International Journal of Fertility & Sterility
Year:2010 | Volume:4 | Issue:SUPPLEMENT 1 (5TH ROYAN NURSING AND MIDWIFERY SYMPOSIUM)|Papers Count:36

The role of imaging in female infertility has undergone a revolution over the past few decades .Sonography plays an integral role in the evaluation of gynecologic disease. It can determine the organ or site of abnormality and provide a diagnosis or short differential in the vast majority of patients. Both the transabdominal and transvaginal approaches are now well –established techniques for assessing the female pelvic organs. Transvaginal sonography is now considered an essential part of almost all pelvic ultrasound examinations. Color and spectral Doppler sonography have evolved to play a role in assessing normal and pathologic blood flow. Doppler can also distinguish vascular structures from nonvascular structures, such as dilated fallopian tubes or fluid-filled bowel loops. The more recent addition of Hysterosonography (SHG) has provided more detailed evaluation of the endometrium, allowing differentiation among intracavitary, endometrial, and submucosal lesions. Threedimensional (3D) ultrasound also plays an important role in the diagnosis of congenital uterine anomalies and endometrial volume measurements. Sonography also plays an important role in guiding interventional procedures such as magnetic resonance imaging (MRI). MRI because of excellent tissue characterization, can occasionally be helpful when sonography is inconclusive and in the staging of pelvic malignancies. Computed tomography (CT) has a limited role but is used for cancer staging. Hysterosalpingography (HSG) is the radiographic evaluation of the cavity of the uterus and fallopian tube and as a commonly performed examination plays an important role in reproductive medicine.

Background: Infertility & Obesity have often been linked among of reproductive age. Obesity results in an increased production of Estrogen and Androgen, these hormonal imbalances interfere with ovulation, which of course is the basis of successful conception. Obesity is a characteristic of polycystic ovary syndrome (PCOS). Obesity is linked to several health conditions, including cardiovascular disease, Hypertention, Diabetes. In obesity assessment it is necessary to pay attention to other disease such as thyroid dysfunctions, fatty liver, and hyperlipidemia before pregnancy. As well as request some blood test that is needed and refer to the related specialist if necessary. Women affected by obesity not only have problems with fertility but are also at a greater risk for pregnancy complications such as having Caesarean Section, giving birth to a large baby, Gestational Diabetes. There are many options available in treating obesity such as: Altering diet, Exercises regularly, Medication & different kind of surgical methods.Materials and Methods: We do our study on 172 subjects committed Nutrition Unit in Royan Institute during 6 months that divided in two groups 88 were PCOS & 84 NonPCOS. We measures BMI, Waist and Hip circumference. BMI is calculated by dividing a person's weight (in Kg) by his or her height (in meters squared). Waist and Hip circumference by measuring the smallest circumference of the natural Waist, usually just above the belly button, and dividing by the hip circumferences at its widest part of the buttocks or hip. Also we requested for all patients (TSH, SGOT, SGPT, LDL, HDL, TG, and Cholestrol). Results: Totally all subjects had approximately 8 Kg weight loss indurations 6 month. (MAX: 3 Kg, MIN: 24 Kg). No significant difference in comparisons between the average of the Lab variants, Waist and BMI were seen between PCOS and nonPCOS group, but TSH (p=0.02) and history of hyperthyroidism (16.7% versus 2.3%) were so higher in nonPCOS group, on the whole 19% of Nutrition Clinic’s patients had a history of hypothyroidism that indicate our attention to thyroid dysfunction in obese patients. Also liver enzymes dysfunctions in PCOS group was 11.4% and in nonPCOS was 4.2% that in PCO group possibly it was because of fatty liver resulting from insulin resistance. Additionally Chol- LDL>130 mg/dl range in PCOS group was so higher (25% versus 14.6%). Conclusion: Studies have shown that modest weight loss can have a significant effect on women with PCOS, often resulting in a regular menstrual cycle and fertility. Ideally weight loss should be accomplished prior to a conception & pregnancy. It is believed that weight loss prior to pregnancy may significantly decrease maternal & fetal risks associated with pregnancy. Additionally study exhibits the important measurement of TSH, Liver function and Lipid profile tests in obese patients who referred to nutrition clinics.

More than 15 % of couples have infertility problems. The causes of infertility are equally distributed among men and women. Assisted reproduction is an option which can help many of these couples. Because of ongoing research and development of the infertility treatments the pregnancy outcome after in vitro fertilization can be increased. Embryo transfer (ET) has in the Nordic countries, by tradition been performed by a gynecologist. As the gynecologists often have a busy schedule, midwives and nurses have become increasingly important in planning the treatment, providing subjects information, ultrasound monitoring and assistance at ET. As part of the continuous development of our IVF programmer, we have carried out a prospective randomized study where either a midwife or a gynecologist has performed ET. The objective of this study was to investigate if an experienced IVF midwife could perform ET with similar results as a gynecologist. The result show that the clinical pregnancy rates between ETs performed by midwives versus gynecologists was 31 % and 29% respectively. The patients were satisfied when a midwife performed ET as reported in questionnaire. Our conclusion was that it is a feasible option to allow midwives to carry out ETs.

Background: To find out those reproductive factors to incidence of breast cancer overall and by menopausal status. Materials and Methods: This was a case – control study, in which, the risk of menstrual, pregnancy- delivery and menopausal factors were determined in women with breast cancer (case) against those without (control). The risk factors stratified by menopausal status also. A total of 500 women, diagnosed with breast cancer, (250 in premenopausal and 250 in post menopausal status), were selected from shohada hospital and cancer institute in Tehran, and 500 women as controls visiting patients at the same time or living next door to cases. Results: The results showed that early menarche (OR=17.26, p=0.000), breast feeding less than 3 months in life (OR=2.73, p=0.000) are overall risk factors for breast cancer and both at pre (OR=15.61, p=0.000 and OR=1.77, p=0.000), and postmenopausal (OR=0.05, p=0.003 and OR=0.28, p=0.001). Menstrual interval less than 26 days, and irregular menstruation period was related to breast cancer (OR=0.30, p=0.000 and OR=2.39, p=0.026 respectively) and in premenopausal period (OR=0.25, p=0/000 and OR=2.71, p=0.017 respectively). On the other hand, irregular menstrual period in the age of 30, time interval more than 20 years between menarche and first pregnancy were related to breast cancer (OR=18.66, p=0/000 and OR=0.45 , p=0.000 respectively). We also found that two mentioned variables were risk factors of breast cancer in post menopausal period (OR=0.02, p=0.000 and OR=2.85, p=0.000 respectively). This study showed that overall, cancer of the breast is statistically related to scantly menstrual bleeding (OR=1.72, p=0.000) and occurrence of first pregnancy after age of 20 (OR=2.40 , p=0.000 ) , history of post term delivery (OR=3.15 , p=0.038) ,history of 2 spontaneous abortion (OR=2.16 , P=0.043), history of induced abortion (OR=2.03, p=0.018), and the usage of oral contraceptive pill more than 5 years (OR=0.40, p=0.001) were only related to premenopausal breast cancer. It was also shown that, dysmenorrheal (OR=2.24, p=0.027), marital age after age of 30 (OR=3.79, p=0.011), hot flashes at menopause (OR=0.32, p=0.004) and occurrence of menopause after the age of 55 (OR=3.84, p=0.000) were only related to breast cancer of post menopausal status.Conclusion: Regarding our results the age in which the disease is diagnosed is a prominent point for sow factors. It can be assumed that the most important factors are irregular menstruation at the age of 30 for both pre and post menopause. Meanwhile, early menarche for premenopausal breast cancer and menopausal age for post menopausal breast cancer were considered to be the most important factors.

Infertility is defined as failure to conceive after 1 year of unprotected intercourse(6 months for women over 35). The prevalence of infertility appears to be increasing; many women are postponing childbearing for social, professional, financial, or psychological reasons. The current evidence indicates a 9% prevalence of infertility (of 12 months) with 56% of couples seeking medical care. 80% of all women desiring children conceive within 1 year of marriage and another 10% within the second year. In the late 20th century, medical science has made great advances in understanding each stage of the reproductive process and in identifying the problems that can occur at each step. In an increasing number of cases these barriers can be corrected or worked around in order to achieve fertility for about 65% of couples who seek the help of fertility specialists. Despite public worry and discussion, the actual incidence of infertility has remained fairly stable over the years. One American couple out of 5 or 6 currently experiences infertility. Infertility grows more common with increasing age; about 33% of couples in their late 30s are infertile. The age factor has taken on new importance as many people in the United States and similar industrialized countries have put off marriage and children until certain educational or career goals are reached. Increased awareness and availability of modern treatments that assist couples to conceive and the decreased supply of infants for adoption have led more couples to seek infertility therapy. While the inability to conceive distresses many couples, they differ in their willingness to undergo intensive investigation and treatment for infertility. All women should be aware of certain information before trying to conceive. It is also important to counsel women about smoking cessation, weight control. Natural fertility declines with age. The main causes of infertility are related to ovulatory dysfunction; blocked or damaged fallopian tubes; and abnormalities of sperm number, motility, or morphology. Questions should focus on four main areas: ovulatory dysfunction, risk factors for tubal infertility, sexual factors, and male or sperm factors. Physical examination of women includes assessment of body mass index, thyroid, breasts, and signs of hyperandrogenism. A Pap smear should be done if indicated, along with a bimanual examination to search for signs of endometriosis or pelvic adhesions, such as a fixed retroverted uterus, adnexal masses or tenderness, and uterosacral ligament thickening, nodules, or tenderness. Infertility investigations aim to assess three main areas: ovulation, tubal damage or dysfunction, and male factors. First-line investigations generally include a semen analysis and assessment of tubal patency, usually by HSG. Semen analysis is readily available in most communities. The need for blood tests is determined by the history; a battery of tests is rarely required. Routine random measurement of FSH, TSH, and prolactin. A woman with a suspicion of chronic anovulation most probably due to polycystic ovary (PCO) syndrome, as there is a long history of irregular cycles and clinical presentation with hirsutism, her serum levels of testosterone hormone, SHBG, DHEA, DHEAS and prolactin should be evaluated to prove the provisional diagnosis and to detect the source of excess androgens. Semen analysis is best performed after 72 hours of abstinence. A longer period of abstinence results in increased sperm count, but reduced motility. There are three main types of fertility treatment: medical treatment (such as ovulation induction therapy); surgical treatment (such as laparoscopy and hysteroscopy); and the different assisted reproduction techniques (ART) such as IUI, IVF, ICSI, IVM, Choice of infertility treatment often related to issues of efficacy, cost, ease of use or administration, and its side effects. Legal, cultural and religious inquiries have limited the available choices in some countries, such as the use of donor sperms or oocytes.Treatment options available for any particular infertile couple will depend also on the duration of their infertility, which partner is affected, the age of the female partner. It is customary to transfer more than one embryo to the uterus to increase the chance of at least one embryo implanting; the risk of multiple pregnancies must be balanced with the chance of achieving a pregnancy at all .It is not appropriate to replace more than two embryos in women under the age of 37. High multiple pregnancies are much more likely to be the result of inappropriate ovulation induction in polycystic ovarian syndrome than they are of in vitro fertilization and embryo transfer. Fertility clinics should address the psycho-social and emotional needs of infertile couples as well as their medical needs. The content of counseling may differ depending on the concerned couple and the existing treatment options. It usually involves treatment implication counseling, emotional support counseling, and therapeutic counseling. Infertility by itself does not threaten the life, but it has devastating psycho-social consequences on infertile couples. It remains a worldwide problem challenge. Management of infertility has been and still a difficult medical task not only because of the difficulty in the diagnosis and treatment of the reproductive disorders in each partner, or the poorly unstated interaction between the partners' fertility potentials, but also because of the fact that success of treatment is clearly identifiable entity; the achievement of pregnancy. The treating doctor who is counseling the couple regarding their infertility must be familiar with the causes, investigations and the treatment options available. The couple needs to be given realistic information about their chances of having a live birth, as well as, the risks and costs of the management plan and its alternatives.

Background: The main objectives of this study are to examine the Meta analysis of the relation between apoptosis and decline of sperm motility, concentration and semen volume in infertile men. Through testis biopsy, high amounts of apoptosis have been reported. Since the results of sperm analysis shows a medium prediction of fertility. Infertility due to male factor is 30%-40% of infertility of couples, so clinical evaluations and new methods in male factor can be a more accurate prediction for the condition and function of their sperm, therefore sperm apoptosis can be a useful index for evaluating male fertility.Materials and Methods: An internet study, by the use of Medline and Scopus database from 2003 to 2009 was performed. The key words were sperm apoptosis and its quality. This study is done on human subjects. The selected articles were not biased nor had the minimum bias. Among the 20 initial articles, only 9 had the wanted characteristics and were chosen. The results were obtained from a Random-Effects model which is more conservative than a fixed-Effect model. The homogeneousness of the effects was performed by the use of Cochran’s Chi-squared (Q-Test) and I2 statistics. The homogeneousness of the effects depends on the type of variables which evaluate the apoptosis and quality of sperms. The effects of small study and low quality of the study were done through cumulative Meta analysis and analysis of sub groups. Metaregration was done for recognizing the Covariance of the study level and its Heterogenic. The bias of study was done through Funnel plot. CMA statistical software is used in this Meta analysis. Results: This results show a significant difference between motility of sperm in two groups.(p=0.000)also based on Random model the concentration of sperm in control and case groups are significant differences. (p=0.001) but there is not a significant deference between semen volume and intensity of apoptosis (p=0.275). Conclusion: Apoptosis and its intensity can affect the motility and concentration of sperm therefore can be affect sperm parameters.  

The success of assisted reproduction, although gradually increasing over the years, is still less than satisfactory. Many couples have benefited from this treatment; many have also been left frustrated following multiple failed attempts (Bulent Urman et al. 2005). Repeated implantation failure (RIF), defined as three or more failed IVF attempts or failure of IVF after cumula- tive transfer of more than 10 good quality embryos, represents one of the major challenges to assisted reproduction practice (Christophe Blockeel et al. 2008). One of the prime factors implicated in the failure of assisted conception treatment is the inability of the embryo to implant into the endometrium. Several areas have been explored in attempts to improve implantation, including: the embryo transfer technique (Anderson et al. 2002; Pope et al. 2004); endometrial receptivity (Stern et al. 2003; Stephenson and Fluker 2000); the presence of hydrosalpinges and uterine fibroids (Barmat et al. 1999; Camus et al. 1999; Strandell et al. 1999; Hart et al. 2001; Check et al. 2002) and implantation potential of the embryo itself (Levitas et al. 2004; Caglar et al. 2005). It is evident that the aetiology underlying recurrent implantation failure is complex that cannot be attributed to a single abnormality. In couples who repeatedly give rise to bad quality embryos, Preimplantation genetic diagnosis (PGD) may be undertaken to assess the ploidy status of individual embryos. The genetic analysis is performed on one or two blastomeres, by fluorescent in situ hybridization (FISH) for cytogenetic diagnosis, or polymerase chain reaction (PCR) for molecular diagnosis. Genetic analysis of the first or second polar body can be used to study maternal genetic contribution (Claire Basille et al. 2009). Such couples should be discouraged from undergoing further treatments if all embryos are aneuploid. When euploid embryos are found among the cohort, further treatment attempts may eventually be rewarded with a conception. In couples who fail to conceive despite the transfer of good quality embryos, other factors that may impede implantation should be sought and corrected when identified. Normality of the uterine cavity should be confirmed with office hysteroscopy (Urman et al. 2005). Faulty embryo transfer technique should be rectified. Intratubal embryo transfer may be considered if the patient underwent previous difficult transcervical embryo Assisted hatching and blastocyst transfer can also be considered in patients with recurrent implantation failure. Screening for APA (Antiphospholipid antibody) is not routinely carried out, nor are empirical treatments such as aspirin, heparin, or leukocyte isoimmunization. co-cultures, these should be advised with caution. In couples with recurrent implantation failure with the transfer of good quality embryos, preimplantation genetic screening does not increase the implantation rates after IVF−intracytoplasmic sperm injection (Christophe Blockeel et al., 2008).

Background: A common wish which is found in almost all humans is desire for having a child. Infertility depression is considered as life and identity crises. The intertwined network of physical, mental, and social factors affect the infertile person. The elements, relationship and activities of this complex network determine the way the person responds to the problem of infertility. Beside all the factors that lead to depression, the infertile people are more susceptible to depression due to specific factors related to their infertility. It is expected that demographic factors, as a part of social background, are effective in how an individual meets the problems resulted from infertility. Beside demographic issues marital satisfaction is another factor which is effective in life satisfaction and nervous health of infertile couples. This research is designed in order to study the relation of demographic factors on the nervous disorders in the fertile women as well as identifying the relation of sexual disorder and infertility.Materials and Methods: This research is a qualitative quantitative study. In this study, 100 infertile women were selected through simple random sampling. They were studied by means of two questionnaires, MHQ and Sexual Disorder Questionnaire. The collected data were analyzed with SPSS software by t test and statistical analyses. Results: The results of this research indicated that there is no significant relationship between the age of the infertile women and their anxiety and depression score (the average age of the subjects was 31.2 years old.) there was a significant relationship between the education level and attitude towards infertility. The subjects with very low level of education (primary school) and those with high level of education (master degree and higher) were affected more. In subjects with high level of education the type of attitude they had toward infertility caused them to lose their social reputation, instability in their social status, and the feeling of being belittled in the society. Occupational and high income of the espouse increased confidence of the women under costly treatments. Most of these couples were sensitive toward attitudes of their relatives and associates. The women who lived in the house of one of their parents had higher level of depression. Change of attitude in the infertile women after diagnosis had affected sexual relations in the following ways: dissatisfaction with sexual relations (50%), disorder in the couples’ relations (47%), reduction of intercourse (32%), Libido (67%), lack of orgasm in more than half of sexual intercourses (60%). 57% of infertile women suffered from depression and 67.2% suffered from anxiety. Conclusion: Infertility is not a merely medical problem but it faces many of infertile couples with crisis in different aspects of their lives. Identifying prevalent emotional problems among these couples, offering consultation services in the first visit considering the cultural, educational, and social level of couples, establishing sexual consultation centers in the clinics of infertility, nutritional consultation, and improving the quality of life along with medical treatments are considered important in order to reduce these problems.

Air is our main contact with the environment in which we find ourselves. Every day, we breathe in 15 kg of air; that’s more than our daily food intake. Air, in cities and confined environments where houses are really close together, consists of particles of different sizes charged of chemical pollutants. The finer particles will come into contact with the alveoli and will allow some pollutants go directly into the bloodstream, resulting in diseases. Our environment is directly linked to emergence of diseases. Purifying the air in your house becomes vital. Thanks to new technological methods, it is possible to purify the air you breathe by reducing the number of micro-particles. Some other toxic chemical that can be found in the air we breathe at home are glycol ethers. They can cause infertility in men and women. In recent years, numerous studies showed that exposure to environmental air pollutants affected reproductive functions and in particular, produced adverse effects on pregnancy outcomes. Increased circulating Pb levels are also associated with adverse changes in sperm count, ejaculate volume, percentage of motile sperm, swimming velocity and morphology. Total sperm count and concentration were shown to decrease with increasing concentrations of blood Pb. Blood Pb levels are also inversely correlated with the percentage of live sperm found that even moderate exposure to Pb significantly reduced human semen quality but they did not find any conclusive evidence for Pb-related derangement of male reproductive endocrine function. Interestingly, Pb accumulates in male reproductive organs; human testes and sperm contain numerous potassium channels through which metallic toxicants can enter into mature sperm (Pb can compete with, or even replace the Zn in human protamine at two different sites, so causing a conformational change in the protein. This interaction adversely affects sperm chromatin condensation, recently observed that sperm concentration was reduced by 49% in men with a blood Pb concentration >50 μg/dl; however, there was no indication of a linear trend of lower sperm concentration with increasing blood Pb values, and sperm chromatin deterioration was not correlated with blood Pb concentration. The comparative evaluation of sperm parameters, absorption markers and environmental concentrations indicates that Pb is probably causing the impaired spermatogenesis. Alteration of sperm function could be considered a precocious marker of detrimental toxicological effects. High rates of air pollution can reduce the number of boys born and may be linked to increased rates of miscarriage, the conference was told. Pollution from air, food or water, or it might be radiation, thermal heat or chemical additives in food affects fertility. Men might improve their fertility by reducing how much pollution they breathe in. The dirtier the air, the lower a man's sperm count and the more sperm with fragmented DNA he produces. A study was conducted on thousands of patients in England discovered that women who regularly breathe in polluted space, have 24 percent smaller chance to get pregnant compared to those who live in less polluted areas. Nitrogen dioxide, a toxin produced by the exhaust of cars and trucks and gas stove, have a negative impact on the opportunities of women to have babies.

Introduction: Mild-to-moderate nausea and/or vomiting affects up to 80% of all pregnant women, usually peaking by week 9 and subsiding by week 20. For 9% to 20% of women, nausea and vomiting of pregnancy persist longer; Nausea and vomiting are complex responses involving various neural pathways and motor responses to sensory stimuli. Definition: Ginger, the rhizome of Zingiber officinale, is one of the most widely used species of the ginger family (Zingiberaceae) and is a common condiment for various foods and beverages. Ginger has a long history of medicinal use dating back 2,500 years in China and India for conditions such as headaches, nausea, rheumatism, and colds.1 Characterized in traditional Chinese medicine as spicy and hot, ginger is claimed to warm the body and treat cold extremities, improve a weak and tardy pulse, address a pale complexion, and strengthen the body after blood loss. Mechanisms of Action: The mechanism underlying ginger’s anti-emetic activity is not clearly understood, but the aromatic, spasmolytic, carminative, and absorbent properties of ginger suggest it has direct effects on the gastrointestinal tract. Ginger extracts exhibit inhibition of platelet aggregation and thromboxane synthesis in vitro, which has led to concerns ginger extracts may prolong bleeding; however, several European studies using ginger orally did not find any significant anticoagulant effects in vivo. The exact mechanism of action of ginger is thought to be a gastric effect, to increase tone and peristalsis due to anticholinergic and antiserotonin action. Dosage: For most purposes a typical dose of ginger is 1-4 g daily, taken in divided doses. To prevent motion sickness, it is best to begin treatment 1-2 days before the scheduled trip and continue dosing throughout the duration of travel. For nausea and vomiting during pregnancy, ginger tea made from fresh ginger root, boiled and diluted to taste, appears to work best. Side Effects and Toxicity: Ginger is on the U. S. Food and Drug Administration’s GRAS (generally recognized as safe) list. The British Herbal Compendium documents no adverse effects of ginger. Animal studies have reported both mutagenic and antimutagenic effects of isolated components of ginger, and human studies have conflicting results regarding potential inhibition of platelet aggregation when ginger is consumed at high doses. One recent study examined pregnancy outcomes in 187 women known to have consumed ginger during the first trimester and found no statistically significant difference in major malformations, spontaneous abortion, and stillbirth rates between the ginger and the comparison group. The FDA classifies ginger as “Generally Recognized as Safe,” and the German Commission E monographs report no known side effects and no known drug/herb interactions. Adverse effects after ingestion of ginger are uncommon, but they can include mild gastrointestinal effects such as heartburn, diarrhea, and irritation of the mouth. Because there is a possibility that ginger may affect fibrinolytic activity, it may be prudent for patients taking anticoagulants such as war-farin. While data are insufficient to recommend ginger universally and there are concerns with product quality due to limited regulation of dietary supplements, ginger appears to be a fairly low-risk and effective treatment for nausea and vomiting associated with pregnancy. In low doses, this may be appropriate for patients not responding to traditional first-line therapies. Animal studies demonstrate effects on the gastrointestinal tract, the cardiovascular system, on experimental pain and fever, antioxidative, antilipidemic and antitumor effects, as well as central and other effects. The most relevant human pharmacological studies require a confirmatory study to exclude interaction of ginger preparations with platelet aggregation. Pharmacokinetic data are only available for [6]-gingerol and zingiberene. Preclinical safety data do not rule out potential toxicity, which should be monitored especially following ginger consumption over longer periods. Final Comment: Given that many antiemetic medications have the potential for sedation as a side effect, the use of ginger is a reasonable and safe alternative to treat pregnancy-induced nausea and vomiting.

In Multipregnancies, The careful control of Number of follicles in stimulation cycles and Number of embryos transferred in ART cycles is so important. Just twin pregnancies are reason for racial death (12- 15%).The risk for CP in twin pregnancies is 8 times more and for Triple is 47 times more than simple ones. Approximately all prenatal problems increase in multiple pregnancies and therefore this kind of pregnancies are considered high risk pregnancies. One of the most issues in prenatal care in Multiple pregnancies is to detect the number of corions that its best detective time is in first trimester by about 100% accuracy. mono Corion pregnancies have more danger for Newborns for example 5 times increase in loss of fetus, 10 times increase in Low birth weight. Mono Corion twin Consequences are as follow: Imbalanced Blood transfer between two fetus, mono amnions twin, death of one fetus in uterus (IUFD), TRAP twins and sucked twins.

Oocyte donation is allowed in Sweden according to a legislation accepted on the first of January 2003. Before then, Swedish woman had to seek these treatments outside of the country. The legislation had been under evaluation for several years so the need for this treatment option had accumulated and a large number of patients were on waiting list. There were also issues regarding criteria for treatment and economical compensation for the donor’s expenses, which needed clarification. This lead to a delay for an additional 6 months from the acceptance of the legislation. There is a great demand for oocyte donation. It is very hard to specify how long the couples have to wait to get treated. This is due to the availability of donors. The waiting list depends resources allocated by the hospital and prioritation. In our hospital the coordination is managed by midwifes. Midwifes is taking contact to both donors and recipients and also making the suggestions for donation. The doctor is shown the suggestions and is responsible for the treatments.

Background: The objectives of this study are aimed to find out the main relevant risk factors of female infertility and to meet the service needs of people who have problem associated with infertility. To reduce their feelings of social isolation on improved relationship with family and male partners. To promote physical, spiritual and mental health also knowledge and awareness of infertility among focus group.Materials and Methods: This research is initiated for coping, health related quality of life and psychological well-being of women facing the problem of infertility. The research was organized between January to April,2009 Nellore district rural area in southern part of India, with women facing infertility problems in their family setting.40 Islam women ages spanned from 20-38years( with an average of 26.8 years ) who do not wish for mother hood via other routes expressed their concern to participate in this research. The period of no conceiving ranges from 2 – 10 years after marriage (with an average of 8.2 years). The subjects participated in this study expressed infertility is a problem of their social, psychological and stressful to marital life. Subjects income categories are below and just above the national average income.21% of the participants have secondary education,46% pre secondary education and the rest 33%are observant religious education. In a gesture to promote health perceptive of the focus group physical exercise, Meditation and counseling protocols were administered for 4 months. Pre and post test scores of cardio-vascular efficiency compared for physical health, Meditation for spiritual health, wellbeing, and anxiety and stress disorders. Causes of infertility, treatment priorities, knowledge and awareness through counseling. Results: The over whelming success in an evidence through paired t test results indicated statistically significant increase in cardio-vascular efficiency, spiritual health, well-being, anxiety and stress perceptive and positive marital relationship in infertile Islam marginalized female groups. Knowledge, awareness, causes and treatment priorities on infertility also found to be increased among the target group. Conclusion: The findings supported that positive treatment protocols cause’s significantly infertile females physical and psychological well-being perspectives. These findings lend support to the findings of Hoi-Yanchan, celia et al. (2005) and Geok-ling Lee et al. (2006) infertile people expressed psychological well-being, positive marital relationship and social support through the implementation of coping strategies.

Background: In spite of the great deal of research in assisted reproductive techniques, more than 80% of transferred embryos by IVF/ICSI methods fail to be implanted. The causes for repeated implantation failures (RIF) may be reduced endometrial receptivity or other various uterine pathologies, such as thin endometrium, altered expression of adhesive molecules or immunological factors; whereas genetic abnormalities of male or female individuals, sperm defects, embryonic aneuploidy or zona hardening are other etiologies for implantation failures. Clinically, endometriosis, polycystic ovaries and hydrosalpinx may decrease implantation following embryo transfer due to dual disorders in the quality of embryos or endometrium. Material and Methods: This article presents the result of a systematic review about Repeated Implantation Failures.Results: Probable causes and methods of evaluation for RIF patients have been reviewed and the suggested methods for their treatment.Conclusion: In this study, probable causes and methods of evaluation for RIF patients have been reviewed and the suggested methods for their treatment, including myomectomy, endometrial stimulation, immunotherapy, hysteroscopy, preimplantation genetic screening (PGS), assisted hatching, zygote intra-fallopian transfer (ZIFT), co-culture, blastocyst transfer, cytoplasm transfer, tailoring stimulation protocols, intracytoplasmic sperm injection (ICSI) and salpingectomy for hydrosalpinges have been discussed.

Background: Infertility is an unfavorable issue in reproductive health worldwide. At least one in six couples refers to infertility clinic. Varity factors including weight, diet, genetic factors, smoking and exposure to extreme heat, environmental pollutant, infections and medical disorders are suggested to be involved with infertility disorder. Materials and Methods: Through a systematic review of literature using Medline and Pubmed from May 2009 onward, overall 6 case-control articles had inclusion criteria and were reviewed accordingly. Results: There are several lifestyle elements including dietary factors are reported to be involved with infertility problem. Antioxidants decrease sperm damage especially in men with DNA fragment and lipid peroxides. Oxidative stress can be resulted in poor semen quality by selenium and decreasing expression of HSP70 protein which is play a role in germ cell differentiation and spermatogenesis and 39% of men with abnormal semen have had low levels of Cobalamin. Also 62% of men with more than 24% DNA fragment index (DFI) who had received antioxidant for 3 month were successful in having baby, whereas the corresponding rate was 37% in the control group. Decreased alcohol and coffee consumption as well as smoking cession programs in couples with normal sexual activity have improved semen quality up to 76%. Men with sperm count more than 20 million have had more carbohydrate, fibers, foliate, Vit C, licopen intakes and less protein and fat in their regimen. More than one-third (35.0%) of infertile men who routinely used sea foods, had an elevated mercury blood level. Low fruits and vegetables intake were the significant risk factors associated with oligospermia. Conclusion: Quality of semen decreases with diet full of diary and meat which could be in part due to existence of lipophilic materials like Xenoesterogens and anabolic steroids.

During pregnancy, the placenta delivers "cord blood" to the baby through the umbilical cord serving as a lifeline of nourishment from the mother to baby. At birth, "cord blood" remains in the umbilical cord and placenta and until recently, had typically been discarded. The tragedy of this practice is that "cord blood" contains very special cells called "stem cells". Recent advances in medical research, have allowed us to identify stem cells as the building blocks of every type of cell in our bodies. In light of these and other recent advances in medical research, people have started saving or "banking" their baby's cord blood. Cord blood can be collected both at vaginal delivery and in connection with Caesarean section. Cord blood is collected from the remains of the umbilical cord. Remains that would have otherwise been discarded immediately after birth. It is collected with a syringe by puncturing the umbilical vein immediately after the umbilical cord has been clamped, cut, and cleaned with antiseptic solution. Cord blood is a very rich source of stem cells. This very rich source of stem cells must be collected at birth or it is lost forever. If your child or someone else in your family develops a life-threatening and/or debilitating disease or condition, they may be considered for a stem cell transplant. Banking your baby's cord blood ensures that you will have your family's stem cells readily available as a life-saving resource. Umbilical cord blood stem cells are the "most immature," available form of stem cells that are genetically unique to your baby and to your entire family. Cord blood derived stem cells are also free of controversy associated with embryonic stem cells, another type of stem cells. Storing these cells essentially stops the clock and prevents aging and damage that would normally occur to cells as they age. A third type of stem cells is adult stem cells, such as those found in bone marrow. Bone marrow stem cells are “older” stem cells, and are less desirable as a treatment option because they are 1) less readily available as they more difficult to harvest (involves putting the donor’s life at risk), 2) less suitable for other family members (degree of match has to be greater because these cells are older and 3) are associated with poorer treatment outcomes.Medical Uses: The following conditions are currently being treated with stem cells. Cord Blood derived stem cells are an area of intense ongoing research. The list of diseases treated with stem cells is growing daily. Any disease which requires the regeneration of tissue (due to injury or disease) is a potential candidate for stem cell therapy. Hemoglobinopathies/Blood Disorders: Sickle-cell anemia, b thalassemia. Inborn Errors of Metabolism: Adrenoleukodystrophy, Batten disease, Gunther disease, Hunter syndrome, Hurler syndrome, Lesch-Nyhan disease, Tay-Sachs disease Immunodeficiencies: Chronic granulomatous disease, Common variable immune deficiency (CVID), Omenn’s syndrome, Severe combined immune deficiency (SCID and SCID-ADA), Reticular dysgenesis, Thymic dysplasia, Wiskott-Aldrich syndrome, X-linked lymphoproliferative disease, Bare lymphocyte syndrome (MHC class II deficiency), Leukocyte adhesion deficienc Other diseases: Evans syndrome, Familial erythrophagocytic hemophagocytic, Langerhans cell histiocytosis, Osteopetrosis. Heart regeneration to repair injury due to heart attack. Brain regeneration to repair injury, due to stroke, heart attack, Alzheimer's.

Polycystic ovarian syndrome (PCOS) is one of the most popular diseases that cause menstrual dysfunction and infertility in women. The present paper is a brief retrospection on the progress in treatment of PCOS caused infertility with integrative Chinese and Western medicine (ICWM). It can be seen from these materials that using traditional Chinese medicine (TCM) recipes formulated by Shen-replenishing herbs or acupuncture to reinforce Gan-Shen, regulate Chong-Ren Channels in treating PCOS, stable clinical efficacy could be obtained, with less adverse reaction, though the effect initiated somewhat late. Whereas, when Shen-replenishing recipe and acupuncture are combined with hormone or ovulation promoting drugs of Western medicine, the above-mentioned shortcomings would be overcome. So, this combined therapy is frequently used in clinical practice.

Background: Pregnancy after assisted reproduction technology is the one of risk factors that can result in anxiety. Many studies showed that for up to 20% of infertile women, the emotional burden of infertility persist even after successful treatment. This study aims to determine anxiety level and its relation with duration of infertility in ARTs pregnant women undergoing sample infertility centers in Tehran. Materials and Methods: In this cross sectional study, 100 ARTs pregnant women were participated. Data was collected by Beck Anxiety Inventory (BDI) and personality/ demographic questionnaires. Data analysis was performed with SPSS.V.14. Results: Mean age was 33.7±6.81 and mean of married duration, gestational age and infertility duration was 8.70±5.18, 20.18±10.8 and 7.37±6.81 respectively. Of 45 pregnant women in first trimester, 28/9% (n=13) have moderate and sever anxiety. Of 20 pregnant women in second trimester, 35% (n=7) have moderate and sever anxiety and finally, of 20 pregnant women in third trimester, 40% (n=14) have moderate and sever anxiety. There is a significant relation between anxiety level and duration of infertility (p=0.03).Conclusion: Careful consideration and psychological consultation for ARTs pregnant women is necessary to detect high-risk pregnant and reduce the anxiety and poor pregnancy outcomes.

Background: Large part of research related to re productive factors in breast cancer risk before and after menopause, a study case - control is that it factors in deliberate and spontaneous abortion in the two groups of women with breast cancer (cases) and non-infected women (control group) study, described odds ratio in women, breast cancer was measured. In this study, after recognizing the above factors in breast cancer risk in their separation, before menopause and after menopause were considered.Materials and Methods: 500 cases referred to shohadaye Tajrish Hospital and cancer Institute of Imam Khomeini hospital that they 250 premenopausal and 250 postmenopausal breast cancer patients were a select group method and continuous participation in the research was. The control group was composed of 500 persons during the study as visitor centers or with or referred to in the vicinity of group homes, women had lived in Tehran and sampling were selected in available or easy.Results: Employing logistic regression analysis and calculated the risk ratio findings showed that: The use of hormonal methods of contraception) p=0.036, OR=1.39), more than 25 years of age at the time of starting the tablets (p=0.052, OR=2.99) and less than 5 years from the last tablet from the time of diagnosis (OR=0.000, p=3.28) with breast cancer are connected. Conclusion: According to the findings can be concluded that taking contraceptive pills is own weak risk factor for breast cancer. 

Background: Large part of research related to reproductive factors in breast cancer risk before and after menopause, a study case - control is that it factors in deliberate and spontaneous abortion in the two groups of women with breast cancer (cases) and non-infected women (control group) study, described odds ratio in women, breast cancer was measured. In this study, after recognizing the above factors in breast cancer risk intheir separation, before menopause and after menopause were considered.Materials and Methods: 500 cases referred to shohadaye Tajrish Hospital and cancer Institute of Imam Khomeini hospital that they 250 premenopausal and 250 postmenopausal breast cancer patients were a select group method and continuous participation in the research was. The control group was composed of 500 persons during the study as visitor centers or with or referred to in the vicinity of group homes, women had lived in Tehran and sampling were selected in available or easy. Results: Employing logistic regression analysis and calculated the risk ratio findings showed: history of 2 spontaneous abortion (p=0.043 and OR=2.38) in total breast cancer wasn’t associated but separated before and after menopause correlation. Induced abortion in total (p=0.018 and OR=1.57) And at times before the menopause (p=0.018 and OR=2.03) were associated with breast cancer. Conclusion: According to the findings can be concluded that abortion is not itself a significant risk factor for breast cancer.

Background: This study was conducted to evaluate the attitudes of infertile menopausal women towards the menopause and its relation with demographic characteristics. Materials and Methods: This was a cross-sectional study that evaluated 189 infertile menopausal women attending primary health care centers in Shiraz. Five health centers in different parts of the city were chosen and the participants were selected from these women attending the above-mentioned health care centers randomly. Then, they were interviewed and a questionnaire was filled in.Results: The mean age of the participants was 54.9(±5.5) years. 160(42.3%) were illiterate and 9(2.4%) had a college degree. Seventy (18.5%) of them were smoker. The mean and standard deviation of the total score of attitude was 102.7±11.8 (Rang: 71-135). As statistically significant relation was observed between during of infertility and total score of attitude in multiple regression analysis.Conclusion: According to the results of the study, there are some differences various between infertility women and these differences lead to different attitudes among in women. Infertility is very important in attitudes towards menopause. Therefore, it is very important to make some plans for evaluating infertility menopausal and controlling them.

Background: A peer group is a group with the same age, social status and interests that its characteristics lead to consider peer education as an effective behavioral change strategy in reproductive health worldwide. Aim to assessment of peer interventional health programs in students groups this study has been designed and conducted based on peer participatory approach. Materials and Methods: This interventional study has been conducted in a medical science university through stakeholders' partnership and selection of 24 volunteer students according to their knowledge, interest, communication skills, and etc. Then capacity building of them was performed through holding a highly interactive Reproductive Health Coarse contained the topics, Marital Health, Pregnancy and consequence of illegal Abortion, Family planning, STI/AIDS, Communication and Counseling skills. Trained peer educators have introduced to other student and present education and counseling formally and informally. A post interventional study has been conducted after 9 month in order to find its effectiveness. Results: In this way, peer education and counseling was evaluated for assess its effectiveness. As a result, %64/7 of students was agreed with peer education and they were feeling empathy due to same condition of peers (%60) especially in sensitive topics. %55.3 of them felt need to existence of peer educator core in the university. According to students' opinion, we conclude Peer education is effective strategy for reproductive health promotion and reinforces positive behaviors in youth. Conclusion: Universities are appropriate real world for experience a friendly youth program and then disseminate it to other young communities. There seems peer education is effective strategy for Reproductive Health promotion and reinforce positive behaviors in youth.

Background: Celiac disease is an intestinal inflammatory disease that is triggered by gluten in the diet. Patients present with a wide array of symptoms due to malabsorption that include diarrhea, abdominal pain, and bloating and weight loss. Materials and Methods: In women, this disease may have implications on menstrual and reproductive health. The symptom complex includes delayed menarche, early menopause, secondary amenorrhea, infertility, recurrent miscarriages and intrauterine growth restriction.Results: These women benefit from early diagnosis and treatment. Therefore, celiac disease should be considered and screening tests performed on women presenting with menstrual and reproductive problems and treated accordingly. Conclusion: The objective of this article is to review the current literature on celiac disease and its association with the above-mentioned disorders.

Background: Participation of adolescents and young women in strenuous sports activity may lead to various metabolic and psychological derangements of clinical relevance to the endocrinologist. Materials and Methods: The most common manifestations encountered in practice are primary and secondary amenorrhea, reduced bone mineral density and eating disorders. The occurrence of all three together has been named "the athletic triad". The underlying hormonal drivers that lead to some of these manifestations are the reduced leptin level as well as the persistent low grade stress response commonly observed in such females. Results: "Exercise-related female reproductive dysfunction" (ERFRD), can possibly include short-term (infertility) and long-term (osteoporosis) consequences. Functional hypothalamic amenorrhea, a manifestation of ERFRD in adolescence, is an integrated response to the combination of excessive physical and emotional stress, exercise, and/or reduced food intake characterized by decreased endogenous GNRH secretion.Conclusion: The primary aim of treating these athletes should be the prevention of the development of any component of the triad as well as the whole complex by educating athletes, trainers, parents and health care professionals about proper nutrition and safe training. The long term prognosis is good. However, significant long term morbidity may affect these young women later in life.

Background: Insulin resistance (IR) is a consequence of obesity, and in women it is often inextricably linked with ovarian function leading to clinical reproductive manifestations such as early menarche onset, subfertility and polycystic ovary syndrome (PCOS). Materials and Methods: Likewise, the dramatic fall in oestrogen production after menopause may contribute to weight gain and changes in adipose tissue distribution.Results: Overall, women who are obese, especially those with reproductive complications including PCOS, have been identified as specific high risk subgroups for further progression through to prediabetes, type 2 diabetes mellitus (T2DM) and potentially cardiovascular disease (CVD). Conclusion: This review focuses on the interrelationship between the ovarian function and obesity as well as its treatment strategies.

Background: Micronutrient deficiencies have been associated with significantly high reproductive risks, ranging from infertility to fetal structural defects and long-term diseases. Materials and Methods: In this review we focus on the reproductive risks related to some micronutrients during the periconceptional period, a critical step in determining fetal development and health due to the potential onset of several disorders. Results: Fertility, conception, implantation, fetal organogenesis and placentation are the critical stages potentially affected by nutrition during the periconceptional period. Reactive oxygen species (ROS) and total homocysteine (tHcy) plasma levels are factors involved in the respective mechanisms. The preconceptional period is particularly important since it affects both fertility and the early stages of gestation. Micronutrients' dietary intake and maternal status affect the different phases of the onset and development of pregnancy as well as of the conceptus. Conclusion: Although human studies are scarce, and conclusive evidence is provided solely for periconceptional folate and prevention of neural tube defects (NTDs), the overall data indicates that micronutrients may affects fertility, embryogenesis and placentation, and the prophylactic use of some micronutrients may be useful in preventing several adverse pregnancy outcomes. Efforts to increase awareness of a healthy diet should be strengthened not only throughout pregnancy but also before.

Background: Sexuality and the desire for a child are strongly interconnected. The same applies to sexual disorders and the unfulfilled desire for a child. Aim: This article indicates the relations between sexual disorders and the unfulfilled desire for a child and outlines the potential effects of diagnostics and treatment in the context of reproductive medicine on the couples' sexuality. Materials and Methods: This research drive was undertaken in well-established medical and psychological literature database with the keywords "infertile" or "infertility" and "sexual dysfunction" or "sexual satisfaction." Results: Sexual dysfunctions (of organic or of psychic origin) as a cause of involuntary childlessness are relatively unusual. By contrast (temporary) sexual disorders resulting from diagnosis and medical therapy are common in couples with fertility problems, with women more frequently affected than men. Conclusion: Counseling for couples with the unfulfilled desire for a child should invariably include explicit and appropriately tactful reference to sexuality and (functional) sexual disorders.

Background: Attachment style is the pattern of an individual in forming relationships with others, which is believed to be determined in the early years of life. Maternal-fetal attachment (MFA) is a term used to describe the relationship between a pregnant woman and her fetus. Qualitative descriptions of maternal attitudes and adaptation to pregnancy indicate that MFA is based on cognitive representations of the fetus. These may include imagined scenarios between mother and child, as well as a mother's attribution of physical and emotional characteristics to the fetus. Mental health during pregnancy affect on fetus growing and baby’s future adoption. Therefore using different ways to promoting maternal mental health can decrease maternal-child problems. Many intervention program were designed to promote maternal mental health. One of these interventions is improving relationship between mother and child. The aim of this study was to compare couples who had conceived by in vitro fertilization (IVF) with matched controls for the prevalence of anxiety and quality of attachment to the baby during pregnancy. Materials and Methods: This article presents the result of a systematic review about the effect of behavioral attachment on maternal after in vitro fertilization conception. Results: The results of this study demonstrate that, despite the finding of no group differences in state and trait anxiety using the Spielberger, the IVF mothers were significantly more anxious about the well-being of their unborn babies and about damage to the babies during childbirth (associated with more negative feelings about the birth and a tendency to a higher tolerance for medical interventions during the birth). Conclusion: Education MFA behaviors during pregnancy can increase prenatal attachment and maternal mental health. So we can promote maternal mental health with education these simple behaviors in vitro fertilization conception.

Infertility is one of the couple´s problems in different society. Based on the researches done, the rate of infertility is almost 12 to 20 percent. Studies considered infertility as a source of metal disorders. It has not only physiological aspects but also psychological aspects. The results of the studies done by mental health specialists, psychologist, have shown that infertile people are affected more by chronic stress and they are at the risk of diseases like depression, anxiety, low self steam and dissatisfaction. In general experiencing stressful event causes. The decrease of person´s control in life and makes the couple irritable and unstable. It also results in aggressive modes, feeling of disability, disappointment, uselessness embarrassment and anxiety. Infertility makes sexual relations undesirable. The results obtained from Mahlsdet ´s study (1987) done with 63 infertile female and 37 infertile male showed that 96% felt disappointment. 81% unenjoyment, 82% irritability and 65% anger, sex is one of the factors that effects the way people react toward infertility. A lot of studies were done in this regard. The results taken from most of them have shown that the experience of infertility is more stressful for women that the men. The infertile women have had more psychological problems than men and infertility has more negative meaning for women than for men Shaver et al. (1992), Gril (1991) have done studies on fertility and concluded that women in comparison with men enjoy. 1. Life confidentiality 2. High depression 3. Low life satisfaction 4. Lack of child as an unacceptable problem 5. Considering infertility as their fault. In terms of depression and anxiety, Domar and et al. (2000) have done some researches. They indicated that the degree of depression and anxiety is higher in women than in men. Newton et al. concluded that shared life for women is less enjoyable that men. What we should know is that the difference in sex and its effect on infertility is more important that the problem person. The role of sex and sexual identity are of great importance in infertility. What we should consider more is the psychosocial aspects of infertility. What we should know is that the difference in sex and its effect on infertility is more important that the problem person. The role of sex and sexual identity are of great importance in infertility. What we should consider more is the psychosocial aspects of infertility.

Doppler ultrasound has important screening and diagnostic capabilities. In addition, Doppler ultrasound has an important contribution to make to the surveillance of the fetus compromised by intrauterine growth restriction (IUGR). This study can be used in a complementary fashion to the traditional biophysical profile and non stress test. Doppler studies have been subjected to a number of important randomized controlled trials, thereby placing these techniques within the realm of evidence- based medicine. The advent of color and pulsed Doppler techniques has permitted the use of Doppler methods to assess fetal structural abnormalities and complex disease processes involving fetal hemolytic anemia, twin-twin transfusion, and non immune hydrops. As a simple, noninvasive method of determining blood flow velocities; Doppler has been used in obstetrics diagnosis for more than 20 years. Doppler ultrasound of the fetal vascular system is an important adjunct for the evaluation of high-risk pregnancies in obstetrics and prenatal medicine. The selective use of fetal Doppler leads to significant reduction in prenatal mortality and morbidity. This workshop has been organized by Department of Reproductive Imaging- Royan Institute to provide an overview of the role of Doppler ultrasound in prenatal fetal assessment.

Disorders of the male reproductive system have become an important public health issue as they can cause infertility, miscarriages and abnormal outcomes in the offspring. It is well recognized that spermatozoa from infertile men often have multiple structural and functional defects. Several recent studies have shown that sperm DNA fragmentation is a completely independent variable with little or nothing to do with the parameters that we measure on the routine semen analysis. It seems that the degree of DNA fragmentation correlates highly with the inability of the sperm to initiate a birth, regardless of the technology used to fertilize the egg. In this workshop, some methods of chromatin damage assessment such as: AOT (Acridine Orange Test), SCSA (Sperm Chromatin Structure Assay), SCD (Sperm Chromatin Dispersion Test) and CMA3 (Chromomycin A3) will be trained and their clinical applications will be discussed. It may be useful for physicians and biologists who wish to learn more about the clinical aspects of DNA fragmentation assessment.

Ultrasound plays an important role in the diagnostic workup of scrotal diseases. Ultrasound of the scrotum is the primary imaging method used to evaluate disorders of the testicles and surrounding tissues. It uses harmless, high-frequency sound waves to form an image. The sound waves are reflected by scrotal tissue to form a picture of internal structures. It is not invasive and involves no radiation. It is used when a patient has acute pain in the scrotum. Some of the problems for which the use of scrotal ultrasound is valuable include an absent or undescended testicle, an inflammation problem, testicular torsion, a fluid collection, abnormal blood vessels, or a mass (lump or tumor). It can differentiate a testicular mass from an extratesticular mass and determine whether the mass is cystic, solid, or complex. Three-dimensional extended imaging (3D XI), which has become available with advances in 3D US, is a powerful processing technique that gives the ability to view an obtained volume with different viewing methods. This workshop has been organized by Department of Reproductive Imaging-Royan Institute to provide an overview of the role of 3D XI as a diagnostic procedure in scrotal mass lesion. The Workshop includes two parts:• Lecture on “Training curriculum in the practice and interpretation of 3D US imaging”.• Procedure of 3D XI of scrotal mass lesion

Nowadays hysteroscopy has considerably evolved in favour of patient comfort. Thanks to smaller instruments, but perhaps more importantly introduction of the vaginoscopic approach, the use of speculum and tenaculum are no longer necessary. Because performing a vaginoscopic biopsy or a small surgical intervention is the gold standard during evaluation of the uterine cavity, removal of certain intrauterine adhesions or polyps can easily be performed without anesthesia and in an office setting.This workshop is designed to introduce:• Office hysteroscopy• Main indications for hysteroscopy• Performing certain hysteroscopic operations

Assessing the quality and effect of different treatments on oocyte, embryo and ovarian tissue reveals essential information which could greatly affect and predict the outcome of IVF, IVM, Ovarian tissue transplantation, Drug treatments and many other different procedures. This workshop focuses and enables a hands-on experience on various staining techniques to assess the effect of different treatments on oocyte, embryo and ovarian tissue. 

SV aspiration is a potential test for the diagnosis of partial EDO. This procedure confirms the presence of intact spermatogenesis, and rules out more proximal obstruction, obviating the need for testicular biopsy. In addition, SV aspiration can be performed without anesthesia or X-ray in an office setting, and use of dye or contrast medium is not necessary.  

Implantation is an important step in establishing a pregnancy and is of major concern in the management of infertility. Failure at this step greatly limits the success of all approach to infertility treatments as well as assisted reproductive technology (ART). Immunological rejection of the fetus due to recognition of paternal antigens by the maternal immune system, resulting in abnormal immune cells and cytokine production, is postulated to be one cause of unexplained pregnancy loss. Most of the recent investigations suggest differences in the expression of some immune cells and molecules in women with recurrent miscarriage. Therefore, understanding the roles of local and systemic immune factors, cytokines, growth factors, adhesion molecules and other matrix-associated proteins in uterine receptivity for implantation is necessary to develop approaches to enhance reproductive health and fertility in humans. Here in this panel we aim to discuss the latest finding related to physiological and immune factors regarding to implantation. Then, we’ll talk about the most recent approach to implantation failure including four lectures in this regards;1. Introduction to Implantation.2. Immunology and physiology of implantation.3. Immunotherapy in the patient with implantation failure.4. Clinical aspect of recurrent implantation failure.And finally, we’ll have three hours open discussion in the implantation panel.