2015 13 10 0 664

Prevalence of polycystic ovary syndrome and its associated complications in Iranian women: A meta-analysis بررسی شیوع سندرم تخمدان پلی کیستیک و عوارض همراه آن در زنان ایرانی : مطالعه مروری و متاآنالیز 2 1 مقدمه: سندرم تخمدان پلی کیستیک (PCOS) شایع ترین اختلال اندوکرین زنان در سنین باروری و شایعترین علت ناباروری ناشی ازعدم تخمک گذاری است. جهت تشخیص این سندرم معیار واحدی وجود ندارد. هدف: هدف از این مطالعه بررسی شیوع سندرم تخمدان پلی کیستیک و عوارض ناشی از آن در زنان ایرانی به روش متاآنالیز است. مواد و روش ها: با جستجو در پایگاههای اطلاعاتی  Magiran, Irandoc, Iranmedex, SID, Pubmed،GoogleScholar و...، مقالات مرتبط در رابطه با شیوع سندرم تخمدان پلی کیستیک، مورد بررسی قرار گرفته و وزن هر مطالعه با توجه به تعداد نمونه و میزان شیوع از توزیع دوجمله ای محاسبه شده است. داده ها با استفاده از روش متاآنالیز مدل اثرات تصادفی(Random effects model)  و با نرم افزار R و 2/11Stata Version  آنالیز شدند. نتایج: تعداد 30 مطالعه که بین سال های 1375 تا1390 انجام شده بودند، وارد متاآنالیز گردیدند. حجم کل نمونه 19226 زن با گروه سنی بین 54-10 سال بود. شیوع سندرم تخمدان پلی کیستیک طبق معیار NIH، 6/8٪ (با فاصله اطمینان 95٪ :5/8 – 11/4) براساس معیارRotterdam ، 19/5٪ (با فاصله اطمینان 95٪ : 24/2- 14/8 ) و براساس روش های سونوگرافی 41/4٪ (فاصله اطمینان 95٪ :68/5-14/4 ) تخمین زده شد. همچنین در این مطالعه، شیوع هیرسوتیسم 13٪ ، آکنه 26٪ ، آلوپسی آندروژنیک9٪ ، اختلالات قاعدگی28٪ ، اضافه وزن 21٪، چاقی19٪ و نازایی 8٪ برآورد گردید. نتیجه گیری: درایران شیوع سندرم تخمدان پلی کیستیک بالا نیست اما با توجه به احتمال ایجاد عوارضی مانند عوارض قلبی - عروقی و ناباروری، پیشگیری از افزایش PCOS مهم می باشد. لذا مسئولان بهداشتی و درمانی باید برنامه ریزی هایی در جهت این امر درجامعه ارائه نمایند.   2 Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and is the most common cause of infertility due to anovulation. There is no single criterion for the diagnosis of this syndrome. Objective: The purpose of this study was to investigate the prevalence of PCOS and its associated complications in Iranian women using meta-analysis method. Materials and Methods: Prevalence of PCOS was investigated from the SID, Goggle scholar, PubMed, Magiran, Irandoc, and Iranmedex, and weighting of each study was calculated according to sample size and prevalence of the binomial distribution. Data were analyzed using a random-effects model meta-analysis (Random effects model) and the software R and Stata Version 11.2. Results: 30 studies conducted between the years 2006 to 2011 were entered into meta-analysis. The total sample size was 19, 226 women aged between 10-45 years. The prevalence of PCOS based on National institute of child health and human disease of the U.S was, 6.8% (95 % CI: 4.11–8.5), based on Rotterdam was 19.5% (95 % CI: 2.24-8.14), and based on ultrasound was 4.41% (95% CI: 5.68-4.14). Also, the prevalence of hirsutism was estimated to be 13%, acne 26%, androgenic alopecia 9%, menstrual disorders 28%, overweight 21%, obesity 19%, and infertility 8%. Conclusion: The prevalence of PCOS in Iran is not high. However, given the risk of complications such as heart disease - cardiovascular and infertility, prevention of PCOS is important; we suggest that health officials must submit plans for the community in this respect. 591 604 2017/10/1 1396/7/9 2017/10/26 1396/8/4 آناهیتا جلیلیان Anahita Jalilian Department of Obstetrics and Gynecology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran ایران فائزه کیانی Faezeh Kiani Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran ایران فاطمه سایه میری Fatemeh Sayehmiri Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran ایران کورش سایه میری Kourosh Sayehmiri Department of Social Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran ایران زهرا خدایی Zahra Khodaee Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran ایران ملیحه اکبری Malihe Akbari Department of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran ایران akbarimalihe@yahoo.com Polycystic ovary syndrome Prevalence Hirsutism Acne Obesity سندرم تخمدان پلی کیستیک شیوع هیرسوتیسم آکنه چاقی. 1. Asgharnia M, Mirblook F, Ahmad Soltani M. The prevalence of polycystic ovary syndrome (PCOS) in high school students in Rasht in 2009 according to NIH criteria. Int J Fertil Steril 2011; 4: 156-159. ##2. Lankarani M, Valizadeh N, Heshmat R, Shafaee AR, Amini MR, Ardeshir Larijani MB, et al. Evaluation of dyslipidemia in polycystic ovary syndrome. J Diabetes Metab Disord 2005; 4: E11+E11i-E11x. ##3. Arshad M, Moradi S, Ahmmadkhani A, Emami Z. Increased prevalence of depression in women with polycystic ovary syndrome. Iranian Journal of Endocrinology and Metabolism 2012; 13: 582-586. ##4. Haji Shafiha M, Zabiri T, Salari Lak SH. Investigating validity criteria of vaginal ultrasound (ovarian volume, the ovarian stroma and the stromal surface of the ovary) in the diagnosis of polycystic ovary syndrome. Urmia Medical Journal 2007; 3: 538-543. ##5. Taghavi M, Fatemi S. Macroprolactinemia accompany in patients with hyperandrogenemic symptoms. Iranian Journal of Endocrinology and Metabolism 2008; 10: 273-276. ##6. Arefi S. PCO prevalence and association with menstrual irregularity in adolescence. J Reprod Infertil 2000; 5: 57-62. ##7. Aali B, Naderi T. Evaluation of clinical, ultrasound and laboratory features of PCOS in Kerman in 1381. Iranian Journal of Endocrinology and Metabolism 2004; 6: 153-161. ##8. Naderi T, Akbarzadeh M, Dabagh Manesh M, Tabatabaei H, Zareh Z. Frequency of facial and body acne in 14- to 18- year-old female high school students and its relationship to polycystic ovary syndrome. JDC 2011; 2: 124-131. ##9. Mehrabian F, Khani B, Kelishadi R, Ghanbari E. The prevalence of polycystic ovary syndrome in Iranian women based on different diagnostic criteria. Endokrynol Pol 2011; 62: 238–242. ##10. Ramezani Tehrani F, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol 2011; 9: 39. ##11. Rahmanpour H, Heidari R, mousavinasab S, sharifi F, Fekri S. The Prevalence of polycystic ovarian syndrome in 14-18 year old girls of Zanjan high schools, 2008. ZUMS Journal 2009; 17: 79-88. ##12. Akbari D, Hossein Pour N. Causes of hirsutism in premenopausal women. JDC 2010; 1: 119-124. ##13. Hashemipour M, Faghihimani S, Zolfaghary B, Hovsepian S, Ahmadi F, Haghighi S. Prevalence of Polycystic Ovary Syndrome in Girls Aged 14–18 Years in Isfahan, Iran. Horm Res 2004; 62: 278–282 ##14. Zandi S, Farajzadeh S, Safari H. Prevalence of polycystic ovary syndrome in women with acne: hormone profiles and clinical findings. Journal of Pakistan Association of Dermatologists 2010; 20: 194-198. ##15. Mohajeri Tehrani M, Parvizi M, Amini Moghadam S, Heshmat R, Shaban Nejad-Khas Z, Golchin M. The prevalence of polycystic ovary syndrome in Iranian women with gestational diabetes: a pilot study. Iranian Journal of Diabetes and Lipid Disorders 2009; 57-64. ##16. Salehpour S, Esmaeilnia Shirvani H, Entezari A. Evaluation of the prevalence of polycystic ovarian syndrome among adolescent (15-18 Years Old) girls in Tehran during 2005-2006. Int J Fertil Steril 2010; 4: 122-127. ##17. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: Hormonal and metabolic profile. J Clin Endocrinol Metab 1999; 84: 4006-4011. ##18. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S. Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clinical Endocrinol Metab 2000; 85: 2434-2438. ##19. Kumarapeli V, Seneviratne R de A, Wijoyaratne CN, Yapa RM, Dodampahala SH. A simple screening approach for assessing community prevalence and phenotype of polycystic ovary syndrome in a semiurban population in Srilanka. Am J Epidemiol 2008; 168: 321-328. ##20. Azziz R, Woods KS, Reyan R, Key TJ, Knochenhauer ES, Yildiz B. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89: 2745-2749. ##21. Ansarin H, Aziz-Jalali MH, Rasi A, Soltani-Arabshahi R. Clinical presentation and etiologic factors of hirsutism in premenopausal Iranian women. Arch Iran Med 2007; 10: 7-13. ##22. Noorbala MT, Kefaie P. The Prevalence of Hirsutism in Adolescent Girls in Yazd, Central Iran. Iran Red Crescent Med J 2010; 12: 111-117. ##23. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25: 544–551. ##24. Lowe P, Kovucs G, Howlett D. Incidence of polycystic ovaries and polycystic ovary syndrome amongst women in Melbourne, Australia. Aust N Z J Obstet Gynaecol 2005; 45: 17–19. ##25. Gatee OB, Al Attia HM, Salama IA. Hirsutism in the united Arab Emirates: ahospital study. Post grad Med J 1996; 72: 168 -171. ##26. Adams J, Polson DW, Franks S. Prevalence of polycystic ovaries in women with unovulation and idiopathic hirsutism. Br Med J 1996; 293; 355-359. ##27. Farquhar CM, Birdsall M, Manning P, Mitchell JM, France JT. The prevalence of polycystic ovaries on ultrasound scanning in a population of randomly selected women. Aust N Z J Obstet Gynaecol 1994; 34: 67-72. ##28. Khoury MY, Baracat EC, Pardin DP, Haidar MA, da Motta EL, de Lima GR. Polycystic ovary syndrome: Clinical and laboratory evaluation. Sao Paulo Med J 1996; 114: 1222-1225. ##29. Cibula D, Hill M, Vohradnikova O, Kuzel D, Fanta M, Zivny J. The role of androgens in determining acne severity in adult women. Br J Dermatol 2000; 143: 399-404. ##30. Van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J. Endocrine features of polycystic ovary syndrome in a Random population sample of 14-16 years old adolescents. Hum Reprod 1999; 14: 2223-2229. ##31. Michelmore KF, Baren AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol 1999; 31: 779-786. ##32. Farhadifar F, Lotfi M, Naseri K, Moghimi N, Yaghma'ee R, Rahimi A. Assessing the association between PCOS and glucose intolerance. The Scientific Journal of Kurdistan University of Medical Sciences 2006; 11: 45-55. ##33. Sohrabvand F, Aqsa M, Haqolahi F, Baqeri M, Shariat M, Al-Yassin A, et al. Examining pregnancy process while using Metformin in pregnant women with infertility background due to polycystic ovary syndrome (PCOS). J Reprod Infertil 2006; 1: 23-29. ##34. Glueck CJ, Wang P, Kobayashi S, Phillips H, Sieve-Smith L. Metformin therapy through pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril 2002; 77: 520-525. ##35. Pate C. Issues faced by women with hirsutism: state of the science. Health Care Women Int 2015; 24: 1-10 ##36. Mcknight E. The prevalence of hirsutism in young women. Lancet 1964; 1: 410-413. ##37. Lobo RA. Hirsutism in Polycystic ovary syndrom current concepts. Clin Obtset Gynecol 199; 34: 817-826. ##38. Kilkenny M, Merlin K, Plunkett A, Marks R. The prevalence of common skin conditions in Australian school students: 3 Acne vulgaris. Br J Dermatol 1998; 139: 840-845. ##39. Bunker CB, Newton JA, Kilborn J, Patel A, Conway GS, Jacobs HS, et al. Most women with acne have polycystic ovaries. Br J Dermatol 1989; 121: 675-680. ##40. Malkud S. A Hospital-based Study to Determine Causes of Diffuse Hair Loss in Women. J Clin Diagn Res 2015; 9: 1-4. ##41. Rushton DH. Management of hair loss in woman. Dermatol Clin 1993; 11: 47-53. ##42. Madani Sani F, Akhbari Z. A review of the factors influential in the development of PCOS. Quarterly Journal 2010; 47, 48: 49-54. ##43. Conway GS, Hanorr JW, Jacobs HS. Heterognsity of the polycystic ovary syndrome: Clinical, endocrine and ultrasound feature in 556 pationts. Clin Endocrinol 1989: 30: 459-470. ##44. Mirzaei F, Kazemi N. Investigate the prevalence of PCOS in women with type two,visiting Kerman diabetes clinic. Sci J Hamadan Univ Med Sci 2007; 14: 38-42. ##45. Mor E, Zograbyan A, Saadat P. The Insulin resistant subpher. Type of polycystic ovory syndrome: clinical parameters and pathogenesis. Am J Obstet Gynecol 2004; 190: 1654-1660. ##46. Sajjadi Mirzaei S. Investigating the effect of treatment in patients with polycystic ovarian disease in hirsute women. Unpublished thesis, Tarbiat Modarres University, Tehran, Iran. Tesis. ##47. Ramezani Tehrani F, Rashidi H, Azizi F. The prevalence of idiopathic hirsutism and polycystic ovary syndrome in the Tehran Lipid and Glucose Study. Reprod Biol Endocrinol 2011, 9: 144. ##48. Farnaqy F, Seirafi H, Zarinpour N. Descriptive study of 110 patients with hirsutism in Razi Hospital in Tehran during the years of 2000-2001. Iran J Dermatol 2002; 6: 21-25. ##49. Ghasemi N, Mortazavizadeh MR, Khorasani Gerdekoohi. Frequency of poly cystic ovary syndrome in patients with premenopausal breast cancer. Iran J Reprod Med 2010; 8: 86-89. ##50. Kashanian M, Fazy Z, Pirak A. Evaluation of the relationship between gestational diabetes and a history of polycystic ovarian syndrome. Diabetes Res Clin Pract 2008; 80: 289–292. ##51. Ghaderi R, Sharifzadeh GH, Javanbakht P. Factors associated with hirsutism. Journal of Birjand University of Medical Sciences 2004; 11: 19-23. ##52. Ghaderi R, Sharifzadeh GH, Faramarzi R. The relationship of with sex hormone levels. Journal of Birjand University of Medical Sciences 2004; 11: 11-16. ##53. Akhyany M, Daneshpajouh M, Barzegari M, Ghandi N, Ghiasi M, Chenari Z, et al. The prevalence of hirsutism in female students of Tehran University School of Medicine. J Dermatol 2006; 9: 242-249. ##54. Horri N, Farmani M, Haghighi S, Sattari G, Pournaqshband Z, Amini M. The prevalence of PCOS in women with type two diabetes in childbearing age. Iranian Journal of Diabetes and Lipid Disorders 2006; 5: 257-263. ##55. Kalantar Hormozi MR, Siadatan SJ, Arya A, Dabbaghmaneh MH, Shams M, Sadegh-Alvad A, et al. Diabetes risk factors in Shiraz in 1386. Iranian Journal of Diabetes and Lipid Disorders 2007; 7: 159-166. ##56. Naderi T, Akbarzadeh M, Dabbaghmaneh MH, Tabatabai HR. The prevalence of polycystic ovary syndrome phenotypes in high school female students in 1388. The Journal of Qazvin University of Medical Sciences 2011; 15: 61-67.  ##57. Jebraiili R., Galedar N. The prevalence of polycystic ovaries in patients with acne. Yafteh J 2001; 11: 35. ##58. Jahanfar S, Maleki H, Mosavi AR, Jahanfar M. Leptin and its association with polycystic ovary syndrome: a twin study. Gynecol Endocrinol 2004; 18: 327-334. ##59. Bani-Hashemi M, famili S, Nahidi Y. Investigating the causes of hirsutism in patients visiting Zahedan’s Khatam-alanbia hospital from 1380 to 1382. Medical Journal of Mashhad University of Medical Sciences 2007; 50: 287–290. ##60. Nqas Hosseini SH, Qavam A. Investigating the prevalence of PCOS among 1000 girls aged 18-15 years old in Kerman high schools. Unpublished thesis, Kerman University of Medical Sciences and Health Services, Kerman, Iran, 2004 Tesis. ##61. Kamkhvah AF, Parvin N. Hormonal status in hirsute patients referred to the laboratory in Shahrekord in 2005. Journal of Shahrekord University of Medical Sciences. 2008; 10; 112-116. ##62. Dadgostar H, Razi M, Aleyasin A, Alenabi T, Dahaghin S. The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes. Sports Med Arthrosc Rehabil Ther Technol 2009, 1: 16.  ## ##

The effect of Setarud (IMODTM) on angiogenesis in transplanted human ovarian tissue to nude mice بررسی اثر Setarud (IMODTM) بر آنژیوژنز در بافت تخمدان انسان پیوند شده به موشهای n‌ude 2 1 مقدمه: یکی از روشهای نوید بخش جهت حفظ باروری زنان مبتلا به سرطان، انجماد کورتکس تخمدان است. اما مشکلات زیادی در این رابطه نظیر آپوپتوز و کاهش قابل ملاحظه دانسیته فولیکولی پس از پیوند در تخمدان مطرح است. یک راه مناسب برای کاهش آسیب های ایسکمیک، تحریک آنژیوژنز پس از پیوند کورتکس تخمدان می باشد. هدف: هدف از مطالعه حاضر، بررسی اثر Setarud بر تحریک آنژیوژنز در بافت تخمدان انسان پیوند شده به موش های  nudeاست. مواد و روش ها: در این مطالعه مورد شاهدی، نمونه های بافت تخمدان انسان از چهار نفر به صورت زیر جلدی به 24 موش nude پیوند شد. موشهای به صورت تصادفی به دو گروه تجربی و کنترل تقسیم شدند (گروه تجربی تحت تیمار با Setarud و گروه کنترل تحت تیمار با حلال قرار گرفتند). هر گروه براساس زمان خروج بافت به سه زیر گروه (n=4) تقسیم شدند. بافتهای پیوند شده در هر گروه در روزهای 2،7 و 30 پس از پیوند از بدن موشها خارج شدند. میزان بیان آنژیوپویتین یک، آنژیوپویتین دو و VEGF در سطح ژن و پروتئین و میزان دانسیته عروق در نمونه های بافت تخمدان پیوند شده مورد بررسی قرار گرفت. نتایج: بیان ژن آنژیوپویتین یک در دومین و هفتمین روز پس از پیوند نسبت به گروه کنترل کاهش معنی داری را نشان داد، درحالی که نتایج در مورد آنژیوپویتین دو و VEGF معکوس بود. این نتایج در سطح بیان پروتئین نیز تائید شد. دانسیته عروق در گروه تیمار شده با Setarud در هفتمین روز پس از پیوند نسبت به زمان قبل از پیوند افزایش معنی داری را نشان داد. نتیجه گیری: نتایج این بررسی نشان می دهد که تیمار با Setarud ممکن است باعث تحریک آنژیوژنز در بافت تخمدان انسان پیوند شده به موشهای nude گردد، گرچه بررسی های بیشتری در این زمینه برای تائید این مطلب لازم است.    2 Background: One of the promising methods in fertility preservation among women with cancer is cryopreservation of ovarian cortex but there are many drawbacks such as apoptosis and considerable reduction of follicular density in the transplanted ovary. One solution to reduce ischemic damage is enhancing angiogenesis after transplantation of ovarian cortex tissue. Objective: The aim of this study was to investigate the effect of Setarud, on angiogenesis in transplanted human ovarian tissue. Materials and Methods: In this case-control study, twenty-four nude mice were implanted subcutaneously, with human ovarian tissues, from four women. The mice were randomly divided into two groups (n=12): the experimental group was treated with Setarud, while control group received only vehicle. Each group was divided into three subgroups (n=4) based on the graft recovery days post transplantation (PT). The transplanted fragments were removed on days 2, 7 and 30 PT and the expression of Angiopoietin-1, Angiopoietin-2, and VEGF at both gene and protein levels and vascular density were studied in the grafted ovarian tissues. Results: On the 2nd and 7th day PT, the level of Angiopoietin-1 gene expression in case group was significantly lower than that in control group, while the opposite results were obtained for Angiopoietin-2 and VEGF. These results were also confirmed at the protein level. The density of vessels in Setarud group elevated significantly on day 7 PT compared to pre-treatment state. Conclusion: Our results showed that administration of Setarud may stimulates angiogenesis in transplanted human ovarian tissues, although further researches are needed before a clear judgment is made. 605 614 2017/10/12017/10/1 1396/7/9 2017/10/262017/10/26 1396/8/4 مریم هرمزی Maryam Hormozi Biochemistry Department, Lorestan University of Medical Sciences, Khorramabad, Iran ایران سعید طالبی Saeed Talebi Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran ایران akhondi@avicenna.ac.ir حمید رضا خرم خورشید Hamid Reza Khorram Khorshid Genetic Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran ایران امیرحسن زرنانی Amir-Hassan Zarnani Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran ایران کورش کمالی Koorosh Kamali Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran ایران محمود جدی تهرانی Mahmood Jeddi-Tehrani Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran ایران هاله سلطان قرایی Haleh Soltangoraee Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran ایران محمد مهدی آخوندی Mohammad Mehdi Akhondi Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran ایران akhondi@avicenna.ac.ir Angiopoietin VEGF Human ovary Setarud آنژیوپویتین VEGF انسان تخمدان Setarud. Yang H, Lee HH, Lee HC, Ko DS, Kim SS. Assessment of vascular endothelial growth factor expression and apoptosis in the ovarian graft: can exogenous gonadotropin promote angiogenesis after ovarian transplantation? Fertil Steril 2008; 90: 1550-1558.##Nottola SA, Camboni A, Van Langendonckt A, Demylle D, Macchiarelli G, Dolmans MM, et al. Cryopreservation and xenotransplantation of human ovarian tissue: an ultrastructural study. Fertil Steril 2008; 90: 23-32.##Bedaiwy MA, Falcone T. Ovarian tissue banking for cancer patients: reduction of post-transplantation ischaemic injury: intact ovary freezing and transplantation. Hum Reprod 2004; 19: 1242-1244.##Losordo DW, Dimmeler S. Therapeutic angiogenesis and vasculogenesis for ischemic disease: part II: cell-based therapies. Circulation 2004; 8; 109: 2692-2697.##Distler JH, Hirth A, Kurowska-Stolarska M, Gay RE, Gay S, Distler O. Angiogenic and angiostatic factors in the molecular control of angiogenesis. Q J Nucl Med 2003; 47: 149-161.##Ding H, Roncari L, Wu X, Lau N, Shannon P, Nagy A, et al. Expression and hypoxic regulation of angiopoietins in human astrocytomas. Neuro Oncol 2001; 3: 1-10.##Shim WS, Ho IA, Wong PE. Angiopoietin: a TIE (d) balance in tumor angiogenesis. Mol Cancer Res 2007; 5: 655-665.##Chen HH, Weng BQ, Cheng KJ, Liu HY, Wang SQ, Lu YY. Effect of the vascular endothelial growth factor expression level on angiopoietin-2-mediated nasopharyngeal carcinoma growth. Vasc Cell 2014; 6: 4.##Eklund L, Saharinen P. Angiopoietin signaling in the vasculature. Exp Cell Res 2013; 319: 1271-1280.##Fagiani E, Christofori G. Angiopoietins in angiogenesis. Cancer Lett 2013; 328: 18-26.##Gupta K, Zhang J. Angiogenesis: a curse or cure? Postgrad Med J 2005; 81: 236-242.##Bouis D, Kusumanto Y, Meijer C, Mulder NH, Hospers GA. A review on pro- and anti-angiogenic factors as targets of clinical intervention. Pharmacol Res 2006; 53: 89-103.##Otrock ZK, Mahfouz RA, Makarem JA, Shamseddine AI. Understanding the biology of angiogenesis: review of the most important molecular mechanisms. Blood Cells Mol Dis 2007; 39: 212-220.##Baghaei A, Esmaily H, Abdolghaffari AH, Baeeri M, Gharibdoost F, Abdollahi M. Efficacy of Setarud (IMod), a novel drug with potent anti-toxic stress potential in rat inflammatory bowel disease and comparison with dexamethasone and infliximab. Indian J Biochem Biophys 2010; 47: 219-226.##Farhoudi M, Najafi-Nesheli M, Hashemilar M, Mahmoodpoor A, Sharifipour E BB, Taheraghdam A, et al. Effect of IMOD™ on the inflammatory process after acute ischemic stroke: a randomized clinical trial. Daru 2013 20; 21: 26.##khorram Khorshid HR, Azonov JA, Novitsky YA, Farzamfar B, Shahhosseiny MH. Hepadtoprotective effects of satarud against carbon tetracholride-induced liver injury in rats. Indian J Gastroentrol 2008; 27: 110-112.##Mohammairad A, Khorram-Khorshid HR, Gharibdoust F, Abdollahi M. Setarud (Imod) as a multiherbal drug with promising benefits in animal and human studies: A comprehensive reivew of biochemical and cellular evidences. Asian J Anim Veter Adv 2011; 6: 1185-1192.##Azonov JA, Khorram Khorshid HR, Novitsky YA, Farhadi M, Ghorbanoghli Z, Shahhosseiny MH.Protective effects of setarud (IMODTM) on development of diet-induced hypercholesterolemia in rabbits. DARU 2008; 16: 218-222.##Alissa EM, Bahijri SM, Gordon AF. The controversy surrounding selenium and cardiovascular disease: a review of the evidence. Med Sci Monit 2003; 9: RA9-18.##Dembinska-Kiec A, Polus A, Kiec-Wilk B, Grzybowska J, Mikolajczyk M, Hartwich J, et al. Proangiogenic activity of beta-carotene is coupled with the activation of endothelial cell chemotaxis. Biochim Biophys Acta 2005; 1740: 222-239.##Kiec-Wilk B, Polus A, Grzybowska J, Mikolajczyk M, Hartwich J, Pryjma J, et al. beta-Carotene stimulates chemotaxis of human endothelial progenitor cells. Clin Chem Lab Med 2005; 43: 488-498.##Li K, Diao Y, Zhang H, Wang S, Zhang Z, Yu B, et al. Tannin extracts from immature fruits of Terminalia chebula Fructus Retz. promote cutaneous wound healing in rats. BMC Complement Altern Med 2011; 11: 86.##Look MP, Rockstroh JK, Rao GS BS, Lemoch H, Kaiser R, Kupfer B, et al. Sodium selenite and n-acetylcysteine in antiretroviral-naive HIV-1-infected patients: a randomized, controlled pilot study. Eur J Clin Invest 1998; 28: 389-397.##McAuslan BR, Reilly W. Selenium-induced cell migration and proliferation: relevance to angiogenesis and microangiopathy. Microvasc Res 1986; 32: 112-120.##Polus A, Kiec-Wilk B, Hartwich J, Balwierz A, Stachura J, Dyduch G, et al. The chemotactic activity of beta-carotene in endothelial cell progenitors and human umbilical vein endothelial cells: A microarray analysis. Exp Clin Cardiol 2006; 11: 117-122.##Whanger PD. Selenocompounds in plants and animals and their biological significance. J Amer Coll Nutr 2002; 21: 223-232.##Ross SA, McCaffery PJ, Drager UC, De Luca LM. Retinoids in embryonal development. Physiol Rev 2000; 80: 1021-1054.##Nisolle M, Casanas-Roux F, Qu J, Motta P, Donnez J. Histologic and ultrastructural evaluation of fresh and frozen-thawed human ovarian xenografts in nude mice. Fertil Steril 2000; 74: 122-129.##Schubert B, Canis M, Darcha C, Artonne C, Smitz J, Grizard G. Follicular growth and estradiol follow-up after subcutaneous xenografting of fresh and cryopreserved human ovarian tissue. Fertil Steril 2008; 89: 1787-1794.##Pfaffl MW, Horgan GW, Dempfle L. Relative expression software tool (REST) for group-wise comparison and statistical analysis of relative expression results in real-time PCR. Nucleic Acids Res 2002; 30: e36.##Harfouche R, Gratton JP, Yancopoulos GD, Noseda M, Karsan A, Hussain SN. Angiopoietin-1 activates both anti- and proapoptotic mitogen-activated protein kinases. FASEB J 2003; 17: 1523-1525.##Valable S, Bellail A, Lesne S, Liot G, Mackenzie ET, Vivien D, et al. Angiopoietin-1-induced PI3-kinase activation prevents neuronal apoptosis. FASEB J 2003; 17: 443-445.##Jeon BH, Khanday F, Deshpande S, Haile A, Ozaki M, Irani K. Tie-ing the antiinflammatory effect of angiopoietin-1 to inhibition of NF-kappaB. Circ Res 2003; 92: 586-588.##Papapetropoulos A, Fulton D, Mahboubi K, Kalb RG, O'Connor DS, Li F, et al. Angiopoietin-1 inhibits endothelial cell apoptosis via the Akt/survivin pathway. J Biol Chem 2000; 275: 9102-9105.##Brindle NP, Saharinen P, Alitalo K. Signaling and functions of angiopoietin-1 in vascular protection. Circ Res 2006; 98: 1014-1023.##Simoes DC, Vassilakopoulos T, Toumpanakis D, Petrochilou K, Roussos C, Papapetropoulos A. Angiopoietin-1 protects against airway inflammation and hyperreactivity in asthma. Am J Respir Crit Care Med 2008; 177: 1314-1321.##Hormozi M, Talebi S, Zarnani AH, Jeddi-Tehrani M, Gohari LH, Soltanghoraei H, et al. 5'-(N-ethylcarboxamido) adenosine improves angiogenesis in transplanted human ovarian tissue. Fertil Steril 2011; 95: 2560-2563.##Shibuya M. Vascular endothelial growth factor-dependent and -independent regulation of angiogenesis. BMB Rep 2008; 41: 278-286.##Fraser HM. Regulation of the ovarian follicular vasculature. Reprod Biol Endocrinol 2006; 4: 18.##Fam NP, Verma S, Kutryk M, Stewart DJ. Clinician guide to angiogenesis. Circulation 2003; 108: 2613-2618.##Tseng JJ, Chou MM. Differential expression of growth-, angiogenesis- and invasion-related factors in the development of placenta accreta. Taiwan J Obstet Gynecol 2006; 45: 100-106.##Voros G, Maquoi E, Demeulemeester D, Clerx N, Collen D, Lijnen HR. Modulation of angiogenesis during adipose tissue development in murine models of obesity. Endocrinology 2005; 146: 4545-4554.##Hur SE, Lee JY, Moon HS, Chung HW. Angiopoietin-1, angiopoietin-2 and Tie-2 expression in eutopic endometrium in advanced endometriosis. Mol Hum Reprod 2006; 12: 421-426.##Calvi C, Dentelli P, Pagano M, Rosso A, Pegoraro M, Giunti S, et al. Angiopoietin 2 induces cell cycle arrest in endothelial cells: a possible mechanism involved in advanced plaque neovascularization. Arterioscler Thromb Vasc Biol 2004; 24: 511-518.##Koga K, Todaka T, Morioka M, Hamada J, Kai Y, Yano S, et al. Expression of angiopoietin-2 in human glioma cells and its role for angiogenesis. Cancer Res 2001; 61: 6248-6254.##Pichiule P, Chavez JC, LaManna JC. Hypoxic regulation of angiopoietin-2 expression in endothelial cells. J Biol Chem 2004; 279: 12171-12180.##Kalinski T, Krueger S, Sel S, Werner K, Ropke M, Roessner A. Differential expression of VEGF-A and angiopoietins in cartilage tumors and regulation by interleukin-1beta. Cancer 2006; 106: 2028-2038.##Niedzwiecki S, Stepien T, Kopec K, Kuzdak K, Komorowski J, Krupinski R, et al. Angiopoietin 1 (Ang-1), angiopoietin 2 (Ang-2) and Tie-2 (a receptor tyrosine kinase) concentrations in peripheral blood of patients with thyroid cancers. Cytokine 2006; 36: 291-295.##Fiedler U, Augustin HG. Angiopoietins: a link between angiogenesis and inflammation. Trends Immunol 2006; 27: 552-558.##Lobov IB, Brooks PC, Lang RA. Angiopoietin-2 displays VEGF-dependent modulation of capillary structure and endothelial cell survival in vivo. Proc Natl Acad Sci USA 2002; 99: 11205-11210.##Zhang ZL, Liu ZS, Sun Q. Expression of angiopoietins, Tie2 and vascular endothelial growth factor in angiogenesis and progression of hepatocellular carcinoma. World J Gastroenterol 2006; 12: 4241-4245.## ##

In vitro developmental competence of bovine oocytes: Effect of corpus luteum and follicle size شایستگی تکاملی تخمک های گاوی در شرایط برون تنی: اثر حضور جسم زرد و اندازه فولیکولی 2 1 مقدمه: مطالعات گذشته تناقضات بسیاری را در رابطه با اثرات جسم زرد و اندازه های مختلف فولیکولی بر شایستگی تکاملی تخمک ها گزارش داده اند. هدف: هدف این مطالعه بررسی اثرات جسم زرد، اندازه های مختلف فولیکولی و اثرات متقابل این دو عامل در شایستگی تکاملی تخمک های گاوی بوده است. مواد و روش ها: پس از دسته بندی تخمدان ها بر اساس حضور یا عدم حضور جسم زرد، فولیکول های مورد نظر بر طبق قطر خود  به  سه  گروه  کوچک (3-6 میلی مترS: )، متوسط (6-9 میلی متر :M) و بزرگ (10-20 میلی متر :L) تقسیم شدند. سپس تخمک های بدست آمده در هر گروه وارد فرآیند تولید برون تنی رویان گردیدند. نتایج: نتایج حاصله نشان داد که میزان تولید بلاستوسیست از تخمک های استحصالی از فولیکول های کوچک و متوسط تخمدان های واجد زرد (به ترتیب CL+S-oocytes و CL+M-oocytes) کمتر از این مقادیر در تخمدان های فاقد جسم زرد (به ترتیب CL-S-oocytes و CL-M-oocytes) بود (به ترتیب، 30/8% و 33/6% در برابر 36/9% و 38/7%). اگرچه درصد تولید بلاستوسیست از CL-M-oocytes و CL-L-oocytes بیشتر از آن مقادیر در CL+S-oocytes و CL+M-oocytes بود، اما هیچ تفاوت معنی داری در رابطه با تولید بلاستوسیست بین گروه کنترل (C-oocytes)، CL-S-oocytes و CL+L-oocytes وجود نداشت. نتیجه گیری: بر اساس نتایج مطالعه حاضر اثر منفی جسم زرد بر شایستگی تکاملی تخمک های گاوی به اندازه فولیکولی وابسته است. بنابراین تخمک های منشأ گرفته از فولیکول های بزرگ و رشد یافته به اندازه ای که تخمک های منشأ گرفته از فولیکول های کوچک و متوسط از اثرات منفی جسم زرد متأثر شده اند، تحت تأثیر قرار نگرفتند. 2 Background: Previous studies reported many discrepancies about the effects of corpus luteum (CL) and ovarian follicle size on the developmental competence of oocytes. Objective: The aim of this study was to investigate the effects of CL and different size of follicle on the developmental potential of bovine oocytes. Materials and Methods: After ovarian classification based on presence or absence of CL, sample follicles were placed in three groups according to their diameter; small (S; 3–6 mm), medium (M; 6–9 mm), and large (L; 10–20 mm). Collected oocytes in each group were subjected to the in vitro embryo production processes. Results: Results showed that, the percentages of blastocyst obtained from oocytes originating from small and medium follicles of ovaries bearing a CL (CL+S-oocytes and CL+M-oocytes, respectively) were lower (p<0.001) than those of small and medium follicles of ovaries not bearing a CL (CL-S-oocytes and CL-M-oocytes, respectively) (30.8% and 33.6% vs. 36.9% and 38.7% respectively). Although, the percentages of blastocyst obtained from CL-M-oocytes and CL-L-oocytes were greater (p< 0.001) than those of CL+S-oocytes and CL+M-oocytes. There were no significant differences in the percentages of blastocyst formation between controls (C-oocytes), CL-S-oocytes and CL+L-oocytes. Conclusion: According to the results of this study, the negative effect of CL on the developmental competence of bovine oocyte depends on the follicle size. Therefore, oocytes originating from large grown follicles were not influenced by negative effects of CL as much as those originating from small and medium follicles did. 615 622 2017/10/12017/10/12017/10/1 1396/7/9 2017/10/262017/10/262017/10/26 1396/8/4 حامد کرمی شبانکاره Hamed Karami Shabankareh IVF and ET Laboratory, Department of Animal Sciences, Razi University, Kermanshah, Iran ایران hkaramishabankareh@yahoo.com محمد حامد شهسواری Mohammad Hamed Shahsavari IVF and ET Laboratory, Department of Animal Sciences, Razi University, Kermanshah, Iran ایران هادی حجاریان Hadi Hajarian IVF and ET Laboratory, Department of Animal Sciences, Razi University, Kermanshah, Iran ایران غلام علی مقدم Gholamali Moghaddam Department of Animal Sciences, Faculty of Agriculture, University of Tabriz, Tabriz, Iran ایران Bovine Development Oocyte.  گاو تکامل اووسیت. Mermillod P, Marchal R. Oocyte of domestic mammals: a model for the study of in vitro maturation. Contracep Fertil Sex 1999; 27: 440-448.##Lonergan P, Gutiérrez‐Adán A, Rizos D, Pintado B, De La Fuente J, Boland MP. Relative messenger RNA abundance in bovine oocytes collected in vitro or in vivo before and 20 hr after the preovulatory luteinizing hormone surge. Mol Reprod Dev 2003; 66: 297-305.##Alm H, Torner H, Löhrke B, Viergutz T, Ghoneim I, Kanitz W. Bovine blastocyst development rate in vitro is influenced by selection of oocytes by brillant cresyl blue staining before IVM as indicator for glucose-6-phosphate dehydrogenase activity. Theriogenology 2005; 63: 2194-2205.##Lonergan P, Fair T, Corcoran D, Evans A. Effect of culture environment on gene expression and developmental characteristics in IVF-derived embryos. Theriogenology 2006; 65: 137-152.##Karami-Shabankareh H, Mirshamsi SM. Selection of developmentally competent sheep oocytes using the brilliant cresyl blue test and the relationship to follicle size and oocyte diameter. Small Ruminant Research 2012; 105: 244-249.##Contreras-Solis I, Diaz T, Lopez G, Caigua A, Lopez-Sebastian A, Gonzalez-Bulnes A. Systemic and intraovarian effects of corpus luteum on follicular dynamics during estrous cycle in hair breed sheep. Anim Reprod Sci 2008; 104: 47-55.##Penitente-Filho JM, Carrascal E, Oliveira FA, Zolini AM, Oliveira CT, Costa Soares ÍA, et al. Influence of dominant follicle and corpus luteum on recovery of good quality oocytes for in vitro embryo production in Cattle. Brit Biotech J 2014; 4: 1305-1312.##Mann GE, Lamming GE, Robinson RS, Wathes DC. The regulation of interferon-tau production and uterine hormone receptors during early pregnancy. J Reprod Fertil Suppl 1998; 54: 317-328.##Powell ML, Kavanaugh S, Sower SA. Identification of a functional corpus luteum in the Atlantic hagfish, Myxine glutinosa. Gen Comp Endocrinol 2006; 148: 95-101.##Field PA. Relaxin and other luteal secretory peptides: cell localization and function in the ovary. In: Familiari G, Makabe S, Motta PM (eds.). Ultrastructure of the Ovary. Kluwer Academic Publishers; 1991: 177-198.##Boediono A, Rajamahendran R, Saha S, Sumantri C, Suzuki T. Effect of the presence of a CL in the ovary on oocyte number, cleavage rate and blastocyst production in vitro in cattle. Theriogenology 1993; 43: 169.##Sugulle AH, Dochi O, Koyama H. Developmental competence of bovine oocytes selected by Brilliant Cresyl Blue Staining: Effect of the presence of corpus luteum on embryo development. J Mammalian Ova Research 2008; 25: 50-55.##Mirshamsi SM, Shabankareh HK. Selection of developmentally competent sheep zygotes using the Brilliant Cresyl Blue (BCB) test, after IVF. Small Ruminant Research 2012; 105: 250-254.##Mirshamsi SM, KaramiShabankareh H, Ahmadi-Hamedani M, Soltani L, Hajarian H, Abdolmohammadi A. Combination of oocyte and zygote selection bybrilliant cresyl blue (BCB) test enhanced prediction of developmental potential to the blastocyst in cattle. Anim Reprod Sci 2013; 136: 245–251.##Motlik J, Fulka J. Factors affecting meiotic competence in pig oocytes. Theriogenology 1986; 25: 87-96.##Yoon K-W, Shin T-Y, Park J-I, Roh S, Lim JM, Lee B-C, et al. Development of porcine oocytes from preovulatory follicles of different sizes after maturation in media supplemented with follicular fluids. Reprod Fertility Dev 2001; 12: 133-139.##Beker-van Woudenberg AR, Zeinstra EC, Roelen BA, Colenbrander B, Bevers MM. Developmental competence of bovine oocytes after specific inhibition of MPF kinase activity: effect of estradiol supplementation and follicle size. Anim Reprod Sci 2006; 92: 231-240.##Blondin P, Sirard M-A. Oocyte and follicular morphology as determining characteristics for developmental competence in bovine oocytes. Mol Reprod Dev 1995; 41: 54-62.##Machatkova M, Krausova K, Jokesova E, Tomanek M. Developmental competence of bovine oocytes: effects of follicle size and the phase of follicular wave on in vitro embryo production. Theriogenology 2004; 61: 329-335.##Shabankareh HK, Kor NM, Hajarian H. The influence of the corpus luteum on metabolites composition of follicular fluid from different sized follicles and their relationship to serum concentrations in dairy cows. Anim Reprod Sci 2013; 140: 109-114.##Parrish J, Susko-Parrish J, Leibfried-Rutledge M, Critser E, Eyestone W, First N. Bovine in vitro fertilization with frozen-thawed semen. Theriogenology 1986; 25: 591-600.##Lawitts JA, Biggers JD. Culture of preimplantation embryos. Methods Enzymol 1993; 225: 153-164.##Fukuda M, Fukuda K, Andersen CY, Byskov AG. Contralateral selection of dominant follicle favours pre-embryo development. Hum Reprod 1996; 11: 1958-1962.##Pirestani A, Hosseini SM, Hajian M, Forouzanfar M, Moulavi F, Abedi P, et al. Effect of ovarian cyclic status on in vitro embryo production in cattle. Int J Fertil Steril 2010; 4: 172-175.##Filho FT, Santos MHB, Carrazzoni PG, Paula-Lopes FF, Neves JP, Bartolomeu CC, et al. Follicular dynamics in Anglo-Nubian goats using transrectal and transvaginal ultrasound. Small Ruminant Research 2007; 72: 51-56.##Islam MR, Khandoker MA, Afroz S, Rahman MG, Khan RI. Qualitative and quantitative analysis of goat ovaries, follicles and oocytes in view of in vitro production of embryos. J Zhejiang Univ Sci B 2007; 8: 465-469.##Kumar N, Paramasivan S, Sood P, Singh M. Micrometry of different category oocytes recovered from goat ovaries. Indian J Anim Sci 2004; 74.##Jamil H, Samad HA, Qureshi ZI, Rehman NU, Lodhi LA. Harvesting and evaluation of riverine buffalo follicular oocytes. Turk J Vet Anim Sci 2008; 32: 25-30.##Findlay J, Drummond A, Dyson M, Baillie A, Robertson D, Ethier J-F. Production and actions of inhibin and activin during folliculogenesis in the rat. Mol Cell Endocrinol 2001; 180: 139-144.##Shabankareh HK, Habibizad J, Torki M. Corpus luteum function following single and double ovulation during estrous cycle in Sanjabi ewes. Anim Reprod Sci 2009; 114: 362-369.##Berisha B, Pfaffl MW, Schams D. Expression of estrogen and progesterone receptors in the bovine ovary during estrous cycle and pregnancy. Endocrine 2002; 17: 207-214.##Adams G. Comparative patterns of follicle development and selection in ruminants. J Reprod Fertil Suppl 1999; 54: 17-32.##Effects of a 6-Day treatment with medroxyprogesterone acetate after prostaglandin F2α-induced luteolysis at midcycle on antral follicular development and ovulation rate in nonprolific western white-Faced Ewes. Biol Reprod 2003; 68, 1403–1412.##Bartlewski PM, Beard AP, Rawlings NC. Ultrasonographic study of the effects of the corpus luteum on antral follicular development in unilaterally ovulating western white-faced ewes. Anim Reprod Sci 2001; 65: 231-244.##Sangha G, Sharma R, Guraya S. Biology of corpus luteum in small ruminants. Small Rumin Res 2002; 43: 53-64.##Campbell BK, Picton HM, Mann GE, McNeilly AS, Baird DT. Effect of steroid-and inhibin-free ovine follicular fluid on ovarian follicles and ovarian hormone secretion. J Reprod Fertil 1991; 93: 81-96.##Vassena R, Mapletoft RJ, Allodi S, Singh J, Adams GP. Morphology and developmental competence of bovine oocytes relative to follicular status. Theriogenology 2003; 60: 923-932.##Taylor C, Rajamahendran R. Effect of mid-luteal phase progesterone levels on the first wave dominant follicle in cattle. Can J Anim Sci 1994; 74: 281-285.##Penitente-Filho JM, Jimenez CR, Zolini AM, Carrascal E, Azevedo JL, Silveira CO, et al. Influence of corpus luteum and ovarian volume on the number and quality of bovine oocytes. Anim Sci J 2015; 86: 148-152.##Takuma T, Otsubo T, Kurokawa Y, Otoi T. 416 Effects of the corpus luteum within the ovary on the follicular dynamics after follicular aspiration and on the developmental competance of aspirated oocytes. Reprod Fertil Deve 2006; 19: 324.##Lequarre AS, Vigneron C, Ribaucour F, Holm P, Donnay I, Dalbiès-Tran R, et al. Influence of antral follicle size on oocyte characteristics and embryo development in the bovine. Theriogenology 2005; 63: 841-859.##Crozet N, Ahmed-Ali M, Dubos M. Developmental competence of goat oocytes from follicles of different size categories following maturation, fertilization and culture in vitro. J Reprod Fertil 1995; 103: 293-298.##Hyttel P, Fair T, Callesen H, Greve T. Oocyte growth, capacitation and final maturation in cattle. Theriogenology 1997; 47: 23-32.##Shabankareh HK, Habibizad J, Sarsaifi K, Cheghamirza K, Jasemi VK. The effect of the absence or presence of a corpus luteum on the ovarian follicular population and serum oestradiol concentrations during the estrous cycle in Sanjabi ewes. Small Rumin Res 2010; 93: 180-185.##Acosta TJ, Miyamoto A. Vascular control of ovarian function: ovulation, corpus luteum formation and regression. Anim Reprod Sci 2004; 82: 127-140.## ##

Cell free fetal DNA testing in maternal blood of Romanian pregnant women آزمایش DNA بدون سلول جنینی در خون مادران حامله رومانی 2 1 مقدمه: کشف DNA جنینی در گردش خون مادر منجر به کشف روشهای جدید غیرتهاجمی جهت تشخیص قبل تولد گردید. هدف: هدف مطالعه تشخیص آنوپلوئیدی جنینی در کروموزومهای 13، 18، 21، x و y بوسیله آزمایش DNA بدون سلول جنینی در خون مادر بدون به خطر انداختن حاملگی بود. مواد و روش ها: این مطالعه گذشته نگر در بخارست، دپارتمان پزشکی مادر و جنین Medlife بین سال های 2013 و 2014 انجام گرفت. به طور کلی به 201 زن، آزمایشات قبل تولد غیر تهاجمی پیشنهاد گردید. نمونه پلاسما مادران از زنان با سن حاملگی بیش از 9 هفته پس از مشاوره ژنتیک و دادن آگاهی به آنها جمع آوری شد. نتایج: از 21 زن، 28 نفر (13/93%) داده ی تستهای غربالگری با ریسک بالا برای تریزومی 21، 116 نفر (57/71%) دارای سن بالای حاملگی، یک نفر (0/49%) دارای مارکرهای سونوگرافی سه ماه دوم بودند و بقیه 56 زن (27/86 %) فقط آزمایش را انجام دادند. از این بیماران 189 نفر (94/02%) نتایج با ریسک پایین داشتند. (10/000>) از بین بیماران با ریسک پایین، 2 نفر آمنیوسنتز با نتیجه نرمال داشتند. پنج بیمار (2/48%) دارای ریسک بالای (99% <) بررسی تریزومی 21 بودند. تریزومی 21 بوسیه آمنیوسنتز در یک بیمار تایید شد و بقیه 4 بیمار از تائید سرباز زدند. هفت بیمار باقیمانده (3/48%) دارای میزان کم DNA جنینی بودند. نتیجه گیری: به نظر میرسد که تشخیص قبل تولد بوسیله DNA جنینی در خون مادر در آینده نقش بیشتری به خاطر دقت بالا در تشخیص های قبل تولد ایفا نماید. 2 Background: The discovery of circulating fetal DNA in maternal blood led to the discovery of new strategies to perform noninvasive testing for prenatal diagnosis. Objective: The purpose of the study was to detect fetal aneuploidy at chromosomes 13, 18, 21, X, and Y by analysis of fetal cell-free DNA from maternal blood, without endangering pregnancy. Materials and Methods: This retrospective study has been performed in Bucharest at Medlife Maternal and Fetal Medicine Department between 2013-2014. In total  201 women were offered noninvasive prenatal test. Maternal plasma samples were collected from women at greater than 9 weeks of gestation after informed consent and genetics counseling. Results: From 201 patients; 28 (13.93%) had screening test with high risk for trisomy 21, 116 (57.71%) had advanced maternal age, 1 (0.49%) had second trimester ultrasound markers and the remaining 56 patients (27.86%) performed the test on request. Of those patients, 189 (94.02%) had a “low risk” result (<1/10,000). Of those who had a low risk result, 2 continued on to have amniocentesis with normal results.Five patients (2.48%) received “high risk” results (>99% risk) all for trisomy 21 (T21). T21 was confirmed by amniocentesis in 1 patient and the other 4 patients declined confirmation. The 7 remaining patients (3.48%) had a low fetal fraction of DNA. Conclusion: It is probably that prenatal diagnosis using fetal DNA in maternal blood would play an increasingly role in the future practice of prenatal testing because of high accuracy. 623 626 2017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/262017/10/262017/10/262017/10/26 1396/8/4 Viorica E Radoi Viorica E Radoi Department of Medical Genetics, UMF Carol Davila, Romania, Bucharest Camil L Bohiltea Camil L Bohiltea Department of Medical Genetics, UMF Carol Davila, Romania, Bucharest gen_og@yahoo.com Roxana E Bohiltea Roxana E Bohiltea Department of Maternal and Fetal Medicine, Medlife Romania, Bucharest Dragos N Albu Dragos N Albu Department of Maternal and Fetal Medicine, Medlife Romania, Bucharest Prenatal Fetal DNA قبل از تولد جنینی DNA. Alfirevic Z, Mujezinovic F, Sundberg K. Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database Syst Rev 2003; 3: CD003252.##Bischoff FZ, Lewis DE, Simpson JL. Cell-free fetal DNA in maternal blood: kinetics, source and structure. Hum Reprod Update 2005; 11: 59-67.##Bianchi DW. Fetal cells in the maternal circulation: feasibility for prenatal diagnosis. Br J Haematol 1999; 105: 574-583.##Tjoa ML, Cindrova-Davies T, Spasic-Boskovic O, Bianchi DW, Burton GJ. Trophoblastic oxidative stress and the release of cell-free feto-placental DNA. Am J Pathol 2006; 169: 400-404.##Stroun M, Maurice P, Vasioukhin V, Lyautey J, Lederrey C, Lefort F, et al. The origin and mechanism of circulating DNA. Ann NY Acad Sci 2000; 906: 161-168.##Saito H, Sekizawa A, Morimoto T, Suzuki M, Yanaihara T. Prenatal DNA diagnosis of a single-gene disorder from maternal plasma. Lancet 2000; 356: 1170.##Wataganara T, Chen AY, LeShane ES, Sullivan LM, Borgatta L, Bianchi DW, et al. Cell-free fetal DNA levels in maternal plasma after elective first-trimester termination of pregnancy. Fertil Steril 2004; 81: 638-644.##Bianchi DW, Williams JM, Sullivan LM, Hanson FW, Klinger KW, Shuber AP. PCR quantitation of fetal cells in maternal blood in normal and aneuploid pregnancies. Am J Hum Genet 1997; 61: 822-829.##Bauer M, Hutterer G, Eder M, Majer S, Leshane E, Johnson KL, et al. A prospective analysis of cell-free fetal DNA concentration in maternal plasma as an indicator for adverse pregnancy outcome. Prenat Diagn 2006; 26: 831-836.##Nicolaides, KH. Validation of targeted sequencing of single-nucleotide polymorphism for non-invasive prenatal detection of aneuploidy of chromosomes 13, 18, 21, X and Y. Prenat Diag 2013; 33: 575-579.##Wang Y, Chen Y, Tian F, Zhang J, Song Z, Wu Y, et al. Maternal mosaicism is a significant contributor to discordant sex chromosomal aneuploidies associated with noninvasive prenatal testing. Clinical Chemistry 2014; 60: 251-259.##Cheung SW, Patel A,Leung TA. Accurate Description of DNA-Based Noninvasive Prenatal Screening. N Engl J Med 2015; 372: 1675-1677.##Norton ME, Brar H, Weiss J, Karimi A, Laurent LC, Caughey AB, et al. Non-Invasive Chromosomal Evaluation (NICE) study: results of a multicenter, prospective, cohort study for detection of fetal trisomy 18. Am J Obstet Gynecol 2012; 207: 137.e1-8.##Canick JA, Kloza EM, Lambert-Messerlian GM, Haddow JE, Ehrich M, van den Boom D, et al. DNA sequencing of maternal plasma to identify Down syndrome and other trisomies in multiple gestations. Prenat Diagn 2012; 32: 730-734.## ##

Association of plasminogen activator inhibitor-1 (PAI-1) and angiotensin converting enzyme polymorphisms with recurrent pregnancy loss in Iranian women بررسی ارتباط پلی مورفیسم های ژن های مهار کننده فعال کننده پلاسمینوژن_1 (PAI-1) و آنزیم تبدیل کننده آنژیوتانسین (ACE)با سقط مکرر جنین در بیماران ایرانی 2 1 مقدمه: سقط مکرر جنین به دو یا بیش از دو سقط متوالی جنین قبل از هفته بیستم حاملگی اطلاق می شود. شواهد به دست آمده نشان میدهد که علل متنوعی در بروز سقط مکرر دخیل هستند که از آن جمله میتوان به اختلال های ترومبوفیلیک اشاره کرد. مهار کننده فعال کننده پلاسمینوژن ـ1 (PAI-1) و آنزیم تبدیل کننده آنژیوتانسین (ACE) رابطه ی تنگاتنگی با حوادث ترومبوفیلیک، تکوین جنین و موفقیت در حامگی دارند از این رو بررسی پلی مورفیسم این ژن ها در زنان مبتلا به سقط مکرر بدون علت، امکان کشف ارتباط این پلی مورفیسم ها با سقط مکرر را فراهم می سازد. هدف: هدف از این مطالعه بررسی پلی مورفیسم ژن های ACE وPAI-1  و ارتباط آن با سقط مکرر می باشد. مواد و روش ها: در این مطالعه ی مورد شاهدی، 100 بیمار با سابقه سقط (حداقل دو بار) به عنوان گروه بیمار و 100 خانم سالم بدون سابقه سقط و با داشتن دو و یا بیشتر فرزند سالم به عنوان گروه کنترل مورد مطالعه قرار گرفتند. برای بررسی پلی مورفیسم های(4G/5G) PAI-1  و (D/I) ACE واکنش زنجیره پلی مراز همراه با استفاده از آنزیم های محدود کننده (PCR-RFLP) طراحی شد. نتایج: در مطالعه ی حاضر برای بررسی پلی مورفیسم(4G/5G) PAI-1 ، ژنوتیپ 4G/4G با فراوانی 17% در گروه بیمار و 5% در گروه شاهد (P=0/006 و میزان خطر نسبی 4/63) مشاهده شد که نشان می دهد ژنوتیپ 4G/4G در جمعیت بیمار نسبت به گروه کنترل افزایش معنی داری دارد. در ارتباط با پلی مورفیسم (D/I) ACE، ژنوتیپ I/I با فراوانی 7% در گروه بیمار و 0% در گروه شاهد ( P=0/034) مشاهده گردید، که نشان دهنده ی عدم وجود ارتباط معنی دار مابین این پلی مورفیسم و گروه مورد مطالعه می باشد. نتیجه گیری: با توجه به نتایج بدست آمده از آنجا که پلی مورفیسم (4G/5G) PAI-1 احتمالا از طریق اختلال در سیستم انعقادی می تواند باعث سقط جنین در این افراد شود. بررسی وجود این جهش همراه با سایر عوامل مشکوک مثل MTHFR، فاکتور 5 لایدن در بیماران مبتلا به سقط مکرر توصیه می شود.     2 Background: Recurrent pregnancy loss (RPL) defined by two or more failed pregnancies before 20 weeks of gestation. Several factors play a role in RPL including thrombophilic conditions which can be influenced by gene polymorphisms. Plasminogen activator inhibitor-1 (PAI-1) and angiotensin converting enzyme (ACE) genes are closely related to fibrinolytic process, embryonic development and pregnancy success. Objective: The aim of this study was to investigate the relationship between RPL and common polymorphisms in ACE and PAI-1 genes. Materials and Methods: In this case control study, 100 women with recurrent abortions (at least two) were selected as cases and 100 healthy women with two or more normal term deliveries without a history of abortion as controls. Total genomic DNA was isolated from blood leukocytes. The status of the PAI-1 4G/5G and ACE (D/I) polymorphism was determined by PCR-RFLP. Results: Homozygosity for PAI-1 4G polymorphism was seen in 17 cases (17%), and 5 controls (5%) (p=0.006) so patients with homozygote 4G mutation were significantly more prone to RPL in contrast to control group (OR: 4.63, % 95 CI: 1.55-13.84). In addition, 7 patients (7 %), and no one from the control group, were homozygote (I/I) for ACE polymorphism (p=0.034), suggesting no significant associations between ACE D allele or DD genotype and RPL. Conclusion: Considering these results, because 4G/4G polymorphism for PAI-1 gene could be a thrombophilic variant leading to abortion, analysis of this mutation and other susceptibility factors are recommended in patients with RPL. 627 632 2017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/262017/10/262017/10/262017/10/262017/10/26 1396/8/4 فاطمه شاکرمی Fatemeh Shakarami Department of Biology, Guilan University, Rasht, Iran ایران محمد تقی اکبری Mohammad Taghi Akbari Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran ایران mtakbari@modares.ac.ir شهره زارع کاریزی Shohreh Zare Karizi Department of Biology, Varamin Pishva Branch, Islamic Azad University, Varamin Pishva, Iran ایران Spontaneous abortion Thrombophilia Plasminogen activator inhibitor-1 Angiotensin converting enzyme سقط مکرر خود به خودی ترومبوفیلی مهار کننده فعال کننده پلاسمینوژن 1 آنزیم مبدل آنژیوتانسین Tulandi T, Huang JY, Tan SL. Preservation of female fertility: an essential progress. Obstet Gynecol 2008; 112: 1160-1172.##Christiansen OB, Nielsen HS, Kolte A, Pedersen AT. Research Methodology and Epidemiology of Relevance in Recurrent Pregnancy Loss. Semin Reprod Med 2006; 24: 5–16.##Franssen MT, Korevaar JC, Leschot NJ, Bossuyt PM, Knegt AC, Gerssen-Schoorl KB, et al. Selective chromosome analysis in couples with two or more miscarriages: case-control study. BMJ 2005; 331: 137–141.##Kuhli C, Luchtenberg M, Scharrer I, Hattenbach LO. Massive subhyaloidal hemorrhage associated with severe PAI-1 deficiency. Graefes Arch Clin Exp Ophthalmol 2005; 243: 963–966.##Festa A, D'Agostino R Jr, Rich SS, Jenny NS, Tracy RP, Haffner SM. Promoter (4G ⁄ 5G) plasminogen activator inhibitor-1 genotype and plasminogen activator-1 levels in blacks, Hispanics and non Hispanic whites: the Insulin Resistance Atherosclerosis Study. Circulation 2003; 107: 2422-2427.##Rigat B, Hubert C, Alhenc-Gelas F, Cambien F, Corvol P, Soubrier F. An insertion/deletion polymorphism in the angiotensin I converting enzyme gene accounts for half the variance of serum enzyme levels. J Clin Invest 1990; 86: 1343–1346.##Asgari N, Akbari MT, Zare S, Babamohammadi G. Positive association of Apolipoprotein E4 polymorphism with recurrent pregnancy loss in Iranian patients. J Assist Reprod Genet 2013; 30: 265–268.##Miller SA, Dykes DD, Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res 1988; 16: 1215-1220.##Buchholz T, Lohse P, Rogenhofer N, Kosian E, Pihusch R, Thaler CJ. Polymorphisms in the ACE and PAI-1 genes are associated with recurrent spontaneous miscarriages. Hum Reprod 2003; 18: 2473–2477.##Dossenbach-Glaninger A, Van Trotsenburg M, Dossenbach M, Oberkanins C, Moritz A, Krugluger W, et al. Plasminogen activator inhibitor 1 4G/5G polymorphism and coagulation factor XIII Val34Leu polymorphism: impaired fibrinolysis and early pregnancy loss. Clin Chem 2003; 49: 1081-1086.##Soltan ghoraei H, Memariani T, Aarabi M, Arefi SS, Hantoushzadeh S, Aarabi M, et al. Association of ACE, PAI-1 and coagulation factor XIII gene polymorphisms with recurrent spontaneous abortion in Iranian patients. J Reprod Infertil 2007; 4: 2324-2330.##Aarabi M, Memariani T, Arefi S, Aarabi M, Hantoosh Zadeh S, Akhondi MA, et al. Polymorphisms of plasminogen activator inhibitor-1, angiotensin converting enzyme and coagulation factor XIII genes in patients with recurrent spontaneous abortion. J Matern Fetal Neonatal Med 2011; 24: 545-548.##Guan LX, Du XY, Wang JX, Gao L, Wang RL, Li HB, et al. Association of genetic polymorphisms in plasminogen activator inhibitor-1 gene and 5, 10-methylenetetrahydrofolate reductase gene with recurrent early spontaneous abortion. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2005; 22: 330-333.##Al Sallout RJ, Sharif FA. Polymorphisms in NOS3, ACE and PAI-1 genes and risk of spontaneous recurrent miscarriage in the Gaza Strip. Med Princ Pract 2010; 19: 99-104.##Ivanov P, Komsa-Penkova R, Konova E, Gecheva S, Ivanov I, Kovacheva K, et al. Combined thrombophilic factors among women with late recurrent spontaneous abortions. Akusherstvo iginekologiia 2011; 50: 8-12.##Coulam CB, Jeyendran RS, Fishel LA, Roussev R. Multiple thrombophilic gene mutations are risk factors for implantation failure. Reprod Biomed Online 2006; 12: 322-327.##Coulam CB, Jeyendran RS. Thrombophilic gene polymorphisms are risk factors for unexplained infertility. Fertil Steril 2009; 91: 1516-1517.##Wolf CE, Haubelt H, Pauer HU, Hinney B, Krome-Cesar C, Legler TJ, et al. Recurrent pregnancy loss and its relation to FV Leiden, FII G20210A and polymorphisms Of plasminogen activator and plasminogen activator inhibitor. Pathophysiol Haemost Thromb 2003; 33: 134-137.##Schenk JF, Stephan B, Zewinger S, Speer T, Pindur G. Comparison of the plasminogen activator inhibitor-1 4G/5G gene polymorphism in females with venous thromboembolism during pregnancy or spontaneous abortion. Clin Hemorheol Microcirc 2008; 39: 329-332.##Su MT, Lin SH, Chen YC, Kuo PL. Genetic association studies of ACE and PAI-1 genes in women with recurrent pregnancy loss: a systematic review and meta-analysis. Thromb Haemost 2012; 109: 8-15.## ##

Slow cryopreservation is not superior to vitrification in human spermatozoa; an experimental controlled study Cryopreservation Slow به انجماد شیشه ای در اسپرماتوزوای انسانی برتری ندارد: یک مطالعه کنترل شده تجربی 2 1 مقدمه: کریوپرزرواسیون (Cryopreservation) اسپرماتوزوا جهت مدیریت ناباروری و یا در موارد دیگر پزشکی کاربرد دارد. کریوپرزرواسیون روتین بستگی دارد به نفوذ کرایوپرتکتانت به طوری که اثرات سمی آن توجه را به طرف روشهای انجماد شیشه ای (Vitrification) که از کرایوپرتکتانت عادی می باشد جلب کرده است. هدف: مقایسه بین کریوپرزرواسیون آهسته و انجماد شیشه ای در اسپرماتوزوای انسانی. مواد و روش ها: این مطالعه کنترل شده تجربی بر روی 33 نمونه مایع منی انجام گرفت. هر نمونه به سه قسمت مساوی تقسیم شد کنترل تازه، فریز آهسته سنتی و انجماد شیشه ای بدون کریوپروتکتانت. زنده مانی (Viability) و توانایی غشاء میتوکندریال (MMP) اسپرماتوزوای کنترل و بعد از ذوب بوسیله کیت زنده مانی اسپرم و کیت Jc-1 به ترتیب اندازه گیری و به وسیله fluorescence-activated cell sorting آنالیز گردید. نتایج: کاهش معنی دار حرکت پیشرونده، زنده مانی و MMP در فریز و ذوب شدن مشاهده شد، در حالیکه هیچ تفاوت معنی داری بین دو روش کریوپرزرواسیون مشاهده نگردید. کریوپرزرواسیون منجر به 48% کاهش در درصد اسپرماتوزواهای زنده و 54/5% افزایش در درصد اسپرماتوزاهای مرده شد. علاوه بر این MMP بالا 24% کاهش و MMP پایین دچار 34/75% افزایش در نتیجه فریز و ذوب گردید. حرکت پیشرونده اسپرماتوزوا به طور معنی داری در ارتباط مثبت با MMP بالا و در ارتباط منفی با MMP پایین در نمونه های کنترل و همچنین نمونه های بعد از ذوب بود. نتیجه گیری: هر چند که هر دو روش کریوپرزرواسیون نتایج مشابه را نشان دادند ولی انجماد شیشه ای ارزانتر، سریعتر، آسانتر و همراه با سمیت کمتری است بنابراین انجماد شیشه ای جهت کاربرد کلینیکی ارجح است. 2 Background: Spermatozoa cryopreservation is used for the management of infertility and some other medical conditions. The routinely applied cryopreservation technique depends on permeating cryoprotectants, whose toxic effects have raised the attention towards permeating cryoprotectants-free vitrification technique. Objective: To compare between the application of slow cryopreservation and vitrification on human spermatozoa. Materials and Methods: This was an experimental controlled study involving 33 human semen samples, where each sample was divided into three equal parts; fresh control, conventional slow freezing, and permeating cryoprotectants-free vitrification. Viability and mitochondrial membrane potential (MMP) of control and post-thawing spermatozoa were assessed with the sperm viability kit and the JC-1 kit, respectively, using fluorescence-activated cell sorting analysis. Results: Significant reduction of the progressive motility, viability and MMP was observed by the procedure of freezing and thawing, while there was not any significant difference between both cryopreservation techniques. Cryopreservation resulted in 48% reduction of the percentage of viable spermatozoa and 54.5% rise in the percentage of dead spermatozoa. In addition, high MMP was reduced by 24% and low MMP was increased by 34.75% in response to freezing and thawing. Progressive motility of spermatozoa was correlated significantly positive with high MMP and significantly negative with low MMP in control as well as post-thawing specimens (r=0.8881/ -0.8412, 0.7461/ -0.7510 and 0.7603/ -0.7839 for control, slow and vitrification respectively, p=0.0001).   Conclusion: Although both cryopreservation techniques have similar results, vitrification is faster, easier and associated with less toxicity and costs. Thus, vitrification is recommended for the clinical application. 633 644 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/262017/10/262017/10/262017/10/262017/10/262017/10/26 1396/8/4 Mohamed Sheata Ali Mohamed Mohamed Sheata Ali Mohamed Women Hospital, Faculty of Medicine, University of Cologne. Kerpener Straße 62, 50937 Cologne, Germany Mohammed.shehatta1@gmail.com Human spermatozoa Cryopreservation Vitrification Sperm viability Mitochondrial membrane potential  اسپرماتوزوای انسانی انجماد شیشه ای زنده مانی اسپرم توانایی غشاء میتوکندریال. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th Ed. WHO Press. 2010.##Isachenko E, Isachenko V, Weiss JM, Kreienberg R, Katkov II, Schulz M, et al. Acrosomal status and mitochondrial activity of human spermatozoa vitrified with sucrose. Reproduction 2008; 136: 167-173.##Isachenko E, Isachenko V, Sanchez R, Katkov II, Kreienberg R. Cryopreservation of spermatozoa: Old routine and new perspectives. In: Donnez J, Kim SS. Principles and practice of fertility preservation. Cambridge, UK: Cambridge University Press, 2010; 177-199.##Isachenko V, Maettner R, Petrunkina AM, Sterzik K, Mallmann P, Rahimi G, et al. Cryoprotectant free vitrification of human spermatozoa in large (to 0.5 mL) volume: novel technology. Clin Lab 2011; 57: 643-650.##Vidament M, Vincent P, Martin FX, Magistrini M, Blesbois E. Differences in ability of Jennies and Mares to conceive with cooled and frozen semen containing glycerol or not. Anim Reprod Sci 2009; 112: 22-35.##Isachenko V, Isachenko E, Petrunkina AM, Sánchez R. Human spermatozoa vitrified in the absence of permeable cryoprotectants: birth of two healthy babies. Reprod Fertil Dev 2012; 24: 323-326.##Isachenko EP, Mallmann G, Rahimi J. Risopatròn M, Schulz V, Isachenko R, et al. Vitrification technique- new possibilities for male gamete low-temperature storage, Current Frontiers in Cryobiology, Chapter 2. Pages 41- 76. Prof. Igor Katkov Ed. Publisher: InTech, 2012.##Isachenko V, Maettner R, Petrunkina AM, Sterzik K, Mallmann P, Rahimi G, et al. Vitrification of human ICSI/IVF spermatozoa without cryoprotectants: new capillary technology. J Androl 2012; 33: 462-468.##Yoon SJ, Kwon WS, Rahman MS, Lee JS, Pang MG. A novel approach to identifying physical markers of cryo-damage in bull spermatozoa. PLoS One 2015; 10: e0126232.##Pukazhenthi BS, Nagashima J, Travis AJ, Costa GM, Escobar EN, França LR, et al. Slow freezing, but not vitrification supports complete spermatogenesis in cryopreserved, neonatal sheep testicular xenografts. PLoS One 2015; 10: e0123957.##Jiménez-Rabadán P, García-Álvarez O, Vidal A, Maroto-Morales A, Iniesta-Cuerda M, Ramón M, et al. Effects of vitrification on ram spermatozoa using free-egg yolk extenders. Cryobiology 2015; 71: 85-90.##Moraes EA, Matos WC, Graham JK, Ferrari WD Jr. Cholestanol-loaded-cyclodextrin improves the quality of stallion spermatozoa after cryopreservation. Anim Reprod Sci 2015; 158: 19-24.##Agha-Rahimi A, Khalili MA, Nabi A, Ashourzadeh S. Vitrification is not superior to rapid freezing of normozoospermic spermatozoa: effects on sperm parameters, DNA fragmentation and hyaluronan binding. Reprod Biomed Online 2014; 28: 352-358.##Esteves SC, Sharma RK, Thomas AJ Jr, Agarwal A. Improvement in motion characteristics and acrosome status in cryopreserved human spermatozoa by swim-up processing before freezing. Hum Reprod 2000; 15: 2173-2179.##Valcarce DG, Cartón-García F, Herráez MP, Robles V. Effect of cryopreservation on human sperm messenger RNAs crucial for fertilization and early embryo development. Cryobiology 2013; 67: 84- 90.##Maettner R1, Sterzik K, Isachenko V, Strehler E, Rahimi G, Alabart JL, et al. Quality of human spermatozoa: relationship between high-magnification sperm morphology and DNA integrity. Andrologia 2014; 46: 547-555.##Quill AT, Garbers LD. Sperm Motility Activation and Chemoattraction. In Daniel M. Hardy. Fertilization. Carlifornia: Academic press 2002: 29.##Figueroa E, Merino O, Risopatrón J, Isachenko V, Sánchez R, Effer B, et al. Effect of seminal plasma on Atlantic salmon (Salmo salar) sperm vitrification. Theriogenology 2015; 83: 238-245.##Gao DY, Liu C, McGann LE, Watson PF, Kleinhans FW, Mazur P, et al. Prevention of osmotic injury to human spermatozoa during addition and removal of glycerol. Hum Reprod 1995; 10: 1109-1122.##Isachenko V, Isachenko E, Sanchez R, Dattena M, Mallmann P, Rahimi G. Cryopreservation of whole ovine ovaries with pedicles as a model for human: parameters of perfusion with simultaneous saturations by cryoprotectants. Clin Lab 2015; 61: 415-420.##O'Connell M, McClure N, Lewis SEM. The effect of cryopreservation on sperm morphology, motility and mitochondrial function. Hum Reprod 2002; 17: 704-709.##Chatterjee S, Gagnon C. Reproduction of reactive oxygen species by spermatozoa undergoing cooling, freezing, and thawing. Mol Reprod Dev 2001; 59, 451-458.##Mierke CT, Kollmannsberger P, Zitterbart DP, Diez G, Koch TM, Marg S, et al. Vinculin facilitates cell invasion into three-dimensional collagen matrices. J Biol Chem 2010; 285: 13121-13130.##Isachenko E, Isachenko V, Katkov II, Rahimi G, Schondorf T, Mallmann P, et al. DNA integrity and motility of human spermatozoa after standard slow freezing versus cryoprotectant-free vitrification. Hum Reprod 2004; 19; 932-939.##Isachenko V, Isachenko E, Katkov II, Montag M, Dessole S, Nawroth F, et al. Cryoprotectant-free cryopreservation of human spermatozoa by vitrification and freezing in vapor: effect on motility, DNA integrity, and fertilization ability. Biol Reprod 2004; 71: 1167–1173.##Kim S, Agca C, Agca Y. Changes in rat spermatozoa function after cooling, cryopreservation and centrifugation processes. Cryobiology 2010; 65: 215–223.##Watson PF. The causes of reduced fertility with cryopreserved semen. Anim Reprod Sci 2000; 60–61; 481–492.##Pettitt MJ, Buhr MM. Extender components and surfactants affect boar sperm function and membrane behavior during cryopreservation. J Androl 1998; 19: 736-746.##Waberski D, Henning H, Petrunkina AM. Assessment of storage effects in liquid preserved boar semen. Reprod Domest Anim 2011; 46: 45–48.##Pe-a AI, Johannisson A, Linde-Forsberg C. Validation of flow cytometry for assessment of viability and acrosomal integrity of dog spermatozoa and for evaluation of different methods of cryopreservation. J Reprod Fertil 2001; 57: 371- 376.##Holt WV. Basic aspects of frozen storage semen. Anim Reprod Sci 2000; 62: 3-22.##Amann RP. Cryopreservation of sperm. In: Knobil E, Neill JD (eds). Encyclopedia of reproduction. Academic Press, Burlington, MA. 1999; 773–783.##Amaral S, Redmann K, Sanchez V, Mallidis C, Ramalho-Santos J, Schlatt S. UVB irradiation as a tool to assess ROS-induced damage in human spermatozoa. Andrology 2013; 1: 707-714.##de Lamirande E, O'Flaherty C. Sperm activation: role of reactive oxygen species and kinases. Biochim Biophys Acta 2008; 1784: 106-115.##Wang MJ, Ou JX, Chen GW, Wu JP, Shi HJ, O WS, et al. Does prohibitin expression regulate sperm mitochondrial membrane potential, sperm motility, and male fertility? Antioxid Redox Signal 2012; 17: 513-519.##Varisli O, Scott H, Agca C, Agca Y. The effects of cooling rates and type of freezing extenders on cryosurvival of rat sperm. Cryobiology 2013; 67: 109-116.##Yamashiro H, Eimei S. Cryopreservation of rat sperm. Current Frontiers in Cryobiology. Pages 165- 178. Prof. Igor Katkov Ed. Publisher: InTech, 2012.##Ghaleno LR, Valojerdi MR, Janzamin E, Chehrazi M, Sharbatoghli M, Yazdi RS. Evaluation of conventional semen parameters, intracellular reactive oxygen species, DNA fragmentation and dysfunction of mitochondrial membrane potential after semen preparation techniques: a flow cytometric study. Arch Gynecol Obstet 2014; 289: 173-180.##Kuleshova LL, MacFarlane DR, Trounson AO, Shaw JM. Sugars exert a major influence on the vitrification properties of ethylene glycol-based solutions and have a low toxicity to embryos and oocytes. Cryobiology 1999; 38: 119–130.##Koshimoto C, Mazur P. Effects of cooling and warming rate to and from -70°C, and effect of further cooling from -70 to -196°C on the motility of mouse spermatozoa. Biol Reprod 2002; 66: 1477–1484.## ##

Sexual behavior of infertile women: a qualitative study عنوان رفتارجنسی زنان نابارور: یک مطالعه کیفی 2 1 مقدمه: ناباروری زندگی جنسی زوجین نابارور بخصوص زنان نابارور را با چالش بزرگی همراه می کند. هنگامی که بارداری اتفاق نمی افتد، زن نابارور فکر می کنند که مقاربت جنسی ثمربخش نبوده و میل جنسی تدریجا کاهش می یابد. این زنان نابارور به تدریج فراموش می کنند که رابطه جنسی پاسخ به نیاز طبیعی آنهاست. هدف: این مطالعه کیفی برای کشف پیامدهای ناباروری بر رفتار جنسی زنان نابارور انجام شد. مواد و روش ها: این یک مطالعه کیفی، مبتنی بر رویکرد تحلیل محتوا و بخشی از یک مطالعه گسترده با رویکرد ترکیبی متوالی بود که از آگوست 2014 تا فوریه 2015 به طول انجامید. نمونه گیری هدفمند از زنان نابارور که به مرکز تحقیقاتی درمانی یزد مراجعه کرده بودند صورت گرفت. روش جمع آوری داده ها در این تحقیق، شامل مصاحبه عمق نیمه ساختار یافته به روش چهره به چهره و یادداشت ها ی در عرصه بود. برای دقت و استحکام داده ها معیارهای اعتبار پذیری، انتقال پذیری، تایید پذیری و ثبات و اطمینان مورد استفاده قرار گرفتند. نتایج: در مجموع 15 زن نابارور و 8 مطلع کلیدی مورد مصاحبه قرار گرفتند. تجزیه و تحلیل داده ها در مورد تاثیر ناباروری بر رفتار جنسی زنان در چهار طبقه مورد تجزیه و تحلیل قرار گرفت: 1. تاثیر داروهای ناباروری بر رفتار جنسی زن و شوهر. 2. تاثیر روش های کمک باروری بر رفتار جنسی زنان. 3. نزدیکی زمان بندی شده در جریان ناباروری 4. تاثیرات روانی ناشی از ناباروری بر رفتار جنسی. نتیجه گیری: برخی از زنان نابارور می توانستند با مشکلات خود کنار بیایند، اما برخی از آنها بشدت تحت تاثیر داروهای ناباروری و روش های کمک باروری قرار می گرفتند. مشاوره روانی-جنسی قبل از درمان های پزشکی می تواند به آنها در داشتن زندگی جنسی بهتر کمک کند. 2 Background: Infertility makes an essential challenge to the sexual life of couples, especially infertile women. When pregnancy does not happen, infertile women think that sexual intercourse is not fruitful and sexual desire became reduce gradually. Infertile women progressively forget that their sexual relationship is also a response to their natural need. Objective: This qualitative study was conducted to explore the infertility consequences in the sexual behavior of infertile women. Materials and Methods: This was a qualitative content analysis study; and it was part of a widespread study, used a sequential mixed-method and conducted from August 2014 until February 2015. A purposeful sampling was used to recruit infertile women who had referred to Yazd Research and Clinical Center for Infertility. Data gathering techniques employed in this research included in-depth semi structured open face-to-face interviews and field notes. Credibility, transferability, confirm ability, and dependability were assessed for the rigor of the data collection. Results: Totally, 15 infertile women and 8 key informants were interviewed. Data analysis showed four themes about impact of infertility on female sexual behavior: 1/ Impact of infertility drugs on couple sexual behavior, 2/ Impact of assisted reproductive technologies on female sexual behavior, 3/ Timed intercourse during infertility and 4/ The psychological impact of infertility on sexual behavior. Conclusion: Some of Iranian infertile women could cope with their problems, but some of them were very affected by infertility drugs and assisted reproductive technologies procedures. Psychosexual counseling before medical treatment could help them to have a better sexual life. 645 656 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/262017/10/262017/10/262017/10/262017/10/262017/10/262017/10/26 1396/8/4 مهشید بکایی Mahshid Bokaie Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Science, Tehran, Iran ایران معصومه سیمبر Masoumeh Simbar Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ایران msimbar@sbmu.ac.ir سیدمجتبی یاسینی اردکانی Seyed Mojtaba Yassini Ardekani Addiction and Behavioral Sciences Research Center, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران Sexual behavior Infertility Sexuality Qualitative study رفتار جنسی ناباروری سکسوالیتی مطالعه کیفی. World Health Organization: WHO. Defining sexual health. Report of a technical consultation on sexual health 2002: World Health Organization; 2006. Available from: http://www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf.##Farajkhoda T, Roudsari RL, Abbasi M. Ethical performance in delivery of sexual and reproductive health services: A Delphi study focused on the right of confidentiality. Health MED 2012; 6: 3385-3394.##Farajkhoda T, Latifnejad Roudsari R, Abbasi M. An exploratory study to develop a practical ethical framework for reproductive health research. Iran J Reprod Med 2013; 11: 31-38.##Collier F. When a couple wants a baby: What are the consequences on their sexuality? Sexologies 2010; 19: 143-146.##World Health Organization: WHO. Developing sexual health programmes: a framework for action: Geneva: World Health Organization; 2010. Available from: http://apps.who.int/iris/handle/10665/70501.##Bokaie M, Simbar M, Yassini SM. From sexual ill-health to well-being in infertile couple. Iran J Reprod Med 2014; 12: 50.##Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS 2012; 9: e1001356.##Parsanezhad ME, Jahromi BN, Zare N, Keramati P, Khalili A. Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis. J Womens Health 2013; 6: 2.##Hart VA. Infertility and the role of psychotherapy. Issues Ment Health Nurs 2002; 23: 31-41.##Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 2004;117:126-131.##Damti OB, Sarid O, Sheiner E, Zilberstein T, Cwikel J. Stress and distress in infertility among women. Harefuah 2008;147: 256-260.##Podolska MZ, Bidzan M. Infertility as a psychological problem. Ginekol Pol 2011; 82: 44-49.##Hasanpoor-Azghdy SB, Simbar M, Vedadhir A. The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study. Iran J Reprod Med 2014; 12: 131.##Nelson Christian J, Shindel Alan W, Naughton Cathy K, Ohebshalom M. Prevalence and predictors of sexual problems, relationship stress, and depression in female partners of infertile couples. J Sex Med 2008; 5: 1907-1914.##Huyghe E, Bonal M, Daudin M, Droupy S. Sexual dysfunctions and infertility. Prog Urol 2013; 23: 745-751. Article in French.##Wischmann T. Sexual disorders in infertile couples: an update. Curr Opin Obstet Gynecol 2013; 25: 220-222.##Mohammadi MR, Khalaj Abadi Farahani F. Emotional and psychological problems of infertility and strategies to overcome them. J Reprod Infertil 2001; 4: 33-39.##Jonaidy A, noranhSaadeddin Sh, Mokhber N, Shakeri MT. Comparing the Marital Satisfaction in Infertile and Fertile Women Referred to the Public Clinics in Mashhad in 2006-07. Iran J Obstet Gynecol Infertil 2009; 12: 7-16.##Abbasi-Shavazi MJ, Inhorn MC, Razeghi-Nasrabad HB, Toloo G. The" Iranian ART Revolution": infertility, assisted reproductive technology, and third-party donation in the Islamic Republic of Iran. Journal of Middle East Women's Studies 2008; 4: 1-28.##Behboodi-Moghadam Z, Salsali M, Eftekhar-Ardabily H, Vaismoradi M, Ramezanzadeh F. Experiences of infertility through the lens of Iranian infertile women: a qualitative study. Jpn J Nurs Sci 2013; 10: 41-46.##Montazeri A. Infertility and health related quality of life: minireview of the literature. J Famil Reprod Health 2007; 1: 55-58.##Khodakarami N, Hashemi S, Seddigh S, Hamdiyeh M, Taheripanah R. Life experience with infertility; a phenomenological study. J Reprod Infertil 2010; 10: 287-297.##Kohan S, Ghasemi Z, Beigi M. Exploring infertile women's experiences about sexual life: A qualitative study. Iran J Nurs Midwifery Res 2015; 20: 34-39.##Pacheco Palha A, Lourenco MF. Psychological and cross-cultural aspects of infertility and human sexuality. Adv Psychosom Med 2011; 31: 164-183.##Venkatesh V, Brown SA, Bala H. Bridging the qualitative-quantitative divide: Guidelines for conducting mixed methods research in information systems. MIS Quarterly 2013; 37: 21-54.##Östlund U, Kidd L, Wengström Y, Rowa-Dewar N. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud 2011; 48: 369-383.##Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15: 1277-1288.##Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 2013; 15: 398-405.##Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Edu Today 2004; 24: 105-112.##Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015; 42: 533-544.##Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health 2012; 40: 795-805.##Thomas E, Magilvy JK. Qualitative rigor or research validity in qualitative research. J Spec Pediatr Nurs 2011; 16: 151-155.##Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2013; 42: 1-12.##Foster A. A nonlinear model of information‐seeking behavior. J Am Soc Inf Sci Technol 2004; 55: 228-237.##Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualit Health Res 2005; 15: 1277-1288.##Shirpak KR, Chinichian M, Maticka-Tyndale E, Ardebili HE, Pourreza A, Ramenzankhani A. A qualitative assessment of the sex education needs of married Iranian women. Sex Cult 2008; 12: 133-150.##Oddens BJ, den Tonkelaar I, Nieuwenhuyse H. Psychosocial experiences in women facing fertility problems—a comparative survey. Hum Reprod 1999; 14: 255-261.##Wischmann T, Schilling K, Toth B, Rösner S, Strowitzki T, Wohlfarth K, et al. Sexuality, Self-Esteem and Partnership Quality in Infertile Women and Men. Geburtshilfe Frauenheilkunde 2014; 74: 759-763.##Hashemi S, Simbar M, Ramezani-Tehrani F, Shams J, Majd HA. Anxiety and success of in vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2012; 164: 60-64.##Hassanin IM, Abd-El-Raheem T, Shahin AY. Primary infertility and health-related quality of life in Upper Egypt. Int J Gynaecol Obstet 2010; 110: 118-121.##Sundby J. Infertility in the Gambia: traditional and modern health care. Patient Educ Couns 1997; 31: 29-37.##Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update 2008; 14: 605-621.##Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: a review of recent literature. Sociol Health Illn 2010; 32: 140-162.##Abbey A, Andrews FM, Halman LJ. Infertility and subjective well-being: the mediating roles of self-esteem, internal control, and interpersonal conflict. J Marriage Fam 1992: 54: 408-417.##Vayena E, Peterson HB, Adamson D, Nygren KG. Assisted reproductive technologies in developing countries: are we caring yet? Fertil Steril 2009; 92: 413-416.##Lenzi A, Lombardo F, Salacone P, Gandini L, Jannini EA. Stress, sexual dysfunctions, and male infertility. J Endocrinol Invest 2003; 26: 72-76.##Wischmann TH. Original research couples'sexual dysfunctions: sexual disorders in infertile couples. J Sex Med 2010; 7: 1868-1876.##Jain K, Radhakrishnan G, Agrawal P. Infertility and psychosexual disorders: relationship in infertile couples. Ind J Med Sci 2000; 54: 1.##Ohl J, Reder F, Fernandez A, Bettahar-Lebugle K, Rongieres C, Nisand I. Impact of infertility and assisted reproductive techniques on sexuality. Gynecol Obstet Fertil 2009; 37: 25-32.##Salama S, Boitrelle F, Gauquelin A, Jaoul M, Albert M, Bailly M, et al. Sexuality and infertility. Gynecol Obstet Fertil 2012; 40: 780-783.##Lechner L, Bolman C, van Dalen A. Definite involuntary childlessness: associations between coping, social support and psychological distress. Hum Reprod 2007; 22: 288-294.##Ramezanzadeh F, Aghssa MM, Jafarabadi M, Zayeri F. Alterations of sexual desire and satisfaction in male partners of infertile couples. Fertil Steril 2006; 85: 139-143.##Taniguchi H, Kawa G, Kinoshita H, Matsuda T. Androgen replacement therapy improves health-related quality of life in late onset hypogonadism patients. Hinyokika Kiyo 2009; 55: 741-744.##Taniguchi H, Kawa G, Kinoshita H, Matsuda T. Androgen replacement therapy improves health- related quality of life in late onset hypogonadism patients. Hinyokika Kiyo 2009; 55: 741-744.##Samplaski MK, Loai Y, Wong K, Lo KC, Grober ED, Jarvi KA. Testosterone use in the male infertility population: prescribing patterns and effects on semen and hormonal parameters. Fertil Steril 2014; 101: 64-69.##Ramasamy R, Lipshultz LI. Relationship between testosterone and sexual function in infertile men. Fertil Steril 2014; 101: 1584.##Bennett LR, Wiweko B, Bell L, Shafira N, Pangestu M, Adayana IP, et al. Reproductive knowledge and patient education needs among Indonesian women infertility patients attending three fertility clinics. Patient Educ Couns 2015; 98: 364-369.##Bokaie M, Farajkhoda T, Enjezab B, Heidari P, Karimi Zarchi M. Barriers of child adoption in infertile couples: Iranian's views. Iran J Reprod Med 2012; 10: 429-434.##Adler J, Boxley R. The psychological reactions to infertility: Sex roles and coping styles. Sex Roles 1985; 12: 271-279.##Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Scie Med 1997; 45: 1679-1704.##Boivin J, Griffiths E, Venetis C. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ 2011; 2: 342.##Verhaak CM, Smeenk J, Evers A, Kremer J, Kraaimaat F, Braat D. Women's emotional adjustment to IVF: a systematic review of 25 years of research. Hum Reprod Update 2007; 13: 27-36.##Reder F, Fernandez A, Ohl J. Does sexuality still have a place for couples treated with assisted reproductive techniques? J Gynecol Obstet Biol Reprod (Paris) 2009; 38: 377-388. Article in French.##Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 1995; 333: 1517- 1521.##Martinez A, Bernardus R, Voorhorst F, Vermeiden J, Schoemaker J. Pregnancy rates after timed intercourse or intrauterine insemination after human menopausal gonadotropin stimulation of normal ovulatory cycles: a controlled study. Fertil Steril 1991; 55: 258-265.##Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Makino T. Emotional distress of infertile women in Japan. Hum Reprod 2001; 16: 966-969.##Gibson DM, Myers JE. Gender and infertility: A relational approach to counseling women. J Couns Dev 2000; 78: 400-410.##Abbey A, Andrews FM, Halman LJ. Gender's role in responses to infertility. Psychol Women Q 1991; 15: 295-316.##Shoji M, Hamatani T, Ishikawa S, Kuji N, Ohta H, Matsui H, et al. Sexual Satisfaction of infertile couples assessed using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Sci Rep 2014; 4: 5203.##Bayar U, Basaran M, Atasoy N, Kokturk F, Arikan II, Barut A. Sexual dysfunction in infertile couples: evaluation and treatment of infertility. Sexual dysfunction. J Pak Med Assoc 2014; 64: 138-145.##Tabong PT-N, Adongo PB. Understanding the social meaning of infertility and childbearing: a qualitative study of the perception of childbearing and childlessness in Northern Ghana. PloS one 2013; 8: e54429.##Huppelschoten AG, van Dongen AJ, Verhaak CM, Smeenk JM, Kremer JA, Nelen WL. Differences in quality of life and emotional status between infertile women and their partners. Hum Reprod 2013; 28: 2168-2176.##Ferraresi RS, Sany AS L, FS de Sa M, M Reis R, CJS Rosa e Silva A. Current research on how infertility affects the sexuality of men and women. Recent Pat Endocr Metab Immune Drug Discov 2013; 7: 198-202.##Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod 2004; 19: 2313-2318.##Millheiser LS, Helmer AE, Quintero RB, Westphal LM, Milki AA, Lathi RB. Is infertility a risk factor for female sexual dysfunction? A case-control study. Fertil Steril 2010; 94: 2022-2025.##Chachamovich JR, Chachamovich E, Ezer H, Fleck MP, Knauth D, Passos EP. Investigating quality of life and health-related quality of life in infertility: a systematic review. J Psychosom Obstet Gynaecol 2010; 31: 101-110.##Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynecol 2007; 21: 293-308.##Shindel AW, Nelson CJ, Naughton CK, Ohebshalom M, Mulhall JP. Sexual function and quality of life in the male partner of infertile couples: prevalence and correlates of dysfunction. J Urol 2008; 179: 1056-1059.##Repokari L, Punamäki R-L, Unkila-Kallio L, Vilska S, Poikkeus P, Sinkkonen J, et al. Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls. Hum Reprod 2007; 22: 1481-1491.##Gameiro S, Boivin J, Peronace L, Verhaak C. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Hum Reprod Update 2012; 18: 652-669.##Peng T, Rosemary C, Bruce M. The impact of infertility on sexuality: A literature review. Australas Med J 2011; 4: 620-627.##Wiersema NJ, Drukker AJ, Mai BT, Giang HN, Nguyen TN, Lambalk CB. Consequences of infertility in developing countries: results of a questionnaire and interview survey in the South of Vietnam. J Transl Med 2006; 4: 54.##World Health Organization: WHO. Defining sexual health. Report of a technical consultation on sexual health 2002: World Health Organization; 2006. Available from: http://www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf.##Farajkhoda T, Roudsari RL, Abbasi M. Ethical performance in delivery of sexual and reproductive health services: A Delphi study focused on the right of confidentiality. Health MED 2012; 6: 3385-3394.##Farajkhoda T, Latifnejad Roudsari R, Abbasi M. An exploratory study to develop a practical ethical framework for reproductive health research. Iran J Reprod Med 2013; 11: 31-38.##Collier F. When a couple wants a baby: What are the consequences on their sexuality? Sexologies 2010; 19: 143-146.##World Health Organization: WHO. Developing sexual health programmes: a framework for action: Geneva: World Health Organization; 2010. Available from: http://apps.who.int/iris/handle/10665/70501.##Bokaie M, Simbar M, Yassini SM. From sexual ill-health to well-being in infertile couple. Iran J Reprod Med 2014; 12: 50.##Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS 2012; 9: e1001356.##Parsanezhad ME, Jahromi BN, Zare N, Keramati P, Khalili A. Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis. J Womens Health 2013; 6: 2.##Hart VA. Infertility and the role of psychotherapy. Issues Ment Health Nurs 2002; 23: 31-41.##Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 2004;117:126-131.##Damti OB, Sarid O, Sheiner E, Zilberstein T, Cwikel J. Stress and distress in infertility among women. Harefuah 2008;147: 256-260.##Podolska MZ, Bidzan M. Infertility as a psychological problem. Ginekol Pol 2011; 82: 44-49.##Hasanpoor-Azghdy SB, Simbar M, Vedadhir A. The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study. Iran J Reprod Med 2014; 12: 131.##Nelson Christian J, Shindel Alan W, Naughton Cathy K, Ohebshalom M. Prevalence and predictors of sexual problems, relationship stress, and depression in female partners of infertile couples. J Sex Med 2008; 5: 1907-1914.##Huyghe E, Bonal M, Daudin M, Droupy S. Sexual dysfunctions and infertility. Prog Urol 2013; 23: 745-751. Article in French.##Wischmann T. Sexual disorders in infertile couples: an update. Curr Opin Obstet Gynecol 2013; 25: 220-222.##Mohammadi MR, Khalaj Abadi Farahani F. Emotional and psychological problems of infertility and strategies to overcome them. J Reprod Infertil 2001; 4: 33-39.##Jonaidy A, noranhSaadeddin Sh, Mokhber N, Shakeri MT. Comparing the Marital Satisfaction in Infertile and Fertile Women Referred to the Public Clinics in Mashhad in 2006-07. Iran J Obstet Gynecol Infertil 2009; 12: 7-16.##Abbasi-Shavazi MJ, Inhorn MC, Razeghi-Nasrabad HB, Toloo G. The" Iranian ART Revolution": infertility, assisted reproductive technology, and third-party donation in the Islamic Republic of Iran. Journal of Middle East Women's Studies 2008; 4: 1-28.##Behboodi-Moghadam Z, Salsali M, Eftekhar-Ardabily H, Vaismoradi M, Ramezanzadeh F. Experiences of infertility through the lens of Iranian infertile women: a qualitative study. Jpn J Nurs Sci 2013; 10: 41-46.##Montazeri A. Infertility and health related quality of life: minireview of the literature. J Famil Reprod Health 2007; 1: 55-58.##Khodakarami N, Hashemi S, Seddigh S, Hamdiyeh M, Taheripanah R. Life experience with infertility; a phenomenological study. J Reprod Infertil 2010; 10: 287-297.##Kohan S, Ghasemi Z, Beigi M. Exploring infertile women's experiences about sexual life: A qualitative study. Iran J Nurs Midwifery Res 2015; 20: 34-39.##Pacheco Palha A, Lourenco MF. Psychological and cross-cultural aspects of infertility and human sexuality. Adv Psychosom Med 2011; 31: 164-183.##Venkatesh V, Brown SA, Bala H. Bridging the qualitative-quantitative divide: Guidelines for conducting mixed methods research in information systems. MIS Quarterly 2013; 37: 21-54.##Östlund U, Kidd L, Wengström Y, Rowa-Dewar N. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud 2011; 48: 369-383.##Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15: 1277-1288.##Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 2013; 15: 398-405.##Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Edu Today 2004; 24: 105-112.##Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015; 42: 533-544.##Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health 2012; 40: 795-805.##Thomas E, Magilvy JK. Qualitative rigor or research validity in qualitative research. J Spec Pediatr Nurs 2011; 16: 151-155.##Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2013; 42: 1-12.##Foster A. A nonlinear model of information‐seeking behavior. J Am Soc Inf Sci Technol 2004; 55: 228-237.##Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualit Health Res 2005; 15: 1277-1288.##Shirpak KR, Chinichian M, Maticka-Tyndale E, Ardebili HE, Pourreza A, Ramenzankhani A. A qualitative assessment of the sex education needs of married Iranian women. Sex Cult 2008; 12: 133-150.##Oddens BJ, den Tonkelaar I, Nieuwenhuyse H. Psychosocial experiences in women facing fertility problems—a comparative survey. Hum Reprod 1999; 14: 255-261.##Wischmann T, Schilling K, Toth B, Rösner S, Strowitzki T, Wohlfarth K, et al. Sexuality, Self-Esteem and Partnership Quality in Infertile Women and Men. Geburtshilfe Frauenheilkunde 2014; 74: 759-763.##Hashemi S, Simbar M, Ramezani-Tehrani F, Shams J, Majd HA. Anxiety and success of in vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2012; 164: 60-64.##Hassanin IM, Abd-El-Raheem T, Shahin AY. Primary infertility and health-related quality of life in Upper Egypt. Int J Gynaecol Obstet 2010; 110: 118-121.##Sundby J. Infertility in the Gambia: traditional and modern health care. Patient Educ Couns 1997; 31: 29-37.##Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update 2008; 14: 605-621.##Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: a review of recent literature. Sociol Health Illn 2010; 32: 140-162.##Abbey A, Andrews FM, Halman LJ. Infertility and subjective well-being: the mediating roles of self-esteem, internal control, and interpersonal conflict. J Marriage Fam 1992: 54: 408-417.##Vayena E, Peterson HB, Adamson D, Nygren KG. Assisted reproductive technologies in developing countries: are we caring yet? Fertil Steril 2009; 92: 413-416.##Lenzi A, Lombardo F, Salacone P, Gandini L, Jannini EA. Stress, sexual dysfunctions, and male infertility. J Endocrinol Invest 2003; 26: 72-76.##Wischmann TH. Original research couples'sexual dysfunctions: sexual disorders in infertile couples. J Sex Med 2010; 7: 1868-1876.##Jain K, Radhakrishnan G, Agrawal P. Infertility and psychosexual disorders: relationship in infertile couples. Ind J Med Sci 2000; 54: 1.##Ohl J, Reder F, Fernandez A, Bettahar-Lebugle K, Rongieres C, Nisand I. Impact of infertility and assisted reproductive techniques on sexuality. Gynecol Obstet Fertil 2009; 37: 25-32.##Salama S, Boitrelle F, Gauquelin A, Jaoul M, Albert M, Bailly M, et al. Sexuality and infertility. Gynecol Obstet Fertil 2012; 40: 780-783.##Lechner L, Bolman C, van Dalen A. Definite involuntary childlessness: associations between coping, social support and psychological distress. Hum Reprod 2007; 22: 288-294.##Ramezanzadeh F, Aghssa MM, Jafarabadi M, Zayeri F. Alterations of sexual desire and satisfaction in male partners of infertile couples. Fertil Steril 2006; 85: 139-143.##Taniguchi H, Kawa G, Kinoshita H, Matsuda T. Androgen replacement therapy improves health-related quality of life in late onset hypogonadism patients. Hinyokika Kiyo 2009; 55: 741-744.##Taniguchi H, Kawa G, Kinoshita H, Matsuda T. Androgen replacement therapy improves health- related quality of life in late onset hypogonadism patients. Hinyokika Kiyo 2009; 55: 741-744.##Samplaski MK, Loai Y, Wong K, Lo KC, Grober ED, Jarvi KA. Testosterone use in the male infertility population: prescribing patterns and effects on semen and hormonal parameters. Fertil Steril 2014; 101: 64-69.##Ramasamy R, Lipshultz LI. Relationship between testosterone and sexual function in infertile men. Fertil Steril 2014; 101: 1584.##Bennett LR, Wiweko B, Bell L, Shafira N, Pangestu M, Adayana IP, et al. Reproductive knowledge and patient education needs among Indonesian women infertility patients attending three fertility clinics. Patient Educ Couns 2015; 98: 364-369.##Bokaie M, Farajkhoda T, Enjezab B, Heidari P, Karimi Zarchi M. Barriers of child adoption in infertile couples: Iranian's views. Iran J Reprod Med 2012; 10: 429-434.##Adler J, Boxley R. The psychological reactions to infertility: Sex roles and coping styles. Sex Roles 1985; 12: 271-279.##Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Scie Med 1997; 45: 1679-1704.##Boivin J, Griffiths E, Venetis C. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ 2011; 2: 342.##Verhaak CM, Smeenk J, Evers A, Kremer J, Kraaimaat F, Braat D. Women's emotional adjustment to IVF: a systematic review of 25 years of research. Hum Reprod Update 2007; 13: 27-36.##Reder F, Fernandez A, Ohl J. Does sexuality still have a place for couples treated with assisted reproductive techniques? J Gynecol Obstet Biol Reprod (Paris) 2009; 38: 377-388. Article in French.##Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 1995; 333: 1517- 1521.##Martinez A, Bernardus R, Voorhorst F, Vermeiden J, Schoemaker J. Pregnancy rates after timed intercourse or intrauterine insemination after human menopausal gonadotropin stimulation of normal ovulatory cycles: a controlled study. Fertil Steril 1991; 55: 258-265.##Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Makino T. Emotional distress of infertile women in Japan. Hum Reprod 2001; 16: 966-969.##Gibson DM, Myers JE. Gender and infertility: A relational approach to counseling women. J Couns Dev 2000; 78: 400-410.##Abbey A, Andrews FM, Halman LJ. Gender's role in responses to infertility. Psychol Women Q 1991; 15: 295-316.##Shoji M, Hamatani T, Ishikawa S, Kuji N, Ohta H, Matsui H, et al. Sexual Satisfaction of infertile couples assessed using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Sci Rep 2014; 4: 5203.##Bayar U, Basaran M, Atasoy N, Kokturk F, Arikan II, Barut A. Sexual dysfunction in infertile couples: evaluation and treatment of infertility. Sexual dysfunction. J Pak Med Assoc 2014; 64: 138-145.##Tabong PT-N, Adongo PB. Understanding the social meaning of infertility and childbearing: a qualitative study of the perception of childbearing and childlessness in Northern Ghana. PloS one 2013; 8: e54429.##Huppelschoten AG, van Dongen AJ, Verhaak CM, Smeenk JM, Kremer JA, Nelen WL. Differences in quality of life and emotional status between infertile women and their partners. Hum Reprod 2013; 28: 2168-2176.##Ferraresi RS, Sany AS L, FS de Sa M, M Reis R, CJS Rosa e Silva A. Current research on how infertility affects the sexuality of men and women. Recent Pat Endocr Metab Immune Drug Discov 2013; 7: 198-202.##Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod 2004; 19: 2313-2318.##Millheiser LS, Helmer AE, Quintero RB, Westphal LM, Milki AA, Lathi RB. Is infertility a risk factor for female sexual dysfunction? A case-control study. Fertil Steril 2010; 94: 2022-2025.##Chachamovich JR, Chachamovich E, Ezer H, Fleck MP, Knauth D, Passos EP. Investigating quality of life and health-related quality of life in infertility: a systematic review. J Psychosom Obstet Gynaecol 2010; 31: 101-110.##Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynecol 2007; 21: 293-308.##Shindel AW, Nelson CJ, Naughton CK, Ohebshalom M, Mulhall JP. Sexual function and quality of life in the male partner of infertile couples: prevalence and correlates of dysfunction. J Urol 2008; 179: 1056-1059.##Repokari L, Punamäki R-L, Unkila-Kallio L, Vilska S, Poikkeus P, Sinkkonen J, et al. Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls. Hum Reprod 2007; 22: 1481-1491.##Gameiro S, Boivin J, Peronace L, Verhaak C. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Hum Reprod Update 2012; 18: 652-669.##Peng T, Rosemary C, Bruce M. The impact of infertility on sexuality: A literature review. Australas Med J 2011; 4: 620-627.##Wiersema NJ, Drukker AJ, Mai BT, Giang HN, Nguyen TN, Lambalk CB. Consequences of infertility in developing countries: results of a questionnaire and interview survey in the South of Vietnam. J Transl Med 2006; 4: 54.## ##

Prevention of birth defects in the pre-conception period: knowledge and practice of health care professionals (nurses and doctors) in a city of Southern Brazil پیشگیری از ناهنجاری های تولد در دوره قبل از لقاح: آگاهی و عملکرد متخصصان سلامت (پرستار و پزشک) در یک شهر جنوب برزیل 2 1 مقدمه: بعضی از ناهنجاری های مادرزادی، قابل پیشگیری در دوره قبل از لقاح می باشند. ولی بسیاری از متخصصان سلامت آماده ارائه خدمات مشاوره ای به زوج ها در این رابطه نمی باشند. هدف: این مطالعه جهت بررسی عملکرد پرستاران و پزشکان در یک واحد مراقبت های اولیه در شهر Floriuopoli برزیل در ارتباط با پیشگیری از ناهنجاری های مادرزادی در یک دوره قبل از لقاح بر اساس توصیه های مرکز کنترل و پیشگیری از بیماری ها انجام شد. مواد و روش ها: این مطالعه مقطعی توصیفی در یک مرکز ارجاع مرحله سوم انجام گردید. در این تحقیق، یک پرسشنامه نیمه سازمان یافته به 160 متخصص سلامت شامل پرستاران و پزشکانی که به طور فعال درگیر مراقبتهای اولیه سلامت در برنامه سلامت خانواده بودند، ارائه شد. آزمایش غیر پارامتریک کای اسکوآر جهت آنالیز داده های بدست آمده از سوالات چند جوابی استفاده گردید. نتایج: نتایج نشان داد که اگرچه 81/9% از متخصصان سلامت به ارائه خدمات مراقبت سلامت براساس پروتکل مشغول بودند ولی فقط 46/2% از آنها از وجود این مسئله در پروتکل باخبر بودند. از بند توجیه های فراهم شده توسط مرکز کنترل و پیشگیری بیماری استفاده از اسیدفولیک بیشتر از همه استفاده می شد. به هر حال این استفاده در بند پرستاران و پزشکان تفاوت معنی داری نداشت(0/85 =p). نتیجه گیری: این مطالعه طبیعت شکننده آگاهی های متخصصان درباره پیشگیری از ناهنجاریهای تولد در دوره قبل لقاح را نشان داد که به وسیله پاسخ نامطمئن آنها ثابت شد. 2 Background: Some congenital defects can be prevented in the pregestational stage. However, many health professionals are not prepared to provide counselling to couples regarding the same. Objective: This study aimed to assess the performance of doctors and nurses from a primary health-care unit in Florianopolis, Brazil, in preventing birth defects in the preconception period based on the recommendations of the Control Center of Disease Prevention. Materials and Methods: This descriptive cross sectional study was performed at a tertiary referral center. In this study, a semi-structured questionnaire was provided to 160 health professionals comprising doctors and nurses who were actively involved in providing primary health care in family health programs. The non-parametric Chi-square (χ2) test was used to analyse the data obtained through multiple choice questions. Results: Our results showed that although 81.9% of health professionals provided health-care assistance based on protocols, and only 46.2% professionals were aware of the presence of the topic in the protocol. Of the recommendations provided by the Control Center of Disease Prevention, the use of folic acid was the most prescribed. However, this prescription was not statistically different between nurses and doctors (P=0.85). Conclusion: This study identified the fragile nature in these professional’s knowledge about the prevention of birth defects in pre-conception period, as evidenced by the inconsistency in their responses. 657 664 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/10/262017/10/262017/10/262017/10/262017/10/262017/10/262017/10/262017/10/26 1396/8/4 Flávia Romariz Ferreira Flávia Romariz Ferreira Department of Administration and Public Health, Paulista School of Nursing, Federal University of São Paulo (EPE-UNIFESP), São Paulo-SP, Brazil Heloisa Regina Russo Akiba Heloisa Regina Russo Akiba Department of Administration and Public Health, Paulista School of Nursing, Federal University of São Paulo (EPE-UNIFESP), São Paulo-SP, Brazil Edward Araujo Júnior Edward Araujo Júnior Department of Obstetrics, Paulista School of Medicine, São Paulo Federal University (EPM-UNIFESP), São Paulo-SP, Brazil araujojred@terra.com.br Elisabeth Niglio Figueiredo Elisabeth Niglio Figueiredo Department of Administration and Public Health, Paulista School of Nursing, Federal University of São Paulo (EPE-UNIFESP), São Paulo-SP, Brazil Anelise Riedel Abrahão Anelise Riedel Abrahão Department of Administration and Public Health, Paulista School of Nursing, Federal University of São Paulo (EPE-UNIFESP), São Paulo-SP, Brazil Congenital defects Public health Primary prevention  نقایص مادرزادی بهداشت عمومی پیشگیری اولیه Brasil. Presidência da República. Lei nº 9.263, de 12 de janeiro de 1996. Regula o § 7º do art. 226 da Constituição Federal, que trata do planejamento familiar, estabelece penalidades e dá outras providências. Brasília. Available at: http://www.planalto.gov.br/ccivil_03/leis/l9263.htm [accessed 21.02.12].##Mumtaz Z, Salway S, Shanner L, Zaman S, Laing L. Addressing disparities in maternal health care in Pakistan: gender, class and exclusion. BMC Pregnancy Childbirth 2012; 12: 80.##Hoke TH, Mackenzie C, Vance G, Boyer B, Canoutas E, Bratt J, et al. Integrating family planning promotion into the work of environmental volunteers: A population, health and environment initiative in Kenya. Int Perspect Sex Reprod Health 2015; 41: 43-50.##Frey KA, Files JA. Preconception healthcare: what women know and believe. Matern Child Health J 2006; 10: S73-77.##Klerman LV. Family planning services: an essential component of preconception care. Matern Child Health J 2006; 10: S157-160.##Cordero JF. Recommendations to improve preconception health and health care [Internet]. 2007. Atlanta: Centers for Disease Control and Prevention: National Center on Birth Defects and Developmental Disabilities. Available at: http://www.cdc.gov/ncbddd/preconception/documents/recommendation%20summary.pdf [accessed 16.07.11].##Biermann J, Dunlop AL, Brady C, Dubin C, Brann A Jr. Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Mater Child Health J 2006; 10: S21-28.##Lu MC, Kotelchuck M, Culhane JF, Hobel CJ, Klerman LV, Thorp JM Jr. Preconception care between pregnancies: the content of internatal care. Mater Child Health J 2006; 10: S107-122.##Dunlop AL, Jack B, Frey K. National recommendations for preconception care: the essential role of the family physician. J Am Board Fam Med 2007; 20: 81-84.##Fundo das Nações Unidas para a Infância. Situação Mundial da Infância. Brasília: UNICEF 1989; 117.##Duchiade MP, Carvalho ML de, Leal MC. As mortes "em domicílio" de menores de um ano na região metropolitana do Rio de Janeiro em 1986 - um "evento - sentinela" na avaliação dos serviços de saúde. Cad Saude Publica 1989; 5: 251-263.##Salotti JA, Tennant PW, Windebank K, Rankin J. Langerhans cell histiocytosis in children with congenital anomalies: A population-based record linkage study. Birth Defects Res A Clin Mol Teratol 2015; 103: 157-160.##Center for Disease Control and Prevention. Department of Health and Human Services. Preconception care. Atlanta: CDC. Available at: http://www.cdc.gov/ncbddd/preconception/document s/preconprogbrf.cleareddraft.pdf.##Heyes T, Long S, Mathers N. Preconception care: practice and beliefs of primary care workers. Fam Pract 2004; 21: 22-27.##Bardin L. Análise de conteúdo Lisboa: Edições 1977.##Brasil. Ministério da Saúde. Parto, Aborto e Puerpério: Assistência humanizada á mulher . Brasília: Secretaria de Políticas de Saúde. Diretos Reprodutivos, Saúde Materna e Perigestational 2001;11-6. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/cd04_13.pdf [accessed 23.01.06].##Santa Catarina. Prefeitura municipal de florianópolis secretaria municipal de saúde diretoria de atenção primária gerência de programas estatégicos programa saúde da mulher. Florianópolis: Prefeitura Municipal de Florianópolis 2006. Available at: http://www.protocolo_de_atencao_a_saude_da_mulher.pdf.##Pollard I. Neuropharmacology of drugs and alcohol in mother and foetus. Semin Fetal Neonatal Med 2007; 12: 106-113.##Kitamura K, Fetters MD, Ban N. Preconception care by family physicians and general practitioners in Japan. BMC Fam Pract 2005; 6: 31.##Gitsels-van der Wal JT, Martin L, Manniën J, Verhoeven P, Hutton EK, Reinders HS. Antenatal counselling for congenital anomaly tests: Pregnant Muslim Moroccan women׳s preferences. Midwifery 2015; 31: e50-57.##Brasil. Presidência da República. Lei nº 9.263, de 12 de janeiro de 1996. Regula o § 7º do art. 226 da Constituição Federal, que trata do planejamento familiar, estabelece penalidades e dá outras providências. Brasília. Available at: http://www.planalto.gov.br/ccivil_03/leis/l9263.htm [accessed 21.02.12].##Mumtaz Z, Salway S, Shanner L, Zaman S, Laing L. Addressing disparities in maternal health care in Pakistan: gender, class and exclusion. BMC Pregnancy Childbirth 2012; 12: 80.##Hoke TH, Mackenzie C, Vance G, Boyer B, Canoutas E, Bratt J, et al. Integrating family planning promotion into the work of environmental volunteers: A population, health and environment initiative in Kenya. Int Perspect Sex Reprod Health 2015; 41: 43-50.##Frey KA, Files JA. Preconception healthcare: what women know and believe. Matern Child Health J 2006; 10: S73-77.##Klerman LV. Family planning services: an essential component of preconception care. Matern Child Health J 2006; 10: S157-160.##Cordero JF. Recommendations to improve preconception health and health care [Internet]. 2007. Atlanta: Centers for Disease Control and Prevention: National Center on Birth Defects and Developmental Disabilities. Available at: http://www.cdc.gov/ncbddd/preconception/documents/recommendation%20summary.pdf [accessed 16.07.11].##Biermann J, Dunlop AL, Brady C, Dubin C, Brann A Jr. Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Mater Child Health J 2006; 10: S21-28.##Lu MC, Kotelchuck M, Culhane JF, Hobel CJ, Klerman LV, Thorp JM Jr. Preconception care between pregnancies: the content of internatal care. Mater Child Health J 2006; 10: S107-122.##Dunlop AL, Jack B, Frey K. National recommendations for preconception care: the essential role of the family physician. J Am Board Fam Med 2007; 20: 81-84.##Fundo das Nações Unidas para a Infância. Situação Mundial da Infância. Brasília: UNICEF 1989; 117.##Duchiade MP, Carvalho ML de, Leal MC. As mortes "em domicílio" de menores de um ano na região metropolitana do Rio de Janeiro em 1986 - um "evento - sentinela" na avaliação dos serviços de saúde. Cad Saude Publica 1989; 5: 251-263.##Salotti JA, Tennant PW, Windebank K, Rankin J. Langerhans cell histiocytosis in children with congenital anomalies: A population-based record linkage study. Birth Defects Res A Clin Mol Teratol 2015; 103: 157-160.##Center for Disease Control and Prevention. Department of Health and Human Services. Preconception care. Atlanta: CDC. Available at: http://www.cdc.gov/ncbddd/preconception/document s/preconprogbrf.cleareddraft.pdf.##Heyes T, Long S, Mathers N. Preconception care: practice and beliefs of primary care workers. Fam Pract 2004; 21: 22-27.##Bardin L. Análise de conteúdo Lisboa: Edições 1977.##Brasil. Ministério da Saúde. Parto, Aborto e Puerpério: Assistência humanizada á mulher . Brasília: Secretaria de Políticas de Saúde. Diretos Reprodutivos, Saúde Materna e Perigestational 2001;11-6. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/cd04_13.pdf [accessed 23.01.06].##Santa Catarina. Prefeitura municipal de florianópolis secretaria municipal de saúde diretoria de atenção primária gerência de programas estatégicos programa saúde da mulher. Florianópolis: Prefeitura Municipal de Florianópolis 2006. Available at: http://www.protocolo_de_atencao_a_saude_da_mulher.pdf.##Pollard I. Neuropharmacology of drugs and alcohol in mother and foetus. Semin Fetal Neonatal Med 2007; 12: 106-113.##Kitamura K, Fetters MD, Ban N. Preconception care by family physicians and general practitioners in Japan. BMC Fam Pract 2005; 6: 31.##Gitsels-van der Wal JT, Martin L, Manniën J, Verhoeven P, Hutton EK, Reinders HS. Antenatal counselling for congenital anomaly tests: Pregnant Muslim Moroccan women׳s preferences. Midwifery 2015; 31: e50-57.## ##