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The aim of the study was to evaluate the association between baseline Lipiodol uptake in hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) with early tumor recurrence, and to identify a threshold baseline uptake value predicting tumor response.

Introduction: Different societies have different cultures and all activities and behaviors of individuals in society are deeply influenced by cultural and social factors. Reproductive behavior is strongly intertwined with the cultural beliefs and values of the society; so, the necessity of controlling reproductive behavior depends on various cultural elements and all plans, especially family planning programs that are associated with reproductive behavior should be grounded in social and cultural conditions. Several reasons can prove the necessity to increase the population of the Islamic Republic of Iran, which include the role of population in national authority and keeping a high proportion of youth for maintaining knowledge-based economy, etc. The aim of this study was to investigate the socioeconomic factors affecting fertility. The development of country is one of the main goals of economists and social planners. Development has different aspects, and if we only care about a few of them we will have unbalanced and abnormal growth that not only can't lead to development, but can also be an impediment. Materials and Methods: This research used review studies. Library documents and dissertations comprised resources for this article. Results: The rise and decline of population growth and its consequences are one of the most important economic and social issues in any society. Educated women are most commonly employed and fertility may be reduced in outdoors women. They also tend to study more, so they are more familiar with contraception and their fertility rates would be reduced. Thus, providing opportunities for teleworking may change the approach of employed women about pregnancy. The fertility rate is higher in younger women. In other words, age may affect female fertility; therefore, facilities for wedding should be provided for youth. Economic status was another variable whose impact on fertility was examined. It was proved that this variable affects women's fertility rate. Conclusion: We can't plan for the future demographic plans in the country so long as decisions regarding population growth have not been made seriously, since current decisions easily affect many investments in the areas of research and decision making. This indicates the lack of expertise in the decision to increase the population. So far, we have not gathered experts who hold different opinions from various fields so they could discuss and reach a comprehensive consensus. It is one of the weaknesses in demographic plans. [ABSTRACT FROM AUTHOR]

Time is an omnipresent aspect of almost everything we experience internally or in the external world. The experience of time occurs through such an extensive set of contextual factors that, after decades of research, a unified understanding of its neural substrates is still elusive. In this study, following the recent best-practice guidelines, we conducted a coordinate-based meta-analysis of 95 carefully-selected neuroimaging papers of duration processing. We categorized the included papers into 14 classes of temporal features according to six categorical dimensions. Then, using the activation likelihood estimation (ALE) technique we investigated the convergent activation patterns of each class with a cluster-level family-wise error correction at p < 0.05. The regions most consistently activated across the various timing contexts were the pre-SMA and bilateral insula, consistent with an embodied theory of timing in which abstract representations of duration are rooted in sensorimotor and interoceptive experience, respectively. Moreover, class-specific patterns of activation could be roughly divided according to whether participants were timing auditory sequential stimuli, which additionally activated the dorsal striatum and SMA-proper, or visual single interval stimuli, which additionally activated the right middle frontal and inferior parietal cortices. We conclude that temporal cognition is so entangled with our everyday experience that timing stereotypically common combinations of stimulus characteristics reactivates the sensorimotor systems with which they were first experienced., (© 2023. The Author(s).)

Background: Myometrial thickness has been expected to be a prognosticator for lower uterine segment function. An abnormal function of the uterine muscle layer can cause common and important reproductive problems. This study aimed to evaluate the relationship between baseline myometrial thickness and assisted reproductive technologies (ART) outcomes., Materials and Methods: In this prospective cohort study, 453 infertile women undergoing ART cycles without any obvious uterine pathology, participated in this prospective cohort study from February 2013 to May 2015. In order to measure the myometrial thickness in the anterior and posterior of the uterine, trans-vaginal ultrasounds were conducted on days 2-4 of the cycle (menstrual phase) preceding ovarian stimulation and the day of human chorionic gonadotropin (hCG) injection. We defined three groups based on the baseline myometrial thickness in the anterior and posterior, including (A) <25 mm, (B) 25-29.9 mm and (C) ≥30 mm. Ovarian stimulation, oocyte retrieval and luteal phase support were performed in accordance with the standard long protocol. Two weeks after embryo transfer, the patients underwent a pregnancy test by checking their serum β-hCG levels. The primary outcome measure was clinical pregnancy rate. Secondary outcome measures were, implantation rate, abortion rate and live birth rate., Results: The clinical pregnancy (P=0.013) and implantation (P=0.003) rates were significantly lower in group A than in two other groups. Although the live birth rate was lower in group A than two other groups, this decrease was not statistically significant (P=0.058)., Conclusion: The findings may be a way for clinicians to draw focus on providing therapeutic strategies and a specific supportive care for women with a baseline myometrial thickness <25 mm in order to improve the reproductive outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI).

Background: There is a definite shift in assisted reproductive centres from cleavage-stage embryo transfer (ET) to blastocyst transfer that is attributed to improvements in laboratory environments and advances in the development of embryo culture media. The aim of the study was to investigate the reproductive outcomes of thawed cleavage-stage ET versus blastocysts derived from an extended culture of these embryos., Materials and Methods: This open-label, randomised, parallel group clinical trial study enrolled 182 women aged ≤37 years who underwent frozen-thawed ET from November 2015 to June 2020 at Royan Institute Research Centre, Tehran, Iran. The women were randomly assigned to either the thawed cleavage ET group (n=110) or the post-thaw extended culture blastocysts group (n=72). The primary outcome measure was the clinical pregnancy rate. Secondary outcome measures were implantation rate, live birth rate (LBR), and miscarriage rate. A P<0.05 indicated statistical significance., Results: There were no significant differences between the two groups in terms of demographic characteristics. Both the mean numbers of embryos transferred and good quality embryos transferred were significantly lower in the postthaw extended culture blastocysts group compared to thawed cleavage-stage ET cycles. However, the post-thaw extended culture blastocysts group had higher clinical pregnancy (56.94 vs. 40.91%, P=0.034), implantation (34.43 vs. 19.84%, P=0.001) and live birth (49.3 vs. 33.63%, P=0.036) rates compared to the thawed cleavage-stage ET group. Miscarriage and multiple gestations rates were comparable between the groups., Conclusion: These results allow us to take a position in favour of post-thaw extended culture blastocysts; thus, it is important to improve the post-thawing extended culture technique (registration number: NCT02681029).

In spite of its high mortality rate and difficulty in finding a cure, scientific advancements have contributed to a reduction in cancer-related fatalities. Aberrant gene expression during carcinogenesis emphasizes the importance of targeting the signaling networks that control gene expression in cancer treatment. Long noncoding RNAs (lncRNAs), which are transcribed RNA molecules that play a role in gene expression regulation, are a recent innovative therapeutic approach for diagnosing and treating malignancies. MALAT1, a well-known lncRNA, functions in gene expression, RNA processing, and epigenetic control. High expression levels of MALAT1 are associated with several human disorders, including metastasis, invasion, autophagy, and proliferation of cancer cells. MALAT1 affects various signaling pathways and microRNAs (miRNAs), and this study aims to outline its functional roles in cancer metastasis and its interactions with cellular signaling pathways. Moreover, MALAT1 and its interactions with signaling pathways can be promising target for cancer treatment., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Since the association between dietary quality scores and semen quality remains unclear, we carried out a hospital-based cross-sectional study to investigate the association of Dietary Total Antioxidant Capacity (dTAC), Dietary Inflammatory Index (DII), and Alternative Healthy Eating Index (AHEI) scores with semen quality in men seeking infertility treatment., Methods: This study enrolled 210 men with unexplained or idiopathic infertility. Semen samples were collected and analyzed according to the WHO 2010 criteria. Dietary data was collected using a 168-item semi-quantitative food frequency questionnaire (FFQ) developed for Tehran Lipid and Glucose Study. Multivariable logistic regression models were used to estimate the relationship between dTAC, AHEI, and DII scores with abnormal semen in crude and adjusted models., Results: There were no significant differences across quartile categories of the dTAC, AHEI, and DII scores regarding semen parameters. There was a trend toward a significant direct association between DII and abnormal semen risk ( p  = 0.01). Infertile men in the highest quartile of DII had a 2.84 times higher risk of abnormal semen in the crude model (OR: 3.84; 95% CI: 1.64-8.95); such that remained after adjusting for several potential confounders. There was no significant association between dTAC or AHEI and the risk of abnormal semen in infertile men, either before or after adjusting for potential confounders. Total energy ( p  = 0.05), fat ( p  = 0.02), saturated fat ( p  = 0.02), mono-saturated fat ( p  = 0.009), Thiamine (Vitamin B1) ( p  = 0.02), Niacin (Vitamin B3) ( p  = 0.03), Calcium ( p  = 0.01), and Selenium ( p  = 0.01) were inversely associated with semen normality., Discussion: The study suggests that certain dietary factors may affect semen quality, and the mechanisms underlying the observed associations are likely multifactorial, involving complex interactions between diet, oxidative stress, inflammation, and hormone levels. Further research is required to confirm the results, fully elucidate the mechanisms underlying the associations, and identify specific dietary interventions that may improve male fertility outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Dabagh, Jahangiri, Taheri Madah, Rostami, Amidi, Khodarahmian, Tavoosian, Shabani Nashtaei and Vatannejad.)

Recent evidence suggests that vitamin D deficiency could play an important role in the development of non-skeletal diseases, including cancer. Vitamin D also affects the function of the reproductive system. In the present study, the relationship between 25(OH)D levels with oocyte quality in Breast Cancer (BC) women and control group have been investigated. After initial evaluations, ovarian stimulation began with the GnRH antagonist protocol in the BC group (N = 16) and control group (N = 16). The serum and follicular fluid (FF) 25(OH)D levels were measured at the time of oocyte retrieval and their relationship to oocyte quality was examined. The mean levels of serum and FF 25(OH)D in BC women were significantly lower than in the control group (22.26 ± 7.98 vs. 29.61 ± 9.12, P = 0.02, 21.65 ± 7.59 vs. 28.00 ± 9.05, P = 0.04, respectively). There was a significant correlation between the levels of 25(OH)D in FF and serum in BC women (r = 0.873, P < 0.001). But there was no correlation between the serum or FF 25(OH)D levels with the parameters related to oocytes (P > 0.05). In the BC women, the number of dysmorph and highly dysmorph oocytes was higher than in the control group (P < 0.001). Women with BC referring to infertility centers for fertility preservation are more likely to be deficient in serum 25(OH)D level; this subsequently affects the FF 25(OH)D level. However, serum and FF 25(OH)D levels may not be suitable indicators for examining maturity and quality of oocytes in terms of morphology in BC women, and the poor morphological quality of oocytes in BC women may be due to other factors., (© 2023. The Author(s).)

Background: Infertility is one of the issues affecting sexual function (SF). Infertility is also one of the complications of polycystic ovary syndrome (PCOS) and endometriosis., Objective: This research seeks to assess and compare SF and the prevalence of sexual dysfunction in infertile women with PCOS and endometriosis., Materials and Methods: A cross-sectional study was carried out with a sample of 630 (210 infertile women with endometriosis, 210 infertile women with PCOS, and 210 healthy women of childbearing age as the control group). SF was assessed by the female sexual function index (FSFI). Descriptive statistics and inferential statistics were used to analyze the data. The primary outcome measured was FSFI score. Secondary outcome was hospital anxiety and depression scale score., Results: The results showed that the mean score of the total FSFI in the 2 groups of PCOS and endometriosis was lower than the control group (p < 0.001). In addition, women with higher education (university education) had a higher total FSFI., Conclusion: Sexual dysfunction rates are high in infertile women with endometriosis and PCOS. Infertility service providers in infertility centers need to pay attention to this issue., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2022 Daneshfar et al.)

Background: Sexuality as a fundamental component of women's health, can be affected by infertility. The current study aimed at comparing the prevalence of sexual dysfunction among women with the most common causes of infertility., Methods: The current cross-sectional study was conducted on 240 infertile females with infertility due to polycystic ovary syndrome (PCOS, n = 80), endometriosis (n = 80) and male factor (n = 80) at Royan Institute for Reproductive Biomedicine (Tehran, Iran) and 160 fertile women at health care centers, between May 2016 and June 2017. Sexual function was assessed by Female Sexual Function Index (FSFI). Data were analyzed using SPSS (version 25.00) and differences were regarded statistically significant at p < 0. 05., Results: The prevalence of female sexual dysfunction was 98.8% in women with PCOS, 100.0% in those with endometriosis, and 80.0% in those with male factor infertility. Overall, 36.2% of the enrolled fertile women were suffering from sexual dysfunction., Conclusions: There was an association between the prevalence of female sexual dysfunction or individual domain scores of the FSFI, and infertility etiologies. Therefore, infertility care providers are required to take this into consideration and develop preventive strategies in this regard. Infertility as a major health care problem affects an estimated 8-12% of couples of reproductive age globally and sexuality as an important part of women's health, can be affected by infertility. In this study, the prevalence of sexual dysfunction among women with the most common causes of infertility has been evaluated. The present study was conducted on 240 infertile females with infertility due to polycystic ovary syndrome (PCOS, n = 80), endometriosis (n = 80) and male factor (n = 80) at Royan Institute (Tehran, Iran) and 160 fertile women at health care centers, between May 2016 and June 2017. Sexual function was assessed by Female Sexual Function Index (FSFI); a brief self-report measure of sexual functioning. Results highlight that the prevalence of sexual dysfunction in women with endometriosis and PCOS was higher than in other groups. As, the prevalence of female sexual dysfunction was 98.8% in women with PCOS, 100.0% in those with endometriosis, and 80.0% in those with male factor infertility. In total, 36.2% of the enrolled fertile women were suffering from sexual dysfunction. The results point to an association between the prevalence of female sexual dysfunction and causes of infertility. Therefore, infertility care providers are required to take this into consideration and develop preventive strategies in this regard., (© 2022. The Author(s).)

Background: The aim of this study is to compare anxiety, depression, body image, self-esteem, sexual function, and quality of life (QoL) between infertile women and control fertile women undergoing tubal ligation (TL) and using condom., Methods: This cross-sectional study was conducted on 600 women in three groups of infertile and control fertile women with or without TL (200 women in each group), who met the inclusion criteria. They were selected from Royan Institute and a number of health care centers in Tehran (Iran) from May 2017 to February 2019. The subjects were asked to fill out the Short Form Health Survey (SF-12), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Body Image Concern Inventory (BICI), and Rosenberg' Self-Esteem Scale (RSES). One-way ANOVA was used to identify the possible statistical differences between the three groups of participants., Results: The mean scores of all FSFI domains were lower in the control TL women, and the differences between the three groups in all dimensions were statistically significant. In addition, the TL group had more female sexual dysfunction (FSD) comparing to the infertile and condom group (22.43 ± 5.30, 24.79 ± 4.74, and 28.03 ± 3.29, respectively P <  0.001). There was a significant difference between the three groups in SF-12 scores (76.59 ± 13.14, 68.49 ± 14.47, and 78.87 ± 12.62, respectively P < 0.001). Also there was a significant difference between the three groups in anxiety, depression, and total scores of HADS (P  < 0.001). Furthermore, infertile women had lower body image (P  < 0.05) and the TL group had lower self-esteem comparing to the two other groups (P  < 0.05)., Conclusions: The findings revealed the adverse effects of using TL on the anxiety, depression, sexual life, body image, and QoL of women. It is recommended that health-care professionals should increase their awareness and knowledge regarding the side-effects of using TL on women's lives and share this information with the patients., (© 2021. The Author(s).)

Background: Endometriosis is one of the most common pelvic diseases associated with dyspareunia, pelvic pain, and infertility. The primary aim of this study is to evaluate the role of diet on the risk of endometriosis among Iranian women., Materials and Methods: This case-control study was conducted in two health research centres between 2015 and 2016. There were 207 women with endometriosis (case) and 206 women without endometriosis (control) who were evaluated by laparoscopy. The women were asked about their frequency of consumption per week of portions of selected dietary items in the Iranian diet in the year before the interview., Results: The results indicated that intake of green vegetables (odds ratio [OR]=0.39, 95% confidence interval [CI]=0.21-0.74, Ptrend=0.004), red meat (OR=0.61, 95% CI=0.41-0.91, Ptrend=0.015) and dairy products (milk [OR=0.65, 95% CI=0.47-0.92, Ptrend=0.014], cheese [OR=0.53, 95% CI=0.37-0.76, Ptrend<0.001]), fresh fruit (OR=0.68, 95% CI=0.50-0.93, Ptrend=0.015) and grain legumes (OR=0.59, 95% CI=0.47-0.77; Ptrend<0.001) had a significant association with lower risk of endometriosis. Consumption of carrots, green tea, fish, eggs and oil was not significantly related to the risk of endometriosis., Conclusion: This study suggests that certain types of dietary components may be related to the risk of endometriosis., Competing Interests: The authors declare no conflicts of interest., (Copyright© by Royan Institute. All rights reserved.)

Objectives: This study aimed to evaluate whether the site of the balloon placement into either the uterine cavity or cervical canal can affect the intensity of pain during sonohysterography., Methods: In this randomized clinical trial, women who underwent saline infusion sonohysterography (SIS) were randomized to intracervical or intrauterine balloon placement between May 2012 and May 2014. The examination was scheduled at the early follicular phase of the menstrual cycle. The primary outcome measures included the degree of pain after inflation and then after deflation of the balloon catheter. Data were analyzed on the basis of the intention-to-treat principle for each woman who underwent SIS., Results: A total of 300 infertile women were assigned to the treatment groups. There were no significant differences in inflation and deflation pain and the total procedure time between the 2 groups. The total volume of required saline for adequate distention of the cavity was significantly lower in the cervical group than the intrauterine group (p = .015). Nulliparous women had insignificantly more pain after the initial inflation of the balloon compared with multiparous women (p = .069). The pain score was not associated with patients' age, the volume of the saline infused, the presence of intrauterine abnormality, and the procedure time., Conclusions: Intracervical catheter placement did not reduce pain during or after SIS. However, intracervical balloon insertion requires a less-significant volume of saline compared with intrauterine placement, leading to a reduced risk of intrauterine infection and the spread of malignant endometrial cells into the peritoneal cavity at the time of the procedure., (© 2020 by the American Institute of Ultrasound in Medicine.)

Background: The aim of this study was to investigate the effects of vaginal sildenafil on the outcome of patients with at least two unsuccessful in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) attempts., Materials and Methods: In this randomized placebo-controlled trial study, a total of 66 infertile women aged ≤38 years, with a history of normal ovarian reserve, two prior consecutive failed IVF/ICSI attempts, human chorionic gonadotropin (hCG) day endometrial thickness <7 mm in all prior IVF/ICSI cycles, normal endometrial appearance by either hysteroscopy, hysterosonography, or hysterosalpingography enrolled in this study. The conventional gonadotropin-releasing hormone (GnRH) protocol was used for ovarian stimulation. The patients were randomly divided into three groups: vaginal sildenafil (suppository-100 mg/daily), vaginal placebo/sildenafil (suppository-100 mg/daily), and vaginal placebo (suppository). Each patient underwent colour Doppler ultrasound on day 14 of their previous cycle to investigate any abnormalities in the uterus and adnexa. Endometrial thickness, echo pattern, uterine artery resistance, and pulsatility indices were recorded pre- and post-treatment. The primary outcome measures were implantation, chemical and clinical pregnancy rates. For data analysis, SPSS version 20 software was used. In all tests, the significance level was considered less than 0.05., Results: There was no significant difference between three groups in endometrial thickness on the hCG injection day. The chemical pregnancy in women who received sildenafil (alone or in combination with placebo) showed a two-fold increase in comparison to the placebo group. This increase was clinically meaningful, but according to sample size, it was statistically non-significant. The results of our study showed that the implantation was higher in women who received placebo/sildenafil compared to the other groups. The abortion rate was not statistically significant among the groups., Conclusion: Vaginal sildenafil may conceivably improve chemical pregnancy rates in repeated IVF failure patients. Further randomized clinical trials using oral or vaginal sildenafil with higher sample size are recommended (Registration number: NCT03192709)., Competing Interests: The authors declare no conflicts of interest., (Copyright© by Royan Institute. All rights reserved.)

Objective: To compare the effect of gonadotropin-releasing hormone (GnRH) agonist microdose flare-up and GnRH agonist flare-up protocols among women with poor ovarian reserve undergoing intracytoplasmic sperm injection (ICSI) cycles., Methods: Randomized controlled trial study among 131 women with poor ovarian reserve who underwent ICSI cycles at a single center in Tehran, Iran, between September 2008 and May 2014. Eligible women were randomly assigned to either the microdose flare-up (n=66) or flare-up (n=65) protocol. The primary outcome measure was live birth rate., Results: Both groups were comparable in cycle cancellation, mean number of dominant follicles, retrieved oocytes, and metaphase II oocytes. Number of stimulation days (P=032) and endometrial thickness (P=0.001) were significantly higher, and gonadotropin dose was non-significantly higher (P=0.075) in the microdose flare-up group than in the flare-up group. No difference in clinical pregnancy, implantation, or abortion rate was observed between the two protocols. Live birth was higher in the microdose flare-up group than in the flare-up group (P=0.036)., Conclusion: The microdose flare-up protocol seemed to be superior to the flare-up protocol, but it required a higher dose of gonadotropins and a longer duration of stimulation. Further prospective clinical trials of the microdose flare-up protocol are recommended. CLINICALTRIALS.GOV: NCT01006954., (© 2019 International Federation of Gynecology and Obstetrics.)

Aim: To evaluate the effect of adjuvant low-dose aspirin therapy on clinical pregnancy rate and uterine perfusion in women undergoing frozen-thawed embryo transfer (FET) cycles., Methods: This study was performed as a pilot randomized, double-blind placebo-controlled trial, from May 2012 to February 2015. Overall, 60 available eligible women who were candidates for FET were randomly assigned to two groups receiving either 100 mg oral aspirin (n =30) or placebo (n =30). The primary outcome measure was clinical pregnancy rate. Secondary outcome measures were pulsatility index (PI), resistance index (RI), implantation rate, live birth rate and miscarriage rate., Results: There was no significant difference in endometrial thickness, PI and RI. However, the study group had higher rates of clinical pregnancy, implantation, live birth (P = 0.042, P = 0.031 and P = 0.007, respectively) and lower rate of miscarriage (P = 0.020) as compared to the control group. Twin birth rate was comparable between the two groups., Conclusion: Our pilot study demonstrated that administration of low-dose aspirin in FET cycles results in better pregnancy, implantation and live birth rates without changing the uterine hemodynamics or endometrial thickness. However, further randomized clinical studies in larger populations are needed to confirm these findings., (© 2018 Japan Society of Obstetrics and Gynecology.)

This prospective cohort study aimed to evaluate the role of premature placental calcification in adverse pregnancy outcomes and identify its associated potential risk factors. We consecutively enrolled 293 women who presented to three academic medical centres from September 2011 to March 2013. Participants underwent transabdominal sonographies between 28-36 weeks of gestation in an attempt to determine placental maturity. We compared maternal and foetal outcomes between two groups of women, those with grade III placenta (n = 69) and those without grade III placenta (n = 224). Passive smoking was the only predictor of early placental calcification. There were more abnormal Doppler, low birth weight (LBW) and caesarean section (CS) deliveries observed in the preterm calcification group. No definite relationship existed between maternal hypertension (HTN), diabetes and other medical diseases with placental calcification. In conclusion, umbilical artery (UA) resistance index (RI) and absent or reversed end-diastolic velocity (AREDV) were observed more often in preterm placental calcification. Serious antepartum follow-up should be advised for these mothers. Impact Statement  • Placental calcification is a physiological phenomenon but normally, a grade III placenta is not frequently found until 36 weeks of gestation (so is called preterm placental calcification - PPC). There is currently a lack of consistent evidence on the clinical significance of PPC and pregnancy outcome. The present study was designed to evaluate the role of PPC in adverse pregnancy outcomes.  • In our study, although none of the pregnant women were smokers, we found that passive smoking was the only predictor of PPC. Abnormal umbilical artery Doppler waveforms considerably and absent end diastolic velocity pattern significantly were observed more often in the PPC group.  • We observed that PPC can be a landmark for high-risk pregnancy and an alarm sign for placental dysfunction. So, close antepartum follow up should be advised for these mothers. Regular and frequent foetal wellbeing tests should be done to prevent pregnancy complications. Certainly larger and more extensive study can provide more valid results.

Objectives: This study aimed to assess the influence of coasting duration on the number and quality of oocytes and fertilization rate in male factor infertile women and those with polycystic ovary syndrome (PCOS)., Methods: In this prospective observational follow-up study, 114 patients undergoing coasting (53 women with male factor infertility and 61 women with PCOS) were evaluated at the Royan Institute Research Center, Iran, between 2010 and 2012., Results: The results were analyzed according to the coasting periods of 1-4 days. In normal females, the number of oocytes retrieved was significantly reduced after the second day ( p = 0.004). In addition, a statistically significant drop was observed in the number of metaphase II oocytes and fertilization rate after the third day ( p = 0.006 and p = 0.006, respectively). No significant differences were observed in the number and quality of oocytes retrieved and fertilization rate with regard to coasting days in PCOS patients., Conclusion: Coasting with duration of more than three days should be performed with caution in normal females who are at risk of developing ovarian hyperstimulation syndrome.

Background: While tuberculosis (TB) can be diagnosed by microscopy and culture, the sensitivity of Ziehl-Neelsen staining is variable and culture results require 4 - 8 weeks to be determined. Polymerase chain reaction (PCR) and its modifications, including nested PCR, might be promising methods for the rapid diagnosis of TB., Objectives: This study aimed to evaluate the performance of nested PCR on urine samples of human immunodeficiency virus (HIV)-positive and -negative patients with different manifestations of clinical TB., Methods: In a prospective study, three early-morning urine samples from 100 patients with pulmonary TB (PTB) or extrapulmonary TB (EPTB) were evaluated using a molecular target with insertion element IS6110, specific to the Mycobacterium tuberculosis genome, and nested PCR was performed. The results were analyzed with SPSS version 22., Results: A total of 100 patients, including 74 (74%) with PTB and 26 (26%) with EPTB, were enrolled. Positive smears were seen in 38 patients (38%). Lymph nodes were the most commonly involved organ in 14 of the 26 (53.8%) EPTB patients (13.5%). Seven (23.1%) of the EPTB patients were HIV-positive. Urine PCR was positive in only 28 patients (28%). Seven HIV-positive patients with PTB showed positive urine PCR results. Moreover, PCR results were positive in only one of the seven HIV-positive subjects with EPTB. Positive PCR results were found in 20 of the 73 HIV-negative patients (27.4%) and in 8 of the 27 HIV-positive patients (29.6%). Therefore, there was no significant difference between the HIV-negative and HIV-positive patients for urine PCR (sensitivity 29.6%, specificity 72.6%; positive and negative predictive values 28% and 72%, respectively; P = 0.138)., Conclusions: Nested PCR showed the same sensitivity in HIV-positive and HIV-negative patients. It can be applied as a rapid technique for the diagnosis of TB.

Objective: The aim of the present study was to determine the prevalence of metabolic syndrome (MS) in infertile Iranian women with polycystic ovary syndrome (PCOS) using the ATPIII criteria., Subjects and Methods: In this cross-sectional study, 624 women with PCOS were enrolled at a tertiary referral center in Tehran, Iran, between April, 2012 and March, 2013. Diagnosis of MS was according to ATPIII criteria. Also, we divided PCOS patients into following two main groups: (i) with MS (n = 123) and (ii) without MS (n = 501), and then compared variables between two groups., Results: The mean age, body mass index (BMI) and waist circumference were 28.6 ± 4.3 years, 26.7 ± 3.7 kg/m2 and 85.2 ± 8.7 cm, respectively. The prevalence of MS was 19.7%. Our findings showed that age, BMI, waist circumference and all metabolic parameters were higher in PCOS women with MS than related values in those without MS. The most and least prevalent forms of MS were low level of high density lipoprotein-cholesterol (HDL-C) and hypertension, respectively., Conclusion: It seems the prevalence of metabolic syndrome in our country isn't as high as western countries. The prevalence rate of MS increased with age and BMI. One of the major cardiovascular risk factors, low level of HDL-C, is the most prevalent metabolic abnormality in our participants.

Objective: To investigate the effects of low-dose ethinyl estradiol (EE) on the clinical pregnancy rate among women with polycystic ovary syndrome (PCOS) undergoing ovulation induction with clomiphene citrate (CC)., Methods: Between March 12, 2011, and February 10, 2013, a randomized, double-blind, placebo-controlled trial was conducted at the Royan Institute Research Center, Tehran, Iran, among women with PCOS who were aged 25-30 years, were undergoing their first intrauterine insemination cycle, and had a history (≥2 years) of infertility, oligomenorrhea, or amenorrhea. Participants were randomly allocated to receive EE (0.05 mg daily for 5 days) or placebo, co-administered with CC cycles (100 mg daily for 5 days). The primary outcome was clinical pregnancy rate. Analyses were per protocol: patients who discontinued the intervention were excluded., Results: Analyses included 45 women who received CC and EE, and 50 women who received CC and placebo. The number of women who achieved a clinical pregnancy was higher among participants who received CC and EE (13 [29%]) than among those in the control group (5 [10%]; P =0 .02). No adverse effects of EE were reported., Conclusion: The combination of CC and EE seems to increase the clinical pregnancy rate among women with PCOS undergoing intrauterine insemination. ClinicalTrials.gov:NCT01219101., (Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objectives: Empty follicle syndrome (EFS), although rare, is a disappointing condition in which no oocytes are retrieved from mature follicle after ovulation induction in in vitro fertilization (IVF) cycles. The aim of this study was to estimate the incidence and factors associated with EFS., Methods: All cycles resulting in EFS from May 2012 to September 2013 were retrospectively identified at a tertiary referral infertility center. Among the 3,356 cycles performed, 58 (1.7%) women who underwent their first IVF cycle and had no oocyte retrieval were enrolled in the study. Three different stimulation protocols (long, antagonist, and miniflare) were mainly used for induction of follicular growth. Data relating to the age, follicle stimulating hormone (FSH) level, anti-Müllerain hormone (AMH) level, and the number of ampules and follicles for each patient was obtained., Results: Out of 58 individuals, 10 (17.2%) showed false type and 48 (82.8%) showed genuine EFS. The most frequent findings in our study were diminished ovarian reserve, low anti-Müllerian hormone (AMH; ≤0.5 ng/mL), and less than four mature follicles, indicating EFS in 1.7% of the patients., Conclusion: Low serum AMH levels and a small number of follicles after ovarian stimulation is the manifestation of diminished ovarian reserve. Thus, we suggest that EFS could be a manifestation of low ovarian reserve.

Objective: The present study was performed to examine the effects of two speech therapy methods on six verbal behaviors of autistic children, including oral speech, listening, organizing, speaking, semantics, and syntax., Materials & Methods: IN THIS STUDY, THIRTY CHILDREN WITH AUTISM WERE ASSIGNED TO ONE OF TWO GROUPS: imitative and cognitive groups. Before starting the main procedures of the study, the children of both groups were homogenized concerning their autism level. In the first phase of the study, the speech development level of the two groups was measured in a pre-test, in which both groups showed similar results. Then, both groups of children received 6 months of speech therapy instruction, during which one group was taught using an imitative method, while the other group was being worked with cognitive method., Results: After 6-month treatment period, a post-test was done, and the t-tests based on the data of the two groups revealed a significant difference between the results., Conclusion: The statistics showed that after the teaching period, autistic that worked with cognitive method gained a better development in their speech abilities, comparing to those worked with the imitative method.

Background: Ectopic pregnancy (EP) is a condition presenting as a major health problem for women of childbearing age. This study aimed to identify potential risk factors for EP and to evaluate the contribution of the risk factors associated to EP., Materials and Methods: This retrospective nested case-control study was conducted from 2006 to 2011. In case group, there were a total of 83 women diagnosed with EP, while in the control group; there was a total of 340 women who gave birth. The basic recorded information included surgical, gynecological, obstetrics, sexual, contraceptive, and infectious histories; demographic characteristics; smoking habits; fertility markers; as well as reproductive outcome after EP. The association between EP and the factors studied was analyzed by logistic regression., Results: The findings reveal that the following factors were associated with increased risk of EP, including: Maternal age (odds ratio [OR] =1.11, confidence interval [CI] [1.06-1.16], P < 0.0001), spouse's cigarette smoking (OR = 1.73, CI [1.05-2.85], P = 0.02), gravidity (OR = 1.50, CI [1.25-1.80], P < 0.0001), prior spontaneous abortions (OR = 1.93, CI [1.11-3.36], P = 0.01), history of EP (OR = 17.16, CI [1.89-155.67], P = 0.01), tubal blockage (OR = 10.85, CI [2.02-58.08], P = 0.01), use of intrauterine device (IUD) (OR = 4.39, CI [1.78-10.81], P = 0.001), tubal damage (OR = 2.704, CI [1.26-5.78], P = 0.01), first pregnancy interval (OR = 1.01, CI [1.00-1.02], P < 0.0001) and history of infertility (OR = 6.13, CI [2.70-13.93], P < 0.0001)., Conclusion: By identifying risk factors being amenable to modification, such as cigarette smoking and use of IUD and first pregnancy interval the effective risk-reduction strategies can be devised.

Background: Rhinoplasty is one of the most popular cosmetic surgical procedures in Iran. Surgery on the vocal tract can potentially change the voice characteristics. To the best of the authors' knowledge, no study has described voice changes after rhinoplasty, and the results of this study may help physicians to be aware of potential voice alterations following rhinoplasty., Methods: The authors selected 27 patients for this study. Patients completed Voice Handicap Index questionnaires, and the authors performed perceptual and acoustic analyses before and 5 months after rhinoplasty., Results: The Voice Handicap Index score and its physical and emotional subscales showed a statistically significant increase after rhinoplasty, indicating a worsening of voice quality after rhinoplasty. Blind perceptual analysis by six trained listeners revealed a statistically significant increase in hyponasality after rhinoplasty. Acoustic analysis showed that the frequency of the first and second nasal murmurs increased for the phonemes "m" and "n," while the amplitude of these murmurs decreased significantly after surgery. The same pattern was seen for the phoneme "a" when it was produced between two nasal consonants, as in the word "man.", Conclusions: Rhinoplasty can change vocal characteristics by narrowing the nasal cavity. Rhinoplasty has some effects on the voice, but these changes are problematic in general for most patients. However, for individuals who rely on their voice for professional reasons, the surgeon should preoperatively discuss these changes with the patient and consider more conservative types of surgery., Clinical Question/level of Evidence: Therapeutic, IV.

Background: : The aim of this study was to evaluate the reproductive outcome of women with history of infertility or recurrent miscarriage following hysteroscopic septum resection., Materials and Methods: :This was a retrospective descriptive study performed on 263 patients, among whom 248 patients were infertile (79% with primary infertility and 21% with secondary infertility) and 15 patients presented with histories of recurrent miscarriage (three or more miscarriages) between 2005 and 2009. All participants underwent hysteroscopic septum resection using monopolar knife electrode. The main outcome measure was reproductive outcome after hysteroscopic metroplasty., Results: The septum was completely removed during the first hysteroscopy in 242 (92%) patients. A residual septum was seen in 21 (8%) patients who required a second sitting of surgery. Three cases were complicated by minor perforations which required no further interventions. One operation complicated with bleeding which was controlled by a Foley catheter. There were no cases of postoperative Asherman's syndrome. Postoperatively, out of 263 patients, outcomes of 203 individuals were analyzed. According to the results, the miscarriage rate reduced significantly from 20.2 to 4.9%. Postoperative ectopic pregnancy rate and preterm labor were lower than prior to septum resection. Term deliveries increased significantly from 2.5 to 33.5%., Conclusion: Hysteroscopic septum resection is a safe and effective method for patients with history of infertility or recurrent miscarriage.

Objective: To determine the impact of the clinical and embryological factors on the pregnancy outcome of frozen-thawed embryo transfer., Materials and Methods: The data of 247 frozen-thawed embryo transfer cycles were assessed at Royan Institute from March 2006 to March 2008. Appropriate statistical analysis was performed using Student t test and Chi-square or Fisher exact test. Forward logistic regression was done to predict the individual impact of factors on the success of frozen embryo transfer., Results: According to our results, 1,523 frozen embryos were thawed with a survival rate of 79.8%. The overall chemical and clinical pregnancy rates per embryo transfer cycle were 28.1% and 26.3%, respectively. A total of 71 gestational sacs were implanted (7.9%). The pregnancy outcome was higher in women who were stimulated with the gonadotrophin releasing hormone agonist long protocol, treated by a combination of follicle stimulating hormone and luteinizing hormone, who had endometrial thickness greater than or equal to 8mm on the embryo transfer day, and who had positive fresh-cycle pregnancy test., Conclusion: Protocol type, gonadotrophin preparations, fresh-cycle outcome, endometrial thickness and the numbers of obtained oocytes, embryos, and high-quality thawed embryos transferred are the factors affecting pregnancy outcome of frozen-thawed embryo transfer., (Copyright © 2011. Published by Elsevier B.V.)

Background: Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment., Objective: The objective of this study was to compare the efficacy of three types of progesterone on biochemical, clinical and ongoing pregnancy rates and abortion and live birth rates., Materials and Methods: A prospective randomized study was performed at Royan Institute between March 2008 and March 2009 in women under 40 years old, who use GnRH analog down-regulation. One hundred eighty six patients in three groups were received progesterone in oil (100 mg, IM daily), intravaginal progesterone (400 mg, twice daily) and 17-α hydroxyprogestrone caproate (375mg, every three days), respectively., Results: Final statistical analysis after withdrawal of some patients was performed in 50, 50 and 53 patients in group 1, 2 and 3 respectively. No differences between the groups were found in baseline characteristics. No statistical significance different was discovered for biochemical, clinical and ongoing pregnancies. Although the abortion rate was statistically higher in group 1 (p=0.025) the live birth rate was not statistically significant between the three groups., Conclusion: The effects of three types of progesterone were similar on pregnancies rate. We suggest the use of intravaginal progesterone during the luteal phase in patients undergoing an IVF-ET program because of the low numbers of abortions, and high ongoing pregnancy rates.

Purpose: This study is designed to compare the results of in vitro fertilisation (IVF) in polycystic ovary syndrome (PCOS) and tubal factor disorders., Materials and Methods: This was a cohort study performed in Royan Institute from 2007 to 2009. For this evaluation, 183 patients with PCOS and 183 patients with tubal factor (control group), whose ages ranged from 22 to 35 years underwent the long protocol of pituitary suppression and were included in the study., Results: In a defined time cycle, the number of ampoules used was higher for the control group (24.6 ± 0.9 versus 33.4 ± 0.9; p<0.0001). The PCOS group produced more oocytes (9.6 ± 0.5 versus 6.4 ± 0.3; p ≤ 0.0001) and embryos (3.7 ± 0.2 versus 2.7 ± 0.1; p=0.001). There were no significant differences in cancellation rate, the occurrence of ovarian hyperstimulation syndrome (OHSS) and cycles that resulted in lacked efficient follicle in the PCOS group and control group. Comparisons for biochemical pregnancy, implantation, clinical pregnancy and ongoing pregnancy rates showed no statistical difference. No significant differences were detected in miscarriage rates and complications., Conclusion: The outcome of IVF in patients with PCOS and in patients with tubal infertility is similar.

In this randomized trial study, two groups of infertile women (n=55) aged≤40 years underwent in vitro fertilization or intracytoplasmic sperm injection treatment cycles with or without 0.2 mL of air pushed into the catheter after embryo transfer. The implantation and clinical pregnancy rates were statistically significantly higher in the study group than in the controls. This improvement on standard ET technique may advance clinical pregnancy rates., (Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Aphasia diagnosis is particularly challenging due to the linguistic uncertainty and vagueness, inconsistencies in the definition of aphasic syndromes, large number of measurements with imprecision, natural diversity and subjectivity in test objects as well as in opinions of experts who diagnose the disease., Methods: Fuzzy probability is proposed here as the basic framework for handling the uncertainties in medical diagnosis and particularly aphasia diagnosis. To efficiently construct this fuzzy probabilistic mapping, statistical analysis is performed that constructs input membership functions as well as determines an effective set of input features., Results: Considering the high sensitivity of performance measures to different distribution of testing/training sets, a statistical t-test of significance is applied to compare fuzzy approach results with NN results as well as author's earlier work using fuzzy logic. The proposed fuzzy probability estimator approach clearly provides better diagnosis for both classes of data sets. Specifically, for the first and second type of fuzzy probability classifiers, i.e. spontaneous speech and comprehensive model, P-values are 2.24E-08 and 0.0059, respectively, strongly rejecting the null hypothesis., Conclusions: THE TECHNIQUE IS APPLIED AND COMPARED ON BOTH COMPREHENSIVE AND SPONTANEOUS SPEECH TEST DATA FOR DIAGNOSIS OF FOUR APHASIA TYPES: Anomic, Broca, Global and Wernicke. Statistical analysis confirms that the proposed approach can significantly improve accuracy using fewer Aphasia features.