA10 expression in endometriosis. J Clin Endocrinol Metab. 2011;96(12):E1925-33.##Valdes CT, Schutt A, Simon C. Implantation failure of endometrial origin : it is not pathology, but our failure to synchronize the developing embryo with a receptive endometrium. Fertil Steril. 2017;108(1):15-8.##Mirabutalebi SH, Karami N, Montazeri F, Fesahat F, Sheikhha MH, Hajimaqsoodi E, et al. The relationship between the expression levels of miR- 135a and HOXA10 gene in the eutopic and ectopic endometrium. Int J Reprod Biomed (Yazd). 2018;16(8):501-6.##Lee HA, Ahn EH, Jang HG, Kim JO, Kim JH, Lee YB, et al. Association between miR-605 A>G, miR-608 G>C, miR-631 I>D, miR-938 C>T, and miR-1302-3 C>T polymorphisms and risk of recurrent implantation failure. Reprod Sci. 2019;26(4):469-75.##Balaguer N, Moreno I, Herrero M, Gonzáléz-Monfort M, Vilella F, Simón C. MicroRNA-30d deficiency during preconception affects endometrial receptivity by decreasing implantation rates and impairing fetal growth. Am J Obstet Gynecol. 2019;221(1):46.e1-46.e16.##Kresowik JDK, Devor EJ, Van Voorhis BJ, Leslie KK. MicroRNA-31 is significantly elevated in both human endometrium and serum during the window of implantation : a potential biomarker for optimum receptivity. Biol Reprod. 2014;91(1):17.##Piltonen TT. Polycystic ovary syndrome: Endometrial markers. Best Pract Res Clin Obstet Gynaecol. 2016;37:66-79.##Zheng J, Luo X, Bao J, Huang X, Jin Y, Chen L, et al. Decreased expression of HOXA10 may activate the autophagic process in ovarian endometriosis. Reprod Sci. 2018;25(9):1446-54.##Chen Y, Zhang J, Wang H, Zhao J, Xu C, Du Y, et al. miRNA-135a promotes breast cancer cell migration and invasion by targeting HOXA10. BMC Cancer. 2012;12:111.##

Rare Disorder of Sexual Differentiation with a Mosaic 46,XX/47,XXY in a Klinefelter Syndrome Individual 2 1 2 Background: Klinefelter syndrome (KS) mosaicism 46,XX/47,XXY is an extremely rare disorder of sex development characterized by the presence of both ovarian and testicular tissues in the same individual. Both elements can be present in the same gonad (ovotestis) or separately in the same individual or as a unilateral ovotestis and the other side with testis or ovary. A mosaic with 46,XY would present with problems related to male infertility and in general, testicular insufficiency, but with a 46,XX mosaic, it is a completely rare presentation. As adolescents, these boys may experience severe emotional and behavioral issues; it is up to the parents to identify these conditions early and get them physician evaluated for possible abnormalities so that they can get the benefit of treatment. Case Presentation: A case of a rare disorder of sexual differentiation with a mosaic 46,XX/47,XXY in a KS individual is reported for whom karyotyping and SRY-FISH work-up was done. Conclusion: Early cytogenetic testing is essential to identify these individuals and testosterone replacement therapy and breast reduction for case management are helpful. Assisted reproductive technology (ART) may assist these individuals father children in some cases. 222 225 Preethi P Pattamshetty Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre India preethi22shah@gmail.com Harika H Mantri Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre India Vasavi V Mohan Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre India CounselingKaryotypingKlinefelter syndromeMosaicismSex determining region Y (SRY gene) 80079.pdf Velissariou V, Christopoulou S, Karadimas C, Pihos I, Kanaka-Gantenbein C, Kapranos N, et al. Rare XXY/XX mosaicism in a phenotypic male with Klinefelter syndrome: case report. Eur J Med Genet. 2006;49(4):331-7.##Mohd Nor NS, Jalaludin MY. A rare 47 XXY/46 XX mosaicism with clinical features of Klinefelter syndrome. Int J Pediatr Endocrinol. 2016;2016:11.##Pleskacova J, Hersmus R, Oosterhuis JW, Setyawati BA, Faradz SM, Cools M, et al. Tumor risk in disorders of sex development. Sex Dev. 2010;4(4-5):259-69.##Talreja SM, Banerjee I, Yadav SS, Tomar V. A rare case of lateral ovotesticular disorder with Klinefelter syndrome mosaicism 46, XX/47, XXY: an unusual presentation. Urol Ann. 2015;7(4):520-3.##Song JS, Lee SH, Jin DK, Kim SH. A case report of rare XXY/XX mosaicism in a phenotypic male with Klinefelter syndrome and mediastinal germ cell tumor. Genet Couns. 2014;25(2):215-20.##

A Clinical Tool for Diagnosis of Isolated Torsion of the Right Fallopian Tube in a Virgin Girl 2 1 2 Background: Isolated tubal torsion is a rare condition that its management remains a challenge. Case Presentation: In this case report, an isolated torsion of the right fallopian tube was described in a virgin girl who was treated laparoscopically. The patient presented to the University Hospital of Larisa, in Greece (January 2017) after 5 days of sharp pain in right iliac fossa. Through this period, she looked for medical care in her home country, in Albania. However, further treatment was not available there. Conclusion: This case manifested that laparoscopy plays an important role in the accurate diagnosis of isolated torsion of the fallopian tube. It thwarts unnecessary delay in treatment and it requires an endoscopy unit. Unfortunately, endoscopy is not commonly the main diagnostic procedure in many countries, including Greece. 225 228 Lialios A LAG Tsagkoulis Department of Obstetrics and Gynaecology, University Hospital of Larisa Department of Obstetrics and Gynaecology, University Hospital of Larisa Greece 'lialiosg@hotmail.com Skoufi I SIG Georgia Occupational Medicine Office, University Hospital of Larisa Occupational Medicine Office, University Hospital of Larisa Greece Tsagkoulis K TKM Matthaios Department of Obstetrics and Gynaecology, University Hospital of Larisa Department of Obstetrics and Gynaecology, University Hospital of Larisa Greece Fallopian tubeIsolated tubal torsionLaparascopySalpingectomy 80075.pdf Hansen OH. Isolated torsion of the fallopian tube. Acta Obstet Gynecol Scand. 1970;49(1):3-6.##Sutton JB. Salpingitis and some of its effects. Lancet. 1890;2:1146-8.##Yalcin OT, Hassa H, Zeytinoglu S, Isiksoy S. Isolated torsion of fallopian tube during pregnancy; report of two cases. Eur J Obstet Gynecol Reprod Biol. 1997;74(2):179-82.##Comerci G, Colombo FM, Stefanetti M, Grazia G. Isolated fallopian tube torsion: a rare but important event for women of reproductive age. Fertil Steril. 2008;90(4):1198.e23-5.##Youssef AF, Fayad MM, Shafeek MA, Egypt C. Torsion of the fallopian tube: a clinico-pathological study. Acta Obstet Gynacol Scand. 1962;41(3):292-309.##Demirel BD, Hancioglu S, Bicakci U, Ariturk E, Bernay F. Isolated tubal torsion: a rare cause of acute abdomen in childhood. Pediatr Rep. 2018;10(1):7604.##Isenberg JS, Silich R. Isolated torsion of the normal fallopian tube in premenarcheal girls. Surg Gynecol Obstet. 1990;170(4):353-4.##Shukla R. Isolated torsion of the hydrosalpinx: a rare presentation. Br J Radiol. 2004;77(921):784-6.##Milki A, Jacobson DH. Isolated torsion of the fallopian tube. a case report. J Reprod Med. 1998;43(9):836-8.##Raziel A, Mordechai E, Friedler S, Schachter M, Pansky M, Ron-El R. Isolated recurrent torsion of the fallopian tube: case report. Hum Reprod. 1999;14(12):3000-1.##Schrager J, Robles G, Platz T. Isolated fallopian tube torsion: a rare entity in a premenarcheal female. Am Surg. 2012;78(2):118-9.##Liu YP, Shih SL, Yang FS. Sudden onset of right lower quadrant pain after heavy exercise. Am Fam Physician. 2008;78:379-84.##Fadıloğlu E, Dur R, Demirdağ E, Öztürk Ç, Fadıloğlu Ş, Kaplan M, et al. Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy. Turk J Obstet Gynecol. 2017;14(3):187-90.##Wang, PH, Yuan CC, Chao HT, Shu LP, Lai CR. Isolated tubal torsion managed laparoscopically. J Am Assoc Gynecol Laparosc. 2000;7(3):423-7.##Ozcan A, Mumusoglu S, Gokcu M, Caypinar SS, Sagiroglu C, Inan AH, et al. Differentiated therapy in pre- and postmenopausal adnexal torsion based on malignancy rates: a retrospective multicentre study over five years. Int J Surg. 2016;29:95-100.##

Exons 1 and 10 Polymorphisms of LHCGR Gene and IVF Success 2 1 2 Dear Editor, We read the publication on "Evaluation of the Prevalence of Exons 1 and 10 Polymorphisms of LHCGR Gene and Its Relationship with IVF Suc-cess" with a great interest (1). Javadi-Arjmand et al. concluded that "It has been revealed that two common SNPs (rs4539842 and rs2293275) in the LHCGR gene are associated with the outcome of IVF in Iranian infertile women (1)". Basically, the polymorphisms of LHCGR gene result in molecular structure change and it can further affect phenotypic expression. Nevertheless, there are other possible genetic polymorphisms that might be associated with outcome of IVF (2). The examples of those polymorphisms are estrogen, progesterone and follicle stimulating hormone receptor polymorphisms (3). It is hard to verify the observed effects of exons 1 and 10 polymorphisms of LHCGR gene in the present report by Javadi-Arjmand et al. (1). Further studies to assess possible confounding effects of those genetic factors are required. Conflict of Interest None. Response to letter to editor Dear Editor, We truly appreciate your consideration upon our manuscript: "Evaluation of the Prevalence of Exons 1 and 10 Polymorphisms of LHCGR Gene and Its Relationship with IVF Success". As you know, IVF is a complex procedure and many ge-netic and environmental factors influence this procedure. Among genetic factors, polymor-phisms in some particular genes such as FSH receptor, estrogen, LH receptor gene, etc. are im-portant in infertile women undergoing IVF. We have chosen one of these important polymor-phisms in LHCGR gene that has not been exam-ined specifically in other studies. In our conclu-sion part, we have mentioned that among three polymorphisms that we have studied and exam-ined in LHCGR, two of them can be suggested only as predictive factors in IVF outcome. We also have mentioned in our article that to confirm our results, first of all, a larger number of infertile women should be analyzed and next, we or other investigators need to do combined assessment on LHCGR and FSHR polymorphisms. Also, it is very important to carry out such studies in different populations and examine other genes associated with IVF outcome. Yours Sincerely, Mohsen Ghadami, M.D., Ph.D., Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences 228 229 Sora S Yasri Private Academic Practice Private Academic Practice Thailand Viroj V Wiwanitkit Department of Community Medicine, Dr DY PAtil University Department of Community Medicine, Dr DY PAtil University India wviroj@yahoo.com No Keyword 80081.pdf Javadi-Arjmand M, Damavandi E, Choobineh H, Sarafrazi-Esfandabadi F, Kabuli M, Mahdavi A, et al. Evaluation of the prevalence of exons 1 and 10 polymorphisms of LHCGR gene and its relationship with IVF success. J Reprod Infertil. 2019;20(4):218-24.##Ivanov AV, Dedul AG, Fedotov YN, Komlichenko EV. Toward optimal set of single nucleotide polymorphism investigation before IVF. Gynecol Endocrinol. 2016;32(sup2):11-8.##Ganesh V, Venkatesan V, Koshy T, Reddy SN, Muthumuthiah S, Paul SFD. Association of estrogen, progesterone and follicle stimulating hormone receptor polymorphisms with in vitro fertilization outcomes. Syst Biol Reprod Med. 2018;64(4):260-5.##