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Introduction: Shift work disorder (SWD) is a sleep disorder that affects the circadian rhythm and is characterized by symptoms such as excessive daytime sleepiness and insomnia. This condition can significantly increase the risk of accidents and diminish the overall quality of life for individuals affected by it. Therefore, using the four-question of shift work disorder questionnaire (SWDQ) can be useful for identifying people at risk of SWD. In this research, we evaluated the accuracy and consistency of the Persian adaptation of the SWDQ among female employees. Methods: In this descriptive cross-sectional investigation, a sampling available method was employed to select employed women who were referred to Royan Institute, Arash Hospital, and Gynecological Office in Tehran. It was used translated and reverse translation methods for the questionnaire of SWDQ. Statistical analysis was performed by using the Statistical Package for the Social Sciences (SPSS version 16, Inc. Chicago, IL, USA).The tests used in this study were Cronbach's alpha, internal correlation, and confirmatory factor analysis. Results: In terms of content validity rate (CVR) with an average of 70% (questions 80%, 80%, 60% and 60%, respectively) and content validity index (CVI) with an average of 87.5% (questions 100%, 90%, 80% and 80%, respectively) was acceptable. The internal homogeneity of the SWD questionnaire with Cronbach's alpha was 63.4% and deleting each of the four items of the questionnaire reduced it. Moreover, the range of total correlated changes for the questionnaire was from 0.339 to 0.488, which was more than the minimum of 0.3. Conclusion: Overall, the validity and reliability of the Persian version of SWDQ (the four-item) have acceptable. Corresponding Author:Farideh Malekzadeh View Orcid in Profile You can search for this author in PubMed Google Scholar Profile

Background: One of the most common endocrine disorders of reproductive age women is polycystic ovary syndrome(PCOS). Women with PCOS are at risk for infertility, endometrial cancer, metabolic disorders, and cardiovascular disease.Awareness of the signs and symptoms of PCOS can be effective in diagnosing early stage PCOS and promotingquality of life (QoL). This study assesses the awareness of PCOS in schoolgirls and their mothers.Materials and Methods: This cross-sectional study was carried out on 1580 high school girls and 480 of their mothersin Tehran (capital of Iran) in 2017 and 2018. We used the stratified sampling method and divided Tehran into fivegeographic regions: north, south, east, west, and central. Schools were randomly selected from each of these regions.Students and their mothers separately answered a self-administered questionnaire that pertained to their knowledgeof PCOS. Statistical analyses were carried out with SPSS, version 22 (Inc. Chicago, IL, USA) and R version 3.2.1.Results: Students had an average age of 16.97 ± 0.84 years and their mothers’ average age was 45.19 ± 5.03 years.The average body mass index (BMI) of the students was 22.01 ± 5.54 kg/m2. The results of this study showed that only48 students (3.2%) and 148 mothers (27%) had acceptable knowledge about PCOS. The knowledge of students aboutPCOS was positively related to their mothers’ knowledge about PCOS (P

Abstract Background: Infertility affects individual's and couples' adjustment. The defense mechanism and marital adjustment are mental processes that play a key role in infertile couples' life. Objective: This study aims to investigate the role of defense mechanisms on marital adjustment in infertile couples based on the cause of infertility. Materials and Methods: This cross-sectional study was conducted on 400 infertile couples at Royan Institute (A referral center for infertility, Tehran, Iran). Infertile couples were divided into 4 groups based on the cause of infertility (female, male, both, and unknown). Demographic questionnaire, revised dyadic adjustment scale, and defense styles questionnaire were used for data collection. Results: Results showed that the mean score of marital adjustment of men based on the cause of infertility (female, male, and both) was significantly higher in comparison with their wives (p = 0.04, p ≤ 0.001, p ≤ 0.001, respectively). However, no difference was observed between the mean score of women, men, and couples (women and husbands) in defense mechanisms. But marital adjustment has a significant positive correlation with mature defense mechanisms and a negative correlation with immature ones (p < 0.05). Conclusion: The mean score of marital adjustment is higher in men than in their wives in all groups. So, counseling infertile couples in the field of marital adjustment and training in the use of mature defense mechanisms is recommended especially in women.

Background: The efficacy of Assisted Reproductive Techniques (ARTs) or technologies used to treat infertile couples has been approved. One such technique is embryo donation. However, there is insufficient knowledge of the experiences of mothers receiving donated embryos. Thus, the present study was conducted with the aim to determine the experiences of mothers receiving donated embryos. Materials and Methods: This qualitative conventional content analysis study was conducted in 2018 for 8 months (from February to September). The research setting was Royan Institute. Mothers receiving donated embryos were selected from among those who were pregnant or were at the postpartum stage using the purposive sampling method. A total of 15 interviews were performed with 13 participants. The qualitative data were collected using deep unstructured interviews and analyzed using the Graneheim and Lundman (2004) method in (version 10; VERBI GmbH, Berlin, Germany) software. Results: Data analysis resulted in 412 open codes that were then categorized into 7 main categories and their subcategories. The main categories were as follows: sociocultural constraint, feeling of insecurity in personal and family identity, protection of personal and family identity, confounded support, pressure and hardship, and achieving relative tranquility. Conclusions: The results of this study showed that the mothers who underwent embryo donation experienced feelings of insecurity regarding both individual and family identities, were confronted with sociocultural difficulties, and faced various pressures. It is suggested that future care plans be focused on the identity crisis of these families and the children resulting from these methods, and that future plans balance the socioeconomic pressures resulting from the use of these methods.

Purpose The present study was to investigate awareness and attitudes toward female fertility and aging, desire for a child and motherhood, and oocyte freezing for non-medical reasons among women candidates for Social Egg Freezing (SEF). Materials and Methods This was a cross-sectional study on all 216 women who sought oocyte cryopreservation for nonmedical reasons at Royan Institute. A 24-item self-administered questionnaire measured knowledge and attitudes to SEF. Responses were as yes/no or a 4-point Likert scale. Results Only 40% of participants accurately indicated that having a sexual partner does not help to preserve their fertility. A quarter of women correctly recalled chance of pregnancy with unprotected intercourse during a period of a year, for women 20 to 40 years old. Only one-third of respondents accurately identified the age-related fertility decline at 35–39 years. Only 6.9% correctly mentioned the low chance of pregnancy after egg freezing at 35 years old. Almost a third of women knew that the age range of 31–35 years is the right age to freeze an egg with the highest chance of pregnancy. Aging and health of offspring were most influential in women’s decisions on SEF. Conclusion In conclusion, there was significant gaps in knowledge about age-related fertility decline, and egg cryopreservation conditions and its complications. It is crucial to impart to these women a better knowledge about fertility and a realistic picture about SEF, especially on the number of high-quality retrieved mature oocytes and live birth rates depend on women's age.

Abstract Background Impaired fertility is one of the side effects of effective cancer therapy. Saving the potential or storing the material to enable people to have biological children after cancer treatment can be of high importance to many cancer survivors. Therefore, we designed a study to determine knowledge and attitudes to fertility preservation (FP) in adult cancer patients and the parents of patients with cancer. Participants who completed this survey were a convenience sample of 384 parents of cancer patients < 18 years and cancer patients ≥ 18 years from two large referral hospitals. A 25-item self-administered questionnaire measured knowledge and attitudes to FP. Responses were yes/no, or on a 4-point Likert scale (greatly, usually, rarely, never) scored from 1 for never to 4 for greatly. Results Most parents and most cancer patients were unaware of the FP methods of embryo cryopreservation (96.3% and 88.4%, respectively) and sperm cryopreservation (97.5% and 89.0%, respectively). Attitudes among cancer patients and parents to use of FP options, based on a 4-point Likert scale, were determined by financial cost, lack of access and information on FP options. Conclusion Of concern in this sample of Iranian adult cancer patients and their parents is that knowledge of the fertility risk associated with cancer therapy and knowledge of FP treatment options was generally poor, particularly among the parents. To enable cancer patients or their parents to make the best decisions about using FP services, oncologists and fertility specialists should discuss FP options during their consultation.

Introduction: Infertility could decrease the self-esteem of the infertile couples. Using the defensive style is one way to deal with stressful events. Therefore, the aim of this study was to investigate the role of self-esteem and defense mechanisms based on the cause of infertility. Methods: In this cross-sectional study, 400 infertile couples referred to infertility center in Tehran, Iran. Participates classified in 4 groups for the cause of infertility: female, male, both and unknown. Data gathering tools in this study were demographic questionnaire, Rosenberg Self-Esteem Scale and Defense Styles Questionnaire (DSQ). Data were analyzed (SPSS 18 software) using paired t-test for comparison between the groups according to the cause of infertility and using regression analyses tests. Results: The results of this study showed that men in female infertility group has significantly higher self –esteem than other groups (P

Background: Body Mass Index (BMI) and maternal age are related to various disorders of the female reproductive system. This study aimed to estimate the causal effects of BMI and maternal age on the rate of metaphase II oocytes (MII) using a new statistical method based on Bayesian LASSO and model averaging. Methods: This investigation was a historical cohort study and data were collected from women who underwent assisted reproductive treatments in Tehran, Iran during 2015 to 2018. Exclusion criteria were gestational surrogacy and donor oocyte. We used a new method based on Bayesian LASSO and model average to capture important confounders. Results: Overall, 536 cycles of 398 women were evaluated. BMI and Age had inverse relationships with the number of MII based on univariate analysis, but after adjusting the effects of other variables, there was just a significant association between age and the number of MII (adjusted incidence rate ratio (aIRR) of age =0.989, 95% CI: [0.979, 0.998], P=0.02). The results of causal inference based on the new presented method showed that the overall effects of age and BMI of all patients were significantly and inversely associated with the number of MII (both P

Background: The most common mental disorders in infertile patients are depression and anxiety. The four-itemPatient Health Questionnaire-4 (PHQ-4) is a widely used tool that consists of the PHQ-2 depression and GeneralizedAnxiety Disorder-2 (GAD-2) scales. Given that PHQ-4 has not been validated in infertile patients, this study aimed toexamine its reliability and validity in this population.Materials and Methods: Participants in this cross-sectional study consisted of 539 infertile patients from a referralfertility centre in Tehran, Iran. The PHQ-4, Hospital Anxiety and Depression Scale (HADS), World Health Organisation-Five Well-Being Index (WHO-5), Penn State Worry Questionnaire (PSWQ) and demographic/infertility questionnaireswere administered to all participants. Factor structure and internal consistency of PHQ-4 were evaluatedvia confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. The convergent validity of this scale wasexamined by its relationship with HADS, WHO-5 and PSWQ.Results: CFA results provided support for a two-factor model of PHQ-4. Internal consistency of the PHQ-4 and its subscalesboth were elevated with Cronbach’s alpha coefficients of 0.767 (PHQ-4), 0.780 (PHQ-2) and 0.814 (GAD-2). Inter-itemcorrelations were between 0.386 and 0.639, and corrected item-total correlations were between 0.576 and 0.687. PHQ-4,PHQ-2 and GAD-2 showed positive correlations with measures of HADS-anxiety, HADS-depression, and PSWQ and negativecorrelations with WHO-5, which confirmed convergent validity. Among demographic/fertility variables, we observedthat gender, infertility duration, and failure in previous treatment were correlated with PHQ-4 and its subscales scores.Conclusion: The PHQ-4 is a reliable and valid ultra-brief screening instrument for measuring both anxiety and depressivesymptoms in infertile patients.

Abstract Background Cognitive strategies play an important role in the prevention of psychological disorders. The aim of this study was to examine the relationships of cognitive emotion regulation with anxiety and depression symptoms in a sample of infertile women in Iran. Results According to correlation analysis, all adaptive strategies (i.e., acceptance, positive refocusing, refocus on planning, positive reappraisal, and putting into perspective), except for Acceptance strategy, were indirectly related to both anxiety and depression symptoms. Conversely, four maladaptive strategies (i.e., self-blame, rumination, catastrophizing, and other-blame) were positively related to anxiety and depression symptoms. After controlling for demographic/infertility information, hierarchical regression analyses indicated that acceptance, rumination, and positive refocusing subscales were significantly associated with anxiety; and refocus of planning was related to depression. Conclusion In sum, cognitive emotion regulation strategies appeared to be related to anxiety and depression symptoms in women suffering from infertility. These results suggest the use of cognitive therapy to reduce the anxiety and depression in these women.

Abstract Background The use of assisted reproductive technology (ART) is increasing worldwide, and observational studies have indicated that women who conceived by ART have an increased risk of pregnancy complications including gestational diabetes mellitus (GDM). We aimed to determine the risk of GDM among women who conceived with ART by systematic review and meta-analysis. Main text A systematic literature search was conducted in ISI Web of Knowledge, MEDLINE, Scopus, and Embase through May 2017 for English-language articles using a list of keywords. All studies comparing GDM in women conceived by ART and those who conceived spontaneously were included. Data extraction was performed by two authors independently and discrepancies were resolved by discussion. In total, 48 studies with 91,487 pregnancies conceived through ART and 2,525,234 spontaneously conceived met the inclusion criteria. There was evidence of substantial heterogeneity among these studies (P < 0.001, I 2 = 98.6%). Random effects meta-analysis showed a significant increase in GDM among those who conceived by ART compared with those who conceived spontaneously (pooled relative risk = 1.51, 95% confidence interval = 1.18–1.93). Visual inspection of the funnel plot did not reveal any publication bias, which was supported by Egger’s test and Begg’s test. Conclusion The findings of this systematic review indicate that the use of ART treatment is associated with a 1.51-fold increase in GDM. Women need to be counselled carefully before undergoing ART treatment about the possibility and risk of GDM.

Objective: To elucidate theoretically the safety and identity of mothers receiving egg and the process of becoming a mother. Methods: This study was conducted during 7 months from July 2018 to January 2019 by using a grounded theory approach. Infertile women at the gestational age who received oocyte were selected with purposive sampling method and then entered the study using theoretical sampling. Mothers who had not decided definitely to participate and had not started the treatment course yet were excluded from the study. The participating mothers were 28-44 years old with a mean age of (37.00±2.49) years. A total of 30 interviews were performed. Data were collected by unstructured deep interviews and field notes. The interview duration ranged between 19 to 74 min with a mean time of 40 min and they were performed individually. Results: Data analysis showed that “feeling of insecurity in personal and familial identity” formed in the context of “exposure to sociocultural constraints” was the main problem of mothers receiving donated oocyte. This led to a set of coping strategies as “gradual acceptance”, “attempts to maintain the marital life”, “sensitivity in selecting donor”, “sensitivity in fetal care”, “seeking information and consultation”, “challenging the internal restlessness”, and “treatment follow-up”, all indicating the concept of “protection of personal and familial identity” as the core variable. Conclusions: The challenge faced by Iranian mothers receiving donated oocyte in the constrained sociocultural context forms a multilateral and all-inclusive insecurity.

Abstract Background Infertility can have a powerful impact on marital quality. The Revised Dyadic Adjustment Scale (RDAS) is a widely used measure of marital quality. This scale has not been validated in infertile patients. Therefore, this study aimed to evaluate the reliability and validity of the RDAS in a sample of infertile patients. Methods The sample of this methodological study consisted of 254 infertile patients referring to a referral infertility clinic in Tehran, Iran. A battery of questionnaires was administered to the participants, including a demographic/fertility questionnaire, the RDAS, the Relationship Assessment Scale (RAS), the Kansas Marital Satisfaction Scale (KMSS), the Couples Satisfaction Index- 4 Item (CSI-4), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Stress Scale-4 Item (PSS-4). Internal consistency of the scale was assessed with Cronbach’s alpha, construct validity was investigated using confirmatory factor analysis (CFA), and convergent validity was examined by correlating the RDAS with RAS, KMSS, CSI-4, HADS, and PSS-4 instruments. Results The mean total RDAS score was 49.26 ± 9.34, and 100 patients (39.4%) had marital distress based on the cut-off value of

Abstract Background The 6-item Female Sexual Function Index (FSFI) is a short form of the original 19-item FSFI that measures sexual function in women. The aim of this study was to examine the factor structure and reliability of the FSFI-6 and to determine the demographic correlates of sexual dysfunction among infertile women in Iran. Results In total, 250 infertile women participated in this study. The mean total FSFI-6 score was 20.71 ± 5.09. Internal consistency of the FSFI-6 was high (Cronbach’s alpha = 0.856). All inter-item correlations and item-total correlations were in acceptable range. The results of confirmatory factor analysis provided support for a unidimensional model of the FSFI-6. Among demographic and infertility variables, higher women’s age, low education, unwanted marriage, short infertility duration, and low frequency of intercourse were associated with sexual dysfunction. Conclusions The FSFI-6 demonstrated sound reliability and validity in this study, supporting its continued use for measuring sexual disfunction among infertile women. Its brevity and comprehensiveness allow a quick assessment both in clinical and research settings.

Abstract Background Studies on relationship between tubal ligation and endometrial cancer have led to contradictory findings. In several studies, however, a reduced endometrial cancer risk was suggested following tubal ligation. Therefore, a systematic review and meta-analysis was conducted to examine the relationship between tubal ligation and endometrial cancer risk. Methods In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar were searched for relevant studies published up to May 30th, 2018. We compared endometrial cancer risk in women with and without tubal ligation in retrieved studies. Results Two hundred nine studies were initially retrieved from the data bases. After exclusion of duplicates and studies which did not meet inclusion criteria, ten cohort and case-control studies, including 6,773,066 cases, were entered into the quantitative meta-analysis. There was 0.90% agreement between two researchers who searched and retrieved the studies. The summary OR (SOR) was reported using a random effect model. Begg’s test suggested that there was no publication bias, but a considerable heterogeneity was observed (I2 = 95.4%, P = 0.001). We pooled the raw number of tables cells (i.e. a, b, c, and d) of eight studies. The SOR suggested that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.577, 95% CI = 0.420–0.792). Also, given the rare nature of endometrial cancer (

Abstract Objective The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) is a widely used instrument that measures breastfeeding self-efficacy. This study aimed to examine the reliability and validity of the Persian version of BSES-SF in Iranian mothers. Results The English version of BSES-SF was translated into Persian using the standard forward–backward translation procedure. No changes (i.e., neither delete nor rephrase the items) were made to the BSES-SF items. The mean BSES-SF total score was 50.80 ± 8.91. The Cronbach’s alpha coefficient for internal consistency for the BSES-SF was 0.910. The confirmatory factor analysis results provided evidence for unidimensionality of the scale (χ2/df = 4.42; CFI = 0.96; NFI = 0.95; IFI = 0.96; RMSEA = 0.095 and SRMR = 0.054). The divergent validity of the BSES-SF was proved via a significant negative correlation with scores of the Edinburgh Postnatal Depression Scale (r = − 0.273, P

Abstract Background Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility. Methods In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7. Results The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms. Conclusion Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.

Abstract Objective Infertility can have a considerable effect on a person’s marital satisfaction. The Quality of Marriage Index (QMI) is a self-report inventory to measure global perceptions of marital satisfaction. The current study examined the reliability and validity of the Persian language version of QMI in a sample of infertile patients. Results The mean QMI total score was 36.54 ± 6.87. The internal consistency of the scale was good, with a Cronbach’s alpha of 0.922. All inter-item correlations and item-total correlations were also in acceptable range. The confirmatory factor analysis results provided evidence for unidimensionality of the scale (χ2/df = 3.10; GFI = 0.97; CFI = 0.99; NFI = 0.99; RMSEA = 0.091 and SRMR = 0.020). The convergent validity of the QMI was demonstrated via significant correlations with measures of the Relationship Assessment Scale, Kansas Marital Satisfaction Scale, and Couples Satisfaction Index-4 Item. These correlations also tended to be larger than correlations with measures of Hospital Anxiety and Depression Scale and Perceived Stress Scale-4 Item. Among demographic/fertility variables, only infertility duration was negatively correlated to QMI scores. In sum, the QMI is a reliable and valid brief inventory for measuring overall marital satisfaction in infertile patients. Trial registration This was a cross-sectional study (NOT clinical trial); thus, the trail registration number is not required for the present study

Abstract Objective Women undergoing assisted reproductive technology treatment, are often anxious and depressed because of their fertility problem and the uncertainties of the treatment with which they have to deal. On the other hand, recent studies have shown that the effects of psychological distress on the IVF treatment outcome is unclear. This study aimed to examine the effects of anxiety, depression, and stress symptoms before IVF treatment on the clinical pregnancy rate, controlling for known confounders. Results In total, 142 women undergoing IVF treatment participated in this prospective study. The clinical pregnancy rate was 26.8% in this study. Controlling for age, infertility duration, and cause of infertility, there were no relationship between IVF outcome and anxiety (relative risk (RR) = 1.00; 95% CI 0.91–1.09), depression (RR = 0.96; 95% CI 0.88–1.05), and stress (RR = 1.01; 95% CI 0.96–1.07) symptoms. High woman’s age and women with both cause of infertility were independent predictors of IVF clinical pregnancy rate. In sum, we found that anxiety, depression, and stress symptoms were not associated with the IVF clinical pregnancy rate.

Abstract Background The objective of this systematic review and meta-analyses was to assess the risk of preeclampsia among women who conceived with assisted reproductive technology (ART). Methods We searched the ISI Web of Knowledge, Medline/PubMed, Scopus, and Embase (from inception to May 2017) for English language articles using a list of key words. In addition, reference lists from identified studies and relevant review articles were also searched. Data extraction was performed by two authors, and the study quality was assessed using the Newcastle–Ottawa Scale. Random-effects model meta-analysis was applied to pool the relative risks (RR) across studies. Results A total of 48 studies (5 case-control studies and 43 cohort studies) were included in this meta-analysis. The Cochran Q test and I2 statistics revealed substantial heterogeneity (Q = 26,313.92, d.f. = 47, p

Background Infertility, one of life’s great stressors, may adversely affect marital satisfaction. No studies have in- vestigated the relationship between perceived stress and marital satisfaction at the dyadic level. The current study assessed the actor and partner effects of perceived stress on marital satisfaction in husband-wife dyads using an in- novative dyadic analysis approach, the Actor-Partner Interdependence Model (APIM). Materials and Methods In this cross-sectional study, we recruited a total of 141 infertile couples. Marital satisfac- tion and stress were assessed using the ENRICH Marital Satisfaction Scale (EMS Scale) and Perceived Stress Scale-4 Item (PSS-4), respectively. Dyadic data have been analysed by the APIM approach, with distinguishable dyads. In this approach, actor effect is the impact of a person᾽s perceived stress on his/her own marital satisfaction. Partner effect is the impact of a person's perceived stress on the partner᾽s marital satisfaction. Results Both men and women’s perceived stress exhibited an actor effect on their marital satisfaction (β=-0.312, P < 0.001, β=-0.405, P < 0.001, respectively). Women’s perceived stress had a negative relationship to the marital satis- faction of their partner (β=-0.174, P=0.040). Although the partner effect of men’s perceived stress on woman’s marital satisfaction was not significant (β=-0.138, P=0.096), women whose husbands had higher levels of stress were more likely to have poorer marital satisfaction. Both actor and partner effects of perceived stress on marital satisfaction were similar among men and their wives. Conclusion The findings of this study have highlighted that marital satisfaction in patients with infertility was in- fluenced by not only their own perceived stress, but also their spouses’ perceived stresses. Therefore, psychological interventions that target a reduction in perceived stress and enhancement of marital satisfaction in the context of infer- tility should treat the couple as a unit.

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Background and Objective: People that undergo assisted infertility treatments experience more sleep problems. Alt-hough Pittsburgh Sleep Quality Index (PSQI) frequently has been used as a sleep quality assessment scale in different clinical and non-clinical settings, different sample characteristics may account for different structures. The current study aimed to evaluate the factor structure of PSQI among women seeking infertility treatment in Iran. Materials and Methods: Using a convenience sampling method, 157 infertile women or women whose husbands had infertility problems were included in a cross-sectional study in Royan Institute, a main referral infertility center in Teh-ran, Iran. The factor structure of PSQI was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results: The Cronbach’s alpha coefficient for PSQI was 0.65. A two-factor model was extracted by EFA; 56% of the total variance was accounted for by this model. The results of CFA indicated that extracted model obtained acceptable fit statistics [comparative fit index (CFI) = 0.942, standardized root mean square residual (SRMR) = 0.042, root mean square error of approximation (RMSEA) = 0.128, χ2 = 19.8, degree of freedom (df) = 12, P = 0.071] compared to other original single-factor or 3-factor models. Conclusion: Our results revealed the limited usefulness of single-factor structure of PSQI. A two-factor model of Per-sian version of PSQI should be used to assess sleep problems among women seeking assisted infertility treatments.

Infertile women are at a higher risk of sexual dysfunction compared to fertile women. Infertility is a major source of stress, anxiety, and depression, which strongly affects sexual health. The aim of this study is to estimate the prevalence of female sexual dysfunction (FSD) among infertile Iranian women. We searched the main international databases (Web of Science, PubMed, Medline, and Scopus) and national databases (Scientific Information Database, Magiran, and IranMedex) from their inception until April, 2017. Due to heterogeneity between the studies, the extracted data were pooled using a random-effects model by Stata software. Out of 313 retrieved studies, we included 18 studies of 3419 infertile women in the meta-analysis. The pooled prevalence of FSD was 64.3% [95% confidence interval (CI): 53.3-75.3]. Our findings revealed that sexual desire (59.9%, 95% CI: 38.7-81.2) was the most prevalent disorder and vaginismus (19.2%, 95% CI: 11.3-27.2) was the least prevalent among infertile women. The results of our meta- analysis suggested that more than 64% of infertile Iranian women reported sexual dysfunction, which was meaning- fully high. This study also showed that sexual desire was significantly more common than other sexual dysfunction dimensions and the prevalence of vaginismus was the least common.

Background and objective: Generalized anxiety disorder (GAD) is common in people with infertility problems, but no studies have examined the reliability and validity of measures of GAD among these patients. Thus, this study aimed to evaluate the psychometric properties of the Persian Version of the GAD-7 in people with infertility. Methods: In a cross-sectional study, the GAD-7, the HADS (Hospital Anxiety and Depression Scale) and the PSWQ (Penn State Worry Questionnaire) were administered to 539 Iranian men and women with infertility problems in 2017. Internal consistency of the GAD-7 was assessed with Cronbach’s alpha, construct validity was evaluated via confirmatory factor analysis (CFA), and convergent validity was examined by correlating the GAD-7 with HADS and PSWQ scores. Results: The mean total GAD-7 score was 7.37 ± 5.40, and 178 patients (33.0%) had scores of 10 or higher, suggesting moderate or high GAD. The results of CFA confirmed the unidimensional factor structure of the GAD-7 (χ2/df = 3.48; CFI = 0.99; GFI = 0.97; RMSEA = 0.068 and SRMR = 0.031). The internal consistency of the scale was good, with a Cronbach’s alpha of 0.876. All corrected item-total correlations and inter-item correlations were in acceptable range. The GAD-7 showed a moderate to strong correlation with the anxiety (r = 0.782) and depression (r = 0.524) subscales of the HADS, and with the PSWQ (r = 0.605), confirming convergent validity. Conclusion: The GAD-7 demonstrated satisfactory reliability and validity; these results support its use to measure GAD in people with infertility problems. Keywords: GAD-7, Generalized anxiety disorder, Reliability, Validity, Infertility

Background and objective: Polycystic ovary syndrome (PCOS), as a major hormonal issue among reproductive age women, is categorized into four phenotypes regarding hyperandrogenism, oligo-anovulation and polycystic ovary morphology. This study aims to compare and predict the phenotypes based on metabolic and hormonal parameters. Methods: This cross-sectional study was conducted using clinical, hormonal, and ultrasound information of PCOS women referred to a major referral infertility center in Tehran between January 2014 and April 2017. Based on the Rotterdam Consensus of 2003 criterion, the phenotypes were defined as A: presence of olig-anovulation, hyperandrogenism, polycystic ovary morphology; B: presence of olig-anovulation and hyperandrogenism; C: presence of hyperandrogenism and polycystic ovary morphology; and D: presence of olig-anovulation and polycystic ovary morphology. Results: Among of 635 patients, 372 (58.6%) were A, 28 (4.4%) were B, 34 (5.4%) were C, and 201 (31.7%) were D phenotypes of PCOS. Higher prolactin increases the odds of phenotype C than A, and higher anti-mullerian hormone increases the odds of phenotype A than B (OR = 1.22) and C (OR = 1.19). Older patients are more prone to be in phenotype D than A. Patients with higher mean serum glutamate-pyruvate transaminase has 0.03 more odds of phenotype B than A. History of abortion was associated with more likelihood of phenotype A than D. The receiver operating characteristic curve found a cut-off point of 7.15 for anti-mullerian hormone regarding morphology (area under curve = 0.66). Conclusion: This study showed that PRL, AMH, Age, SGPT, and history of abortion are affecting factors for distinguishing the phenotypes of PCOS. Keywords: Polycystic ovary syndrome, Phenotype, Hyperandrogenism, Anovulation, Morphology, Logistic regression

Abstract Background Attention to additional factors affecting the success of assisted reproduction techniques (ARTs) is very important and with appropriate interventions in some of these factors, success rate can be as high as improve a lot. There is a lot of evidence that lifestyle factors can influence on ARTs outcomes. Current knowledge of the effect of combined effect of several lifestyle factors on the outcomes of ARTs is low and contradictory. The importance of the causality of this phenomenon is felt by the pandemic of inappropriate lifestyle as well as the dramatic increase in infertility in the world. The aim of this cohort study is to scrutinize the casual effect of a specific range of contemporary lifestyle factors on ARTs outcomes. Methods A prospective cohort study will be conducted in Royan institute, Tehran, Iran. Each infertile couple will be monitored from the first visit to the end of treatment cycle. The data will be collected electronically and include the following: detailed interview about lifestyle and socioeconomic status, past medical history, general physical examination, assessment of menstrual and ovulatory status, assessment of tuboperitoneal, assessment of uterine, assessment of cervix, urogenital examination, semen analysis, anti-sperm antibodies, biochemical analysis, sperm-cervical mucus contact test, in vitro cervical mucus penetration test and sperm functional assays. To estimate the casual effect of lifestyle variables on clinical pregnancy and live birth, the obtained propensity score (PS) from generalized boosted models (GBM) will be matched between couple with and without live birth. Discussion This is the first study to prospectively obtain detailed information on causes of ARTs success. Determining the casual effect of lifestyle variables on ARTs success will be important to inform strategies most likely to increase the success rates in ARTs.

Background and objective: Infertility is a global public health concern and affects marital satisfaction. The Relationship Assessment Scale (RAS) is a short 7-item self-report inventory designed to measure relationship satisfaction. The objective of this study was to examine the psychometric properties of the RAS in Iranian infertile people. Methods: The study sample consist of 254 infertile peoples drawn from a referral infertility treatment center in Tehran, Iran between February and May 2017. A battery of measures was used including the RAS, Couples Satisfaction Index (CSI-4), Kansas Marital Satisfaction Scale (KMSS), the Hospital Anxiety and Depression Scale (HADS), and a demographic/clinical information. Tests of data quality included descriptive statistics of the data, internal reliability consistency, inter-item correlations, corrected item total correlations, confirmatory factor analysis (CFA), and convergent validity. Results: The mean total RAS score was 29.46 ± 4.98. The internal consistency of the RAS was high (Cronbach’s alpha = 0.828). All inter-item correlations and item-total correlations were in acceptable range. The CFA results provided support for the unidimensionality of the scale (χ2/df = 2.39; CFI = 0.98; RMSEA = 0.074 and SRMR = 0.038). The RAS score was significantly correlated with CSI-4, KMSS, HADS-anxiety and HADS-depression, demonstrating convergent validity. Among demographic/clinical variables, only infertility duration was significantly correlated with RAS scores. Conclusion: The RAS appear valid and reliable for assessing global relationship satisfaction among people experiencing infertility problem in Iran. It can also be used as brief and easy to administer inventory for assessment of relationship satisfaction in large sample survey research. Keywords: Relationship Assessment Scale, Relationship satisfaction, Psychometric properties, Infertility, Iran

Background and objective: Few studies have evaluated marital satisfaction and social support in infertile women with polycystic ovary syndrome (PCOS). The aim of this study was to assess and compare marital satisfaction and social support among infertile women with and without PCOS. Methods: This case-control study was performed at the Royan Institute, a referral fertility center, in Tehran, Iran between July and September 2015. A total of 150 infertile women with PCOS were compared with 150 infertile women without PCOS. Marital satisfaction and social support were assessed using the ENRICH marital satisfaction scale and the Multidimensional Scale of Perceived Social Support (MSPSS), respectively. Results: The results showed that there is no significant difference between infertile women with or without PCOS in terms of marital satisfaction and social support (p > 0.05). Conclusion: According to these results, although PCOS may have negative effects in different aspects of suffering people, it cannot singly reduce social support and marital satisfaction among infertile women; and infertility can be more important than PCOS for infertile women. Keywords: Marital satisfaction, Social support, Infertility, Polycystic ovary syndrome

Background and Objective: Depression is one of the most common psychiatric disorders among infertile patients. We aimed to determine the prevalence of depression in infertile patients and to identify demographic and fertility characteristics associated with this disorder. Methods: In this cross-sectional study, a random sample of 1506 people with infertility from a referral infertility center in Tehran, Iran were invited to participate. We collected data between May and October 2017. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9). The relationships between depression and demographic/fertility characteristics were explored using simple and multiple logistic regression with odds ratio (OR) and 95% confidence interval (CI). Results: The mean total PHQ-9 score was 7.05 (SD = 6.03). Using a cut-off value of 10, the prevalence of depression was 30.5%. Depression was significantly associated with being female (OR = 2.71, 95% CI = 2.10–3.50), long infertility duration (OR = 1.04, 95% CI = 1.01–1.08), failure in previous treatment (OR = 1.41, 95% CI = 1.10–1.81), and self-cause of infertility compared to partner-cause of infertility (OR = 1.41, 95% CI = 1.03–1.92). Conclusion: The prevalence of depression in this study was considerably higher than general population estimates. This disorder was more prevalent in women, patient with long infertility duration, treatment failure, and self-cause of infertility. These findings deserve significant attention in health care planning and programs for this population. Keywords: Depression, Infertility, Prevalence, PHQ-9, Iran

Background and objective: Infertility is a low control stressor with negative psychological consequences. The 10-item Perceived Stress Scale (PSS-10) is one of the most frequently used instrument to measure perceived stress. The aim of this study was to examine the psychometric properties of the PSS-10 in Iranian infertile women. Methods: This cross-sectional study included 240 infertile women in a referral fertility center in Tehran, Iran between February 2017 and March 2017. The PSS-10 and the Hospital Anxiety and Depression Scale (HADS) were administrated to all participants. Confirmatory factor analysis (CFA) was used to evaluate the factor structure of the PSS-10. Cronbach’s alpha was used to evaluate internal consistency reliability, and Pearson correlations were used to examine convergent validity with HADS subscales. Results: The CFA result indicated an acceptable fit of the data to the two-factor model (Perceived Helplessness and Perceived Self-Efficacy factors) of PSS-10 (χ2/df = 2.58, CFI = 0.96; RMSEA = 0.081 and SRMR = 0.061). Internal consistency of the scale and subscale scores was good. The PSS-10 and its subscales were significantly correlated with anxiety and depression (all Ps

Abstract Background Dyadic data analysis (DDA) is increasingly being used to better understand, analyze and model intra- and inter-personal mechanisms of health in various types of dyads such as husband-wife, caregiver-patient, doctor-patient, and parent-child. A key strength of the DDA is its flexibility to take the nonindependence available in the dyads into account. In this article, we illustrate the value of using DDA to examine how anxiety is associated with marital satisfaction in infertile couples. Methods This cross-sectional study included 141 infertile couples from a referral infertility clinic in Tehran, Iran between February and May 2017. Anxiety and marital satisfaction were measured by the anxiety subscale of the Hospital Anxiety and Depression Scale and 10-Item ENRICH Marital Satisfaction Scale, respectively. We apply and compare tree different dyadic models to explore the effect of anxiety on marital satisfaction, including the Actor-Partner Interdependence Model (APIM), Mutual Influence Model (MIM), and Common Fate Model (CFM). Results This study demonstrated a practical application of the dyadic models. These dyadic models provide results that appear to give different interpretations of the data. The APIM analysis revealed that both men’s and women’s anxiety excreted an actor effect on their own marital satisfaction. In addition, women’s anxiety exerted a significant partner effect on their husbands’ marital satisfaction. In MIM analysis, in addition to significant actor effects of anxiety on marital satisfaction, women’s reports of marital satisfaction significantly predicted men’s marital satisfaction. The CFM analysis revealed that higher couple anxiety scores predicted lower couple marital satisfaction scores. Conclusion In sum, the study highlights the usefulness of DDA to explore and test the phenomena with inherently dyadic nature. With regard to our empirical data, the findings confirmed that marital satisfaction was influenced by anxiety in infertile couples at both individual and dyadic level; thus, interventions to improve marital satisfaction should include both men and women. In addition, future studies should consider using DDA when dyadic data are available.

Abstract Background Much evidence consistent with the Marital Discord Model of Depression (MDMD) suggests that marital discord is associated with depression, but no studies examine the relationship between marital satisfaction and depression at the dyadic level in infertile couples. This study examined the effect of actors’ and partners’ marital satisfaction on depressive symptoms in husband-wife dyads with infertility using an innovative dyadic analysis approach, the Actor–Partner Interdependence Model (APIM). Methods In this cross-sectional study, the sample comprised of 141 infertile couples in the evaluation phase of treatment. We collected data in a referral infertility center in Tehran, Iran between February and May 2017. Marital satisfaction and depression were measured using ENRICH marital satisfaction scale and Hospital Anxiety and Depression Scale, respectively, before starting the treatment. Dyadic analysis applying the APIM was used. In this study, actor effect is the impact of a person’s marital satisfaction on his/her own depression. Partner effect is the impact of a person’s marital satisfaction on his/her partner’s depression. Results The APIM analysis revealed that both men and women’s marital satisfaction excreted an actor effect on their own depression (β = − 0.412, P

Background Many infertile couples experience psychological distress and suffer from impaired quality of life. Gen- erally, when couples are dealing with uncontrolled events such as infertility, it is important to manage it well and to use the suitable coping style; so this can represent an example of attribution style. The purpose of this study is to investigate the quality of life, relationship beliefs and attribution style in infertile couples. Materials and Methods This cross-sectional study consisted of 50 infertile couples, who were at least 18 years of age and could read and write in Persian. Participants provided demographic and general characteristics and completed the quality of life (SF-12), relationship belief inventory (RBI) and attribution style (ASQ) forms. Data was analyzed by the paired t test, Pearson correlation tests and multiple linear regression analysis, using SPSS version 22 statistical software. Results Overall, 50 infertile couples participated in our study. The males had a significantly higher score for quality of life compared to the females (P=0.019). In RBI subscales except “Disagreement is Destructive” all others signifi- cantly higher in wives than husbands. All subscales of RBI had a negative correlation with the quality of life. The quality of life had a significant correlation with positive internal (r=0.213, P=0.033). The adjusted regression model showed that the quality of life for males was higher than in females (β=-3.098, P=0.024). Conclusion The current data indicate that in infertile couples, the husbands have a higher quality of life in comparison to their wives. Also, all subscales of relationship beliefs have a negative correlation with the quality of life, but in at- tribution style, just internal attribution style for positive events is associated with the quality of life. In general, there is a correlation between relationship beliefs and the quality of life in infertile couples.

Objective Stem cells that have unlimited proliferation potential as well as differentiation potency are considered to be a promising future treatment method for incurable diseases. The aim of the present study is to evaluate the future trend of stem cell researches from researchers’ viewpoints. Materials and Methods This was a cross-sectional descriptive study on researchers involved in stem cell research at Royan Institute. We designed a questionnaire using a qualitative study based on expert opinion and a literature review. Content validity was performed using three rounds of the Delphi method with experts. Face validity was undertaken by a Persian literature expert and a graphics designer. The questionnaire was distributed among 150 researchers involved in stem cell studies in Royan Institute biology laboratories. Results We collected 138 completed questionnaires. The mean age of participants was 31.13 ± 5.8 years; most (60.9%) were females. Participants (76.1%) considered the budget to be the most important issue in stem cell research, 79.7% needed financial support from the government, and 77.5% felt that charities could contribute substantially to stem cell research. A total of 90.6% of participants stated that stem cells should lead to commercial usage which could support future researches (86.2%). The aim of stem cell research was stipulated as increasing health status of the society according to 92.8% of the participants. At present, among cell types, importance was attached to cord blood and adult stem cells. Researchers emphasized the importance of mesenchymal stem cells (MSCs) rather than hematopoietic stem cells (HSCs, 57.73%). The prime priorities were given to cancer so that stem cell research could be directed to sphere stem cell research whereas the least preference was given to skin research. Conclusion Regenerative medicine is considered the future of stem cell research with emphasis on application of these cells, especially in cancer treatment.

Abstract Background Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders among infertile patients. This study aimed to determine the prevalence of GAD and its associated factors among infertile patients in Tehran, Iran. Methods This cross-sectional study included 1146 infertile patients in a referral fertility center in Tehran, Iran between May and October 2017. GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. The associations between GAD and demographic/fertility characteristics were estimated using simple and multiple logistic regression with odds ratio (OR) and 95% confidence interval (CI). Results The mean total GAD-7 score was 6.61 (SD = 5.32). Using a cut-off value of 10, the prevalence of GAD was 28.3%. In adjusted analysis, female sex (OR = 2.54, 95% CI = 1.88–3.42, P

Background and objective: Infertility is a global public health issue and may adversely influence marital quality. The Kansas Marital Satisfaction Scale (KMSS) is a quick, easy to administer and score, 3-item scale measuring marital quality. The aim of this study was to evaluate the psychometric properties of the KMSS in Iranian infertile people. Materials and methods: The research sample consist of 254 infertile people drawn from a referral fertility clinic in Tehran, Iran from February to May 2017. The participants were administered the KMSS, Couples Satisfaction Index (CSI-4), the Hospital Anxiety and Depression Scale (HADS), and a demographic questionnaire. Tests of data quality included descriptive statistics of the data, internal reliability consistency, inter-item correlations, corrected item total correlations, confirmatory factor analysis (CFA), and convergent validity. Results: The mean total KMSS score was 17.73 ± 3.02. The Cronbach’s alpha coefficient for KMSS was 0.901. All corrected item-total correlations and inter-item correlations were in acceptable range. Based on CFA result, the one-factor model was fully saturated, and all three factor loadings were significant and in the expected direction. The KMSS significantly correlated with CSI-4, HADS-anxiety and HADS-depression, indicating an acceptable convergent validity. Conclusion: In summary, the present study provides further evidence that the KMSS is psychometrically sound and therefore it can be recommended for further use by researchers interested in the context of marital quality. Keywords: Kansas Marital Satisfaction Scale, Marital quality, Psychometric properties, Infertility

Abstract Background There are several studies regarding the predictors or risk factors of unintended pregnancy, but only a small number of studies have been carried out concerning the socio-economic factors influencing the unintended pregnancy rate. This study aimed to determine the socioeconomic inequality of unintended pregnancy in Tehran, Iran, as a developing country. Methods In this hospital based cross-sectional study, 5152 deliveries from 103 hospitals in Tehran (the capital of Iran) were included in the analysis in July 2015. Socioeconomic status (SES) was measured through an asset-based method and principal component analysis was carried out to calculate the household SES. The concentration index and curve was used to measure SES inequality in unintended pregnancy, and then decomposed into its determinants. The data was analyzed by statistical Stata software. Results The Wagstaff normalized concentration index of unintended pregnancy (− 0.108 (95% Confidence Interval (CI) = − 0.119 ~ − 0.054)) endorses that unintended pregnancy is more concentrated among poorer mothers. The results showed that SES accounted for 27% of unintended pregnancy inequality, followed by the mother’s nationality (19%), father’s age (16%), mother’s age (10%), father’s education level (7%) and Body Mass Index (BMI) groups (5%). Conclusion Unintended pregnancy is unequally distributed among Iranian women and is more concentrated among poor women. Economic status had the most positive contribution, explaining 27% of inequality in unintended pregnancy.

Abstract Background Infertility can cause psychological distress and has a negative impact on quality of life (QoL). There have been no studies investigating the effect of depression on QoL in infertile couples at the dyadic level. This study aimed to investigate the effects of actors’ and partners’ depression on QoL in male-female dyads experiencing infertility using an innovative dyadic analysis approach, the Actor–Partner Interdependence Model (APIM). Methods We conducted this cross-sectional study on 180 infertile couples in Tehran, Iran, during August-September 2017. Quality of life and depression were assessed using Fertility Quality of Life and Patient Health Questionnaire-9, respectively. Dyadic data were analyzed by the APIM approach. In this method, actor effect is the impact of a person’s depression on his/her own QoL. Partner effect is the impact of a person’s depression on his/her partner’s QoL. Results Results from APIM revealed that both males and females’ depression exuded an actor effect on their own QoL (β = − 0.589, p

Objectives Over the past few decades, the prevalence of cesarean sections (CS) have risen dramatically worldwide, particularly in Iran. The aim of this study was to determine the prevalence of CS in Tehran, and to examine the associated risk factors. Methods A cross-sectional study of 4,308 pregnant women with singleton live-births in Tehran, Iran, between July 6–21, 2015 was performed. Multilevel logistic regression analysis was performed using demographic and obstetrical variables at the first level, and hospitals as a variable at the second level. Results The incidence of CS was 72.0%. Multivariate analysis showed a significant relationship between CS and the mother’s age, socioeconomic status, body mass index, parity, type of pregnancy, preeclampsia, infant height, and baby’s head circumference. The intra-class correlation using the second level variable, the hospital was 0.292, indicating approximately 29.2% of the total variation in the response variable accounted for by the hospital. Conclusion The incidence of CS was substantially higher than other countries. Therefore, educational and psychological interventions are necessary to reduce CS rates amongst pregnant Iranian women.

Background Polycystic ovary syndrome (PCOS) is a frequent condition in reproductive age women with a prevalence rate of 5-10%. This study intends to determine the relationship between PCOS and the outcome of assisted reproductive treatment (ART) in Tehran, Iran. Materials and Methods In this historical cohort study, we included 996 infertile women who referred to Royan Institute (Tehran, Iran) between January 2012 and December 2013. PCOS, as the main variable, and other potential confounder variables were gathered. Modified Poisson Regression was used for data analysis. Stata software, version 13 was used for all statistical analyses. Results Unadjusted analysis showed a significantly lower risk for failure in PCOS cases compared to cases without PCOS [risk ratio (RR): 0.79, 95% confidence intervals (CI): 0.66-0.95, P=0.014]. After adjusting for the confounder variables, there was no difference between risk of non-pregnancy in women with and without PCOS (RR: 0.87, 95% CI: 0.72-1.05, P=0.15). Significant predictors of the ART outcome included the treatment protocol type, numbers of embryos transferred (grades A and AB), numbers of injected ampules, and age. Conclusion The results obtained from this model showed no difference between patients with and without PCOS ac- cording to the risk for non-pregnancy. Therefore, other factors might affect conception in PCOS patients.

Background: In recent years, the prevalence of Cesarean section (CS) has risen significantly worldwide, especially in Iran. The aim of this study was to determine the prevalence of Cesarean section among primipars, and identify related factors in Tehran province. Methods: This cross-sectional study was conducted on 2120 primipars who gave singleton birth in Tehran province from 6 to 21 July 2015. Data were collected by a researcher-made questionnaire through interview with mothers and review of their medical records. To identify factor associated with Cesarean section, logistic regression model was used. Findings: The prevalence of Cesarean section was 72.1%. In univariate analysis, higher maternal age, parents’ educational level, economic status, body mass index, fetal head circumference, preeclampsia, and use of assisted reproductive technology were associated with Cesarean section. Moreover, multivariate analysis showed a significant relationship between Cesarean section with mother’s age, economic status, and body mass index and also with fetal head circumference. Conclusion: The prevalence of Cesarean section is very high in Tehran province. Factors such as mother’s age, socioeconomic status, and body mass index, and fetal head circumference were related to Cesarean section. Moreover, there is a critical need to improve the education, quality of natural delivery services, and providing psychological interventions to reduce the Cesarean section rate and its adverse outcomes.

Background: Infertility and its treatments have a negative impact on a person’s well-being. Purpose: This study aimed to determine the prevalence of poor well-being and associated factors among infertile people, in Tehran, Iran. Methods: This cross-sectional study included 539 people with infertility in a referral fertility clinic in Tehran, Iran from May to August 2017. Psychological well-being was measured using the WHO-5 Well-Being Index. To identify factor associated with poor well-being, logistic regression model was used. Results: The mean total WHO-5 score was 53.70 ± 23.45. Using a cut-off value of 50, the prevalence of poor well-being was 44.3%. In multiple logistic regression analysis, female sex, low educational level, treatment failure, and both/unknown cause of infertility were significantly associated with poor well-being. Conclusions: The prevalence of poor well-being is relatively high in infertile people, especially in female, low educated, patients having treatment failure and patients with both/unknown cause of infertility. Keywords: Well-Being, Infertility, Prevalence, Iran

Background: Infertility is a public health problem and can lead to depressive symptoms. In recent years, the WHO-five Well-being Index (WHO-5) has been used as a screening measure for depression, but study on psychometric properties in people with infertility is scarce. The objective of this study was to examine the reliability and validity of the Persian version of the WHO-5 in people with infertility. Methods: Overall, 539 infertile patients from a referral infertility center in Tehran, Iran in the period between May and Aug 2017, completed the WHO-5, along with other psychological measures: the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). Construct validity and internal consistency of WHO-5 were evaluated using confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was examined by relationship with PHQ-9 and HADS. Results: The prevalence of poor well-being was 44.3% and that of depression was 18.6%. CFA confirmed the unidimensional factor structure of the WHO-5. Internal consistency of the WHO-5 was good (Cronbach’s alpha=0.858). The WHO-5 significantly correlated with the PHQ-9 (r=-0.522), HADS-anxiety (r=-0.524) and HADS-depression (r=-0.630), confirming convergent validity. Conclusion: The WHO-5 is a short and easy to use questionnaire with satisfactory reliability and validity that appears suitable for use as a screening test for depressive symptom in infertile people. In addition, the prevalence of depression and poor well-being was very high in this population.

چکیده مقدمه: ماکروزومی، یک عامل خطر برای پیامدهای نامطلوب زایمانی است. هدف از انجام پژوهش حاضر، تعیین میزان ماکروزومی در تولدهای تک ‌قلویی زنده و عوامل مرتبط با آن در زایشگاه‌های استان تهران بود. روش‌ها: این مطالعه‌ی مقطعی بر روی 4342 زن باردار با زایمان تک ‌قلویی زنده مراجعه ‌کننده به زایشگاه‌های استان تهران طی 30-15 تیرماه 1394 انجام شد. داده‌ها با استفاده از چک‌ لیست محقق‌ساخته و از طریق مصاحبه با مادران و بررسی پرونده‌ی آنان در اتاق زایمان جمع‌آوری شد. به‌ منظور بررسی عوامل مرتبط با ماکروزومی، از مدل Logistic regression استفاده گردید. یافته‌ها: میزان ماکروزومی در این مطالعه، برابر با 4/3 درصد بود. نتایج تحلیل تک‌ متغیره نشان داد که سن بالا، قد بلند و نمایه‌ی توده‌ی بدنی بالای مادر، سن حاملگی بیشتر، مرتبه‌ی تولد بزرگ‌تر و جنسیت پسر نوزاد با ماکروزومی ارتباط دارد (050/0 > P). در تحلیل چند متغیره، قد و نمایه‌ی توده‌ی بدنی مادر، سن حاملگی، مرتبه‌ی تولد و جنسیت پسر، بر تولد نوزاد ماکروزوم اثر معنی‌داری داشتند (050/0 > P). نتیجه‌گیری: عواملی مانند سن، قد و نمایه‌ی توده‌ی بدنی مادر، سن حاملگی، مرتبه‌ی تولد و جنسیت نوزاد در افزایش تولد نوزاد ماکروزوم نقش دارند. توجه به این عوامل، می‌تواند در شناسایی نوزادان پرخطر و کاهش عوارض مادری- نوزادی ناشی از ماکروزومی ﻣﺆثر باشد.

Background: Over the last few decades, Cesarean section (CS) rates have increased significantly worldwide particularly in Iran. Classification methods including logistic regression (LR), random forest (RF) and artificial neural network (ANN) were used to identify factors related to CS among primipars. Methods: This cross-sectional study included 2120 primipars who gave singleton birth in Tehran, Iran between 6 and 21 July 2015. To identify factor associated with CS, the classification methods were compared in terms of sensitivity, specificity, and accuracy. Results: The CS rate was 72.1%. Mother’s age, SES, BMI, baby’s head circumference and infant weight were the most important determinant variables for CS as identified by the ANN method which had the highest accuracy (0.70). The association of RF predictions and observed values was 0.36 (kappa). Conclusion: The ANN method had the best performance that classified CS delivery compared to the RF and LR methods. The ANN method might be used as an appropriate method for such data.

Background: Generalized anxiety disorder (GAD) is a common disorder in infertile people. The aim of this study was the identification of associated risk factors for the severity of GAD in infertile people using an ordinal model with a flexible link function. Materials and Methods: This cross-sectional study was conducted on 1146 individuals with a couple's infertility problem selected from an infertility center in Tehran, Iran. Data collected using self-administered questionnaires include demographic/clinical information and GAD-7. We used a Bayesian-ordered symmetric power logit (splogit) model to identify the risk factors for the severity of GAD. Furthermore, we implemented standard ordinal models to compare with the ordered splogit model. Results: Female gender (B coefficient 0.48, 95% credible interval [CrI]: 0.34–0.62), longer duration of infertility (B coefficient 0.03, 95% CrI: 0.01–0.04), previous treatment failure (B coefficient 0.17, 95% CrI: 0.03–0.30), and self-cause of infertility (B coefficient 0.12, 95% CrI: 0.01–0.23) were associated factors with the severity of GAD. The splogit model had a better fit and performance to determine the associated risk factor for the severity of GAD as compared to standard models. It provided more precise estimates of risk factors and one more significant risk factor. Conclusion: Infertile people with female gender, longer duration of infertility, failure in previous treatments, and self-cause infertility are more likely to experience higher severity levels of GAD and require additional psychological, and support interventions. Furthermore, it can be argued that the ordinal splogit model is more powerful to identify the associated risk factors for the severity of GAD.

Background & Aim: The aim of the current study was to investigate the advantages of Bayesian method in comparison to traditional methods to detect best antioxidant in Freezing of human male gametes. Methods & Materials: Semen samples were obtained from 40 men whose sperm had normal criteria. A part of each sample was separated without antioxidant as fresh and the remaining was freezed with and without antioxidant. Taurine (in concentrations of 25 mm and50mm) and cysteine (5mm and10mm) as antioxidants were prepared as intervention. Traditional results were obtained from randomized incomplete block design and compared with Bayesian results in their ability to find the significant difference among our groups. Using Markov chain Monte Carlo algorithm within the WinBUGS software, we developed a Bayesian approach to estimate the protective effect of antioxidant against inverse effect of freezing on the quality of sperm. Results: Classic method could detect the significant difference just in cycteine10mm for viability which was confirmed by Bayesian method. In Bayesian method, in addition to results from classic method, we could find the significant improvement in abnormality: cysteine 10mm, protamin deficiency: taurine 25 mm and10 mm, viability: cysteine 10mm, DNA fragmentation: cysteine 10mm which all of them was interested in clinically, but could not be proved by the traditional methods. Conclusion: Bayesian approach in sperm biology research can be considered as a good replacement of the traditional methods for estimation. Using this method, we can solve complex and intractable statistical models. Future researches should be done to confirm our suggestion.