مرضیه شیوا

Polycystic ovary syndrome (PCOS) is one of the most common endocrine women’s disorders in reproductive age. Hyperandrogenism has a critical role in the etiology of PCOS and it can cause fault in Steroidogenesis process. During steroidogenesis, steroidogenic acute regulatory protein (StAR) seems to increase the delivery of cholesterol through mitochondrial membrane. Therefore, polymorphisms of StAR might effect on this protein and play a role in the etiology of PCOS.

The aim of this study was to investigate the association between StAR SNPs with PCOS. Thus, seven polymorphisms in this gene: rs104894086, rs104894089, rs104894090, rs137852689, rs10489487, rs104894085 were detected.

In this case control study, 45 PCOS women, 40 male factor/unexplained infertile women, and 40 fertile women as two control groups were participated from 2008-2012. Polymorphisms were detected using restriction fragment length polymorphism (PCR-RFLP) method.

Heterozygote genotyping for rs137852689 SNP (amino acid 218 C > T) was only seen in seven PCOS patients, one in normal ovulatory women, and five in male factor/unexplained infertile women (15.5%, 2.5%, 12.5%, respectively) (p= 0.12). While, it has shown no association between other SNPS with PCOs.

The RFLP results for seven chosen SNPs, which located in exon 5 and 7 showed normal status in three groups, it means no heterozygous or homozygous forms of selected SNPs were observed. So, it seems evaluation of the active amino acid sites should be investigated and also the study population should be increased.

Traditionally, septate uterus was diagnosed with invasive method like hysterosalpingography and hysteroscopy. Nowadays transvaginal ultrasonography was reported to be a sensitive tool for detection of septate uterus too.

The objective of the present study was to evaluate the application of two dimensional ultrasound (2-DUS) and real time three dimensional ultrasound (3-DUS) in differentiating various type of septated uterus. Hysteroscopy confirmation was assigned as the gold standard.

This retrospective study was performed among 215 infertile women with suspected septate uterus from October 2008 to July 2012. An inclusion criterion was septated uterus based on HSG or experiencing abortion, preterm labor, or recurrent IVF failure. Fusion anomalies were excluded from the study (unicornuate, bicornuate and didelphys anomalies). The results of 3D and 2D sonographies were compared, while they were confirmed by hysteroscopy result in detection of septated uterus. Kappa index for agreement between 2DUS and hysteroscopy, as well as 3-DUS and hysteroscopy in detection of septate uterus was carried out. By receiver operating characteristic (ROC) curve, cut off points for predicting the kind of anomalies were proposed.

The women were evaluated by 2-DUS (n=89) and (II) 3-DUS (n=126). All women underwent hysteroscopy, following 2-DUS and 3-DUS at the same or subsequent cycle. The results of kappa (K) index were 0.575 and 0.291 for 3-DUS and hysteroscopy, as well as 2-DUS and hysteroscopy, respectively. Also, the cutoff points were 27% for arcuate and subseptate, and 35% for differentiating septate and subseptate.

Real time 3-DUS has better ability for visualization both uterine cavity and the fundal uterine, so it has higher agreement in detection of septate uterus than 2-DUS.

One of the factors affecting maternal role is access to supportive resources. In addition to the challenges of motherhood surrogacy commissioning mothers for the first time, are faced with a unique situation. But so far no study to examine the experiences of these women and how to access support resources. In order to identify these resources is essential for planning based on client needs and optimal use of these resources that reduce stress and hardship of the transition to motherhood. This study has examined surrogacy commissioning mothers ' perceptions of their support systems in the process of becoming a mother. This study has been done with qualitative approach from August 2010 to Jun 2012. The method of data collection was unstructured interview and sampling was purposeful. Generally 32 interviews were done with 15 commissioning mothers with gestational surrogacy and 5 infertility center's personnel. Environment of research was Royan Research Center in Tehran and other governmental or nongovernmental infertility centers, hospitals and clinics that have done surrogacy in Iran. Data analysis has been done by use of conventional content analysis method. During the process of content analysis, two themes was revealed that indicate the nature and dimension of commissioning mothers perception about their support resources in the process of becoming a mother. These themes was including: 1. Having the support containe of two main categories “Benefit from the support of a trusted” and “support of i nfertility centers in facilitation of motherhood process” and 2. Non- effective support containe of three main categories: “Inadequacy of organizational services”, “Lack of adequate support from husband, family and friends” and “Not percepted support”. Each one has a more sub- sub-sub- classes. Concusion: Findings show that despite the limited resources available to support of mothers in the family and community, mothers ignore them consciously and they looking for someone who are reliable and trustworthy to help them. Awareness of mothers needs can help to managers, planners and officials, especially in infertility centers in future planning.

Infertile women's live experiences at the time of confrontation with surrogacy and decision making for having child in this manner is a subject that haven’t been paid attention in researches. The more recognition from perception and attitude of commissioning mothers is important and it can help nurses to be able to empower them. The purpose of this study is to explore and to explain the commissioning mother's experiences at the time of confrontation and decision making to start remedy. In this qualitative study which has been carried out in 2010-2011, 11 commissioning mothers had gestational surrogacy for the first time (in waiting time or child rearing) selected by using purposeful sampling from Ruyan Institute and then the other infertility centers. Also to fulfill the study purpose, the researchers have interviewed with 5 infertility center's personnel for triangulating resources. Totally 25 deep unstructured interviews have been done with 16 persons. Data analysis has been done and by use of conventional content analysis method. Participant’s experiences expressed commonly that “mothers usually pass a period of stressful doubt and decision making’ which has been formed two main and seven subsidiary categories including 1.”The regret of having child" including two dimensions" infertility harm" and "to wish being mother" and 2. "Accepting the method as the only hopeful way" which includes five dimensions: "searching information", "decision making", "resistance and uncertainty about surrogacy acceptance", "assaying priorities" and "starting surrogacy acceptance". Infertile women suffer heavy stress and they pass complex process for final decision making. Nurses are providers of family and society care and they could play noteworthy role in presenting enough information and new technologies which can be helpful for fertility, and as a result they can play a supportive role to their patients.

Surrogacy is a new reproductive technology that yet has deep ethical، legal، religious and social consequences. Collected data in this regard is necessary not only to inform the founders of this technology and legislators but also in order to set appropriate and safe rules for infertile couples، surrogate mother and the child. The purpose of this study was to explain the legal implications of surrogacy to surrogate mothers and evaluate how they encounter these situations. This qualitative research was done in 2011on 20 participants and 11 commissioning mothers، 4 surrogates were selected by using targeted sampling from Royan institute and other infertility centers in Iran. In order to integrate the sources، 5 staff of infertility centers was also interviewed. Data were collected by using 25 deep unstructured interviews. For better organization of data، MaxQDA 2007 software was used. While gathering data، they were analyzed by using conventional content analysis method. This study was approved by the Ethics Committee of the Tarbiat Modares University and Royan Institute. ِData collected and analysis was performed based on conventional content. Results have shown that surrogate clients experience high stress during and after surrogacy and because of lack of legal supports، they experience so many problems. Participants'' experiences، the common theme of «legally bound» revealed three dimensions: «inadequacy of existing laws»، «lack of adequate educational support services» and «stress and frustration». Participants'' experiences indicated the inadequate legal framework and great stresses to customers of this new method. Serious encounters، determined and approved rules seems necessary in order to prevent mental and financial stresses. Also، medical staff needed to make clients fully aware of ethical and legal implications when they are applied to assisted reproduction.