فهرست مطالب عباس افلاطونیان

 Monthly regeneration of endometrium after cyclical mensturation confirmed the ability of specific population of the cells that presence in the basalis layer and undergone consecutive hormonal changes that could prepared the endometrial layer for probable implantation. These cells, known as, stem cell. The aim of this study was the isolation and culture of human endometrial derived mesenchymal stem/stromal cells (EnMSCs).

.In this study, human endometrial tissues were collected after fully-informed patient consent, which attended the Research and Clinical Center for Infertility. After washing and enzymatic treatment, EnMSCs were isolated and cultured in vitro.

Cells from endometrium were successfully isolated using enzymatically treatment and mechanically dissociation, then cultured and expanded for several passages for further characterization and evaluations. Endometrium derived cells were morphologically similar to mesenchymal stem/stromal cells (MSCs).

The results of the present study confirm previous reports in vitro studies for the isolation and culture of human EnMSCs. Endometrial tissue is a part of uterus with available source of MSCs with self-renewal and differentiation capacity that undergoes a cyclical regeneration every month in normal women’s life span. In this regard, human EnMSCs could be used for future novel therapeutic methods in regenerative medicine for treatment of uterine-factor infertile patients, which can lead to recurrent pregnancy loss (RPL) and finally resolve of surrogacy problems.

Endometriosis is a disease that affects women of reproductive age. This disease is characterized by the presence of endometrial-like tissues (endometrial or stromal glands) outside the uterus and shows significantly elevated prevalence in industrial regions. Additionally, an interaction between genetics and environmental factors is assumed for the disease. Enzymes belonging to the cytochrome P450 (CYP) family are participated in detoxification process of a wide range of environmental toxins and carcinogens. Thereby, they are good link for the interaction. CYP1A1 which belong to cytochrome P450 (CYPs) superfamily, is a very important gene for the metabolism of carcinogens.

The aim of this study was to analyze the frequency of the MspI polymorphism of CYP1A1 gene and its relation to endometriosis.

Genomic DNA was isolated from 93 endometriosis women and 139 healthy controls. Genotyping was performed using polymerase chain reaction followed by restriction fragment length polymorphism analysis.

Frequencies of the TT, TC, and CC genotype of CYP1A1 gene polymorphism in patients were 73.1%, 22.6%, and 4.3%, while frequencies in controls were 74.1%, 22.3%, and 3.6%, respectively. So there was no significant differences between the genotypes in two groups (p=0.961).

According to our study, MspI polymorphism of CYP1A1 gene appears to be not associated with the risk of endometriosis in the studied population. However, additional studies, especially with larger sample size are needed to validate these findings.

  Male infertility has increased during recent years in countries of the world including Iran. Among many factors that influence the infertility, smoking, alcohol, and addictive drugs were investigated in this study. This case-control retrospective study was conducted on 600 male patients consisting of 300 individuals with natural semen and 300 people with defective semen. The first step in investigation of infertility in each couple was to conduct a spermogram to detect the male infertility. The case group included men who referred to the Yazd Infertility Treatment Center and had at least one abnormal test result among considering the parameters of semen test. The control group included the men who referred to the same center and had normal semen test result. The data collection tools were a researcher-made checklist based on the parameters required for the study with epidemiological and observational design, as well as the semen analysis test. The age mean in the case and control groups were 34.71 and 33.82 years with the standard deviation of ± 7.3 and ± 6.41, respectively. The means of marriage age in the case and control groups were 26.28 and 26.28 ±5.3 years, respectively. The mean duration of infertility in the case group was 6.30 ± 4.60 and in the control group was 5.15± 3.88. No significant difference was observed between the mean age (P = 0.084) and marital age (P = 0.448) in two groups, but the mean duration of infertility (P <0.001) was significantly different between the two groups .The prevalence of smoking was significantly different between the two groups (P = 0.032). Considering the daily frequency of smoking, the highest rate was 11-20 cigarettes in both groups (case group 21.7% and control group 15.3%). The P value was set at 0.018. In this study, smoking and consumption of alcohol were not considered as the predictive factors of semen quality, but consumption of drugs and the age of starting consumption of drugs had a significant relationship with the semen disorders.

Endometriosis is a prevalent gynecological disease, with limited known etiology and more researches are required to identify its etiology. In this manner, there is no evidence for expression and function of 3´HOX genes in 4 clusters in the limb and pelvic organs such as the uterus and its disorders (Genes in the HOXA-D clusters are subdivided into 13 paralogous groups).

This study designed to investigate the expression profile of 5 paralogous (1-5) in four clusters of HOX genes (A, B, C, and D) in ectopic and eutopic tissues of women with endometriosis compared to the normal endometrium.

Samples were obtained from thirty patients (15 with and 15 without endometriosis) of reproductive age with normal menstrual cycles. The same patient provided both eutopic and ectopic tissues and control women were laparoscopically checked for the absence of endometriosis. The expression profile of these HOX genes was investigated by quantitative real-time polymerase chain reaction technique.

We observed significant up-regulation of some members of HOXC and D clusters (HOXD1, HOXD3, HOXC4 and HOXC5) in ectopic and eutopic tissues vs. control. Also, our data showed significant down-regulation of all of HOXA and HOXB paralogous except HOXA1 in ectopic tissues versus control.

Our data showed specific cluster dependent modulation of the HOX genes expression in endometriosis (over-expression of some HOX genes in cluster C and D and down-regulation of HOX genes in cluster A and B) in ectopic and eutopic tissues compare to control group. Therefore, it is possible that change of expression level of these genes in endometrium plays a role in the pathogenesis of endometriosis

Anti-Mullerian hormone (AMH) is considered as a good marker for quantitative evaluation of ovarian response to the stimulation during assisted eproductive technology cycles.

To evaluate the association between serum AMH level and embryo orphokinetics using time-lapse imaging and intracytoplasmic sperm injection ICSI) outcomes in women with polycystic ovarian syndrome (PCOS).

We evaluated a total of 547 embryos from 100 women nderwent ICSI cycles; 50 women with PCOS and 50 women with tubal factor infertility. Serum AMH level was measured in all participants. Time-laps records were annotated for time to pronuclear fading (tPNf), time to 2-8 cells (t2-t8), reverse cleavage, direct cleavage, and also for the presence of multinucleation.

AMH was negatively correlated with t5, t8, and the third cell cycle (p=0.02, p=0.02, and p=0.01; respectively) in PCOS group. AMH had no correlation with embryo kinetics in infertile women with tubal factor infertility. Moreover, AMH level is similar between embryos with and without direct cleavage as well as reverse cleavage and Multinucleation in both groups. The Receiver operating characteristic curves analyses indicated that AMH was not an accurate predictor of clinical pregnancy as well as a live birth (AUC=0.59 [95% CI, 0.42-0.76]) in PCOS women. However, in the women with tubal factor infertility AMH showed a fair prediction value for clinical pregnancy (AUC=0.64 [95% CI, 0.48-0.82]) along with the live birth (AUC=0.70 [95% CI, 0.55-0.85]).

Some of the time-lapse embryo parameters may be related to the AMH concentration. However, AMH is not an accurate tool to predict the ICSI outcomes in PCOS women.

The use of embryo cryopreservation excludes the possible detrimental effects of ovarian stimulation on the endometrium, and higher reproductive outcomes following this policy have been reported. Moreover, gonadotropin-releasing hormone agonist trigger in gonadotropin-releasing hormone (GnRH) antagonist cycles as a substitute for standard human chorionic gonadotropin trigger, minimizes the risk of ovarian hyperstimulation syndrome (OHSS) in fresh as well as frozen embryo transfer cycles (FET).

To compare the reproductive outcomes and risk of OHSS in fresh vs frozen embryo transfer in high responder patients, undergoing in vitro fertilization triggered with a bolus of GnRH agonist.

In this randomized, multi-centre study, 121 women undergoing FET and 119 women undergoing fresh ET were investigated as regards clinical pregnancy as the primary outcome and the chemical pregnancy, live birth, OHSS development, and perinatal data as secondary outcomes.

There were no significant differences between FET and fresh groups regarding chemical (46.4% vs. 40.2%, p=0.352), clinical (35.8% vs. 38.3%, p=0.699), and ongoing (30.3% vs. 32.7%, p=0.700) pregnancy rates, also live birth (30.3% vs. 29.9%, p=0.953), perinatal outcomes, and OHSS development (35.6% vs. 42.9%, p=0.337). No woman developed severe OHSS and no one required admission to hospital.

Our findings suggest that GnRHa trigger followed by fresh transfer with modified luteal phase support in terms of a small human chorionic gonadotropin bolus is a good strategy to secure good live birth rates and a low risk of clinically relevant OHSS development in in vitro fertilization patients at risk of OHSS.

Management of poor-responding patients is still major challenge inassisted reproductive techniques (ART). Delayed-start GnRH antagonist protocol isrecommended to these patients, but little is known in this regards.

The goal of this study was assessment of delayed-start GnRH antagonistprotocol in poor responders, and in vitro fertilization (IVF) outcomes.

This randomized clinical trial included sixty infertilewomen with Bologna criteria for ovarian poor responders who were candidate forIVF. In case group (n=30), delayed-start GnRH antagonist protocol administeredestrogen priming followed by early follicular-phase GnRH antagonist treatment for7 days before ovarian stimulation with gonadotropin. Control group (n=30) treatedwith estrogen priming antagonist protocol. Finally, endometrial thickness, the ratesof oocytes maturation, , embryo formation, and pregnancy were compared betweentwo groups.

Rates of implantation, chemical, clinical, and ongoing pregnancy indelayed-start cycles were higher although was not statistically significant.Endometrial thickness was significantly higher in case group. There were nostatistically significant differences in the rates of oocyte maturation, embryoformation, and IVF outcomes between two groups.

Delayed-start GnRH antagonist protocol can be a new hope method totreatment poor ovarian responders.

Serum concentrations of antimullerian hormone (AMH) correlate with ovarian response during assisted reproduction treatment (ART) cycles.

This retrospective study attempted to evaluate the selection of ovarian stimulation protocols based on serum AMH levels in patients and its impact on the results of ART.

Based on AMH levels, the patients with tubal factor infertility were divided in three groups of normal, low and high AMH levels. Oocyte, good embryo number and pregnancy rate in each group were analyzed.

Using agonist and antagonist protocols, an increase in serum AMH led to higher number of oocytes and better quality embryos. At all low, normal and high AMH levels, the agonist protocol led to a more significant increase in the number of oocytes than the antagonist protocol (p

Findings of this study suggested that the ART results are predictable, taking into account the AMH levels. The protocol specific to each patient can be used given the AMH level in each individual. This is because the results of each protocol depend on individual conditions.

Implantation failure is one of the most important factors limiting success in IVF treatment. The majority of trials have demonstrated favorable effect of endometrial injury on implantation success rate especially in women with recurrent implantation failure, while some studies failed to detect any benefit.

The purpose of our trial was to explore whether endometrial injury in luteal phase prior to frozen-thawed embryo transfer cycles would improve pregnancy outcomes?

We conducted a prospective controlled trial of 93 consecutive subjects at a research and clinical center for infertility. All women were undergone frozen-thawed embryo transfer (FTE) cycles. Women in the experimental group underwent endometrial biopsy with a Pipelle catheter in luteal phase proceeding FET cycle. Primary outcomes were implantation and clinical pregnancy rates and secondary outcomes were chemical, ongoing and multiple pregnancy and miscarriage rates.

45 subjects who underwent endometrial injury (EI) were compared with 48 control group which did not include any uterine manipulation. There were no significant differences in baseline and cycle characteristics between two groups. The difference in implantation rate was trend to statistically significance, 11.8% in EI group vs. 20.5% in control group (p=0.091). The chemical, clinical and ongoing pregnancy rates were lower in EI group compared with control group but not statistically significant. The multiple pregnancy rate and miscarriage rate also were lower in EI group compared with control group.

Based on results of this study, local injury to endometrium in luteal phase prior to FET cycle had a negative impact on implantation and clinical pregnancy rates.

Despite of higher pregnancy rate after frozen embryo transfer (FET) which is accepted by the majority of researches, the safety of this method and its effect on neonatal outcome is still under debate.

The aim of this study was to evaluate pregnancy and neonatal outcome of FET compare to fresh cycles.

In this study,1134 patients using fresh ET and 285 women underwent FET were investigated regarding live birth as primary outcome and gestational age, birth weight, gender, multiple status, ectopic pregnancy, still birth and pregnancy loss as secondary outcomes.

Our results showed that there is no difference between FET and fresh cycles regarding live birth (65.6% vs. 70.4% respectively). Ectopic pregnancy, still birth and abortion were similar in both groups. The mean gestational age was significantly lower among singletons in FET group compared to fresh cycles (p=0.047). Prematurity was significantly elevated among singleton infants in FET group (19.6%) in comparison to neonates born after fresh ET (12.8%) (p=0.037).

It seems that there is no major difference regarding perinatal outcome between fresh and frozen embryo transfer. Although, live birth is slightly increased in fresh cycles and prematurity was significantly increased among singleton infants in FET group.

Genital tuberculosis (GTB) is an important cause of female infertility, especially in developing countries. The positive results of polymerase chain reaction (PCR) in endometrial GTB in the absence of tubal damage raise the possibility of the detection of sub-clinical or latent disease, with doubtful benefits of treatment.

To evaluate the mycobacterium tuberculosis infection in endometrial biopsy samples collected from unexplained infertile women attending Yazd Research and Clinical Center for Infertility by using PCR techniques.

In this cross sectional study, 144 infertile women with unexplained infertility aged 20-35 years old and normal Histro-saplango graphy findings were enrolled. Endometrial biopsy samples from each participant were tested for mycobacterium tuberculosis detecting by PCR. In 93 patients, peritoneal fluid was also taken for culture and PCR.

The PCR results of endometrial specimens were negative in all cases, demonstrating that there was no GTB infection among our patients.

Our results showed that GTB could not be considered as a major problem in women with unexplained infertility. Although, studies have indicated that PCR is a useful method in diagnosing early GTB disease in infertile women with no demonstrable evidence of tubal or endometrial involvement.

Recently, motile sperm organelle morphology examination (MSOME) criteria as a new real time tool for evaluation of spermatozoa in intracytoplasmic sperm injection (ICSI) cycles has been considered.

The aim was to investigate the predictive value of MSOME in in vitro fertilization (IVF) in comparison to ICSI cycles and evaluation of the association between MSOME parameters and traditional sperm parameters in both groups.

This is a cross sectional prospective analysis of MSOME parameters in IVF (n=31) and ICSI cycles (n=35). MSOME parameters were also evaluated as the presence of vacuole (none, small, medium, large or mix); head size (normal, small or large); cytoplasmic droplet; head shape and acrosome normality. In sub-analysis, MSOME parameters were compared between two groups with successful or failed clinical pregnancy in each group.

In IVF group, the rate of large nuclear vacuole showed significant increase in failed as compared to successful pregnancies (13.81±9.7vs7.38±4.4, respectively, p=0.045) while MSOME parameters were the same between successful and failed pregnancies in ICSI group. Moreover, a negative correlation was noticed between LNV and sperm shape normalcy. In ICSI group, a negative correlation was established between cytoplasmic droplet and sperm shape normalcy. In addition, there was a positive correlation between sperm shape normalcy and non-vacuolated spermatozoa.

The high rate of large nuclear vacuoles in sperm used in IVF cycles with failed pregnancies confirms that MSOME, is a helpful tool for fine sperm morphology assessment, and its application may enhance the assisted reproduction technology success rates.

Recurrent pregnancy loss (RPL) has been defined as two or more miscarriages before 20th week of gestation. It seems that IL-27 may reduce inflammatory responses and affect the survival of the embryo during human pregnancy. IL-27 polymorphisms may influence RPL by altering the levels or the activity of gene product.

We studied for the first time the association of IL-27 -964 A>G single nucleotide polymorphism (SNP) with RPL in Iranian women.

A case-controlled study was performed on two groups consisting of 150 healthy women with at least one delivery (control group) and 150 women with two or more primary RPLs history (RPL group). The -964 A>G SNP in IL-27 gene was determined by PCR-RFLP technique. Genotype and allele frequencies were compared using c2 tests between two groups.

There was no difference between the two groups regarding age of women (29±4.4 [control] vs. 30.84±5.2 years [case]). In the RPL group, the genotype frequencies of -964 A>G polymorphism were AG (49.3%), AA (40%), and GG (10.7%), and in the control group, they were AG (43.3%), AA (48.7%), and GG (8%). There was no significant difference between the genotypes of AA, AG, and GG in two groups (p=0.23). As the frequency of allele A was 64.7% in the RPL group and 70.3% in the control group, the difference in frequency of allele A in -964 A>G between two groups was not significant (p=0.19).

Our findings indicate that SNP of -964 A>G in IL-27 gene is not a risk factor for RPL in Iranian women.

Frozen- thawed embryo transfer is an essential part of ART treatment and outcomes of this procedure are associated with several clinical factors. Several studies have showed an increase level of IVF outcomes in women with sufficient vitamin D.

whether treatment of vitamin D insufficiency can improve pregnancy rates in frozen-thawed embryo transfer cycles.

This is an interventional, randomized clinical trial. Serum 25-(OH) vitamin D level of 128 women who had undergone IVF/ICSI with cryopreservation of embryos was checked. One hundred fourteen infertile women with insufficient serum vitamin D (less than 30 ng/ml) were included in the study. Fifty seven women were treated with supplementary vitamin D, 50000 IU weekly, for 6-8 weeks and fifty seven women were received no supplementation. One hundred six women completed frozen thawed embryo transfer cycles and included in the final analysis. Primary and secondary outcomes were chemical and clinical pregnancy respectively.

Our study did not show any significant difference between vitamin D insufficient and treated women in term of chemical (29.40% vs. 29.10% respectively, p=1.00) or clinical (25.50% vs. 21.80% respectively, p=0.81) pregnancy rates.

Vitamin D insufficiency treatment is not associated with higher pregnancy rate in frozen-thawed embryo transfer cycles.

Some trials have compared laparoscopic ovarian drilling (LOD) with gonadotropins but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies.

To evaluate the relative efficacy of LOD and gonadotropins for infertile women with clomiphene citrate- resistant poly cystic ovary syndrome (PCOS).

A complete electronic literature search in databases including EMBASE, MEDLINE, Cochrane Library and Google scholar for some specific keywords was accomplished. We contained randomized clinical trials comparing outcomes between LOD, without medical ovulation induction, and gonadotropins.

Six trials, covering 499 women, reported on the primary outcome of pregnancy rate. There was no evidence of a difference in pregnancy rate when LOD compared with gonadotropins (OR: 0.534; 95% CI: 0.242-1.176, p=0.119, 6 trials, 499 women, I2=73.201%). There was evidence of significantly fewer live births following LOD compared with gonadotropin (OR: 0.446; 95% CI: 0.269-0.74, p=0.02, 3 trials, 318 women, I2=3.353%). The rate of multiple pregnancies was significantly lower in the LOD arm compared to the gonadotropins arm (OR: 0.127; 95% CI: 0.028-0.579, p=0.008, 3 trials, 307 women, I2=0%).

Our result revealed that there was no evidence of a significant difference in rates of clinical pregnancy and miscarriage in women with clomiphene citrate-resistant PCOS undergoing LOD compared to the gonadotropin arm. The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive. The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women. However, more focus on the long-term effects of LOD on ovarian function is suggested.

Increased serum progesterone on the day of human chorionic gonadotropin administration may affect in vitro fertilization (IVF) outcome.

The aim of this study was to evaluate whether progesterone elevation on the day of human chorionic gonadotropin administration is associated with poor IVF outcome.

To determine the relationship between serum progesterone on the day of HCG and the outcome of IVF-embryo transfer treatment, 378 infertile patients undergoing IVF-embryo transfer at Yazd Research and Clinical Center for Infertility from October 2009 to March 2011 were prospectively studied.

In this study, absolute p-value and P/E2 ratio were not a good predictor outcome of in-vitro fertilization but progesterone per metaphase II were predictive of implantation rate and pregnancy rate with statistically significant results but had no effect on the fertilization rate.

We suggest avoided the increased progesterone that the cause of advanced endometrial maturation and impaired endometrial receptivity. If the progesterone is greater than 0.32 per oocyte metaphase II, the embryo transfer can be canceled and freezing all embryos for future transfer must be considered, to increase acceptance of the endometrium and thus increase the success rate.

The human female reproductive tract (FRT) is constantly deal with the invading pathogens. Recognition of these pathogens is attributed to the family of Toll like receptors (TLR) as a major part of the innate immune system. We and others have previously revealed that TLRs1-6 express in the female reproductive tract. However, more studies should be done to detect TLRs 7-10 in the female reproductive tract, especially in the fallopian tubes.

To examine the expression of TLRs7-10 in human fallopian tube tissue.

Using immunostaining techniques, distribution of TLR7-10 was studied in surgical sections from the uterine tubes, obtained from patients undergoing tubal ligation and hysterectomy for benign gynecological conditions. RT-PCR was used to show the existence of TLR7-10 genes in fallopian tube tissue.

TLR7-10 proteins were detected in the fallopian tube epithelium, although the intensity of staining was not equal in cases. TLR7-10 genes were expressed in human fallopian tube tissue.

This study indicates that TLR7-10 is expressed in fallopian tubes tissues, and may play an important role in microbial recognition, and in host defense against ascending infection.

To investigate the association between thrombophilia and unexplained recurrent miscarriage and to evaluate the efficacy of anticoagulant treatment. In this quasi experimental, we enrolled 520 women, who had a history of recurrent miscarriage. Two hundred fifty two women with unexplained recurrent miscarriage were assigned to receive aspirin (80 mg daily) for two month before pregnancy and after confirmation of a viable pregnancy until 36 weeks of gestation or receive aspirin, as the same, plus heparin (5000 unit twice a day) subcutaneously after confirmation of viable pregnancy until 4 weeks after delivery. Type of medication was chosen for each woman according to number of abortion and age. Live-birth rates did not different significantly among the two study groups. The proportions of women who gave birth to a live normal infant were 74.5% in the group receiving aspirin plus heparin (combination-therapy group) and 79.8% in the aspirin group. Live-birth rates did not different significantly among the two study groups. So, using aspirin or aspirin plus heparin did not change pregnancy rate in these patients. Using aspirin is easier than injecting heparin which should be chosen case by case Using aspirin, heparin, or both in women with unexplained recurrent miscarriage could be useful, because this problem might be initiated by thrombosis in decidual vessels.

This Prospective, randomized, unblinded clinical study aimed to evaluate the efficiency of calcium ionophore on fertilization and pregnancy rate after intracytoplasmic sperm injection (ICSI) in infertile men suffer from teratoospermia. Thirty eight women with teratoospermic partner underwent ICSI with GnRH-antagonist protocol. A total of 313 metaphase II (MII) oocytes were randomly divided after ICSI into two groups: In the oocytes of the control group (n=145), routine ICSI was applied. Oocytes in the AOA group (n=168) immediately after ICSI, were cultured in culture medium supplemented with 5 μΜ calcium/100 μM calcium ionophore (A23187) for 5 minutes and then washed at least three times with MOPS solution. In both groups, the fertilization was evaluated 16-18 hours after ICSI. The number of embryos obtained and fertilized oocytes were significantly different between two groups (p=0.04 for each). There was no significantly difference between the two studied groups in the fertilization and cleavage rate. (95.33% vs. 89.56 %; and 84.4% vs. 87.74%; respectively, p<0.05) Implantation rate was higher in AOA group than in control group, but the difference was not significant. (17.64% vs. 7.4%, p=0.14). No significant differences were observed in chemical and clinical pregnancy rate between groups (47.1% vs. 16.7%, P=0.07; and 41.2% vs. 16.7%; p=0.14, respectively). Oocyte activation with calcium ionophore may improve ICSI outcomes in infertile men suffer from teratoospermia. Although, we found no significant difference in the implantation and pregnancy rate between the two groups of patients. Further study with more cases can provide greater value.

Preterm labor (PTL) is one of the most important causes in neonatal mortality and morbidity. Late preterm labor (34-36w) includes 75% of such birth. Assisted reproductive technology (ART) pregnant women are at increased risk of PTL. The study has been undertaken to determine whether beginning and continuing 17-α hydroxy progesterone caproate can reduce risk of PTL or change neonatal mortality. In a double-blind clinical randomized control trial, 106 women were treated by ART technique for their infertility and in gestational age at 16 weeks entered in our study. In one group, 17-α hydroxy progesterone caproate (Femolife) was injected intramuscularly every week until 36 weeks of gestation and in another group; placebo was injected from 16 until 36 weeks of gestetion. Data collected from pregnancy outcomes, infancy, and subsidiary problems were statistically analyzed by a questionnaire. The risk of PTL in placebo group was 2.48 higher than control group that was not significant (Cl: 0.81-9.94). Femolife side effect in case group was gestational diabetes and local complication was not frequent. NICU admission was not significantly different between groups. Although it seems that 17-α hydroxy progesterone caproate does not cause significantly decrease in PTL in singleton ART gestations but any reduction of PTL in such high risk pregnancies may improve final gestational outcome. There is critical need for larger clinical trials to better understanding causes of PTL, specifically late preterm labor, to prevent mortality and morbidity in ART gestation

The aim of our study was to assess the effect of storage duration of frozen embryo on ART outcome. In this retrospective study the data of 651 frozen-thawed embryo transfer cycles were assessed over a 36-months period. Our patients were categorized according to storage time of freeze. Group I: less than 90 days, Group II: between 90-365 days. Group III: between 365-730 days. Group IV: between 730-1095 days. Group V: more than 1095 days. Clinical pregnancy and implantation rate were defined and statistical analysis was performed using Student t-test and Chi-square. According to our finding patient’s mean age was 31.05±5.231 years (range, 18-53 years), and 1204 embryos were transferred. The mean storage duration was 296.72±301.82 days. The mean number of embryo transferred per cycle was similar between groups (p=0.224). According to our analysis clinical pregnancy rate per embryo transfer cycle was similar between groups (p=0.563). Our results showed that duration of storage had no negative effects on implantation of cryopreserved embryos. In our literature review we found a little article In this context. However our study showed duration of freezing don’t have any negative effects on implantation and pregnancy outcome, but more studies are needed to evaluate long term effects of storage duration on babies were born by cryopreserved embryos. Cryopreservation of embryos has been an usual component of clinic in assisted reproductive technology (ART) programs. Recently the dramatic increase in cryobiology activity in the clinical centers has enhanced methods of freezing and improved vitrification protocols are being developed.

Various immunological abnormalities have been reported in women with RSA of unknown aetiologies including autoimmune abnormalities and increased cellular immunity such as elevated natural killer (NK)، Th1 and Th17 cell levels. Th17 and Th1 cells play a central role during inflammation. Th1 cells product cytokines IFN-γ، IL-2 and Th17 cells mainly cytokines IL-17A، F، IL-22. The aim of this study is evaluation of Th1 and Th17 activity in women with recurrent spontaneous abortion.

In this case-control study، 30 women with history of two or more abortion who at least 3 months past after last abortion considered as case group and 30 normal fertile healthy women with at least one delivery as control group. We determined the levels of IL-17A، F and IFN-γ in cell culture supernatant of peripheral blood mononuclear cells (PBMC) stimulated with the mitogen phytohemagglutinin (PHA) by enzyme-linked immunosorbent assay (ELISA) method and compared in the two groups. The results obtained using the one-sample kolmogorov-smirnov Test، Kruskal-wallis Test and Spearman were analyzed using SPSS 16 software.

The level of IFN- γ in case group was significantly higher than control group (186/53±30/41 versus 88/06±21/44 pg/ml، P < 0. 005). Also the level of IL-17 A، F in case group was significantly higher than control group (84/74±21/26 versus 28/41±8 pg/ml، P < 0. 01). IFN-γ concentration showed positive correlation with IL-17 A، F in case group (P=0. 015، r= 0. 455).

In this study the increased levels of cytokines IFN- γ and IL-17 A، F in women with recurrent spontaneous abortion shows a propensity of pro inflammation via Th17 and Th1 immunity and may be these cells play a pivotal role in rejecting fetus antigens.

Endometriosis is a common hormone-dependent gynecologic disease with a high recurrence. Laparotomy or laparoscopy is the standard surgery for the large endometrioma. Also, sclerotherapy is basically used to treat different diseases one of which is endometrioma.

The study was designed to assess the value of transvaginal ultrasound-guided ethanol sclerotherapy in patients with a recurrent endometrioma.

In a randomized clinical trial, an interventional group of 20 patients underwent transvaginal ethanol sclerotherapy for recurrent ovarian endometrioma. The patients were followed up first after one and two weeks and then after one, two, and three months. If the patients had no endometrioma, they were treated with in vitro fertilization (IVF) (standard long protocol). A control group of 20 patients with endometrioma were enrolled for an IVF protocol. They had no treatment by ethanol sclerotherapy. IVF parameters, pregnancy rates, and implantation rates were compared in both groups.

The demographic data showed no difference between the two groups. The initial mean endometria size was 41.45±15.9 cm, the recurrence rate after 6 months was 4 (20%), FSH before and after sclerotherapy was 6.97±2.25 IU/L and 6.78±1.88 IU/L (p=0.343). The clinical pregnancy rate was 6 (33.3%) vs. 3 (15%), (p=0.616). The fertilization rate emerged 63.06% in study group vs. 60.38%, (p=0.57). The implantation rate turned out 12.9% in study group vs. 7.5%, (p=0.52). None of these results were significant. However, the data pointed to a better trend toward the ethanol sclerotherapy group.

Ethanol sclerotherapy could be an effective strategy for the treatment of recurrent endometrioma especially before IVF.

One of the most important steps in success of assisted reproductive techniques is appropriate ovulation induction and effective ovarian follicles stimulation. The aim of this study was to investigate the comparison of low-dose hCG plus gonadotropin releasing hormone (GnRH) agonist on ovulation induction and with standard dose hCG alone in intrauterine insemination technique with antagonist protocol. This clinical trial was conducted on 100 infertile couples who referred to infertility research center in Shahid Sadoughi university of medical sciences، Yazd، 2010 - 2011. Infertile women aged 18 to 35 who were treated with antagonist protocol were divided randomly into two groups after development of at least 3 follicles beyond 18mm diameter. Low dose of hCG (2500 IU) plus GnRH agonist (0. 2mg Triptorelin، intra muscular) were given to one group (n=70) and the next group (n=70) received hCG alone (10،000 IU، intra muscular). After 34 to 36 hours of injection intrauterine insemination was done in both groups. Data were analyzed with SPSS software version 11. 5 and T student and Chi-square tests. P value less than 0. 05 was considered significant. The patients were not different in terms of endometrial thickness، estradiol levels on day of hCG injection and the number of used gonadotropin ampoules (p=0. 1). Higher incidence of ovarian hyperstimulation syndrome (OHSS) was seen in the only hCG group، but this difference was not statistically significant (p=0. 1). Chemical pregnancy was significantly higher in low dose of hCG plus GnRH agonist (p=0. 03). However، no differences were observed between two groups in terms of clinical pregnancy (p=0. 07). Using low dose hCG plus GnRH agonist can be considered as an appropriate and alternative method instead of standard methods of hCG in ovulation induction with antagonist protocols.

Recurrent pregnancy loss (RPL) caused by various genetic and non-genetic factors. After chromosome abnormality, thrombophilia is one of the most important genetic factors that could cause RPL. Factor V Leiden and factor II G20210A mutation were the most common mutations cause thrombophilia in the world.

The purpose of this study was to determine the frequency of factor V Leiden and prothrombine gene mutations in women with RPL compared with women who had uneventful pregnancies.

This case control study evaluates the frequency of factor V-Leiden and factor II G20210 genotypes in 80 women with two or more pregnancy losses, compared with 80 women without adverse pregnancy outcome. The mutations were assessed by PCR-RFLP.

Frequency of the factor V Leiden among cases was 2.5%, which was higher than controls (1.25%), but the difference was not significant. No factor II G20210 mutation was found among cases and controls.

These data did not confirm that factor V Leiden and factor II G20210 mutation might play a role in recurrent pregnancy loss in Iranian women.