2008 6 2 0 0

Vitamins C, E and lipid peroxidation levels in sperm and seminal plasma of asthenoteratozoospermic and normozoospermic men 2 2 Background: It has been shown that reactive oxygen species (ROS) can lead to deleterious effects on a range of sperm parameters. Vitamins E and C are capable of reducing ROS levels and lipid peroxidation. Objective: The aim of study was to determine the level of lipid peroxidation as indicated by Malondialdehyde (MDA) and vitamins E and C in sperm and seminal plasma of asthenoteratozoospermic and normozoospermic men and their relationships with semen parameters. Materials and Methods: Forty men with normozoospermic and 60 infertile men with asthenoteratozoospermic semen profiles were randomly selected. Semen analysis was done according to the WHO standard. Sex hormonal profiles were measured by ELISA methods. The level of vitamins (C and E) and MDA were measured by HPLC and tiobarbiotic acid, respectively. Results: MDA concentration in the spermatozoa (0.10.06 nmol/ml) and seminal plasma (1.90.35 nmol/ml) of asthenoteratozoospermic were significantly higher than in normozoospermic males (p<0.001).The level of vitamins E and C in seminal plasma of normozoospermic were significantly higher than in asthenoteratozoospermic males (p<0.01). However, the amount of vitamin C in the spermatozoa of normozoospermic was significantly less than in asthenoteratozoospermic males (p<0.01). Sensitivity, specificity, positive and negative prognostic value of MDA of seminal plasma and spermatozoa were more than vitamins C and E. The level of vitamin C of spermatozoa had more diagnostic value when compare to vitamins C and E in seminal plasma. Conclusion: The level of MDA in seminal plasma and spermatozoa and vitamin C in spermatozoa may be a diagnostic tool for etiology of infertility in the asthenoteratozoospermic patients. 1 0 2017/10/1 1396/7/9 2017/10/5 1396/7/13 Mohammad Nouri Mohammad Nouri Biochemistry Department, Tabriz University of Medical Sciences, Tabriz, Iran Nourimd@yahoo.com Aliyeh Ghasemzadeh Aliyeh Ghasemzadeh Infertility Center, Tabriz University of Medical Sciences, Tabriz, Iran Laya Farzadi Laya Farzadi Infertility Center, Tabriz University of Medical Sciences, Tabriz, Iran Vahideh Shahnazi Vahideh Shahnazi Infertility Center, Tabriz University of Medical Sciences, Tabriz, Iran Marefat Ghaffari Novin Marefat Ghaffari Novin Infertility Center, Tabriz University of Medical Sciences, Tabriz, Iran Asthenoteratozoospermia MDA Vitamin E Vitamin C Lipid peroxidation Antioxidants activity Infertility. Aitken RJ, Fisher H. Reactive oxygen species generation and human spermatozoa: the balance of benefit and risk. Bioassays 1994; 16: 259-267.##Sanocka D, kurpisz M. Reactive oxygen species and sperm cells. Reprod Biol Endocrinol 2004; 2: 12-19.##Agarwal A, saleh RA, Bedaiwy MA. Role of reactive oxygen species in the pathophysiology of human reproduction. Fertil and Steril 2003; 79: 829-843.##Girotti MJ, khao N, Melellen BA. Early measurement of systemic lipid peroxidation products in plasma of major blunt trauma patients. J Trauma 1991; 31: 32-35.##Zini A, de Lamirande E, Gagnon C. Reactive oxygen species in semen of infertile patients: levels of superoxide dismutase and catalase-like activities in seminal plasma and spermatozoa. Int J Andro 1993; 16: 183-188.##Thiele JJ, Friesleben HJ, Fuchs J, Ochsendorf FR. Ascorbic acid and urate in human seminal plasma: determination and interrelationships with chemiluminescence in washed semen. Human Reproduction 1995; 10: 110-115.##Tavilani H, Doosti M, Saeidi H. Malondialdehyde levels in sperm and seminal plasma of asthenozoospermic and its relationship with semen parameters. Clinica Chem Acta 2005; 365: 199-203.##Koca Y, O¨zdal O¨ L, C¸elik M, U¨nal S, Balaban N. Antioxidant activity of seminal plasma in fertile and infertile men. Archives of Andrology 2003; 49: 355-359.##Song GJ, Norkus EP, Lewis V. Relationship between seminal ascorbic acid and sperm DNA integrity in infertile men. International Journal of Andrology 2006; 29; 569-575.##World Health Organization WHO: Laboratory Manual for the examination of Human semen and semen- cervical Mucus interaction. 4th ed. Cambridge, UK, Cambridge University press, 1999.##Yagi K. Assay for blood plasma or serum. Methods Enzymol 1984; 105: 328-331.##Lee Bl, Chua SC, Ong HY, Ong CN. HPLC Method for routine determination of vitamins A and B- carotene in plasma. Journal of Chromato 1992; 581: 41- 47.##Natelson S. Determination of ascorbic acid using 2,4 dinitrophneyl hydrazine. In, "Technique of clinical chemistry." C C. Thomas, Spring field, Illinois, 1971.##Landat A, Karine L, Guechot J, Palluet AM. Values of sperm thiobarbituric acid- reactive substances in fertile men. Clin Chem Acta 2002; 325: 113-115.##Shang XJ, Lik Y, Chen YG, Huang YF: Analysis of lipid peroxidative levels in seminal plasma of in fertile men by HPLC. Arch Androl 2004; 50: 411-416.##Mostafa T, Anis TH, Ghazi S, El-Nashar AR, Imam H, Osman IA. Reactive oxygen species and antioxidants relationship in the internal spermatic vein blood of infertile men with varicocele. Asian J Androl 2006; 8: 451-454.##Fraga CG, Motchnik PA, Shigenaga MK, Helbock HJ, Jacob RA, Ames BN. Ascorbic acid protects against endogenous oxidative DNA damage in human sperm. Proceedings of the National Academy of Sciences of the United States of America 1991; 88: 11003-11006.##Lewis SE, Sterling ES, Young IS, Thompson W. Comparison of individual antioxidants of sperm and seminal plasma in fertile and infertile men. Fertil and Steril 1997; 67: 142-147.##Buettner GR. The pecking order of fl'ee radicals and antioxidants, lipid peroxidation, alpha-tocopherol and ascorbate. Arch Biochem Biophys 1993; 300: 535-543.##Aitken RJ, Fisher H. Reactive oxygen species generation and human spermatozoa: the balance of benefit and risk. Bioassays 1994; 16: 259-267.##Sanocka D, kurpisz M. Reactive oxygen species and sperm cells. Reprod Biol Endocrinol 2004; 2: 12-19.##Agarwal A, saleh RA, Bedaiwy MA. Role of reactive oxygen species in the pathophysiology of human reproduction. Fertil and Steril 2003; 79: 829-843.##Girotti MJ, khao N, Melellen BA. Early measurement of systemic lipid peroxidation products in plasma of major blunt trauma patients. J Trauma 1991; 31: 32-35.##Zini A, de Lamirande E, Gagnon C. Reactive oxygen species in semen of infertile patients: levels of superoxide dismutase and catalase-like activities in seminal plasma and spermatozoa. Int J Andro 1993; 16: 183-188.##Thiele JJ, Friesleben HJ, Fuchs J, Ochsendorf FR. Ascorbic acid and urate in human seminal plasma: determination and interrelationships with chemiluminescence in washed semen. Human Reproduction 1995; 10: 110-115.##Tavilani H, Doosti M, Saeidi H. Malondialdehyde levels in sperm and seminal plasma of asthenozoospermic and its relationship with semen parameters. Clinica Chem Acta 2005; 365: 199-203.##Koca Y, O¨zdal O¨ L, C¸elik M, U¨nal S, Balaban N. Antioxidant activity of seminal plasma in fertile and infertile men. Archives of Andrology 2003; 49: 355-359.##Song GJ, Norkus EP, Lewis V. Relationship between seminal ascorbic acid and sperm DNA integrity in infertile men. International Journal of Andrology 2006; 29; 569-575.##World Health Organization WHO: Laboratory Manual for the examination of Human semen and semen- cervical Mucus interaction. 4th ed. Cambridge, UK, Cambridge University press, 1999.##Yagi K. Assay for blood plasma or serum. Methods Enzymol 1984; 105: 328-331.##Lee Bl, Chua SC, Ong HY, Ong CN. HPLC Method for routine determination of vitamins A and B- carotene in plasma. Journal of Chromato 1992; 581: 41- 47.##Natelson S. Determination of ascorbic acid using 2,4 dinitrophneyl hydrazine. In, "Technique of clinical chemistry." C C. Thomas, Spring field, Illinois, 1971.##Landat A, Karine L, Guechot J, Palluet AM. Values of sperm thiobarbituric acid- reactive substances in fertile men. Clin Chem Acta 2002; 325: 113-115.##Shang XJ, Lik Y, Chen YG, Huang YF: Analysis of lipid peroxidative levels in seminal plasma of in fertile men by HPLC. Arch Androl 2004; 50: 411-416.##Mostafa T, Anis TH, Ghazi S, El-Nashar AR, Imam H, Osman IA. Reactive oxygen species and antioxidants relationship in the internal spermatic vein blood of infertile men with varicocele. Asian J Androl 2006; 8: 451-454.##Fraga CG, Motchnik PA, Shigenaga MK, Helbock HJ, Jacob RA, Ames BN. Ascorbic acid protects against endogenous oxidative DNA damage in human sperm. Proceedings of the National Academy of Sciences of the United States of America 1991; 88: 11003-11006.##Lewis SE, Sterling ES, Young IS, Thompson W. Comparison of individual antioxidants of sperm and seminal plasma in fertile and infertile men. Fertil and Steril 1997; 67: 142-147.##Buettner GR. The pecking order of fl'ee radicals and antioxidants, lipid peroxidation, alpha-tocopherol and ascorbate. Arch Biochem Biophys 1993; 300: 535-543.## ##

Effect of Nelumbo nucifera seeds on the reproductive organs of female rats 2 2 Background: Nelumbo nucifera has been used as antifertility agent in females by the local tribals of Rajasthan especially of Udaipur district India. Objective: The present study was conducted to investigate the effect of Nelumbo nucifera on the fertility and general physiology in female rats. Materials and Methods: 20 female albino rats were taken and divided into two groups. Group 1 served as control and group 2 received ethanolic extract at dose of 800mg/kg b.wt. for investigating the nature of the drug and antifertility effect. Vaginal smear was monitored everyday in the morning to study the estrous cycle. On day 41st all the animals were sacrificed and various haematological and biochemical parameters were estimated. Results: Data revealed that oral administration of Nelumbo nucifera extract brought about a significant decline in the weight of Ovary; Control (43±4.75mg), Nelumbo extract treated (25±3.86mg), Uterus; Control (236±0.004mg), Nelumbo extract treated (214±0.007mg) and Vagina; Control (221±0.002mg), Nelumbo extract treated (178±0.003mg) as well as protein and glycogen level, however cholesterol level increased significantly. In addition, the diestrous phase of the estrous cycle was found to be prolonged; Control (1.81±0.21) days, Nelumbo extract treated (3.62±0.42) days. Conclusion: These results suggest that Nelumbo nucifera has the anti-estrogenic nature without altering the general physiology of the female rats. 7 0 2017/10/12017/10/1 1396/7/9 2017/10/52017/10/5 1396/7/13 Anju Mutreja Anju Mutreja Reproductive Physiology and Biochemistry Section, Center for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, India Meera Agarwa Meera Agarwa Reproductive Physiology and Biochemistry Section, Center for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, India drmeera_agarwal@yahoo.co.in Sonalika Kushwaha Sonalika Kushwaha Reproductive Physiology and Biochemistry Section, Center for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, India Alka Chauhan Alka Chauhan Reproductive Physiology and Biochemistry Section, Center for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, India Anti-estrogenic Female rats Nelumbo nucifera Estrous cycle Talieh K, Kazem M, Alireza A, Mohsen S, Alireza S. Abortifacient effect of Prangos ferulacia on pregnant rats. Contraception 2006; 73: 554-556.##Khushalani H, Taltke P, Singh K. Antifertility activity of dried flowers of Woodfordia fructicosa kurz. Indian Journal of Pharmaceutical Sciences 2006; 68: 528-529.##Gupta M, Mazumder UK, Vamsi MLM, Sivakumar T, Kandar CC. Antisteroidogenic activity of the two Indian medicinal plants in mice. Journal of Ethnopharmacology 2004; 90: 21-25.##Mukherjee PK, Das J. Antipyretic activity of Nelumbo nucifera rhizome extract. Indian Journal of Experimental Biology 1996; 34: 275-276##Gupta M, Mazumdar UK. Antisteroidogenic effect of the seed extract of Nelumbo nucifera in the testis and ovary of rat. Indian Journal of Pharmaceutical Sciences 1996; 58: 326-242.##Mazumdar UK, Gupta M. Antifertility activity of seeds of Nelumbo nucifera in mice. Indian Journal of Experimental Biology 1992; 30: 533-534.##WHO: protocol CG-04. Preparation of alcoholic extract for bioassay and phytochemical studies (APJF/IP, 1001 A). Geneva,World Health Organization 1983 a.##Mc Leod LJ. Pharmacological experiments on intact preparation. Treatment of all or none principle, First ed. Churchill Livingstone Ltd., Edinburgh 1976: 105##Vogel HG. Ovarian hormones. In: Pharmacological Assay, 2nd ed. Springer-verlag, Berlin, Heidelberg, 1997: 637-645##Makonnen E, Rostum Amr AH, Assefa G, Zerihun L. Antifertility effect of Jatropha curcus L. seeds in guinea pigs. Ethiopian Journal of Health Development 1997; 11: 145-148.##Lowry OH, Rosen burgh NJ, Farr AL, Ran dell RJ. Protein measurement with the Folin phenol reagent. J Biol Chem 1951; 193: 265-275##Montgomery R. Determination of Glycogen Arch. Biochem Biophy 1957; 67: 378.##Oser BL. In: Hawk's Physiological Chemistry 14th Ed. Mc Graw Hill, New York, 1965: 246##Schalm OM, Jain NC, Carrolt EJ. Veterinary haematology 3rd ed, Lea and Febiger Philadelphia, 1975: 324-335.##Lynch JM, Raphel SS, Melvir LD, Spare PD, Inwood MJM. In: medical laboratory and clinical pathology pub, Sounders Company Sohm Ltd., Tokyo, 1969: 626, 647-662.##Makrem A. Haemoglobin, myoglobin and hepatoglobin. In: Henry Cannon Winkelmann. Ed. Clinical Chemistry. Principles and techniques. 1969; 1111-1214##Astoor A, King EJ. Simplified calorimetric blood sugar method. J Biol Chem 1954; 50 XIIV.##Ipstein J, Poly F. Brancroft's Introduction to biostatics, 2nd ed. Harper International, New York : 44##Gandhi M, Lal R, Sankaranarayanan, Sharma PL. Post-coital antifertility activity of Ruta graveolens in female rats and hamsters. J Ethnopharm 1991: 49-59.##Denker HW. Cell biology of endometrial receptivity and of trophoblast- endometrial interaction .In: Glasser SP, Mulholland J, Psychoyos A. Endocrinology of embryo-endometrium interactions, Plenum Press, New York, 1994: 17-32.##Mukherjee P. Quality control Herbal drugs: an approach to evaluation of botanicals, First ed. Business Horizons, New Delhi 2002.##Gebrie E, Makonnen E, Debella A, Zerihun L. Phytochemical screening and pharmacological evaluations for the antifertility effect of the methanolic root extract of Rumex steudelii. J Ethnopharm 2005; 96: 139-143.##Strauss JF III, Schuler LA, Tanaka T. Cholesterol metabolism by ovarian tissue. Advances in Lipid Research 1981; 18: 99.##Shivalingappa H, Satyanarayan ND, Purohit MG, Sharanabasappa A, Patil SBJ. Effect of ethanol extract of Rivea hypocrateriformis on the estrous cycle of the rat. Ethnopharm 2002; 82: 11-17.##Agarwal M, Dixit VP, Sandhu JS. Possible mechanism of antifertility activity of 3-chloro-1, 2-Propanediol (U-5897) on the female genital tract of Rattus rattus Rufescens- A Biochemical and Histophysiological study. Proc Ind Natn Sci Acad 1980; 46: 293-301.##Mohla S, Prasad MRN. Oestrogen antiestrogen interaction: Effect of U-11100 A, MRL-41 (Clomiphene) and U-11555 A on oestrogen induced uterine glycogen and protein synthesis in the rat during delayed implantation. Acta Endo 1969; 162: 482-487.##Talieh K, Kazem M, Alireza A, Mohsen S, Alireza S. Abortifacient effect of Prangos ferulacia on pregnant rats. Contraception 2006; 73: 554-556.##Khushalani H, Taltke P, Singh K. Antifertility activity of dried flowers of Woodfordia fructicosa kurz. Indian Journal of Pharmaceutical Sciences 2006; 68: 528-529.##Gupta M, Mazumder UK, Vamsi MLM, Sivakumar T, Kandar CC. Antisteroidogenic activity of the two Indian medicinal plants in mice. Journal of Ethnopharmacology 2004; 90: 21-25.##Mukherjee PK, Das J. Antipyretic activity of Nelumbo nucifera rhizome extract. Indian Journal of Experimental Biology 1996; 34: 275-276##Gupta M, Mazumdar UK. Antisteroidogenic effect of the seed extract of Nelumbo nucifera in the testis and ovary of rat. Indian Journal of Pharmaceutical Sciences 1996; 58: 326-242.##Mazumdar UK, Gupta M. Antifertility activity of seeds of Nelumbo nucifera in mice. Indian Journal of Experimental Biology 1992; 30: 533-534.##WHO: protocol CG-04. Preparation of alcoholic extract for bioassay and phytochemical studies (APJF/IP, 1001 A). Geneva,World Health Organization 1983 a.##Mc Leod LJ. Pharmacological experiments on intact preparation. Treatment of all or none principle, First ed. Churchill Livingstone Ltd., Edinburgh 1976: 105##Vogel HG. Ovarian hormones. In: Pharmacological Assay, 2nd ed. Springer-verlag, Berlin, Heidelberg, 1997: 637-645##Makonnen E, Rostum Amr AH, Assefa G, Zerihun L. Antifertility effect of Jatropha curcus L. seeds in guinea pigs. Ethiopian Journal of Health Development 1997; 11: 145-148.##Lowry OH, Rosen burgh NJ, Farr AL, Ran dell RJ. Protein measurement with the Folin phenol reagent. J Biol Chem 1951; 193: 265-275##Montgomery R. Determination of Glycogen Arch. Biochem Biophy 1957; 67: 378.##Oser BL. In: Hawk's Physiological Chemistry 14th Ed. Mc Graw Hill, New York, 1965: 246##Schalm OM, Jain NC, Carrolt EJ. Veterinary haematology 3rd ed, Lea and Febiger Philadelphia, 1975: 324-335.##Lynch JM, Raphel SS, Melvir LD, Spare PD, Inwood MJM. In: medical laboratory and clinical pathology pub, Sounders Company Sohm Ltd., Tokyo, 1969: 626, 647-662.##Makrem A. Haemoglobin, myoglobin and hepatoglobin. In: Henry Cannon Winkelmann. Ed. Clinical Chemistry. Principles and techniques. 1969; 1111-1214##Astoor A, King EJ. Simplified calorimetric blood sugar method. J Biol Chem 1954; 50 XIIV.##Ipstein J, Poly F. Brancroft's Introduction to biostatics, 2nd ed. Harper International, New York : 44##Gandhi M, Lal R, Sankaranarayanan, Sharma PL. Post-coital antifertility activity of Ruta graveolens in female rats and hamsters. J Ethnopharm 1991: 49-59.##Denker HW. Cell biology of endometrial receptivity and of trophoblast- endometrial interaction .In: Glasser SP, Mulholland J, Psychoyos A. Endocrinology of embryo-endometrium interactions, Plenum Press, New York, 1994: 17-32.##Mukherjee P. Quality control Herbal drugs: an approach to evaluation of botanicals, First ed. Business Horizons, New Delhi 2002.##Gebrie E, Makonnen E, Debella A, Zerihun L. Phytochemical screening and pharmacological evaluations for the antifertility effect of the methanolic root extract of Rumex steudelii. J Ethnopharm 2005; 96: 139-143.##Strauss JF III, Schuler LA, Tanaka T. Cholesterol metabolism by ovarian tissue. Advances in Lipid Research 1981; 18: 99.##Shivalingappa H, Satyanarayan ND, Purohit MG, Sharanabasappa A, Patil SBJ. Effect of ethanol extract of Rivea hypocrateriformis on the estrous cycle of the rat. Ethnopharm 2002; 82: 11-17.##Agarwal M, Dixit VP, Sandhu JS. Possible mechanism of antifertility activity of 3-chloro-1, 2-Propanediol (U-5897) on the female genital tract of Rattus rattus Rufescens- A Biochemical and Histophysiological study. Proc Ind Natn Sci Acad 1980; 46: 293-301.##Mohla S, Prasad MRN. Oestrogen antiestrogen interaction: Effect of U-11100 A, MRL-41 (Clomiphene) and U-11555 A on oestrogen induced uterine glycogen and protein synthesis in the rat during delayed implantation. Acta Endo 1969; 162: 482-487.## ##

Correlation between sperm parameters and sperm DNA fragmentation in fertile and infertile men 2 2 Background: It is established that sperm DNA integrity is essential in fertilization and normal embryo and fetal development. Routine semen analysis gives an approximate evaluation of the functional competence of spermatozoa, but does not always reflect the quality of sperm DNA. Therefore, the evaluation of sperm DNA integrity, in addition to routine sperm parameters, could add further information on the quality of spermatozoa and reproductive potential of males. Objective: The objective of this study was to determine the levels of sperm DNA damage in fertile and infertile males and its correlation with semen parameters. Materials and Methods: Semen samples were collected from 45 infertile men selected from couples attending the infertility clinic with a history of infertility of ≥1 years and 75 healthy volunteers of proven fertility (initiated a successful pregnancy) served as the control group. After routine sperm analysis, DNA damage was determined using single cell gel electrophoresis (comet) assay method. Results: The mean of DNA damage (comet value) in the sperms of infertile males was significantly higher than that of fertile males (12.9±7.59 vs. 48.77±24.42, p<0.001). A significant negative correlation was observed between DNA damage and sperm motility in fertile group (p<0.02, R=-0.263). In infertile males, significant negative correlations were observed between DNA damage with sperm motility (p<0.002, R=-0.45) and morphology (p<0.03, R=-0.317). There was no significant correlation between sperm concentration and sperm DNA damage in both groups. Conclusion: These results indicate that sperm DNA damages in infertile males is significantly higher than fertile males and sperms with abnormal morphology and low levels of motility has more abnormal DNA damages than motile and normal sperms. 13 0 2017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/5 1396/7/13 Nasrin Sheikh Nasrin Sheikh Department of Biochemistry and Nutrition, School of Medicine, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Iraj Amiri Iraj Amiri Molecular Medicine Research Center, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran amiri44@yahoo.com Marzieh Farimani Marzieh Farimani Infertility Center, Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Rezvan Najafi Rezvan Najafi Department of Biochemistry and Nutrition, School of Medicine, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Jafar Hadeie Jafar Hadeie Molecular Medicine Research Center, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran Sperm parameters Male infertility DNA integrity Comet assay. Agarwal A, Allamaneni SSR. The effect of Sperm DNA damage on assisted reproduction outcomes, a review. Minereva Ginocol 2004; 56: 235-245.##Sharma RK, Said T, Agarwal A. Sperm DNA damage and its clinical relevance in assessing reproductive outcome. Asian J Androl 2004; 6:139-148.##Sun JG, Jurisicova A, Casper RF. Detection of deoxyribonucleic acid fragmentation in human sperm: correlation with fertilization in vitro. Biol Reprod 1997; 56: 602-607.##Saleh RA, Agarwal A, Nada EA, El-Tonsy MH, Sharma RK, Meyer A, et al. Negative effects of increased sperm DNA damage in relation to seminal oxidative stress in men with idiopathic and male factor infertility. Fertil Steril 2003; 79 Suppl 3: 1597-1605.##Alvarez JG. DNA fragmentation in human spermatozoa: significance in the diagnosis and treatment of infertility. Minerva Ginecol 2003; 55: 233-239.##Morris ID, Ilott S, Dixon L, Brison DR. The spectrum of DNA damage in human sperm assessed by single cell gel electrophoresis (Comet assay) and its relationship to fertilization and embryo development. Hum Reprod 2002; 17: 990-998.##Perreault SD, Aitken RJ, Baker HW, Evenson DP, Huszar G, Irvine DS, et al. Integrating new tests of sperm genetic integrity into semen analysis: breakout group discussion. Adv Exp Med Biol 2003; 518: 253-268.##Ramos L, Wetzels AM. Low rates of DNA fragmentation in selected motile human spermatozoa assessed by the TUNEL assay. Hum Reprod 2001; 16: 1703-1707##Shen HM, Dai J, Chia SE, Lim A, Ong CN. Detection of apoptotic alterations in sperm in subfertile patients and their correlations with sperm quality. Hum Reprod 2002; 17: 1266-1273.##Giwercman A, Richthoff J, Hjollund H, Bonde JP, Jepson K, Frohm B, et al. Correlation between sperm motility and sperm chromatin structure assay parameters. Fertil Steril 2003; 80: 1404-1412.##McVicar CM, McClure N, Williamson K, Dalzell LH Lewis SE. Incidence of Fas positivity and deoxyribonucleic acid double-stranded breaks in human ejaculated sperm. Fertil Steril 2004; 81 Suppl 1: 767-774.##Lachaud C, Tesarik J, Canadas ML, Mendoza C. Apoptosis and necrosis in human ejaculated spermatozoa. Hum Reprod 2004; 19: 607-610.##Sills ES, Fryman JT, Perloe M, Michels KB, Tucker MJ. Chromatin fluorescence characteristics and standard semen analysis parameters correlations observed in andrology testing among 136 males referred for infertility evaluation. J Obstet Gynaecol 2004; 24: 74-77.##Oosterhuis GJ, Mulder AB, Kalsbeek-Batenburg E, Lambalk CB, Schoemaker J, Vermes I. Measuring apoptosis in human spermatozoa a biological assay for semen quality. Fertil Steril 2000; 74: 245-250.##Lopes S, Sun JG, Juriscova A, Meriano J, Casper RF. Sperm deoxyribonucleic acid fragmentation is increased in poor-quality semen samples and correlates with failed fertilization in intracytoplasmic sperm injection. Fertil Steril 1998; 69: 528-532.##Irvine DS, Twigg JP, Gordon EL, Fulton N, Milne PA, Aitken RJ. DNA integrity in human spermatozoa relationships with semen quality. J Androl 2000; 21: 33-44.##Hughes CM, Lewis SE, McKelvey-Martin VJ, Thompson W. A comparison of baseline and induced DNA damage in human spermatozoa from fertile and infertile men, using a modified comet assay. Mol Hum Reprod 1996; 2: 613-619.##Henkel R, Kierspel E, Hajimohammad M, Stalf T, Hoogendijk C, Mehnert C, et al. DNA fragmentation of spermatozoa and assisted reproduction technology. Reprod Biomed Online 2003; 7: 477-484.##Singh N, McCoy M, Tice R, Schneider E. A simple technique for quantitiation of low levels of DNA damage in individual cells. Exp Cell Res 1988; 175: 184-191.##World Health Organization WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction.1999 4th ed, Cambridge University Press, Cambridge, UK.##Kruger TF, Menkveld R, Stander FS, Lombard CJ, Van der Merwe JP, van Zyl JA, et al. Sperm morphologic features as a prognostic factor in in vitro fertilization. Fertil Steril 1986; 46: 1118-1120##Angelis KJ, Dusinska M, Collins AR. Single cell gel electrophoresis: detection of DNA damage at different levels of sensitivity. Electrophoresis 1999; 20: 2133-2138.##https://doi.org/10.1002/(SICI)1522-2683(19990701)20:103.0.CO;2-Q##Agarwal A, Allamaneni SSR. The effect of Sperm DNA damage on assisted reproduction outcomes, a review. Minereva Ginocol 2004; 56: 235-245.##Sharma RK, Said T, Agarwal A. Sperm DNA damage and its clinical relevance in assessing reproductive outcome. Asian J Androl 2004; 6:139-148.##Sun JG, Jurisicova A, Casper RF. Detection of deoxyribonucleic acid fragmentation in human sperm: correlation with fertilization in vitro. Biol Reprod 1997; 56: 602-607.##Saleh RA, Agarwal A, Nada EA, El-Tonsy MH, Sharma RK, Meyer A, et al. Negative effects of increased sperm DNA damage in relation to seminal oxidative stress in men with idiopathic and male factor infertility. Fertil Steril 2003; 79 Suppl 3: 1597-1605.##Alvarez JG. DNA fragmentation in human spermatozoa: significance in the diagnosis and treatment of infertility. Minerva Ginecol 2003; 55: 233-239.##Morris ID, Ilott S, Dixon L, Brison DR. The spectrum of DNA damage in human sperm assessed by single cell gel electrophoresis (Comet assay) and its relationship to fertilization and embryo development. Hum Reprod 2002; 17: 990-998.##Perreault SD, Aitken RJ, Baker HW, Evenson DP, Huszar G, Irvine DS, et al. Integrating new tests of sperm genetic integrity into semen analysis: breakout group discussion. Adv Exp Med Biol 2003; 518: 253-268.##Ramos L, Wetzels AM. Low rates of DNA fragmentation in selected motile human spermatozoa assessed by the TUNEL assay. Hum Reprod 2001; 16: 1703-1707##Shen HM, Dai J, Chia SE, Lim A, Ong CN. Detection of apoptotic alterations in sperm in subfertile patients and their correlations with sperm quality. Hum Reprod 2002; 17: 1266-1273.##Giwercman A, Richthoff J, Hjollund H, Bonde JP, Jepson K, Frohm B, et al. Correlation between sperm motility and sperm chromatin structure assay parameters. Fertil Steril 2003; 80: 1404-1412.##McVicar CM, McClure N, Williamson K, Dalzell LH Lewis SE. Incidence of Fas positivity and deoxyribonucleic acid double-stranded breaks in human ejaculated sperm. Fertil Steril 2004; 81 Suppl 1: 767-774.##Lachaud C, Tesarik J, Canadas ML, Mendoza C. Apoptosis and necrosis in human ejaculated spermatozoa. Hum Reprod 2004; 19: 607-610.##Sills ES, Fryman JT, Perloe M, Michels KB, Tucker MJ. Chromatin fluorescence characteristics and standard semen analysis parameters correlations observed in andrology testing among 136 males referred for infertility evaluation. J Obstet Gynaecol 2004; 24: 74-77.##Oosterhuis GJ, Mulder AB, Kalsbeek-Batenburg E, Lambalk CB, Schoemaker J, Vermes I. Measuring apoptosis in human spermatozoa a biological assay for semen quality. Fertil Steril 2000; 74: 245-250.##Lopes S, Sun JG, Juriscova A, Meriano J, Casper RF. Sperm deoxyribonucleic acid fragmentation is increased in poor-quality semen samples and correlates with failed fertilization in intracytoplasmic sperm injection. Fertil Steril 1998; 69: 528-532.##Irvine DS, Twigg JP, Gordon EL, Fulton N, Milne PA, Aitken RJ. DNA integrity in human spermatozoa relationships with semen quality. J Androl 2000; 21: 33-44.##Hughes CM, Lewis SE, McKelvey-Martin VJ, Thompson W. A comparison of baseline and induced DNA damage in human spermatozoa from fertile and infertile men, using a modified comet assay. Mol Hum Reprod 1996; 2: 613-619.##Henkel R, Kierspel E, Hajimohammad M, Stalf T, Hoogendijk C, Mehnert C, et al. DNA fragmentation of spermatozoa and assisted reproduction technology. Reprod Biomed Online 2003; 7: 477-484.##Singh N, McCoy M, Tice R, Schneider E. A simple technique for quantitiation of low levels of DNA damage in individual cells. Exp Cell Res 1988; 175: 184-191.##World Health Organization WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction.1999 4th ed, Cambridge University Press, Cambridge, UK.##Kruger TF, Menkveld R, Stander FS, Lombard CJ, Van der Merwe JP, van Zyl JA, et al. Sperm morphologic features as a prognostic factor in in vitro fertilization. Fertil Steril 1986; 46: 1118-1120##Angelis KJ, Dusinska M, Collins AR. Single cell gel electrophoresis: detection of DNA damage at different levels of sensitivity. Electrophoresis 1999; 20: 2133-2138.##https://doi.org/10.1002/(SICI)1522-2683(19990701)20:103.0.CO;2-Q## ##

Repeated IVF/ICSI-ETs failures and impact of hysteroscopy 2 2 Background: Despite numerous developments in the field of assisted reproduction, the implantation rate remains low. Among the various reasons of implantation failure, endometrial regularity has an important role. Hysteroscopy is an accurate method for evaluating the endometrial characteristics, with the ability to treat uterine pathology. Objective: The aim of the present study was to evaluate the findings on hysteroscopy and thereafter the result of subsequent IVF/ICSI in infertile women with the history of frequent unexplained and unsuccessful IVF/ICSI attempts. Materials and Methods: In this observational study, the hysteroscopy findings and the outcomes of subsequent IVF/ICSI were evaluated in 89 infertile women admitted in Avicenna Infertility Clinic, with previous repeated (more than two) failed IVF/ICSI-ETs, including the patients with normal Hysterosalpinography (HSG) and excluding severe male factor infertility and also thrombophilia, genetic and immunologic problems. The data were analyzed with SPSS software and Fisher exact, chi-square, and MC-Nemar tests. Results: In 53 (59.5%) cases, hysteroscopy revealed abnormal intrauterine findings including adhesions 7 (13.7%), single polyp 11 (20.7%), endometrial polyposis 10 (18.8%), endometrial hyperplasia 10 (18.8%), uterine cavity hypoplasia 4 (7.8%) and myoma 5 (9.8%). These abnormalities were significantly higher in women with more than 8 years of infertility (chi-square=4.7, p-value=0.03). After hysteroscopy and subsequent IVF/ICSI-ET attempt using standard long protocol, pregnancy rate were significantly higher compared with the previous repeated IVF/ICSI attempts (35.8% versus 0%). Conclusion: According to this study, we strongly suggest evaluation of endometrial integrity by hysteroscopy in patients with repeated IVF/ICSI-ETs failure, before entering any other fertilization procedures. 19 0 2017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/52017/10/5 1396/7/13 Soheila Arefi Soheila Arefi Reproductive Immunology Department, Reproductive Biotechnology Research Center, Avicenna Research Institute, Avesina Infertility Center, Tehran, Iran soheilaarefi@yahoo.com Haleh Soltanghoraee Haleh Soltanghoraee Genetic Departement, Reproductive Biotechnology Research Center, Avicenna Research Institute, Avesina Infertility Center, Tehran, Iran Amir Hassan Zarnani Amir Hassan Zarnani Reproductive Immunology Department, Reproductive Biotechnology Research Center, Avicenna Research Institute, Avesina Infertility Center, Tehran, Iran Ali Sadeghpour Tabaei Ali Sadeghpour Tabaei Iran University, Shahid Rajaei Hospital, Tehran, Iran Marefat Ghaffari Novin Marefat Ghaffari Novin Cellular and Molecular Biology Research Center, Shaheed Beheshti University (M.C.), Tehran, Iran Hojat Zeraati Hojat Zeraati Tehran University of Medical Sciences, School of Public Health, Department of Epidemiology and Biostatistics Pegah Ebadi Pegah Ebadi Reproductive Endocrinology and Embryology Departement, Reproductive Biotechnology Research Center, Avicenna Research Institute, Avesina Infertility Center, Tehran, Iran Hysteroscopy Repeated IVF/ICSI -ET failure Margalioth EJ, Ben -Chetrit A, Gal M, Eldar Geva T. Investigation and treatment of repeated implantation failure following IVF-ET. Hum Reprod 2006; 21: 3036-3043.##Putowski L, Darmochwal-Kolarz D, Rolinski J,Oleszczuk J, Jakowicki J. The immunological profile in infertile women after repeated IVF failures (preliminary study). Eur J Obstet Gynecol Reprod Biol 2004; 112: 192-196.##Azem F, Many A, Ben Ami I, Yovel I, Amit A, Lessing JB, et al. Increased rate of thrombophilia in women with repeated IVF failure. Hum Reprod 2004; 19: 368-370.##Laird SM, Tuckerman EM, Li TC. Cytokine expression in the endometrium of women with implantation failure and recurrent abortion. Reprod Biomed Online 2006; 13: 13-23.##Raziel A, Friedler S, Schachter M, Kasterstein E, Strassburger D, Ron-El R. Increased frequency of female partner chromosomal abnormalities in patients with high order implantation failure after in vitro fertilization. Fertil Steril 2002; 78: 515-519.##Stern C, Pertile M, Norris H, Hale L, Baker HW. Chromosomal translocations in couples with in vitro fertilization implantation failure. Hum Reprod 1999; 14: 2097-2101##Golan A, Ron-El R, Herman A, Soffer Y, Bukovsky I, Caspi E. Diagnostic hysteroscopy: its value in an in-vitro fertilization/embryo transfer unit. Hum Reprod 1992; 7:1433-1434.##Shalev J, Meizner I, Bar-Hava I, Dicker D, Mashiach R, Ben-Rafael Z. Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility. Fertil Steril 2000; 73: 412-417.##Hauge K, Flo K, Riedhart M, Granberg S. Can ultrasound -based investigations replace laparascopy and hysteroscopy in infertility? Eur J Obstet Gynecol Reprod Biol 2000; 92:167-170.##de Kroon CD, de bock GH, Dieben SW, Jansen FW. Saline hysterosonography in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 2003; 110: 938-947.##Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopyin Reproductive- aged women with or without abnormal uterine bleeding. Fertil Steril 2005; 84: 682-686.##Rogerson L, Bates J, Weston M, Duffy S. A comparison of outpatients hysteroscopy with saline infusion hysterosonography. BJOG 2002; 109:800-804.##Schiano A, Jourdain O, Papaxanthos A, Hocke C, Horovitz J, Dallay D. The value of hysteroscopy after repeated implantation failures with in vitro fertilization. Contracept Fertil Sex 1999; 27: 129-132.##Noyes N. Hysteroscopic cervical canal shaving: A new therapy for cervical stenosis before embryo transfer in patients undergoing in vitro fertilization. Fertil Steril 1999; 71: 965-966.##Dicker D, Ashkenazi J, Feldberg D, Farhi J, Shalev J, Ben-Rafael Z. The value of repeat hysteroscopic evaluation in patients with in vitro fertilization transfer cycles. Fertil Steril 1992; 58: 833-835.##Makris N, Xygakis A, Michalas S, Dachlythras M, Prevedourakis C. Day clinic diagnostic hysteroscopy in a state hospital. Clin Exp Obstet Gynecol 1999; 26:91-92.##Alborzi S, Dehbashi S, Khodaee R. Sonohysterosal-pingographic screening for infertile patients. Int J Gynaecol Obstet 2003; 82(1): 57-62.##Alborzi S, Parsanezhad ME, Mahmoodian N, Alborzi S, Alborzi M . Sonohysterography versus transvaginal Sonography for screening of patients with abnormal uterine bleeding. Int J Gynaecol Obstet 2007; 96: 20-23.##diagnosis and treatment of infertility. Rev Med Chir Soc Med Nat Iasi 2005; 109: 537-541.##Mihaila C, Anton E. Significance of hysteroscopy in the Ragni G, Diaferia D, Vegetti W, Colombo M, Arnoldi M, Crosignani PG. Effectiveness of sonohysteroscopy in infertile patient workshop: a comparison with transvaginal ultrasonography and hysteroscopy. Gynecol Obstet Invest 2005; 59:184-188.##Faghali J, Bakar J, Mayenga JM, Ségard L, Hamou J, Driguez P, et al. Systematic hysteroscopy prior to in vitro fertilization. Gynecol Obstet Fertil 2003; 31: 127-131.##La Sala GB, Montanari R, Dessanti L , Cigarini C, Sartori F. The role of diagnostic hysteroscopy and endometrial biopsy in assisted reproductive endocrinologies. Fertil Steril 1998; 70:378-380.##Oliveria FG, Abdelmassih VG, Diamond MP, Dozortsev D, Nagy ZP, Abdelmassih R. Uterine cavity findings and hysteroscopic interventions in patients undergoing in vitro fertilization -embryo transfer who repeatedly cannot conceive. Fertil Steril 2003; 80: 1371-1375.##Kdous M, Hachicha R, Zhiou F, Ferchiou M, Chaker A, Meriah S. Fertility after hysteroscopic treatment of intra-uterine adhesions. Gynecol Obstet Fertil 2003; 31: 422-428.##Pabuccu R, Ceyhan ST , Onalan G, Goktolga U, Ercan CM, Selam B. Successful treatment of cervical stenosis with hysteroscopic canalization before embryo transfer in patients undergoing IVF: A case series. J Minimum Invasive Gynecol 2005; 12: 436-438.##Woolcott R, Petchpud A. The efficacy of hysteroscopy: a comparison of women presenting with infertility versus other gynaecological symptoms. Aust N Z J Obstet Gynaecol 1996; 36: 226-227.## ##

Pregnancy complications of grandmultiparity at a rural setting of South Africa 2 2 Background: Intrapartam complications such as foetal malpresentation, placental abruption, dysfunctional labour, and postpartum haemorrhage are associated with grandmultiparity. In developing countries and many parts of Africa and sub-Saharan Africa, there is limited access to medical care. There is a need in these areas to identify women whose pregnancies are at risk of complication and it is an important part of antenatal screening and care during delivery to reduce adverse outcomes. Objective: The objectives of this study were to evaluate the complications during pregnancy and delivery of grandmultiparity and to compare it with other parity groups. Materials and Methods: A retrospective case control study was conducted targeting women delivered at Empangeni Hospital during April to December 2004. Among all women who delivered at the hospital, 352 grandmultimaras, 3326 nulliparas and 3772 who had parity 1 to 5, were taken as cases and controls respectively for the study. Results: Significantly higher rates of ante partum (1%) and post partum (2%) haemorrhages, post term delivery (3%), and intrauterine foetal deaths (4.5%) were observed in grandpultiparas compared to nulliparous women but there was no difference with parity group 1-5. Assisted vaginal delivery rates were significantly lower in grandpultiparas women (2%) compared to nulliparous (5%) group (p < 0.05) but there was no difference with parity group 1-5. There were no significant differences in anaemia (14%), hypertension (10%), eclampsia (0.5%) and diabetes (3%), elective and emergency caesarean delivery (14.2%) and low-birth-weight delivery rates (13.2%) among different parity groups. Conclusion: Grandmultiparity was not safer compared to other lower parity groups. Thus strategies are needed to guide women to seek proper care during pregnancy and if possible to avoid pregnancy if they had higher parity. 25 0 2017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/52017/10/52017/10/5 1396/7/13 Monjurul Hoque Monjurul Hoque Medical Manager, Empangeni Hospital, KwaZulu-Natal, New Germany 3610, South Africa monjurul.hoque@kznhealth.gov.za Ehsanul Hoque Ehsanul Hoque Lecturer, Statistician, Mangosuthu University of Technology, Jacobs, 4026, South Africa Suriya B Kader Suriya B Kader Hospital Manager,Wentworth Hospital, Private Bag JACOBS, 4026, South Afric Pregnancy outcome Grandmultiparity Pregnancy complications Rural setting. Eidelman AI, Kamar R, Schimmel MS, Baron E. The grand multipara: is she still at risk? Am J Obstet Gynecol 1998; 158: 389-392.##Solomons B. The dangerous multipara. Lancet 1934; 2: 8-11.##Roman H, Robillard PY, Verspyck E, Hulsey TG, Marpeau L, Barau G. Obstetric and Neonatal Outcomes in Grand Multiparity. Am Obstet Gynecol 2004; 103: 1294- 1299.##King PA, Duthie SJ, Ma HK. Grandmultiparity: a reappraisal of risks. Int J Gynaecol Obstet 1994; 36: 13-16.##Seidman DS, Armor Y, Roff D, Stevenson DK, Gale R. Grandmultiparity: an obstetric or neonatal risk factors? Am J Obstet Gynecol 1988; 158: 1034 - 1039.##Fuchs K, Peretz BA, Marcovic R, Timor-Tritsch I. The grandmultipara: is it a problem? A review of 5,785 cases. Int J Gynaecol Obstet 1985; 23: 321-325.##Samueloff A, Mor-Yosef S, Seidman D, Rabinowitz R, Simon A, Schenker J. Grandmultiparity: a nationwide survey. Isr J Med Sci 1989; 25: 625-629.##Rizk DE, Khalfan M, Ezimokhai M. Obstetric outcome in the United Arab Emirates: a case control study. Arch Gynecol Obstet 2001; 264: 194-198.##Wilkinson D, Cutts F, Ntuli N, Abdul Karrim SS. Maternal and child health indicators in rural South African health district. S Afr Med J 1997; 87:456-459.##Lyrenas S. Labour in the grand multipara. Gynecol Obstet Invest 2002; 53: 6-12.##Department of Health. Guidelines for Maternity Care in South Africa - A manual for clinics, community health centers and district hospitals. Department of Health, Pretoria, 2002, 2nd Edition, ISBN 1- 875017:71-72.##Goldman GA, Kaplan B, Neri A, Hecht-Resnick R, Harel L, Ovadia J. The grand multipara. Eur J Obstet Gynecol Reprod Biol 1995; 61: 105-109.##Tando TG, Bungum L. The grand multipara: maternal and neonatal complications. Acta Obstet Gynecol Acand 1987; 66:53-56.##Mor-Yosef S, Seidman DS , Samueloff A, Schenker JG. The effects of the socioeconomic status on the perinatal outcome of grand multipara. Eur J Obstet Gynecol Reprod Biol 1990; 36:117-123.##Abu-Heija AT, Chalabi HE. The great grandmultiparity: is it a risk? Int J Gynaecol Obstet 1997; 59: 213-216.##Roman H, Robillard PY, Verspyck E, Hulsey TC , Marpeau L, Barau G. Obstetric and neonatal outcomes in grandmultiparity. Obstet Gynecol 2004; 103: 1294-1299.##Tai C, Urquhart R. Grandmultiparity in Malaysian women. Asia Oceania J Obstet Gynaecol 1991; 17: 327-334.##Ellis Simonsen SM, Lyon JL, Alder SC, Varner MW. Effect of Grand Multiparity on Intrapartum and Newborn Complications in Young Women. Obstet Gynecol 2005; 106: 454 - 460.##Babinzki A, Kerenyi T, Torok O, Grazi V, Lapinsky RH, Berkowitz RL. Perinatal outcome in grand and great-grandmultiparity: Effects of parity on obstetric risk factors. Am J Obstet Gynecol 1999; 181: 669 - 674.##Toohey JS, Keegan KA, Morgan MA, Francis J, Task S, de Veciana M. The dangerous multipara: fact or fiction? Am J Obstet Gynecol 1995; 172: 683 - 686.##Scholl TO, Hediger ML, Ances IG, Cronk CE. Growth during early teenage pregnancies. Lancet 1988, 1: 710-711.##Bai J, Wong FM, Bauman A, Moshin M. Parity and pregnancy outcomes. Am J Obstet Gynecol 2002; 186: 274 - 278.##Lundsberg LS, Bracken MB, Saftlas AF. Low-to-moderate gestational alcohol use and intrauterine growth retardation, low birth weight and preterm delivery. Ann Epidemiol 1997; 7: 498-508.##Fretts RG, Schmittdiel J, McLean FH, Usher RH, Goldman MB. Increased maternal age and the risk of fetal death. N Engl J Med 1995; 333: 953-957.##Olesen AW, Westergaard JG, Olsen J. Perinatal and maternal complications related to postterm delivery: A national register-based study, 1978-1993. Am J Obstet Gynecol 2003; 189: 222-227.##Bugg GJ, Atwal GS, Maresh M. Grandmultiparae in a modern setting. Br J Obstet Gynaecol 2002; 109: 249-253.##Tsoka JM, Le Seur D, Sharp BL. Maternal health services utilization in ubombo district. S Afr J Obs Gynae 2003; 9: 70 -73.##Eidelman AI, Kamar R, Schimmel MS, Baron E. The grand multipara: is she still at risk? Am J Obstet Gynecol 1998; 158: 389-392.##Solomons B. The dangerous multipara. Lancet 1934; 2: 8-11.##Roman H, Robillard PY, Verspyck E, Hulsey TG, Marpeau L, Barau G. Obstetric and Neonatal Outcomes in Grand Multiparity. Am Obstet Gynecol 2004; 103: 1294- 1299.##King PA, Duthie SJ, Ma HK. Grandmultiparity: a reappraisal of risks. Int J Gynaecol Obstet 1994; 36: 13-16.##Seidman DS, Armor Y, Roff D, Stevenson DK, Gale R. Grandmultiparity: an obstetric or neonatal risk factors? Am J Obstet Gynecol 1988; 158: 1034 - 1039.##Fuchs K, Peretz BA, Marcovic R, Timor-Tritsch I. The grandmultipara: is it a problem? A review of 5,785 cases. Int J Gynaecol Obstet 1985; 23: 321-325.##Samueloff A, Mor-Yosef S, Seidman D, Rabinowitz R, Simon A, Schenker J. Grandmultiparity: a nationwide survey. Isr J Med Sci 1989; 25: 625-629.##Rizk DE, Khalfan M, Ezimokhai M. Obstetric outcome in the United Arab Emirates: a case control study. Arch Gynecol Obstet 2001; 264: 194-198.##Wilkinson D, Cutts F, Ntuli N, Abdul Karrim SS. Maternal and child health indicators in rural South African health district. S Afr Med J 1997; 87:456-459.##Lyrenas S. Labour in the grand multipara. Gynecol Obstet Invest 2002; 53: 6-12.##Department of Health. Guidelines for Maternity Care in South Africa - A manual for clinics, community health centers and district hospitals. Department of Health, Pretoria, 2002, 2nd Edition, ISBN 1- 875017:71-72.##Goldman GA, Kaplan B, Neri A, Hecht-Resnick R, Harel L, Ovadia J. The grand multipara. Eur J Obstet Gynecol Reprod Biol 1995; 61: 105-109.##Tando TG, Bungum L. The grand multipara: maternal and neonatal complications. Acta Obstet Gynecol Acand 1987; 66:53-56.##Mor-Yosef S, Seidman DS , Samueloff A, Schenker JG. The effects of the socioeconomic status on the perinatal outcome of grand multipara. Eur J Obstet Gynecol Reprod Biol 1990; 36:117-123.##Abu-Heija AT, Chalabi HE. The great grandmultiparity: is it a risk? Int J Gynaecol Obstet 1997; 59: 213-216.##Roman H, Robillard PY, Verspyck E, Hulsey TC , Marpeau L, Barau G. Obstetric and neonatal outcomes in grandmultiparity. Obstet Gynecol 2004; 103: 1294-1299.##Tai C, Urquhart R. Grandmultiparity in Malaysian women. Asia Oceania J Obstet Gynaecol 1991; 17: 327-334.##Ellis Simonsen SM, Lyon JL, Alder SC, Varner MW. Effect of Grand Multiparity on Intrapartum and Newborn Complications in Young Women. Obstet Gynecol 2005; 106: 454 - 460.##Babinzki A, Kerenyi T, Torok O, Grazi V, Lapinsky RH, Berkowitz RL. Perinatal outcome in grand and great-grandmultiparity: Effects of parity on obstetric risk factors. Am J Obstet Gynecol 1999; 181: 669 - 674.##Toohey JS, Keegan KA, Morgan MA, Francis J, Task S, de Veciana M. The dangerous multipara: fact or fiction? Am J Obstet Gynecol 1995; 172: 683 - 686.##Scholl TO, Hediger ML, Ances IG, Cronk CE. Growth during early teenage pregnancies. Lancet 1988, 1: 710-711.##Bai J, Wong FM, Bauman A, Moshin M. Parity and pregnancy outcomes. Am J Obstet Gynecol 2002; 186: 274 - 278.##Lundsberg LS, Bracken MB, Saftlas AF. Low-to-moderate gestational alcohol use and intrauterine growth retardation, low birth weight and preterm delivery. Ann Epidemiol 1997; 7: 498-508.##Fretts RG, Schmittdiel J, McLean FH, Usher RH, Goldman MB. Increased maternal age and the risk of fetal death. N Engl J Med 1995; 333: 953-957.##Olesen AW, Westergaard JG, Olsen J. Perinatal and maternal complications related to postterm delivery: A national register-based study, 1978-1993. Am J Obstet Gynecol 2003; 189: 222-227.##Bugg GJ, Atwal GS, Maresh M. Grandmultiparae in a modern setting. Br J Obstet Gynaecol 2002; 109: 249-253.##Tsoka JM, Le Seur D, Sharp BL. Maternal health services utilization in ubombo district. S Afr J Obs Gynae 2003; 9: 70 -73.## ##

GnRHa stop protocol versus long protocol in poor responder IVF patients 2 2 Background: Recently different studies suggested that discontinuation of gonadotrophin releasing hormone analogue (GnRHa) at beginning of ovarian stimulation (improvement of ovarian response to gonadotrophins) may have some benefit to poor responder patients in invitro fertilization (IVF) cycles. Objective:The efficacy of GnRHa stop protocol in poor responder patients in IVF cycles was assessed. Materials and Methods: This study was a prospective, randomized controlled trial that 40 poor responder patients (less than three mature follicles in a previous cycle) with normal basal follicle stimulating hormone (FSH) were randomly allocated into two protocols: 1) Non-stop protocol: long GnRHa suppression, and start gonadotrophins from day 3 of mense. 2) Stop-protocol: GnRHa is stopped with the onset of menses, and gonadotrophin doses remained similar to group 1. Results: A significantly higher number of follicles, oocytes, embryos and fertilization rate also shorter stimulation days and lower human menopausal gonadotropins (HMG) ampoules were recorded in the stop protocol compared to the control group. Both protocols resulted in a similar cancellation rate, pregnancy rate, estradiol level and LH level. Conclusion: Early follicular cessation of GnRHa permitted the retrieval of a significantly higher number of follicles, oocytes and embryos, and can reduce the number of HMG and stimulation days. 33 0 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/52017/10/52017/10/52017/10/5 1396/7/13 Ensieh Shahrokh Tehrani nejad Ensieh Shahrokh Tehrani nejad Vali-e-Asr Reproductive Health Research Center (V.R.H.R.C), Tehran University of Medical Sciences (T.U.M.S), Vali-e-Asr Hospital, Imam Khomeini Hospital, Tehran, Iran Behnaz Attar Shakeri Behnaz Attar Shakeri Vali-e-Asr Reproductive Health Research Center (V.R.H.R.C), Tehran University of Medical Sciences (T.U.M.S), Vali-e-Asr Hospital, Imam Khomeini Hospital, Tehran, Iran be_shakeri@yahoo.com Batool Hoseini Rashidi Batool Hoseini Rashidi Vali-e-Asr Reproductive Health Research Center (V.R.H.R.C), Tehran University of Medical Sciences (T.U.M.S), Vali-e-Asr Hospital, Imam Khomeini Hospital, Tehran, Iran Fatemeh Ramezanzade Fatemeh Ramezanzade Vali-e-Asr Reproductive Health Research Center (V.R.H.R.C), Tehran University of Medical Sciences (T.U.M.S), Vali-e-Asr Hospital, Imam Khomeini Hospital, Tehran, Iran Mamak Shariat Mamak Shariat Vali-e-Asr Reproductive Health Research Center (V.R.H.R.C), Tehran University of Medical Sciences (T.U.M.S), Vali-e-Asr Hospital, Imam Khomeini Hospital, Tehran, Iran GnRHa long protocol IVF Poor respondr GnRHa stop protocol Tarlatzis BC, Zepiridis L, Grimbizis G, Bontis J. Clinical management of low ovarian response to stimulation for IVF. Hum Reprod Update 2003; 9: 61-76.##Garcia JE, Jones GS, Acosta AA, Wright GJr. Human menopausal gonadotropin/human chorionic gonadotropin follicular maturation for oocyte aspiration. Fertil Steril 1983; 39(2): 174-179.##Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol 1997; 104: 521-527.##Scott RT Jr. Evaluation and treatment of low responders. Semin Reprod Endocrinol 1996; 14: 317-337##Karande V, Gleicher N. A rational approach to the management of low responders in in-vitro fertilization. Hum Reprod 1999; 14: 1744-1748.##Faber BM, Mayer J, Cox B, Jones D, Toner JP, Oehninger S, et al. Cessation of gonadotrophin-releasing hormone agonist therapy combined with high-dose gonadotrophin stimulation yields favorable pregnancy results in low responders. Fertil Steril 1998; 69: 826-830.##Dirnfield M, Fruchter O, Yshai D. Cessation of gonadotrophin-releasing hormone analogue (GnRH-a) upon down-regulation versus conventional long GnRH-a protocol in poor responders undergoing in vitro fertilization. Fertil Steril 1999; 72: 406-411.##Detti L, Williams DB, Robins JC, Maxwell RA, Thomas MA. Comparison of three downregulation approaches for poor responders undergoing in vitro fertilization, Fertil Steril 2005; 84(5): 1401-1405.##Beckers NGM, Laven JSE, Eijkemans MJC. Follicular and luteal phase characteristics following early cessation of gonadotrophin-releasing hormone agonist during ovarian stimulation for in-vitro fertilization. Hum Reprod 2000; 15: 43-49.##Garcia-Velasco JA, Isaza V, Requena A, Martínez-Salazar FJ, Landazábal A, Remohí J, et al. High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod 2000; 15: 2292-2296.##Gil-Salom M, Mínguez Y, Rubio C, De los Santos MJ, Remohí J, Pellicer A. Efficacy of intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1995; 10: 3166-3170.##Sungurtekin U, Jansen RPS. Profound Latinizing hormone suppression after stopping the gonadotrophin releasing hormone-agonist leuprolide acetate. Fertil Steril 1995; 63: 663-665.##Horvath PM, Styler M, Hammond JM, Shelden RM, Kemmann E. Exogenous gonadotropin requirements are increased in leuprolide suppressed women undergoing ovarian stimulation. Fertil Steril 1988; 49: 159-162.##Kowalik A, Barmat L, Damario M, Liu HC, Davis O, Rosenwaks Z. Ovarian estradiol production in vivo. Inhibitory effect of leuprolide acetate. J Reprod Med 1998; 43: 413-417.##Latouche J, Crumeyrolle-Arias M, Jordan D, Kopp N, Augendre-Ferrante B, Cedard L, et al. GnRH receptors in human granulosa cells: anatomical localization and characterization by autoradiographic study. Endocrinology 1989; 125: 1739-1741.##Aleem, FA, Predanic M. The hemodynamic effect of GnRH agonist therapy on uterine leiomyoma vascularity: a prospective study using transvaginal color Doppler sonography. Gynecol Endocrinol 1995; 9: 253-528.##Zeleznik AJ, Schuler HM, Reichert LEJ. Gonadotrophin-binding sites in the Rhesus monkey ovary: role of the vasculature in the selective distribution of human chorionic gonadotrophin to the preovulatory follicle. Endocrinology 1981; 109: 356-362.##Engmann L, Sladkevicius P, Agrawal R, Bekir JS, Campbell S, Tan SL. Value of ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of in vitro fertilization treatment. Fertil Steril 1999; 71: 22-29.##Bhal PS, Pugh ND, Chui DK, Gregory L, Walker SM, Shaw RW. The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles. Hum Reprod 1999; 14: 939-945.##Lashen H, Ledger W, Lopez-Bernal A, Barlow D. Poor responders to ovulation induction: is proceeding to in-vitro fertilization worthwhile? Hum Reprod 1999; 14: 964-969.##Schachter M, Friedler S, Raziel A, Strassburger D, Bern O, Ron-el R. Improvement of IVF outcome in poor responders by discontinuation of GnRH analogue during the gonadotropin stimulation phase--a function of improved embryo quality. J Assist Reprod Genet 2001; 18: 197-204.##Tarlatzis BC, Zepiridis L, Grimbizis G, Bontis J. Clinical management of low ovarian response to stimulation for IVF. Hum Reprod Update 2003; 9: 61-76.##Garcia JE, Jones GS, Acosta AA, Wright GJr. Human menopausal gonadotropin/human chorionic gonadotropin follicular maturation for oocyte aspiration. Fertil Steril 1983; 39(2): 174-179.##Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol 1997; 104: 521-527.##Scott RT Jr. Evaluation and treatment of low responders. Semin Reprod Endocrinol 1996; 14: 317-337##Karande V, Gleicher N. A rational approach to the management of low responders in in-vitro fertilization. Hum Reprod 1999; 14: 1744-1748.##Faber BM, Mayer J, Cox B, Jones D, Toner JP, Oehninger S, et al. Cessation of gonadotrophin-releasing hormone agonist therapy combined with high-dose gonadotrophin stimulation yields favorable pregnancy results in low responders. Fertil Steril 1998; 69: 826-830.##Dirnfield M, Fruchter O, Yshai D. Cessation of gonadotrophin-releasing hormone analogue (GnRH-a) upon down-regulation versus conventional long GnRH-a protocol in poor responders undergoing in vitro fertilization. Fertil Steril 1999; 72: 406-411.##Detti L, Williams DB, Robins JC, Maxwell RA, Thomas MA. Comparison of three downregulation approaches for poor responders undergoing in vitro fertilization, Fertil Steril 2005; 84(5): 1401-1405.##Beckers NGM, Laven JSE, Eijkemans MJC. Follicular and luteal phase characteristics following early cessation of gonadotrophin-releasing hormone agonist during ovarian stimulation for in-vitro fertilization. Hum Reprod 2000; 15: 43-49.##Garcia-Velasco JA, Isaza V, Requena A, Martínez-Salazar FJ, Landazábal A, Remohí J, et al. High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod 2000; 15: 2292-2296.##Gil-Salom M, Mínguez Y, Rubio C, De los Santos MJ, Remohí J, Pellicer A. Efficacy of intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1995; 10: 3166-3170.##Sungurtekin U, Jansen RPS. Profound Latinizing hormone suppression after stopping the gonadotrophin releasing hormone-agonist leuprolide acetate. Fertil Steril 1995; 63: 663-665.##Horvath PM, Styler M, Hammond JM, Shelden RM, Kemmann E. Exogenous gonadotropin requirements are increased in leuprolide suppressed women undergoing ovarian stimulation. Fertil Steril 1988; 49: 159-162.##Kowalik A, Barmat L, Damario M, Liu HC, Davis O, Rosenwaks Z. Ovarian estradiol production in vivo. Inhibitory effect of leuprolide acetate. J Reprod Med 1998; 43: 413-417.##Latouche J, Crumeyrolle-Arias M, Jordan D, Kopp N, Augendre-Ferrante B, Cedard L, et al. GnRH receptors in human granulosa cells: anatomical localization and characterization by autoradiographic study. Endocrinology 1989; 125: 1739-1741.##Aleem, FA, Predanic M. The hemodynamic effect of GnRH agonist therapy on uterine leiomyoma vascularity: a prospective study using transvaginal color Doppler sonography. Gynecol Endocrinol 1995; 9: 253-528.##Zeleznik AJ, Schuler HM, Reichert LEJ. Gonadotrophin-binding sites in the Rhesus monkey ovary: role of the vasculature in the selective distribution of human chorionic gonadotrophin to the preovulatory follicle. Endocrinology 1981; 109: 356-362.##Engmann L, Sladkevicius P, Agrawal R, Bekir JS, Campbell S, Tan SL. Value of ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of in vitro fertilization treatment. Fertil Steril 1999; 71: 22-29.##Bhal PS, Pugh ND, Chui DK, Gregory L, Walker SM, Shaw RW. The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles. Hum Reprod 1999; 14: 939-945.##Lashen H, Ledger W, Lopez-Bernal A, Barlow D. Poor responders to ovulation induction: is proceeding to in-vitro fertilization worthwhile? Hum Reprod 1999; 14: 964-969.##Schachter M, Friedler S, Raziel A, Strassburger D, Bern O, Ron-el R. Improvement of IVF outcome in poor responders by discontinuation of GnRH analogue during the gonadotropin stimulation phase--a function of improved embryo quality. J Assist Reprod Genet 2001; 18: 197-204.## ##

Fatty acid composition in normozoospermic, asthenozoopermic, asthenoteratozoospermic and oligoasthenoteratozoospermic ejaculates 2 2 Background: The lipids of the spermatozoa membrane are important for the fluidity and flexibility of spermatozoa. However, spermatozoa’s lipids are the main substrates for peroxidation, which may provoke severe functional disorder of sperm. Objective: The aim of this study was to investigate the fatty acids composition of spermatozoa in men with asthenozoospermia, asthenoteratozoospermia and oligoasthenoteratozoospermia compared with normozoospermic males. Materials and Methods: A cross-sectional study was designed. The patients were 51 men with seminal parameters abnormalities undergoing infertility screening. The patients were grouped into asthenozoospermic (n=15), asthenoteratozoospermic (n=21) and oligoasthenoteratozoospermic (n=15). The patients were compared with 21 males with normozoospermia. Sperm fatty acid analysis was performed using capillary gas chromatography. Results: Levels of stearic acid and oleic acid were significantly higher in oligoasthenoteratozoospermic subjects compared with these levels in normozoospermic males. Levels of arachidonic acid and DHA were significantly lower in the sperms of oligoasthenoteratozoospermic males than normozoospermic men. Sperm motility and morphology were correlated positively with levels of arachidonic acid and DHA while a negative correlation was observed with levels of stearic acid and oleic acid. Conclusion: In conclusion, impaired sperm function can originate from the disorder of sperm lipid metabolism. Low levels of DHA and arachidonic acid in spermatozoa of oligoasthenoteratozoospermic subjects may be the result of breakdown of them. 39 0 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/52017/10/52017/10/52017/10/52017/10/5 1396/7/13 Ali Khosrowbeygi Ali Khosrowbeygi School of Medicine, Lorestan University of Medical Sciences, Khoramabad, Lorestan, Iran Nosratollah Zargham Nosratollah Zargham Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran zarghami@tbzmed.ac.ir Laya Farzadi Laya Farzadi Department of Obstetrics and Gynecology, Tabriz University of Medical Sciences, Tabriz, Iran Sperm Fatty acid Asthenozoospermia Asthenoteratozoospermia Oligoasthenoteratozoospermia. Zalata AA, Christophe AB, Depuydt CE, Schoonjans F, Comhaire FH. The fatty acid composition of phospholipids of spermatozoa from infertile patients. Mol Hum Reprod 1998; 4: 111-118.##Ollero M, Powers RD, Alvarez JG. Variation of docosahexaenoic acid content in subsets of human spermatozoa at different stages of maturation: implications for sperm lipoperoxidative damage. Mol Reprod Dev 2000; 55: 326-334.##https://doi.org/10.1002/(SICI)1098-2795(200003)55:33.0.CO;2-A##Gil-Guzman E, Ollero M, Lopez MC, Sharma RK, Alvarez JG, Thomas Jr AJ , et al. Differential production of reactive oxygen species by subsets of human spermatozoa at different stages of maturation. Hum Reprod 2001; 16: 1922-1930.##Zarghami N, Khosrowbeygi A. Evaluation of lipid peroxidation as an indirect measure of oxidative stress in seminal plasma. Iranian J Reprod Med 2004; 2: 34-39.##Khosrowbeygi A, Zarghami N, Deldar Y. Correlation between sperm quality parameters and seminal plasma antioxidants status. Iranian J Reprod Med 2004; 2: 58-64.##Agarwal A, Prabakaran S. Oxidative stress and antioxidants in male infertility: a difficult balance. Iranian J Reprod Med 2005; 3: 1-8.##Khosrowbeygi A, Zarghami N. Levels of oxidative stress biomarkers in seminal plasma and their relationship with seminal parameters. BMC Clin Pathol 2007; 7: 6.##Conquer JA, Martin JB, Tummon I, Watson L, Tekpetey F. Fatty acid analysis of blood serum, seminal plasma, and spermatozoa of normozoospermic vs. asthenozoospermic males. Lipids 1999; 34: 793-799.##Gulaya NM, Margitich VM, Govseeva NM, Klimashevsky VM, Gorpynchenko II, Boyko MI. Phospholipid composition of human sperm and seminal plasma in relation to sperm fertility. Arch Androl 2001; 46: 169-175.##Calamera J, Buffone M, Ollero M, Alvarez J, Doncel GF. Superoxide dismutase content and fatty acid composition in subsets of human spermatozoa from normozoospermic, asthenozoospermic, and polyzoospermic semen samples. Mol Reprod Dev 2003; 66: 422-430.##Aksoy Y, Aksoy H, Altinkaynak K, Aydin HR, Ozkan A. Sperm fatty acid composition in subfertile men. Prostaglandins, Leukotrienes and Essential Fatty Acids 2006; 75: 75-79.##Tavilani H, Doosti M, Abdi K, Vaisiraygani A, Joshaghani H. Decreased polyunsaturated and increased saturated fatty acid concentration in spermatozoa from asthenozoospermic males as compared with normozoospermic males. Andrologia 2006; 38: 173-178.##Shibahara H, Suzuki T, Obara H, Hirano Y, Onagawa T, Taneichi A, et al. Accuracy of the normal sperm morphology value by Sperm Quality Analyzer IIC: comparison with the strict criteria. Int J Androl 2002; 25: 45-48.##Suzuki T, Shibahara H, Tsunoda H, Hirano Y, Taneichi A, Obara H, et al. Comparison of the Sperm Quality Analyzer IIC variables with the computer-aided sperm analysis estimates. Int J Androl 2002; 25: 49-54.##Zalata AA, Christophe AB, Depuydt CE, Schoonjans F, Comhaire FH. The fatty acid composition of phospholipids of spermatozoa from infertile patients. Mol Hum Reprod 1998; 4: 111-118.##Ollero M, Powers RD, Alvarez JG. Variation of docosahexaenoic acid content in subsets of human spermatozoa at different stages of maturation: implications for sperm lipoperoxidative damage. Mol Reprod Dev 2000; 55: 326-334.##https://doi.org/10.1002/(SICI)1098-2795(200003)55:33.0.CO;2-A##Gil-Guzman E, Ollero M, Lopez MC, Sharma RK, Alvarez JG, Thomas Jr AJ , et al. Differential production of reactive oxygen species by subsets of human spermatozoa at different stages of maturation. Hum Reprod 2001; 16: 1922-1930.##Zarghami N, Khosrowbeygi A. Evaluation of lipid peroxidation as an indirect measure of oxidative stress in seminal plasma. Iranian J Reprod Med 2004; 2: 34-39.##Khosrowbeygi A, Zarghami N, Deldar Y. Correlation between sperm quality parameters and seminal plasma antioxidants status. Iranian J Reprod Med 2004; 2: 58-64.##Agarwal A, Prabakaran S. Oxidative stress and antioxidants in male infertility: a difficult balance. Iranian J Reprod Med 2005; 3: 1-8.##Khosrowbeygi A, Zarghami N. Levels of oxidative stress biomarkers in seminal plasma and their relationship with seminal parameters. BMC Clin Pathol 2007; 7: 6.##Conquer JA, Martin JB, Tummon I, Watson L, Tekpetey F. Fatty acid analysis of blood serum, seminal plasma, and spermatozoa of normozoospermic vs. asthenozoospermic males. Lipids 1999; 34: 793-799.##Gulaya NM, Margitich VM, Govseeva NM, Klimashevsky VM, Gorpynchenko II, Boyko MI. Phospholipid composition of human sperm and seminal plasma in relation to sperm fertility. Arch Androl 2001; 46: 169-175.##Calamera J, Buffone M, Ollero M, Alvarez J, Doncel GF. Superoxide dismutase content and fatty acid composition in subsets of human spermatozoa from normozoospermic, asthenozoospermic, and polyzoospermic semen samples. Mol Reprod Dev 2003; 66: 422-430.##Aksoy Y, Aksoy H, Altinkaynak K, Aydin HR, Ozkan A. Sperm fatty acid composition in subfertile men. Prostaglandins, Leukotrienes and Essential Fatty Acids 2006; 75: 75-79.##Tavilani H, Doosti M, Abdi K, Vaisiraygani A, Joshaghani H. Decreased polyunsaturated and increased saturated fatty acid concentration in spermatozoa from asthenozoospermic males as compared with normozoospermic males. Andrologia 2006; 38: 173-178.##Shibahara H, Suzuki T, Obara H, Hirano Y, Onagawa T, Taneichi A, et al. Accuracy of the normal sperm morphology value by Sperm Quality Analyzer IIC: comparison with the strict criteria. Int J Androl 2002; 25: 45-48.##Suzuki T, Shibahara H, Tsunoda H, Hirano Y, Taneichi A, Obara H, et al. Comparison of the Sperm Quality Analyzer IIC variables with the computer-aided sperm analysis estimates. Int J Androl 2002; 25: 49-54.## ##

Tubal patency after ultrasound guided local injection of KCL to tubal ectopic pregnancy with alive fetus 2 2 Background: Ectopic pregnancy is one of the pathologic entities that it destroys the fallopian tube and impairs the future pregnancy. There are different medical and surgical therapies in order the treatment and reserve of fertility. The aim of this report is discuss a case of successful intrauterine after management of ectopic pregnancy with local injection of KCL in an infertile PCOD patient. Case: The patient was a PCOD woman with gestational age of 8.5 weeks. One gestational sac and alive fetus with normal heart beat was seen in the right adnexa. Hemodynamic situation was stable. 0.5cc KCL 10% was injected to the fetal heart and the extracted tissue sent for pathology. We evaluated the effects of this treatment by measuring serial human chorionic gonadotropin (hCG) titers. Moreover, we used hysterosalpingogrphy to diagnose and to evaluate the patency of the tubes. Induction ovulation and intrauterine insemination was done and pregnancy occurred. Patient passed the pregnancy very good and she delivered by cesarean section due to breech presentation at 39 weeks of gestational age. There was no sign of pathologic finding in the tubes or adhesion or sequel of ectopic pregnancy. Conclusion: The beneficial outcomes of this kind of treatment suggest that local injection of KCL as a low invasive treatment can be the choice treatment for alive and progressed ectopic pregnancy or heterotopic pregnancy. Because of rarity of this management and successful intrauterine we reported the usefulness of local KCL injection for the successful conservative treatment of alive ectopic pregnancy in Iran. 45 0 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/52017/10/52017/10/52017/10/52017/10/52017/10/5 1396/7/13 Robabeh Taheripanah Robabeh Taheripanah Obstetrics and Gynecology Dept, IRHRC Center, Shahid Beheshti University, Tehran, Iran Taheripanahf@yahoo.com Maryam sadat Hosseini Maryam sadat Hosseini Obstetrics and Gynecology Dept, Imam Hossein Hospital, Shahid Beheshti university (M.C),Tehran, Iran Mohamad Hashemi Mohamad Hashemi Pathology Department, Shahid Beheshti University (M.C), Tehran, Iran Ectopic pregnancy KCL injection Tubal patency Abusheikba N, Salha O, Brinssden P. Extrauterine pregnancy following assisted conception treatment. Hum Reprod Update 2000; 5: 80-82.##Ludwig M, Kaisi M, Bauer O, Diedrich K. Heterotopic pregnancy in a spontaneous cycle: do not forget about it. Eur J Obstet Gynecol Reprod Biol 199l; 87: 91-93.##Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarean section scar. Fertil Steril 1997; 67: 398-400.##Nawroth F, Foth D, Wilhelm L, Schmidt T, Warm M, Romer T.Conservative treatment of ectopic pregnancy in a caesarean section scar with methotrexate: a case report. Eur J Obstet Gynecol Reprod Biol 2001; 99:135-137.##Mukul LV, Teal SB. Current Management of Ectopic Pregnancy. Obstet Gynecol Clin N Am 2007; 4: 403-419.##Stovall TG, Ling FW, Gray LA, Carson SA, Buster JE. Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Obstet Gynecol 1991; 77: 749-753.##Fernandez H, Benifla JL, Lelaidier C, Baton C, Frydman R. Methotrexate treatment of ectopic pregnancy: 100 cases treated by primary transvaginal injection under sonographic control. Fertil Steril 1993; 59: 773-777.##Sperrof L, Fritz MA. Clinical Gynecologic endocrinology and infertility. 7th edition. Lippincott. 2005: 1275-1300##Roberts H, Kohlenber C, Lanzarone V, Murray H. Ectopic pregnancy in lower segment uterine scar. Aust NZ J Obstet Gynecol 1998; 38: 114-116.##Monteagudo A, Tarricone NJ, Timor-Tritsch IE, Lerner JP. Successful transvaginal ultrasound-guided puncture and injection of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy and a history of a previous cervical pregnancy. Ultrasound Obstet. Gynecol 1996; 8: 381-386.##Benifla JL, Fernandez H, Sebban E, Darai E, Frydman R, Madelenat P. Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. Eur J Obstet Gynecol Reprod Biol 1996; 70: 151-156.##Rotterdam. The Netherlands.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.Fertil Steril 2004; 81:19-25.##World Health Organiztion, Laboratory, manual for examination of human sperm and Sperm-mucus interaction. 4th edition. Cambridge University press 1999.##Jeng CJ, Ko ML, Shen J. Transvaginal ultrasound-guided treatment of cervical pregnancy. Obstet Gynecol 2007; 109:1076-1082.##Salomon LJ, Fernandez H, Chauveaud A, Doumerc S, Frydman R .Successful management of a heterotopic Caesarean scar pregnancy: potassium chloride injection with preservation of the intrauterine gestation: case report. Hum Reprod 2003; 18:189-191.##Papiernik E, Grangé G, Zeitlin J. Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies? J Perinat Med 1998; 26:365-370.##.Ozgur K, Isikoglu M. Cornual heterotopic pregnancy: conservative treatment with transvaginal embryo reduction. Arch Gynecol Obstet 2005; 271(1):73-75.##Verma U, Jacques E.Conservative management of live tubal pregnancies by ultrasound guided potassium chloride injection and systemic methotrexate treatment. J Clin Ultrasound 2005; 33: 460-463.##Takashima M, Yamasaki M, Fujita I, Ohashi M, Matsuo H, Mochizuki M, et al. Enhanced magnetic resonance imaging in monitoring of conservative treatment of cervical pregnancy. J Obstet Gynaecol 1995; 21: 545-550.##Monteagudo A, Minior VK, Stephenson C, Monda S, Timor-Tritsch IE. Non-surgical management of live ectopic pregnancy with ultrasound -guided local injection:a case series.Ultrasound Obstet Gynecol 2005; 25: 282-288.##Goldstein JS, Ratts VS, Philpott T, Dahan MH. Risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy. Obstet Gynecol 2006; 107:506-508.##Raughley MJ, Frishman GN. Local treatment of ectopic pregnancy. Semin Reprod Med 2007; 25:99-115.##Gyamfi C, Cohen S, Stone JL. Maternal complication of cervical heterotopic pregnancy after successful potassium chloride fetal reduction. Fertil Steril 2004; 82:940-943.##Ujvari E, Krizsa F, Sebestyen A, Varbiro S, Paulin F. Successful management of intrauterine twin and concomitant cervical pregnancy: a case report. Fetal Diagn Ther 2006; 21:181-184.##Frates MC,Benson cb, Doubilet PM. Cervical ectopic pregnancy :results of conservative treatment. Radiology 1994; 191:773.##Benifla JL, Fernandez H, Sebban E, Darai E, Frydman R, Madelenat P. Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. Eur J Obstet Gynecol Reprod Biol 1996: 27; 70:151-156.##Ghazeeri GS, Phillips OP, Emerson DS, Kutteh WH, Ke RW. Live birth after treatment of a heterotopic cornual pregnancy with fetal intrathoracic KCI. A case report. J Reprod Med 2002; 47:1038-1040.##Abusheikba N, Salha O, Brinssden P. Extrauterine pregnancy following assisted conception treatment. Hum Reprod Update 2000; 5: 80-82.##Ludwig M, Kaisi M, Bauer O, Diedrich K. Heterotopic pregnancy in a spontaneous cycle: do not forget about it. Eur J Obstet Gynecol Reprod Biol 199l; 87: 91-93.##Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarean section scar. Fertil Steril 1997; 67: 398-400.##Nawroth F, Foth D, Wilhelm L, Schmidt T, Warm M, Romer T.Conservative treatment of ectopic pregnancy in a caesarean section scar with methotrexate: a case report. Eur J Obstet Gynecol Reprod Biol 2001; 99:135-137.##Mukul LV, Teal SB. Current Management of Ectopic Pregnancy. Obstet Gynecol Clin N Am 2007; 4: 403-419.##Stovall TG, Ling FW, Gray LA, Carson SA, Buster JE. Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Obstet Gynecol 1991; 77: 749-753.##Fernandez H, Benifla JL, Lelaidier C, Baton C, Frydman R. Methotrexate treatment of ectopic pregnancy: 100 cases treated by primary transvaginal injection under sonographic control. Fertil Steril 1993; 59: 773-777.##Sperrof L, Fritz MA. Clinical Gynecologic endocrinology and infertility. 7th edition. Lippincott. 2005: 1275-1300##Roberts H, Kohlenber C, Lanzarone V, Murray H. Ectopic pregnancy in lower segment uterine scar. Aust NZ J Obstet Gynecol 1998; 38: 114-116.##Monteagudo A, Tarricone NJ, Timor-Tritsch IE, Lerner JP. Successful transvaginal ultrasound-guided puncture and injection of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy and a history of a previous cervical pregnancy. Ultrasound Obstet. Gynecol 1996; 8: 381-386.##Benifla JL, Fernandez H, Sebban E, Darai E, Frydman R, Madelenat P. Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. Eur J Obstet Gynecol Reprod Biol 1996; 70: 151-156.##Rotterdam. The Netherlands.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.Fertil Steril 2004; 81:19-25.##World Health Organiztion, Laboratory, manual for examination of human sperm and Sperm-mucus interaction. 4th edition. Cambridge University press 1999.##Jeng CJ, Ko ML, Shen J. Transvaginal ultrasound-guided treatment of cervical pregnancy. Obstet Gynecol 2007; 109:1076-1082.##Salomon LJ, Fernandez H, Chauveaud A, Doumerc S, Frydman R .Successful management of a heterotopic Caesarean scar pregnancy: potassium chloride injection with preservation of the intrauterine gestation: case report. Hum Reprod 2003; 18:189-191.##Papiernik E, Grangé G, Zeitlin J. Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies? J Perinat Med 1998; 26:365-370.##.Ozgur K, Isikoglu M. Cornual heterotopic pregnancy: conservative treatment with transvaginal embryo reduction. Arch Gynecol Obstet 2005; 271(1):73-75.##Verma U, Jacques E.Conservative management of live tubal pregnancies by ultrasound guided potassium chloride injection and systemic methotrexate treatment. J Clin Ultrasound 2005; 33: 460-463.##Takashima M, Yamasaki M, Fujita I, Ohashi M, Matsuo H, Mochizuki M, et al. Enhanced magnetic resonance imaging in monitoring of conservative treatment of cervical pregnancy. J Obstet Gynaecol 1995; 21: 545-550.##Monteagudo A, Minior VK, Stephenson C, Monda S, Timor-Tritsch IE. Non-surgical management of live ectopic pregnancy with ultrasound -guided local injection:a case series.Ultrasound Obstet Gynecol 2005; 25: 282-288.##Goldstein JS, Ratts VS, Philpott T, Dahan MH. Risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy. Obstet Gynecol 2006; 107:506-508.##Raughley MJ, Frishman GN. Local treatment of ectopic pregnancy. Semin Reprod Med 2007; 25:99-115.##Gyamfi C, Cohen S, Stone JL. Maternal complication of cervical heterotopic pregnancy after successful potassium chloride fetal reduction. Fertil Steril 2004; 82:940-943.##Ujvari E, Krizsa F, Sebestyen A, Varbiro S, Paulin F. Successful management of intrauterine twin and concomitant cervical pregnancy: a case report. Fetal Diagn Ther 2006; 21:181-184.##Frates MC,Benson cb, Doubilet PM. Cervical ectopic pregnancy :results of conservative treatment. Radiology 1994; 191:773.##Benifla JL, Fernandez H, Sebban E, Darai E, Frydman R, Madelenat P. Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. Eur J Obstet Gynecol Reprod Biol 1996: 27; 70:151-156.##Ghazeeri GS, Phillips OP, Emerson DS, Kutteh WH, Ke RW. Live birth after treatment of a heterotopic cornual pregnancy with fetal intrathoracic KCI. A case report. J Reprod Med 2002; 47:1038-1040.## ##