Division of Female Pelvic Medicine and Surgery, Department of Obstetrics and Gynecology, Emam Khomeini Hospital, Tehran University of medical sciences proposed a clinically relevant algorithm to guide appropriate decision making based on underlying risk stratification and resource utilization in order to resume elective surgeries, following COVID-19 pandemic crisis. The consequence of standardized decision-making factors and transparency of the principles will provide more assurance, consistency, and reliability on both sides, care providers and the patient. It also will decrease ethical dilemmas and moral criticism for surgeons. Eventually, this approach is applicable in any other disaster preparedness as a logical stratification of surgical indications for the female pelvic floor surgical procedures.

Objective: To assess the attitude of Jordanian health care workers toward surrogacy.
Materials and methods: Three municipalities in Jordan were randomly selected, one from each region: north, south and central of Jordan. A total of: four public hospitals, three private hospitals, one university hospital, 40 health centers and 40 private clinics were included in the study. Healthcare workers in the selected facilities were randomly approached using a self– administered questionnaire to collect data. Distributions of attitude by gender, job title, and physician’s specialty were used to describe participants’ attitude toward surrogacy.
Results: Responses of 382 participants were reported, of whom, 230 (60.2%) were females. Three in every four participants didn’t support legalizing surrogacy in Jordan. Majority reported negative attitude toward commercial surrogacy (85.1%) and noncommercial surrogacy (76.4%). Religious considerations were the main reason (71.1%) for the attitude toward surrogacy. Most items describing attitude toward surrogacy were significantly distributed across different job titles: nurses, medical doctors, and other healthcare workers (p < 0.05).
Conclusion: Negative attitude among health care workers toward surrogacy was mainly driven by religious beliefs. However, there are core cultural changes in the community which might alter the attitude toward surrogacy in the future.

Objective: To compare the effect of dydrogesterone and Gonadotropin releasing hormone (GnRH) antagonists on prevention of premature luteinizing hormone (LH) surge and pregnancy outcomes in infertile women undergoing Invitro fertilization/ Intra cytoplasmic sperm injection (IVF/ICSI).
Materials and methods: In a Randomized controlled trial (RCT), two-hundred eligible women undergoing in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) treatment were randomly assigned into two groups. Human menopausal gonadotropin (HMG) was administered for controlled ovarian stimulation (COS) in both groups. Intervention group (group 1) received 20 mg dydrogesterone from day 2 of menstrual cycle till trigger day and control group (group2) received GnRH antagonist from the day that leading follicle reached 13 mm in diameter till trigger day. Serum levels of LH, estradiol and progesterone were measured on the trigger day. The primary outcome measure was the incidence of a premature LH surge, and the secondary outcomes investigated were the chemical and clinical pregnancy rates in the first FET cycles.
Results: There were no significant differences in patients' age, BMI, AMH levels, previous IVF cycle, and cause of infertility between the two groups. None of the patients in two groups experienced a premature luteinizing hormone surge. The numbers of retrieved oocytes, the MII oocytes and good quality embryos, were significantly higher in the intervention group than antagonist group (p < 0.05). The overall chemical pregnancy rate in intervention group (43/91: 46.2%) and control group (45/91: 49.5%) (p = 0.820) was similar. Meanwhile, the clinical pregnancy rate was similar between groups too.
Conclusion: Regarding the cost, efficacy and easy usage of dydrogestrone, it may be reasonable to use it as an alternative to GnRH antagonist for the prevention of premature LH surge.

Objective: Women with premature ovarian insufficiency, menopause, gonadal dysgenesis, and genetic disorders as well as those with a history of recurrent in vitro fertilization failure may benefit from the assisted fertility techniques. These women experience concerns that directly affect their married life especially in egg donation treatment. This study was conducted to investigate the reproductive health concerns of infertile women who were candidates for egg donation.
Materials and methods: This qualitative content analysis was conducted in 17 infertile women who were referred to Imam Khomeini Hospital Infertility Clinic from July 2018 to March 2019. The participants were selected through purposeful sampling. Data were collected through individual in-depth semi-structured interviews. A conventional qualitative content analysis approach was adopted for data analysis using the MAXQDA12 software.
Results: The results of data analysis showed five themes, including threatened married life, lack of supportive situation, religious beliefs, psychosocial damage, and damaged feminine identity.
Conclusion: Infertility is usually accompanied by a great psychological sadness referred to as "stress of infertility". Assisted reproductive techniques (ART) are also a source of stress for patients; therefore, it has a significant impact on the marital relationship and mental health of infertile women. Hence, there is a need for psychological support from the treatment team to reduce woman reproductive health concerns.

Objective: Quality of work life is one of the most important variables recently considered by many managers who seek to improve the quality of their human resources. Considering the vital factor of job satisfaction of family physicians as a service provider, this study was conducted to evaluate the quality of working life of family physicians in Bam.
Materials and methods: This research is a cross-sectional and descriptive type. Research population includes all family physicians working at health centers in Bam. The Van Larr Quality of Work Life Questionnaire, which was validated by Nekoei Moghadam, was used. The questionnaire data is analyzed by SPSS 24 from statistical-descriptive tests (mean and standard deviation) and T-test and ANOVA.
Results: Quality of work life score in family physicians is obtained 2.93 out of 5. Control ambiance in work (CAW) has the highest mean (3.16) and Work-life balance (WLB) has the lowest mean (2.29). Work experience has a meaningful relationship just with the two components of WLB and SAW in Quality of work life (p = 0.036). Furthermore, in the factor of GWB, the average score of unmarried physicians (Mean = 3.18) were more than the married ones (Mean = 3.05) (p = 0.010). The mean score of unmarried physicians was more than the married ones.
Conclusion: The quality of work life from the family physicians is about upper-intermediate.
Thus, authorities of the family physician concept in the ministry of Health, and also in the Bam city should pay more attention to the family physician’s work life and consider programs and solutions in order to improve it.

Objective: This study aimed to determine the effect of Extra Virgin Olive Oil (EVOO) on vasodilator enzyme by repairing angiogenic function in rat model of preeclampsia.
Materials and methods: This research consisted of five groups; negative control (normal pregnant rats) group, positive control (preeclampsia rat model) group, preeclampsia rat model groups given EVOO in 3 different doses (0.5 ml/day, 1 ml/day, and 2 ml/day, respectively). Blood pressure measurements were carried out on day 12, 15, and 19 of pregnancy. After the rats were sacrificed, the placentas were collected to determine endothelial Nitric Oxide Synthase (eNOS) level of maternal plasma to determine soluble Fms-like Tyrosine Kinase 1 (sFlt-1) and Vascular Endothelial Growth Factor (VEGF) level.
Results: There were significant higher sFlt-1 level (p < 0.001), lower VEGF level (p = 0.009), and lower eNOS level (p = 0.034) between negative and positive control groups. After EVOO administration, sFlt-1 level was lower in dose 1 and 2 groups but higher in dose 3 group in accordance with VEGF and eNOS levels that were increasing both in dose 1 and dose 2 groups but decreasing in dose 3. There were significant differences between positive control and dose 1 (p = 0.015) and dose 2 (p = 0.001) in sFlt-1 level. None of all dose groups were statistically different with positive control group in VEGF level (dose 1 p = 0.601; dose 2 p = 0.297; dose 3 p = 0.805). eNOS levels of all dose groups were statistically different from that of the positive control group (dose 1 p = 0.014; dose 2 p = 0.001; dose 3 p = 0.024).
Conclusion: Administration of EVOO modulates eNOS as vasodilator enzyme by repairing the angiogenic function indicated by decreased sFlt-1 level and increased VEGF in rat model of preeclampsia.

Objective: Voluntary HIV testing is one of the key strategies in the HIV/AIDS prevention and control program. New National Strategic Plan for 2016-2030 in Malaysia, adapt three zeros viz. ‘zero new infections of HIV/AIDS, zero discrimination and zero AIDS-related deaths’. This study aimed to determine the predictors of voluntary HIV testing in Sarawak.
Materials and methods: A cross-sectional study was conducted with a total of 900 respondents
(450 males and 450 females) from the state of Sarawak, aged 18 years and above, who were selected by gender-stratified multistage cluster sampling. Data were obtained by face-to-face interview using a pretested questionnaire. Binary logistic regression analysis was done to determine the potential predictors for voluntary HIV testing.
Results: The prevalence of HIV testing was higher among female respondents (26%) compared to male respondents (14.2%), and the difference was statistically significant (p < 0.001). Binary logistic regression analysis revealed that household income more than MYR 1501 (p = 0.009), not living with a partner (p < 0.001) and discussion on HIV/AIDS (p = 0.019) appeared to be predictors for the male respondents, while, ethnicity was statistically significant for female respondents (p < 0.001).
Conclusion: The utilisation of HIV testing was low in both males and females. Thus, the finding of this study could be considered when designing HIV education and screening program in Sarawak.

Objective: Preterm birth is associated with high rates of neonatal morbidity and mortality. This study aimed to investigate the relationship between inter-pregnancy interval and the incidence of preterm birth.
Materials and methods: In a case-control study, 185 women with preterm delivery and 185 women with term delivery were included. Data including inter-pregnancy interval, demographic characteristics, history of prenatal and neonatal complications, parity, gravidity, type of delivery, and smoking status were collected.
Results: The mean of the inter-pregnancy interval in the case and control groups were 79.84 ± 45.55 months and 78.49 ± 41.29 months, respectively (P = 0.767). Inter-pregnancy interval 12-month or less in comparison with Inter-pregnancy interval more than 24 months significantly increased the odds of preterm delivery (OR: 4.05, 95% CI: 1.06-15.39, p = 0.040). However, inter-pregnancy interval of 13-24 months was not a risk factor when compared with more than 24-month inter-pregnancy interval (OR: 1.54, 95% CI: 0.62-3.80, p = 0.351). Having an educational level less than high school in comparison with tertiary level decreased the odds of preterm delivery (OR: 0.25, 95% CI: 0.11-0.56, P = 0.040). With each increase in number of gravidity odds of preterm delivery increased by 1.5 times (95% CI: 1.11-2.04, P = 0.009). Having a history of preterm delivery (OR: 2.57, 95% CI: 1.17-5.64, P = 0.019) and experiencing preeclampsia (OR: 1.98, 95% CI: 1.06-3.68, P = 0.032) increased the odds of preterm delivery.
Conclusion: Inter-pregnancy interval of 12-month or less in comparison with more than 2-year inter-pregnancy interval, experiencing preeclampsia, history of preterm delivery and increased number of gravidity increase the risk of preterm delivery. Health care providers need to be informed with the appropriate inter-pregnancy interval and counsel women to make an informed decision regarding their pregnancy.

Objective: Isolated salpingeal torsion (IST) is a rare cause of acute abdomen in women of the
reproductive age group. The lack of pathognomonic clinical, laboratory or radiographic findings makes
early diagnosis a challenge. We describe a case of IST in a 13-year-old who suffered from a repeat
torsion following initial conservative management.
Case Report: A 13-year-old girl presented with acute right lower quadrant abdominal pain of insidious
onset. Her past medical history was non-contributory and her initial workup was unremarkable.
Exploratory laparoscopy subsequently revealed isolated torsion of the right fallopian tube which was
detorted. She presented 10 months later with similar complaints and further workup demonstrated right
adnexal torsion which was confirmed by laparoscopy; salpingo-oophorectomy was necessary due to
gangrenous necrosis.
Conclusion: Conservative management of fallopian tube torsion confers the advantage of fertility
preservation but the risk of repeat torsion remains clinically significant.