ladan kashani

While the effects of polycystic ovary syndrome (PCOS) and infertility on women’s health have oftenbeen discussed, not many studies have assessed the other complications of infertility. One of these complications isfemale sexual dysfunction (FSD), a range of psychosexual disorders. The aim of this study is to investigate the prevalenceof FSD in PCOS and its comparison with other causes of infertility. In this cross-sectional study, two questionnaires were filled out by two groups (60 peopleeach) of infertile patients, due to PCOS and other causes, referred to Arash Women’s Hospital from December 2018to 2019. The data was analyzed in SPSS software to evaluate the frequency of FSD in the whole study populationand each group separately as well as its relationship with age, history of pregnancy, the literacy level of the patient orspouse, body mass index (BMI), infertility duration, hirsutism, and acne. The frequency of FSD in the study group had a significant inverse relationship with the women’s level ofeducation (P=0.044), although no such correlation was found with age, pregnancy history, spouse’s literacy level,BMI, duration of infertility, acne, and hirsutism. In the comparison group, there was a significant relationship betweenthe duration of infertility and FSD (P=0.002). The prevalence of FSD in the study and comparison groups was 43.1and 52%, respectively. The prevalence of FSD sub-domains in all categories, except for pain, was higher in the studygroup. PCOS, compared to other groups, presented at a relatively younger age. In the PCOS group, patients with lower education levels were more likely to suffer from FSD. This suggeststhe effect of education and awareness on the sexual performance of these people. No significant difference inFSD experience was found between PCOS and other groups.

After the imposed war, Iran’s ranking in number of publications and citations, especially compared to Iran’s traditional competitor, Turkey, was not acceptable. Several approaches were used to surpass Turkey beginning in 2010 based on Scopus data and again in 2017 based on Clarivate Analytics data (1-3) (Figure 1).1. Increasing share of research funding from the GDP.2. Establishing and equipping research canters.  3. Revising policies to promote academic staff and successfully graduating students.4. Increasing postgraduate education programs.5. Awarding scholarships to students to study in postgraduate programs abroad.6. Increasing number of Iranian scientific journals indexed in Clarivate Analytics, Scopus and PubMed.7. Development of international relations.8. Meritocracy in scientific environments.9. Increasing salaries of academic staff members to accommodate for inflation.10. Most importantly, encouraging hope for the future and attracting young and elite professionals to Iran.Unfortunately, since 2021, due to economic problems in Iran and decrease in share of research funds from the GDP, as well as changes in the above-mentioned 10 approaches, we first lost our position in the Clarivate Analytics and then in Scopus. Turkey has surpassed Iran, and Saudi Arabia is developing scientifically due to proper investments. If we want to return to path of development, we must first invest in basic sciences. With our average research grants for basic science projects, we can no longer compete at any level in the world. Let’s think of a solution to attract young and elite graduates. There is no doubt that increasing income of academic staff members, especially in basic sciences, will help improve scientific development of Iran. For development of research in clinical fields, other solutions are needed, such as restarting MD-PhD programs and recruiting basic science faculty members in clinical departments. Comprehensive research training in the residency curriculum, recruitment of academic staff with research experience to clinical departments, development of biobanks, disease registry studies and cohort studies are just some of the steps we can initiate.

 Pregnancy in the rudimentary horn of the unicornuate uterus is highly rare. Its incidence is 1 in 75000-150000 pregnancies. It is difficult to diagnose the rudimentary horn of the unicornuate uterus before the rupture of an ectopic pregnancy.

 The current study reports the case of a 35-year-old Iranian mother with a natural contraceptive method. The mother was a primigravida woman at the gestational age of 7 weeks, based on her last period. She complained of abdominal pain in the right and lower abdomen and had a positive pregnancy test with a beta-human chorionic gonadotropin beta-human chorionic gonadotropin (beta-hCG) titration of 38982 on May 17, 2021. The ultrasound report on May 17, 2021, showed a right adnexal mass with a size of 32*32*31 and a fetal pole, and yolk sac. A fetal heart of six weeks and one day in favor of ectopic pregnancy was detected. and its endometrial thickness was 12 mm. There were no abdominal or pelvic-free fluids. Thus, after being diagnosed with an ectopic pregnancy that included a heart, the patient was transferred to the operating room for laparoscopy. During laparoscopy, we found that the pregnancy was in the rudimentary horn of the unicornuate uterus. The rudimentary horn was resected, and the salpingectomy of the right side was performed for the patient. The samples were then transferred to the laboratory for pathological analysis.

 We should increase awareness about pregnancies that occur in this uterine abnormality so that there is a high suspicion index for faster diagnosis before the rupture of ectopic pregnancy and worse events can be prevented accordingly.

Postpartum depression (PPD) impairs mother-infant interaction and has negative effects on the child’s emotional, behavioral, and cognitive skills. There is considerable evidence to suggest that inflammation plays a role in the pathogenesis of depression. Controlled trials indicate that celecoxib has antidepressant effects in patients with major depressive disorder. A 34-year-old woman with mild to moderate PPD received a celecoxib capsule twice a day. This treatment has not been reported in previous studies and is novel in clinical practice. The patient was assessed using the Hamilton Depression Rating Scale (HDRS). Moreover, levels of brain-derived neurotrophic factor (BDNF) and inflammatory cytokines were measured at baseline and at the end of celecoxib therapy. This case suggests that celecoxib can improve depressive symptoms in patients with mild to moderate PPD. No adverse effects occurred during follow-up.

Depression is the most prevalent and debilitating disease with great impact on societies. Evidence suggests Brain-Derived Neurotrophic Factor (BDNF) plays an important role in pathophysiology of depression. Depression is associated with altered synaptic plasticity and neurogenesis. BDNF is the main regulatory protein that affects neuronal plasticity in the hippocampus. A wealth of evidence shows decreased levels of BDNF in depressed patients. Important literature demonstrated that BDNF-TrkB signaling plays a key role in therapeutic action of antidepressants. Numerous studies have reported antidepressant effects on serum/plasma levels of BDNF and neuroplasticity which may be related to improvement of depressive symptoms. Most of the evidence suggested increased levels of BDNF after antidepressant treatment. This review will summarize recent findings on the association between BDNF, neuroplasticity, and antidepressant response in depression. Also, we will review recent studies that evaluate the association between postpartum depression as a subtype of depression and BDNF levels in postpartum women.

Selecting a suitable and preferable method for endometrial preparation in frozen embryo transfer (FET) cycles for women with adenomyosis is still challenging in infertility treatment.

To compare 2 artificial endometrial preparation regimens with and without gonadotropin-releasing hormone agonist (GnRHa) pretreatment in women with adenomyosis undergoing FET cycles.

This randomized clinical trial study was conducted on 140 adenomyosis cases who underwent FET cycles at Arash Women’s hospital, Tehran, Iran from May 2020 to March 2021. Participants were randomly allocated into hormonal replacement therapy (HRT) and HRT+GnRHa pretreatment groups (n = 70/each). Endometrial preparation with 2-6 mg daily estradiol was started in the HRT+GnRHa group, taking after down-regulation with the GnRHa. Within the HRT group, the same dose of estradiol was commenced within the early follicular stage. The main (chemical and clinical pregnancy rates) and auxiliary results (twin pregnancy, miscarriage, and live birth rates) were compared between groups.

The demographic characteristics and severity of adenomyosis, endometrial thickness, and pattern at starting progesterone administration were similar in the 2 groups, and triple-line endometrium was found to be the dominant pattern in both groups (p = 0.65). No significant differences were observed in chemical, clinical, and twin pregnancy rates as well as miscarriage and live birth rates between groups (p = 0.71, p = 0.81, p = 0.11, and p = 0.84, respectively). However, the total estrogen dose and duration of estrogen consumption were significantly higher in the pretreatment group (p = 0.001, and p = 0.003).

These results indicated that the hormonal endometrial preparation with estrogen and progestin for FET cycles is as efficacious as a protocol involving preceding pituitary suppression with a GnRHa. Further large randomized clinical studies are required to confirm these findings.

Patient satisfaction is considered as one of the most important elements of the evaluation of healthcare centers. In this research, the level of satisfaction of infertile patients was evaluated.

This study is a cross-sectional descriptive study. The research population is infertile patients who referred to the infertility clinic (at least 4 visits) and hospitalized in four hospitals affiliated with the Tehran University of Medical Sciences. The satisfaction questionnaire was valid researcher-made which included 56 questions in 9 areas, and were collected from May 2021 to September 2022. In order to comply with the ethical principles in research, hospitals were named 1-4.The results were analyzed using the chi-square test or Fisher's exact test for qualitative variables and analysis of variance for quantitative variables in SPSS software, version 24 (SPSS Inc., Chicago, IL, US).

Results:

 Three hundred–four infertile women in four hospitals were studied. The mean age of the participants was 33.8 years, with a standard deviation of 5.8 years. The average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in the number-1 Hospital had the highest score, and the average satisfaction with nursing or midwifery services, diagnostic and therapeutic services (radiology/laboratory), hospital services, charter patient rights, management services, paid expenses in Hospital 4 received the most points. The mean score of satisfaction was the highest among those who visited the infertility clinic of Hospital 3 (161.54±21.41). Average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in Hospital No. 1 had the highest score, and average satisfaction with nursing or midwifery services, medical diagnostic services (radiology/laboratory), hospital services, respecting the patient's rights, management services, paid expenses in hospital number 4 got the most points. The average of nursing or midwifery services, respecting the patient's rights, and hotelling in all hospitals received the highest score, respectively, and nutrition services and paid expenses received the lowest points (most dissatisfaction) (P<0.05).

The level of satisfaction of women referring to the infertility clinic in 35.9% of cases was considered to be at an appropriate and exceptional level, in 49.3% of cases it was at a partially appropriate level, and in 14.8% at an inappropriate level.

An association between microRNAs (miRNAs) and adhesion proteins expression with repeated implantationfailure (RIF) has been recently reported; however, these findings are controversial. This study aims to evaluatethe endometrial and circulating expressions of miR-145, miR-155-5p, and miR-224 in addition to the endometrialexpressions of membrane protein palmitoylated-5 (MPP-5) and endothelial cell adhesion molecule-1 (PECAM-1) inpatients with RIF compared to control subjects. This case-control study was carried out between June 2021-July 2022. Subjects included 17patients with RIF and 17 control subjects, who had previous spontaneous term pregnancy with a live birth, who referredto the Medical Centre of Arash Hospital, Tehran, Iran. Endometrial tissue samples were obtained via hysteroscopyand Pipelle catheter in the RIF and control subjects, respectively. Plasma samples were collected after ovulationin all subjects. The expression levels of MPP5, PECAM-1, miR-224, miR-145, and miR-155-5p were evaluated byquantitative real-time polymerase chain reaction (qRT-PCR). The student’s t test, chi-square, Mann-Whitney U, andanalysis of covariance (ANCOVA) were used for data analyses. RIF patients had less endometrial miR-155-5p expression, and higher endometrial and circulating expressions ofmiR-145 and miR-224 compared to control subjects. Endometrial PECAM-1 and MPP5 expression significantly decreased inpatients with RIF compared to the control group. There was a positive correlation between circulating miR-224 and endometrialmiR-155-5p, and between circulating miR-155-5p and endometrial PECAM-1 expression levels in patients with RIF. The present study suggests that circulating miR-224, endometrial miR-145, and PECAM-1 can bereliable, novel biomarkers for diagnosis of RIF.

Studies have evaluated different endometrial preparation methods, but the optimal frozen-thawed embryo transfer (FET) cycle strategy in terms of the in-vitro fertilization outcome is still debated.

To compare the natural versus modified natural cycles for endometrial preparation in women undergoing FET.

This study was designed as a randomized clinical trial, and it was performed at the Arash women’s hospital between August 2016-2018. 140 eligible participants were enrolled in this study and were randomly divided into 2 groups by using the block randomization method, including true natural FET (n = 70) and modified natural FET (mNFET) (n = 70) cycles. Both groups were monitored for endometrial thickness and follicular size; simultaneously spontaneous luteinizing hormone surge using urinary luteinizing hormone testing kits. The mNFET group received 5000 IU of human chorionic gonadotropin injection to trigger final follicular maturation. Luteal support by vaginal progesterone (cyclogest 400 mg twice daily) was used in true natural FET from the day of transfer until the 10th wk of pregnancy. Chemical and clinical pregnancy and abortion rates were considered as the primary outcomes.

There were no differences in the participants’ baseline characteristics between groups. There was no difference in clinical pregnancy and abortion rate between groups, while the implantation rate was significantly higher in the mNFET group (29.2% vs. 17.6%; p = 0.036).

The results demonstrated that both types of natural cycles were similar in pregnancy outcomes, while modified cycles might be associated with a higher implantation rate.

Polycystic Ovarian Syndrome (PCOS) is a common female gynecological endocrinopathy disorder with ages ranging from 18 to 45 years. PCOS significantly increases the risk of infertility, cardiovascular diseases, and type II diabetes in women. Cinnamon has a strong history of decreasing insulin resistance and treatment of PCOS. Therefore, we aim to review the effects of the cinnamon herb and extract on changes in the serum levels of sex hormones and ovarian tissue, metabolic activity, lipid profile, and insulin resistance.

One of the traditional aphrodisiacs used in various cultures is Crocus sativus, commonly called saffron. Previous studies have pointed to the possible applicability of saffron for sexual dysfunction in both men and women. This study investigates the effects of saffron capsules on female sexual dysfunction. This study was a parallel-group, double-blind, randomized, placebo-controlled clinical trial. Participants, who were married women between 18 and 55 years of age suffering from severe sexual dysfunction, were randomized to receive either 15 mg Crocus sativus capsules twice daily or placebo. The treatment continued for 6 weeks, and patients were evaluated every 2 weeks. The primary outcome was the change in the female sexual function index score. Other outcomes included the female sexual function index sub-domains. Seventy-four patients were equally randomized to each group, and 34 in each group completed the trial. Participants in both groups experienced improved total scores at each visit. However, a repeated-measures ANOVA revealed that time ´ treatment differed between groups in favor of the saffron group (p=0.050). During the 6th week follow-up, the saffron group had a 62% score improvement from baseline. Desire, lubrication, and satisfaction were female sexual function index domains in which saffron demonstrated superiority over placebo. The adverse event profile was similar for the groups, and no participant discontinued treatment. Findings of this study suggest that saffron might be a safe and effective option to ameliorate female sexual dysfunction. Further robust research is warranted.

Endometriosis is a common, chronic, inflammatory disorder in women, characterized by the presence of endometrial tissue outside the uterus cavity. The disease affects ~10% of women during their reproductive age. There are some debates on the pathogenesis of endometriosis and its mechanism among scientists; therefore, different hypotheses have been suggested. According to Sampson's theory, a possible mechanism for seeding ectopic endometriotic lesions is a dysregulation of endometrial mesenchymal stem cells (eMSCs). In the present study, we evaluated the expression of candidate genes in eMSCs obtained from endometriosis patients and compared them with non-endometriosis female patients. In addition, bioinformatic analysis was conducted to uncover the genes in the list of our co-expression gene network in endometriosis. According to our results, the expression of vascular endothelial growth factor A, C-X-C-motif chemokine ligand 8, interleukin-6, and intercellular adhesion molecule-1 genes were up-regulated in the eMSCs isolated from endometriosis patients. There was no significant difference in the expression of the LaminB1 gene between the endometriosis and non-endometriosis patients. On the other hand, our bioinformatics analysis demonstrated that co-expressed genes were enriched in the cytokine signaling pathway. Our study provides valuable insights into the gene expression dysregulation in eMSCs derived from endometriosis patients and suggests a possible function for co-expressed networks in the pathogenesis of endometriosis. To confirm the results, more investigations are required.

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous women with total uterine inversion after a normal vaginal delivery.

Case Report: 

A 28 years old, gravid3 pregnant women was admitted to the hospital in the first stage of labor. She had a Past medical history of curettage due to abnormal vaginal bleeding following her second vaginal delivery and the present pregnancy proceeded without complications. After the delivery of the fetal  due to the history of placental adhesion, umbilical cord traction was avoided and after 20 minutes, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist. and subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta inccreta and The placenta was found completely adherent at the fundus.

Conclusion :

Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in third stage of labor to manage the possibility of inversion.

Saffron or crocus sativus L. (C. sativus) has been widely used as a food additive as well as a therapeutic agent in traditional medicine for centuries, especially in Asian countries. This spice consists of three bioactive components, including picrocrocin, safranal, and crocin, which exert alleviating effects in a wide range of disorders (e.g.cardiovascular, respiratory, gastrointestinal, neurodegenerative, psychiatric and female-specific disorders). Anti-nociceptive, anti-inflammatory, and anti-oxidative characteristics were reported for this herbal agent. Additionally, several studies have addressed the potential role of saffron in modulating the serotonergic system, which could be helpful in treatment of some diseases specific to women such as Premenstrual Syndrome (PMS), Postpartum Depression (PPD), postmenopausal symptoms, and sexual dysfunction. Nowadays, use of herbal medicine instead of chemical prescriptions has become very popular due to their generally lesser side effects and cultural acceptability. In the present report, we provided an overview of the current literature regarding the potential effects of saffron on women’s health. Taken together, saffron seems a spice with strong beneficial impacts on various aspects that a woman might challenge with. Further trials could pave the way for the introduction of saffron as a routine safe treatment of aforementioned conditions in women population.

Nearly 25-50% of infertile women have endometriosis. There are reports of disorders in the expression of granulocyte colony-stimulating factor (G-CSF) receptors in women with endometriosis.

To examine the effect of intrauterine administration of G-CSF in in vitro fertilization (IVF) cycles on the fertility rate of infertile women with moderate-to-severe endometriosis.

This clinical trial was conducted on 66 infertile women with moderate-to-severe endometriosis, undergoing IVF and intracytoplasmic sperm injection (ICSI). The participants were allocated into two groups via simple randomization: the G-CSF (n = 27) and control (n = 39) groups. In the G-CSF intervention group, on the oocyte pick-up day, immediately after an ovarian puncture, 300 μg of G-CSF was injected through a transcervical catheter under abdominal ultrasound guide to visualize flushing into the uterine cavity. Women in the control group received no intervention. The two groups were evaluated for clinical pregnancy.

No significant difference was noted in the demographic characteristics of the two groups. The rate of clinical pregnancy was 28.2% in the control group and 25.9% in the G-CSF group, indicating no significant difference (p = 0.83).

The results showed that the intrauterine injection of G-CSF had no effects on pregnancy in women with stage-3/4 endometriosis undergoing IVF.

Ovarian stimulation (OS) for poor ovarian response (POR) patients is still a major challenge in assisted reproductive techniques. Aromatase inhibitors as co-treatment in antagonist protocol are suggested to these patients, but there are controversial reports.

To evaluate the effectiveness Letrozole (LZ) as adjuvant treatment in gonadotropin-releasing hormone (GnRH)-antagonist protocol in POR patients undergoing in vitro fertilization/ intracytoplasmic sperm injection cycles.

This double-blind randomized clinical trial was conducted in Arash women's hospital. One hundred sixty infertile women with POR based on Bologna criteria were allocated into two groups randomly: LZ + GnRH-antagonist (LA) and placebo + GnRH-antagonist (PA) groups. In the experimental group, the patients received 5 mg LZ on the first five days of OS with 150 IU of recombinant human follicle-stimulating hormone (rFSH) and 150 IU of human menopausal gonadotropin (HMG). The cycle outcomes were compared between groups.

The total number of retrieved oocytes and the metaphase II oocytes in LA-treated group were significantly higher than those in the control group (p = 0.008, p = 0.002). The dosage of hMG used and the duration of OS and antagonist administration in LZ-treated group were significantly lower than those of the control group. The number of patients with no oocyte, in the control group, was higher than the LZ-treated group, and the clinical pregnancy rate in LA-treated group (25%) was higher than the control group (18%); however, the differences were not significant statistically.

Adding 5 mg of LZ to rFSH/hMG antagonist protocol may improve the in vitro fertilization/intracytoplasmic sperm injection cycle outcome in POR patients.

Saffron was found efficient and safe in treatment of neuropsychiatric disorders, in particular depression. We compared the efficacy of saffron with duloxetine in treatment of patients with fibromyalgia. In this double-blind parallel-group clinical trial, outpatients with fibromyalgia were randomized to receive either saffron 15 mg or duloxetine 30 mg starting with 1 capsule per day in the first week followed by 2 capsules per day from week 2 until the end of week 8. Participants were men and women aged 18-60 years diagnosed with fibromyalgia based on the American College of Rheumatology 2010 criteria who also had a pain score ≥40 based on visual analogue scale. Participants were excluded in case they had rheumatologic diseases, inflammatory/infectious/autoimmune arthritis, comorbid neuropsychiatric disorders except depressive disorders, pain due to traumatic injuries, drug history of duloxetine or saffron use, current use of psychoactive medications, recent use of muscle relaxants, steroids, opioid analgesics, benzodiazepines, anti-epileptics, or injective analgesics. Primary outcomes included differences in mean score changes from baseline to endpoint between the treatment arms for Hamilton Rating Scale for Depression, Fibromyalgia Impact Questionnaire, and Brief Pain Inventory. Socio-demographic characteristics and baseline scores were similarly distributed between the two treatment arms (2n=46). No significant difference was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms (Mean score changes: -4.26 to 2.37; p-values: 0.182-0.900) nor in terms of time´treatment interactions (p-values: 0.209-0.964). Saffron and duloxetine demonstrated comparable efficacy in treatment of fibromyalgia symptoms

The purpose of the current study was to investigate the impact of a 2-months implementation of GnRH-agonist (prolonged) versus the OCP隉 protocol before in-vitro fertilization-embryo transfer (IVF-ET) on IVF outcomes in infertile patients with Grade III-IV endometriosis. A total of 70 infertile patients with endometriosis participated in this randomized clinical trial and randomly received either the prolonged GnRH-agonist protocol (38 patients) as control or the OCP隉 protocol (32 patients) as the case group. This was followed by standard controlled ovarian hyperstimulation (COH) in all subjects. The fertilization rate, the implantation rate, and the clinical pregnancy rate were measured and compared between the two groups. A statistically significant trend toward better embryo quality was observed in the control group (P=0.01). In addition, clinical pregnancy rate, implantation rate and fertilization rate did not differ significantly between two groups (P=0.43, P=0.54, P=0.1 respectively). GnRH agonist treatment for 2 months before ART in women with high-grade endometriosis was associated with better embryo quality compared to three weeks of treatment with OCP. OCP before assisted reproductive technology (ART) was as effective as GnRH agonist treatment regarding clinical pregnancy and implantation rates in infertile patients with severe endometriosis.

The aim of this study was to evaluate the outcomes of adding low-dose hCG (human chorionic gonadotropin), as an LH active supplement, to a GnRH antagonist protocol in patients undergoing assisted reproduction techniques. In this parallel-group randomized clinical trial, 137 infertile female outpatients aged 20 - 39 years were randomized into two groups: hCG group and non-hCG group. All patients received r-FSH (150-300 IU) and then a GnRH-antagonist, Cetrorelix (0.25 mg/day). Concomitantly with Cetrorelix, patients in the hCG group received low-dose hCG (200 IU daily), but the patients in the non-hCG group did not. 10,000 IU Urinary hCG (10,000 IU) was injected to all patients, and ICSI was performed after oocyte retrieval. The primary outcome of this study was comparing the pregnancy rates between two study groups. Other differences between two groups such as serum estradiol concentration, fertilization rate, etc. were considered as secondary outcomes. A total of 130 patients completed this trial. No significant difference was detected between pregnancy rates of the two groups (P=0.52) as well as the fertilization, implantation and ongoing pregnancy rates (P=0.11, P=0.75 and P=0.06 respectively). The only significant difference between two groups was a higher concentration of estradiol in the hCG-treated patients (P<0.05). HCG-treated patients experienced a shorter treatment duration and a lower r-FSH required dose than the non-hCG group, but none of these differences were statistically significant (P=0.19 and P=0.10, respectively). The findings of the current study did not support advantages of adding low-dose hCG to GnRH antagonist plus r-FSH protocol in an unselected population of patients. Well-designed trials with a larger sample size for specific patients’ subgroups are warranted.

The aim of this study was to evaluate knowledge, attitude and practice of herbal remedies (HRs) in infertile patients. This was a cross sectional study in a referral infertility care center. Three hundred and six outpatients, both women and men, presenting for the first time with complaint of infertility at Arash hospital, were recruited. Verbal consent for participation was received. A self administered questionnaire was used. Main outcome measure was knowledge, attitude and practice of patients toward herbal medications. 47.3% of participants were knowledgeable of HRs with female gender and lower educational background being the associated factors in knowledge. 43.4% of patients with significant female dominancy had positive attitude toward HRs. 31% of participants were using HRs. Only 3.2% of those using HRs informed their physician. The most common health condition promoting herbal use was psychological (33.3%) and gastrointestinal (30.8%) disorders. 3.5% of participants used HRs as fertility treatment which was significantly observed in women and those with lower levels of formal education. A considerable proportion of our population had used HRs without sufficient knowledge and had positive attitude toward HRs. More importantly, patients did not disclose their use of HRs to physicians. Therefore, physicians should inquire about the use of alternative remedies and provide patients with appropriate information.

Premenstrual syndromes (PMS) are a group of menstrually related, chronic and cyclical disorders characterized by emotional, behavioral, and physical symptoms in the second half (luteal phase) of the menstrual cycle. Several line of evidence point to a significant role of the serotonergic system in the course of the luteal phase in women with PMS/ Premenstrual Dysphoric Disorder. It has been reported that herbal medicine is useful in relieving the symptoms of PMS. An American telephone survey suggested that up to 80% self-medicating sufferers use complementary remedies. This review focused on herbal medicine in the treatment of PMS.

Although pregnancy was once thought to protect against psychiatric disorders, gravid and non gravid women have similar risks for major depression, at 10% to 15%. Both depression and antidepressant treatment during pregnancy have been associated with risks. Few medications have been proved unequivocally safe during pregnancy. Although certain antidepressants have not been linked with an increased risk of birth defects or impaired development including bupropion, citalopram, escitalopram and venlafaxine, the latest studies arent necessarily reassuring. As researchers continue to learn more about antidepressants, the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis. This review discusses about the use of new generation of antidepressants in pregnancy