2011 9 1 0 0

Effects of Tyrode's solution osmolarities and milk on bull sperm storage above zero temperatures اثر اسمولاریتی های مختلف محلول تیرود و شیر بر ذخیره سازی اسپرم گاو در دماهای بالاتر از صفر درجه سانتی گراد 2 1 مقدمه: کنترل اسمولاریتی و دمای محیط در طول دستکاری کوتاه مدت و بلند مدت اسپرم ضروری است. هدف: اهداف مطالعه حاضر، یافتن تاثیر اسمولاریتی های مختلف محلول تیرود و شیر برای انکوباسیون اسپرم گاو در دماهای بالای صفر درجه سانتی گراد می باشد. مواد و روش کار: جهت انجام آزمایشات از 5 رأس گاو نجدی خوزستان دو بار انزال تهیه گردید. نمونه ها سانتریفیوژ شده و بخش عمده مایع منوی خارج شد. آزمایش اول: انزال های غلیظ شده به 9 حجم مساوی تقسیم شدند و در محیط با سه اسمولاریتی مختلف (200، 300 و 400 میلی اسمول) در سه دما (5، 25 و 39 درجه سانتی گراد) به مدت 15 و 60 دقیقه مورد ارزیابی قرار گرفتند. آزمایش دوم: انزال غلظ شده به حجم های مساوی تقسیم شد و با حجم برابر شیر در دو دمای 5 و 25 درجه سانتی گراد و شیر به همراه 7 % گلیسرول در دمای 5 درجه سانتی گراد مخلوط و پس 15 و 60 دقیقه انکوباسیون مورد بررسی قرار گرفتند. نتایج: اسمولاریتی کم و به خصوص در دمای پایین تحرک اسپرم را به شدت تحت تأثیر قرار داد (p<0.05). افزایش دمای انکوباسیون اثرات مخرب اسمولاریتی پایین بر زنده مانی اسپرم را کاهش داد (p<0.05). اما کاهش تحرک اسپرم ناشی از اسمولاریتی پایین با افزایش دمای محیط حتی تا ا ساعت انکوباسیون بهبود نیافت (p>0.05). شیر زنده مانی و تحرک اسپرم را در دمای پایین محافظت نمود (p<0.05) و افزودن گلیسرول به شیر اثر بهبود دهنده ای بر انکوباسیون اسپرم در دماهای بالای صفر درجه سانتی گراد نداشت (p>0.05). نتیجه گیری: محلول های ایزو و هیپر اسموتیک تحرک و زنده مانی اسپرم را دماهای 25 و 39 درجه سانتی گراد حفاظت می کنند و شیر در دمای 5 درجه سانتی گراد از اسپرم محافظت می نماید.   2 Background: Control of the medium osmolarity and temperature during long or short time sperm manipulation is essential. Objective: The objectives of the present study were to find the effects of different osmolarities of modified Tyrode's solution and milk on the bull sperm during incubation at above zero temperatures. Materials and Methods: Semen samples were collected twice from five Najdi bull. Centrifuged and most parts of seminal plasma were removed. First experiment: The concentrated semen were splited into nine aliquots to incubate in three different osmolarities (200, 300 and 400 mOsm) at three temperatures (5, 25 and 39°C) for 15 and 60 min of incubation. Second experiment: The semen samples were splited, mixed with the same volume of whole cow milk (5 and 25°C) and milk with 7% glycerol (5°C) and incubated for 15 and 60 min. Results: Sperm motility severely affected (p<0.05) by incubation at low ionic tension (200 mOsm/l) especially at low temperature (5°C). The impact of low osmolarity on sperm viability can reduce by increasing the incubation temperature to 39°C. The decreased sperm motility, which was induced by lowering osmolarity, was not improved (p>0.05) by increasing temperature during 1 h of incubation. Milk can protect the sperm viability and motility at cool conditions and there is no beneficial effect of glycerol in combination of milk on sperm incubation at above zero temperatures (p<0.05). Conclusion: Iso- and hyper-osmotic solutions protect bull sperm motility and viability at 25 and 39°C, while milk can be used for protecting sperm at 5°C.  0 0 2017/10/1 1396/7/9 2017/10/5 1396/7/13 فرید براتی Farid Barati Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran Iran fabrtir@yahoo.com, baratif@scu.ac.ir احمدعلی پاپهن Ahmad Ali Papahn Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran ایران مهسا افروغ Mahsa Afrough Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran ایران محمد براتی Mohammad Barati Department of Applied Chemistry, University of Tabriz, Tabriz, Iran ایران  Bull sperm Tyrode's solution Whole milk Osmolarity Glycerol اسپرم گاو محلول تیرود شیر کامل اسمولاریتی گلیسرول Gao DO, Mazur P, Critser JK. Fundamental cryobiology of mammalian spermatozoa, In: Karow AM, Critser JK. (Eds.). Reproductive tissue banking: scientific priniciples, San Diego, USA: Academic press; 1997: 263-328.##Morris GJ, Faszer K, Green JE, Draper D, Grout BWW, Fonseca F. Rapidly cooled horse spermatozoa: Loss of viability is due to osmotic imbalance during thawing, not intracellular ice formation. Theriogenology 2007; 68:804-812.##Niasari-Naslaji A, Mosaferi S, Bahmani N, Abarghani A, Gharahdaghi AA, Gerami A. Effect of lactose extender with different levels of osmolality and pH on the viability of Bactrian camel (Camelus bactrianus) spermatozoa. IJVR 2006; 7: 14-22.##Andrade AFCd, Celeghini ECC, Yonezawa LA, Spers A, Arruda RPd. In vitro efficiency of three extenders for rabbit semen. Braz J Vet Res Anim Sci 2008; 45: 33-39.##Rigby SL, Brinsko SP, Cochran M, Blanchard TL, Love CC, Varner DD. Advances in cooled semen technologies: seminal plasma and semen extender. Anim Reprod Sci 2001;68: 171-180.##Agca Y, Gilmore J, Byers M, Woods EJ, Liu J, Critser JK. Osmotic characteristics of mouse spermatozoa in the presence of extenders and sugars. Biol Reprod 2002; 67:1493-1501.##Liu ZS, Foote RH. Osmotic effects on volume and motility of bull sperm exposed to membrane permeable and nonpermeable agents. Cryobiology 1998; 37:207-218.##Waterhouse KE, Gjeldnes A, Tverdal A, De Angelis PM, Farstad W, Haard M, Kommisrud E. Alterations of sperm DNA integrity during cryo preservation procedure and in vitro incubation of bull semen. Anim Reprod Sci 2010; 117: 34-42.##Pommer AC, Rutllant J, Meyers SA. The role of osmotic resistance on equine spermatozoal function. Theriogenology 2002; 58: 1373-1384.##Chaveiro A, Liu J, Engel B, Critser JK, Woelders H. Significant variability among bulls in the sperm membrane permeability for water and glycerol: Possible implications for semen freezing protocols for individual males. Cryobiology 2006; 53:349-359.##Varisli O, Uguz C, Agca C, Agca Y. Motility and acrosomal integrity comparisons between electro-ejaculated and epididymal ram sperm after exposure to a range of anisosmotic solutions, cryoprotective agents and low temperatures. Anim Reprod Sci 2009; 110: 256-268.##Zhao YY, Buhr MM. Cryopreservation extenders affect calcium flux in bovine spermatozoa during a temperature challenge. J Androl 1995; 16: 278-285.##Vishwanath R, Shannon P. Storage of bovine semen in liquid and frozen state. Anim Reprod Sci 2000; 62: 23-53.##Cooper TG, Hellenkemper B. Method-Related Estimates of Sperm Vitality. J Androl 2009; 30: 214-218.##SAS. SAS/STAT User's Guide. Release 6.03 Edn., Statistical Analysis Systems Institute, Inc., Cary, NC.; 1996: 550-641.##Brackett BG, Oliphant G. Capacitation of rabbit spermatozoa in vitro. Biol Reprod 1975; 12:260-274.##Webb GW, Arns MJ. Influence of modified Tyrode's media on motility of cold-stored stallion spermatozoa. J Equine Vet Sci 1995; 15: 441-444.##Parks JE. Hypothermia and mammalian gametes. In: Karow AM, Critser JK. (Eds.). Reproductive tissue banking: scientific principles, San Diego, USA: Academic press; 1997: 229-247.##Batellier F, Vidament M, Fauquant J, Duchamp G, Arnaud G, Yvon JM, Magistrini M. Advances in cooled semen technology. Anim Reprod Sci 2001; 68: 181-190.##Ball BA. Oxidative stress, osmotic stress and apoptosis: Impacts on sperm function and preservation in the horse. Anim Reprod Sci 2008; 107:257-267.##Zhang BR, Buhr M, Kroetsch T, Leibo SP. Glycine betaine improves survival of fresh bovine spermatozoa. Reproduction Fertility Dev 2001; 13: 187-192.##Zhou JB, Yue KZ, Luo MJ, Chang ZL, Liang H, Wang ZY, Tan JH. Effect of extenders and temperatures on sperm viability and fertilizing capacity of Harbin white boar semen during long-term liquid storage. AJAS 2004; 17: 1501-1508.##Li G, Saenz J, Godke RA, Devireddy RV. Effect of glycerol and cholesterol-loaded cyclodextrin on freezing-induced water loss in bovine spermatozoa. Reproduction 2006; 131: 875-886.##Van Thuan N, Wakayama S, Kishigami S, Wakayama T. New preservation method for mouse spermatozoa without freezing. Biol Reprod 2005; 72: 444-450.##Gao DO, Mazur P, Critser JK. Fundamental cryobiology of mammalian spermatozoa, In: Karow AM, Critser JK. (Eds.). Reproductive tissue banking: scientific priniciples, San Diego, USA: Academic press; 1997: 263-328.##Morris GJ, Faszer K, Green JE, Draper D, Grout BWW, Fonseca F. Rapidly cooled horse spermatozoa: Loss of viability is due to osmotic imbalance during thawing, not intracellular ice formation. Theriogenology 2007; 68:804-812.##Niasari-Naslaji A, Mosaferi S, Bahmani N, Abarghani A, Gharahdaghi AA, Gerami A. Effect of lactose extender with different levels of osmolality and pH on the viability of Bactrian camel (Camelus bactrianus) spermatozoa. IJVR 2006; 7: 14-22.##Andrade AFCd, Celeghini ECC, Yonezawa LA, Spers A, Arruda RPd. In vitro efficiency of three extenders for rabbit semen. Braz J Vet Res Anim Sci 2008; 45: 33-39.##Rigby SL, Brinsko SP, Cochran M, Blanchard TL, Love CC, Varner DD. Advances in cooled semen technologies: seminal plasma and semen extender. Anim Reprod Sci 2001;68: 171-180.##Agca Y, Gilmore J, Byers M, Woods EJ, Liu J, Critser JK. Osmotic characteristics of mouse spermatozoa in the presence of extenders and sugars. Biol Reprod 2002; 67:1493-1501.##Liu ZS, Foote RH. Osmotic effects on volume and motility of bull sperm exposed to membrane permeable and nonpermeable agents. Cryobiology 1998; 37:207-218.##Waterhouse KE, Gjeldnes A, Tverdal A, De Angelis PM, Farstad W, Haard M, Kommisrud E. Alterations of sperm DNA integrity during cryo preservation procedure and in vitro incubation of bull semen. Anim Reprod Sci 2010; 117: 34-42.##Pommer AC, Rutllant J, Meyers SA. The role of osmotic resistance on equine spermatozoal function. Theriogenology 2002; 58: 1373-1384.##Chaveiro A, Liu J, Engel B, Critser JK, Woelders H. Significant variability among bulls in the sperm membrane permeability for water and glycerol: Possible implications for semen freezing protocols for individual males. Cryobiology 2006; 53:349-359.##Varisli O, Uguz C, Agca C, Agca Y. Motility and acrosomal integrity comparisons between electro-ejaculated and epididymal ram sperm after exposure to a range of anisosmotic solutions, cryoprotective agents and low temperatures. Anim Reprod Sci 2009; 110: 256-268.##Zhao YY, Buhr MM. Cryopreservation extenders affect calcium flux in bovine spermatozoa during a temperature challenge. J Androl 1995; 16: 278-285.##Vishwanath R, Shannon P. Storage of bovine semen in liquid and frozen state. Anim Reprod Sci 2000; 62: 23-53.##Cooper TG, Hellenkemper B. Method-Related Estimates of Sperm Vitality. J Androl 2009; 30: 214-218.##SAS. SAS/STAT User's Guide. Release 6.03 Edn., Statistical Analysis Systems Institute, Inc., Cary, NC.; 1996: 550-641.##Brackett BG, Oliphant G. Capacitation of rabbit spermatozoa in vitro. Biol Reprod 1975; 12:260-274.##Webb GW, Arns MJ. Influence of modified Tyrode's media on motility of cold-stored stallion spermatozoa. J Equine Vet Sci 1995; 15: 441-444.##Parks JE. Hypothermia and mammalian gametes. In: Karow AM, Critser JK. (Eds.). Reproductive tissue banking: scientific principles, San Diego, USA: Academic press; 1997: 229-247.##Batellier F, Vidament M, Fauquant J, Duchamp G, Arnaud G, Yvon JM, Magistrini M. Advances in cooled semen technology. Anim Reprod Sci 2001; 68: 181-190.##Ball BA. Oxidative stress, osmotic stress and apoptosis: Impacts on sperm function and preservation in the horse. Anim Reprod Sci 2008; 107:257-267.##Zhang BR, Buhr M, Kroetsch T, Leibo SP. Glycine betaine improves survival of fresh bovine spermatozoa. Reproduction Fertility Dev 2001; 13: 187-192.##Zhou JB, Yue KZ, Luo MJ, Chang ZL, Liang H, Wang ZY, Tan JH. Effect of extenders and temperatures on sperm viability and fertilizing capacity of Harbin white boar semen during long-term liquid storage. AJAS 2004; 17: 1501-1508.##Li G, Saenz J, Godke RA, Devireddy RV. Effect of glycerol and cholesterol-loaded cyclodextrin on freezing-induced water loss in bovine spermatozoa. Reproduction 2006; 131: 875-886.##Van Thuan N, Wakayama S, Kishigami S, Wakayama T. New preservation method for mouse spermatozoa without freezing. Biol Reprod 2005; 72: 444-450.## ##

Infertility in Mazandaran province - north of Iran: an etiological study بررسی اتیولوژیک ناباروری در مازندران – شمال ایران 2 1 مقدمه: شیوع ناباروری و نیز توزیع علل مختلف آن در میان جمعیت زوج های نابارور در نواحی مختلف دنیا متفاوت می باشد. در خصوص بررسی علل مختلف ناباروری مطالعات انجام شده در ایران محدود هستند. هدف: این مطالعه به منظور مشخص کردن علل اصلی ناباروری در بیماران نابارور منطقه مازندران و تعیین نسبت هر یک از علت ها انجام شده است. مواد و روش ها: در این مطالعه توصیفی، پرونده پزشکی 3734 زوج نابارور مراجعه کننده به دو کلینیک اصلی ناباروری استان مازندران، طی سال های 1380 تا 1385 مورد بررسی قرار گرفت. در این مطالعه افراد نابارور کسانی در نظر گرفته شدند که پس از یک سال زناشویی بدون پیشگیری بچه دار نشده بودند. یافته ها: از کل جمعیت نابارور مورد مطالعه، 78/7 درصد نازایی اولیه و 3/21 درصد نازایی ثانویه داشتند. میانگین دوره ناباروری پیش از اولین مراجعه به یک کلینیک ناباروری 4 ±5/7 سال بوده است. تعیین علل ناباروری در بیماران نشان داد که 38/9 درصد نازایی ها، بدلیل علل مردانه، 34/7 درصد به علل زنانه و در 14/6 درصد، هر دو زوج درگیر بودند. در 11/8 درصد موارد هم علت ناباروری شناخته نشد. نتیجه گیری: در این مطالعه، تاخیر زمانی قابل توجه ای در مراجعه زوج های نابارور به یک کلینیک ناباروری دیده می شود. بدین ترتیب بنظر می رسد برنامه آموزش بهداشت باروری و آگاهی دادن در خصوص فاکتورهای خطر از جمله تاخیر در درمان نازایی و راههای پیشگیری از وقوع احتمالی مشکلات باروری، باید مورد توجه بیشتری قرار گیرند.   2 Background: The prevalence and etiology of infertility are not similar in different parts of the world. There are only few reports of this topic in Iran. Objective: This study was conducted to determine the clinical patterns and major causes of infertility in Mazandaran province in north of Iran. Materials and Methods: The medical records of 3734 consecutive couples attending two infertility clinics in Mazandaran province, from 2003 to 2008, were reviewed. The couples had not had a viable birth after at least 1 year of unprotected intercourse and were fully investigated. Results: Of the entire samples, 78.7% had primary infertility and 21.3% had secondary infertility. The mean duration of infertility in couples was 5.7±4 years. The etiology of infertility in couples revealed; male factor in 38.9%, female factor in 34.7%, combined factors in 14.6% and undetermined cause in 11.8%. Conclusion: In this study, delayed attendance of infertile couples to the infertility clinic was found. Therefore, there is a need to revise public health program on infertility to focus on the education and prevention of infertility and its risk factors. 0 0 2017/10/12017/10/1 1396/7/9 2017/10/52017/10/5 1396/7/13 عباسعلی کریم پور ملکشاه Abbasali Karimpour Malekshah Department of Embryology, Cellular and Molecular Center, Imam University Hospital, Infertility Center, Mazandaran University of Medical Sciences, Sari, Iran ایران امیر اسماعیل نژاد مقدم Amir Esmailnejad Moghaddam Department of Embryology, Infertility Center, Imam University Hospital, Mazandaran University of Medical Sciences, Sari, Iran ایران نرگس مسلمی زاده Narges Moslemizadeh Department of Obstetrics and Gynecology, Infertility Center, Imam University Hospital, Mazandaran University of Medical Sciences, Sari, Iran ایران سپیده پیوندی Sepideh Peivandi Department of Obstetrics and Gynecology, Infertility Center, Imam University Hospital, Mazandaran University of Medical Sciences, Sari, Iran ایران ایوب برزگرنژاد Ayyub Barzegarnejad Department of Urology, Infertility Center, Imam University Hospital, Mazandaran University of Medical Sciences, Sari, Iran ایران ayubbarzgarnejad@gmail.com نادعلی موسی نژاد Nadali Musanejad Department of Urology, Infertility Center, Imam University Hospital, Mazandaran University of Medical Sciences, Sari, Iran ایران غلامعلی جورسرایی Gholamali Jursarayee Department of Embryology, Fatemeh Zahra Infertility Center, Babol University of Medical Sciences, Babol, Iran ایران Primary infertility Secondary infertility Male factor Ovarian dysfunction Varicocel ناباروری اولیه ناباروری ثانویه فاکتورهای مردانه نارسایی تخمدان واریکوسل World Health Organization. Infertility: A tabulation of available data on prevalence of primary and secondary infertility, Geneva: WHO program on maternal and child health and family planning, division of family health, 1991.##Kds A, Nguyen T. Infertility in developing countries. Reproductive Health Outlook 1997; 15: 1-14.##Moghaddam A, Karimpour Malekshah A, Talebpour Amiri F, Taringou F. The prevalence of infertility in center region of Mazandaran province in 1999. Journal of Mazandaran University of Medical Sciences 2000; 10:12-18.##Vahidi S, Ardalan A, Kazem m. The epidemiology of primary infertility in the Islamic republic of iran in 2004-2005. Journal of Reproduction and Infertility 2006; 7: 243-251.##Leke RJ, Bassol-Mayagoitia S. Bacha AM, Grigor KM. Regional and geographical variation in infertility: effects of environmental, cultural and socioeconomic factors. Environ Health Perspect 1993; 101: 73-80.##Terava AN, Gissler M, Hemminiki E, Luoto R. Infertility and the use of infertility treatments in Finland: prevalence and socio-demographic determinants 1992-2004. Eur J Obstet Gynecol Reprod Biol 2008; 136: 61-66.##Wyshak G. Infertility in Americian college alumnae. International Journal of Gynecol Obstet 2001; 73: 237-242.##Aflatoonian A, Seyedhassani SM, Tabibnejad N. The epidemiological and etiological aspect of infertility inYazd province of Iran. Iranian Journal of Reproductive Medicine 2009; 7: 117-122.##Safarinejad M. Infertility among couples in a population-based study in Iran: prevalence and associated risk factors. Int J Androl 2008; 31: 303-314.##World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction, 4th edition, Cambridge: Cambridge university press, 1999.##Esmeilzadeh S, Farsi M, Nazari T.The cause of infertility in the patients referring to Babol township fatemeh Zahra infertility center from May 1996 to May 1998. Journal of Mazandaran University of Medical Sciences 2002; 12: 29-33.##Kamali M, Kashfi F, Baghestani AR, Kashani H, Tavajohi SH, Amirchaghmaghi E. The epidemiologic survey on causes of infertility in patients refered to Royan institute. Medical Journal of Tabriz University of Medical Sciences 2006; 28: 103-105.##Cates W, Farley TMM, Rowe PJ. Worldwide patterns of infertility. Is Africa different? Lancet 1985; 2: 596-598.##Orhue A, Aziken M. Experience with a comprehensive university hospital-based infertility program in Nigeria. Int J Gynaecol Obstet 2008; 101: 11-15.##Bayasgalan G, Naranbat D, Tsedmaa B, Tsogmaa B, Sukhee D, Amarjargal O, Lhagvasuren T, Radnaabazar J, Rowe PJ. Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynaecol Res 2004; 30: 386-394.##World health organization. Infections, pregnancies and infertility: Perspectives on prevention. Fertil Steril 1987; 47: 964-968.##Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M. Epidemiologic and aspects of primary infertility in the Kashmir region of India. Fertil Steril 1997; 68: 637-643.##Omu AE, Ismail AA, AL-Qattan F. Infertility in Kuwait. Int J Gynaecol Obstet 1999; 67: 113-114.##Cates W, Farley TM, Rowe PJ. Patterns of infertility in the developed and developing world. in: Rowe PJ, Vikhlaeva EM (eds) WHO symposium on diagnosis and treatment of infertility, Yerevan, Armenia Toronto: Han,s Huber publisher, 1988: 57-67.##Isaksson R, Tiitinen A. Present concept of unexplained infertility. Gynaecol Endocrionol 2004: 18: 278-290.##Forti G, Krausz C. Evaluation and treatment of the infertile couple. Clin Endocrinol Metabol 1998; 83: 4177-4188.##Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three Franch regions (1988-1989). Hum Reprod 1991; 6: 811-816.##Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, Coulson C, Lambert PA, Watt EM, Desai KM. Population study of causes, treatment and outcome of infertility. Br Med J (Clin Res Ed) 1985; 291: 1693-1697.##Rahim R, Majid SS. Aetiological factors of infertility. JPMI 2004; 18: 166-171.##Philippov OS, Radionchenko AA, Bolotova VP, Voronovskaya NI, Potemkina TV. Estimation of the prevalence and causes of infertility in western Siberia. Bull World Health Organ 1998; 76: 183-187.##Inhorn Mc, Buss KA. Ethnography epidermiology and infertility in Egypt. Social Science and Medicine1994; 39: 671-686.##Ericksen K, Brunette T. Patterns and predictors of infertility among African women: A cross-national survey of twenty seven nations. Social Science and Medicine 1996; 42: 209-220.##World Health Organization. Infertility: A tabulation of available data on prevalence of primary and secondary infertility, Geneva: WHO program on maternal and child health and family planning, division of family health, 1991.##Kds A, Nguyen T. Infertility in developing countries. Reproductive Health Outlook 1997; 15: 1-14.##Moghaddam A, Karimpour Malekshah A, Talebpour Amiri F, Taringou F. The prevalence of infertility in center region of Mazandaran province in 1999. Journal of Mazandaran University of Medical Sciences 2000; 10:12-18.##Vahidi S, Ardalan A, Kazem m. The epidemiology of primary infertility in the Islamic republic of iran in 2004-2005. Journal of Reproduction and Infertility 2006; 7: 243-251.##Leke RJ, Bassol-Mayagoitia S. Bacha AM, Grigor KM. Regional and geographical variation in infertility: effects of environmental, cultural and socioeconomic factors. Environ Health Perspect 1993; 101: 73-80.##Terava AN, Gissler M, Hemminiki E, Luoto R. Infertility and the use of infertility treatments in Finland: prevalence and socio-demographic determinants 1992-2004. Eur J Obstet Gynecol Reprod Biol 2008; 136: 61-66.##Wyshak G. Infertility in Americian college alumnae. International Journal of Gynecol Obstet 2001; 73: 237-242.##Aflatoonian A, Seyedhassani SM, Tabibnejad N. The epidemiological and etiological aspect of infertility inYazd province of Iran. Iranian Journal of Reproductive Medicine 2009; 7: 117-122.##Safarinejad M. Infertility among couples in a population-based study in Iran: prevalence and associated risk factors. Int J Androl 2008; 31: 303-314.##World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction, 4th edition, Cambridge: Cambridge university press, 1999.##Esmeilzadeh S, Farsi M, Nazari T.The cause of infertility in the patients referring to Babol township fatemeh Zahra infertility center from May 1996 to May 1998. Journal of Mazandaran University of Medical Sciences 2002; 12: 29-33.##Kamali M, Kashfi F, Baghestani AR, Kashani H, Tavajohi SH, Amirchaghmaghi E. The epidemiologic survey on causes of infertility in patients refered to Royan institute. Medical Journal of Tabriz University of Medical Sciences 2006; 28: 103-105.##Cates W, Farley TMM, Rowe PJ. Worldwide patterns of infertility. Is Africa different? Lancet 1985; 2: 596-598.##Orhue A, Aziken M. Experience with a comprehensive university hospital-based infertility program in Nigeria. Int J Gynaecol Obstet 2008; 101: 11-15.##Bayasgalan G, Naranbat D, Tsedmaa B, Tsogmaa B, Sukhee D, Amarjargal O, Lhagvasuren T, Radnaabazar J, Rowe PJ. Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynaecol Res 2004; 30: 386-394.##World health organization. Infections, pregnancies and infertility: Perspectives on prevention. Fertil Steril 1987; 47: 964-968.##Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M. Epidemiologic and aspects of primary infertility in the Kashmir region of India. Fertil Steril 1997; 68: 637-643.##Omu AE, Ismail AA, AL-Qattan F. Infertility in Kuwait. Int J Gynaecol Obstet 1999; 67: 113-114.##Cates W, Farley TM, Rowe PJ. Patterns of infertility in the developed and developing world. in: Rowe PJ, Vikhlaeva EM (eds) WHO symposium on diagnosis and treatment of infertility, Yerevan, Armenia Toronto: Han,s Huber publisher, 1988: 57-67.##Isaksson R, Tiitinen A. Present concept of unexplained infertility. Gynaecol Endocrionol 2004: 18: 278-290.##Forti G, Krausz C. Evaluation and treatment of the infertile couple. Clin Endocrinol Metabol 1998; 83: 4177-4188.##Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three Franch regions (1988-1989). 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Controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unilateral tubal blockage diagnosed by hysterosalpingography انجام تحریک کنترل شده تخمدانی و تزریق درون رحمی نطفه در بیماران مبتلا به انسداد یک طرفه لوله رحمی تشخیص داده شده با هیستروسالپنگوگرافی 2 1 مقدمه: تحریک کنترل شده تخمدانی همراه با  تزریق درون رحمی نطفه یک برنامه درمانی مناسب برای برخی از بیماران نابارور میباشد. بنابراین ما تصمیم گرفتیم که  این برنامه درمانی را در درمان بیمارانی که بسته بودن یک طرفه لوله رحمی آنها توسط هیستروسالپنگوگرافی نشان داده شده است، امتحان نمائیم.   هدف: بررسی تاثیر بسته بودن یک طرفه لوله رحمی (نشان داده شده توسط هیستروسالپنگوگرافی)  بر روی میزان تجمعی حاملگی در سیکل های تحریک شده تزریق درون رحمی نطفه. مواد و روش ها: این تحقیق یک مطالعه مقطعی- موردی است که از مهر ماه 1385 تا مهرماه  1388، در یک مرکز دانشگاهی ناباروری انجام شده است. دو گروه بیمار مورد بررسی قرار گرفته اند. در گروه مطالعه 64 زوج با تشخیص بسته بودن یک طرفه لوله رحمی، و در گروه شاهد  200 زوج با تشخیص نازایی با عامل ناشناخته قرار گرفتند.  سه سیکل تحریک شده ( کلومیفن سیترات و (hMG به همراه تزریق درون رحمی نطفه دراین بیماران انجام و میزان تجمعی حاملگی در این دو گروه مقایسه گردید. نتایج: مشخصات دموگرافیک گروه ها یکسان می باشد. میزان حاملگی در گروه مطالعه(26/6%) و در گروه شاهد  ( 28%) بود  که ازنظر آماری تفاوت معنی داری بین دو گروه مشاهده نگردید  p=0.87; OR=1.075; 95% CI: 0.57 -2.28)                                                                                           بحث: بسته بودن یک طرفه لوله ها که  توسط هیستروسالپنگوگرافی نشان داده شده است، اثری بر روی میزان موفقیت سیکل های تحریک شده همراه با تزریق داخل رحمی نطفه ندارد. بنابرین سیکل های تحریک شده همراه با تزریق داخل رحمی نطفه را می توان به عنوان اولین اقدام درمانی در این گروه بیماران نابارورپیشنهادکرد.   2  Background: Controlled ovarian hyperstimulation and intrauterine insemination (IUI) cycle is an ideal protocol for some subfertile patients. So, we decided to try this therapeutic protocol for the patients with unilateral tubal blockage diagnosed by hysterosalpingography (HSG).        Objective: To evaluate the effect of unilateral tubal blockage diagnosed by HSG on cumulative pregnancy rate (CPR) of the stimulated IUI cycles.           Materials and Methods: A cross-sectional analysis was performed between October 2006 and October 2009 in an academic reproductive endocrinology and infertility center. Two groups of patients undergoing stimulated IUI cycles were compared. Sixty-four infertile couples with unilateral tubal blockage diagnosed by HSG as the sole cause of infertility in the group (І), and two hundred couples with unexplained infertility in the group (II). The patients underwent 3 consecutive ovarian hyperstimulation (Clomiphen citrate and human menopausal gonadotropin) and IUI cycles. The main outcome measurements were the CPRs per patients for 3 consecutive stimulated IUI cycles.                                             Results: Cycle characteristics were found to be homogenous between the both groups. CPRs were similar in group І (26.6%) and group II (28%) (p=0.87; OR=1.075; 95% CI: 0.57 -2.28). Conclusion: Unilateral tubal blockage (diagnosed on HSG) has no effect on success rate of stimulated IUI cycles, so COH and IUI could be recommended as the initial therapeutic protocol in these patients. 0 0 2017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/5 1396/7/13 مهبد ابراهیمی Mahbod Ebrahimi Department of Obstetrics and Gynecology, Mirza Koochak Khan Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran , Iran ایران Maeb214@Yahoo.com فیروزه اکبری اسبق Firoozeh Akbari Asbagh Department of Obstetrics and Gynecology, Mirza Koochak Khan Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran , Iran ایران عزیزه قاسمی نژاد Azizeh Ghaseminejad Department of Obstetrics and Gynecology, Mirza Koochak Khan Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran , Iran ایران Hysterosalpingography Intrauterine insemination Ovarian hyperstimulation هیستروسالپنگوگرافی تزریق درون رحمی نطفه تحریک تخمدانی Evert JL. Female subfertility, Lancet 2002; 360:151-159.##National Institue for Clinical Excellence. Fertility: Assessment and Treatment for People with Fertility problem. Full Guideline 2002, RCOG press, London.##Cheong YC, Li TC, Evidence-based management of tubal disease and infertility. Current Obstet Gynecol 2005; 15: 306-313.##Mol BW, Collin JA, Van Der Veen F, Bossuryt PM. Cost-effectiveness of hysterosalpingography, laparoscopy and Chlamydia antibodies testing in subfertile couples. Fertil Steril 2001; 75: 571-580.##Swart P, Mol BW, Van der veen F. The accuracy of hysterosalpingography and diagnosis of tubal pathology: a meta-analysis, Fertil Steril 1995, 64: 486-891.##Feyez JA, Mutie G, Schneider PJ. The diagnostic value of hysterosalpingography and laparoscopy in infertility investigation.Int J Fertil 1988; 33: 98-101.##Hutchins CJ, Laparoscopy and hysterosalpingography in the assessment of tubal patency. Obstet Gynecol 1997; 49:325-327.##Karasick S, Goldfarb AF. Peritubal adhesion in infertile women: diagnosis with hysterosalpingography. Am J Rentgenol 1989; 152:777-779.##Tanahatoe S, Lambalk CB, Hompes PGA. The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study. Hum Reprod 2005; 20: 3225-3230.##Lavy Y, Lev-sagie A, Holtzer H, Revel A, Hurwitz A. Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingography or suspected unilateral tubal pathology? European J OB ;GYN 2004; 114:64-68.##Fatum M, Laufer N, Simon A. Should diagnostic laparoscopy be performed after normal hysteroscopy in treating infertility suspected to be unknown origin? Hum Reprod 2002; 17:1-3.##The ESHRE Capri Workshop Group. Optimal use of infertility diagnostic tests and treatment. Hum Reprod 2000; 15: 723-732.##Honore GM, Holden AEC, Schenken RS, Pathophysiology and management of proximal tubal blockage. Fertil Steril 1999; 71: 785-795.##Papaioannou S, A hypothesis for the pathogenesis and natural history of proximal tubal blockage. Hum Reprod 2004; 19: 481-485.##Dchaud H, Reyftmann L, Faidherbe J, Hamamah S, Hedon B. Evidence-based reproductive surgery: tubal infertility . International Congress Series 2004; 1266: 96-100.##Coppus SFPG, Steures P, Van der steeg JW, Hompes PG A, Van der veen F, Mol BWJ. Unilateral tubal pathology on hysterosalpingography or diagnostic laparoscopy does not have prognostic significance for treatment – independent pregnancy at 12 months follow-up. Fertil Steril 2007; 88:s191.##Mol BWJ, Swart P, Bossuyt P, Van der veen F. Is hysterosalpingography an important tool in predicting fertility outcome? Fertil Steril 1997:67; 663-669.##Nordenskjold F, Ahlgren M. Laparoscopy in female infertility. Acta Obstet Gynecol Scand 1983; 62: 609-615.##Farhi J, Ben-Haroush A, Lande Y, Fish B. Role of treatment with ovarian stimulation and intrauterine insemination in women with unilateral tubal occlusion diagnosed by hysterosalpingography. Fertil Steril 2007; 88:396-400.##World Health Organization, Laboratory manual of the examination of human semen and sperm-mucus interaction, Cambridge, University Press, Cambridge, U.K; 1992.##American Fertility Society. Intervention of the infertile couple. Birmingham, AL: American Fertility Society; 1992##Rowe PJ, Comhaire FA, Hargreave TB, Mahmoud AMA. WHO, Manual for the standardized investigation of infertile couples. Cambridge, U K, Cambridge University, Press; 1993.##Chapron C, Querieu D, Bruhat MA, Madelenat P, Frenandez H, Pierre F, Dubuisson JB, Surgical complications of diagnostic and operative gynecological laparoscopy: a series of 29966 cases. Hum Reprod 1998; 13:867-872.##Gutmann JN, Emaging in the evaluation of female infertility. J Reprod Med 1992; 37; 54-61.##Parazzini F, Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Hum Reprod 1999; 14: 1332-1334.##Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 1997; 337:217-222.##Simon A, Laufer N. Unexplained infertility: a reappraisal. Ass Reprod Rev 1993; 3: 3026-36.##Mol BW, Dijkman B, Wertheim P, Lijmer J, Van der veen F, Bossuy PM, The accuracy of serum Chlamydia antibodies in the diagnosis of tubal pathology: a meta-analysis . Fertil Steril 1997; 67: 1031-1037.##Mol B W, Collins J A, BurrowEA, Van der veen F, Bossoyt P M. Comprison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod 1999; 14: 1237-1242.##Dessole S, Battista G, Capobianco G, Menzoni MA, Ambrosini G, Canalis GC. A second hysterosalpingography reduce the use of selective technique for treatment of a proximal tubal obstruction. Fertil Steril 2000; 73: 1037-1039.##Evert JL. Female subfertility, Lancet 2002; 360:151-159.##National Institue for Clinical Excellence. Fertility: Assessment and Treatment for People with Fertility problem. Full Guideline 2002, RCOG press, London.##Cheong YC, Li TC, Evidence-based management of tubal disease and infertility. Current Obstet Gynecol 2005; 15: 306-313.##Mol BW, Collin JA, Van Der Veen F, Bossuryt PM. Cost-effectiveness of hysterosalpingography, laparoscopy and Chlamydia antibodies testing in subfertile couples. Fertil Steril 2001; 75: 571-580.##Swart P, Mol BW, Van der veen F. The accuracy of hysterosalpingography and diagnosis of tubal pathology: a meta-analysis, Fertil Steril 1995, 64: 486-891.##Feyez JA, Mutie G, Schneider PJ. The diagnostic value of hysterosalpingography and laparoscopy in infertility investigation.Int J Fertil 1988; 33: 98-101.##Hutchins CJ, Laparoscopy and hysterosalpingography in the assessment of tubal patency. Obstet Gynecol 1997; 49:325-327.##Karasick S, Goldfarb AF. Peritubal adhesion in infertile women: diagnosis with hysterosalpingography. Am J Rentgenol 1989; 152:777-779.##Tanahatoe S, Lambalk CB, Hompes PGA. The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study. Hum Reprod 2005; 20: 3225-3230.##Lavy Y, Lev-sagie A, Holtzer H, Revel A, Hurwitz A. Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingography or suspected unilateral tubal pathology? European J OB ;GYN 2004; 114:64-68.##Fatum M, Laufer N, Simon A. Should diagnostic laparoscopy be performed after normal hysteroscopy in treating infertility suspected to be unknown origin? Hum Reprod 2002; 17:1-3.##The ESHRE Capri Workshop Group. Optimal use of infertility diagnostic tests and treatment. Hum Reprod 2000; 15: 723-732.##Honore GM, Holden AEC, Schenken RS, Pathophysiology and management of proximal tubal blockage. Fertil Steril 1999; 71: 785-795.##Papaioannou S, A hypothesis for the pathogenesis and natural history of proximal tubal blockage. Hum Reprod 2004; 19: 481-485.##Dchaud H, Reyftmann L, Faidherbe J, Hamamah S, Hedon B. Evidence-based reproductive surgery: tubal infertility . International Congress Series 2004; 1266: 96-100.##Coppus SFPG, Steures P, Van der steeg JW, Hompes PG A, Van der veen F, Mol BWJ. Unilateral tubal pathology on hysterosalpingography or diagnostic laparoscopy does not have prognostic significance for treatment – independent pregnancy at 12 months follow-up. Fertil Steril 2007; 88:s191.##Mol BWJ, Swart P, Bossuyt P, Van der veen F. Is hysterosalpingography an important tool in predicting fertility outcome? Fertil Steril 1997:67; 663-669.##Nordenskjold F, Ahlgren M. Laparoscopy in female infertility. Acta Obstet Gynecol Scand 1983; 62: 609-615.##Farhi J, Ben-Haroush A, Lande Y, Fish B. Role of treatment with ovarian stimulation and intrauterine insemination in women with unilateral tubal occlusion diagnosed by hysterosalpingography. Fertil Steril 2007; 88:396-400.##World Health Organization, Laboratory manual of the examination of human semen and sperm-mucus interaction, Cambridge, University Press, Cambridge, U.K; 1992.##American Fertility Society. Intervention of the infertile couple. Birmingham, AL: American Fertility Society; 1992##Rowe PJ, Comhaire FA, Hargreave TB, Mahmoud AMA. WHO, Manual for the standardized investigation of infertile couples. Cambridge, U K, Cambridge University, Press; 1993.##Chapron C, Querieu D, Bruhat MA, Madelenat P, Frenandez H, Pierre F, Dubuisson JB, Surgical complications of diagnostic and operative gynecological laparoscopy: a series of 29966 cases. Hum Reprod 1998; 13:867-872.##Gutmann JN, Emaging in the evaluation of female infertility. J Reprod Med 1992; 37; 54-61.##Parazzini F, Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Hum Reprod 1999; 14: 1332-1334.##Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 1997; 337:217-222.##Simon A, Laufer N. Unexplained infertility: a reappraisal. Ass Reprod Rev 1993; 3: 3026-36.##Mol BW, Dijkman B, Wertheim P, Lijmer J, Van der veen F, Bossuy PM, The accuracy of serum Chlamydia antibodies in the diagnosis of tubal pathology: a meta-analysis . Fertil Steril 1997; 67: 1031-1037.##Mol B W, Collins J A, BurrowEA, Van der veen F, Bossoyt P M. Comprison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod 1999; 14: 1237-1242.##Dessole S, Battista G, Capobianco G, Menzoni MA, Ambrosini G, Canalis GC. A second hysterosalpingography reduce the use of selective technique for treatment of a proximal tubal obstruction. Fertil Steril 2000; 73: 1037-1039.## ##

The pregnancy outcome in patients with minor β-thalassemia بررسی پیش آگهی حاملگی در بیماران مبتلا به بتا تالاسمی مینور 2 1 مقدمه: بتا تالاسمی شایع ترین بیماری وراثتی در ایران میباشد و حدود 2 میلیون نفر ناقل ژن بتا تالاسمی در این کشور زندگی می کنند. هدف : این مطالعه جهت بررسی پیش آگهی حاملگی در بیماران مبتلا به بتا تالاسمی مینور، طراحی شده است. روش کار : این تحقیق، یک مطالعه مورد-شاهدی است که بر روی بیمارانی که بین سالهای 1385 تا 1388، در 2 بیمارستان دانشگاهی شیراز زایمان داشته اند، انجام شد. بیماران به دو گروه بر اساس حضور بتاتالاسمی مینور تقسیم شدند. بیماران درگروه شاهد و مورد بر اساس سن مادر، سن حاملگی و تعداد حاملگیهای قبلی هماهنگ بودند. انجام سزارین، بیماریهای پرفشاری خون، دیابت حاملگی، پارگی زود رس کیسه آب و زایمان زودرس در هر گروه ثبت و بوسیله تست های χ2  یا  Fisher exact مقایسه گردید. نتایج: در کل 510 بیمار بتا تالاسمی مینور و 512 فرد غیر تالاسمی بررسی شده اند. در بیماران با بتا تالاسمی مینور میزان الیگو  هیدرآمینیوس ((p<0.001 و سزارین )p=0.002( ، بالاتر بود. اختلاف معنی دار آماری در آپگار دقیقه یک (p=0.65) ، دقیقه پنج )p=0.25( ، محدودیت رشد داخل رحمی )p=0.74( ، دیابت حاملگی (p=0.43) و پره اکلامپسی (p=0.11) وجود نداشت. بحث و نتیجه گیری:  بتا تالاسمی مینور روی پیامد حاملگی تاثیر منفی عمده نداشت. 2 Background: β-thalassemia is the most common hereditary disease in Iran and more than 2 million carriers of the β-thalassemia mutant gene are living in this country. Objective: To determine pregnancy outcome of women with β-thalassemia minor. Materials and Methods: In this retrospective, case-control study in two universities affiliated hospitals in Shiraz, all pregnancies occurred between 2006 and 2008 were included. Patients were divided in two groups regarding the presence of β-thalassemia minor. Patients in case and control groups were matched according to maternal age, gestational age and number of previous pregnancies. Cesarean delivery, hypertensive disorders, gestational diabetes mellitus, premature rupture of membranes and preterm labor were recorded in each group and were compared using the χ2 or Fisher exact tests.  Results: Overall 510 β-thalassemia minor subjects and 512 healthy controls were studied. Cases with β-thalassemia minor had significantly higher prevalence of oligohydramnios (p<0.001) and cesarean section delivery (p=0.001). There was no significant difference regarding Apgar score in 1st (p=0.65) and 5th minute (p=0.25), IUGR (p=0.073), gestational diabetes mellitus (DM) (p=0.443) and preeclampsia (p=0.116) between two study groups.     Conclusion: β-thalassemia minor does not significantly influence the pregnancy outcome in the negative way.   0 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 صدیقه عمویی Sedigheh Amooee Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran ایران عالمتاج صمصامی Alamtaj Samsami Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran ایران جمیله جهانبخش Jamileh Jahanbakhsh Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran ایران مهران کریمی Mehran Karimi Hematology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran ایران karimim@sums.ac.ir Minor β-thalassemia Pregnancy outcome Gestational diabetes mellitus Oligohydramnios بتا تالاسمی مینور پیامد حاملگی دیابت حاملگی الیگو هیدرآمینیوس محدودیت رشد داخل رحمی Weatherall D, Letsky B. 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How does lead induce male infertility? چگونه سرب منجر به ناباروری مردان می شود؟ 2 1 قسمت مهمی از ناباروری مردان با علت نامشخص ممکن است در ارتباط با محیط ها و شغلهای مختلفی باشد که باعث تماس با مواد سمی مانند سرب می شوند. اثرات سرب بر روی تولید مثل پیچیده بوده و مسیرهای مختلفی را در بر می گیرد که بسیاری از آنها هنوز کاملاً شناخته نشده اند. بعنوان مثال هنوز مشخص نیست که مشکلات تولید مثل مردان، تحت تاثیر اثر سرب در ارتباط با توزیع هورمونهای جنسی می باشد یا اینکه بر اثر تاثیر مستقیم سرب بر روی غدد جنسی است و یا هر دو؟ پاسخ به این سوال مشکل می باشد زیرا سرب بخصوص با غلظتهای بالا ممکن است اثرات سوئی بر بسیاری از ارگانهای بدن انسان داشته باشد. هرچند که سرب می تواند بوسیله کاهش در تعداد و حرکت اسپرم ها، بوجود آوردن اشکال غیر طبیعی و همچنین تاثیر بر پارامترهای عملکردی باعث ناباروری درمردان گردد، ولی تمام مطالعات قادر به نشان دادن این موضوع نشده اند. بعلاوه مطالعات نشان داده اند  که سد خونی بیضه ها می تواند سلولهای بیضه را در مقابل اثرات مقادیر بالای سرب در خون حفظ نماید. بنا به دلایل ذکر شده و بادر نظر گرفتن اثرات وسیع سرب بر روی هورمونهای تولید مثل، این مطالعه مروری پیشنهاد می کند که اثر اصلی سرب بر روی تولید مثل مردان، احتمالاً بوسیله تغییر دادن محور هورمونهای تولید مثل و کنترل آنها بر روی تولید اسپرم، بجای اثر مستقیم بر روی لوله های اسپرم ساز بیضه عمل می کند. با توجه به آنکه حتی مقادیر کمتر از استاندارد های کاری از غلظت سرب نیز می تواند اثرات سوئی بر روی باروری مردان داشته باشد، لذا مطالعات آینده باید در پی اثبات رابطه بین تماس با سرب ( بخصوص در مقیاس کم) و ناباروری مردان باشند.  مطالعات همچنین باید توجه بیشتری به اثرات سرب بر روی کاهش باروری مردان با توجه به تغییرات محور هورمونی و همچنین تغییرات مشخصات اسپرم داشته باشند. 2 An important part of male infertility of unknown etiology may be attributed to various environmental and occupational exposures to toxic substances, such as lead. The reproductive effects of lead are complex and appear to involve multiple pathways, not all of which are fully understood. It is still unclear, for example, if male reproductive issues in lead-exposed persons are mostly related to the disruption of reproductive hormones, whether the problems are due to the lead’s direct effects on the gonads, or both? This question has been difficult to answer, because lead, especially at high levels, may adversely affect many human organs. Although lead can potentially reduce male fertility by decreasing sperm count and motility, inducing abnormal morphology and affecting functional parameters; not all studies have been able to clearly demonstrate such findings. In addition, research has shown that the blood-testis barrier can protect testicular cells from direct exposure to high levels of blood lead. For these reasons and considering the wide spectrum of lead toxicity on reproductive hormones, the present review suggests that lead’s main influence on male reproduction probably occurs by altering the reproductive hormonal axis and the hormonal control on spermatogenesis, rather than by a direct toxic effect on the seminiferous tubules of the testes. As blood lead concentrations below the currently accepted worker protection standard may still adversely affect male fertility, future studies should aim to establish more concrete links between lead exposure (especially at low levels) and subsequent male infertility. Research should also pay more attention to lead’s effects on reducing male fertility rates based on not only hormonal axis alteration, but also on the changes in sperm characteristic among exposed subjects. 0 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 محسن ویژه Mohsen Vigeh Department of Hazard Evaluation and Epidemiology Research, National Institute of Occupational Safety and Health, Kawasaki, Japan ژاپن vigeh@h.jniosh.go.jp درک- آر اسمیت Smith Derek R School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah, Australia استرالیا پلینگ چی هو Ping-Chi Hsu Departmant of Safety, Health and Environmental Engineering, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan تایوان Lead Male reproduction Infertility Reproductive hormone Spermatogenesis سرب تولید مثل مردان ناباروری هورمونهای تو لید مثل تولید اسپرم. Tas S, Lauwerys R, Lison D. 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The correlation of factors affecting the endometrial thickness with pregnancy outcome in the IUI cycles ارتباط فاکتورهای موثر بر ضخامت آندومتر با بروز حاملگی در سیکل های IUI 2 1 مقدمه: مطالعات زیادی برای درک اثر ضخامت آندومتر بر روی پیش آگهی باروری انجام شده است، در حالیکه فاکتورهای موثر بر روی ضخامت آندومتر هنوز ناشناخته اند. هدف: این مطالعه، برای تعیین فاکتورهایی نظیر سن و تعداد فولیکول ها که میتوانند ضخامت آندومتر را تحت تاثیر قرار دهند، انجام شده است. مواد و روش ها: این مطالعه به صورت گذشته نگر بر روی 680 زن نابارور که کاندید IUI   بودند، انجام شد. پروتکل دارویی IUI  شامل: رژیم کلومید و گنادوتروپین بود و ضخامت آندومتر در روز تزریق HCG تعیین شد. ارتباط بین ضخامت آندومتر و مواردی چون سن، تعداد کل فولیکول ها ، اندازه فولیکول ها ، تعداد آمپولهای گنادوتروپین و میزان حاملگی مورد سنجش قرار گرفت. نتایج: میانگین ضخامت آندومتر8/1 2/7 میلیمتر بود. آندومتر در بیماران مسن تر نازک تر در مقایسه با جوان تر ها بود، اما در همه گروههای سنی میزان حاملگی در ضخامت آندومتر بیشتر از 6 و کمتر یا مساوی 10 میلی متر بالاتر بود. ( 0.05 < p) نتیجه گیری: ما ارتباط معنی دار  آماری بین سن ، تعداد فولیکول ها و تعداد آمپول های گنادوتروپین با ضخامت آندومتر پیدا نکردیم، اما در تمام گروهها ی سنی شانس حاملگی با ضخامت آندومتر بیشتر  از 6 و کمتر یا مساوی 10 میلی متر، بالاتر بود. 2 Background: Many studies have been carried out to understand the effect of endometrial thickness on the reproductive outcome while the factors affecting the pattern itself are still unknown. Objective: To determine the factors such as age and the number of follicles that could affect the endometrial thickness Materials and Methods: This study was conducted as a retrospective study on 680 infertile women considered for intrauterine insemination (IUI). IUI protocol was sequential regimen of clomid and gonadotropin. Endometrial thickness measurement was done on the day of HCG administration. Correlation between endometrial thickness and factors such as age, total follicle numbers, dominant follicle numbers, gonadotropine ampule numbers and pregnancy rate were assessed. Results: The mean endometrial thickness was 7.2±1.8 mm. The endometrium was thinner in older patients compared with younger ones. But in all age ranges pregnancy rate was higher in endometrial thickness 6< ET≤10 mm (p<0.05). Conclusion: We did not find any correlation between age,  number of follicles and gonadotropine ampoules with endometrial thickness but in all age ranges, there is a possibility of higher chance of pregnancy in endometrial thickness 6 < ET≤10 mm.  0 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 ویکتوریا حبیب زاده Victoria Habibzadeh Afzalipour Clinical Center for Infertility, Kerman University of Medical Sciences, Afzalipour Hospital, Kerman, Iran ایران V.habibzadeh@gmail.com سید نورالدین نعمت اللهی ماهانی Sayed Noureddin Nematolahi Mahani Department of Anatomy and Embryology, Faculty of Medicine, Kerman University of Medical Sciences ایران حدیث کامیاب Hadiss Kamyab Afzalipour Clinical Center for Infertility, Kerman University of Medical Sciences, Afzalipour Hospital, Kerman, Iran ایران Endometrial thickness Affecting factors Intrauterine insemination Pregnancy rate ضخامت آندومتر فاکتورهای موثر تلقیح داخل رحمی میزان حاملگی Dieterich C. Increased endometrial thickness on the day of HCC, injection does not adversely affect pregnancy. Fertil Steril 2002, 77: 781.##Noci I- Aging of the human endometrium. European obstetric. Gynecology reproductive biology 1995: 66:181.##Lamanna G. Sciosscia m. Lorusso F-serrate E. selvagi IE. The pregnancy rate increased as the endometrial thickness. Fertility Sterility. 2007 – www.obGyn.net .##Zahir Z.sharani S.H. Roshan Z.there was no statistically significant difference in pregnancy rate in three groups of endometrial thickness (14). IRMS 2007; 12: 257-261.##Al-inary Ahmed M.Abous. setta there was no significant difference in pregnancy rate between all groups in relation to both endometrial thickness. Middle East Fertility Society Journal 2005; 63-67.##De Geyter C , Schmitter M , De Gayter M , Niesch lagE , Holzgreve W , Shnieder HP. Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 10186 infertile women. Fertile Steril 2000; 73:106##Martin W, D – Ferriani KA – mastri co-Maria R-Filho FM.The endometrial volume increase was higher in pregnant women than in non pregnant women. Fertil Steril 2007 –www.obGyn.net##Doneness j.What of the imprication of myoma. Fertility. Sterility Hum Reprod 2002:14:24.##Nabil–EI Tabbakh. Endometrial advancement has been described after HMG stimulation. www.ObGyn.net##Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterin leiomyoma in black and white women. Ultra sound evidence. Am j obstet Gynecol 2003:188:100##Donnez j. jadoul p. What are the implications of myomas on fertility? A need for a debate? Hum Reprod 2002:17:1424-1430##Weissman A-Gotlieb L. Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates. Fertil Steril 1999: 71: 147-149.##Gentry WL. Use of endometrial measurement as an exclusion criterion for in vitro fertilization using clomiphen citrate. J Reproductive Med 1996 41: 545-547.##Reuter H,Cohen.S, Fureg C.Baker.S, sonographic appearance of the endometrium and ovaries during cycles stimulated with human menopausal gouadotropin. J Reprod Med 1996: 41: 509- 514.##Tomlinson Mj.prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Human Reprod 1996; 11:1892-1896.##Hock DL Sonographic assessment of endometrial pattern and thickness in patients treated with CC, HMG and IUI. Fertil Steril 1997; 68: 242-245.##Tsai HD, Change CC, Hsieh YY, Lee CC. lolly. Artificial insemination. Role of ET and patiern, of vascular impedence of the spiral and uterine arteries, and of the dominant follicle. J Reprod Med 2000; 45: 195-200.##Hsieh YY. Low dose aspirin for infertile women with thin endometrium receiving intrauterine insemination: a perspective randomized Study. J Assist Reprod Genet 2000 17: 174-177.##Zollner U. Impact of 3-D measured endometrial volume on the pregnancy rate after IUI. Zentralbi Gynakol 2003; 125: 136-141.##Kolibiianahis E.M.Endometrial thickness cannot predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for IUI. Reprod Biomed online 2004; 8: 115-118.##Unfer V. High does of phytoestrognes can reverse the antiestrogenic effect of cc on the endometrium in patients undergoing IUI: A randomized trial. J Soc Gynecol Interesting 2004; 11: 323-328##Esmailzadeh, S, Endometrial thickness and pregnancy outcome after IUI. Fertility Sterility 2007 88: 432 – 437.##Merviel. P. Predictive factors for pregnancy after IUI: An analysis of 1038 cycles and a review of the literature. Fertil Steril 2008. Nov 7.##Dickey Rp, olar TT, Taylor SN, Curok DN, Matulich EM. Relationship of endometrial thickness and pattern to fecundity in ovulation induction cycles: ffect of cc alone and with HMG. Fertil Steril 1993; 59: 756-760.##Wiser Amir M.D .Baum Micha M.D predicting factors for ET during treatment with ART. Fertil Steril 2007; 87: 799-804.##Dieterich C. Increased endometrial thickness on the day of HCC, injection does not adversely affect pregnancy. Fertil Steril 2002, 77: 781.##Noci I- Aging of the human endometrium. European obstetric. Gynecology reproductive biology 1995: 66:181.##Lamanna G. Sciosscia m. Lorusso F-serrate E. selvagi IE. The pregnancy rate increased as the endometrial thickness. Fertility Sterility. 2007 – www.obGyn.net .##Zahir Z.sharani S.H. Roshan Z.there was no statistically significant difference in pregnancy rate in three groups of endometrial thickness (14). IRMS 2007; 12: 257-261.##Al-inary Ahmed M.Abous. setta there was no significant difference in pregnancy rate between all groups in relation to both endometrial thickness. Middle East Fertility Society Journal 2005; 63-67.##De Geyter C , Schmitter M , De Gayter M , Niesch lagE , Holzgreve W , Shnieder HP. Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 10186 infertile women. Fertile Steril 2000; 73:106##Martin W, D – Ferriani KA – mastri co-Maria R-Filho FM.The endometrial volume increase was higher in pregnant women than in non pregnant women. Fertil Steril 2007 –www.obGyn.net##Doneness j.What of the imprication of myoma. Fertility. Sterility Hum Reprod 2002:14:24.##Nabil–EI Tabbakh. Endometrial advancement has been described after HMG stimulation. www.ObGyn.net##Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterin leiomyoma in black and white women. Ultra sound evidence. Am j obstet Gynecol 2003:188:100##Donnez j. jadoul p. What are the implications of myomas on fertility? A need for a debate? Hum Reprod 2002:17:1424-1430##Weissman A-Gotlieb L. Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates. Fertil Steril 1999: 71: 147-149.##Gentry WL. Use of endometrial measurement as an exclusion criterion for in vitro fertilization using clomiphen citrate. J Reproductive Med 1996 41: 545-547.##Reuter H,Cohen.S, Fureg C.Baker.S, sonographic appearance of the endometrium and ovaries during cycles stimulated with human menopausal gouadotropin. J Reprod Med 1996: 41: 509- 514.##Tomlinson Mj.prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Human Reprod 1996; 11:1892-1896.##Hock DL Sonographic assessment of endometrial pattern and thickness in patients treated with CC, HMG and IUI. Fertil Steril 1997; 68: 242-245.##Tsai HD, Change CC, Hsieh YY, Lee CC. lolly. Artificial insemination. Role of ET and patiern, of vascular impedence of the spiral and uterine arteries, and of the dominant follicle. J Reprod Med 2000; 45: 195-200.##Hsieh YY. Low dose aspirin for infertile women with thin endometrium receiving intrauterine insemination: a perspective randomized Study. J Assist Reprod Genet 2000 17: 174-177.##Zollner U. Impact of 3-D measured endometrial volume on the pregnancy rate after IUI. Zentralbi Gynakol 2003; 125: 136-141.##Kolibiianahis E.M.Endometrial thickness cannot predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for IUI. Reprod Biomed online 2004; 8: 115-118.##Unfer V. High does of phytoestrognes can reverse the antiestrogenic effect of cc on the endometrium in patients undergoing IUI: A randomized trial. J Soc Gynecol Interesting 2004; 11: 323-328##Esmailzadeh, S, Endometrial thickness and pregnancy outcome after IUI. Fertility Sterility 2007 88: 432 – 437.##Merviel. P. Predictive factors for pregnancy after IUI: An analysis of 1038 cycles and a review of the literature. Fertil Steril 2008. Nov 7.##Dickey Rp, olar TT, Taylor SN, Curok DN, Matulich EM. Relationship of endometrial thickness and pattern to fecundity in ovulation induction cycles: ffect of cc alone and with HMG. Fertil Steril 1993; 59: 756-760.##Wiser Amir M.D .Baum Micha M.D predicting factors for ET during treatment with ART. Fertil Steril 2007; 87: 799-804.## ##

Causes of delay in proper treatment of patients with undescended testis بررسی علل تاخیر در درمان به موقع بیماران مبتلا به بیضه نزول نکرده 2 1 مقدمه : عدم نزول بیضه، شایعترین اختلال اندوکرین در کودکان مذکرمی باشد که تاخیردر تشخیص و درمان به موقع آن، منجر به عوارضی مانند ناباروری، بدخیمی و چرخش بیضه ها می گردد. هدف : هدف از این مطالعه، بررسی علل تاخیر در درمان به موقع بیماران مبتلا به بیضه نزول نکرده در جمعیت مورد نظر می باشد. مواد و روش ها : در این مطالعه مشاهده ای- توصیفی- مقطعی، 143 بیمار مذکر که جهت عمل ارکیوپکسی به بیمارستان شهید صدوقی دانشگاه علوم پزشکی یزد مراجعه کرده بودند، مورد بررسی قرار گرفتند. حداکثر سن پیشنهادی جهت عمل جراحی ارکیوپکسی در این مطالعه 18 ماهگی بود. نتایج : میانگین سنی بیماران هنگام مراجعه 34/5 سال بود. نتایج حاصل از ارزیابی مطالعه نشان داد که تنها 44 نفر (30/8%) از بیماران قبل از18 ماهگی تشخیص و تحت عمل جراحی قرار گرفتند. شایعترین علت تاخیر در درمان به موقع به ترتیب شامل: عدم تشخیص اولیه توسط پزشکان (42/5%) ، عدم اطلاع والدین در مورد ضرورت عمل جراحی و عوارض آن (33/7%) و بی اطلاعی والدین نسبت به بیماری )23/8%) بود. در این میان تنها 19/6% از بیماران در بدو تولد در بیمارستان توسط پزشکان تشخیص داده شده بودند. 49% والدین آگاهی کافی نسبت به سن مناسب جراحی داشتند و 40/6% از آن ها اطلاعات کافی از ضرورت انجام عمل جراحی و عوارض بیماری داشتند. سطح سواد والدین، محل اقامت بیماران و نوع کریپتورکیدیسم ارتباط معنی داری با علل تاخیر در تشخیص بیماری نداشتند. (0/05p> ( نتیجه گیری : نتایج این مطالعه نشان می دهد که عدم تشخیص اولیه بیماری توسط پزشکان وعدم آگاهی کافی والدین از آن، دلایل اصلی تاخیر در تشخیص و درمان به موقع بیماری می باشند؛ لذا آموزش جامعه بویژه والدین و معاینه دقیق نوزادان در بدو تولد و پیگیری منظم آن ها تا 18 ماهگی می تواند در تشخیص و درمان به موقع بیماری موثر باشد. 2 Background: Undescended testis (UDT) is the most common endocrine disorder in male children. Delayed diagnosis and treatment of UDT lead to complications such as infertility, malignancy and testis rotation. Objective: The aim of this study was to evaluate the causes of delay in proper treatment of patients with undescended testis in our population. Materials and Methods: An observational, descriptive, cross sectional study of 143 male patients, who applied to Shahid Sadoughi University Hospitals for orchiopexy operation was performed. The maximum recommended age for orchiopexy was 18 months. Results: The mean age at referral was 5.34 years. Only 44 (30.8%) cases were operated on before the age of 18 months. The most common reasons of delay in treatment were absence of early diagnose (42.5%), parent's unawareness of surgery necessity and its complications associated (33.7%) and parent's disregard (23.5%). Only 19.6% of patients were diagnosed at born in the hospital. 49% of parents had the correct information for proper operation age and 40.6% of them had enough information about necessity of surgery and side effects of disease. Parent’s literacy, place of living and type of cryptorchidism had no significant relation with delay diagnosis (p> 0.05). Conclusion: These results revealed that late diagnosis by physician and lack of insight of parents are the main reasons in delayed diagnosis and treatment of UDT. Therefore, education of parents and careful physical examination of the babies at birth and regular follow-up until 18 months can prevent the delay in diagnosis.  0 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 سید مصطفی شیریزدی Seyyed Mostafa Shiryazdi Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران smshiryazdi@ssu.ac.ir عباس مدیر Abbas Modir Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران سهیل بن رضوی Soheil Benrazavi Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران نوشین موسوی Nooshin Moosavi Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران محمد کرمانی القریشی Mohammad Kermani-Alghoraishi Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران راحیل قهرمانی Rahil Ghahramani Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران Delayed diagnosis Undescended testis Orchiopexy Infant تاخیر در تشخیص بیضه نزول نکرده ارکیوپکسی کودک Kolon TF, Patel RP, Huff DS. Cryptorchidism; diagnosis, treatment and long-term prognosis. Urol Clin N Am 2005; 31: 469-480.##Barthold JS, Gonzales R. The Epidemiology of Congenital Cryptorchidism, Testicular Ascent and Orchiopexy. J Urol 2003; 170: 2396-401.##Virtanen HE, Toppari J. Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Update 2008; 14: 49-58.##Elert A, Jahn K, Heidenreich A, Hofmann R. The familial undescended testis. Klin Padiat 2003; 215: 40-45.##Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol 1998; 160: 1145-1149.##Virtanen HE, Bierknes R, Cortes D, Jorgensen N, Rajpert-De Meyts E, Thorsson AV, et al. Cryptorchidism: classification, prevalence and long-term consequences. Acta Paediatr 2007; 96: 611-616##Wang F, Roberts SM, Butfi loski EJ, Sobel ES. Acceleration of autoimmunity by organochlorine pesticides: a comparison of splenic B-cell effects of chlordecone and estradiol in (NZBxNZW) F1 mice. Toxicological Sciences 2007; 99: 141-152.##Docimo SG, Silver RI, Cromie W. The undescended testicle: diagnosis and management. Am Fam Physician 2000; 62: 2037-2044.##Capello SA, Georgi LJ Jr, Kogan BA. Orchiopexy practice patterns in New York State from 1984 to 2002. J Urol 2006; 176: 1180-1183.##Upadhyay V, Kothari M, Manoharan M. The referral pattern for undescended testes in Auckland. NZ Med J 2001; 114: 310-311.##Lamah M, McCaughey ES, Finlay FO, Burge DM. The ascending testis: Is late orchidopexy due to failure of screening or late ascent? Paediatr Surg Int 2002; 17: 421-423.##Hack WW, Meijer RW, VanDer VLM, Bos SD, De Kok ME. Previous testicular position in boys referred for an undescended testis; further explanation of the late orchiopexy enigma? BJU 2003; 92: 293-296.##Thayyil S, Shenoy M, Agrawal K. Delayed orchiopexy: failure of screening or ascending testis. Arch Dis Child 2004; 89: 890.##Brown JJ, Wacogne I, Fleckney S, Jones L, Ni Bhrolchain C. Achieving early surgery for undescended testes: quality improvement through a multifaceted approach to guideline implementation. Child Care Health Dev 2005; 31: 97- 102.##Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. American Academy of Pediatrics. Pediatrics 1996; 97: 590-594.##United Kingdom Testicular Cancer Study Group. Aetiology of testicular cancer: Association with congenital abnormalities, age at puberty, infertility, and exercise. Br Med J 2008; 308: 1393-1399.##Cortes D, Kjellberg EM, Breddam M, Thorup J. The true incidence of cryptorchidism in Denmark. J Urol 2008; 179: 314-318.##Hadziselimovic F, Huff D. Gonadal differentiation-Normal and abnormal testicular development. Adv Exp Med Biol 2002; 511: 15- 21.##Huff DS, Fenig DM, Canning DA, Carr MG, Zderic SA, Snyder HM. Abnormal germ cell development in cryptorchidism. Horm Res 2001; 55: 11-17.##Guven A, Kogan BA. Undescended testis in older boys: further evidence that ascending testes are common. J Pediatr Surg 2008; 43: 1700-1704.##Davey RB. Undescended testes: early versus late maldescent. Pediatr Surg Int 1997; 12: 165-167.##Cendron M, Huff DS, Keating MA, Snyder HM 3rd, Duckett JW. Anatomical, morphological and volumetric analysis: a review of 759 cases of testicular maldescent. J Urol 1993; 149: 570-573.##Seddon JM, Savory L, Scott-Conner C. Cryptorchidism: the role of medical education in diagnosis. South Med J 1985; 78: 1201-1204.##A Sarmah. Late diagnosis of cryptorchidism: a failure of medical screening? Arch Dis Child 1992; 67: 728–730##Raghavendran M, Mandhani A, Kumar A, Chaudary H, Srivastava A, Bhandari M, Dubey D, Kapoor R. Adult cryptorchidism: Unrevealing the cryptic facts. Indian Journal of Surgery 2004; 66: 160-163.##Steckler RE, Zaontz MR, Skoog SJ, Rushton HG Jr. Cryptorchidism, pediatricians, and family practitioners: patterns of practice and referral. J Pediatr 1995; 127: 948-951.##Sinha CK, Vinay S, Kulkarni R, Nour S. Delayed diagnosis for undescended testes. Indian Pediatr 2008; 45: 503-504.##Rabinowitz R, Hulbert WC Jr. Late presentation of cryptorchidism: the etiology of testicular re-ascent. J Urol 1997; 157: 1892-1894.##Gyawali B, Bhattacharyya S, Reid JA. Medical audit of community screening for undescended testes in Halton District. Public Health 1993; 107: 343-347.##Kolon TF, Patel RP, Huff DS. Cryptorchidism; diagnosis, treatment and long-term prognosis. Urol Clin N Am 2005; 31: 469-480.##Barthold JS, Gonzales R. The Epidemiology of Congenital Cryptorchidism, Testicular Ascent and Orchiopexy. J Urol 2003; 170: 2396-401.##Virtanen HE, Toppari J. Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Update 2008; 14: 49-58.##Elert A, Jahn K, Heidenreich A, Hofmann R. The familial undescended testis. Klin Padiat 2003; 215: 40-45.##Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol 1998; 160: 1145-1149.##Virtanen HE, Bierknes R, Cortes D, Jorgensen N, Rajpert-De Meyts E, Thorsson AV, et al. Cryptorchidism: classification, prevalence and long-term consequences. Acta Paediatr 2007; 96: 611-616##Wang F, Roberts SM, Butfi loski EJ, Sobel ES. Acceleration of autoimmunity by organochlorine pesticides: a comparison of splenic B-cell effects of chlordecone and estradiol in (NZBxNZW) F1 mice. Toxicological Sciences 2007; 99: 141-152.##Docimo SG, Silver RI, Cromie W. The undescended testicle: diagnosis and management. Am Fam Physician 2000; 62: 2037-2044.##Capello SA, Georgi LJ Jr, Kogan BA. Orchiopexy practice patterns in New York State from 1984 to 2002. J Urol 2006; 176: 1180-1183.##Upadhyay V, Kothari M, Manoharan M. The referral pattern for undescended testes in Auckland. NZ Med J 2001; 114: 310-311.##Lamah M, McCaughey ES, Finlay FO, Burge DM. The ascending testis: Is late orchidopexy due to failure of screening or late ascent? Paediatr Surg Int 2002; 17: 421-423.##Hack WW, Meijer RW, VanDer VLM, Bos SD, De Kok ME. Previous testicular position in boys referred for an undescended testis; further explanation of the late orchiopexy enigma? BJU 2003; 92: 293-296.##Thayyil S, Shenoy M, Agrawal K. Delayed orchiopexy: failure of screening or ascending testis. Arch Dis Child 2004; 89: 890.##Brown JJ, Wacogne I, Fleckney S, Jones L, Ni Bhrolchain C. Achieving early surgery for undescended testes: quality improvement through a multifaceted approach to guideline implementation. Child Care Health Dev 2005; 31: 97- 102.##Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. American Academy of Pediatrics. Pediatrics 1996; 97: 590-594.##United Kingdom Testicular Cancer Study Group. Aetiology of testicular cancer: Association with congenital abnormalities, age at puberty, infertility, and exercise. Br Med J 2008; 308: 1393-1399.##Cortes D, Kjellberg EM, Breddam M, Thorup J. The true incidence of cryptorchidism in Denmark. J Urol 2008; 179: 314-318.##Hadziselimovic F, Huff D. Gonadal differentiation-Normal and abnormal testicular development. Adv Exp Med Biol 2002; 511: 15- 21.##Huff DS, Fenig DM, Canning DA, Carr MG, Zderic SA, Snyder HM. Abnormal germ cell development in cryptorchidism. Horm Res 2001; 55: 11-17.##Guven A, Kogan BA. Undescended testis in older boys: further evidence that ascending testes are common. J Pediatr Surg 2008; 43: 1700-1704.##Davey RB. Undescended testes: early versus late maldescent. Pediatr Surg Int 1997; 12: 165-167.##Cendron M, Huff DS, Keating MA, Snyder HM 3rd, Duckett JW. Anatomical, morphological and volumetric analysis: a review of 759 cases of testicular maldescent. J Urol 1993; 149: 570-573.##Seddon JM, Savory L, Scott-Conner C. Cryptorchidism: the role of medical education in diagnosis. South Med J 1985; 78: 1201-1204.##A Sarmah. Late diagnosis of cryptorchidism: a failure of medical screening? Arch Dis Child 1992; 67: 728–730##Raghavendran M, Mandhani A, Kumar A, Chaudary H, Srivastava A, Bhandari M, Dubey D, Kapoor R. Adult cryptorchidism: Unrevealing the cryptic facts. Indian Journal of Surgery 2004; 66: 160-163.##Steckler RE, Zaontz MR, Skoog SJ, Rushton HG Jr. Cryptorchidism, pediatricians, and family practitioners: patterns of practice and referral. J Pediatr 1995; 127: 948-951.##Sinha CK, Vinay S, Kulkarni R, Nour S. Delayed diagnosis for undescended testes. Indian Pediatr 2008; 45: 503-504.##Rabinowitz R, Hulbert WC Jr. Late presentation of cryptorchidism: the etiology of testicular re-ascent. J Urol 1997; 157: 1892-1894.##Gyawali B, Bhattacharyya S, Reid JA. Medical audit of community screening for undescended testes in Halton District. Public Health 1993; 107: 343-347.## ##

Metformin-letrozole in comparison with Metformin-clomiphene citrate in clomiphene-resistance PCOS patients undergoing IUI مقایسه ترکیب متفورمین- لتروزول با متفورمین- کلومیفن سیترات در بیماران با سندرم تخمدان پلی کیستیک مقاوم به کلومیفن که تحت درمان IUI قرار گرفته اند 2 1 مقدمه: سندرم تخمدان پلی کیستیک در 75% زنان نازا با عدم تخمک گذاری دیده می شود.همچنین حدود 25-20% این بیماران به کلومیفن پاسخ نمی دهند که مقاوم به کلومیفن نامیده می شوند.اختلاف بین میزان تخمک گذاری و حاملگی که با کلومیفن دیده می شود را به اثر آنتی استروژنی آن نسبت میدهند و به همین علت  مهار کننده های آروماتاز بعنوان درمان جایگزین در این بیماران پیشنهاد می گردد. هدف:مقایسه اثرمتفورمین-لتروزول با متفورمین-کلومیفن در بیماران با سندرم تخمدان پلی کیستیک که تحت IUIقرار می گیرند. مواد و روش ها:در این کارآزمایی تصادفی یک سوکور100بیمار مقاوم به کلومیفن وارد مطالعه شدند. معیار ورود به مطالعه، بیماران با سندرم تخمدان پلی کیستیک که بعد از دریافت 150میلیگرم کلومیفن روزانه تا سه سیکل حامله نشدند، بود. بیماران از نظر سن، شاخص توده بدنی و مدت نازائی یکسان بودند.بیماران به طور تصادفی به دو گروه متفورمین-لتروزول (50نفر) ومتفورمین-کلومیفن (50نفر) تقسیم و از نظرحاملگی شیمیائی کلینیکی و میزان سقط در دو گروه مقایسه شدند. نتایج:از نظر میزان حامگی، اختلاف معنی داری بین دو گروه دیده نشد.یک مورد سقط(2%) در گروه متفورمین-کلومیفن دیده شد در حالیکه در گروه متفورمین-لتروزول هیچ مورد دیده نشد. نتیجه گیری: با وجود اینکه از نظر آماری اختلاف معنی داری در میزان حاملگی دو گروه کلومیفن و لتروزول بدست نیامد ولی میزان آن در گروه اول 2% و درگروه دوم 5%بوده است. 2 Background: Polycystic ovary syndrome (PCOS) is associated with approximately 75% of women who suffer from infertility due to anovulation. Additionally, around 20– 25% of anovulatory women with PCOS do not respond at all to clomiphene citrate and are considered to be “clomiphene– resistant”. Aromatase inhibitors have been suggested as an alternative treatment to clomiphene as the discrepancy between ovulation and pregnancy rates with clomiphene citrate has been attributed to its anti-estrogenic action and estrogen receptor depletion. Objective: The aim of this study is to compare results of Metformin-letrozole with Metformin-clomiphene citrate in clomiphene resistance PCOS patients undergoing IUI. Materials and Methods: In this single blind randomized trial, ovarian cycles were studied in 100 clomiphene- resistant patients with PCOS. The inclusion criteria were patients who received 150mg clomiphene citrate daily for 3 cycles and failed to become pregnant. The patients were matched for their age, body mass index (BMI), and infertility period. They were randomly allocated to a metformin-letrozole group (n=50) and a metformin-clomiphene citrate group (n=50). Chemical and clinical pregnancies were assessed after IUI. Abortion rates were determined in both groups. Results: Regarding pregnancy rate, there was no significant difference between the two groups. One miscarriage (2%) occurred in the metformin-clomiphene citrate group, whereas none was seen in the metformin-letrozole group. Conclusion: There is no significant difference in pregnancy rate between clomiphene citrate and letrozole groups although it has been 2% in the former and 5% in the latter. Article 0 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 رباب داور Robab Davar Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران r_davar@yahoo.com مژگان جاودانی Mojgan Javedani Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران محمد حسین فلاح زاده Mohammad Hossein Fallahzadeh Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران Letrozole Clomiphene citrate Ovarian stimulation PCO IUI Metformin لتروزول کلومیفن سیترات تحریک تخمدان تخمدان پلی کیستیک IUI متفورمین Gordon P, Treasure JL, King EA, Wheeler M, Russell GF. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed) 1986; 293: 956-957.##Hull MG. 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A case report of spontaneous pregnancy during hormonal replacement therapy for premature ovarian failure گزارش یک مورد بارداری خود بخودی در حین درمان جایگزینی هورمونی در بیمار مبتلا به نارسایی زودرس تخمدانی 2 1 مقدمه:نارسایی زودرس تخمدان یک بیماری شایع است. شیوع این بیماری 1 در   100 زن در سنین قبل از 40 سالگی می باشد. هورمون درمانی تا شروع سنین معمول یائسگی گزینه مناسبی در این بیماران میباشد. برگشت موقت فعالیت تخمدان ها در این بیماران گزارش شده است. حاملگی یک پدیده بسیار نادر در بیماران بانارسایی زودرس تخمدان است. دراینجا ما یک مورد حاملگی خود بخود در بیمار مبتلا به نارسایی زود رس تخمدان  را معرفی می نماییم. مورد:یک زن نازا 30 ساله با بیماری نارسایی زودرس تخمدان اثبات شده، به دنبال جراحی لگنی و استرس هیجانی شدید به صورت خودبخودباردار شده است. نتیجه گیری:برگشت عملکرد تخمدان و بروز حاملگی در زنان با نارسایی زودرس تخمدان امکان پذیر می باشد. 2 Background: Premature ovarian failure (POF) is a common condition; its incidence is estimated to be as great as 1 in 100 by the age of 40 years. Physiologic replacement of ovarian steroid hormones seems rational until the age of normal menopause. Temporary return of ovarian function and pregnancy may occur rarely in women with POF. We report a case of POF who conceived during hormone replacement therapy. Case: A 30 years-old woman with confirmed POF after pelvic surgery and sever emotional stress conceived spontaneously. Conclusion: Return of ovarian function and achievement of pregnancy is possible in women with POF. 0 0 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/52017/10/52017/10/52017/10/52017/10/52017/10/52017/10/52017/10/52017/10/5 1396/7/13 فیروزه اکبری اسبق Firoozeh Akbari Asbagh Department of Obstetrics and Gynecology, Mirza Koochak Khan Hospital, Faculty of Medicine, Tehran University, Tehran, Iran ایران F.AsbaghM.D@yahoo.com مهبد ابراهیمی Mahbod Ebrahimi Department of Obstetrics and Gynecology, Mirza Koochak Khan Hospital, Faculty of Medicine, Tehran University, Tehran, Iran ایران Premature ovarian failure Transient ovarian failure Hypergonadotropic hypogonadism Hypergonadotropic amenorrhea Hormone replacement نارسایی زودرس تخمدان نارسایی موقت تخمدان هیپوگنادیسم هیپوگنادوتروپیسم آمنوره هیپرگنادوتروپیسم هورمون درمانی Conway GS. Premature ovarian failure. Br Med Bull. 2000; 56: 643-498.##Luborsky JL. Meyer P, Sowers MF, Gold EB. Premature menopause in a multi-ethnic population study of the menopause transition. Hum Reprod 2003; 18: 199-206.##Laml T, Schulz-Lobmeyr I, Obbruca A, Huber JC, Hartmann BW. Premature ovarian failure: etiology and prospects. Gynecol Endocrinol 2000; 14: 292-302.##Pal L, Santoro N, Premature ovarian failure (POF): discordance between somatic and reproductive aging. Res Rev 2002; 1: 413-423.##Netter A, Lambert A, Lumbroso P. Etudes sur les amenorrhees. Les amenorrhees ovariplegiques. Bull Mem Soc Hop Paris 1958; 74: 248-250.##Panay N, Kalu E. Management of premature ovarian failure. Best Practice and Research Clinical Obstet Gynecol 2009; 23: 129-140.##Goswami D, Conway GS, Premature ovarian failure. Hum Reprod update 2005; 11: 391-410.##Van Kasteren YM. Treatment concepts for premature ovarian failure. J Soc Gynecol Investig 2001; 8: S58-59.##Anassti JN. Premature ovarian failure: an update. Fertil Steril 1998; 70: 1-15.##Sayegh R, Garcia CR. Ovarian function after conservational ovarian surgery: a long-term follow-up study. Int J Gynecol Obstet 1992; 39: 303-309.##Donnez J, Squifflet J, Van Eyck AS. Restoration of ovarian function in orthotopically transplanted cryopreserved ovarian tissue: a pilot experience. Reprod Biomed on line. 2008; 16: 694-704.##Huang JY, Tulandi T,Holzer H. Combining ovarian tissue crobanking with retrieval of immature oocytes followed by in vitro maturation and vitrification: an additional strategy of fertility preservation. Fertil Steril 2008; 69: 567-572.##Hefler L A, Grimm C, Bentz EK, A model for predicting age at menopause in white women. Fertil Steril 2006; 65: 451-454.##Broekmans FJ, Kwee J, Hendriks DJ. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod update 2006; 12: 685-718.##Corrigan EC, Raygada MJ, Vanderhoof VH, Lawrence M, Neison LM. A woman with spontaneous premature ovarian failure gives birth to a child with fragile X syndrome. Fertil Steril 2005, 84: 1508.e 5-8.##Keegan DA, Krey LC, Noys N. Younger ( ##