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Efficacy of intraovarian injection of autologous platelet-rich plasma on outcome of in vitro fertilization in women with poor ovarian response: A systematic review اثربخشی تزریق پلاسمای غنی از پلاکت به داخل تخمدان بر نتایج لقاح مصنوعی در بیماران با پاسخ تخمدانی ضعیف: یک مرور سیستماتیک 2 1 مقدمه: اثرات سودمند و بلندمدت پلاسما غنی از پلاکت تخمدانی (PRP) در چرخه‌های فناوری کمک‌باروری همچنان مورد بحث و اختلاف نظر است. هدف: هدف مطالعه حاضر تعیین تأثیر PRP تخمدانی بر پیامدهای لقاح آزمایشگاهی در زنان با پاسخ ضعیف تخمدانی است. مواد و روش­ ها: این مطالعه به‌صورت مرور نظام‌مند به منظور پاسخ به سؤال پژوهش از طریق فرآیند جستجوی ساخت‌یافته انجام شد. بانک‌های اطلاعاتی PubMed، ScienceDirect، Scopus، Web of Science، Embase، Cochrane و موتور جستجوی Google Scholar با استفاده از کلیدواژه‌هایی همچون "بارداری بالینی"، "تولد زنده"، "سقط جنین"، "پاسخ ضعیف تخمدان"، "پلاسما غنی از پلاکت" و "لقاح آزمایشگاهی" مورد جستجو قرار گرفتند. جستجو بدون محدودیت زمانی تا تاریخ ۲۰ دسامبر ۲۰۲۴ انجام شد. پس از غربالگری عنوان، چکیده و متن کامل ۶۶۴۶ مطالعه، در نهایت ۱۴ مطالعه برای ورود به مرور انتخاب شدند. نتایج: در 3 مطالعه، هیچ اثر قابل توجهی بر نرخ سقط جنین مشاهده نشد، اما در یک مطالعه هیچ موردی از سقط جنین در گروه مداخله گزارش نشد که این امر نگرانی‌هایی درباره نقش احتمالی این روش ایجاد کرده است. در 5 مطالعه، PRP به طور معناداری موجب افزایش موفقیت بارداری با لقاح آزمایشگاهی شد. در مقابل، 6 مطالعه این اثر را معنی­دار ندانستند و 2 مطالعه نتایج غیرقطعی گزارش کردند. در خصوص تولد زنده، 5 مطالعه تأثیر مثبت PRP را نشان دادند، در حالی که 3 مطالعه نتایج غیر معنی­دار و 2 مطالعه نتایج غیرقطعی گزارش کرده‌اند. یک مطالعه افزایش نرخ بارداری پایدار در گروه PRP را نشان داد و 2 مطالعه افزایش میزان لانه‌گزینی را گزارش کردند. نتیجه­ گیری: اثربخشی PRP تخمدانی در درمان ناباروری با توجه به نتایج متناقض مطالعات، همچنان مشخص نیست. 2 Background: The beneficial and long-term effects of ovarian platelet-rich plasma (PRP) in assisted reproductive technology cycles are still debatable. Objective: The aim of the current study is to determine the effect of ovarian PRP on the outcome of in vitro fertilization in women with poor ovarian response. Materials and Methods: This is a systematic review conducted to address the research question through a structured search process. We searched databases including PubMed, ScienceDirect, Scopus, Web of Science, Embase, Cochrane, and Google Scholar search engine using keywords such as "clinical pregnancy", "live birth", "miscarriage", "poor ovarian response", "platelet-rich plasma", and "in vitro fertilization". The search was conducted without a time limit until December 20, 2024. After screening the titles, abstracts, and full texts of 6646 studies, 14 studies were ultimately selected for inclusion in the review. Results: In 3 studies, no significant effect was observed on abortion rates, but in 1 study, no abortions were reported in the intervention group, raising concerns about the possible role of this procedure. In 5 studies, PRP significantly increased pregnancy success with in vitro fertilization. In contrast, 6 studies found this effect to be non-significant, and 2 reported inconclusive results. In terms of live birth, 5 studies showed a positive effect of PRP, but 3 studies reported non-significant results, and 2 studies reported inconclusive results. One study showed an increase in ongoing pregnancy rates in the PRP group, and 2 studies showed an increase in implantation. Conclusion: The effectiveness of ovarian PRP in infertility treatment remains unclear due to conflicting results. 459 474 2024/12/31 1403/10/11 2025/03/18 1403/12/28 Marzieh Zamaniyan Marzieh Zamaniyan Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Marziehzamaniyan@gmail.com Sepideh Peivandi Sepideh Peivandi Department of Obstetrics and Gynecology, IVF Ward, Faculty of Medicine, Sexual and Reproductive Health Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran. dr_peyvandi@yahoo.com Maryam Pashazadeh Maryam Pashazadeh Islamic Azad University, Ardabil Branch, Ardabil, Iran. M.pashazadeh98@gmail.com Farnaz Safarloo Farnaz Safarloo IVF ward, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran. safarloo203@gmail.com Ovarian platelet-rich plasma Poor ovarian response In vitro fertilization. پلاسما غنی از پلاکت تخمدانی پاسخ ضعیف تخمدانی لقاح آزمایشگاهی. 1. Peng E, Ai M, Tan X, Zhao X, Xu D. Efficacy of single and double platelet-rich plasma treatment for diminished ovarian reserve. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2025; 50: 45-51. ##2. Barrenetxea G, Celis R, Barrenetxea J, Martínez E, De Las Heras M, Gómez O, et al. Intraovarian platelet-rich plasma injection and IVF outcomes in patients with poor ovarian response: A double-blind randomized controlled trial. Hum Reprod 2024; 39: 760-769. ##3. Sa’diah YS, Dewanto A, Chandra L. Efficacy of intraovarian autologous platelet-rich plasma administration in women with low ovarian reserve: A systematic review and meta-analysis. Asian Pacific J Reprod 2024; 13: 60-67. ##4. Ansere VA, Ali-Mondal S, Sathiaseelan R, Garcia DN, Isola JVV, Henseb JD, et al. Cellular hallmarks of aging emerge in the ovary prior to primordial follicle depletion. Mech Ageing Dev 2021; 194: 111425. ##5. Tesarik J, Galán-Lázaro M, Mendoza-Tesarik R. Ovarian aging: Molecular mechanisms and medical management. Int J Mol Sci 2021; 22: 1371. ##6. Shahrokh Tehraninejad E, Razavi MS, Tarafdari Menshadi A, Shariat M, Shahsavari S, Haghollahi F, et al. How does platelet-rich plasma injection in ovaries of poor responders affect the retrieved oocytes, and anti mullerian hormone: A clinical trial. J Family Reprod Health 2023; 17: 165-173.##7. Herlihy NS, Cakiroglu Y, Whitehead Ch, Reig A, Tiras B, Scott RTJr, et al. Effect of intraovarian platelet-rich plasma injection on IVF outcomes in women with poor ovarian response: The PROVA randomized controlled trial. Hum Reprod 2024; 39: deae093. ##8. Adiga PK, Marconi N, Ravishankar N, Vitthala S. Effect of intra-ovarian injection of platelet-rich plasma on the patients with a poor ovarian response (POR) or premature ovarian insufficiency (POI): A systematic review and meta-analysis. Middle East Fertil Soc J 2024; 29: 24.##9. Éliás M, Kónya M, Kekk Z, Turan C, das Virgens IPA, Tóth R, et al. Platelet-rich plasma (PRP) treatment of the ovaries significantly improves fertility parameters and reproductive outcomes in diminished ovarian reserve patients: A systematic review and meta-analysis. J Ovarian Res 2024; 17: 104. ##10. Zamaniyan M, Peyvandi S, Heidaryan Gorji H, Moradi S, Jamal J, Yahya Poor Aghmashhadi F, et al. Effect of platelet-rich plasma on pregnancy outcomes in infertile women with recurrent implantation failure: A randomized controlled trial. Gynecol Endocrinol 2021; 37: 141-145. ##11. Pietrzak WS, Eppley BL. Platelet rich plasma: Biology and new technology. J Craniofac Surg 2005; 16: 1043-1054. ##12. Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: A review and author’s perspective. J Cutan Aesthet Surg 2014; 7: 189-197.##13. Sundman EA, Cole BJ, Karas V, Della Valle C, Tetreault MW, Mohammed HO, et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014; 42: 35-41.##14. Nikolidakis D, Jansen JA. The biology of platelet-rich plasma and its application in oral surgery: Literature review. Tissue Eng Part B Rev 2008; 14: 249-258. ##15. Choi BH, Zhu SJ, Kim BY, Huh JY, Lee SH, Jung JH. Effect of platelet-rich plasma (PRP) concentration on the viability and proliferation of alveolar bone cells: An in vitro study. Int J Oral Maxillofac Surg 2005; 34: 420-424. ##16. Hosseini L, Shirazi A, Naderi MM, Shams-Esfandabadi N, Borjian Boroujeni S, Sarvari A, et al. Platelet-rich plasma promotes the development of isolated human primordial and primary follicles to the preantral stage. Reprod Biomed Online 2017; 35: 343-350. ##17. Vahabi Dastjerdi M, Sheibani S, Taheri M, Hezarcheshmeh FK, Jahangirian J, Jazayeri M, et al. Efficacy of intra-ovarian injection of autologous platelet-rich plasma in women with poor responders: A systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309: 2323-2338. ##18. Maged AM, Mohsen RA, Salah N, Ragab WS. The value of intraovarian autologous platelet rich plasma in women with poor ovarian reserve or ovarian insufficiency: A systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24: 85. ##19. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ 2015; 349: g7647.##20. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13: 141-146.##21. Garavelas A, Mallis P, Michalopoulos E, Nikitos E. Clinical benefit of autologous platelet-rich plasma infusion in ovarian function rejuvenation: Evidence from a before-after prospective pilot study. Medicines 2023; 10: 19. ##22. Tickoo S, Reddy AP, Agarwal R, Sirohia M, Agarwal S. Role on intraovarian platelet-rich plasma in the poor ovarian responder. J South Asian Federat Obstet Gynaecol 2023; 15: 601-604.‌##23. Barad DH, Albertini DF, Molinari E, Gleicher N. Preliminary report of intraovarian injections of autologous platelet-rich plasma (PRP) in extremely poor prognosis patients with only oocyte donation as alternative: A prospective cohort study. Hum Reprod Open 2022; 3: hoac027.##24. Cakiroglu Y, Yuceturk A, Karaosmanoglu O, Kopuk SY, Korun ZEU, Herlihy N, et al. Ovarian reserve parameters and IVF outcomes in 510 women with poor ovarian response (POR) treated with intraovarian injection of autologous platelet rich plasma (PRP). Aging 2022; 14: 2513-2523.##25. Tülek F, Kahraman A. The effects of intra-ovarian autologous platelet rich plasma injection on IVF outcomes of poor responder women and women with premature ovarian insufficiency. J Turk Ger Gynecol Assoc 2022; 23: 14-21. ##26. Pacu I, Zygouropoulos N, Dimitriu M, Rosu G, Ionescu CA. Use of platelet-rich plasma in the treatment of infertility in poor responders in assisted human reproduction procedures. Exp Ther Med 2021; 22: 1412.##27. Cakiroglu Y, Saltik A, Yuceturk A, Karaosmanoglu O, Kopuk SY, Scott RT, et al. Effects of intraovarian injection of autologous platelet rich plasma on ovarian reserve and IVF outcome parameters in women with primary ovarian insufficiency. Aging 2020; 12: 10211-10222.##28. Petryk N, Petryk M. Ovarian rejuvenation through platelet-rich autologous plasma (PRP)-a chance to have a baby without donor eggs, improving the life quality of women suffering from early menopause without synthetic hormonal treatment. Reprod Sci 2020; 27: 1975-1982.##29. Najafian A, Alyasin A, Aghahosseini M, Hosseinimousa S, Kazemi SN. Beneficial effects of intraovarian injection of platelet-rich plasma in women with poor ovarian response. Clin Exp Reprod Med 2023; 50: 285-291.##30. Davari Tanha F, Salimi Setudeh S, Ebrahimi M, Feizabad E, Khalaj Sereshki Z, Akbari Asbagh F, et al. Effect of intra-ovarian platelet rich plasma in women with poor ovarian response. Caspian J Intern Med 2023; 14: 485-489.##31. Aflatoonian A, Lotfi M, Saeed L, Tabibnejad N. Effects of intraovarian injection of autologous platelet-rich plasma on ovarian rejuvenation in poor responders and women with primary ovarian insufficiency. Reprod Sci 2021; 28: 2050-2059.##32. Melo P, Navarro C, Jones C, Coward K, Coleman L. The use of autologous platelet-rich plasma (PRP) versus no intervention in women with low ovarian reserve undergoing fertility treatment: A non-randomized interventional study. J Assist Reprod Genet 2020; 37: 855-863.##33. Stojkovska S, Dimitrov G, Stamenkovska N, Hadzi-Lega M, Petanovski Z. Live birth rates in poor responders' group after previous treatment with autologous platelet-rich plasma and low dose ovarian stimulation compared with poor responders used only low dose ovarian stimulation before in vitro fertilization. Open Access Maced J Med Sci 2019; 7: 3184-3188.##Peng E, Ai M, Tan X, Zhao X, Xu D. Efficacy of single and double platelet-rich plasma treatment for diminished ovarian reserve. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2025; 50: 45-51.##Barrenetxea G, Celis R, Barrenetxea J, Martínez E, De Las Heras M, Gómez O, et al. Intraovarian platelet-rich plasma injection and IVF outcomes in patients with poor ovarian response: A double-blind randomized controlled trial. Hum Reprod 2024; 39: 760-769.##Sa'diah YS, Dewanto A, Chandra L. Efficacy of intraovarian autologous platelet-rich plasma administration in women with low ovarian reserve: A systematic review and meta-analysis. Asian Pacific J Reprod 2024; 13: 60-67.##Ansere VA, Ali-Mondal S, Sathiaseelan R, Garcia DN, Isola JVV, Henseb JD, et al. Cellular hallmarks of aging emerge in the ovary prior to primordial follicle depletion. Mech Ageing Dev 2021; 194: 111425.##Tesarik J, Galán-Lázaro M, Mendoza-Tesarik R. Ovarian aging: Molecular mechanisms and medical management. Int J Mol Sci 2021; 22: 1371.##Shahrokh Tehraninejad E, Razavi MS, Tarafdari Menshadi A, Shariat M, Shahsavari S, Haghollahi F, et al. How does platelet-rich plasma injection in ovaries of poor responders affect the retrieved oocytes, and anti mullerian hormone: A clinical trial. J Family Reprod Health 2023; 17: 165-173.##Herlihy NS, Cakiroglu Y, Whitehead Ch, Reig A, Tiras B, Scott RTJr, et al. Effect of intraovarian platelet-rich plasma injection on IVF outcomes in women with poor ovarian response: The PROVA randomized controlled trial. Hum Reprod 2024; 39: deae093.##Adiga PK, Marconi N, Ravishankar N, Vitthala S. Effect of intra-ovarian injection of platelet-rich plasma on the patients with a poor ovarian response (POR) or premature ovarian insufficiency (POI): A systematic review and meta-analysis. Middle East Fertil Soc J 2024; 29: 24.##Éliás M, Kónya M, Kekk Z, Turan C, das Virgens IPA, Tóth R, et al. Platelet-rich plasma (PRP) treatment of the ovaries significantly improves fertility parameters and reproductive outcomes in diminished ovarian reserve patients: A systematic review and meta-analysis. J Ovarian Res 2024; 17: 104.##Zamaniyan M, Peyvandi S, Heidaryan Gorji H, Moradi S, Jamal J, Yahya Poor Aghmashhadi F, et al. Effect of platelet-rich plasma on pregnancy outcomes in infertile women with recurrent implantation failure: A randomized controlled trial. Gynecol Endocrinol 2021; 37: 141-145.##Pietrzak WS, Eppley BL. Platelet rich plasma: Biology and new technology. J Craniofac Surg 2005; 16: 1043-1054.##Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: A review and author's perspective. J Cutan Aesthet Surg 2014; 7: 189-197.##Sundman EA, Cole BJ, Karas V, Della Valle C, Tetreault MW, Mohammed HO, et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014; 42: 35-41.##Nikolidakis D, Jansen JA. The biology of platelet-rich plasma and its application in oral surgery: Literature review. Tissue Eng Part B Rev 2008; 14: 249-258.##Choi BH, Zhu SJ, Kim BY, Huh JY, Lee SH, Jung JH. Effect of platelet-rich plasma (PRP) concentration on the viability and proliferation of alveolar bone cells: An in vitro study. Int J Oral Maxillofac Surg 2005; 34: 420-424.##Hosseini L, Shirazi A, Naderi MM, Shams-Esfandabadi N, Borjian Boroujeni S, Sarvari A, et al. Platelet-rich plasma promotes the development of isolated human primordial and primary follicles to the preantral stage. Reprod Biomed Online 2017; 35: 343-350.##Vahabi Dastjerdi M, Sheibani S, Taheri M, Hezarcheshmeh FK, Jahangirian J, Jazayeri M, et al. Efficacy of intra-ovarian injection of autologous platelet-rich plasma in women with poor responders: A systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309: 2323-2338.##Maged AM, Mohsen RA, Salah N, Ragab WS. The value of intraovarian autologous platelet rich plasma in women with poor ovarian reserve or ovarian insufficiency: A systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24: 85.##Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ 2015; 349: g7647.##Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13: 141-146.##Garavelas A, Mallis P, Michalopoulos E, Nikitos E. Clinical benefit of autologous platelet-rich plasma infusion in ovarian function rejuvenation: Evidence from a before-after prospective pilot study. Medicines 2023; 10: 19.##Tickoo S, Reddy AP, Agarwal R, Sirohia M, Agarwal S. Role on intraovarian platelet-rich plasma in the poor ovarian responder. J South Asian Federat Obstet Gynaecol 2023; 15: 601-604.‏##Barad DH, Albertini DF, Molinari E, Gleicher N. Preliminary report of intraovarian injections of autologous platelet-rich plasma (PRP) in extremely poor prognosis patients with only oocyte donation as alternative: A prospective cohort study. Hum Reprod Open 2022; 3: hoac027.##Cakiroglu Y, Yuceturk A, Karaosmanoglu O, Kopuk SY, Korun ZEU, Herlihy N, et al. Ovarian reserve parameters and IVF outcomes in 510 women with poor ovarian response (POR) treated with intraovarian injection of autologous platelet rich plasma (PRP). Aging 2022; 14: 2513-2523.##Tülek F, Kahraman A. The effects of intra-ovarian autologous platelet rich plasma injection on IVF outcomes of poor responder women and women with premature ovarian insufficiency. J Turk Ger Gynecol Assoc 2022; 23: 14-21.##Pacu I, Zygouropoulos N, Dimitriu M, Rosu G, Ionescu CA. Use of platelet-rich plasma in the treatment of infertility in poor responders in assisted human reproduction procedures. Exp Ther Med 2021; 22: 1412.##Cakiroglu Y, Saltik A, Yuceturk A, Karaosmanoglu O, Kopuk SY, Scott RT, et al. Effects of intraovarian injection of autologous platelet rich plasma on ovarian reserve and IVF outcome parameters in women with primary ovarian insufficiency. Aging 2020; 12: 10211-10222.##Petryk N, Petryk M. Ovarian rejuvenation through platelet-rich autologous plasma (PRP)-a chance to have a baby without donor eggs, improving the life quality of women suffering from early menopause without synthetic hormonal treatment. Reprod Sci 2020; 27: 1975-1982.##Najafian A, Alyasin A, Aghahosseini M, Hosseinimousa S, Kazemi SN. Beneficial effects of intraovarian injection of platelet-rich plasma in women with poor ovarian response. Clin Exp Reprod Med 2023; 50: 285-291.##Davari Tanha F, Salimi Setudeh S, Ebrahimi M, Feizabad E, Khalaj Sereshki Z, Akbari Asbagh F, et al. Effect of intra-ovarian platelet rich plasma in women with poor ovarian response. Caspian J Intern Med 2023; 14: 485-489.##Aflatoonian A, Lotfi M, Saeed L, Tabibnejad N. Effects of intraovarian injection of autologous platelet-rich plasma on ovarian rejuvenation in poor responders and women with primary ovarian insufficiency. Reprod Sci 2021; 28: 2050-2059.##Melo P, Navarro C, Jones C, Coward K, Coleman L. The use of autologous platelet-rich plasma (PRP) versus no intervention in women with low ovarian reserve undergoing fertility treatment: A non-randomized interventional study. J Assist Reprod Genet 2020; 37: 855-863.##Stojkovska S, Dimitrov G, Stamenkovska N, Hadzi-Lega M, Petanovski Z. Live birth rates in poor responders' group after previous treatment with autologous platelet-rich plasma and low dose ovarian stimulation compared with poor responders used only low dose ovarian stimulation before in vitro fertilization. Open Access Maced J Med Sci 2019; 7: 3184-3188.## ##

Influence of assisted hatching on pregnancy outcomes in women with poor ovarian response: An RCT تأثیر هچینگ کمکی بر نتایج بارداری در زنان با پاسخ ضعیف تخمدانی: یک کارآزمایی بالینی 2 1 مقدمه: پیشرفت‌های فناوری کمک‌باروری منجر به بهبود نتایج از طریق نوآوری‌های مختلف شده است. برای لانه‌گزینی، جنین باید از لایه بیرونی بدون سلول و مبتنی بر گلیکوپروتئین خود به نام زونا پلوسیدا خارج شود. هچینگ کمکی روشی است که برای افزایش لانه‌گزینی جنین پیشنهاد شده است. هدف: این مطالعه با هدف ارزیابی اثربخشی هچینگ کمکی در بهبود نتایج بارداری در زنان با پاسخ ضعیف تخمدانی تحت درمان لقاح آزمایشگاهی/تزریق اسپرم به داخل سیتوپلاسم انجام شد. مواد و روش­ ها: این کارآزمایی تصادفی کنترل‌شده بر روی ۱۷۰ زن با پاسخ ضعیف تخمدانی (گروه‌های ۳ و ۴ POSEIDON) که از دسامبر ۲۰۲۳ تا ژوئن ۲۰۲۴ تحت درمان IVF/ICSI در پژوهشکده علوم تولید­مثل یزد قرار گرفتند، انجام شد. شرکت‌کنندگان به طور تصادفی به دو گروه هچینگ و کنترل تقسیم شدند. نرخ بارداری شیمیایی، بارداری بالینی، بارداری مداوم و سقط بین دو گروه مقایسه شد. نتایج: تفاوت معناداری بین گروه هچینگ و گروه کنترل از نظر بارداری شیمیایی(۴/24% در مقابل 3/17%، 271/0 p =)، بارداری بالینی (1/23% در مقابل 8/%14، 183/0 p =)، بارداری مداوم (7/16% در مقابل 1/11%، 310/0 p =) و نرخ سقط (8/27% در مقابل 0/25%، 866/0 p =) مشاهده نشد. با این حال، در زیرگروه انتقال جنین فریز شده، گروه هچینگ نرخ بارداری بالینی و بارداری مداوم بالاتری نسبت به گروه کنترل داشت. نتیجه­ گیری: اگرچه هچینگ کمکی به طور کلی منجر به بهبود نتایج بارداری در زنان با پاسخ ضعیف تخمدانی نشد، اما ممکن است شانس بارداری بالینی و بارداری مداوم را در سیکل‌های انتقال جنین فریز شده افزایش دهد. 2 Background: Advances in assisted reproductive technology have led to improved outcomes through various innovations. The embryo must hatch from its acellular glycoprotein-based outer layer, the zona pellucida, before it can be implanted. Assisted hatching (AH) is a technique proposed to enhance embryo implantation. Objective: This study aimed to evaluate the efficacy of AH in improving pregnancy outcomes among women with poor ovarian response (POR) undergoing in vitro fertilization/intracytoplasmic sperm injection. Materials and Methods: A randomized controlled trial was conducted involving 170 women with POR (POSEIDON groups 3 and 4) undergoing in vitro fertilization/intracytoplasmic sperm injection at the Yazd Reproductive Sciences Institute, Yazd, Iran from December 2023-June 2024. Participants were randomly assigned to either the hatching group or the control group. Clinical pregnancy, chemical pregnancy, ongoing pregnancy, and miscarriage rates were compared between the 2 groups. Results: No significant difference was observed between the hatching and control group in terms of chemical pregnancy (24.4% vs. 17.3%. p = 0.271), clinical pregnancy (23.1% vs. 14.8%, p = 0.183), ongoing pregnancy (16.7% vs. 11.1%, p = 0.310), and miscarriage rates (27.8% vs. 25.0%, p = 0.866). However, a significant difference was observed in the frozen embryo transfer subgroup, with the hatching group demonstrating significantly higher rates of ongoing and clinical pregnancies compared to the control group. Conclusion: While AH did not demonstrate overall benefits in improving pregnancy outcomes in women with POR, it may enhance the chances of ongoing and clinical pregnancy in frozen embryo transfer cycles. 475 484 2024/12/312024/11/20 1403/8/30 2025/03/182025/07/9 1404/4/18 Razieh Dehghani Firouzabadi Razieh Dehghani Firouzabadi Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. dr_firouzabadi@ssu.ac.ir Nahid Homayoon Nahid Homayoon Department of Gynecology and Infertility, Shiraz Fertility Center, Shiraz, Iran. nahid.homayoon@hotmail.com Sahereh Arabian Sahereh Arabian Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran. sahereh_arabian@yahoo.com; s.arabian@semums.ac.ir Fatemeh Dehghanpour Fatemeh Dehghanpour Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. dehghanpour64@yahoo.com Esmat Mangoli Esmat Mangoli Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. es.mangoli@gmail.com Hamide Barzegar Hamide Barzegar Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. hamide.barzegar@gmail.com Sajad Zare Garizi Sajad Zare Garizi Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. SajadZare828@gmail.com Assisted reproductive technologies Frozen embryo transfer Laser-assisted hatching. فناوری‌های کمک‌باروری انتقال جنین فریز شده هچینگ کمکی با لیزر. 1. Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem 2018; 62: 2-10.##2. Sunderam S, Kissin DM, Zhang Y, Jewett A, Boulet SL, Warner L, et al. Assisted reproductive technology surveillance - United States, 2017. MMWR Surveill Summ 2020; 69: 1-20.##3. Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2016; 5: Cd002118.##4. Practice Committee of the American Society for Reproductive Medicine. The role of assisted hatching in in vitro fertilization: A guideline. Fertil Steril 2022; 117: 1177-1182.##5. Sharma K, Gupta S, Yadav S, Singh D. Retrospective study showing improved pregnancy rates with laser assisted hatching on day 5 blastocysts in FET cycles in Indian population. Fertil Sci Res 2023; 10: 117-122.##6. Cohen J, Malter H, Fehilly C, Wright G, Elsner C, Kort H, et al. Implantation of embryos after partial opening of oocyte zona pellucida to facilitate sperm penetration. Lancet 1988; 332: 162.##7. Liu Y, Jones C, Coward K. The current practice of assisted hatching for embryos in fertility centres: A general survey. Reprod Sci 2022; 29: 2664-2673.##8. Ng C, Wais M, Nichols T, Garrow S, Hreinsson J, Luo ZC, et al. Assisted hatching of vitrified-warmed blastocysts prior to embryo transfer does not improve pregnancy outcomes. J Ovarian Res 2020; 13: 88.##9. Yalcin S, Özkan S, Shah T. Incubation temperature and lighting: Effect on embryonic development, post-hatch growth, and adaptive response. Front Physiol 2022; 13: 899977.##10. Curfs MH, Cohlen BJ, Slappendel EJ, Schoot DC, Derhaag JG, van Golde RJ, et al. A multicentre double-blinded randomized controlled trial on the efficacy of laser-assisted hatching in patients with repeated implantation failure undergoing IVF or ICSI. Hum Reprod 2023; 38: 1952-1960.##11. Shi W, Hongwei T, Zhang W, Li N, Li M, Li W, et al. A prospective randomized controlled study of laser-assisted hatching on the outcome of first fresh IVF-ET cycle in advanced age women. Reprod Sci 2016; 23: 1397-1401.##12. Kanyo K, Zeke J, Kriston R, Szücs Z, Cseh S, Somoskoi B, et al. The impact of laser-assisted hatching on the outcome of frozen human embryo transfer cycles. Zygote 2016; 24: 742-747.##13. Wei C, Xiang S, Liu D, Wang C, Liang X, Wu H, et al. Laser-assisted hatching improves pregnancy outcomes in frozen-thawed embryo transfer cycles of cleavage-stage embryos: A large retrospective cohort study with propensity score matching. J Assist Reprod Genet 2023; 40: 417-427.##14. Lacey L, Hassan S, Franik S, Seif MW, Akhtar MA. Assisted hatching on assisted conception (in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI)). Cochrane Database Syst Rev 2021; 3: CD001894.##15. Liu L, Cai B, Zhang X, Huang J, Zhou C. Euploid blastocyst rates in patients from POSEIDON groups 3 and 4 using propensity score matching. Reprod BioMed Online 2022; 45: 374-383.##16. Homayoon N, Arabian S, Mangoli E, Bayati F, Eftekhar M. Effect of sequential cleavage and blastocyst embryo transfer compared to single cleavage stage embryo transfer on assisted reproductive technology outcome: An RCT. Int J Reprod BioMed 2024; 22: 433-440.##17. Hill GA, Freeman M, Bastias MC, Rogers BJ, Herbert III CM, Osteen KG, et al. The influence of oocyte maturity and embryo quality on pregnancy rate in a program for in vitro fertilization-embryo transfer. Fertil Steril 1989; 52: 801-806.##18. Khalili M. New perspectives on technical aspects of micromanipulation (ICSI) in clinical assisted reproduction. Biomed J Sci Tech Res 2023; 52: 43331-43339.##19. Razi MH, Halvaei I, Razi Y. Laser assisted zona hatching does not improve live birth rate in patients undergoing their first ICSI cycles. Iran J Reprod Med 2013; 11: 1021-1026.##20. Dashti S, Eftekhar M. Luteal-phase support in assisted reproductive technology: An ongoing challenge. Int J Reprod BioMed 2021; 19: 761-772.##21. Dehghanpour F, Khalili MA, Mangoli E, Talebi AR, Anbari F, Shamsi F, et al. Free centrifuge sorting method for high‐count sperm preparation improves biological characteristics of human spermatozoa and clinical outcome: A sibling oocytes study. Andrologia 2022; 54: e14554.##22. Sciorio R, Greco PF, Adel M, Maresca L, Greco E, Fleming S. Exploring the benefit of different methods to perform assisted hatching in the ART laboratory: A narrative review. Reprod Biol 2024; 24: 100923.##23. Li D, Yang D-L, An J, Jiao J, Zhou Y-M, Wu Q-J, et al. Effect of assisted hatching on pregnancy outcomes: A systematic review and meta-analysis of randomized controlled trials. Sci Rep 2016; 6: 31228.##24. Zeng M, Su S, Li L. The effect of laser-assisted hatching on pregnancy outcomes of cryopreserved-thawed embryo transfer: A meta-analysis of randomized controlled trials. Lasers Med Sci 2018; 33: 655-666.##25. Wang Y, Chen C, Liang J, Fan L, Liu D, Zhang X, et al. A comparison of the clinical effects of thinning and drilling on laser-assisted hatching. Lasers Med Sci 2022; 37: 1-9.##26. Lu X, Liu Y, Cao X, Liu S-Y, Dong X. Laser-assisted hatching and clinical outcomes in frozen-thawed cleavage-embryo transfers of patients with previous repeated failure. Lasers Med Sci 2019; 34: 1137-1145.##27. Pan JP, Liang SS, Huang MY, Zhao M, Kong PC, Liu YP, et al. Obstetric and neonatal outcomes after frozen-thawed embryos transfer with laser-assisted hatching: A retrospective cohort study. Arch Gynecol Obstet 2022; 305: 529-534.##28. Dallagiovanna C, Vanni VS, Somigliana E, Busnelli A, Papaleo E, Villanacci R, et al. Risk factors for monozygotic twins in IVF-ICSI cycles: A case-control study. Reprod Sci 2021; 28: 1421-1427.##29. Liu C, Su K, Liu G, Shang W, Wang X, Li C, et al. The impact of assisted hatching on monozygotic twinning is related to female age and insemination method: A new perspective. Twin Res Hum Genet 2022; 25: 202-205.##30. Lundin K, Bentzen JG, Bozdag G, Ebner T, Harper J, Le Clef N, et al. Good practice recommendations on add-ons in reproductive medicine†. Hum Reprod 2023; 38: 2062-2104.##31. Xu W, Yu Y, Li S. Dual laser-assisted hatching: An effective technique to salvage low-grade cleavage-stage embryos and harvest day 7 blastocysts. Lasers Med Sci 2023; 38: 226.##32. Shats M, Fenchel D, Katz G, Haas J, Machtinger R, Gat I, et al. Obstetric, neonatal and child development outcomes following assisted hatching treatment: A retrospective cohort study. Gynecol Endocrinol 2021; 37: 41-45.##33. Jwa J, Jwa SC, Kuwahara A, Yoshida A, Saito H. Risk of major congenital anomalies after assisted hatching: Analysis of three-year data from the national assisted reproduction registry in Japan. Fertil Steril 2015; 104: 71-78.## ##

Impact of COVID-19 infection on placental histopathology and maternal-perinatal outcomes: A cross-sectional study اثرات عفونت کووید 19 بر هیستوپاتولوژی جفت، نتایج مادری و پره‌ناتال: یک مطالعه مقطعی 2 1 مقدمه: بیماری کروناویروس ۲۰۱۹ (کووید 19) طیف گسترده‌ای از عوارض بالینی را نشان می‌دهد و برخلاف سایر کروناویروس‌ها، خطرات قابل توجهی برای زنان باردار به همراه دارد. یکی از نگرانی‌های اصلی، احتمال انتقال عمودی ویروس از مادر به جنین است که هم برای مادر و هم برای جنین خطراتی ایجاد می‌کند.  هدف: این مطالعه به بررسی هیستوپاتولوژی جفت و پیامدهای مادری-نوزادی در مادران مبتلا به کووید 19 پرداخته است. مواد و روش ­ها: در این مطالعه مقطعی، ۴۰ زن باردار مراجعه‌کننده به بیمارستان گنجویان در دزفول، ایران، برای زایمان بین خرداد تا مهر ۱۴۰۰، در دو گروه مورد بررسی قرار گرفتند: گروه 1: 30 زن مبتلا به کووید 19 و گروه 2: 10 زن غیرمبتلا. نمونه‌های بافت جفت پس از زایمان جمع‌آوری شدند تا تغییرات هیستوپاتولوژیک و وزن جفت بررسی شوند. همچنین، پیامدهای مادری و نوزادی، شامل سن مادر، تعداد زایمان‌ها و بارداری‌های قبلی، سن حاملگی، نمرات آپگار در دقیقه ۱ و ۵، نیاز مادر به اکسیژن‌تراپی، روش زایمان و نتایج آزمایش کووید 19 نوزاد، بین دو گروه مقایسه شدند. نتایج: بین دو گروه از نظر سن مادر، سن حاملگی، تعداد زایمان، امتیاز آپگار، وزن جفت، اکسیژن‌درمانی و روش زایمان تفاوت معناداری مشاهده نشد. با این حال، گروه اول مبتلایان به (کووید 19) شیوع بالاتری از ناهنجاری‌های بافتی جفت از جمله ترومبوز جنینی داخل پرزها (002/0 = p)، رسوب فیبرین، نفوذ لنفوسیتی، کورانژیوز، ادم، خونریزی بین‌پرزی، تشکیل ندول‌های سن‌سیشیال، هیپوپلازی پرزهای دیستال، و پرزهای فاقد رگ را نشان دادند (001/0 > p). نتیجه­ گیری: بر اساس این مطالعه، بافت جفت زنان بارداری که در سه ‌ماهه سوم بارداری به کووید 19 مبتلا شده‌اند، تغییراتی را نشان می‌دهد که می‌تواند منجر به اختلال در تبادلات بین مادر و جنین شود. 2 Background: Coronavirus disease 2019 (COVID-19) presents a broad spectrum of clinical outcomes and, unlike other coronaviruses, poses significant risks during pregnancy. A primary concern is the potential for vertical transmission from mother to fetus, affecting both maternal and fetal health. Objective: This study aimed to investigate the placental histopathology and maternal-perinatal outcomes in mothers infected with COVID-19. Materials and Methods: In this cross-sectional study, 40 pregnant women referred to Ganjavian hospital, Dezful, Iran for delivery from June to October 2021 were enrolled in 2 groups: group I who were women with COVID-19 on the day of delivery (n = 30) and group II who were women without COVID-19 (n = 10). Placental tissue samples were collected post-delivery to assess histopathological changes and placental weight. Additionally, maternal and neonatal characteristics including maternal age, the number of prior deliveries and pregnancies, gestational age, 1- and 5-min Apgar scores, and maternal oxygen administration, mode of delivery, and neonatal COVID-19 test results, were compared between the groups. Results: No significant differences were found between the groups regarding maternal age, gestational age, parity, Apgar scores, placental weight, oxygen therapy, or delivery method. However, group I showed significantly higher rates of placental abnormalities such as intravillous fetal thrombosis (p = 0.002), fibrin deposition, lymphocytic infiltration, chorangiosis, edema, intervillous hemorrhage, syncytial node formation, distal villous hypoplasia, and avascular villi (p < 0.001). Conclusion: According to our study, the placental tissue of pregnant women who have been infected with COVID-19 during their third trimester indicates tissue changes that can lead to poor exchanges between mother and fetus. 485 492 2024/12/312024/11/202024/10/18 1403/7/27 2025/03/182025/07/92025/05/31 1404/3/10 Seyedeh Mahsa Poormoosavi Seyedeh Mahsa Poormoosavi Department of Histology, School of Medicine, Research and Clinical Center for Infertility, Dezful University of Medical Sciences, Dezful, Iran. m.poormoosavi@ymail.com Mohammad Amin Behmanesh Mohammad Amin Behmanesh Department of Histology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran. behmanesh.ma@yahoo.com Fatemeh Pourmotahari Fatemeh Pourmotahari Department of Biostatistics, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran. pourmotahari@gmail.com Kosar Tavvalapour Kosar Tavvalapour Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran. K.tavallapour@gmail.com Sima Janati Sima Janati Department of Obstetrics and Gynecology, School of Medicine, Research and Clinical Center for Infertility, Dezful University of Medical Sciences, Dezful, Iran. janati.s@dums.ac.ir; sjanati@ymail.com Pathology Placenta Pregnancy Severe acute respiratory syndrome coronavirus 2 COVID-19. آسیب‌شناسی جفت بارداری سندروم حاد تنفسی کووید 2019. 1. Khan S, Jun L, Nawsherwan, Siddique R, Li Y, Han G, et al. Association of COVID-19 with pregnancy outcomes in healthcare workers and general women. Clin Microbiol Infect 2020; 26: 788-790.##2. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-1242.##3. Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med 2020; 20: 124-127.##4. Shanes ED, Mithal LB, Otero S, Azad HA, Miller ES, Goldstein JA. Placental pathology in COVID-19. Am J Clin Pathol 2020; 154: 23-32.##5. Liu S, Diao L, Huang C, Li Y, Zeng Y, Kwak-Kim JYH. The role of decidual immune cells in human pregnancy. J Reprod Immunol 2017; 124: 44-53.##6. Mahyuddin AP, Kanneganti A, Wong JJL, Dimri PS, Su LL, Biswas A, et al. Mechanisms and evidence of vertical transmission of infections in pregnancy, including SARS-CoV-2. Prenat Diagn 2020; 40: 1655-1670.##7. Gralinski LE, Menachery VD. Return of the Coronavirus: 2019-nCoV. Viruses 2020; 12: 135.##8. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382: 1199-1207.##9. Motwani R, Deshmukh V, Kumar A, Kumari C, Raza K, Krishna H. Pathological involvement of placenta in COVID-19: A systematic review. Infez Med 2022; 30: 157-167.##10. Mulvey JJ, Magro CM, Ma LX, Nuovo GJ, Baergen RN. Analysis of complement deposition and viral RNA in placentas of COVID-19 patients. Ann Diagn Pathol 2020; 46: 151530.##11. Argueta LB, Lacko LA, Bram Y, Tada T, Carrau L, Rendeiro AF, et al. Inflammatory responses in the placenta upon SARS-CoV-2 infection late in pregnancy. Iscience 2022; 25: 104223.##12. Blasco Santana L, Miraval Wong E, Álvarez‐Troncoso J, Sanchez Garcia L, Bartha JL, Regojo‐Zapata RM. Maternal and perinatal outcomes and placental pathologic examination of 29 SARS-CoV-2-infected patients in the third trimester of gestation. J Obstet Gynaecol Res 2021; 47: 2131-2139.##13. Schwartz DA, Avvad-Portari E, Babál P, Baldewijns M, Blomberg M, Bouachba A, et al. Placental tissue destruction and insufficiency from COVID-19 causes stillbirth and neonatal death from hypoxic-ischemic injury. Arch Pathol Lab Med 2022; 146: 660-676.##14. Nascimento ACM, Avvad-Portari E, Meuser-Batista M, Conde TC, de Sá RAM, Salomao N, et al. Histopathological and clinical analysis of COVID-19-infected placentas. Surg Exp Pathol 2024; 7: 4.##15. Singh N, Buckley T, Shertz W. Placental pathology in COVID-19: Case series in a community hospital setting. Cureus 2021; 13: e12522.##Khan S, Jun L, Nawsherwan, Siddique R, Li Y, Han G, et al. Association of COVID-19 with pregnancy outcomes in healthcare workers and general women. Clin Microbiol Infect 2020; 26: 788-790.##Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-1242.##Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med 2020; 20: 124-127.##Shanes ED, Mithal LB, Otero S, Azad HA, Miller ES, Goldstein JA. Placental pathology in COVID-19. Am J Clin Pathol 2020; 154: 23-32.##Liu S, Diao L, Huang C, Li Y, Zeng Y, Kwak-Kim JYH. The role of decidual immune cells in human pregnancy. J Reprod Immunol 2017; 124: 44-53.##Mahyuddin AP, Kanneganti A, Wong JJL, Dimri PS, Su LL, Biswas A, et al. Mechanisms and evidence of vertical transmission of infections in pregnancy, including SARS-CoV-2. Prenat Diagn 2020; 40: 1655-1670.##Gralinski LE, Menachery VD. Return of the Coronavirus: 2019-nCoV. Viruses 2020; 12: 135.##Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382: 1199-1207.##Motwani R, Deshmukh V, Kumar A, Kumari C, Raza K, Krishna H. Pathological involvement of placenta in COVID-19: A systematic review. Infez Med 2022; 30: 157-167.##Mulvey JJ, Magro CM, Ma LX, Nuovo GJ, Baergen RN. Analysis of complement deposition and viral RNA in placentas of COVID-19 patients. Ann Diagn Pathol 2020; 46: 151530.##Argueta LB, Lacko LA, Bram Y, Tada T, Carrau L, Rendeiro AF, et al. Inflammatory responses in the placenta upon SARS-CoV-2 infection late in pregnancy. Iscience 2022; 25: 104223.##Blasco Santana L, Miraval Wong E, Álvarez‐Troncoso J, Sanchez Garcia L, Bartha JL, Regojo‐Zapata RM. Maternal and perinatal outcomes and placental pathologic examination of 29 SARS-CoV-2-infected patients in the third trimester of gestation. J Obstet Gynaecol Res 2021; 47: 2131-2139.##Schwartz DA, Avvad-Portari E, Babál P, Baldewijns M, Blomberg M, Bouachba A, et al. Placental tissue destruction and insufficiency from COVID-19 causes stillbirth and neonatal death from hypoxic-ischemic injury. Arch Pathol Lab Med 2022; 146: 660-676.##Nascimento ACM, Avvad-Portari E, Meuser-Batista M, Conde TC, de Sá RAM, Salomao N, et al. Histopathological and clinical analysis of COVID-19-infected placentas. Surg Exp Pathol 2024; 7: 4.##Singh N, Buckley T, Shertz W. Placental pathology in COVID-19: Case series in a community hospital setting. Cureus 2021; 13: e12522.## ##

Knowledge and attitudes toward sexual and reproductive health among youth in Jordan: A cross-sectional study دانش و نگرش نسبت به سلامت جنسی و باروری در میان جوانان اردن: یک مطالعه مقطعی 2 1 مقدمه: ۱۶% از جمعیت جهان را نوجوانان تشکیل می‌دهند که در میان آنها تغییرات کلیدی که در هنگام رشد اتفاق می­افتد بر سلامت آنها تأثیر می­گذارد. رفتارهای پرخطر جنسی احتمال ابتلا به عفونت‌های مقاربتی را افزایش می‌دهد، به طوری که ۴۰% از موارد جدید HIV در جهان در افراد 25-15 ساله رخ می‌دهد. هدف: این مطالعه با هدف ارزیابی نگرش‌های سلامت جنسی در میان جوانان اردن انجام شده است. مواد و روش ­ها: این مطالعه مقطعی از ژانویه تا آوریل ۲۰۲۴ با شرکت ۸۶۴ شرکت‌کننده بین 22-15 سال انجام شد. داده‌ها از طریق یک نظرسنجی آنلاین معتبر شامل ۴۳ سؤال که در برگیرنده عوامل اجتماعی و دموگرافیک، دانش و نگرش نسبت به آموزش جنسی، خودارضایی، پورنوگرافی، رفتارهای جنسی و قاعدگی بود جمع‌آوری گردید. نتایج: از بین شرکت‌کنندگان، ۵۴% زن، 4/66% دانشجوی دانشگاه و 2/92% در مناطق شهری ساکن بودند. اکثر افراد (1/72%) از آموزش جنسی و گنجاندن آن در مدارس (7/76%) حمایت کردند. خودارضایی توسط 9/88% تأیید شد و ۹/69% پورنوگرافی را مشاهده کرده بودند که این موضوع ارتباط قوی با جنسیت مذکر داشت (001/0 > p). 6/%31 تماس فیزیکی با جنس مخالف را گزارش کردند در حالی که 8/13% با آن قبل از ازدواج مخالف بودند. لمس جنسی ناخواسته به طور قابل توجهی توسط زنان بیشتر گزارش شد (001/0 > p). علاوه بر این، ۷/۷5% برای مسائل جنسی تمایل به دریافت کمک متخصص داشتند. تنها 7/66% از زنان قبل از شروع قاعدگی در مورد آن اطلاعات کسب کرده بودند. نتیجه­ گیری: علیرغم محافظه کاری فرهنگی غالب، جوانان اردنی دید باز و آگاهی قابل توجهی در مورد سلامت جنسی نشان می‌دهند. این یافته‌ها بر نیاز به آموزش جنسی ساختارمند و حساس به فرهنگ و گفتگوی آزاد برای ارتقاء سلامت باروری نوجوانان تأکید می‌کند. 2 Background: Adolescents constitute 16% of the world's population, among whom critical developmental changes influence their health. Risky sexual behaviors increase the likelihood of contracting sexually transmitted infections, with 40% of global new HIV cases occurring in individuals aged 15-25 yr. Objective: This study aims to assess sexual health attitudes among youth in Jordan. Materials and Methods: This cross-sectional study was conducted from January to April, 2024, involving 864 participants aged between 15 and 22. Data were collected through a validated online survey comprising 43 questions covering socio-demographic factors and knowledge/attitudes toward sexual education, masturbation, pornography, sexual behaviors, and menstruation. Results: Of the participants, 54% were females, 66.4% were university students, and 92.2% resided in urban areas. Most supported sexual education (72.1%) and its inclusion in schools (76.7%). Masturbation was recognized by 88.9%, and pornography had been viewed by 69.9%, with a strong association with male gender (p < 0.001). Physical contact with partners was reported by 31.6% while 13.8% opposed it before marriage. Unwanted sexual touch was significantly more reported by females (p < 0.001). Additionally, 75.7% would seek expert help for sexual issues. Only 66.7% of females learned about menstruation before its onset. Conclusion: Despite prevailing cultural conservatism, Jordanian youth show considerable openness and awareness regarding sexual health. These findings highlight the need for culturally sensitive, structured sexual education and open dialogue to promote adolescent reproductive well-being. 493 506 2024/12/312024/11/202024/10/182024/11/1 1403/8/11 2025/03/182025/07/92025/05/312025/06/9 1404/3/19 Lina Almahmoud Lina Almahmoud Department of Medical Doctors, Farah Medical Campus, Amman, Jordan. linaalmahmoud@hotmail.com Laith Altawil Laith Altawil Department of Medical Doctors, Farah Medical Campus, Amman, Jordan. lmaltaweel16@med.just.edu.jo Yazan Shahatit Yazan Shahatit Department of Medical Doctors, Farah Medical Campus, Amman, Jordan. y.shahatit1995@gmail.com Rawan Sami Rawan Sami Faculty of Medicine, The Hashemite University, Zarqa, Jordan. rsamiyou@gmail.com Ayman Abdullah Qatawneh Ayman Abdullah Qatawneh Department of Medical Doctors, Farah Medical Campus, Amman, Jordan. aymanqtwh@yahoo.com Zaid Mohannad Alkhdaire Zaid Mohannad Alkhdaire Department of Medical Doctors, Farah Medical Campus, Amman, Jordan. zaid98@hotmail.com Rajai Zurikat Rajai Zurikat Department of General Medicine, Hospitalist Services, Abdali Hospital, Amman, Jordan. rajaizurikat@hotmail.com Akram Mohammad Karmoul Akram Mohammad Karmoul Faculty of Medicine, Jordan University for Science and Technology, Irbid, Jordan. akram.karmoul97@gmail.com Abdallah Abuawad Abdallah Abuawad Faculty of Medicine, The Hashemite University, Zarqa, Jordan. abdallahabuawad@hotmail.com Wasan Al-Dalabeeh Wasan Al-Dalabeeh Faculty of Medicine, The Hashemite University, Zarqa, Jordan. aldalabeehwasan@yahoo.com Mohammad Abu Khait Mohammad Abu Khait Faculty of Medicine, Yarmouk University, Irbid, Jordan. mohammedabukhait28@gmail.com Morad Bani-Hani Morad Bani-Hani Department of General Surgery, Urology, and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, Jordan. morad_bh@hu.edu.jo Sexual health Health services Health knowledge Attitudes Practice Adolescent Jordan. سلامت جنسی خدمات بهداشتی دانش بهداشتی نگرش تمرین و تکرار نوجوان اردن. 1. UNICEF. Adolescents: Overview. 2024. Available at: https://data.unicef.org/topic/adolescents/overview/.##2. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health 2018; 2: 223-228. ##3. Graber JA, Brooks-Gunn J, Petersen AC. Transitions through adolescence. New York: Psychology Press; 2018: 85-110.##4. Majlesi F, Mahmoodi M, Rahimi A, Hosseinzadeh P. [The impact of lecture and educational package methods in knowledge and attitude of teenage girls on puberty health]. Hormozgan Med J 2012; 15: 327. (In Persian)##5. WHO Regional Office for the Eastern Mediterranean. Training workshop on school health and nutrition promotion. 2011. Available at: http://www.emro.who.int/.##6. Azene ZN, Tsegaye L, W/Gebriel M, Tadesse A, Tadele A, Aynalem GL, et al. Risky sexual practice and associated factors among youth preparatory students in Gondar City, northwest Ethiopia. Front Public Health 2022; 10: 843359.##7. Joint United Nations Program on HIV/AIDS. At the crossroads: Accelerating youth access to HIV/AIDS interventions. Available at: https://www.un.org/esa/socdev/unyin/documents/aidsunfpa.pdf.##8. Bourguignon JP, Parent AS, Mullis PE. Puberty from bench to clinic: Lessons for clinical management of pubertal disorders. 1st Ed. Switzerland: S Karger AG; 2015: 174-184.##9. Saghi S, Mirghafourvand M, Mohammad Alizadeh Charandabi S, Nabighadim A, Seidi S, Rahmani A. Knowledge and attitude about pubertal health and their socio-demographic predictors in Iranian adolescents. Int J Adolesc Med Health 2016; 28: 397-405. ##10. World Health Organization. Sexual and reproductive health and rights. 2024. Available at: https://www.who.int/health-topics/sexual-and-reproductive-health-and-rights. ##11. Tamang L, Raynes-Greenow C, McGeechan K, Black KI. Knowledge, experience, and utilisation of sexual and reproductive health services amongst Nepalese youth living in the Kathmandu Valley. Sex Reprod Healthc 2017; 11: 25-30. ##12. Bashir Q, Usman A, Amjad A, Amjad U. The taboo that silences': Awareness about sexual and reproductive health issues among adolescent females during pubertal transition. Isra Med J 2017; 9: 381-385.##13. Azmat SK, Ali M, Ishaque M, Mustafa G, Hameed W, Khan OF, et al. Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: Results of a cross-sectional baseline survey. Reprod Health 2015; 12: 25. ##14. Likith RS. Exploring factors influencing parent-adolescent communication on sexual and reproductive health (SRH): A qualitative study from Bengaluru, India. J Psychosex Health 2024; 6: 235-241.##15. Zangeneh Jolovi S, Tarrahi MJ, Safdari Dehsheshmeh F, Nekuei NS. Barriers to sexual health education for female adolescents in schools from health care providers' perspective. J Midwifery Reprod Health 2023; 11: 3694-3703. ##16. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 2007; 370: 1453-1457. ##17. Menshawy A, Abushouk AI, Ghanem E, Senna M, Lotfy N, Abdel-Maboud M, et al. Break the silence: Knowledge and attitude towards sexual and reproductive health among egyptian youth. Community Ment Health J 2021; 57: 238-246. ##18. Alsubaie ASR. Exploring sexual behaviour and associated factors among adolescents in Saudi Arabia: A call to end ignorance. J Epidemiol Global Health 2019; 9: 76-80.##19. Hoseini SSh. Masturbation: Scientific evidence and Islam’s view. J Relig Health 2017; 56: 2076-2081. ##20. Brody S. Blood pressure reactivity to stress is better for people who recently had penile–vaginal intercourse than for people who had other or no sexual activity. Biol Psychol 2006; 71: 214-222. ##21. Tarhan F, Demir K, Orçun A, Madenci OC. Effect of ejaculation on serum prostate-specific antigen concentration. Int Braz J Urol 2016; 42: 472-478. ##22. Rowland DL, Cooper SE. Pornography and sexual dysfunction: Is there any relationship? Current Sexual Health Reports 2024; 16: 19-34. ##23. Choo EK, van Dis J, Kass D. time’s up for medicine? Only time will tell. N Engl J Med 2018; 379: 1592-1593.##UNICEF. Adolescents: Overview. 2024. Available at: https://data.unicef.org/topic/adolescents/overview/.##Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health 2018; 2: 223-228.##Graber JA, Brooks-Gunn J, Petersen AC. Transitions through adolescence. New York: Psychology Press; 2018: 85-110.##Majlesi F, Mahmoodi M, Rahimi A, Hosseinzadeh P. [The impact of lecture and educational package methods in knowledge and attitude of teenage girls on puberty health]. Hormozgan Med J 2012; 15: 327. (In Persian)##WHO Regional Office for the Eastern Mediterranean. Training workshop on school health and nutrition promotion. 2011. Available at: http://www.emro.who.int/.##Azene ZN, Tsegaye L, W/Gebriel M, Tadesse A, Tadele A, Aynalem GL, et al. Risky sexual practice and associated factors among youth preparatory students in Gondar City, northwest Ethiopia. Front Public Health 2022; 10: 843359.##Joint United Nations Program on HIV/AIDS. At the crossroads: Accelerating youth access to HIV/AIDS interventions. Available at: https://www.un.org/esa/socdev/unyin/documents/aidsunfpa.pdf.##Bourguignon JP, Parent AS, Mullis PE. Puberty from bench to clinic: Lessons for clinical management of pubertal disorders. 1st Ed. Switzerland: S Karger AG; 2015: 174-184.##Saghi S, Mirghafourvand M, Mohammad Alizadeh Charandabi S, Nabighadim A, Seidi S, Rahmani A. Knowledge and attitude about pubertal health and their socio-demographic predictors in Iranian adolescents. Int J Adolesc Med Health 2016; 28: 397-405.##World Health Organization. Sexual and reproductive health and rights. 2024. Available at: https://www.who.int/health-topics/sexual-and-reproductive-health-and-rights.##Tamang L, Raynes-Greenow C, McGeechan K, Black KI. Knowledge, experience, and utilisation of sexual and reproductive health services amongst Nepalese youth living in the Kathmandu Valley. Sex Reprod Healthc 2017; 11: 25-30.##Bashir Q, Usman A, Amjad A, Amjad U. The taboo that silences': Awareness about sexual and reproductive health issues among adolescent females during pubertal transition. Isra Med J 2017; 9: 381-385.##Azmat SK, Ali M, Ishaque M, Mustafa G, Hameed W, Khan OF, et al. Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: Results of a cross-sectional baseline survey. Reprod Health 2015; 12: 25.##Likith RS. Exploring factors influencing parent-adolescent communication on sexual and reproductive health (SRH): A qualitative study from Bengaluru, India. J Psychosex Health 2024; 6: 235-241.##Zangeneh Jolovi S, Tarrahi MJ, Safdari Dehsheshmeh F, Nekuei NS. Barriers to sexual health education for female adolescents in schools from health care providers' perspective. J Midwifery Reprod Health 2023; 11: 3694-3703.##von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 2007; 370: 1453-1457.##Menshawy A, Abushouk AI, Ghanem E, Senna M, Lotfy N, Abdel-Maboud M, et al. Break the silence: Knowledge and attitude towards sexual and reproductive health among egyptian youth. Community Ment Health J 2021; 57: 238-246.##Alsubaie ASR. Exploring sexual behaviour and associated factors among adolescents in Saudi Arabia: A call to end ignorance. J Epidemiol Global Health 2019; 9: 76-80.##Hoseini SSh. Masturbation: Scientific evidence and Islam's view. J Relig Health 2017; 56: 2076-2081.##Brody S. Blood pressure reactivity to stress is better for people who recently had penile-vaginal intercourse than for people who had other or no sexual activity. Biol Psychol 2006; 71: 214-222.##Tarhan F, Demir K, Orçun A, Madenci OC. Effect of ejaculation on serum prostate-specific antigen concentration. Int Braz J Urol 2016; 42: 472-478.##Rowland DL, Cooper SE. Pornography and sexual dysfunction: Is there any relationship? Current Sexual Health Reports 2024; 16: 19-34.##Choo EK, van Dis J, Kass D. time's up for medicine? Only time will tell. N Engl J Med 2018; 379: 1592-1593.## ##

Association of sperm protamine1 and protamine2 transcript content with paternal age: A cross-sectional study ارتباط محتوای رونوشت‌های پروتامین 1 و 2 اسپرم با سن پدر: یک مطالعه مقطعی 2 1 مقدمه: در طول دهه گذشته میانگین سن پدر افزایش قابل توجهی داشته است. هدف: مطالعه حاضر به بررسی اثرات سن مرد بر پارامترهای اسپرم، قطعه­قطعه شدن DNA و بیان ژن­های PRM1 و PRM2 در مردان با اسپرم نرمال    می­پردازد. مواد و روش­ ها: در این مطالعه مقطعی نمونه منی از 106 مرد با اسپرم نرمال جمع­آوری شد. افراد به سه گروه 25-20، 35-30، 45-40 سال تقسیم شدند. آنالیز غلظت، تحرک و مورفولوژی طبیعی اسپرم انجام شد. تکه­تکه شدن DNA اسپرم و سطوح ژن­های PRM1 و PRM2 اسپرم آنالیز شد. نتایج: بیشترین میزان غلظت، تحرک و مورفولوژی طبیعی اسپرم در مردان 25-20 ساله مشاهده شد. کاهش قابل توجهی در تحرک کلی اسپرم (006/0 p =) و مورفولوژی طبیعی (015/0 = p) بعد از 40 سالگی در مقایسه با مردان مشاهده شد. به طور معنی­داری (001/0 > p) میزان آسیب DNA در مردان 45-40 ساله بالاتر بود. قطعه­قطعه شدن DNA به­طور قابل توجهی با تحرک کل اسپرم (012/0 = p، 242/0- = r) و مورفولوژی طبیعی (008/0 = p، 257/0- = r) ارتباط دارد. کمترین میزان رونوشت PRM1 و PRM2 در مردان 45-40 ساله مشاهده شد. آسیب DNA به­طور قابل توجهی با کاهش سطح ژن­های PRM1 (018/0 = p، 453/0- = r) و PRM2 (009/0 = p، 492/0- = r) همراه بود. سطوح رونوشت PRM1 و PRM2 در اسپرم انزالی با سن مردان ارتباط   معنی­داری داشت. نتیجه­ گیری: یافته­های ما تغیرات مرتبط با سن را در محتوای رونوشت­های PRM1 و PRM2 اسپرم و ارتباط آن­ها با پارامترهای اسپرم و قطعه­قطعه شدن DNA نشان می­دهد. 2 Background: Over the last decade, there has been a significant increase in average paternal age. Objective: The present study investigated the effects of male age on sperm parameters, DNA fragmentation, and protamine1 (PRM1) and protamine2 (PRM2) transcript content in normozoospermic men. Materials and Methods: In this cross-sectional study, 106 semen samples from normozoospermic men were obtained. The objects were divided into 3 age groups: 20-25, 30-35, and 40-45 yr. Sperm parameters and DNA fragmentation were assessed, and transcript levels of PRM1 and PRM2 were analyzed in ejaculated spermatozoa. Results: The highest levels of sperm concentration, motility, and normal morphology were observed in men aged between 20 and 25 yr. Significant declines were seen in sperm total motility (p = 0.006) and normal morphology (p = 0.015) after 40 yr compared to younger men. Significantly (p < 0.001) higher levels of DNA damage were seen in 40-45-yr-old men. DNA fragmentation correlated significantly with sperm total motility (r = -0.242, p = 0.012) and normal morphology (r = -0.257, p = 0.008). The lowest levels of PRM1 and PRM2 transcripts were seen in 40-45-yr-old men. DNA damage was significantly associated with reduced transcript levels of PRM1 (r = -0.453, p = 0.018) and PRM2 (r = -0.492, p = 0.009). Transcript levels of PRM1 and PRM2 in ejaculated spermatozoa were correlated significantly with the age of men. Conclusion: Our findings demonstrate age-related changes in sperm PRM1 and PRM2 transcript content and their correlations with sperm parameters and DNA fragmentation. 507 516 2024/12/312024/11/202024/10/182024/11/12024/11/28 1403/9/8 2025/03/182025/07/92025/05/312025/06/92025/06/17 1404/3/27 Baharan Dolatshahi Baharan Dolatshahi Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran. baharandolatshahi@gmail.com Mehran Dorostghoal Mehran Dorostghoal Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran. dorostghoal@gmail.com Hamid Galehdari Hamid Galehdari Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran. galehdari187@yahoo.com Masoud Hemadi Masoud Hemadi Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. mhemadi79@gmail.com Paternal age DNA damage Protamines Transcription. سن پدر آسیب DNA پروتامین ها رونوشت برداری. 1. Agarwal A, Baskaran S, Parekh N, Cho C-L, Henkel R, Vij S, et al. Male infertility. Lancet 2021; 397: 319-333. ##2. Zabak S, Varma A, Bansod S, Pohane MR. Exploring the complex landscape of delayed childbearing: Factors, history, and long-term implications. Cureus 2023; 15: e46291. ##3. Halvaei I, Litzky J, Esfandiari N. Advanced paternal age: Effects on sperm parameters, assisted reproduction outcomes and offspring health. Reprod Biol Endocrinol 2020; 18: 110.##4. Murugesu S, Kasaven LS, Petrie A, Vaseekaran A, Jones BP, Bracewell-Milnes T, et al. Does advanced paternal age affect outcomes following assisted reproductive technology? A systematic review and meta-analysis. Reprod Biomed Online 2022; 45: 283-331.##5. Brandt JS, Cruz Ithier MA, Rosen T, Ashkinadze E. Advanced paternal age, infertility, and reproductive risks: A review of the literature. Prenat Diagn 2019; 39: 81-87.##6. Deenadayal Mettler A, Govindarajan M, Srinivas S, Mithraprabhu S, Evenson D, Mahendran T. Male age is associated with sperm DNA/chromatin integrity. Aging Male 2020; 23: 822-829.##7. Farkouh A, Salvio G, Kuroda S, Saleh R, Vogiatzi P, Agarwal A. Sperm DNA integrity and male infertility: A narrative review and guide for the reproductive physicians. Transl Androl Urol 2022; 11: 1023-1044.##8. Bibi R, Jahan S, Razak S, Hammadeh ME, Almajwal A, Amor H. Protamines and DNA integrity as a biomarkers of sperm quality and assisted conception outcome. Andrologia 2022; 54: e14418.##9. Sarasa J, Enciso M, García L, Leza A, Steger K, Aizpurua J. Comparison of ART outcomes in men with altered mRNA protamine 1/protamine 2 ratio undergoing intracytoplasmic sperm injection with ejaculated and testicular spermatozoa. Asian J Androl 2020; 22: 623-628.##10. Amor H, Shelko N, Hamad MF, Zeyad A, Hammadeh ME. An additional marker for sperm DNA quality evaluation in spermatozoa of male partners of couples undergoing assisted reproduction technique (IVF/ICSI): Protamine ratio. Andrologia 2019; 51: e13400. ##11. Dehghanpour F, Fesahat F, Yazdinejad F, Motamedzadeh L, Talebi AR. Is there any relationship between human sperm parameters and protamine deficiency in different groups of infertile men? Rev Int Androl 2020; 18: 137-143.##12. Bashiri Z, Amidi F, Amiri I, Zandieh Z, Maki CB, Mohammadi F, et al. Male factors: The role of sperm in preimplantation embryo quality. Reprod Sci 2021; 28: 1788-1811.##13. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th Ed. Geneva, Switzerland: World Health Organization; 2010.##14. Caliskan Z, Kucukgergin C, Aktan G, Kadioglu A, Ozdemirler G. Evaluation of sperm DNA fragmentation in male infertility. Andrologia 2022; 54: e14587.##15. Singh NP, Muller CH, Berger RE. Effects of age on DNA double-strand breaks and apoptosis in human sperm. Fertil Steril 2003; 80: 1420-1430.##16. Ye X, Peng T, Chen Z, Liao C, Li X, Lan Y, et al. Semen parameters' mediation effect on the association between advanced paternal age and IVF clinical outcomes: A 10-year retrospective cohort study. Maturitas 2023; 173: 20-27.##17. Jin NM, Ahmad MF, Azmi R, Abdul Karim AK. The influence of paternal age on semen parameters and pregnancy outcome following intrauterine insemination. Clin Case Rep Int 2023; 7: 1463.##18. Elbardisi H, Arafa M, Singh N, Betts B, Agrawal A, Henkel R, et al. The effect of paternal age on intracytoplasmic sperm injection outcome in unexplained infertility. Arab J Urol 2021; 19: 274-280.##19. Pino V, Sanz A, Valdés N, Crosby J, Mackenna A. The effects of aging on semen parameters and sperm DNA fragmentation. JBRA Assist Reprod 2020; 24: 82-86.##20. Vuarin P, Lesobre L, Levêque G, Saint Jalme M, Lacroix F, Hingrat Y, et al. Paternal age negatively affects sperm production of the progeny. Ecol Lett 2021; 24: 719-727.##21. Lu R, Chen X, Yu W, Jiang F, Zhou X, Xu Y, et al. Analysis of age‐associated alternation of SCSA sperm DNA fragmentation index and semen characteristics of 1790 subfertile males in China. J Clin Lab Anal 2020; 34: e23548.##22. Evenson DP, Djira G, Kasperson K, Christianson J. Relationships between the age of 25,445 men attending infertility clinics and sperm chromatin structure assay (SCSA®) defined sperm DNA and chromatin integrity. Fertil Steril 2020; 114: 311-320.##23. Borges Jr E, Zanetti BF, Setti AS, Braga DPAF, Provenza RR, Iaconelli Jr A. Sperm DNA fragmentation is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in reproductive cycles of non–male factor infertility. Fertil Steril 2019; 112: 483-490.##24. Dorostghoal M, Galehdari H, Hemadi M, Abdi S. Sperm dna damage and protamine transcripts content in iranian men with unexplained infertility. Gene Cell Tissue 2021; 8: e114727.##25. Kaarouch I, Bouamoud N, Madkour A, Louanjli N, Saadani B, Assou S, et al. Paternal age: Negative impact on sperm genome decays and IVF outcomes after 40 years. Mol Reprod Dev 2018; 85: 271-280.##26. Elango K, Kumaresan A, Talluri TR, Raval K, Paul N, Samuel King John Peter E, et al. Impact of sperm protamine on semen quality and fertility. J Reprod Healthc Med 2022; 3: 1-9.##27. Ozsait-Selcuk B, Bulgurcuoglu-Kuran S, Sever-Kaya D, Coban N, Aktan G, Kadioglu A. Sperm RNA quantity and PRM1, PRM2, and TH2B transcript levels reflect sperm characteristics and early embryonic development. Asian J Androl 2025; 27: 76-83. ##28. Schneider S, Balbach M, Jikeli JF, Fietz D, Nettersheim D, Jostes S, et al. Re-visiting the Protamine-2 locus: Deletion, but not haploinsufficiency, renders male mice infertile. Sci Report 2016; 6: 36764.##29. Akmal M, Aulanni'am A, Widodo MA, Sumitro SB, Purnomo BB, Widodo N. The important role of protamine in spermatogenesis and quality of sperm: A mini review. Asian Pac J Reprod 2016; 5: 357-360.##30. Kusumawati A, Satrio FA, Indriastuti R, Rosyada ZNA, Pardede BP, Agil M, et al. Sperm head morphology alterations associated with chromatin instability and lack of protamine abundance in frozen-thawed sperm of Indonesian local bulls. Animals (Basel) 2023; 13: 2433.##31. Rogenhofer N, Ott J, Pilatz A, Wolf J, Thaler CJ, Windischbauer L, et al. Unexplained recurrent miscarriages are associated with an aberrant sperm protamine mRNA content. Hum Reprod 2017; 32: 1574-1582.##32. Gunawan A, Sumantri C, Arifiantini RI. Differential expressions of protamine 1 (prm1) and protamine 2 (prm2) genes as markers of semen quality in pasundan bulls. Trop Anim Sci J 2022; 45: 423-428.##33. Ishchuk MA, Malysheva OV, Komarova EM, Mekina ID, Lesik EA, Gzgzyan AM, et al. Protamine 1 and 2 mRNA abundance in human spermatozoa and its relation to semen quality and sperm DNA fragmentation among fertility clinic patients. Russian J Genet 2021; 57: 213-220.##Agarwal A, Baskaran S, Parekh N, Cho C-L, Henkel R, Vij S, et al. Male infertility. Lancet 2021; 397: 319-333.##Zabak S, Varma A, Bansod S, Pohane MR. Exploring the complex landscape of delayed childbearing: Factors, history, and long-term implications. Cureus 2023; 15: e46291.##Halvaei I, Litzky J, Esfandiari N. Advanced paternal age: Effects on sperm parameters, assisted reproduction outcomes and offspring health. Reprod Biol Endocrinol 2020; 18: 110.##Murugesu S, Kasaven LS, Petrie A, Vaseekaran A, Jones BP, Bracewell-Milnes T, et al. Does advanced paternal age affect outcomes following assisted reproductive technology? A systematic review and meta-analysis. Reprod Biomed Online 2022; 45: 283-331.##Brandt JS, Cruz Ithier MA, Rosen T, Ashkinadze E. Advanced paternal age, infertility, and reproductive risks: A review of the literature. Prenat Diagn 2019; 39: 81-87.##Deenadayal Mettler A, Govindarajan M, Srinivas S, Mithraprabhu S, Evenson D, Mahendran T. Male age is associated with sperm DNA/chromatin integrity. Aging Male 2020; 23: 822-829.##Farkouh A, Salvio G, Kuroda S, Saleh R, Vogiatzi P, Agarwal A. Sperm DNA integrity and male infertility: A narrative review and guide for the reproductive physicians. Transl Androl Urol 2022; 11: 1023-1044.##Bibi R, Jahan S, Razak S, Hammadeh ME, Almajwal A, Amor H. Protamines and DNA integrity as a biomarkers of sperm quality and assisted conception outcome. Andrologia 2022; 54: e14418.##Sarasa J, Enciso M, García L, Leza A, Steger K, Aizpurua J. Comparison of ART outcomes in men with altered mRNA protamine 1/protamine 2 ratio undergoing intracytoplasmic sperm injection with ejaculated and testicular spermatozoa. Asian J Androl 2020; 22: 623-628.##Amor H, Shelko N, Hamad MF, Zeyad A, Hammadeh ME. An additional marker for sperm DNA quality evaluation in spermatozoa of male partners of couples undergoing assisted reproduction technique (IVF/ICSI): Protamine ratio. Andrologia 2019; 51: e13400.##Dehghanpour F, Fesahat F, Yazdinejad F, Motamedzadeh L, Talebi AR. Is there any relationship between human sperm parameters and protamine deficiency in different groups of infertile men? Rev Int Androl 2020; 18: 137-143.##Bashiri Z, Amidi F, Amiri I, Zandieh Z, Maki CB, Mohammadi F, et al. Male factors: The role of sperm in preimplantation embryo quality. Reprod Sci 2021; 28: 1788-1811.##World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th Ed. Geneva, Switzerland: World Health Organization; 2010.##Caliskan Z, Kucukgergin C, Aktan G, Kadioglu A, Ozdemirler G. Evaluation of sperm DNA fragmentation in male infertility. Andrologia 2022; 54: e14587.##Singh NP, Muller CH, Berger RE. Effects of age on DNA double-strand breaks and apoptosis in human sperm. Fertil Steril 2003; 80: 1420-1430.##Ye X, Peng T, Chen Z, Liao C, Li X, Lan Y, et al. Semen parameters' mediation effect on the association between advanced paternal age and IVF clinical outcomes: A 10-year retrospective cohort study. Maturitas 2023; 173: 20-27.##Jin NM, Ahmad MF, Azmi R, Abdul Karim AK. The influence of paternal age on semen parameters and pregnancy outcome following intrauterine insemination. Clin Case Rep Int 2023; 7: 1463.##Elbardisi H, Arafa M, Singh N, Betts B, Agrawal A, Henkel R, et al. The effect of paternal age on intracytoplasmic sperm injection outcome in unexplained infertility. Arab J Urol 2021; 19: 274-280.##Pino V, Sanz A, Valdés N, Crosby J, Mackenna A. The effects of aging on semen parameters and sperm DNA fragmentation. JBRA Assist Reprod 2020; 24: 82-86.##Vuarin P, Lesobre L, Levêque G, Saint Jalme M, Lacroix F, Hingrat Y, et al. Paternal age negatively affects sperm production of the progeny. Ecol Lett 2021; 24: 719-727.##Lu R, Chen X, Yu W, Jiang F, Zhou X, Xu Y, et al. Analysis of age‐associated alternation of SCSA sperm DNA fragmentation index and semen characteristics of 1790 subfertile males in China. J Clin Lab Anal 2020; 34: e23548.##Evenson DP, Djira G, Kasperson K, Christianson J. Relationships between the age of 25,445 men attending infertility clinics and sperm chromatin structure assay (SCSA®) defined sperm DNA and chromatin integrity. Fertil Steril 2020; 114: 311-320.##Borges Jr E, Zanetti BF, Setti AS, Braga DPAF, Provenza RR, Iaconelli Jr A. Sperm DNA fragmentation is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in reproductive cycles of non-male factor infertility. Fertil Steril 2019; 112: 483-490.##Dorostghoal M, Galehdari H, Hemadi M, Abdi S. Sperm dna damage and protamine transcripts content in iranian men with unexplained infertility. Gene Cell Tissue 2021; 8: e114727.##Kaarouch I, Bouamoud N, Madkour A, Louanjli N, Saadani B, Assou S, et al. Paternal age: Negative impact on sperm genome decays and IVF outcomes after 40 years. Mol Reprod Dev 2018; 85: 271-280.##Elango K, Kumaresan A, Talluri TR, Raval K, Paul N, Samuel King John Peter E, et al. Impact of sperm protamine on semen quality and fertility. J Reprod Healthc Med 2022; 3: 1-9.##Ozsait-Selcuk B, Bulgurcuoglu-Kuran S, Sever-Kaya D, Coban N, Aktan G, Kadioglu A. Sperm RNA quantity and PRM1, PRM2, and TH2B transcript levels reflect sperm characteristics and early embryonic development. Asian J Androl 2025; 27: 76-83.##Schneider S, Balbach M, Jikeli JF, Fietz D, Nettersheim D, Jostes S, et al. Re-visiting the Protamine-2 locus: Deletion, but not haploinsufficiency, renders male mice infertile. Sci Report 2016; 6: 36764.##Akmal M, Aulanni'am A, Widodo MA, Sumitro SB, Purnomo BB, Widodo N. The important role of protamine in spermatogenesis and quality of sperm: A mini review. Asian Pac J Reprod 2016; 5: 357-360.##Kusumawati A, Satrio FA, Indriastuti R, Rosyada ZNA, Pardede BP, Agil M, et al. Sperm head morphology alterations associated with chromatin instability and lack of protamine abundance in frozen-thawed sperm of Indonesian local bulls. Animals (Basel) 2023; 13: 2433.##Rogenhofer N, Ott J, Pilatz A, Wolf J, Thaler CJ, Windischbauer L, et al. Unexplained recurrent miscarriages are associated with an aberrant sperm protamine mRNA content. Hum Reprod 2017; 32: 1574-1582.##Gunawan A, Sumantri C, Arifiantini RI. Differential expressions of protamine 1 (prm1) and protamine 2 (prm2) genes as markers of semen quality in pasundan bulls. Trop Anim Sci J 2022; 45: 423-428.##Ishchuk MA, Malysheva OV, Komarova EM, Mekina ID, Lesik EA, Gzgzyan AM, et al. Protamine 1 and 2 mRNA abundance in human spermatozoa and its relation to semen quality and sperm DNA fragmentation among fertility clinic patients. Russian J Genet 2021; 57: 213-220.## ##

Prenatal diagnosis using next-generation sequencing in genetic counseling: Novel mutations in three large Iranian families: A case series تشخیص پیش از تولد با استفاده از توالی‌یابی نسل جدید در مشاوره ژنتیک: جهش‌های نوظهور در سه خانواده پرجمعیت ایرانی: یک گزارش مورد 2 1 مقدمه: تعداد قابل ‌توجهی از خانواده‌ها به‌دلیل سابقه خانوادگی مثبت در ابتلا به اختلالات ژنتیکی ناهمگون، به منظور برنامه‌ریزی برای بارداری بعدی، متقاضی مشاوره ژنتیک هستند. تشخیص پیش از تولد با بهره‌گیری از روش‌های توالی‌یابی نسل جدید (NGS) ابزاری قدرتمند برای شناسایی علل ناهنجاری‌های ژنتیکی فراهم می‌آورد که امکان مداخله به‌موقع و تصمیم‌گیری آگاهانه در زمینه فرزندآوری را مهیا می‌سازد. این مطالعه به بررسی توانمندی توالی‌یابی کل اگزوم (WES) در کشف واریانت‌های ژنتیکی در زوج‌هایی می‌پردازد که برای بارداری بعدی خود به مراکز مشاوره ژنتیک مراجعه کرده‌اند. مورد: در این مطالعه از روش WES جهت شناسایی واریانت‌های ژنتیکی مرتبط با ناتوانی ذهنی و رشدی در خانواده‌های مراجعه‌کننده به مرکز مشاوره ژنتیک استفاده شد. سه خانواده ایرانی که دست‌کم یک فرزند مبتلا به تأخیر تکاملی و یا ناتوانی ذهنی داشتند، برای بهبود نتایج بارداری بعدی به مرکز تحقیقات سقط پژوهشکده علوم تولید­مثل یزد مراجعه کردند. در پی بررسی‌های ژنتیکی فرزندان مبتلا در هر خانواده، سه جهش متفاوت شناسایی شد. نتایج به ترتیب شامل یک جهش ختم رونویسی هموزیگوت de novo در ژن malate dehydrogenase 1 (MDH1) (NM_005917.4:c.4C>T; p.Arg2Ter)، یک جهش در محل پذیرنده اسپلایس در ژن PGAP1 (NM_024989.4:c.1221-1G>T)، و یک جهش missense در ژنLYST (NM_000081.4:c.949G>A; p.Glu317Lys) بود. نتیجه­ گیری: WES روشی تشخیصی موفق در موارد تأخیر تکاملی و ناتوانی ذهنی بدون علت مشخص محسوب می‌شود. وجود ناهمگونی ژنتیکی گسترده در خانواده‌های پرجمعیت ایرانی، اهمیت ویژه واریانت‌های de novo را در تشخیص تقویت می‌کند. یافته‌های این مطالعه نقش ژن‌های PGAP1، MDH1 و LYST را در پاتوفیزیولوژی ناتوانی ذهنی و تأخیر رشدی تأیید می‌کند و ظرفیت بالقوه غربالگری ژنتیکی پیش از تولد را در اصلاح روند مشاوره ژنتیک نشان می‌دهد. 2 Background: All considerable families are seeking genetic counseling aiming to manage the next pregnancy according to the positive family history of heterogenetic disorders. Prenatal diagnosis utilizing next-generation sequencing provides a significant means to identify the causes of genetic abnormalities, allowing for timely interventions that support informed family planning. This study explores the power of whole-exome sequencing (WES) in uncovering genetic variants in couples who are seeking genetic counseling for their next pregnancy. Case Presentations: In this study, WES was used to identify genetic variations associated with disability in families seeking genetic counseling. 3 families who had at least 1 child with developmental delay (DD) and/or intellectual disability (ID) participated in a genetic counselling clinic, Yazd Reproductive Science Institute, Yazd, Iran to have successful outcomes for the next pregnancy. 3 distinct mutation sites from 3 families were diagnosed, following the WES for affected children with intellectual disabilities. Results showed a homozygous de novo stop-gain mutation in malate dehydrogenase 1 gene (NM_005917.4:c.4C>T; p.Arg2Ter), a splice acceptor mutation in the post-glycosylphosphatidylinositol attachment to proteins inositol deacylase 1 gene (NM_024989.4:c.1221-1G>T), and a missense mutation in the lysosomal trafficking regulator gene (NM_000081.4:c.949G>A; p.Glu317Lys) in each family, respectively.  Conclusion: For cases with DD and unexplained ID, WES is a very successful diagnostic approach. Unfortunately, large Iranian families exhibit significant genetic heterogeneity, highlighting the critical role of de novo variants in diagnosis. The results of this study confirm that proteins inositol deacylase 1, malate dehydrogenase 1, and lysosomal trafficking regulator are involved in the pathophysiology of ID/DD and the transformative potential of prenatal genetic screening. 517 526 2024/12/312024/11/202024/10/182024/11/12024/11/282025/03/8 1403/12/18 2025/03/182025/07/92025/05/312025/06/92025/06/172025/06/30 1404/4/9 Hamidreza Ashrafzadeh Hamidreza Ashrafzadeh Department of Biology, Pa.c., Islamic Azad University, Parand, Iran. hr.ashrafzadeh@gmail.com Farzaneh Tafvizi Farzaneh Tafvizi Department of Biology, Pa.c., Islamic Azad University, Parand, Iran. farzanehtafvizi54@gmail.com Nasrin Ghasemi Nasrin Ghasemi Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. nghasemi479@gmail.com Mohammad Yahya Vahidi Mehrjardi Mohammad Yahya Vahidi Mehrjardi Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. mmvahidi@gmail.com Vahid Naseh Vahid Naseh Department of Biology, Pa.c., Islamic Azad University, Parand, Iran. vahid55vet@yahoo.com Prenatal diagnosis Genetic counselling Whole exome sequencing Intellectual disability Developmental delay. تشخیص پیش از تولد مشاوره ژنتیک توالی‌یابی کل اگزوم ناتوانی ذهنی تأخیر رشدی. 1. Schmidt JL, Maas R, Altmeyer SR. Genetic counseling for consumer‐driven whole exome and whole genome sequencing: A commentary on early experiences. J Genet Couns 2019; 28: 449-455.##2. Li P, Xu F, Shu W. The spectrum of cytogenomic abnormalities in patients with developmental delay and intellectual disabilities. N A J Med Sci 2015; 8: 172-178.##3. Chai H, DiAdamo A, Grommisch B, Boyle J, Amato K, Wang D, et al. Integrated FISH, karyotyping and aCGH analyses for effective prenatal diagnosis of common aneuploidies and other cytogenomic abnormalities. Med Sci 2019; 7: 16.##4. Harripaul R, Noor A, Ayub M, Vincent JB. The use of next-generation sequencing for research and diagnostics for intellectual disability. Cold Spring Harb Perspect Med 2017; 7: a026864.##5. Peterlin A, Peterlin B. Contemporary approach to diagnosis of genetic causes of intellectual disability. J Spec Educ Rehab 2016; 17: 62-70.##6. Muthusamy B, Selvan LDN, Nguyen TT, Manoj J, Stawiski EW, Jaiswal BS, et al. Next-generation sequencing reveals novel mutations in X-linked intellectual disability. Omics 2017; 21: 295-303.##7. Schwarz JM, Cooper DN, Schuelke M, Seelow D. Mutation taster 2: Mutation prediction for the deep-sequencing age. Nat Methods 2014; 11: 361-362.##8. Kircher M, Witten DM, Jain P, O'roak BJ, Cooper GM, Shendure J. A general framework for estimating the relative pathogenicity of human genetic variants. Nat Genet 2014; 46: 310-315.##9. Jagadeesh KA, Wenger AM, Berger MJ, Guturu H, Stenson PD, Cooper DN, et al. M-CAP eliminates a majority of variants of uncertain significance in clinical exomes at high sensitivity. Nat Genet 2016; 48: 1581-1586.##10. Serra-Vinardell J, Sandler MB, De Pace R, Manzella-Lapeira J, Cougnoux A, Keyvanfar K, et al. LYST deficiency impairs autophagic lysosome reformation in neurons and alters lysosome number and size. Cell Mol Life Sci 2023; 80: 53.##11. Song Y, Dong Z, Luo S, Yang J, Lu Y, Gao B, et al. Identification of a compound heterozygote in LYST gene: A case report on Chediak-Higashi syndrome. BMC Med Genet 2020; 21: 4.##12. Acevedo A, Torres F, Kiwi M, Baeza-Lehnert F, Barros LF, Lee-Liu D, et al. Metabolic switch in the aging astrocyte supported via integrative approach comprising network and transcriptome analyses. Aging 2023; 15: 9896.##13. Ait-El-Mkadem S, Dayem-Quere M, Gusic M, Chaussenot A, Bannwarth S, François B, et al. Mutations in MDH2, encoding a Krebs cycle enzyme, cause early-onset severe encephalopathy. Am J Hum Genet 2017; 100: 151-159.##14. Zuend M, Saab AS, Wyss MT, Ferrari KD, Hösli L, Looser ZJ, et al. Arousal-induced cortical activity triggers lactate release from astrocytes. Nat Metab 2020; 2: 179-191.##15. Chen Z, Yuan Z, Yang S, Zhu Y, Xue M, Zhang J, et al. Brain energy metabolism: Astrocytes in neurodegenerative diseases. CNS Neurosci Ther 2023; 29: 24-36.##16. McNair LM, Andersen JV, Waagepetersen HS. Stable isotope tracing reveals disturbed cellular energy and glutamate metabolism in hippocampal slices of aged male mice. Neurochem Int 2023; 171: 105626.##17. Hanse EA, Ruan C, Kachman M, Wang D, Lowman XH, Kelekar A. Cytosolic malate dehydrogenase activity helps support glycolysis in actively proliferating cells and cancer. Oncogene 2017; 36: 3915-3924.##18. Murakami Y, Tawamie H, Maeda Y, Büttner C, Buchert R, Radwan F, et al. Null mutation in PGAP1 impairing Gpi-anchor maturation in patients with intellectual disability and encephalopathy. PLoS Genet 2014; 10: e1004320.##19. Kettwig M, Elpeleg O, Wegener E, Dreha-Kulaczewski S, Henneke M, Gärtner J, et al. Compound heterozygous variants in PGAP1 causing severe psychomotor retardation, brain atrophy, recurrent apneas and delayed myelination: A case report and literature review. BMC Neurol 2016; 16: 74.##Schmidt JL, Maas R, Altmeyer SR. Genetic counseling for consumer‐driven whole exome and whole genome sequencing: A commentary on early experiences. J Genet Couns 2019; 28: 449-455.##Li P, Xu F, Shu W. The spectrum of cytogenomic abnormalities in patients with developmental delay and intellectual disabilities. N A J Med Sci 2015; 8: 172-178.##Chai H, DiAdamo A, Grommisch B, Boyle J, Amato K, Wang D, et al. Integrated FISH, karyotyping and aCGH analyses for effective prenatal diagnosis of common aneuploidies and other cytogenomic abnormalities. Med Sci 2019; 7: 16.##Harripaul R, Noor A, Ayub M, Vincent JB. The use of next-generation sequencing for research and diagnostics for intellectual disability. Cold Spring Harb Perspect Med 2017; 7: a026864.##Peterlin A, Peterlin B. Contemporary approach to diagnosis of genetic causes of intellectual disability. J Spec Educ Rehab 2016; 17: 62-70.##Muthusamy B, Selvan LDN, Nguyen TT, Manoj J, Stawiski EW, Jaiswal BS, et al. Next-generation sequencing reveals novel mutations in X-linked intellectual disability. Omics 2017; 21: 295-303.##Schwarz JM, Cooper DN, Schuelke M, Seelow D. Mutation taster 2: Mutation prediction for the deep-sequencing age. Nat Methods 2014; 11: 361-362.##Kircher M, Witten DM, Jain P, O'roak BJ, Cooper GM, Shendure J. A general framework for estimating the relative pathogenicity of human genetic variants. Nat Genet 2014; 46: 310-315.##Jagadeesh KA, Wenger AM, Berger MJ, Guturu H, Stenson PD, Cooper DN, et al. M-CAP eliminates a majority of variants of uncertain significance in clinical exomes at high sensitivity. Nat Genet 2016; 48: 1581-1586.##Serra-Vinardell J, Sandler MB, De Pace R, Manzella-Lapeira J, Cougnoux A, Keyvanfar K, et al. LYST deficiency impairs autophagic lysosome reformation in neurons and alters lysosome number and size. Cell Mol Life Sci 2023; 80: 53.##https://doi.org/10.1007/s00018-023-04695-x##Song Y, Dong Z, Luo S, Yang J, Lu Y, Gao B, et al. Identification of a compound heterozygote in LYST gene: A case report on Chediak-Higashi syndrome. BMC Med Genet 2020; 21: 4.##Acevedo A, Torres F, Kiwi M, Baeza-Lehnert F, Barros LF, Lee-Liu D, et al. Metabolic switch in the aging astrocyte supported via integrative approach comprising network and transcriptome analyses. Aging 2023; 15: 9896.##Ait-El-Mkadem S, Dayem-Quere M, Gusic M, Chaussenot A, Bannwarth S, François B, et al. Mutations in MDH2, encoding a Krebs cycle enzyme, cause early-onset severe encephalopathy. Am J Hum Genet 2017; 100: 151-159.##Zuend M, Saab AS, Wyss MT, Ferrari KD, Hösli L, Looser ZJ, et al. Arousal-induced cortical activity triggers lactate release from astrocytes. Nat Metab 2020; 2: 179-191.##Chen Z, Yuan Z, Yang S, Zhu Y, Xue M, Zhang J, et al. Brain energy metabolism: Astrocytes in neurodegenerative diseases. CNS Neurosci Ther 2023; 29: 24-36.##McNair LM, Andersen JV, Waagepetersen HS. Stable isotope tracing reveals disturbed cellular energy and glutamate metabolism in hippocampal slices of aged male mice. Neurochem Int 2023; 171: 105626.##Hanse EA, Ruan C, Kachman M, Wang D, Lowman XH, Kelekar A. Cytosolic malate dehydrogenase activity helps support glycolysis in actively proliferating cells and cancer. Oncogene 2017; 36: 3915-3924.##Murakami Y, Tawamie H, Maeda Y, Büttner C, Buchert R, Radwan F, et al. Null mutation in PGAP1 impairing Gpi-anchor maturation in patients with intellectual disability and encephalopathy. PLoS Genet 2014; 10: e1004320.##Kettwig M, Elpeleg O, Wegener E, Dreha-Kulaczewski S, Henneke M, Gärtner J, et al. Compound heterozygous variants in PGAP1 causing severe psychomotor retardation, brain atrophy, recurrent apneas and delayed myelination: A case report and literature review. BMC Neurol 2016; 16: 74.## ##