Realities and Hopes in Social Freezing: A Developing Practice to Stop Reproductive Ageing 2 1 2 Social and economic factors have led to a gradual trend to delay childbearing in most developed countries, especially among the upper class. This is strongly related to the increase in the average age of women at first pregnancy, which has recently reached 29 years in industrialized countries. Reasons for postponing the first pregnancy include spending a long time in colleges and universities to earn advanced degrees, prolonged financial instability, striving for higher income levels, job insecurity, and an everlasting struggle for career advancement. Also, most women consider a stable and long-term relationship as a key factor in having children (1). Therefore, with the increase in age of women, forced childlessness becomes a spreading phenomenon in most societies. Now the main concern is proposing a solution for this problem. Many approaches to target the challenge are within the powers and duties of politicians and governments, which are beyond the scope of this article; yet, our main objective is to propound only medical and reproduction interventions. Women's fertility has an inverse relation with age, and postponement in having children leads to increased risk of infertility from 6% at the ages of 20-24 to 64% at the ages of 40-44, and consequently the need to use assisted reproductive technology (ART). However, the success rate of ART also declines with advanced maternal age due to the decrease in ovarian reserve, quality of the remaining oocytes, and higher incidence of oocyte aneuploidy, especially in women over 37-38 years. Based on today’s lifestyle, this delay is sometimes too long that many of these women lose their ability to conceive with their own gametes and therefore have to use oocytes from younger donors. Therefore, the speed of ovarian aging and related processes exceeds the time and duration for the completion of women’s education, employment, and fulfillment of financial and social plans (2). Advances in ART during the last two decades have led to the introduction of new technologies such as prolonged in vitro culture, preimplantation genetic testing (PGT), time-lapse technology for embryo culture and selection, fertility preservation, and many other add-ons. These techniques provide new opportunities for treatment of infertile couples or elevate the success rate of current treatments. Nevertheless, the overuse and inappropriate application of some of these methods may bring new challenges for the scientific community. One such example is preserving fertility in women for non-medical purposes. One of the fertility preservation techniques is oocyte freezing for possible use in the future. The first successful pregnancy from a frozen oocyte was reported in 1986. At that time, oocyte freezing was recognized as an experimental method following the improvement and development of cryopreservation techniques (from slow to ultra-rapid freezing; vitrification); through implementing the technique, the survival rate of oocytes and pregnancy rate significantly increased, so that in 2013, ASRM removed the "experimental" label from oocyte freezing and introduced it as a clinical procedure. Until now, this facility is mostly provided for patients with various types of cancer undergoing gonadotoxic treatments, including chemotherapy and radiotherapy. But over the past decade, its application has expanded for women who plan to protect their fertility despite their advanced maternal age and associated risk of infertility. Also, international societies and academies approved that such procedure for fertility preservation is ethical. Therefore, they provided ethical recommendations for service providers who are responsible to inform patients of the effectiveness, safety, benefits, and risks of oocyte freezing. They should also inform clients for unknown long-term consequences and adverse effects on children as well as other possible harms that are not yet fully understood (3). According to recent estimates, fertility preservation through oocyte freezing is expanding rapidly in developing and developed countries, especially following COVID-19 pandemic. Women who seek for freezing should be cognizant of the fact that such treatment is not definitive. Moreover, fertility preservation for young women is not a cost-effective alternative, due to high risks of unnecessary medical interventions, significant financial burden, high cost of long-term oocyte storage, and decreased chance of pregnancy by frozen oocytes in comparison to high odds of natural conception. According to statistical and cost-effectiveness analysis results, oocyte freezing should ideally be performed before the age of 36 years, assuming that the probability of using frozen oocytes might be about 50%. But currently, less than 10% of frozen oocytes are used by owners through ART. In addition, pregnancy and live birth rate in women over 40 who use oocyte freezing is very low which implicates that fertility preservation is not a suitable alternative in this group. It seems that in case of social freezing, legal, ethical, and economic considerations are of paramount significance for each individual besides medical issues (4). There is always the concern that most clinics overestimate the likelihood of a successful pregnancy using frozen oocytes, and advertise oocyte freezing as a safe insurance-based practice for childbirth in women with advanced maternal age. This typical everyday scenario is propagated by some physicians and clinics on social media such as Instagram, Facebook, and Twitter which are deceptive and mainly devised to attract the customer and create a thriving business. They conceal the fact that fertility preservation through oocyte freezing is time-consuming and invasive, requiring consecutive days of well-timed hormone injections, regular follicular growth scans, and oocyte retrieval under anesthesia in the operating room. In addition, young women in their 20s have enough time and chance to conceive naturally without the need for oocyte freezing, but some doctors do not inform women of relevant issues in fertility preservation during counseling sessions (1, 2). Although social freezing gives women the hope of having their biological child at an older age, it requires the contribution of a consultation team including a reproductive endocrinologist, an embryologist, and a psychologist who must pinpoint that oocyte freezing does not guarantee a live birth and a successful pregnancy. The low probability of using frozen oocytes (less than 10%), the low pregnancy rates with thawed oocytes in some clinics, and the high costs of oocyte freezing and ART compared to other choices should be discussed with the clients through counseling sessions. Furthermore, a woman with frozen oocytes should be aware that while aging of her frozen oocytes is stopped, she is still aging and thus pregnancy at older age using frozen oocyte may result in more complications for the fetus and the mother. Therefore, it would be the responsibility of the counseling team to provide a comprehensive explanation for the clients and encourage them to use the frozen oocytes as soon as possible since aging is a determining factor in successful pregnancy using assisted reproductive technology. 01 3 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@avicenna.ac.ir No Keyword 140174.pdf Poli M, Capalbo A. Oocyte cryopreservation at a young age provides an effective strategy for expanding fertile lifespan. Front Reprod Health. 2021;3:704283.##Slater A, Liew R, Peate M. Age-related fertility decline and elective oocyte cryopreservation: Knowledge, attitudes and practices in a pilot study of general practitioners. Aust J Gen Pract. 2022;51(8):611-9.##Walker Z, Lanes A, Ginsburg E. Oocyte cryopreservation review: outcomes of medical oocyte cryopreservation and planned oocyte cryopreservation. Reprod Biol Endocrinol. 2022;20(1):10. ##Kasaven LS, Jones BP, Heath C, Odia R, Green J, Petrie A, et al. Reproductive outcomes from ten years of elective oocyte cryopreservation. Arch Gynecol Obstet. 2022;306(5):1753-60.##

Commitment Theory as the Theoretical Framework in Third-Party Reproduction 2 1 2 Assisted reproductive technology (ART) and third-party reproduction provide the opportunity for infertile couples to have children through different genetic links. This type of treatment has created many challenges for infertile couples. With this treatment, the infertile couple will have a child who is biologically related to the gamete/embryo donor. Accordingly, the transformation that occurs in the structure of traditional families and the concept of parenthood is one of the main consequences and challenges which requires in-depth research. In spite of the successful expansion of infertility treatment and third-party reproduction, there is still no proper social context for implementing third-party infertility treatments in Iran. Therefore, despite the need to use the technology, some couples refuse the treatment unless their confidentiality is preserved. Many couples follow the practice surreptitiously by keeping the donation treatment confidential, to get rid of the existing social stigma and protect their identity, the child and the donor’s identity. Commitment theory as a theoretical strategy is proposed to solve the problems of all parties involved in this type of "social and non-biological" parenting. Commitment theory in the context of third-party reproduction expresses the commitment to the contract accepted by the donor and the recipient of the gamete/embryo, based on which, the recipients consider the resulting child as their own, and are committed to all the related paternal-maternal rights and duties such as "alimony" and "inheritance". On the other hand, the donors undertake to waive all their paternal-maternal rights and duties by donating gamete/embryo. 03 11 Zohreh Z Behjati Ardakani Department of Sociology, Central Tehran Branch, Islamic Azad University Department of Sociology, Central Tehran Branch, Islamic Azad University Iran Mohammad Mehdi MM Akhondi محمدمهدی آخوندی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran Amir Hossein AH Khodaparast امیرحسین خداپرست Iranian Institute of Philosophy Iranian Institute of Philosophy Iran Fahimeh F Ranjbar Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences Iran Mehrdad M Navabakhsh Faculty of Humanistic and Social Sciences, Science and Research Branch, Islamic Azad University Faculty of Humanistic and Social Sciences, Science and Research Branch, Islamic Azad University Iran navabakhsh@srbiau.ac.ir Commitment theoryDonationInfertility treatmentThird-party reproduction 140175.pdf Dyer SJ. The value of children in African countries–insights from studies on infertility. J Psychosom Obstet Gynecol. 2007;28(2):69-77.##Martins MV, Basto-Pereira M, Pedro J, Peterson B, Almeida V, Schmidt L, et al. Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review. Hum Reprod Update. 2016;22(4):466-78.##Akhondi MM, Behjati Ardakani Z, Arefi S, Sadri Ardakani H, Arabi M, Zarnani A, et al. A close look at natural and in vitro fertilization as well as the need for donated gametes in treatment of infertility. Payesh. 2007;6(4):307-21.##Hendriks S, Dondorp W, de Wert G, Hamer G, Repping S, Dancet EA. Potential consequences of clinical application of artificial gametes: a systematic review of stakeholder views. Hum Reprod Update. 2015;21(3):297-309.##Darbandi S, Darbandi M, Khorram Khorshid HR, Sadeghi MR, Agarwal A, Sengupta P, et al. Ooplasmic transfer in human oocytes: efficacy and concerns in assisted reproduction. Reprod Biol Endocrinol. 2017;15(1):77.##Tremayne S, Akhondi MM. Conceiving IVF in Iran. Reprod Biomed Soc Online. 2016;2:62-70.##Behjati Ardakani Z, Navabakhsh M, Ranjbar F, Akhondi MM, Mohseni Tabrizi A. Step-by-step decision-making process in third party assisted reproduction: a qualitative study. Hum Fertil (Camb). 2022;25(3):487-98.##Abbasi-Shavazi MJ, Nasrabad HB, Ardekani ZB, Akhondi MM. Attitudes of infertile women towards gamete donation: a case study in Tehran. J Reprod Infertil. 2006;7(2):139-48.##Sheibani S. Whither kinship? new assisted reproduction technology practices, authoritative knowledge and relatedness-case studies from Iran. Payesh. 2007;6(4):299-306.##Golombok S. Parenting in new family forms. Curr Opin Psychol. 2017;15:76-80.##Silber SJ. Judaism and reproductive technology. Cancer Treat Res. 2010;156:471-80.##Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts Views Vis Obgyn. 2016;8(1):33-48.##Al-Bar MA, Chamsi-Pasha H. Assisted reproductive technology: Islamic perspective. In: Al-Bar MA, Chamsi-Pasha H, editors. Contemporary bioethics. Germany: Springer; 2015. p. 173-86.##Inhorn MC. Making muslim babies: IVF and gamete donation in sunni versus shi’a islam. Cult Med Psychiatry. 2006;30(4):427-50.##Inhorn MC, Tremayne S. Islam and assisted reproductive technologies. 1st ed. New York: Berghahn Books; 2012. 346 p.##Al-Hasani S. Islamic consideration (in suni school) regarding bioethics and ART (especially oocyte and embryo donation) and the law in Germany. Payesh. 2007;6(4):379-84.##Serour GI, Dickens BM. Assisted reproduction developments in the islamic world. Int J Gynecol Obstet. 2001;74(2):187-93.##Safaiee SH. Failures of IRI “embryo donation act” based on a comparative study. Payesh. 2007;6(4):323-29.##Act of embryo donation. Islamic Parliament of Iran. Official Gazette No. 17033.. 2003; No.17033. ##Executive by law of the Act of Embryo Donation. Official Gazette. 2005; No.17496. ##Behjati-Ardakani Z, Karoubi MT, Milanifar A, Masrouri R, Akhondi MM. Embryo donation in Iranian legal system: a critical review. J Reprod Infertil. 2015;16(3):130-7.##Greenfeld DA. Effects and outcomes of third-party reproduction: parents. Fertil Steril. 2015;104(3):520-4.##Katoozian N. [Civil law, public theory of obligations]. 8nd ed. Tehran; Mizan Publication;2015. 912 p. Persian.##United Nations. General Assembly. Universal declaration of human rights. Department of State, United States of America. 1949;302(2):14-25.##An-Na'im AA. Human rights in the Arab world: a regional perspective. Hum Rts Q. 2001;23:701.##Al-Midani MA. Arab Charter Committee of Human Rights. Elgar Encyclopedia of Human Rights. Edward Elgar Publishing. 2022. p. 135-9. https://doi.org/10.4337/9781789903621.arab.charter.committee.hr##Hill JL. What does it mean to be a" parent"? The claims of biology as the basis for parental rights. 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Pennsylvania: Pennsylvania state university press; 1999. p. 65-86. https://philpapers.org/rec/NARHAR##Klock SC, Greenfeld DA. Parents’ knowledge about the donors and their attitudes toward disclosure in oocyte donation. Hum Reprod. 2004;19(7):1575-9.##

The Association of Soluble VEGFR-1 Serum Level and Genetic (rs7993418) Polymorphism with In Vitro Fertilization and Embryo Transfer Outcome in the Population of Northern Iran 2 1 2 Background: Vascular endothelial growth factor receptors (VEGFRS) play an important role in embryo implantation. The aim of the present study was to examine the association of VEGFR1 circulating level and gene polymorphism with in vitro fertilization and embryo transfer (IVF-ET) outcome. Methods: In this case–control study, 120 women who had unsuccessful IVF (IVF–) history and 120 women who had successful IVF outcome (IVF+) as controls were included. Genomic DNA was extracted from blood samples. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The serum levels of soluble VEGFR1 (sVEGFR1) were measured by ELISA. ANOVA test was used for statistical analysis. Results: The frequency of T and C alleles in IVF+ individuals were 87.5%, 12.5% and among IVF- were 75.5%, 24.5%, respectively (p=0.0006). The minor allele (C) was associated with an increased risk of IVF failure based on results from codominant (OR=3.86, 95%CI 1.19-12.47), dominant (OR=2.32, 95%CI 1.31-4.10), recessive (OR=3.22, 95%CI 1.00-10.29), and allele models (OR=2.28, 95%CI 1.40-3.69). We also showed that there is a significant decrease in serum sVEGFR1 levels in IVF as compared to IVF+ (p=0.006) groups. Moreover, TT genotype is significantly associated with increased serum sVEGFR1 concentration in IVF group (TT, CT, and CC serum levels were 106.55±11.04, 94.33±10.75, and 83.33±9.13 ng/ml, and in IVF+ group were 156.11±18.08, 120.66±16.51, and 84.66±20.31 ng/ml, respectively). Conclusion: The results of this study indicate that VEGFR1 polymorphism and sVEGFR1 circulating levels are associated with IVF-ET outcome. Moreover, CC genotype is associated with decreased sVEGFR-1 serum concentration and IVF-ET failure. 11 18 Sadegheh S Moeinfar Department of Biology, Faculty of Sciences, University of Guilan Department of Biology, Faculty of Sciences, University of Guilan Iran Farhad F Mashayekhi Department of Biology, Faculty of Sciences, University of Guilan Department of Biology, Faculty of Sciences, University of Guilan Iran umistbiology20@gmail.com Mohammad Hadi MH Bahadori Cellular and Molecular Research Center, Guilan University of Medical Sciences Cellular and Molecular Research Center, Guilan University of Medical Sciences Iran Roya R Faraji Department of Community Medicine and Biostatistics, Faculty of Medicine, Guilan University of Medical Sciences Department of Community Medicine and Biostatistics, Faculty of Medicine, Guilan University of Medical Sciences Iran Zivar Z Salehi Department of Biology, Faculty of Sciences, University of Guilan Department of Biology, Faculty of Sciences, University of Guilan Iran ELISAETIranIVF failureRFLPVascular endothelial growth factor AVEGFA 140172.pdf Plaseska-Karanfilska D, Noveski P, Plaseski T, Maleva I, Madjunkova S, Moneva Z. Genetic causes of male infertility. Balkan J Med Genet. 2012;15(Sup-pl):31-4.##Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. International committee for monitoring assisted reproductive technology (ICMART) and the World health organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril. 2009;92(5):1520-4.##Wright VC, Chang J, Jeng G, Chen M, Macaluso M, Centers for Disease Control and Prevention. Assisted reproductive technology surveillance-United States, 2004. MMWR Surveill Summ. 2007;56(6):1-22.##Mahajan N, Kaur S, Alonso MR. Window of implantation is significantly displaced in patients with adenomyosis with previous implantation failure as determined by endometrial receptivity assay. J Hum Reprod Sci. 2018;11(4):353-8.##van Mourik MS, Macklon NS, Heijnen CJ. Embryonic implantation: cytokines, adhesion molecules, and immune cells in establishing an implantation environment. J Leukoc Biol. 2009;85(1):4-9.##Lai TH, Vlahos N, Shih IeM, Zhao Y. Expression patterns of VEGF and Flk-1 in human endometrium during the menstrual cycle. J Reprod Infertil. 2015;16(1):3-9.##Cottrell HN, Wu J, Rimawi BH, Duran JM, Spencer JB, Sidell N, et al. Human endometrial stromal cell plasticity: Reversible sFlt1 expression negatively coincides with decidualization. Hypertens Pregnancy. 2017;36(2):204-11.##Shibuya M. Structure and dual function of vascular endothelial growth factor receptor-1 (Flt-1). Int J Biochem Cell Biol. 2001;33(4):409-20.##Xiong Y, Huo Y, Chen C, Zeng H, Lu X, Wei C, et al. Vascular endothelial growth factor (VEGF) receptor- tyrosine 1175 signaling controls VEGF-induced von Willebrand factor release from endothelial cells via phospholipase C-gamma 1- and protein kinase A-dependent pathways. J Biol Chem. 2009;284(35):23217-24.##Millauer B, Wizigmann-Voos S, Schnürch H, Martinez R, Møller NP, Risau W, et al. High affinity VEGF binding and developmental expression suggest Flk-1 as a major regulator of vasculogenesis and angiogenesis. Cell. 1993;72(6):835-46.##Clark DE, Smith SK, Sharkey AM, Charnock-Jones DS. Localization of VEGF and expression of its receptors flt and KDR in human placenta throughout pregnancy. Hum Reprod. 1996;11(5):1090-8.##Halder JB, Zhao X, Soker S, Paria BC, Klagsbrun M, Das SK, et al. Differential expression of VEGF isoforms and VEGF (164)-specific receptor neuropilin-1 in the mouse uterus suggests a role for VEGF (164) in vascular permeability and angiogenesis during implantation. Genesis. 2000;26(3):213-24.##Karimlo FK, Mashayekhi F, Sorouri ZZ, Bahador MH, Salehi Z. Association of GSTM1 and GSTT1 gene polymorphisms and in-vitro fertilisation outcome in a population in northern Iran. J Obstet Gynaecol. 2015;35(1):46-8.##Alipour M, Mashayekhi F, Salehi Z. Association of leukemia inhibitory factor gene polymorphism and in vitro fertilization outcome in a population in northern Iran. Cell Mol Biol (Noisy-le-grand). 2017;63(3):58-61.##Shabanipour S, Mashayekhi F, Bahadori MH, Soruri ZZ. The relationship between MMP-9 promoterpolymorphism and IVF outcome. Cell Mol Biol (Noisy-le-grand). 2015;61(1):64-7.##De Geyter C. Assisted reproductive technology: Impact on society and need for surveillance. Best Pract Res Clin Endocrinol Metab. 2019;33(1):3-8.##Crawford G, Ray A, Gudi A, Shah A, Homburg R. The role of seminal plasma for improved outcomes during in vitro fertilization treatment: review of the literature and meta-analysis. Hum Reprod Update. 2015;21(2):275-84.##Goodman C, Jeyendran RS, Coulam CB. Vascular endothelial growth factor gene polymorphism and implantation failure. Reprod Biomed Online. 2008;16(5):720-3.##Zarezade N, Saboori Darabi S, Ramezanali F, Amirchaghmaghi E, Khalili G, Moini A, et al. mRNA expression of VEGF and its receptors in fallopian tubes of women with ectopic pregnancies. Int J Fertil Steril. 2015;9(1):55-64.##Kim CH, Ahn JW, Kim SH, Chae HD, Kang BM. Effects on in vitro fertilization-embryo transfer outcomes of vascular endothelial growth factor receptor-1, -2 and -3 in eutopic endometrial tissue of women with endometriosis. J Obstet Gynaecol Res. 2011;37(11):1631-7.##Amirchaghmaghi E, Rezaei A, Moini A, Roghaei MA, Hafezi M, Aflatoonian R. Gene expression analysis of VEGF and its receptors and assessment of its serum level in unexplained recurrent spontaneous abortion. Cell J. 2015;16(4):538-45.##Fasouliotis SJ, Spandorfer SD, Witkin SS, Liu HC, Roberts JE, Rosenwaks Z. Maternal serum vascular endothelial growth factor levels in early ectopic and intrauterine pregnancies after in vitro fertilization treatment. Fertil Steril. 2004;82(2):309-13.##Asimakopoulos B, Nikolettos N, Papachristou DN, Simopoulou M, Al-Hasani S, Diedrich K. Follicular fluid levels of vascular endothelial growth factor and leptin are associated with pregnancy outcome of normal women participating in intracytoplasmic sperm injection cycles. Physiol Res. 2005;54(3):263-70.##Gupta P, Deo S, Jaiswar SP, Sankhwar PL. Case control study to compare serum vascular endothelial growth factor (VEGF) level in women with recurrent pregnancy loss (RPL) compared to women with term pregnancy. J Obstet Gynaecol India. 2019;69(Suppl 2):95-102.##Garrido N, Navarro J, Remohí J, Simón C, Pellicer A. Follicular hormonal environment and embryo quality in women with endometriosis. Hum Reprod Update. 2000;6(1):67-74.##Chen H, Zheng JB, Wang DM, Xing H, Wang H. Association between vascular endothelial growth factor and clinical outcomes of IVF-ET/ICSI. J Coll Physicians Surg Pak. 2019;29(1):19-23.##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.##Jung YW, Ahn EH, Kim JO, An HJ, Cho SH, Kim YR, et al. Association of genetic polymorphisms in VEGF -460, -7 and -583 and hematocrit level with the development of idiopathic recurrent pregnancy loss and a meta-analysis. J Gene Med. 2018;20(9):e3048.##Sajjadi MS, Ghandil P, Shahbazian N, Saberi A. Association of vascular endothelial growth factor A polymorphisms and aberrant expression of connexin 43 and VEGFA with idiopathic recurrent spontaneous miscarriage. J Obstet Gynaecol Res. 2020;46(3):369-75.##Vagnini LD, Nascimento AM, Canas Mdo C, Renzi A, Oliveira-Pelegrin GR, Petersen CG, et al. 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Association Between Single Nucleotide Polymorphisms (rs1484215 and rs6495096) in CYP11A1 Gene in Iranian Women with Polycystic Ovary Syndrome 2 1 2 Background: Genetic factors are significantly have important role in the etiology of the polycystic ovary syndrome (PCOS). This study examined the possible relation of rs1484215 and rs6495096 polymorphisms of CYP11A1 gene in Iranian women with PCOS. Methods: The population of the case-control research included 100 women presenting with PCOS and 100 women as a control group who were referred to Infertility Center in Qom, Iran. The genotypes of rs1484215 and rs6495096 polymorphisms in CYP11A1 gene were detected with the tetra-ARMS PCR method. The independent segregation of alleles was tested for the Hardy–Weinberg equilibrium (HWE). Differences in quantitative traits were assessed between each group with a single PCOS feature and control group using Mann–Whitney U test for categorical variables and student’s t-test for continuous variables. Statistical analysis of allele and genotype frequencies between women with PCOS and control was performed using the chi-square test. Significance level was defined as p<0.05. Results: There was a significant association of C with G alleles in rs6495096 polymorphism and susceptibility to PCOS (p=0.001), but no significant relation was found between C and T alleles in rs1484215 polymorphism and susceptibility to PCOS. Also, GG genotype of rs6495096 was significantly associated with the waist-to-hip ratio (WHR) and infertility duration compared to CG and CC (p0.01). However, rs1484215 showed no association with these variables. Conclusion: The results from the research indicated that rs6495096 polymorphism of CYP11A1 gene is related to the PCOS risk in Iranians women. 18 26 Parry P Fathy Department of Biology, Science and Arts University Department of Biology, Science and Arts University Iran Ebrahim E Cheraghi Department of Biology, Faculty of Science, University of Qom Department of Biology, Faculty of Science, University of Qom Iran e.cheraghi@qom.ac.ir Seyed Mohsen SM Miresmaeili Department of Biology, Science and Arts University Department of Biology, Science and Arts University Iran Cholesterol side-chain cleavage enzymeInfertilityPolycystic ovarian syndromePolymorphismSingle nucleotide 60077.pdf Fox R, Corrigan E, Thomas PA, Hull MG. The diagnosis of polycystic ovaries in women with oligo‐amenorrhoea: predictive power of endocrine tests. Clin Endocrinol (Oxf). 1991;34(2):127-31.##Payne AH, Hales DB. Overview of steroidogenic enzymes in the pathway from cholesterol to active steroid hormones. Endocr Rev. 2004;25(6):947-70.##Dadachanji R, Shaikh N, Mukherjee S. Genetic variants associated with hyperandrogenemia in PCOS pathophysiology. Genet Res Int. 2018;2018:7624932.##Petry CJ, Ong KK, Michelmore KF, Artigas S, Wingate DL, Balen AH, et al. Association of aromatase (CYP 19) gene variation with features of hyperandrogenism in two populations of young women. Hum Reprod. 2005;20(7):1837-43.##Gaasenbeek M, Powell BL, Sovio U, Haddad L, Gharani N, Bennett A, et al. Large-scale analysis of the relationship between CYP11A promoter variation, polycystic ovarian syndrome, and serum testosterone. J Clin Endocrinol Metab. 2004;89(5):2408-13.##Jones MR, Italiano L, Wilson SG, Mullin BH, Mead R, Dudbridge F, et al. Polymorphism in HSD17B6 is associated with key features of polycystic ovary syndrome. Fertil Steril. 2006;86(5):1438-46.##Prapas N, Karkanaki A, Prapas I, Kalogiannidis I, Katsikis I, Panidis D. Genetics of polycystic ovary syndrome. Hippokratia. 2009;13(4):216-23.##Araki T, Elias R, Rosenwaks Z, Poretsky L. Achieving a successful pregnancy in women with polycystic ovary syndrome. Endocrinol Metab Clin North Am. 2011;40(4):865-94.##Unluturk U, Harmanci A, Kocaefe C, Yildiz BO. The genetic basis of the polycystic ovary syndrome: a literature review including discussion of PPAR-γ. PPAR Res. 2007;2007:49109.##Kaur R, Kaur T, Sudhir N, Kaur A. Association analysis of CYP11A1 variants with polycystic ovary syndrome: a case-control study from north India. Reprod Sci. 2021;28(10):2951-60.##Akgül S, Derman O, Alikaşifoğlu M, Aktaş D. CYP1A1 polymorphism in adolescents with polycystic ovary syndrome. Int J Gynecol Obstet. 2011;112(1):8-10.##Ashraf S, Nabi M, Rashid F, Amin S. Hyperandrogenism in polycystic ovarian syndrome and role of CYP gene variants: a review. Egypt J Med Hum Genet. 2019;20(1):1-10.##Shan B, Zhou L, Yang S, Yan M, Wang Z, Ouyang Y, et al. Li Z. Association between polycystic ovary syndrome (PCOS) and CYP11A1 polymorphism in Hainan, China: a case-control study. Int J Clin Exp Pathol. 2016;9(1):230-6.##Celhar T, Gersak K, Ovcak Z, Sedmak B, Mlinaric-Rascan I. The presence of the CYP11A1 (TTTTA) 6 allele increases the risk of biochemical relapse in organ confined and low-grade prostate cancer. Cancer Genet Cytogenet. 2008;187(1):28-33.##Setiawan VW, Cheng I, Stram DO, Giorgi E, Pike MC, Van Den Berg D, et al. A systematic assessment of common genetic variation in CYP11A and risk of breast cancer. Cancer Res. 2006;66(24):12019-25.##Zheng W, Gao YT, Shu XO, Wen W, Cai Q, Dai Q, et al. Population-based case-control study of CYP11A gene polymorphism and breast cancer risk. Cancer Epidemiol Biomark Prev. 2004;13(5):709-14.##Terry K, McGrath M, Lee IM, Buring J, De Vivo I. Genetic variation in CYP11A1 and StAR in relation to endometrial cancer risk. Gynecol Oncol. 2010;117(2):255-9.##Pau C, Saxena R, Welt C K. Evaluating reported candidate gene associations with polycystic ovary syndrome. Fertil Steril. 2013;99(6):1774-8.##Zhang CW, Zhang XL, Xia YJ, Cao YX, Wang WJ, Xu P, et al. Association between polymorphisms of the CYP11A1 gene and polycystic ovary syndrome in Chinese women. Mol Biol Rep. 2012;39(8):8379-85.##Gao N, Tang H, Gao L, Tu G, Luo H, Xia Y. CYP3A4 and CYP11A1 variants are risk factors for ischemic stroke: a case control study. BMC Neurol. 2020;20(1):77.##Hong SH, Hong YS, Jeong K, Chung H, Lee H, Sung YA. Relationship between the characteristic traits of polycystic ovary syndrome and susceptibility genes. Sci Rep. 2020;10(1):10479.##Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.##Miller SM, Dykes DD, Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res. 1988;16(3):1215.##Ahlawat S, Sharma R, Maitra A, Roy M, Tantia M. Designing, optimization and validation of tetra-primer ARMS PCR protocol for genotyping mutations in caprine Fec genes. Meta Gene. 2014;2:439-49.##Bayoumy N, El-Shabrawi M, Younes S, Atwa K. CYP1A1 gene (6235T<C) polymorphism as a risk factor for polycystic ovarian syndrome among Egyptian women. Hum Fertil (Camb). 2020;23(2):142-7.##Abdel-Mageed W S, Dabous E, Gerguis A. Association between polymorphisms of the CYP11A1 gene and polycystic ovary syndrome in Egyptian Female. Res J Appl Biotechnol. 2016;2(1):19-28.##Sakoda LC, Blackston C, Doherty JA, Ray RM, Lin MG, Stalsberg H, et al. Polymorphisms in steroid hormone biosynthesis genes and risk of breast cancer and fibrocystic breast conditions in Chinese women. Cancer Epidemiol Biomark Prev. 2008;17(5):1066-73.##Gao GH, Cao YX, Yi L, Wei ZL, Xu YP, Yang C. [Polymorphism of CYP11A1 gene in Chinese patients with polycystic ovarian syndrome]. 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The Association Between Increment of Interleukin-1 and Interleukin-6 in Women with Polycystic Ovary Syndrome and Body Mass Index 2 1 2 Background: There is an association between inflammatory factors and polycystic ovary syndrome (PCOS) and most of women with PCOS experience the symptoms of hirsutism. The purpose of this study was to evaluate the role of obesity in PCOS occurrence, which is linked with inflammation and hirsutism. Methods: This study was designed as a case-control research. It was performed on 102 women with PCOS and 102 healthy women as controls who were age-matched. Serum concentrations of testosterone, estradiol (E2), IL-1, IL-6, high-sensitivity c-reactive protein (hs-CRP), and aromatase activity were measured in blood samples. Statistical tests including unpaired t-tests, Mann-Whitney U test, Kruskal-Wallis, Spearman’s correlation, and Chi-square tests were used for data analysis. Statistical significance was set at p<0.05. Results: A significant difference was found between hs-CRP, IL-1, and IL-6 in PCOS patients and healthy individuals (p<0.001). Aromatase activity was markedly lower in PCOS cases. The serum level of IL-1 (p=0.392) and IL-6 (p=0.764) was not different between overweight and normal weight women. In both studied groups (case and control), hirsutism frequency was markedly higher in individuals with BMI ≥25 kg/m2 (p<0.05). Inflammatory factors significantly affected the PCOS group (p<0.05). However, logistic regression showed that hs-CRP increment is more effective on increasing the risk of PCOS (OR: 6.324, p<0.001). Conclusion: In this study, hs-CRP, IL-1, and IL-6 levels increased in all PCOS women. Although the incidence of hirsutism in PCOS is associated with obesity, in PCOS pathogenesis, only IL-1 and IL-6 were independent of BMI. 26 35 Sahar S Mazloomi Department of Clinical Biochemistry, Faculty of Medicine, Hamadan University of Medical Sciences Department of Clinical Biochemistry, Faculty of Medicine, Hamadan University of Medical Sciences Iran Zeinab z Barartabar Department of Clinical Biochemistry, Faculty of Medicine, Hamadan University of Medical Sciences Department of Clinical Biochemistry, Faculty of Medicine, Hamadan University of Medical Sciences Iran Shamim Sh Pilehvari Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences Iran sh.pilehvari@yahoo.com AromataseBMIHirsutismInterleukin-1Interleukin-6Polycystic ovarian syndrome 140176.pdf Eiras MC, Pinheiro DP, Romcy KAM, Ferriani RA, Reis RMD, Furtado CLM. Polycystic ovary syndrome: the epigenetics behind the disease. Reprod Sci. 2022;29(3):680-94.##Hoeger KM, Dokras A, Piltonen T. Update on PCOS: consequences, challenges, and guiding treatment. J Clin Endocrinol Metab. 2021;106(3):e1071-e83.##Mancini A, Bruno C, Vergani E, d’Abate C, Giacchi E, Silvestrini A. Oxidative stress and low-grade inflammation in polycystic ovary syndrome: controversies and new insights. Int J Mol Sci. 2021;22(4):1667.##Kordestani F, Mazloomi S, Mortazavi Y, Mazloomzadeh S, Fathi M, Rahmanpour H, et al. Preliminary study showing no association between G238A (rs361525) tumor necrosis factor-α (TNF-α) gene polymorphism and its serum level, hormonal and biochemical aspects of polycystic ovary syndrome. BMC Med Genet. 2018;19(1):149.##Barlampa D, Bompoula MS, Bargiota A, Kalantaridou S, Mastorakos G, Valsamakis G. Hypothalamic inflammation as a potential pathophysiologic basis for the heterogeneity of clinical, hormonal, and metabolic presentation in PCOS. Nutrients. 2021;13(2):520.##Qu X, Donnelly R. Sex hormone-binding globulin (SHBG) as an early biomarker and therapeutic target in polycystic ovary syndrome. Int J Mol Sci. 2020;21(21):8191.##Goswami S, Choudhuri S, Bhattacharya B, Bhattacharjee R, Roy A, Mukhopadhyay S, et al. Chronic inflammation in polycystic ovary syndrome: A case–control study using multiple markers. Int J Reprod Biomed. 2021;19(4):313-20.##Zangeneh FZ, Naghizadeh MM, Masoumi M. Polycystic ovary syndrome and circulating inflammatory markers. Int J Reprod Biomed. 2017;15(6):375-82.##Silva JR, Lima FE, Souza AL, Silva AW. Interleukin-1β and TNF-α systems in ovarian follicles and their roles during follicular development, oocyte maturation and ovulation. Zygote. 2020;28(4):270-7.##Mizgier M, Jarząbek-Bielecka G, Wendland N, Jodłowska-Siewert E, Nowicki M, Brożek A, et al. Relation between inflammation, oxidative stress, and macronutrient intakes in normal and excessive body weight adolescent girls with clinical features of polycystic ovary syndrome. Nutrients. 2021;13(3):896.##Hanna A, Frangogiannis NG. Inflammatory cytokines and chemokines as therapeutic targets in heart failure. Cardiovasc Drugs Ther. 2020;34(6):849-63.##Alissa EM, Algarni SA, Khaffji AJ, Al Mansouri NM. Role of inflammatory markers in polycystic ovaries syndrome: in relation to insulin resistance. J Obstet Gynaecol Res. 2021;47(4):1409-15.##Rudnicka E, Suchta K, Grymowicz M, Calik-Ksepka A, Smolarczyk K, Duszewska AM, et al. Chronic low grade inflammation in pathogenesis of PCOS. Int J Mol Sci. 2021;22(7):3789.##Aboeldalyl S, James C, Seyam E, Ibrahim EM, Shawki HE-D, Amer S. The role of chronic inflammation in polycystic ovarian syndrome—a systematic review and meta-analysis. 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Endocr Rev. 2022;43(1):91-159.##Yuxin L, Chen L, Xiaoxia L, Yue L, Junjie L, Youzhu L, et al. Research progress on the relationship between obesity-inflammation-aromatase axis and male infertility. Oxid Med Cell Longev. 2021;2021:6612796.##Tanbo T, Mellembakken J, Bjercke S, Ring E, Åbyholm T, Fedorcsak P. Ovulation induction in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2018;97(10):1162-7.##Coradini D, Oriana S. Impact of sex hormones dysregulation and adiposity on the outcome of postmenopausal breast cancer patients. Clin Obes. 2021;11(1):e12423.##Trenti A, Tedesco S, Boscaro C, Trevisi L, Bolego C, Cignarella A. Estrogen, angiogenesis, immunity and cell metabolism: solving the puzzle. Int J Mol Sci. 2018;19(3):859.##Kolanska K, Alijotas‐Reig J, Cohen J, Cheloufi M, Selleret L, D’argent E, et al. Endometriosis with infertility: a comprehensive review on the role of immune deregulation and immunomodulation therapy. Am J Reprod Immunol. 2021;85(3):e13384.##Prins JR, Gomez-Lopez N, Robertson SA. Interleukin-6 in pregnancy and gestational disorders. J Reprod Immunol. 2012;95(1-2):1-14.##Krouni A, Forouhari S, Namavarjahromi B, Dabbaghmanesh MH, Shayan A, Sepasi S, et al. The evaluation of the relationship between some related hormone levels and diet in obese or overweight patients with hirsutism: a randomized clinical trial. J Family Med Prim Care. 2017;6(4):755-9.##Bode D, Seehusen DA, Baird D. Hirsutism in women. Am Fam Physician. 2012;85(4):373-80.##Bakry OA, Al Gayed EM, Seadan AG. Assessment of obesity, dyslipidemia, and insulin resistance in idiopathic hirsutism: a case–control study. J Egyptian Women Dermatol Soci. 2020;17(2):113.##Lumezi BG, Berisha VL. Investigation of body mass index, insulin resistance and diabetes in patients with hirsutism. Postepy Dermatol Alergol. 2021;38(6):1006-10.##Guo R, Zheng Y, Yang J, Zheng N. Association of TNF-alpha, IL-6 and IL-1beta gene polymorphisms with polycystic ovary syndrome: a meta-analysis. BMC Genet. 2015;16(1):5.##Broekmans FJ, Knauff EAH, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BCJM. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO‐II anovulation and association with metabolic factors. BJOG. 2006;113(10):1210-7.##Ożga K, Krzyczkowska-Sendrakowska M, Hubalewska-Dydejczyk A, Gilis-Januszewska A, Ratajczak M, Ratajczak M, et al. The value of the free androgen index depends on the phenotype of polycystic ovary syndrome-a single-centre experience. Endokrynol Pol. 2019;70(4):330-5.##Mohammadi M. Oxidative stress and polycystic ovary syndrome: a brief review. Int J Prev Med. 2019;10:86.##Kałużna M, Człapka-Matyasik M, Wachowiak-Ochmańska K, Moczko J, Kaczmarek J, Janicki A, et al. Effect of central obesity and hyperandrogenism on selected inflammatory markers in patients with PCOS: a WHtR-matched case-control study. J Clin Med. 2020;9(9):3024.##Rostamtabar M, Esmaeilzadeh S, Tourani M, Rahmani A, Baee M, Shirafkan F, et al. Pathophysiological roles of chronic low‐grade inflammation mediators in polycystic ovary syndrome. J Cell Physiol. 2021;236(2):824-38.##Kelly CC, Lyall H, Petrie JR, Gould GW, Connell JM, Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome. J Clinl Endocrinol Metab. 2001;86(6):2453-5.##Olszanecka-Glinianowicz M, Banaś M, Zahorska-Markiewicz B, Janowska J, Kocełak P, Madej P, et al. Is the polycystic ovary syndrome associated with chronic inflammation per se? Eur J Obstet Gynecol Reprod Biol. 2007;133(2):197-202.##Escobar-Morreale HF, Luque-Ramírez M, González F. Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis. Fertil Steril. 2011;95(3):1048-58.e2.##Alissa EM, Algarni SA, Khaffji AJ, Al Mansouri NM. Impact of interlukin-6 on central obesity measures in women with polycystic ovarian syndrome. 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Molecular and Serological Epidemiology of Herpes Simplex Virus Type 1 and 2 in Pregnant Women of Gorgan City, North East of Iran 2 1 2 Background: As one of the most widespread sexually transmitted infections, Herpes Simplex Virus (HSVs) globally account for 60-95% of persistent infections in adults. This infection is prevalent in women of gestational age and is likely to be transmitted from the infected mother to her neonate. Additionally, it gives rise to devastating complications in neonates. This study was designed to estimate the molecular and serological prevalence of HSV-1 and 2 in pregnant women of Gorgan city, North East of Iran. Methods: Vaginal secretions and blood specimens of 315 pregnant women referred to an educational hospital in the North east of Iran were tested for HSV-1 and HSV-2 using multiplex PCR and ELISA assays. Chi-Square test was utilized to evaluate the association of qualitative variables and the level of significance was set at p≤0.05. Moreover, statistical analysis was performed using SPSS V.19.0. Results: HSV-1 and HSV-2 DNA was detected in 5.7% and 8.3% of participants, respectively. Given the serological analyses of total HSV-1 and HSV-2 antibodies, 92.7% (239/315) of patients were IgG positive and 5.4% (17/315) were IgM positive. Conclusion: The rate of HSV-1 and 2 in the present study was lower than that reported by World Health Organization (WHO). This study emphasizes the conduction of further investigations on HSVs since these viruses are probably playing significant role in sexually transmitted infections. 35 43 Seyyede Delafruz SD Hosseini Infectious Diseases Research Center, Golestan University of Medical Sciences Infectious Diseases Research Center, Golestan University of Medical Sciences Iran Mohammad M Yasaghi Infectious Diseases Research Center, Golestan University of Medical Sciences Infectious Diseases Research Center, Golestan University of Medical Sciences Iran Elham E Mobasheri Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences Iran Hadi H Razavi Nikoo Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences Iran Alijan A Tabarraei Infectious Diseases Research Center, Golestan University of Medical Sciences Infectious Diseases Research Center, Golestan University of Medical Sciences Iran tabarraei@goums.ac.ir HSV-1HSV-2IranPregnant womenSexually transmitted infections 140177.pdf Szczubiałka K, Pyrć K, Nowakowska M. In search for effective and definitive treatment of herpes simplex virus type 1 (HSV-1) infections. RSC Advan. 2016;6(2):1058-75.##Ruderfer D, Krilov LR., Herpes simplex viruses 1 and 2. Pediatr Rev. 2015;36(2):86-90.##Hammad WAB, Konje JC. Herpes simplex virus infection in pregnancy–an update. Eur J Obstet Gynecol Reprod Biol. 2021;259:38-45.##Khadr L, Harfouche M, Omori R, Schwarzer G, Chemaitelly H, Abu-Raddad LJ. The epidemiology of herpes simplex virus type 1 in Asia: systematic review, meta-analyses, and meta-regressions. Clin Infect Dis. 2019;68(5):757-72.##Marchi S, Trombetta CM, Gasparini R, Temperton N, Montomoli E. Epidemiology of herpes simplex virus type 1 and 2 in Italy: a seroprevalence study from 2000 to 2014. J Prev Med Hyg. 2017;58(1):E27-E33.##Bradley H, Markowitz LE, Gibson T, McQuillan GM. Seroprevalence of herpes simplex virus types 1 and 2—United States, 1999–2010. J Infect Dis. 2014;209(3):325-33.##Pebody RG, Andrews N, Brown D, Gopal R, De Melker H, François G, et al. The seroepidemiology of herpes simplex virus type 1 and 2 in Europe. Sex Transm Infect. 2004;80(3):185-91.##Sert UY, Ozgu-Erdinc AS, Saygan S, Engin-Ustun Y. Herpes simplex infection during pregnancy, results of a tertiary referral center in Turkey. Z Geburtshilfe Neonatol. 2020;224(1):22-5.##Wang C, Zhou YH, Yang HX, Poon LC. Intrauterine vertical transmission of SARS‐CoV‐2: what we know so far. Ultrasound Obstet Gynecol. 2020;55(6):724-5.##Lima L, Padalecki G, Castro C, Cordeiro J, de Paula V. Seroprevalence of human herpesvirus type 2 in a reference center for pregnant women in Rio de Janeiro, Brazil. Virus Rev Res. 2017;22(1):20-1.##Kimberlin DW. Neonatal herpes simplex infection. Clin Microbiol Rev. 2004;17(1):1-13.##Patton ME, Bernstein K, Liu G, Zaidi A, Markowitz LE. Seroprevalence of herpes simplex virus types 1 and 2 among pregnant women and sexually active, nonpregnant women in the United States. Clin Infect Dis. 2018;67(10):1535-42.##James SH, Kimberlin DW. Neonatal herpes simplex virus infection. Infect Dis Clin North Am. 2015;29(3):391-400.##Tookey PA, Mahdavi S, Peckham CS. Surveillance of neonatal herpes in the British Isles 2004-2006. F1000Research, 2020;9(163):163.##Mahant S, Hall M, Schondelmeyer AC, Berry JG, Kimberlin DW, Shah SS. Neonatal herpes simplex virus infection among medicaid-enrolled children: 2009-2015. Pediatrics. 2019;143(4):e20183233.##Samies NL, James SH. Prevention and treatment of neonatal herpes simplex virus infection. Antiviral Res. 2020;176:104721.##Aggerholm BS, Ostenfeld EB, Andersen LH, Krogh RH, Arendt LH, Sandager P. [Genital herpes simplex virus infection in pregnancy]. Ugeskr Laeger. 2020;182(5):V09190527. Danish.##Looker KJ, Magaret AS, May MT, Turner KM, Vickerman P, Gottlieb SL, et al. Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012. PloS One. 2015;10(10):e0140765.##Kahlon J, Whitley RJ. Antibody response of the newborn after herpes simplex virus infection. J Infect Dis. 1988;158(5):925-33.##Woestenberg PJ, Tjhie JH, de Melker HE, van der Klis FR, van Bergen JE, van der Sande MA, et al. Herpes simplex virus type 1 and type 2 in the Netherlands: seroprevalence, risk factors and changes during a 12-year period. BMC Infect Dis. 2016;16:364.##Yasaghi M, Hosseini SD, Moradi A, Hassanpour M, Tabarraei A. Molecular detection of HHV-1, HHV-2, HHV-5 and HBV in semen of fertile and infertile men by multiplex PCR method. Iran J Microbiol. 2022;14(6):921-7.##Malary M, Abedi G, Hamzehgardeshi Z, Afshari M, Moosazadeh M. The prevalence of herpes simplex virus type 1 and 2 infection in Iran: a meta-analysis. Int J Reprod Biomed. 2016;14(10):615-24.##Monavari SH, Vaziri MS, Khalili M, Shamsi-Shahrabadi M, Keyvani H, Mollaei H, et al. Asymptomatic seminal infection of herpes simplex virus: impact on male infertility. J Biomed Res. 2013;27(1):56-61.##Mohammed MS, Y.E. Yousif, and N. Hisham, Al Tayeb. Molecular Detection of Herpes Simplex-1 and 2 Viruses among Pregnant Women in Khartoum State (Sudan). African J Med Sci. 2020;5(7).##Rezaei-Chaparpordi S, Assmar M, Amirmozafari N, Modiri L, Massiha A, Shokri-Fashtali S, et al. Seroepidemiology of herpes simplex virus type 1 and 2 in northern iran. Iran J Public Health. 2012;41(8):75-9.##Mehta SD, Nandi D, Agingu W, Green SJ, Bhaumik DK, Bailey RC, et al. Vaginal and penile microbiome associations with herpes simplex virus type 2 in women and their male sex partners. J Infect Dis. 2022;226(4):644-54.##Wald A, Langenberg AG, Krantz E, Douglas Jr JM, Handsfield HH, DiCarlo RP, et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med. 2005;143(10):707-13.##Martin ET, Krantz E, Gottlieb SL, Magaret AS, Langenberg A, Stanberry L, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med. 2009;169(13):1233-40.##Wald A, Langenberg AG, Link K, Izu AE, Ashley R, Warren T, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA. 2001;285(24):3100-6.##Goyal S, Prabhu SS. Condom herpes: an interesting entity. Iran J Dermatol. 2022;25(1):70-3.##Nagot N, Ouedraogo A, Defer MC, Vallo R, Mayaud P, Van de Perre P. Association between bacterial vaginosis and Herpes simplex virus type-2 infection: implications for HIV acquisition studies. Sex Transm Infect. 2007;83(5):365-8.##Cherpes TL, Melan MA, Kant JA, Cosentino LA, Meyn LA, Hillier SL. Genital tract shedding of herpes simplex virus type 2 in women: effects of hormonal contraception, bacterial vaginosis, and vaginal group B Streptococcus colonization. Clin Infect Dis. 2005;40(10):1422-8.##Abbai NS, Govender S, Nyirenda M. Herpes simplex virus-2 infections in pregnant women from Durban, South Africa: prevalence, risk factors and co-infection with HIV-1. South African J Infect Dis. 2018;33(5):1-7.##Sharma P, Ganga RT. A study to assess the prevalence of Herpes simplex type 2 (HSV-2) infections in pregnant women in a tertiary care hospital. Int J Health Sci. 2022;6(S1):11938-45.##Mezher MN, Mejbel FA, Hussein HK. Detection of Herpes Simplex-2 Virus in Women with Spontaneous Abortion in Al-Najaf City/Iraq. J Pharm Sci Res. 2018;10(1):110-13.##Saheduzzaman M, Sharmin Z, Al Hossain A, Hoque MM, Das MK, Rahman MA. Relation of IgM antibody with Herpes simplex virus type-2 among women with spontaneous abortion and normal delivery. J Brahmanbaria Med College. 2021;3(2):14-7.##

The Effects of Chemotherapy on the Levels of Serum Anti-Müllerian Hormone in Patients with Gestational Trophoblastic Neoplasia 2 1 2 Background: Gestational trophoblastic neoplasia (GTN) is a group of tumors highly responsive to chemotherapy. It has been suggested that cancer therapies have detrimental effects on female fertility. Anti-Müllerian hormone (AMH) is considered fertility potential and ovarian reserves in women. The aim of this study was to compare serum AMH levels between the patients with GTN treated with chemotherapy and the patients with hydatidiform mole who underwent suction curettage without receiving any chemotherapy. Methods: In 35 patients with GTN, serum AMH levels were measured before suction curettage and after the administration of chemotherapy and compared with serum AMH levels measured in 35 patients with hydatidiform mole, who did not receive any chemotherapy as a control. In controls, serum levels of AMH were measured before suction curettage and at the time when beta human chorionic gonadotrophin (ß-hCG) levels approached zero concentration. Results: The mean serum AMH levels in the GTN group were significantly lower than those measured in the control group after chemotherapy. In addition, serum AMH levels measured after intervention in each group significantly decreased compared to the basal levels (p=0.034). Serum AMH levels showed significant differences between the patients who received chemotherapy regimens with methotrexate (MTX) alone, actinomycin-D (Act-D) alone, or the combination of MTX and Act-D (p=0.001). Conclusion: Our study showed that fertility preservation is of great importance in patients with GTN treated with chemotherapy. Furthermore, both MTX and Act-D could have potential adverse effects on ovarian reserve. 43 49 Mehrangiz M Zamani Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Iran Fatemeh F Mohsenpour Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Iran drfmohsenpour@gmail.com Faezeh F Torkzaban Faculty of Rehabilitation, Hamadan University of Medical Sciences and Health Services Faculty of Rehabilitation, Hamadan University of Medical Sciences and Health Services Iran Nazanin N Atrvash Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Iran Amir A Majlesi Besat Hospital, Hamadan University of Medical Sciences and Health Services Besat Hospital, Hamadan University of Medical Sciences and Health Services Iran Amirfazel A Torkzaban National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Iran Anti- mullerian hormoneChemotherapyFertilityGestational trophoblastic neoplasiaHydatidiform mole 140173.pdf Rattanaburi A, Boonyapipat S, Supasinth Y. Human chorionic gonadotropin (hCG) regression curve for predicting response to EMA/CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine) regimen in gestational trophoblastic neoplasia. Asian Pac J Cancer Prev. 2015;16(12):5037-41.##Goto H, Lindoso JAL. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther. 2010;8(4):419-33.##Jordan S, Randall LM, Karamurzin Y, Ward P, Lin F, Brewster W, et al. Differentiating squamous cell carcinoma of the cervix and epithelioid trophoblastic tumor. Int J Gynecol Cancer. 2011;21(5):918-22.##Abike F, Temizkan O, Payasli A, Avsar F, Karahan N, Baspinar S. Postmenopausal complete hydatidiform mole: a case report. Maturitas. 2008;59(1):95-8.##Leenharattanarak P, Lertkhachonsuk R. Quality of life in gestational trophoblastic neoplasia patients after treatment in Thailand. Asian Pac J Cancer Prev. 2014;15(24):10871-4.##Wang X, Yang J, Li J, Zhao J, Ren T, Feng F, et al. Fertility-sparing uterine lesion resection for young women with gestational trophoblastic neoplasias: single institution experience. Oncotarget. 2017;8(26):43368-75.##Cameron KE, Kole MB, Sammel MD, Ginsberg JP, Gosiengfiao Y, Mersereau JE, et al. Acute menopausal symptoms in young cancer survivors immediately following chemotherapy. Oncology. 2018;94(4):200-6.##Kondapalli LA, Dillon KE, Sammel MD, Ray A, Prewitt M, Ginsberg JP, et al. Quality of life in female cancer survivors: is it related to ovarian reserve? Qual Life Res. 2014;23(2):585-92.##Dunlop CE, Anderson RA. Uses of anti-Müllerian hormone (AMH) measurement before and after cancer treatment in women. Maturitas. 2015;80(3):245-50.##Gupta AA, Chong AL, Deveault C, Traubici J, Maloney AM, Knight S, et al. Anti-Müllerian hormone in female adolescent cancer patients before, during, and after completion of therapy: a pilot feasibility study. J Pediatr Adolesc Gynecol. 2016;29(6):599-603.##Harzif AK, Wiweko B, Addina P, Iswaranti K, Silvia M, Mariana A, et al. Anti-Mullerian hormone levels in female cancer patients of reproductive age in Indonesia: A cross-sectional study. F1000Res. 2019;8:159.##Bi X, Zhang J, Cao D, Sun H, Feng F, Wan X, et al. Anti-Müllerian hormone levels in patients with gestational trophoblastic neoplasia treated with different chemotherapy regimens: a prospective cohort study. Oncotarget. 2017;8(69):113920-7.##Cavaliere A, Ermito S, Dinatale A, Pedata R. Management of molar pregnancy. J Prenat Med. 2009;3(1):15-7.##Perveen S, Jabbar S, Nizar S. Gestational Trophoblastic Disease and Gestational Trophoblastic Neoplasm-An Experience at Tertiary Care Hospital. Ann Abbasi Shaheed Hosp Karachi KMDC. 2018;23(3):136-42.##Spears N, Lopes F, Stefansdottir A, Rossi V, De Felici M, Anderson R, et al. Ovarian damage from chemotherapy and current approaches to its protection. Hum Reprod Update. 2019;25(6):673-93.##Wenners A, Grambach J, Koss J, Maass N, Jonat W, Schmutzler A, et al. Reduced ovarian reserve in young early breast cancer patients: preliminary data from a prospective cohort trial. BMC Cancer. 2017;17(1):632.##Gadducci A, Lanfredini N, Cosio S. Reproductive outcomes after hydatiform mole and gestational trophoblastic neoplasia. Gynecol Endocrinol. 2015;31(9):673-8.##Fong SL, Lugtenburg P, Schipper I, Themmen A, De Jong F, Sonneveld P, et al. Anti-mullerian hormone as a marker of ovarian function in women after chemotherapy and radiotherapy for haematological malignancies. Hum Reprod. 2008;23(3):674-8.##Decanter C, Morschhauser F, Pigny P, Lefebvre C, Gallo C, Dewailly D. Anti-Müllerian hormone follow-up in young women treated by chemotherapy for lymphoma: preliminary results. Reprod Biomed Online. 2010;20(2):280-5.##Fréour T, Barrière P, Masson D. Anti-müllerian hormone levels and evolution in women of reproductive age with breast cancer treated with chemotherapy. Eur J Cancer. 2017;74:1-8.##Iwase A, Sugita A, Hirokawa W, Goto M, Yamamoto E, Takikawa S, et al. Anti-Müllerian hormone as a marker of ovarian reserve following chemotherapy in patients with gestational trophoblastic neoplasia. Eur J Obstet Gynecol Reprod Biol. 2013;167(2):194-8.##Camp-Sorrell D. Cancer and its treatment effect on young breast cancer survivors. Semin Oncol Nurs. 2009;25(4):251-8.##Uyar I, Yucel OU, Gezer C, Gulhan I, Karis B, Hanhan HM, et al. Effect of single-dose methotrexate on ovarian reserve in women with ectopic pregnancy. Fertil Steril. 2013;100(5):1310-3.##Olberding KE, Wang X, Zhu Y, Pan J, Rai SN, Li C. Actinomycin D synergistically enhances the efficacy of the BH3 mimetic ABT-737 by downregulating Mcl-1 expression. Cancer Biol Ther. 2010;10(9):918-29.##Oriol B, Barrio A, Pacheco A, Serna J, Zuzuarregui JL, Garcia-Velasco JA. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve. Fertil Steril. 2008;90(5):1579-82.##Blumenfeld Z, Avivi I, Eckman A, Epelbaum R, Rowe JM, Dann EJ. Gonadotropin-releasing hormone agonist decreases chemotherapy-induced gonadotoxicity and premature ovarian failure in young female patients with Hodgkin lymphoma. Fertil Steril. 2008;89(1):166-73.##

Perception of Female Identity in Women with Premature Ovarian Insufficiency: A Qualitative Study 2 1 2 Background: Premature ovarian insufficiency (POI) occurs in women before the age of 40. Although the outcomes of POI in women include its adverse effects on general health, sexual-reproductive health, and finally reduced quality of life. One of the first adverse consequences is a threat to female identity of the patients. The purpose of the present study was to investigate the perception and experience of women with POI about female identity. Methods: In this qualitative study, interviews were conducted with 15 women having POI. Data included participants' recorded voices that were analyzed using conventional content analysis. Results: After content analysis of the interviews with a focus on the perception and experience of women with POI about female identity, four categories emerged; they included the failure in realization of motherhood dream, the importance of menstruation, construction of female identity, and attempts to normalize the situation. Conclusion: After analyzing the emerged categories obtained by interviewing with POI women, it seems that physicians need to pay special attention to the distortion of the female identity of these patients and educate the medical team about the importance of the effect of treatment on improving their emotional health. 49 58 Somayeh S Moukhah Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences Iran Behzad B Ghorbani بهزاد قربانی Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Iran Zahra Z Behboodi Moghadam Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences Iran Behboodi@tums.ac.ir Simin S Zafardoust Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Iran Azadeh A Haji Parvaneh Avicenna Fertility Center, Avicenna Research Institute, ACECR Avicenna Fertility Center, Avicenna Research Institute, ACECR Iran Elham E Alinaghi Avicenna Fertility Center, Avicenna Research Institute, ACECR Avicenna Fertility Center, Avicenna Research Institute, ACECR Iran Rasoul R Moukhah Department of Quality Assurance, Pasteur Institute of Karaj Department of Quality Assurance, Pasteur Institute of Karaj Iran Female identityPrimary ovarian insufficiencyQualitative research 140171.pdf Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009;360(6):606-14.##Kumar N, Manesh I. Premature ovarian insufficiency: aetiology and long term consequences. Int J Womens Health. 2017;3(2):45-58.##Podfigurna-Stopa A, Czyzyk A, Grymowicz M, Smolarczyk R, Katulski K, Czajkowski K, et al. Premature ovarian insufficiency: the context of long-term effects. J Endocrinol Invest. 2016;39(9):983-90.##Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Sci Med. 1997;45(11):1679-704.##Singer D, Hunter MS. Dealing with loss of fertility. Br Med J. 1997;315(7099):66.##Singer D, Hunter MS. The experience of premature menopause: a thematic discourse analysis. J Reprod Infant Psychol. 1999;17(1):63-81.##Ventura J, Davis M, Calis K, Koziol D, Covington S, Nelson L. Symptoms of depression and their impact on daily functioning in women with spontaneous premature ovarian failure. Fertil Steril. 2006; 86(3):S54.##Groff AA, Covington SN, Halverson LR, Fitzgerald OR, Vanderhoof V, Calis K, et al. Assessing the emotional needs of women with spontaneous premature ovarian failure. Fertil Steril. 2005;83(6):1734-41.##Schmidt PJ, Cardoso GMP, Ross JL, Haq N, Rubinow DR, Bondy CA. Shyness, social anxiety and impaired self-esteem in Turner syndrome and premature ovarian failure. JAMA. 2006;295(12):1374-6.##Van der Voort K, Grabill J, Troendle S, Covington L, Nelson LM. Women with spontaneous premature ovarian failure have reduced self-esteem and perceived social support. Fertil Steril. 2003;84:S22.##van der Stege JG, Groen H, van Zadelhoff SJ, Lambalk CB, Braat DD, van Kasteren YM, et al. Decreased androgen concentrations and diminished general and sexual well being in women with premature ovarian failure. Menopause. 2008;15(1):23-31.##Benetti-Pinto CL, De Almeida DM, Makuch MY. Quality of life in women with premature ovarian failure. Gynecol Endocrinol. 2011;27(9):645-9.##The impact of premature ovarian failure on quality of life: results from the UK 1958 Birth Cohort. 2011;26(suppl 1):108-10.##Sergeant J. An exploration of women's identity during menopause: a grounded theory study [dissertation]. [Roehampton]: University of Roehampton. 2016. 58 p.##Cheek JM. Identity orientations and self-interpretation. In: Buss DM, Cantors N, editors. Personality psychology: recent trends and emerging directions. New York: Springer; 1989. p. 275-85.##American Psychological association. Identity. dictionary.apa.org. Retrieved 2022-02-22.##Weinreich P. The operationalisation of identity theory in racial and ethnic relations. In: Rex J, Mason D, Mason DS, editors. Cambridge: Cambridge University Press; 1986. p. 299-320.##Leary MR. What is the self? a plea for clarity. Self Identity. 2004;3(1):1-3.##Karimi M, Samani RO, Shirkavand A. A qualitative study of the experiences of infertile woman in Iran. Payesh. 2015;14(4):453-65.##Thorn P. Understanding infertility: psychological and social considerations from a counselling perspective. Int J Fertil Steril. 2009;3(2):48-51.##Charmaz, K. The body identity and self: adapting to impairment. Sociol Q. 1995;36(4):657-80.##Hunter MS, O’Dea I. Menopause: bodily changes and multiple meanings. In: Ussher JM, editor. Body talk. London: Routledge; 2002. p. 211-34.##Paechter C. Educating the other: gender, power and schooling. 1st ed. London: Routledge; 1998. 152 p.##Beauvoir S. The second sex. London: Random House; 1949. 873 p.##Minnaar TA. Is ovarian cancer the end of womanhood? a feminist theological engagement [dissertation]. [Stellenbosch]. Stellenbosch University; 2018. 148 p.##Hungr C, Sanchez-Varela V, Bober SL. Self-image and sexuality issues among young women with breast cancer: practical recommendations. Rev Invest Clin. 2017;69(2):114-22.##Yazdkhasti M, Negarandeh R, Behboodi-Moghadam Z. Threat of the feminine identity: The emerging structure in exploring the process of women's empowerment for menopause management: a grounded theory study. Int J Med Res Health Sci. 2016;5(11):509-20.##European Society for Human Reproduction and Embryology (ESHRE) Guideline Group on POI, Webber L, Davies M, Anderson R, Bartlett J, Braat D, et al. ESHRE guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016;31(5):926-37.##Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. 5th ed. Philadelphia: Lippincott Wil-liams & Wilkins; 2011. 419 p.##Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 8th ed. Philadelphia:Lippincott: Williams and Wilkins; 2017. 723 p.##Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15 (9):1277-88.##Zhang Y, Wildemuth BM. Qualitative analysis of content. In: Wildemuth BM, editor. Applications of social research methods to questions in information and library science. UK: Libraries Unlimited. 2016. p.1-12.##Wildemuth BM. Applications of social research methods to questions in information and library science. 2nd ed. UK: Libraries Unlimited; 2016. 433 p.##Lincoln SY, Guba EG. Naturalistic inquiry. 1st ed. Thousand Oaks: SAGE; 1984. 382 p.##Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative content analysis: a focus on trustworthiness. SAGE Open. 2014;4(1):2158244014522633.##Birks M, Mills J. Grounded theory: a practical guide. 2nd ed. London: SAGE; 2015. 24 p.##Pasquali EA. Premature menopause and self-concept disjunctions: a case for crisis management. J Psychosoc Nurs Ment Health Serv. 2002;40(9):20-9.##Orshan SA, Furniss KK, Forst C, Santoro N. The lived experience of premature ovarian failure. J Obstet Gynecol Neonatal Nurs. 2001;30(2):202-8.##Nauman I. Aspects of Mary and the church through the centuries. Campus ministry at the university of dayton: Marian Resources. 2010. 128 p.##Skultans V. The symbolic significance of menstruation and the menopause. Man. 1970;5(4):639-51.##Golezar S, Keshavarz Z, Tehrani FR, Ebadi A. An exploration of factors affecting the quality of life of women with primary ovarian insufficiency: a qualitative study. BMC Women's Health. 2020;20 (1):163.##Boughton MA. Premature menopause: multiple disruptions between the woman's biological body experience and her lived body. J Adv Nurs. 2002;37(5):423-30.##Panos K. Generations of fertility: a bioethical and evolutionary analysis [dissertation]. [DePauw]: DePauw University; 2019. 101 p.##Rafique S, Sterling EW, Nelson LM. A new approach to primary ovarian insufficiency. Obstet Gynecol Clin North Am. 2012;39(4):567-86.##Lockley GS. Premature menopause–the experiences of women and their partners [dissertation]. 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Infertility Does Not Increase the Rate of Breast Fibroadenoma 2 1 2 Background: Fibroadenoma (FA) and infertility can share common risk factors and probably common underlying pathophysiology, but yet there is no study evaluating the prevalence of FA in infertile women. Therefore, the aim of in the present study, the purpose was evaluating the association of FA and infertility for the first time. Methods: This short communication is a secondary analysis of a primary study that was performed in Arash Women’s Hospital, Tehran, Iran. Participants were selected among reproductive-aged women with a history of infertility as the case and women without infertility as the control group. The criteria for diagnosis of FA were histopathologic assessment for lumps 1 cm in size or larger, and a typical ultrasound image for smaller lumps. Assisted reproductive technology (ART) was defined as any previous history of undergoing ovulation stimulation, intrauterine insemination, intracytoplasmic sperm injection, or in vitro fertilization. Results: Overall, 155 cases with a mean age of 39.2±6.9, and 167 controls with a mean age of 43.08±8.3 were included (p=0.0001). Interestingly, the incidence of FA was lower in the case group (18.7% vs. 25.7%), however, the difference was not statistically significant (p=0.13). Also, logistic regression analysis showed that the chance for an infertile woman who undergoes ART to get FA is 1.7 times higher in comparison to non-ART group, although the difference was not significant (p=0.21). Conclusion: Infertility and ART were not associated with increased risk of FA; however, larger prospective studies should be conducted in the future in order to achieve conclusive results. 58 63 Mandana M Motamedi Breast Disease Research Center (BDRC), Tehran University of Medical Sciences Breast Disease Research Center (BDRC), Tehran University of Medical Sciences Iran Ashraf A Moini Breast Disease Research Center (BDRC), Tehran University of Medical Sciences Breast Disease Research Center (BDRC), Tehran University of Medical Sciences Iran Khadije Kh Maajani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Iran Arezoo A Maleki-Hajiagha Department of Anatomy, School of Medicine, Tehran University of Medical Sciences Department of Anatomy, School of Medicine, Tehran University of Medical Sciences Iran Sadaf S Alipour Breast Disease Research Center (BDRC), Tehran University of Medical Sciences Breast Disease Research Center (BDRC), Tehran University of Medical Sciences Iran sadafalipour@yahoo.com, salipour@sina.tums.ac.ir Assisted reproductive technologyBreast neoplasmBreast ultrasoundFibroadenomaInfertility 120101.pdf Pearlman MD, Griffin JL. Benign breast disease. Obstet Gynecol. 2010;116(3):747-58.##Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer Jr WD, Rados MS, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. 1994;331(1):10-5.##Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353(3):229-37.##Yadav RK, Min ZJ, Verma SK, Yadav SK, Gupta A, Dhakal D. Review on fibroaderma. Int J Sci Inventation J. 2019;8(2):295-9.##Bidgoli SA, Eftekhari T. Role of exogenous and endogenous sources of estrogen on the incidence of breast fibroadenoma: case-control study in Iran. Asian Pac J Cancer Prev. 2011;12(5):1289-93.##Brugo-Olmedo S, Chillik C, Kopelman S. Definition and causes of infertility. Reprod Biomed Online. 2001;2(1):41-53.##Andarieh M, Delavar M, Moslemi D, Ahmadi M, Zabihi E, Esmaeilzadeh S. Infertility as a risk factor for breast cancer: results from a hospital-based case–control study. J Cancer Res Ther. 2019;15(5):976-80.##Lundberg FE, Iliadou AN, Rodriguez-Wallberg K, Gemzell-Danielsson K, Johansson ALV. The risk of breast and gynecological cancer in women with a diagnosis of infertility: a nationwide population-based study. Eur J Epidemiol. 2019;34(5):499-507.##Barcroft JF, Galazis N, Jones BP, Getreu N, Bracewell-Milnes T, Grewal KJ, et al. Fertility treatment and cancers-the eternal conundrum: a systematic review and meta-analysis. Hum Reprod. 2021;36(4):1093-107.##Eliassen AH, Missmer SA, Tworoger SS, Spiegelman D, Barbieri RL, Dowsett M, et al. Endogenous steroid hormone concentrations and risk of breast cancer among premenopausal women. J Natl Cancer Inst. 2006;98(19):1406-15.##Pasqualini JR, Cortes-Prieto J, Chetrite G, Talbi M, Ruiz A. Concentrations of estrone, estradiol and their sulfates, and evaluation of sulfatase and aromatase activities in patients with breast fibroadenoma. 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Intravesical Herniation of Tubal Fimbria Through Vesicovaginal Fistula Associated with Ureterovaginal Fistula Mimicking Bladder Mass: A Case Report of Unreported and Undescribed Hernia 2 1 2 Background: One of the few remaining important issues in urological and gynaecological surgery relates to fistulas between the urinary tract and the vagina. Vesicovaginal fistula (VVF) and ureterovaginal fistulas (UVF) are defined as abnormal connections between the urinary tract, on the one side, and the female genital system, on the other. Case Presentation: This study is about an unreported and undescribed case of 24 year old female who presented with the complaints of continuous urinary incontinence for 18 months following total abdominal hysterectomy. Preoperative cystoscopy and vaginal/speculum findings revealed a papillary frond like mass protruding intravesically from VVF site which was free from the edges of fistulous opening all around. Also, left ureteric orifice was not visualized. On exploration, there was evidence of intravesical herniation of right tubal fimbria through the common opening of VVF and left UVF near left vaginal vault apex mimicking a bladder mass presenting with continuous incontinence for 18 months. Modified O' Conners VVF repair with left ureteric reimplantation was done. The postoperative period was uneventful with patient having no incontinence. Conclusion: It seems that surgical resection of ovarian cyst with VVF and UVF repair is the definitive treatment and histopathological examination is essential to exclude malignant transformation. 63 66 Prakash P Sankapal Department of Urology, Grant Government Medical College & Sir JJ Hospital Department of Urology, Grant Government Medical College & Sir JJ Hospital India Gite GV Arjunrao Department of Urology, Grant Government Medical College & Sir JJ Hospital Department of Urology, Grant Government Medical College & Sir JJ Hospital India balajigite@yahoo.com Agrawal A Mayank Department of Urology, Grant Government Medical College & Sir JJ Hospital Department of Urology, Grant Government Medical College & Sir JJ Hospital India Maheshwari M Mudit Department of Urology, Grant Government Medical College & Sir JJ Hospital Department of Urology, Grant Government Medical College & Sir JJ Hospital India Sharma Sh Shashank Department of Urology, Grant Government Medical College & Sir JJ Hospital Department of Urology, Grant Government Medical College & Sir JJ Hospital India Bladder massFimbriaIncontinenceOvarian cystUreterovaginal fistulaVesicovaginal fistula 140178.pdf Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. 1980;123(3):370-4.##Meeks GR, Ghafa MA. Rectovaginal Fistulas. In: Peter von Dadelszen editor. The global library of women’s medicine’s. UK: International federation of gynecology and obstetrics; 2012. DOI 10.3843/ GLOWM.10065##Gupta SK, Kumar M, Singh M, Kumar V, Tiwari RK, Suman SK, et al. Ovarian dermoid cyst perforating into the urinary bladder. Uro Today Int J. 2012;5(4).##Seth J, Kiosoglous A, Pakzad M, Hamid R, Shah J, Ockrim J, et al. Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: report of a series from a specialized center. Int J Urol. 2019;26(7):717-23.##