Objective: To investigate the performance of first trimester Down syndrome (DS) screening markers in Iranian pregnancies.Although sonographic and serum markers are currently recommended for the first trimester screening of Down syndrome, the screening performance of the markers depends on the race and ethnicity.
Materials and methods: A retrospective case-control study using first trimester screening results recorded with the prenatal diagnostic multi-centers in Iran. A total of 6,384 pregnant women were examined from March 2012 to February 2017. Totally 100 Down syndrome cases and 266 matched controls were selected and the maternal characteristics, sonographic and biochemical screening data were collected. Statistical analysis was performed using logistic regression and descriptive statistics. A decision tree model was designed using the chi-squared automatic interaction detection method based on serum markers.
Results: For screening of DS pregnancies, PAPP-A (cut-off 0.795 MoM) yielded the highest sensitivity (86%) and NB marker presented highest specificity (96.24%). combination of the biochemical markers PAPP-A and β-hCG (cut-off: 1.55 MoM) showed the highest sensitivity over other combined markers. The decision-tree model based on serum markers improved (91% DR For a 5% FPR) first trimester screening performance.
Conclusion: The novel decision-tree model base on serum markers revealed a better predictive value to achieve high sensitivity and specificity of first trimester Down syndrome screening in Iranian population.

Objective: The fertility potential of women declines with aging and the likelihood of infertility and stillbirth increase. Treatment protocols involving dehydroepiandrosterone (DHEA) provide pathways on improving fertility and live birth rate. This randomized clinical trial aimed to evaluate the effect of DHEA on In Vitro Fertilization (IVF) outcomes in women over 35 years and normal ovarian reserve.
Materials and methods: One hundred and six consecutive women with advanced reproductive age undergoing IVF due to infertility were enrolled in the study. Participants in the intervention group received 75 mg/day of DHEA orally 8 weeks before starting the cycle of ovulation induction. Participants in placebo group received placebo tablets during the same period. After 8 weeks, routine procedure of IVF was initiated then Clinical pregnancy, Miscarriage, Endometrial thickness and Duration of stimulation were evaluated for all the participants in both groups.
Results: There is no significant difference between groups in terms of age and BMI. Mean endometrial thickness was significantly lower in DHEA group (9.63 ± 0.70vs.8.05 ± 0.70; p < 0.001) while Duration of stimulation was higher (8.98 ± 1.29vs.10.59 ± 1.43; p < 0.001). There was no significant difference between pregnancy rate, and miscarriage rate of the groups.
Conclusion: According to the result of this study, DHEA supplementation may improve IVF outcomes in infertile women. Although additional larger and placebo-controlled studies using different DHEA protocols are required to support our present findings.

Objective: To compare administration of weekly high dose versus daily low dose vitamin D₃ in treatment of vitamin D₃ deficiency in pregnancy.
Materials and methods: A randomized controlled clinical trial was performed between July 2016 until 2 July 2017 on 215 pregnant women with vitamin D₃ deficiency (serum levels < 30 ng/ml) and gestational age less than 14 weeks. The participants were randomly assigned to 2 treatment groups of A: receiving 1000 unit vitamin D₃ daily, and B: 50,000 units weekly for 10 weeks. At 24-28 weeks of gestation, serum levels of vitamin D₃ were measured again. Data entry and statistical analysis were performed by SPSS software v. 20 and P value less than 0.05 was considered as statistically significant level.
Results: Primary mean serum vitamin D3 level in group A was: 17.3 ± 6.8 and in group B: 15.2 ± 7.3 ng/ml while mean serum vitamin D3 level after treatment in group A was significantly lower than group B
(31.9 ± 118 B vs. 42.9 ± 15.5, p-value: < 0.001); both groups were successfully treated, no remarkable side effects were observed in either groups.
Conclusion: As both regimens treat vitamin D deficiency successfully and consuming weekly high dose vitamin D₃ makes more acceptable serum levels for mothers with no apparent side effects weekly high dose vitamin D₃ can be safely administered for vitamin D₃ deficiency in pregnancy, if further studies show similar results.

Objective: Andropause syndrome is caused due to the deficiency in sex hormones and brings about symptoms of physical, psychological, and sexual nature. This study aims at investigating the prevalence of andropause syndrome in 40-65-year-old men in the central city of Iran (Arak).
Materials and methods: This study is a descriptive cross-sectional research conducted on 600 men living in the city of Arak in 2017. The subjects were selected through cluster sampling and qADAM was used for collecting data including three areas (level of energy, psychological and sexual). The data were analyzed through descriptive and inferential statistics (independent t-test and ANOVA) and using SPSS 16.
Results: The results showed that the average questionnaire score increased with an increase in age up to 50 years and above. Correlation test for the three subscales of physical, psychological, and sexual showed that the psychological subscale had the highest correlation with andropause score (p < 0.05). Among the items related to the subscales, the statement” I feel my sex drive has decreased” with mean and standard deviation of 3.62 ± 1.06 had the highest correlation with andropause and the statement “I feel I have no value for society” with mean and standard deviation of 1.7 ± 0.86 had the lowest correlation with andropause.  
Conclusion: Andropause age in Arak is 50 years and above. Average questionnaire score showed a positive direct relation with age. Decreased sex drive had the highest correlation and losing social value had the lowest correlation with andropause state.

Objective: Cisplatin has been established to cause reproductive dysfunction; Cochlospermum planchonii is globally used in folklore medicine and has numerous therapeutic benefits. This study focused on fertility enhancing activities of Cochlospermum planchonii (Cp) on cisplatin-induced reproductive dysfunctions.
Materials and methods: Total of 30 male and 30 female adult Sprague-Dawley rats were used for this study. The male rats randomly assigned into Group A (control) was given normal saline 2 ml/kg, Group B, C, D and E rats received(single dose of 8 mg/kg Cisplatin (i.p.) on the first day), (500 mg/kg body weight (bwt) of Cponce once daily for 14 days), (single dose of 8 mg/kg Cisplatin (i.p.) on 1^st day followed by 500 mg/kg bwt of Cp once daily for 14 days) and (single dose of 8 mg/kg Cisplatin on first day followed by 50 mg/kg vitamin C for 14 days). Parameters tested include reproductive hormones, testicular histology, testicular antioxidants, semen parameters and fertility test.
Results: Histological profile of the testes revealed derangement of the testis cytoarchitecture; Seminiferous epithelium, body, testes, accessory sex organs weight and sperm parameters, were significantly reduced (p <0.05). Hormonal assay showed significant changes in testosterone (p< 0.05) while luteinizing hormone and follicle stimulating hormone remained unchanged following cisplatin administration and a marked improvement was observed after Cochlospermum planchonii administration. Similarly, Cochlospermum planchonii improved the reduction of antioxidant parameters (SOD, CAT, GPx and GSH) and the increased MDA caused by cisplatin ingestion.
Conclusion: Cochlospermum planchonii may thus offer protection against free radical mediated oxidative stress of rats with cisplatin induced reproductive dysfunction.

Objective: Mothers with low birth weight infants experience more stress, which results in reduced breastfeeding self-efficacy and exclusive breastfeeding; In this regard, stress Inoculation Training (SIT) is one of the effective ways for inoculation against stress and psychological distress; Therefore, this study aimed to investigate the effect of SIT on breastfeeding self-efficacy and perceived stress of mothers with low birth weight infants.
Materials and methods: This clinical trial study was conducted from October to December 2017 on 100 mothers with low birth weight infants; the infants had been hospitalized in the neonatal intensive care unit (NICU) in Kermanshah, Iran. The eligible mothers were randomly divided into two groups, i.e., intervention (n = 50) and control (n = 50) groups.
Results: The mean score of breastfeeding self-efficacy, before SIT (33.82 ± 8.92) compared to after SIT (42.02 ± 8.83), significantly increased (p < 0.001), though no statistically significant difference was reported in the control group (p > 0.05). The mean score of perceived stress was significantly reduced after SIT (26.29 ± 6.49) compared to values before SIT (31.25 ± 5.82) (p < 0.001).
Conclusion: The present study showed that on the one hand, SIT can effectively increase the breastfeeding self-efficacy in mothers with low birth weight infants; on the other hand, it can reduce their perceived stress. Therefore, the need for holding in-service training courses is felt in order to train the caregiving personnel, especially nurses, in applying the SIT technique.

Spontaneous uterine inversion rarely occurs in times other than the postpartum period. This condition is usually associated with the presence of a polypoid mass in the fundus, which is often a uterine leiomyoma or, in rare cases, a uterine sarcoma. Herein we report a case of a multipara, 51-year-old woman, presented with pelvic pain and vaginal bleeding. On the speculum examination, a circular mass of about 10 Cm, was observed in the vagina. In an ultrasound, a 55×62 mm intramural fibroid was observed. the patient was scheduled for surgery. After accessing the abdominal cavity, the patient was diagnosed with the uterine inversion. A longitudinal incision was made on the retraction ring. The base of the prolapsed mass was clamped at the incision site, and the mass was driven up into the vaginal canal and a total hysterectomy was performed.

Objective: Triplet or higher-order multiple pregnancies are often caused due to ovulation induction. Spontaneous quadruplet pregnancy is a rare phenomenon which is associated with maternal and fetal complications. Here in, we report a spontaneous quadruplet pregnancy with no family history and as a result of an unwanted pregnancy.
Case report: The patient was a 34-year-old, G4 L2 Ab1. She noticed being pregnant during breastfeeding, a spontaneous quadruplet pregnancy. There was no case of multiple pregnancies in her or her husband's family. In week 29 she was hospitalized due to the diagnosis of preterm labour. At 32 weeks and 4 days of gestation, because of the restart of labour contractions and dilatation development, she underwent a cesarean section. The outcome was the birth of 4 healthy neonates weighing between 1800 to 2100 gram and normal Apgar score.
Conclusion: Quadruplet pregnancy can rarely occur spontaneously even unintentionally, and can reach the third trimester without prophylactic cerclage.