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Background: In vitro fertilization (IVF) is a useful assisted reproductive technology to achieve pregnancy in infertilecouples. However, it is very important to optimize the success rate after IVF by controlling for its influencing factors.This study aims to classify successful deliveries after IVF according to couples’ characteristics and available data onoocytes, sperm, and embryos using several classification methods.Materials and Methods: This historical cohort study was conducted in a referral infertility centre located inTehran, Iran. The patients’ demographic and clinical variables for 6071 cycles during March 21, 2011 to March20, 2014 were collected. We used six different machine learning approaches including support vector machine(SVM), extreme gradient boosting (XGBoost), logistic regression (LR), random forest (RF), naïve Bayes (NB),and linear discriminant analysis (LDA) to predict successful delivery. The results of the performed methods werecompared using accuracy tools.Results: The rate of successful delivery was 81.2% among 4930 cycles. The total accuracy of the results exposed RFhad the best performance among the six approaches (ACC=0.81). Regarding the importance of variables, total numberof embryos, number of injected oocytes, cause of infertility, female age, and polycystic ovary syndrome (PCOS) werethe most important factors predicting successful delivery.Conclusion: A successful delivery following IVF in infertile individuals is considerably affected by the number ofembryos, number of injected oocytes, cause of infertility, female age, and PCOS.

Background: Sexual self-concept has a considerable impact on mental and sexual health. However, the relationship between sexual self-concept and infertility is unknown. This study aimed to compare sexual self-concept betweenfertile and infertile women.Materials and Methods: This cross-sectional study was conducted on a sample of 250 fertile and 250 infertilewomen who had referred to 9 health centers affiliated to Medical universities in Tehran and Royan infertility treatmentclinics in Tehran, Iran in 2017. Sexual self-concept was measured using the Multidimensional Sexual Self-ConceptQuestionnaire (MSSCQ) consisting of 20 subscales. Analysis of covariance (ANCOVA) was performed to comparesexual self-concept between the two groups.Results: The mean age of fertile and infertile women was 34 ± 5.62 and 29.74 ± 5.29 years, respectively. The highestscore in both groups was for the sexual self-schemata subscale (mean score for fertile=3.21 ± 0.68 and for infertile=3.42 ± 0.62). The lowest score was for sexual-depression subscale (mean score for fertile=0.59 ± 0.81 and forinfertile=0.61 ± 0.76). After adjustment for the age of each subject, the husband's age, duration of marriage, and women’seducation, we analyzed the sexual-satisfaction, the power-other sexual control, and the fear-of-sex subscales,which were found to be significantly lower in infertile women (p

Abstract Background Regenerative medicine plays a major role in biomedicine, and given the ever-expanding boundaries of this knowledge, numerous ethical considerations have been raised. Main text Rapid advancement of regenerative medicine science and technology in Iran, emerged the Iranian National Committee for Ethics in Biomedical Research to develop a comprehensive national ethical guideline. Therefore, the present ethical guideline which comprises eleven chapters was developed in 2019 and approved in early 2020. The titles of these chapters were selected based on the ethical considerations of various aspects of the field of regenerative medicine: (1) ethical principles of research on stem cells and regenerative medicine; (2) ethical considerations for research on stem cells (embryonic stem cells, epiblast stem cells, tissue-specific stem cells, stem cells derived from transdifferentiation, induced pluripotent stem cells [iPSCs], germline pluripotent stem cells, germline stem cells, and somatic cell nuclear transfer [SCNT] stem cells); (3) ethical considerations for research on somatic cells in regenerative medicine (adult somatic cells, fetal tissue somatic cells, and somatic cells derived from pregnancy products [other than fetus]); (4) ethical considerations for research on gametes in regenerative medicine; (5) ethical considerations for research related to genetic manipulation (human and animal) in regenerative medicine; (6) ethical considerations for research on tissue engineering in regenerative medicine; (7) ethical considerations for pre-clinical studies in regenerative medicine; (8) ethical considerations for clinical trials in regenerative medicine; (9) ethical considerations for stem cells and regenerative medicine bio-banks; (10) ethical considerations for privacy and confidentiality; and (11) ethical considerations for obtaining informed consent. Conclusion This article discusses the process of developing the present ethical guidelines and its practical points. We hope that it can play an important worldwide role in advancing ethics of research on stem cells and regenerative medicine.

Objective: The purpose of the study was to determine whether infertility is associated with coping processes and is there a difference between infertile women and men in the use of coping strategies? Material and Methods: In a cross-sectional study, the study sample consisted of 400 infertile couples, age at least 18 years and could read and write in Persian were enrolled at the Royan institute, Tehran, Iran, between July and September 2014. Participants provided demographic and Ways of coping questionnaire (WOCQ). Data was analyzed by paired t-test and multivariate analysis using SPSS software. Results: There was a significantly higher score for self-control in husbands compared to wives (P = 0.016). As well as wives have lower score of Confronted Coping and Distancing than their husbands however Accepting Responsibility, Positive Reappraisal were lower in wives than husbands but these differences are not significant (P > 0.05). Mean score of Seeking Social Support and escape avoidance of wives was higher and significant (P = 0.037, P = 0.022 respectively). Conclusion: Our finding showed that husbands have more Problem focused coping style and wives have more Emotion focused coping style. Keywords: Infertility, Coping style, Couples

Background: Understanding the prevalence of menstrual disorders has important implications for both health service planning and risk factor epidemiology. Objective: The aim of this review is to identify and collate studies describing the prevalence of menstrual disorders in Iran. Materials and Methods: Studies with original data related to the prevalence of menstrual disorders were identified via searching six electronic databases and reviewing citations. All abstracts or titles found by the electronic searches were independently scrutinized by two reviewers. The Meta-analysis was performed with a random effects model, considering the remarkable heterogeneity among studies. A total of 35 eligible epidemiological studies were included in this review. Results: Overall, the pooled prevalence of primary dysmenorrhea was 73.27% (95% CI=65.12-81.42). The mean proportion of women with oligomenorrhea was 13.11% (95.5%, 95% CI: 10.04-16.19). We identified 16 studies that reported polymenorrhoea with a random effect of pooled prevalence estimate of 9.94% (95% CI 7.33%-12.56%). The prevalence estimate of hypermenorrhea was 12.94% (95% CI 9.31%-16.57%). Overall prevalence of hypomenorrhea was 5.25% (95% CI 3.20%-7.30%), ranging from 0.9- 12.90%. Pooling six studies that reported estimates for menorrhagia, the overall prevalence was 19.24% (95% CI 12.78-25.69). Overall, 6.04% (95% CI: 1.99-10.08) of the women were shown to have metrorrhagia. Conclusion: This systematic review suggests that the average prevalence of menstrual disorders in Iran is substantial. It has been neglected as a fundamental problem of women's reproductive health. Diagnosis and treatment of these disorders should be included in the primary health care system of reproductive health.

Background and objective: Infertility is a global public health issue and is a low control stressor often leading to increased level of anxiety and depression. The objective of this study was to determine the prevalence of anxiety and depression and their related factors among Iranian infertile patients. Materials and methods: This cross-sectional study included 1128 infertile patients (479 men and 649 women) in a referral fertility center in Tehran, Iran from January 2014 to March 2015. The Hospital Anxiety and Depression Scale (HADS) were administrated to all participants. Results: The prevalence rates of anxiety and depression were 49.6% and 33.0%, respectively. Based on adjusted analysis, females were 2.26 times more likely to have anxiety symptoms than males (OR = 2.26, 95% CI: 1.75–2.90), while depression rate was not related to sex (OR = 1.09, 95% CI: 0.84–1.42). Patients with ≥ 5 years infertility duration were 1.51-fold and 1.30-fold more likely than others to have anxiety and depressive symptoms, respectively. Conclusion: We found that the anxiety and depression rates were very high among infertile patients. Thus, there may be a need for infertile patients to receive ongoing psychological interventions and support that matches their background during ART in order to reduce level of anxiety and depression. Keywords: Anxiety, Depression, Prevalence, Fertility, Iran

Background Women undergoing in vitro fertilization (IVF) cycles should successfully go through multiple points during the procedure (i.e., implantation, clinical pregnancy, no spontaneous abortion and delivery) to achieve live births. In this study, data from multiple cycles and multiple points during the IVF cycle are collected for each individual to model the effects of factors associated with success at different stages of IVF cycles in Iranian infertile women. Materials and Methods This historical cohort study includes 996 assisted reproductive technology (ART) cycles of 511 infertile women. Covariates considered in this study were women’s age, type of cycle (fresh or frozen embryo transfer), number of embryos transferred and having polycystic ovarian syndrome during IVF cycles. Generalized estimating equations were used for calculation of odds ratio (OR) and 95% confidence intervals (95% CI) of success at different stages during IVF cycles. Cluster-weighted generalized estimating equations (CWGEE) was also fitted to handle informative cluster size. Results After adjusting for potential confounders, it was seen that receiving frozen embryo transfer was associated with higher odds of success compared to receiving fresh embryo transfer (adj OR: 2.26, 95% CI: 1.66-3.07); however, cycles with fresh embryo transfer exhibited better results in clinical pregnancy compared to those receiving frozen embryo. Being in the age category of 38 to 40 was associated with lower odds of success compared to the reference category (

Background: Gestational weight gain (GWG) is an important issue for all pregnant women due to its effect on pregnancy outcomes. Regarding this, the aim of the present study was to assess the relationship of GWG with cesarean section, birth weight, and gestational age at birth in the women with a pre-pregnancy body mass index (BMI) of ≥ 25 kg/m2. Methods: This cross-sectional study was conducted on 2,147 obese or overweight pregnant females who had singleton births as a secondary analysis. The data were collected by filling out a checklist in 103 hospitals, which were equipped with department of obstetrics and gynecology, in Tehran province, Iran, in 2015. Data analysis was performed using binomial logistic regression model in Stata software version 14. Results: According to the results, the prevalence of cesarean section was 74.35%. Furthermore, the mean GWG was 11.7 kg. The odds of cesarean delivery in the women with low and high GWG were 0.62 times smaller and 1.20 times larger than that for normal GWG, respectively (95% CI: 0.42-0.92, P=0.019 and 95% CI:0.90-1.59, P=0.197, respectively). After adjusting for confounding variables, GWG had no significant association with birth weight and gestational age at birth in the overweight and obese women. Conclusion: The findings of this study revealed a significant relationship between GWG and cesarean section. Furthermore, the odds of cesarean section in the women with low GWG was less than that in the women with normal GWG. Regarding this, GWG should be considered as one of the determinants of cesarean delivery. Therefore, it is suggested to conduct further prospective cohort studies to clarify the impact of GWG on pregnancy complications.

Background: Premenstrual syndrome (PMS) is a common disorder characterized by physical, mental and behavioral changes in the luteal phase of the menstrual cycle in the reproductive age women. Objective: The present study aimed to determine the overall prevalence of PMS in Iran by a systematic review and meta-analysis study. Materials and Methods: In this systematic review and meta-analysis, we searched international databases included ISI Web of Knowledge, PubMed/Medline, Scopus, Google Scholar, and also local databases including Iranmedex, Scientific Information Database, and Magiran for articles in English and Persian language published up to September 2016. We carried out data analysis with Stata version 11. We examined heterogeneity in the results of studies through I2 statistics and Chi-square based Q test. Also, we investigated the effects of potential heterogeneity factors in the prevalence of PMS by meta-regression. Results: We studied a total of 9147 reproductive-age women from 24 articles which entered to meta-analysis. Based on the result of random effect model, we estimated the overall prevalence of PMS 70.8% [95% CI: 63.8-77.7]. The results of subgroup analysis revealed that prevalence of PMS was 80.4% (95% CI; 66.9-93.9) among high school students, 68.9% (95% CI; 59.2-78.6) among university students, and 54.9% (95% CI; 51.6-58.2) in general population. Univariate meta-regression model showed that prevalence of PMS was decreased by increasing the age of subjects but this was not statistically significant (p=0.155). Conclusion: Our finding showed that PMS was prevalent in Iranian reproductive age women especially among high school students. More epidemiological research for determining factors that affect PMS prevalence seems essential.

Background This study compared common psychological symptoms and life satisfaction in husbands and wives according to infertility diagnosis. Materials and Methods We conducted this cross-sectional study on 248 infertile couples between November 1, 2014 and February 28, 2015 at Royan Institute, Tehran, Iran. Participants answered three questionnaires. First, they completed a demographic questionnaire followed by the Hospital Anxiety and Depression Scale (HADS, 14-item self-report instrument) composed of two sub-scales: anxiety (HADS-A) and depression (HADS-D). Participants also completed the Satisfaction with Life Scale (SLWS) comprised of 5 items. Both our questionnaires were validated for the Iranian population. Results In couples with male factor infertility, wives had a significantly higher mean score for anxiety compared to their husbands (P < 0.001). When the cause of infertility was female factor, the wives appeared significantly more anxious (P < 0.001) and depressed (P=0.004) than their husbands. Male patients, those with unknown and female factors, expressed greater satisfaction with life compared to other male patients (P=0.022). Significantly greater depression existed among the couples in which the wives’ educational levels was above their husbands (P=0.045). Conclusion Our findings showed that when the infertility etiology was male factor, female factors or unexplained, wives showed significantly higher anxiety than their husbands. In couples diagnosed with female factor infertility, wives showed significantly more depression than their husbands.

Background Multiple pregnancies are an important complication of assisted reproductive technology (ART). The present study aims to indentify the risk factors for multiple pregnancies independent of the number of transferred embryos. Materials and Methods This retrospective study reviewed the medical records of patients who underwent intracytoplasmic sperm injection (ICSI) cycles in Royan Institute between October 2011 and January 2012. We entered 12 factors that affected the number of gestational sacs into the poisson regression (PR) model. Factors were obtained from two study populations-cycles with double embryo transfer (DET) and cycles that transferred three embryos (TET). We sought to determine the factors that influenced the number of gestational sacs. These factors were entered into multivariable logistic regression (MLR) to identify risk factors for multiple pregnancies. Results A total of 1000 patients referred to Royan Institute for ART during the study period. We included 606 eligible patients in this study. PR analysis demonstrated that the quality of transferred embryos and woman’s age had a significant effect on the number of observed sacs in patients who underwent ICSI with DET. There was no significant predictive variable for multiple pregnancies according to MLR analysis. Our findings demonstrated that both regression models (PR and MLR) had the same outputs. A significant relation existed between age and fertilization rate with multiple pregnancies in patients who underwent ICSI with TET. Conclusion Single embryo transfer (SET) should be considered with the remaining embryos cryopreserved to prevent multiple pregnancies in women younger than 35 years of age who undergo ICSI cycles with high fertilization rates and good or excellent quality embryos. However, further prospective studies are necessary to evaluate whether SET in women with these risk factors can significantly decrease multiple pregnancies and improve cycle outcomes.

Background The multiple pregnancy incidence is increasing worldwide. This increased incidence is concerning to the health care system. This study aims to determine the frequency of multiple pregnancy and identify factors that affect this frequency in Tehran, Iran. Materials and Methods This cross-sectional study included 5170 mothers in labor between July 6-21, 2015 from 103 hospitals with Obstetrics and Gynecology Wards. The questionnaire used in this study consisted of five parts: demographic characteristics; information related to pregnancy; information related to the infant; information regarding the multiple pregnancy; and information associated with infertility. We recruited 103 trained midwives to collect data related to the questionnaire from eligible participants through an interview and medical records review. Frequencies and odds ratios (OR) for the association between multiple pregnancy and the selected characteristics (maternal age, economic status, history of multiple pregnancy in first-degree relatives, and reproductive history) were computed by multiple logistic regression. Stata software, version 13 (Stata Corp, College Station, TX, USA) was used for all statistical analyses. Results Multiple pregnancy had a prevalence of 1.48% [95% confidence interval (CI): 1.19-1.85]. After controlling for confounding variables, we observed a significant association between frequency of multiple pregnancy and mother’s age (OR=1.04, 95% CI: 1.001-1.09, P=0.044), assisted reproductive technique (ART, OR=6.11, 95% CI: 1.7- 21.97, P=0.006), and history of multiple pregnancy in the mother’s family (OR=5.49, 95% CI: 3.55-9.93, P=0.001). Conclusion The frequency of multiple pregnancy approximated results reported in previous studies in Iran. Based on the results, we observed significantly greater frequency of multiple pregnancy in older women, those with a history of ART, and a history of multiple pregnancy in the mother’s family compared to the other variables.

Background: The hospital anxiety and depression scale (HADS) is a common screening tool designed to measure the level of anxiety and depression in different factor structures and has been extensively used in non-psychiatric populations and individuals experiencing fertility problems. Objective: The aims of this study were to evaluate the factor structure, item analyses, and internal consistency of HADS in Iranian infertile patients. Materials and Methods: This cross-sectional study included 651 infertile patients (248 men and 403 women) referred to a referral infertility Center in Tehran, Iran between January 2014 and January 2015. Confirmatory factor analysis was used to determine the underlying factor structure of the HADS among one, two, and threefactor models. Several goodness of fit indices were utilized such as comparative, normed and goodness of fit indices, Akaike information criterion, and the root mean squared error of approximation. In addition to HADS, the Satisfaction with Life Scale questionnaires as well as demographic and clinical information were administered to all patients. Results: The goodness of fit indices through CFAs exposed that three and onefactor model provided the best and worst fit to the total, male and female datasets compared to the other factor structure models for the infertile patients. The Cronbach’s alpha for anxiety and depression subscales were 0.866 and 0.753 respectively. The HADS subscales significantly correlated with SWLS, indicating an acceptable convergent validity. Conclusion: The HADS was found to be a three-factor structure screening instrument in the field of infertility.

Objective: In assisted reproductive technology, it is important to choose high quality embryos for embryo transfer. The aim of the present study was to determine the grade A embryo count and factors related to it in infertile women. Materials and Methods: This historical cohort study included 996 infertile women. The main outcome was the number of grade A embryos. Zero-Inflated Poisson (ZIP) regression and Zero-Inflated Negative Binomial (ZINB) regression were used to model the count data as it contained excessive zeros. Stata software, version 13 (Stata Corp, College Station, TX, USA) was used for all statistical analyses. Results: After adjusting for potential confounders, results from the ZINB model show that for each unit increase in the number 2 pronuclear (2PN) zygotes, we get an increase of 1.45 times as incidence rate ratio (95% confidence interval (CI): 1.23-1.69, P=0.001) in the expected grade A embryo count number, and for each increase in the cleavage day we get a decrease 0.35 times (95% CI: 0.20-0.61, P=0.001) in expected grade A embryo count. Conclusion: There is a significant association between both the number of 2PN zygotes and cleavage day with the number of grade A embryos in both ZINB and ZIP regression models. The estimated coefficients are more plausible than values found in earlier studies using less relevant models.

AIM: To estimate overall prevalence of retinopathy of prematurity (ROP) in Iran using a systematic review and Meta-analysis. METHODS: A systematic review and Meta-analysis was performed of all published studies pertaining to prevalence of ROP using international and national electronic databases (ISI Web of Sciences, PubMed, Scopus, Google Scholar, SID, MagIran, and IranMedex) from their inception until May 2016 with standard keywords. Begg and Egger tests were used to examine the publication bias and Cochran test and I2 statistics were used to evaluate the statistical heterogeneity. Pooled estimate of the prevalence of ROP were calculated using random effects Meta-analysis. RESULTS: The publication bias assumption was rejected by Egger tests with P-value equal to 0.024. The results of Cochran test and I2 statistics revealed substantial heterogeneity (Q=1099.02, df=25, I2=97.7%, P=0.001). The overall prevalence of ROP using the random effect model in Iran was 26.1% (95% CI: 20.3%-31.8%). CONCLUSION: The prevalence of ROP is relatively high in Iran. Low birth weight and gestational age are significant risk factors for the disease. Improved care, including oxygen delivery and monitoring, for preterm babies in all facility settings would reduce the number of babies affected with ROP.

Background The most common chromosomal abnormality due to non-obstructive azoospermia (NOA) is Klinefelter syndrome (KS) which occurs in 1-1.72 out of 500-1000 male infants. The probability of retrieving sperm as the outcome could be asymmetrically different between patients with and without KS, therefore logistic regression analysis is not a well-qualified test for this type of data. This study has been designed to evaluate skewed regression model analysis for data collected from microsurgical testicular sperm extraction (micro-TESE) among azoospermic patients with and without non-mosaic KS syndrome. Materials and Methods This cohort study compared the micro-TESE outcome between 134 men with classic KS and 537 men with NOA and normal karyotype who were referred to Royan Institute between 2009 and 2011. In addition to our main outcome, which was sperm retrieval, we also used logistic and skewed regression analyses to compare the following demographic and hormonal factors: age, level of follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone between the two groups. Results A comparison of the micro-TESE between the KS and control groups showed a success rate of 28.4% (38/134) for the KS group and 22.2% (119/537) for the control group. In the KS group, a significantly difference (P < 0.001) existed between testosterone levels for the successful sperm retrieval group (3.4 ± 0.48 mg/mL) compared to the unsuccessful sperm retrieval group (2.33 ± 0.23 mg/mL). The index for quasi Akaike information criterion (QAIC) had a goodness of fit of 74 for the skewed model which was lower than logistic regression (QAIC=85). Conclusion According to the results, skewed regression is more efficient in estimating sperm retrieval success when the data from patients with KS are analyzed. This finding should be investigated by conducting additional studies with different data structures.

Background: This study evaluated hope, depression, anxiety, and stress among three groups of infertile couples. Materials and Methods: This cross-sectional study consisted of three groups of infertile couples-candidates for oocyte donation (n=60), embryo donation (n=60), and normal infertile (n=60). Participants included couples seen at Royan Institute, Tehran, Iran between 2013-2014 who were at least 18 years of age and could read and write in Persian. Participants provided demographic and general characteristics and completed the Persian version of the Adult Trait Hope Scale (hope, agency and pathway) and Depression, Anxiety, and Stress Scale (DASS). Data was analyzed by the paired t test, ANOVA, ANCOVA and Pearson correlation tests using SPSS statistical software. Results: Overall, 180 infertile couples participated in the three groups. There was a significant higher mean score for hope in husbands compared to wives in the normal infertile group (P=0.046). Husbands in the normal infertile group also had a significantly higher mean score for pathway (P=0.032). The frequency of anxiety significantly differed in female subjects (P=0.028). In the normal infertile group, the anxiety distribution significantly differed between wives and husbands (P=0.006). There was a significantly different stress frequency in male subjects (P=0.048). In the embryo donation group, stress significantly differed between wives and husbands (P=0.002). In the normal infertile group, stress also significantly differed between wives and husbands (P=0.05). Conclusion: The results have suggested that hope might be important in reducing psychological symptoms and psychological adjustment in those exposed to infertility problems who follow medical recommendations, which accelerates recovery. It is recommended to hold psychological counseling sessions (hope therapy) during reproduction cycles.

AIM: To estimate the overall prevalence of diabetic retinopathy (DR) in Iran by a systematic review and Meta-analysis. METHODS: We conducted a search of all published literature on diabetic patients for the prevalence of DR using Web of Sciences, PubMed, Scopus, Google Scholar, and national electronic databases SID, Magiran, and Iranmedex from their inception until September 2016 with standard keywords. Pooled estimates of the DR prevalence and the corresponding 95% confidence intervals (CI) were calculated using random effects models. RESULTS: Thirty-one studies involving 23 729 patients with type I and II diabetes were included. The publication bias assumption for prevalence of DR was rejected by Begg and Egger tests (P=0.825, P=0.057, respectively). The results of Cochran test and I2 statistics showed considerable heterogeneity for prevalence of DR (Q=1278.21, d.f.=30, P

Background In order to empower infertile individuals and provide high quality patient-centered infertility care, it is necessary to recognize and meet infertile individuals’ educational needs. This study aims to examine infertility patients’ knowledge and subsequently their education needs given their attitudinal approach to infertility education in terms of patients who undergo assisted reproduction treatment. Materials and Methods This descriptive study enrolled 150 subjects by conveni- ence sampling of all patients who received their first assisted reproductive treatment between July and September 2015 at a referral fertility clinic, Royan Institute, Tehran, Iran. We used a questionnaire that measured fertility and infertility information (8 questions) as well as attitude toward education on the causes and treatment of infertility (5 questions). Chi-square, independent sample t test, and one way ANOVA analyses were conducted to examine differences by sex. P < 0.05 was considered statistically significant. Results Total mean knowledge was 3.08 ± 0.99. Clients’ responses indicated that the highest mean knowledge scores related to knowledge of factors that affected pregnancy (3.97 ± 1.11) and infertility treatment (3.97 ± 1.16). The lowest mean knowledge scores related to knowledge of the natural reproductive cycle (2.96 ± 1.12) and anatomy of the genital organs (2.94 ± 1.16). Most females (92.1%) and males (83.3%) were of the opinion that infertility education programs should include causes of infertility and types of treatment associated with diagnostic and laboratory procedures. No statistically significant difference existed between male and female participants (P=0.245). Conclusion Most participants in this study expressed awareness of factors that affect pregnancy and infertility treatment. It is imperative to educate and empower infertile individuals who seek reproduction treatment in terms of infertility causes and types of treatment, as well as diagnostic and laboratory procedures to enable them to make informed decisions about their assisted reproductive procedures.

Objective After the introduction of assisted reproductive techniques, human embryos were officially introduced into laboratories and now thousands of them are cryopreserved in such settings. Embryonic stem cells and the future application of such cells in the treatment of disease opened the door to further research on human embryos. These developments raise many ethical issues, some of which have religious aspects. The main question is: what is the embryo? Should we consider it a human being? Thus, the purpose of this study was to investigate attitudes towards the personhood of the embryo. Materials and Methods In this cross sectional study, 203 infertile patients (n=406), 54 clinic staff and 49 embryo researchers, selected using convenience sampling at the Royan Institute, completed a questionnaire on personhood of human embryo. The questionnaire had been developed following qualitative research and had satisfied face and content validity tests. Results At the pre-implantation stage the majority of participants in all three groups considered the human embryo as "not a human being". Also, at the post-implantation stage of development, the majority of infertile couples and clinic staff considered the embryo as "not a human being" but, half the researchers (51%) considered the embryo in this stage as a "potential human". Half of the infertile couples considered the human fetus before ensoulment time (19th week of pregnancy according to the Shiite Islamic scholars) as "not-human being", while more than half of researchers (55.1%) considered it as a "potential human". Conclusion Ensoulment time is a major and important border for personhood. Most infertile couples and clinic staff consider the human embryo as "not a human being" but majority of all study participants considered the human fetus to be a complete human after ensoulment time.

Introduction: Developing a tool for measuring patient’s problems is a vital step in the process of infertility treatment and research. Fertility Problem Inventory (FPI) is a questionnaire, which was made by Newton in 1999 to detect fertility problem associated within fertile couples, including 46 questions and five domains. Since validity and reliability of any instrument should be evaluated in the new environment and culture, the aim of this study was to assess the validity and reliability of the FPI in Iranian infertile couples. Materials and methods: Four hundred and ten patients in different stages of infertility treatment filled Fertility Problem Inventory. Forty-five patients answered the questionnaire twice at an interval of 2 weeks. Reliability and validity of the questionnaire were measured by Cronbach’s alpha, interclass correlation, test retest, inter-rater agreement (IRA), exploratory factorial analyses and multi-trait scaling analysis. Results: Using a conservative approach, the IRA for the overall relevancy and clarity of the tool was 88.34% and 92.14%, respectively. Overall appropriateness and clarity were 92.23% and 94.48%, respectively. Overall integrity of the instrument was determined to be 87%. Cronbach’s alpha coefficient was greater than 70% for all domains. The ICC ranged between 0.78 (Relationship concern) and 0.92 (Sexual concern). Exploratory factorial analyses demonstrate five fields suitable for instrument. The correlation of each item with its own scale (Rho ⩾ 0.4) represented a high convergent validity. In the discriminant validity of the tool, the correlation of each item with its own hypothesized domain was also greater than its correlation with other areas of the questionnaire. Conclusion: The results showed that Persian version of the FPI is a reliable and valid instrument for measuring the fertility problems in infertile patients.

Background Infertility and its treatment can have a considerable effect on a person’s quality of life (QoL). The Fertility QoL (FertiQoL) questionnaire is currently the most frequently used instrument to measure QoL in people with fertility problems. This study aims to examine the reliability and validity of the FertiQoL in infertile Iranian women. Materials and Methods This cross-sectional study included 155 women with fertility problems in a referral fertility clinic in Tehran, Iran from January to March 2014. A battery of instruments was used: FertiQoL, Satisfaction with Life Scale (SWLS), Hospital Anxiety and Depression Scale (HADS), and a demographic questionnaire. Construct validity of the scale was evaluated using confirmatory factor analysis (CFA). We assessed internal consistency with Cronbach’s alpha and convergent validity was examined by correlating the FertiQoL with SWLS and HADS. Results The results of the CFA generally supported the four-factor model of Core FertiQoL and two-factor model of Treatment FertiQoL. Both FertiQoL modules and their subscales revealed acceptable internal consistency that ranged from 0.643 to 0.911. However, the FertiQoL might be improved if Q15 and T2 items were removed from the scale. These items had low loadings on the Relational and Environment factors which decreased their internal consistency. The FertiQoL and their subscales significantly correlated with both SWLS and HADS, which confirmed convergent validity. Conclusion The Persian version of the FertiQoL is a valid, reliable instrument to measure QoL in infertile women and seems to perform as well as the original English Version.

Background: Due to the worldwide increase in infertility, it is both necessary and important to have assisted reproductive technology (ART) registries. In Iran, donation and surrogacy programs are approved by decrees from religious scholars. ART has been used since 1984 in Iran and the first Iranian infant conceived by gamete intra-fallopian transfer (GIFT) was born in 1989. This report, however, is the first national report on Iranian ART centers. Materials and Methods: This cross-sectional study, conducted under the supervision of the Iranian Ministry of Health, presented a summary of the numbers and percentages of centers that provided infertility services in Iran, as well as the status of ART in Iran during 2011. Results: A total of 52 centers reported treatment cycles and performed approximately 29000 intrauterine insemination (IUI), in addition to 35000 in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI) cycles. Conclusion: Iran has considerable potential to provide IVF services for both Iranians as well as other nationalities throughout the region. This proves the need for a national center that will implement a registry system.

Background: Few studies have been conducted on the infertility problems in Iran. This study aimed to investigate the prevalence of infertility problems and related factors in Iranian infertile patients. Materials and Methods: In this cross sectional study, 405 infertile patients referred to Royan Institute, Tehran, Iran, between 2014 and 2015, were selected by simple random sampling. Participants completed the Fertility Problem Inventory (FPI) including 46 questions in five domains (social concern, sexual concern, relationship concern, rejection of parenthood, and need for parenthood). Mean difference between male and female was verified using independent-samples Student’s t test. A generalized linear model (GLM) was also used for testing the effect of variables on the fertility problems. Data was analyzed using Stata software version 13. Results: The mean age (SD) of participants was 31.28 (5.42). Our results showed that 160 infertile men (95.23%) were classified as very high prevalence of infertility problems. Among infertile women, 83 patients (35.02%) were as very high prevalence of infertility problems, and 154 patients (64.98%) were as high prevalence. Age (P < 0.001), sex (P < 0.001), a history of abortion (P=0.009), failure of previous treatment (P < 0.001), and education (P=0.014) had a significant relationship with FPI scores. Conclusion: Bases on the results of current study, an younger male with lower education level, history of abortion and history of previous treatments failure experienced more infertility problems.

Background In 1993, Muller developed the Prenatal Attachment Inventory (PAI) which has been used widely in many studies and translated into several languages. The current study aimed to translate the PAI into Persian, assess the underlying structure of the PAI, and the appropriateness of the one-factor solution proposed by Muller. Materials and Methods In this cross-sectional study, we recruited a total of 322 primi- gravidae in their 27th to 34th gestational weeks that referred to private and governmental prenatal clinics in Tehran, Iran. All participants completed the Persian versions of the PAI and a demographic questionnaire. Participants were re-tested 2 weeks after the initial test- ing. The following psychometric properties of the PAI were investigated: construct validity by confirmatory factor analysis (CFA), internal consistency reliability with Cronbach’s alpha, and test-retest reliability according to the intraclass correlation coefficient (ICC). Results The CFA results indicated that a single-factor model provided good fit to the data, which confirmed the original model by its developer. The Cronbach’s alpha coef- ficient for PAI was 0.856 and the test-retest reliability with ICC was 0.784. Consider- ing the duration between marriage and pregnancy, women with low duration scored significantly higher than women with high duration on PAI (P=0.043). Conclusion The Persian version of the PAI showed that one factor structure was ad- equate and could be used for measuring psychological affectionate attachment between Iranian mothers and their fetuses.

Background: There has been a dramatic increase over the past few decades in the use of modern fertility technologies and the demand by infertile couples for using these techniques have increased as well. Studies exploring the experiences of women fertilized with egg donation technique in their treatment process have been rare. Aim: This study aimed to explore and explain the treatment experiences of women fertilized with egg donation. Method: This is a Qualitative study. Data were analyzed simultaneously as they were being collected and according to the conventional content analysis method. The study began in July 2013 and continued until September 2014. Fourteen unstructured, in-depth interviews were carried out with 12 infertile women who had been fertilized or had given birth to children through egg donation. One of Tehran’s referral centers for infertility was used as the study setting. All participants submitted their written consent prior to the start of the study. Results: Analysis of the findings showed "difficult and stressful treatment" as the final theme with 6 subthemes, including: 1) religious barriers, 2) treatment difficulties, 3) treatment frustration (including the following subcategories: fatigue and despair, and the experience of frequent failures), 4) dissatisfaction with the services provided, 5) confusions in treatment, and 6) Perception of relative peace. Implications for Practice: Exposure to various assisted reproductive technologies, including egg donation, is a stressful process, and providing emotional support to patients is one of the most essential care services they require from treatment centers. The results of the present study can assist in planning future strategies for meeting the specific needs of these distinguished patients.

Background: Infertility is a global public health issue and may adversely affect life satisfaction. One of the most widely instruments used to assess life satisfaction is the Satisfaction with Life Scale (SWLS). Objective: The objective of this study was to examine the psychometric properties of the SWLS in Iranian infertile women. Materials and Methods: In this descriptive cross-sectional study, a total of 125 infertile women referring to Royan Institute in Tehran were selected by convenience sampling method. The participants were administered the SWLS, the Hospital Anxiety and Depression Scale (HADS), and a demographic questionnaire. The psychometric properties of the SWLS were examined: construct validity using confirmatory factor analysis (CFA), reliability using Cronbach’s alpha and convergent validity by examining the relationship with HADS. Result: Results of the CFA indicated that a single-factor model provides a good fit to the data (χ2/df= 1.58; GFI= 0.975; CFI= 0.995; NFI= 0.985; RMSEA= 0.069 and SRMR= 0.027). The Cronbach’s alpha coefficient for SWLS was 0.887. Significant negative correlations were found between SWLS and HADS scores for anxiety (r= -0.410) and depression (r= -0.434), indicating an acceptable convergent validity. Conclusion: The SWLS has adequate psychometric properties for assessing life satisfaction in Iranian infertile women.

Background & Aim: One of the assisted reproductive technologies is the use of donated oocyte. Although, the data about medical aspects of this process is available, knowledge of the psychological aspect related to this therapy is limited. Each individualchr('39')s psychological aspects can be assessed by the self-concept and the self-discrepancy. Therefore, the present study aimed to assess the self-concept and self-discrepancy among women receiving and donating oocyte. Methods & Materials: In this descriptive-analytical investigation, carried out in 2015, given the limited research population, 53 women referred to Royan infertility institute, were investigated in each of the donor and recipient groups using the available sampling method. The data were collected by three questionnaires including demographic questions, Rogers’s self-concept scale and self discrepancy scale (ideal-self discrepancy and ought-self discrepancy). The data were analyzed through the descriptive statistics, Chi-square and t-test using SPSS v.16. Results: Results showed that the self-concept and self-discrepancy scores were poor in both the donor group and the recipient group. Scores of the recipient women (the questionnaire was reverse scored) were more than scores of the donor women. There was no significant difference between the two groups in the mean scores of self-concept (P=0.53). There was a significant difference between the two groups in the ought-self discrepancy score (P=0.02) but no significant difference was found between the two groups in the ideal-self discrepancy score (P=0.15). Conclusion: According to the results, it should be noted that in the process of oocyte donation, only physical assessment is not enough but individuals’ psychological needs are necessary to be taken into account. So, the authorities should consider measures to assess the psychological aspects of women receiving and donating oocyte.

Background To our knowledge, there is no valid and comprehensive questionnaire that considers attitude toward oocyte donation (OD). Therefore this study has aimed to design and develop a tool entitled attitude toward donation-oocyte (ATOD-O) to measure attitude toward OD. Materials and Methods This methodological, qualitative research was undertaken on 15 infertile cases. In addition, we performed a literature review and search of various databases. Validity of this questionnaire was conducted by knowledgeable experts who determined indices such as relevancy, clarity, and comprehensiveness. Reliability of the questionnaire was assessed based on the opinions of experts and infertile couples referred to Royan Institute. Results ATOD-O was designed in 52 statements that covered various issues such as the OD process, donor and recipient characteristics, as well as family, emotional, psychological, legal, religious, and socio-economic dimensions. Results were scored as five points: 1 (strongly disagree), 2 (disagree), 3 (somewhat), 4 (agree), and 5 (strongly agree). The overall relevancy of the questionnaire was 97% and clarity was 96%. Overall comprehensiveness was 100%. Conclusion The findings from this preliminary validation study have indicated that ATOD-O is a valid measure for measuring and assessing attitude toward donated oocytes. This questionnaire can be used in studies regarding different groups of a society.

Objective (s): Nearly all women consider child as the main part of the marriage in Iran. Women define child as "taste of the life" and a communication tool which binds them to other women. In fact, a womanchr('39')s personality and identity is not completed unless she has child. This study aimed to explore the experience of infertile woman in Iran. Methods: Grounded theory was the method that guided this research. Twenty-one infertile women were selected using theoretical sampling. Data were collected through semi structured in-depth interviews at Royan Institute, Tehran, Iran. Results: The core category we observed was "pressure on infertile women". Stigmatization was the main source of pressure, regardless of financial problems. When this pressure internalized in patients and coincides with social expectations of woman, they felt that they failed leading to ignores other dimensions of their life. Nevertheless, every infertile woman identified that they imagine of having child in their mind. Conclusion: When all social spaces are full of pressure and anxiety for infertile women, isolation is a natural consequence. Our study showed that most pressure was from fertile women to infertile women.

One of the most important applications of transgenic animals for medical purposes is to transplant their organs into human’s body, an issue which has caused a lot of ethical and scientific discussions. we can divide the ethical arguments to two comprehensive groups; the first group which is known as deontological critiques (related to the action itself regardless of any results pointing the human or animal) and the second group, called the consequentialist critiques (which are directly pointing the consequences of the action). The latter arguments also can be divided to two subgroups. In the first one which named anthropocentrism, just humankind has inherent value in the moral society, and it studies the problem just from a human-based point of view while in second named, biocentrism all the living organism have this value and it deals specially with the problem from the animal-based viewpoint. In this descriptive-analytic study, ethical issues were retrieved from books, papers, international guidelines, thesis, declarations and instructions, and even some weekly journals using keywords related to transgenic animals, organ, and transplantation. According to the precautionary principle with the strong legal and ethical background, due to lack of accepted scientific certainties about the safety of the procedure, in this phase, transplanting animal’s organs into human beings have the potential harm and danger for both human and animals, and application of this procedure is unethical until the safety to human will be proven.

The right to information Act was implemented in the Iranian legal system through accession of the Merida Convention ensuring the right to information as a fundamental right for the public. One significant aspects of this subject is the ratification of the "Disclosure and Access to Information Act" by which it is recognized as a right of all Persian individuals and citizens to access state-held information in Iran administration. The Iranian legislature, with regard to the role of access to information and its significance, clarified the scope, permitted subjects of access, and exceptions of the right to state-held information. In this essay, we will discuss the legal aspects and scope of ensuring access to medical information in the Iranian statutes and their exceptions. It is argued that the Iranian legislation ensures the principle of maximum disclosure, while sensitive subjects’, specially classified and private information, are exempted. Therefore, the related rules in Iran’s statutes not only do not threaten patient’s information, but also protect them by criminalizing the breaching of the mentioned right.

Background: Mobile phone dependency is an emerging public health problem. The aim of this study was to investigate the associations between general health and mobile phone dependency in college students. Methods: In this cross-sectional study, 334 students from Arak University of Medical Sciences of Iran were selected by stratified random sampling. Data were collected by (1) demographic checklist, (2) 27-item Mobile Phone Problem Usage Scale, and (3) General Health Questionnaire-28 (GHQ-28). Results: Mean scores of mobile phone dependency and GHQ-28 were 119.83 ± 43.53 and 23.73 ± 12.77, respectively. In multiple linear regression, age, family economic status, anxiety and sleep disorder, and social dysfunction were the main significant predictors of mobile phone dependency (R = 0.469, R2 = 0.220, adjusted R2 = 0.203). Conclusions: Based on the finding of this study, prevention strategies for management of mobile phone use in students can be adopted.

Rapid development in assisted reproductive techniques along with relieving the pain of childlessness has brought new ethical and policy dilemmas. Posthumous assisted reproduction is the most challenging, difficult and sensitive issue to be discussed ethically and religiously. In this paper the acceptability of the posthumous reproduction in Islamic contexts is evaluated and major concerns like Consent and ownership of the gametes after death, Family and Marriage vision and Welfare of the child are discussed together with some international legislation. We can conclude that upon Islamic vision to assisted reproductive techniques as treatment of families and relieving the serious problem of childlessness, posthumous assisted reproduction is unacceptable even with previously frozen gametes or embryos. Also, Islamic vision to marriage, consent and welfare of the child confirms the unacceptability. There must be some law or legislation to ban this procedure in Islamic contexts.

Background A family traditionally consisted of a married man, his wife, and their children. The new reproductive technologies including use of the third party as egg, sperm and embryo donation and also surrogacy have changed the traditional meanings of lineage, ancestry and family. The increasing number of lesbians and gays in addition to single women requesting fertility treatment from IVF centers in the world has brought a debate: “Can fertility treatment be offered to single persons or homosexuals?” According to ASRM and ESHRE taskforces, there is no such limitation, but as legislations and law, also ethical and social considerations depending on the culture, believes and religion of societies must be considered as limitations in some contexts like Iran. Materials and methods In this study we review the Iran law and also some Islamic resources about offering the fertility treatment to single mothers or homosexuals. Results Homosexuality is not accepted in Islamic contexts and is considered as a crime. Children should have a family with both mother and father, unless they lose one of them or both. In the latter situation Islamic court will hand over the custody of the child to someone else like uncle or grandfather. Conclusion We concluded that according to Islam and Iran’s law, fertility treatment cannot be offered to single mothers and homosexuals mostly because of welfare of the child.

Introduction: The purpose of this study was to evaluated the effect of β-mercaptoethanol on resumption of meiosis, in vitro maturation of immature mouse oocytes and resulting embryo development with and without BSO (DL-Buthionine sulfoximine). Material and Methods: Germinal vasicle (GV) were recovered from 6-8 weeks old NMRI ovaries and cultured in maturation medium in MEMα supplemented with 7.5IU/ml hCG, 100mIU/ml rhFSH, 5% FCS (control group) and adding 100μm β-mercaptoethanol (group 1) or with 5mM BSO + 100μm β-mercaptoethanol (group 2) for 24h. The matured oocytes then were fertilized and cultured for 5 days. Fertilization and development were accomplished in T6 medium. Results: The percentage of GV oocytes reaching to metaphase I (or undergo GVBD) were 78.5%, 85%, 86% in control group, group 1 and group 2 respectively, that no significant difference was detected between groups. The proportion of oocytes that progressed to the metaphase II (MII) stage was minimum within 5mM BSO group (group 2) and maximum within β-mercaptoetanol group (group 1) with significant difference comparing with control and each other (P≤0.05). The percentage of embryos reaching to morula stage within β-mercaptoetanol group was significantly higher than the control group (5% and 12.2% respectively). None of oocytes treated with BSO could pass the 8 cell stage. Conclusion: β-mercaptoetanol enhances IVM and improves embryo development. While adding BSO into the maturation medium even with β-mercaptoetanol decreases maturation and declines the embryo development.

Introduction: DEHP [di(2-ethylhexyl) phthalate)] is widely used in plastic industry and some reproductive toxicity has been shown with it. So, this study was designed to evaluate DEHP effects on resumption of meiosis and in vitro maturation of mouse oocytes as well as development of embryos resulted from them. Material and Methods: Mice of 4-6 weeks old were administered daily doses of 50, 100, 200 µl of 2.56 µM DEHP solution for 12 days. Immature mouse oocytes were recovered from all experimental groups and matured in MEM-α medium containing 5% FCS with and without 7.5 IU hCG and 100 mIU rFSH. IVF was performed T6 medium. Results: Resumption of meiosis and in vitro maturation were significantly lower in all experimental groups in culture media without hormones compared to controls. Fertilization and embryo development were also significantly decreased in both culture media (with and without hormones). Conclusions: This study showed the adverse effects of DEHP on in vitro maturation and embryo development in a dose dependent manner.

We are interested the article by Niknejadi et al. (1) highly scientific and provocative however there seem to be a lack of clarity on some of the methodological issues; 1. In the materials and methods section, it was mentioned that: “in cases that had normal endometrial findings on transvaginal sonography (TVS), a hysteroscopy was not scheduled due to ethical considerations” whereas in the results, a total of 466 cases with negative TVS were presented. It is not mentioned how these patients were found. If they have other indications for hysteroscopy, it may add bias to your research which may affect the results (verification bias). The bias would be present since both the TVS positive and negative patients would come from different patient populations that have different indications as a result of their various medical conditions. For example, most likely the TVS negative patients in this study came from patients who presented with in vitro fertilization (IVF) failure, intrauterine insemination (IUI) failure and abnormalities seen in clinical exams, to name a few. The TVS positive cases would beare the people diagnosed during routine TVS for infertility evaluation. Although your research is retrospective, it would be better to consider such differences between subjects (2-6). 2. Considering that TVS negative patients do not routinely undergoto hysteroscopies; therefore one can conclude that TVS is a highly sensitive test, thus positive patients will not be missed. Laparoscopy is a highly specific test needed solely for confirming the diagnosed problem and can 88 Royan Institute International Journal of Fertility and Sterility Vol 4, No 2, Jul-Sep 2010 filter out healthy patients (2). It seems that in your report, the sensitivity of TVS is not very high. On the other hand, if we assume that there are some degrees of verification bias in your study, the real sensitivity even will be lower than calculated