Objective: Multipurpose prevention technologies (MPTs) are developmental dual-purpose options that would provide women with a contraceptive as well as a prevention modality aimed at sexually transmitted infections. The contraceptive vaginal ring (CVR) has many properties that makes it an ideal MPT candidate. The objective of this study is to understand women’s attitudes towards menstrual suppression, a potential side effect of using a CVR, and how to address these attitudes for MPT vaginal rings in development.
Materials and methods: We analyzed data derived from a subset of cohort study participants (n=45) in Thika, Kenya between January 2016- December 2018. The primary study enrolled 121 women 18-40 years with bacterial vaginosis and randomized them to cyclic or continuous CVR use for eight months. During the 6-month follow-up, a questionnaire eliciting attitudes towards menstrual suppression was administered. Responses to the menstrual suppression questionnaire between participants in the cyclic and continuous CVR use groups were compared. Likert-scale responses were summed to create a menstrual suppression attitude summary score, and a hierarchical cluster analysis was conducted to identify similarities in response patterns among all participants.
Results: Totally 81.8% of continuous CVR users believed that one was less likely to get pregnant after using hormonal medication to suppress menses, compared to 47.8% of cyclic CVR users (P=0.02), and were more worried it would cause long-term health effects (86.4% vs 60.9%, p = 0.05). The menstrual suppression attitude summary score ranged from 8 to 42, with lower scores indicating negative attitudes. The summary score identified three distinct clusters. When asked if menstrual suppression effects long-term health; 100% of Cluster 3 was worried compared to 80.8% of Cluster 2 and 46.2% of Cluster 1 (p = 0.03). The average summary score among Cluster 3 (Mean = 14.8, SD = 4.6) was lower
(p < 0.001) and women were more worried about discomfort during sex (p=0.05) as well as their sexual partners feeling the ring (p=0.02).
Conclusion: Women are more likely to have negative attitudes if they believe menstrual suppression hinders future reproductive health. Education on cycle control and fertility could mitigate negative attitudes and improve uptake of CVRs.

Objective: Whether ileal conduit diversion (ICD) or orthotopic neobladder (ONB) urinary diversion provides better quality of life (QoL) is still under debate. The Bladder Cancer Index (BCI) is a specific tool for bladder cancer (BCa) patients, providing reliable results in previous studies. A validated Farsi version of the BCI concerning cultural aspects could help Farsi-speaking clinicians gain more reliable feedback on QoL following urinary diversion.
Materials and methods: Based on WHO suggestions, we translated the BCI questionnaire into the Persian language. Then, we performed a cross-sectional study on BCa patients who underwent ICD or ONB urinary diversion. We compared their QoL via BCI and WHO questionnaires. Chi-square and independent t-tests were used where appropriate.
Results: The content validity ratio and the content validity indexes were 1 and 0.8-1.0, respectively. Of 57 participants, six patients (10.5%) were women. The ICD was performed for 38 (66.7%) and ONB diversion for 19 (33.3) participants. The mean age of ICD and ONB was 68.71 ± 7.40 and 64.28 ± 8.34 years, respectively (p-value: 0.055). In all sub-domains of BCI, except bowel habits, the mean scores were higher in the ICD group. A significant difference between ICD and ONB groups was found regarding urinary function (p-value<0.001). There was no significant difference between ICD and ONB groups in none of the domains of the WHO questionnaire.
Conclusion: The QoL of ICD and ONB patients did not differ significantly. Even ICD may be superior in ritual purification, while the psychological status of ONB patients was better.

Objective: This study aims at understanding the level of knowledge, attitude, and practice of breastfeeding among mothers and the factors associated with good knowledge about breastfeeding.
Materials and methods: A cross-sectional study among 251 mothers of infants admitted in the pediatric wards of SAT Hospital, Thiruvananthapuram was conducted during November-December 2019. The mothers of infants born between 37 and 42 weeks of gestation and without major birth defects were included in the study. The data were entered into an MS Excel sheet and analyzed using Statistical Package of Social Sciences version 26.0. Significance of association was tested using Chi-square test and multivariate analysis was done using binary logistic regression test.
Results: The mean age of the participants was 26.25 (SD 4) years. On multivariable analysis, higher education and older age were found to be significantly associated with good knowledge. Independent sample T-Test results show that there was a statistically significant difference between the mean age of mothers with good knowledge (26.4(±4), 25.14(±3.7)), p-0.015 and statistically significant association was found between the mean attitude scores (34.07(5.58)) with current breastfeeding practices (p=0.002). Chi-square test shows that exclusive breastfeeding was significantly associated with the mother’s age (p=0.006); 64.2% of women practicing exclusive breastfeeding were less than 25 years of age. This study also demonstrated a significant association between the initiation of breastfeeding within an hour and exclusive breastfeeding (p=0.003).
Conclusion: This study shows that mothers with higher age and higher educational qualifications were significantly associated with good knowledge about breastfeeding. Even though mothers have good knowledge, nearly half the mothers only exclusively breastfeed their infants for six months. Improving the educational qualification of women and increasing awareness about the benefits of breastfeeding among young women will promote breastfeeding practices.

Objective: The purpose of this study is comparison of carob with placebo in the treatment of male infertility.
Materials and methods: This study was performed as a clinical trial with two-group pretest-posttest design. Each group consisted of 30 members. The first group received 1.5 grams of carob per day, and the second group received placebo treatments. Treatment lasted for 12 weeks. Semen analysis as well as testosterone, prolactin, (LH), (FSH) and (TSH) were performed before and after drug treatment in two groups. Sexual function was assessed in the groups in two stages before and after the intervention using the standard International Index of Erectile Function. P-value less than 0.05 was considered statistically significant. Statistical analysis of data was performed using SPSS 16.
Results: The participants’ mean age was 34.83 ±6.22 in the placebo and 33.67 ±5.82 years in the Carob group. The results showed in the carob group compared to the placebo group, the rate of normal sperm counts increased by 17% and also the normal level of testosterone was 40% higher than the abnormal levels of the placebo group and these differences were statistically significant (P <0.05). And in most areas of sexual function, the mean scores after the intervention were higher than before (P> 0.05).
Conclusion: It is recommended to use carob supplements to improve spermogram parameters and male sex hormones.

Objective: Nowadays, the presence of husbands during the childbirth process is regarded as an important factor that can contribute to lower rate of the C-section, better success of physiologic delivery and higher satisfaction in childbirth experience. Considering the special sociocultural characteristics of the Iranian society, this method requires accurate assessment to be practical and effective. The aim of this research was finding out how husbands perceive the environmental and physical characteristics of delivery spaces via studying these physical characteristics, exploring them through husbands’ perception and finally discovering the mechanism behind formation of this perception.
Materials and methods: First, the conceptual model of the study was developed after a review of the physiologic childbirth literature. Then, a research questionnaire was designed and distributed among
120 husbands who recently had the experience of accompanying their wives during physiologic childbirth.
Results: The results showed that light, color and temperature play a significant role in husbands’ perception of delivery spaces under the special psychological conditions and stress that they experience during the childbirth. Designer should pay due attention to these three factors when designing the structure of childbirth spaces.
Conclusion: Promoting the environmental quality of the physiologic delivery room based on husband's perception can help mothers and medical staff better manage childbirth pain which is an integral part of natural childbirths.

Objective: Platelet Rich Plasma (PRP) is proposed to have important role in cell division and proliferation, angiogenesis and health. This study evaluates the effect of a single injection of autologous PRP on ovarian response markers in women with poor ovarian response (POR).
Materials and methods: This non-randomized clinical trial was conducted between August 2020 and September 2021. Fifty six women with Bologna criteria for POR willingly chose to participate in one of the following groups: PRP for one cycle in the time of oocyte pickup (OPU) (intervention group, n= 34) or control group (n=22).The primary outcomes were: number and quality of oocytes in coming 2 cycles of ICSI, and Anti Mullerian Hormone (AMH) level two months after PRP injection. The secondary outcomes were the number and quality of embryos and chemical pregnancy rate after embryo transfer.
Results: A total of 45 participants continued the study, of which 23 were in the intervention group and 22 in control group. There were no demographic differences between two groups. At a two cycle follow up, PRP group experienced a significant improvement in AMH level and there was no respective change in control group. In one year follow up the overall pregnancy rates were same in both groups (3% Vs. 0, p=.60), while there was no difference in cumulative number and quality of embryos.
Conclusion: PRP injection can improve ovarian reserve marker without adverse effects. Further evidence is required to evaluate the impact of PRP on assisted reproduction outcomes.

Objective: Pelvic access is a challenging matter in abdominal hysterectomy especially in obese
patients and presence of pelvic adhesions. Uterus manipulators (UM) have been used in a number of studies on laparoscopic approach to improve surgical performance. This study aimed to assess the impact of UM application on the operation time and blood loss in total abdominal hysterectomy (TAH) for benign diseases.
Materials and methods: Forty-one patients aged 34 to 56 years were enrolled for abdominal hysterectomy – 20 as the case group (hysterectomy with UM application) and 21 as the control group (conventional hysterectomy). In the case group, UM was used after uterus artery ligation during TAH. The control group underwent traditional TAH.
Results: The mean operation time was significantly less in TAH with UM compared to traditional TAH (90.23 ± 10.54 minutes vs. 140.5 ± 16.61 minutes; p-value<0.001). The mean decline between preoperative and 12-hour postoperative hemoglobin was 0.74 ± 0.23 mg/dL in the TAH with UM group and 1.65± 1.02 mg/dL in the traditional TAH group (p-value<0.001). Also, no difference was detected in intra- and post-operative complications.
Conclusion: The current study showed that, using UM is beneficial in total abdominal hysterectomy by decreasing the operative time and blood loss.

Objective: Postpartum depression (PPD) is a common mental disorder among women and it can cause negative consequences for them, children, and families; however, accurate statistics and underlying factors on PPD and its severity are not available in Iran.
Materials and methods: In this cross-sectional study, 200 women referred to an academic hospital for normal vaginal delivery, which had a full-term and single pregnancy and had passed between 6 weeks and 6 months of delivery, were selected by convenience sampling methods. The Edinburgh Depression Inventory and the checklist for demographic information of mothers were completed.
Results: The prevalence of postpartum depression was 11.0% and 68.2% of mothers had a mild type. 31.8% had a history of depression. There was a significant relationship between the severity of postpartum depression in women with a previous history of depression (P = 0.012). Between postpartum depression and maternal age (P = 0.115), body mass index at delivery (P = 0.571), number of pregnancies (P = 0.693), number of deliveries (P = 0.446), number of abortions (P = 0.424), willing
or unwilling pregnancy (P = 0.451), neonatal sex (P = 0.533), history of neonatal hospitalization
(P = 0.725), previous history disease (P = 0.725) was no statistical association.
Conclusion: The prevalence of PPD was approximately 11%, and there was a significant association between postpartum depression severity and a history of depression Physicians and policymakers should consider early screening for PPD, especially among women with previous depression.

Erratum.
J Family Reprod Health. 2023;17(4):270.DOI: https://doi.org/10.18502/jfrh.v17i4.14667

Objective: Changes in endocrine, nervous, renal, cardiovascular, and respiratory systems during pregnancy have been studied, but changes in liver function have been poorly studied. Therefore, the purpose of this study was to investigate the trend of changes in liver enzymes in normal pregnancy.
Materials and methods: This prospective longitudinal study included 68 pregnant women who were referred to the Obstetrics and Gynecology Clinic of Amiral Momenin Hospital in Zabol in 2021. In terms of the trimester of pregnancy, the presence of underlying diseases, history of previous pregnancies, disorders of the enzymes of recent patients, the patients were evaluated, and the information from the patients' files was analyzed.
Results: The average AST levels in pregnant women in the first, second, and third trimesters were 16.82, 17.47, and 18.00, respectively, which show that garlic consumption is increasing. The average PT in pregnant women decreased in the first, second, and third trimesters. The average direct and total bilirubin levels in pregnant women in the first and second trimesters showed a constant trend. The amount of total protein increased in pregnant women during the first, second, and third trimesters. In the second and third trimesters, the enzyme level was significantly higher in pregnant women than in nonpregnant women. The level of GGT in pregnant women in the first, second, and third trimesters showed a different trend.
Conclusion: Accurate evaluation of patients, especially in the third trimester, is necessary from the point of view of increasing enzyme levels in other countries.

Objective: In case of uterine prolapse, hyseroxacropexy, a conservative surgical approach, which allows the sparing of body image and sexuality, could be the choice in fertile women. Few information are reported on subsequent pregnancy after surgery.
Case report: A 33 years-old women with symptomatic prolapse underwent a laparoscopic hysterosacropexy. Subsequently she expressed her pregnancy desire and she got pregnant. A scheduled caesarean section was performed without complication. The subsequent follow-up was regular: the patient was asymptomatic and presented no sign of prolapse recurrence.
Conclusion: In motivate and well counselled patient, informed about the risk of prolapse recurrence, pregnancy could be considered after hysterosacropexy.