Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 14 3 2020 11 22 131 149 Pedro Brandão Department of Reproductive Medicine, Infertility Institute of Valencia, Valenica, Spain AND Faculty of Medicine, University of Porto, Porto, Portugal Manuel Gonçalves-Henriques Department of Obstetrics and Gynecology, Prof. Doutor Fernando da Fonseca - Amadora Hospital, Lisbon, Portugal 2020 06 03 2020 09 20 Objective: To review publish data about human microbiome. It is known to modulate many body functions. In the field of Reproductive Medicine, the main question is in what extent may female genital tract microbiome influence fertility, both by spontaneous conception or after Assisted Reproductive Treatments (ART). The aim of this work is to review publish data about this matter. Materials and methods: This is a systematic review on the effect of the microbiota of the female genital tract on human fertility and on the outcomes of ART. Results: Fourteen articles were retrieved, concerning female lower genital tract and endometrium microbiota, including 5 case-controls studies about its impact on fertility, 8 cohort studies regarding ART outcomes and 1 mixed study. The main variables considered were richness and diversity of species, Lactobacillus dominance and the role of other bacteria. Results and conclusions of the various studies were quite diverse and incoherent. Despite the inconsistency of the studies, it seems that vaginal, cervical and endometrial microbiome may eventually play a role. Whether high richness and diversity of species, low amounts of Lactobacillus spp. or the presence of other bacteria, such as Gardnerella spp., may adversely affect reproductive outcomes is not clear. Conclusion: The influence of female genital microbiota on the ability to conceive is still unclear, due to the paucity and inconsistency of published data. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1432 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1432/526

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 14 3 2020 11 22 150 157 Michela Cirillo Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy AND Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy Maria Coccia Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy AND Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy Cinzia Fatini Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy AND Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy 2020 07 31 2020 09 20 Objective: The preconception period is largely neglected, whereas it represents an opportunity to identify and modify clinical and behavioral risks, particularly in infertile women characterized by an unfavorable vascular burden. The present study was performed to strengthen previous findings and to increase the awareness of clinicians who should envision a broader preconception approach in infertile women, beyond their reproductive health. Materials and methods: In this cross-sectional study, we investigated 1003 Caucasian women, referred to the Internal Medicine Clinic at the Assisted Reproductive Technologies Center, Florence. Results: A high prevalence of dyslipidemia (57.4%), overweight/obesity (29.1%) and, smoking habit (26.6%) were found. We provided evidence of unhealthy lifestyle habits, represented by a closer adherence to the Mediterranean diet in the 9.5% only and by a sedentary behavior in 73%. A significant correlation between the Mediterranean Diet score and both anthropometric and metabolic parameters was found. We also observed a lower score adherence with both metabolic syndrome and diabetes (for both p=0.02), but not with hypertension. Conclusion: Before infertility treatment, the correction and the management of modifiable and non-modifiable cardiovascular risk factors are mandatory and represent the main goal for a safe pregnancy, and lifetime women’s health. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1492 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1492/527

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 14 3 2020 11 22 205 208 Marjaneh Farazestanian Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Asieh Maleki Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Somayeh Bolandi Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Zohreh Yousefi Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Malihe Hasanzadeh Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Laya Shirinzadeh Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Sara Kamandi Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 2020 03 10 2020 09 20 Objective: The presence of a normal fetus with normal karyotype accompanied by molar changes in the placenta is a rare condition, which carries a significant risk to the mother and fetus. There is a controversy regarding the proper management of this condition. Here, we present the case of a singleton pregnancy that showed molar changes in the pathological study of the placenta, but ended up with a normal viable neonate. Case Report: A 23-year-old primigravida woman, with a 3-year history of infertility, presented with vaginal bleeding and spotting. Her ß-human chorionic gonadotropin (HCG) at 13th week was 36500 mIU/ml. Serial sonography assessments were suggestive for molar changes and a normal fetus with growth retardation but normal Doppler assessment. The patient underwent elective Cesarean section at 37 weeks gestation and a healthy female neonate with an Apgar score of 9-10, weighing 2270 g was born. Pathological assessment of the placenta confirmed the diagnosis of incomplete hydatidiform mole. After two months, the mother had no complications, her ß-HCG level was untraceable, and the infant was in good condition. Conclusion: Despite being a rare condition, partial moles can be accompanied by delivery of a normal fetus. The management of this condition still remains challenging and should be done under close monitoring with extreme caution. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1334 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1334/535

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 14 3 2020 11 22 158 165 Maryam Bagheri Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Fedyeh Haghollahi Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran Mamak Shariat Maternal, Fetal & Neonatal Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, Iran Mina Jafarabadi Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran Parastoo Aryamloo Department of Nursing, Tehran University of Medical Sciences, Tehran, Iran Elahe Rezayof Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran 2020 08 04 2020 08 31 Objective: The coronavirus disease 19 (COVID-19) is a highly transmittable and pathogenic viral infection, causes severe acute respiratory syndrome and was spread throughout the world in early 2020. The effects of vitamin and micronutrient supplements on the prevention and treatment of COVID- 19 seems challenging in scientific considerations. On the other side generally, experts warn against over-consumption of these supplements. Materials and Methods: This study aimed to investigate the vitamin and micronutrient supplementation usage pattern in past history of patients with COVID-19 via a cross-sectional inquiry. Totally 510 patients referring to the infectious disease clinic of Imam Khomeini Hospital in Tehran from March 2020 to May 2020 were recruited. The inclusion criterion was suspected patients for COVID-19 based on clinical findings and CT scans of the lung. The infected patients included both inpatients (171) and outpatients (339). Demographic information, clinical signs, and the supplement pattern use were collected through a questionnaire and the data were statistically analyzed. Results: Vitamin D3 intake was reported in 30% (103 patients) of outpatients and 16.5% (28 patients) of hospitalized patients, which is statistically significant (P=0.001). It shows that, the frequency of vitamin D3 consumption in the outpatient group was higher than inpatient group. This significant difference has also been shown in zinc consumption, in 29 patients (9%) outpatients versus 4 patients (2%) inpatients were reported (P=0.007). Multi nominal regression showed that vitamin D3 intake has a supportive effect and reduces the risk of exacerbation and worsening of the disease. (OR=0.291; 95% CI 0.102-.0834, P=0.022). Conclusion: According to the results of the present study and the findings of other studies, considering the supportive effect of vitamin D3 in reducing the severity of infectious diseases; Clinical trials with an appropriate sample size are recommended to investigate the functional role of this vitamin in improving viral diseases of the respiratory tract   https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1501 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1501/528

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 14 3 2020 11 22 166 172 Alireza Mirahmadizadeh Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Ali Semati Department of Health Deputy, Shiraz University of Medical Sciences, Shiraz, Iran Babak Eshrati Preventive Medicine and Public Health Research Center, Social Injury Prevention Research Institute, Iran University of Medical Sciences, Tehran, Iran Fariba Moradi Non-communicable disease administration, Research Center for Geriatric, Shiraz University of Medical Sciences, Shiraz, Iran Nasrin Asadi Department of Obstetrics and Gynecology, Research Center for Maternal-Fetal, Shiraz University of Medical Sciences, Shiraz, Iran 2020 02 11 2020 09 08 Objective: we aimed to carry out an applied methodological tool, using Root-Cause Analysis (RCA), to determine the main causes of maternal mortality in Fars province, south of Iran, in 2014. Materials and methods: This is a case-series study and was conducted based on a careful examination of records and verbal autopsy with the family of the deceased person and their medical care team. Using RCA, quantitative dynamic modeling was done to display the overall impacts of different causes on maternal mortality. Finally, sensitivity analysis was done to determine the magnitude of contribution of each root-cause of maternal mortality. Results: Totally, all 10 maternal deaths with Maternal Mortality Rate (MMR) of 13.4 per 100.000 births, were recorded in the maternal surveillance system during 2014. The RCA results revealed that the root-causes of maternal mortality were ignorance and negligence (50%), delay in diagnosis (30%), delay in service provision in the first 24 hours after delivery (10%), and undesirable health care (10%). The results of sensitivity analysis in different scenarios revealed that medical negligence had the highest contribution to maternal mortality. Conclusion: Although maternal surveillance system stated some causes such as hemorrhage to be responsible for maternal deaths, the RCA showed that root-causes such as medical neglects had a fundamental role. Therefore, maternal mortality can be prevented by reforming the health care system and training all service providers, especially for high-risk mothers https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1314 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1314/529

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 14 3 2020 11 22 173 179 Mahboubeh Firouz Department of Obstetrics and Gynecology, Ali Ibn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran Narjes Noori Department of Obstetrics and Gynecology, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Marzieh Ghasemi Department of Obstetrics and Gynecology, Ali Ibn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran AND Moloud Infertility Center, Ali Ibn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran Alireza Dashipour Cellular and Molecular Research Center, Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran Narjes Keikha Moloud Infertility Center, Ali Ibn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran 2020 03 29 2020 09 22 Objective: Intrauterine insemination (IUI) is an assisted conception technique that involves the deposition of a processed semen sample in the upper uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract. Hence, we compared the results of doing intra-uterine insemination 36 and 42 hours after human chorionic gonadotropin (hCG) hormone injection to achieve clinical and chemical pregnancy rates. Materials and methods: One hundred and sixty infertile women with unexplained infertility participated in this clinical trial. They were divided into two groups: those who underwent IUI 36 hours after hCG injection (control group), and those who underwent IUI 42 hours after hCG injection (case group). Statistical analyses were done using IBM-SPSS 25.0. and Chi-square test were used for data analysis. Results: The percentages of clinical and chemical pregnancies were significantly higher in the 42h group compared to the other group (P = 0.038 vs. P = 0.009, respectively). There was no significant difference regarding frequency of abortion, twin and ectopic pregnancies between the two groups (P > 0.05). Conclusion: Doing IUI 42 hours after hCG injection can significantly increase chances of fertility compared to doing it 36 hours after hCG injection. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1343 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1343/530

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 14 3 2020 1an Masoumeh Masoumi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Amirali Barkhordarioon Department of Obstetrics and Gynecology, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Azadeh Tarafdari Department of Obstetrics and Gynecology, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2025 03 01 2025 09 30 Objective: To evaluate the efficacy of 50 mg/day intramuscular (IM) progesterone in achieving optimal serum P4 levels during endometrial preparation and investigate the association between serum P4 levels on ET day and subsequent fertility outcomes in hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles. Materials and methods: This prospective cohort study included 121 women (aged 22-45 years) undergoing HRT-FET at Imam Khomeini Hospital Complex from December 2022 to January 2024. Endometrial preparation began with oral estradiol valerate (6 mg/day) on cycle day 2. Once an endometrial thickness of ≥8 mm was achieved, daily IM P4 (50 mg) was initiated. Serum P4 levels were measured on ET day, and oral dydrogesterone (20 mg/day) was added for patients with P4 levels <10.0 ng/mL. Primary outcomes included chemical pregnancy, clinical pregnancy, miscarriage, and ongoing pregnancy rates. Results: The mean serum P4 level on ET day was 22.8 ± 10.1 ng/mL, with 78.5% of participants achieving the target range (10-32.5 ng/mL) following IM P4 administration. Overall chemical pregnancy, clinical pregnancy, and ongoing pregnancy rates were 23.1%, 18.2%, and 14.1%, respectively, with a miscarriage rate of 5.0%. Multivariate analysis revealed that P4 levels >27.8 ng/mL were associated with reduced odds of chemical pregnancy (OR = 0.20; 95% CI: 0.05-0.86; p = 0.03), while no significant differences were observed in other pregnancy outcomes across P4 quartiles. Conclusion: Daily administration of 50 mg IM P4 effectively achieved optimal serum P4 levels in most patients. While higher P4 levels (>27.8 ng/mL) were associated with reduced chemical pregnancy rates, the absence of significant correlations with other pregnancy outcomes highlights the multifactorial nature of embryo implantation success. These findings emphasize the need for further research to refine P4 thresholds and identify additional predictive factors influencing pregnancy outcomes in FET cycles.   https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3155 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3155/734

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 19 3 2025 11 04 226 231 Mohadese Dashtkoohi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohammad Haddadi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mostafa Saeedinia Shahid Beheshti University of Medical Sciences, Tehran, Iran Fedyeh Haghollahi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Masoumeh Masoumi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Zohreh Heidary Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2025 04 30 2025 09 29 Objective: Infertility is a global health challenge, affecting many couples worldwide. Male infertility contributes to 20–50% of cases. Although semen analysis parameters are widely regarded as key indicators of male fertility, their association with in vitro fertilization (IVF) success remains debated. This study evaluated the relationship between specific semen parameters and grade A embryo formation in IVF among infertile men. Materials and methods: This retrospective cross-sectional study was conducted at a referral infertility center from March 2019 to March 2021, involving 104 men diagnosed with male-factor infertility. Semen parameters, including sperm count, motility, morphology, and volume, were analyzed. The primary outcome was the formation of at least one grade A embryo, defined as a successful IVF outcome. Statistical analyses included chi-square tests and logistic regression. Results: The median age differed significantly between the successful and unsuccessful IVF groups (36 vs. 38 years, p=0.050). No significant differences were observed in semen volume, sperm count, motility, or morphology between groups. Logistic regression revealed that younger age was associated with a higher likelihood of grade A embryo formation (OR=0.935, p=0.012), whereas semen parameters showed no significant association with embryo quality. Conclusion: This study found no significant association between semen parameters and grade A embryo formation in IVF, suggesting that traditional semen analysis has limited predictive value for embryo quality. Although younger age was associated with a higher likelihood of success, the effect size was small (OR=0.935, p=0.012), and its clinical impact may be limited. These findings highlight the potential for successful embryo development despite suboptimal semen parameters and underscore the need for a broader approach to assessing male fertility beyond standard semen analysis. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3233 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3233/735

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 19 3 2025 11 04 232 239 EN Pantea Nazeri Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Najmeh Hamzavi Zarghani Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada Zhale Tahmasebinejad Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohadese Dashtkoohi Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Mehdi Hedayati Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Parvin Mirmiran Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mamak Shariat Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Fereidoun Azizi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2025 05 11 2025 09 30 Background: Several bioactive components are present in breast milk, which contribute to enhancing growth and development. Objectives: This study targeted to investigate the potential role of breast milk iodine concentration (BMIC), insulin-like growth factor-1 (IGF-I), and brain-derived neurotrophic factor (BDNF) during the early stage of lactation in child neurocognitive development. Methods: In this secondary analysis, we examined 122 breastfeeding mothers and their healthy children, all of whom were breastfed for at least six months. Levels of BDNF, IGF-1, and BMIC were assessed in breast milk samples obtained between the third and fifth days after lactation began. Three-year-old children were administered the Bayley-III screening test to assess their cognitive, motor, and language development. Results: The median (interquartile range) concentrations of iodine, BDNF, and IGF-1 in breast milk during the starting few days of lactation were 285.0 (181.0-366.0) µg/l, 0.59 (0.52-0.76) ng/ml, and 12.5 (9.6-18.3) ng/ml, respectively. The mean (standard deviation) cognitive, motor, and language scores were 101.0 (10.8), 93.4 (14.6), 100.1 (13.5) and, respectively. Linear regression models revealed a negative relation between breast milk iodine and children’s cognitive development ((β unadjusted = -0.004 (P = 0.010); β adjusted = -0.003 (P = 0.024)). However, no associations were found between breast milk BDNF and IGF-1 and cognitive, language, or motor scores in three-year-olds. Conclusion: Our findings indicated that early exposure to these breast milk components has no substantial association with neurodevelopment in three-year-old children. Further research is needed on breast milk components’ impact on child health. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3250 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3250/736

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 19 3 2025 11 04 240 246 Fahimeh Ghotbizadeh Vahdani Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Mohammad Haddadi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Sepideh Ahmadi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Zahra Panahi