Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 1 2026 07 22 19 31 Elnaz Kalantari Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Maryam Tajvar Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Shohreh Naderimagham Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran AND Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Amirhossein Takian Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND Center of Excellence for Global Health, Department of Global Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran 2025 10 06 2026 06 03 Objective: Obesity is a global health threat, especially among women of reproductive age, and it adversely affects the health of both mothers and their children. This study aimed to identify and analyze the causes and management challenges of maternal obesity in Iran from the perspectives of key informants. Materials and methods: This is a qualitative study. We conducted semi-structured, in-depth interviews with 20 experts, from September to December 2023. We analyzed data using Leichter’s (1979) framework throught an inductive-deductive approach, facilitaed with MAXQDA 2020 software. Results: We identified challenges in managing maternal obesity and categorized them into 10 main categories and 21 sub-categories, grouped within five constructs according to Leichter’s framework: Situational factors (climate changes and international sanctions), Structural factors (high prevalence of overweight and obesity among women and unfavorable economic conditions), Socio-cultural factors (misconceptions and misuse of traditional Iranian medicine), Environmental or International factors (social norms and values, and the limited influence of international organizations), and Governance and Executive factors (weak governance by the Ministry of Health and Medical Education (MoHME) and poor inter-sectoral cooperation). Conclusion: Addressing maternal obesity is essential to achieve Sustainable Development Goals (SDGs), particularly in low- and middle-income countries (LMICs). Current challenges such as food insecurity, economic decline, and insufficient maternal awareness threaten maternal health in relation to obesity. Tackling these issues requires a coordinated, multi-sectoral approach involving healthcare system strengthening, public awareness campaigns, and empowerment of women and families. Prioritizing maternal obesity within national health agendas is critical for an effective response. Further research on maternal obesity in Iran is recommended to uncover root causes and develop effective interventions, providing policymakers with the evidence needed for informed decision-making. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3512 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3512/750

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 1 2026 07 22 3680 3680 Necmettin Yıldız Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Pamukkale University, Denizli, Turkey 2026 02 25 2026 06 09 No abstract No abstract No abstract https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3680 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3680/757

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 1 2026 07 22 78 82 EN Medha Gudavalli Department of Family Medicine, University of California San Diego, San Diego, California, United States of America Jenny Thai Department of Family Medicine, University of California San Diego, San Diego, California, United States of America Divya Reddy Department of Family Medicine, University of California San Diego, San Diego, California, United States of America Caitlin MacMillen Department of Family Medicine, University of California San Diego, San Diego, California, United States of America Michele Ritter Department of Infectious Diseases, University of California San Diego, San Diego, California, United States of America Madison Kent Department of Obstetrics and Gynecology, University of California San Diego, San Diego, California, United States of America 2026 03 31 2026 06 09 Objective: To describe a rare case of non-menstrual staphylococcal toxic shock syndrome (TSS) with Staphylococcus aureus urinary tract infection as the suspected primary source and to highlight the successful use of linezolid as adjunctive therapy when clindamycin resistance is present. Case report: A 42-year-old woman presented with fever, vomiting, diarrhea, and severe vulvar pain. One month prior, she experienced vaginal pruritus with excoriations and fissuring that never fully resolved. On examination, she had conjunctival injection, tongue inflammation with non-vesicular lesions, and a diffuse erythematous macular rash. Laboratory evaluation revealed elevated transaminases, thrombocytopenia, and bandemia. Urinalysis demonstrated 100,000 CFU of Staphylococcus aureus. Gynecologic examination revealed vulvar and vaginal erythema with ulcerated cervical lesions. Vaginal culture also grew heavy Staphylococcus aureus. Given the constellation of fever, rash, mucosal involvement, hepatic dysfunction, and positive Staphylococcus aureus cultures, a diagnosis of toxic shock syndrome was made. The isolate was resistant to clindamycin, necessitating treatment with vancomycin, piperacillin-tazobactam, and linezolid. The patient improved and completed 14 days of antibiotic therapy with complete resolution of symptoms. Conclusion: Staphylococcus aureus urinary tract infection is an exceedingly rare source of toxic shock syndrome. Clinicians should maintain a high index of suspicion for TSS in patients with any staphylococcal infection presenting with fever and multisystem involvement. Linezolid is an effective alternative to clindamycin for toxin suppression, particularly in cases involving clindamycin-resistant organisms. Prior mucosal barrier disruption may be an important risk factor for TSS development. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3687 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3687/756

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 1 2026 07 22 1 9 Zakaria Rostamitehrani National Horizons Centre, Centre for Biodiscovery, School of Health and Life Sciences, Teesside University, Darlington, DL1 1HG, UK Mina Jafarabadi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Elahe Rezayof Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2026 02 08 2026 06 09 Objective: Cancer is one of the most complex genomic diseases that can gain abilities to resist different therapies. These capabilities, known as the hallmark of cancer, allow specific and personalised therapies such as immunotherapy. Materials and methods: This review paper discusses how different immunotherapies, such as immune checkpoint blockade, chimeric antigen receptor (CAR) T-cell, and Oncolytic viral therapy, which are currently being used and researched to overcome cancer cell capabilities by using the patient’s immune system. Results: Immune checkpoint blockade therapy is used to block immune inhibitory pathways using anti-PD-1 receptor and anti-CTLA-4 receptor antibodies, which make lymphocytes more responsive towards cancer cells. Then, it is discussed how CAR T-cells are designed to make cancer antigens more easily identified by T-cells for a more specific immune response. Furthermore, it is shown that oncolytic viruses directly destroy cancer cells and, indirectly, make them more vulnerable to the immune system. Conclusion: It is proposed that oncolytic viral therapy is a bridge between Immune checkpoint and CAR T-cell therapies for a more effective and more specific immune response towards cancer. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3666 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3666/748

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 1 2026 07 22 32 40 Reza Abdollahi Patient Safety Research Center, Clinical Research Institute, Nursing & Midwifery School, Urmia University of Medical Sciences, Urmia, Iran Yousef Mohammadpour Patient Safety Research Center, Clinical Research Institute, Nursing & Midwifery School, Urmia University of Medical Sciences, Urmia, Iran 2026 01 26 2026 06 09 Objective: Mothers of children with autism spectrum disorder (ASD) in Iran encounter profound social challenges, such as stigma, blame, isolation, and inadequate support, intensified by cultural norms and limited resources. This qualitative study aimed to explore coping strategies used by these mothers in Urmia, northwestern Iran. Materials and methods: Employing conventional content analysis per Graneheim and Lundman’s framework, we purposively sampled 18 mothers of children aged 3–18 years with confirmed ASD, ensuring maximum variation. Semi-structured in-depth interviews were conducted from January 2024 to June 2025 until data saturation. Transcripts were coded and analyzed iteratively via MAXQDA software, with rigor maintained through credibility, dependability, confirmability, and transferability. Results: The overarching theme was “Multifaceted Coping Strategies for Social Challenges,” encompassing four categories: [1] Individual Coping Factors (acceptance, positive reappraisal, self-care, emotional regulation, knowledge acquisition); [2] Interpersonal and Relational Coping Factors (selective social engagement, family/spousal support, educating others); [3] Spiritual and Cultural Coping Factors (religious beliefs, prayer, finding meaning, patience); and [4] Community and External Support Coping Factors (support groups, advocacy, awareness efforts, professional guidance). Conclusion: Mothers integrated emotion-focused (especially spiritual) and problem-focused strategies, influenced by Iranian cultural, religious, and collectivist contexts, underscoring needs for culturally tailored interventions, stigma reduction, and enhanced support services to bolster resilience. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3660 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3660/751

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 1 2026 07 22 10 18 Effat Davoudi-Monfared Department of Clinical Pharmacy, Yas Hospital Complex, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Seyedeh Mahdieh Fotouk Kiaie Yas Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mahbod Ebrahimi Vali-E-Asr Reproductive Health Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2025 12 17 2026 06 03 Objective: Treatment of female infertility consists different strategies including metabolic, hormonal and surgical therapeutic modalities. Non-vitamin supplements with antioxidant activity as carnitines, Inositols, Poly Unsaturated Fatty Acids (PUFAs), coenzyme Q10 and melatonin are among those with most popularity, but their prescription may confer some warnings. Materials and methods: This review narrates the antioxidant mechanism of these supplements, beside their effect on outcomes of infertility treatment while considering side effects, warnings and ranges of doses. Results: Carnitines are used for energy production and fat metabolism, while they have anti-aging and antioxidant effects. Supplementation with carnitines improve obesity outcomes, especially in Poly Cystic Ovarian Disease (PCOS) patients. Rare cases have shown increasing risk of seizure with levocarnitine. Coenzyme Q10 (Ubiquinone) has shown benefit in patients with PCOS or poor ovarian responders. It significantly increased live birth rate and the side effects are minimal even in higher doses. Poly Unsaturated Fatty Acids (PUFAs) have shown impact on follicular development and embryo quality. The hazard is increasing lipid low density lipoprotein (LDL) in high doses. Use of inositols in female infertility treatment is due to its metabolic effect and insulin resistance in PCOS patients resulting in decreasing use of gonadotropins. They have produced acceptable results about count of follicles and oocyte quality. Hypoglycemic effects of inositols have been reported as side effect, especially in combination with other hypoglycemic agents. Melatonin can increase the clinical pregnancy rate, and improve the outcomes about oocyte and quality of embryo via receptor- and non-receptor- action. Dizziness, drowsiness, and headache are reported in higher doses of melatonin. Conclusion: The attitude that all supplement can be prescribed without restriction endangers susceptible patients. Hence, increasing our knowledge about efficacy and safety profile can help individualize prescription of supplements for female infertility. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3622 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3622/749

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 1 2026 07 22 41 51 Abolfazl Mazandarani Plasma and Nuclear Fusion Research School, Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran Shervin Goudarzi Plasma and Nuclear Fusion Research School, Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran 2026 05 15 2026 06 09 Objective: Effective infection control in family and reproductive healthcare settings is essential for preventing transmission of clinically significant pathogens. Plasma-activated saline (PAS), generated by non-thermal atmospheric pressure plasma, has emerged as a promising eco-friendly antimicrobial agent due to the generation of reactive oxygen and nitrogen species (RONS). This study evaluated the antibacterial activity of PAS produced by a dielectric barrier discharge (DBD) plasma system and investigated its potential applicability in reproductive and family healthcare environments. Materials and methods: In this experimental study sterile physiological saline was exposed to a DBD plasma system under atmospheric pressure for different activation durations. Antibacterial activity was evaluated against Pseudomonas aeruginosa, Klebsiella pneumoniae, Salmonella spp., Escherichia coli, Staphylococcus aureus, and Shigella sonnei. Bacterial suspensions were treated with PAS at different exposure times, and viable bacterial counts were quantified using the plate count method. Results: Increasie>192 198 EN Hamideh Moosavi khosravi Department of Midwifery and Reproductive Health, Hamadan University of Medical Sciences, Hamadan, Iran Soodabeh Aghababaei Department of Maternal and Child Health, Mother and Child Care Research Center, School of Nursing and Midwifery, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran Farideh Kazemi Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran Azita Tiznobaik Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran Shahnaz Kohan Department of Midwifery and Reproductive Health, School of Nursing and Midwifery Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 2022 02 18 2022 07 17 Objective: Due to the Covid-19 pandemic crisis, which causes stress and threatens health, especially in vulnerable groups including pregnant women, the present study was conducted to determine the effect of individual counseling on the pregnant women’s stress of Covid-19. Materials and methods: In this randomized controlled clinical trial, 66 pregnant women in 24 to 28 weeks were randomly divided into two groups of intervention (33 participants) and control (33 participants). At the beginning of the study, both groups completed the questionnaires of demographic information and pandemic related pregnancy test. Then, the intervention was performed in 3 sessions with the interval of one week, in the form of individual counseling by BELIFE method for the experimental group. The control group received only the routine services of the centers. The post-test was performed two weeks after the last consultation session for both groups. Data were analyzed using Stata-13 software. Significance level was considered 0.05. Results: The experimental and control groups were almost homogeneous in terms of quantitative and qualitative demographic variables. Total mean and standard deviation of stress score, before and after the intervention in the experimental group, were 40.27 ± 12.65 and 41.71 ± 1.74, respectively. These numbers in the control group were 33.84 ± 13.08 and 43.84 ± 1.69. Comparing the two groups in terms of stress score which was done after the intervention showed that although the stress score in the experimental group was lower than that in the control group, this difference was not statistically significant (p = 0.39). Conclusion: The results of this study show that although individual counseling for pregnant women was able to reduce the mean scores of stress of Covid-19 in the experimental group, this difference was not statistically significant. Therefore, although the BELIFE individual counseling method for pregnant women, who naturally suffer from pregnancy stress, is an acceptable way to reduce their stress, it is recommended to plan and implement early and more effective interventions for these women because the course of stress is severe in them and has an upward trend during Covid-19 pandemic. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2038

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 3 2022 09 06 199 204 Zahra Rezaei Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran Elham Feizabad Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran Mehrnaz Valadan Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran Saeedeh Ebadizare Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran 2022 02 21 2022 03 08 Objective: Intrauterine insemination (IUI) is the first-line treatment in couples suffering from various causes of subfertility and infertility. Considering the relatively low rate of pregnancy achieved with each cycle in this method, optimizing various steps in the process including the time interval from sperm collection to IUI may result in an increased rate of success. The goal of this study was to assess the impact of time intervals from the end of sperm processing to IUI (SP-IUI) on the pregnancy rate in IUI. Materials and methods: This single-center prospective cohort study evaluated couples with normal male partner sperm analysis and idiopathic female infertility undergoing IUI from 2018 to 2021. Cycles were stimulated using subcutaneous recombinant FSH and oral Letrozole. Ovulation was triggered using GnRH antagonist when the leading follicle’s size reached greater than 14mm. The participants were placed in one of the three groups based on SP-IUI: group 1 (0–60 min), group II (60–90 min), and Group III: (>90 min). Results: 269 couples were included in the study. Sperm processing expectedly resulted in an increased concentration of total sperm count and sperm motility (P<0.001). The rate of chemical or clinical pregnancy, abortion, IUFD, multigestation, pregnancy, term birth, and ectopic pregnancy was not significantly different across study groups (P>0.05). Conclusion: The results of this study suggest that SP-IUI intervals evaluated in this study do not vary in terms of pregnancy rate or adverse pregnancy outcomes in IUI with normal male partner semen analysis. Hence, infertile couples can be flexible in the collection of semen specimens without time and site (at home or hospital) limitations. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2040

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 3 2022 09 06 205 211 Allahdad Khodadadi Department of Immunology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Ata Ghadiri Department of Immunology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mehri Ghafourian Department of Immunology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran AND Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Sara Iranparast Department of Immunology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran AND Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mahin Najafian Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran AND Department of Obstetrics and Gynecology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 2022 02 28 2022 07 17 Objective: Worldwide, preeclampsia (PE) is a multifactorial disorder reported in 2–5% of pregnancies, which increases mortality during pregnancy. In general, 10–15% of maternal deaths are directly related to PE and eclampsia. One of the susceptibility genes for PE is tumor necrosis factor-α (TNF-α) expressed by most immune cells. TNF-α is a protein involved in various biological processes, including proliferation and apoptosis, as well as the expression of inflammatory genes. The goal of this study was to investigate the role of TNF-α single nucleotide polymorphism (SNP) -308G/A (rs1800629) and their relationship with TNF-α in PE patients. Materials and methods: The SNP was genotyped in 90 cases and 90 controls. Whole blood was collected from women with PE and normal pregnancy in EDTA containing tubes, and DNA extraction was performed from their blood lymphocytes according to a standard phenol-chloroform procedure. Then, DNA was genotyped by real-time PCR and the polymorphism was detected by TaqMan assay. Serum levels of TNF-α protein were measured by enzyme-linked immunosorbent (ELISA) assay. Results: TNF-α levels in women with PE were significantly higher than in healthy ones (p<0.001). We did not observe any correlation between allelic outbreak (p=0.3) and TNF-α-308G/A polymorphism (p=0.7) with the incidence of PE. Conclusion: Although TNF-α-308G/A gene polymorphism does not appear to affect susceptibility to PE, an increased level of serum TNF-α can be used as a predictor for PE during pregnancy. We recommend that more research be conducted on possible factors related to the incidence of PE https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2045

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