relationship between perceived stress and marital satisfaction in couples with infertility: actor-partner interdependence model

Background: Infertility, one of life's great stressors, may adversely affect marital satisfaction. No studies have in- vestigated the relationship between perceived stress and marital satisfaction at the dyadic level. The current study assessed the actor and partner effects of perceived stress on marital satisfaction in husband-wife dyads using an innovative dyadic analysis approach, the Actor-Partner Interdependence Model [APIM]

Materials and Methods: In this cross-sectional study, we recruited a total of 141 infertile couples. Marital satisfaction and stress were assessed using the ENRICH Marital Satisfaction Scale [EMS Scale] and Perceived Stress Scale-4 Item [PSS-4], respectively. Dyadic data have been analysed by the APIM approach, with distinguishable dyads. In this approach, actor effect is the impact of a person?s perceived stress on his/her own marital satisfaction. Partner effect is the impact of a person's perceived stress on the partner?s marital satisfaction

Results: Both men and women's perceived stress exhibited an actor effect on their marital satisfaction [beta=-0.312, P<0.001, beta=-0.405, P<0.001, respectively]. Women's perceived stress had a negative relationship to the marital satis- faction of their partner [beta=-0.174, P=0.040]. Although the partner effect of men's perceived stress on woman's marital satisfaction was not significant [beta=-0.138, P=0.096], women whose husbands had higher levels of stress were more likely to have poorer marital satisfaction. Both actor and partner effects of perceived stress on marital satisfaction were similar among men and their wives

Conclusion: The findings of this study have highlighted that marital satisfaction in patients with infertility was in- fluenced by not only their own perceived stress, but also their spouses' perceived stresses. Therefore, psychological interventions that target a reduction in perceived stress and enhancement of marital satisfaction in the context of infer- tility should treat the couple as a unit

impact of genetic variation and gene expression level of the follicle-stimulating hormone receptor on ovarian reserve

Objective: ovarian reserve is defined as the capacity of the ovary to provide fertile oocytes. Diminished ovarian reserve [DOR] is a disorder in which ovaries are prone to go through early menopause. Where this loss of function occurs before the age of 40, it results in the premature ovarian failure [POF] disease. Throughout folliculogenesis, the follicle-stimulating hormone receptor [FSHR] starts a signaling cascade in the granulosa cells where its inactivation leads to the arrest of follicle maturation and therefore adversely affects ovarian reserve. The aim of this study was to investigate the association of genetic variation [polymorphisms and inactivating mutations] of FSHR with POF and DOR

Materials and Methods: this case-control study comprised 84 POF, 52 DOR and 80 fertile Iranian women. To determine the presence of the 566C>T mutation and the -29G>A polymorphism in FSHR, PCR-RFLP method was used. SSCP-sequencing was used to identify any allelic variants in exon 10. The expression of human FSHR at the transcript level was also compared between DOR and fertile controls by real time-polymerase chain reaction [PCR]

Results: the 566C>T polymorphism was normal in all the cases. All genotypes of -29G>A and 919G>A [exon 10] polymorphisms were observed. Statistically significant differences were seen in the genotypic distribution of both polymorphisms when comparing the control group with the DOR patient group. A decrease was observed in FSHR expression of DOR patients compared with the control group but was not significant

Conclusion: we conclude that the -29G>A and 919G>A polymorphisms in FSHR may be associated with DOR. Although these polymorphisms had significant differences at the genic level, no significant variation was found at the transcript level

prevalence of menstrual disorders in Iran: a systematic review and meta-analysis

Background: understanding the prevalence of menstrual disorders has important implications for both health service planning and risk factor epidemiology

Objective: the aim of this review is to identify and collate studies describing the prevalence of menstrual disorders in Iran

Materials and Methods: studies with original data related to the prevalence of menstrual disorders were identified via searching six electronic databases and reviewing citations. All abstracts or titles found by the electronic searches were independently scrutinized by two reviewers. The Meta-analysis was performed with a random effects model, considering the remarkable heterogeneity among studies. A total of 35 eligible epidemiological studies were included in this review

Results: overall, the pooled prevalence of primary dysmenorrhea was 73.27% [95% CI=65.12-81.42]. The mean proportion of women with oligomenorrhea was 13.11% [95.5%, 95% CI: 10.04-16.19]. We identified 16 studies that reported polymenorrhoea with a random effect of pooled prevalence estimate of 9.94% [95% CI 7.33%-12.56%]. The prevalence estimate of hypermenorrhea was 12.94% [95% CI 9.31%-16.57%]. Overall prevalence of hypomenorrhea was 5.25% [95% CI 3.20%-7.30%], ranging from 0.9- 12.90%. Pooling six studies that reported estimates for menorrhagia, the overall prevalence was 19.24% [95% CI 12.78-25.69]. Overall, 6.04% [95% CI: 1.99-10.08] of the women were shown to have metrorrhagia

Conclusion: this systematic review suggests that the average prevalence of menstrual disorders in Iran is substantial. It has been neglected as a fundamental problem of women's reproductive health. Diagnosis and treatment of these disorders should be included in the primary health care system of reproductive health

Evaluating the impact of risk factors on birth weight and gestational age: a multilevel joint modeling approach

Background: Abnormalities in birth weight and gestational age cause several adverse maternal and infant out- comes. Our study aims to determine the potential factors that affect birth weight and gestational age, and their association

Materials and Methods: We conducted this cross-sectional study of 4415 pregnant women in Tehran, Iran, from July 6-21, 2015. Joint multilevel multiple logistic regression was used in the analysis with demographic and obstetrical variables at the first level, and the hospitals at the second level

Results: We observed the following prevalence rates: preterm [5.5%], term [94%], and postterm [0.5%]. Low birth weight [LBW] had a prevalence rate of 4.8%, whereas the prevalence rate for normal weight was 92.4, and 2.8% for macrosomia. Compared to term, older mother's age [odds ratio [OR]=1.04, 95% confidence interval [CI]: 1.02-1.07], preeclampsia [OR=4.14, 95% CI: 2.71-6.31], multiple pregnancy [OR=18.04, 95% CI: 9.75- 33.38], and use of assisted reproductive technology [ART] [OR=2.47, 95% CI: 1.64-33.73] were associated with preterm birth. Better socioeconomic status [SES] was responsible for decreased odds for postterm birth com- pared to term birth [OR=0.53, 95% CI: 0.37-0.74]. Cases with higher maternal body mass index [BMI] were 1.02 times more likely for macrosomia [95% CI: 1.01-1.04], and male infant sex [OR=1.78, 95% CI: 1.21-2.60]. LBW was related to multiparity [OR=0.59, 95% CI: 0.42-0.82], multiple pregnancy [OR=17.35, 95% CI: 9.73-30.94], and preeclampsia [OR=3.36, 95% CI: 2.15-5.24]

Conclusion: Maternal age, SES, preeclampsia, multiple pregnancy, ART, higher maternal BMI, parity, and male infant sex were determined to be predictive variables for birth weight and gestational age after taking into consideration their association by using a joint multilevel multiple logistic regression model

Relationship between quality of life, relationship beliefs and attribution style in infertile couples

Background: Many infertile couples experience psychological distress and suffer from impaired quality of life. Gen- erally, when couples are dealing with uncontrolled events such as infertility, it is important to manage it well and to use the suitable coping style; so this can represent an example of attribution style. The purpose of this study is to investigate the quality of life, relationship beliefs and attribution style in infertile couples

Materials and Methods: This cross-sectional study consisted of 50 infertile couples, who were at least 18 years of age and could read and write in Persian. Participants provided demographic and general characteristics and completed the quality of life [SF-12], relationship belief inventory [RBI] and attribution style [ASQ] forms. Data was analyzed by the paired t test, Pearson correlation tests and multiple linear regression analysis, using SPSS version 22 statistical software

Results: Overall, 50 infertile couples participated in our study. The males had a significantly higher score for quality of life compared to the females [P=0.019]. In RBI subscales except "Disagreement is Destructive" all others signifi- cantly higher in wives than husbands. All subscales of RBI had a negative correlation with the quality of life. The quality of life had a significant correlation with positive internal [r=0.213, P=0.033]. The adjusted regression model showed that the quality of life for males was higher than in females [beta=-3.098, P=0.024]

Conclusion: The current data indicate that in infertile couples, the husbands have a higher quality of life in comparison to their wives. Also, all subscales of relationship beliefs have a negative correlation with the quality of life, but in at- tribution style, just internal attribution style for positive events is associated with the quality of life. In general, there is a correlation between relationship beliefs and the quality of life in infertile couples

Factors Associated with Cesarean Section in Tehran, Iran using Multilevel Logistic Regression Model

OBJECTIVES: Over the past few decades, the prevalence of cesarean sections (CS) have risen dramatically worldwide, particularly in Iran. The aim of this study was to determine the prevalence of CS in Tehran, and to examine the associated risk factors. METHODS: A cross-sectional study of 4,308 pregnant women with singleton live-births in Tehran, Iran, between July 6–21, 2015 was performed. Multilevel logistic regression analysis was performed using demographic and obstetrical variables at the first level, and hospitals as a variable at the second level. RESULTS: The incidence of CS was 72.0%. Multivariate analysis showed a significant relationship between CS and the mother's age, socioeconomic status, body mass index, parity, type of pregnancy, preeclampsia, infant height, and baby's head circumference. The intra-class correlation using the second level variable, the hospital was 0.292, indicating approximately 29.2% of the total variation in the response variable accounted for by the hospital. CONCLUSION: The incidence of CS was substantially higher than other countries. Therefore, educational and psychological interventions are necessary to reduce CS rates amongst pregnant Iranian women.

Attitudes of infertile couples, fertility clinic staff and researchers toward personhood of the human embryo in Iran

Objective: After the introduction of assisted reproductive techniques, human embryos were officially introduced into laboratories and now thousands of them are cryopreserved in such settings. Embryonic stem cells and the future application of such cells in the treatment of disease opened the door to further research on human embryos. These developments raise many ethical issues, some of which have religious aspects. The main question is: what is the embryo? Should we consider it a human being? Thus, the purpose of this study was to investigate attitudes towards the personhood of the embryo

Materials and Methods: In this cross sectional study, 203 infertile patients [n=406], 54 clinic staff and 49 embryo researchers, selected using convenience sampling at the Royan Institute, completed a questionnaire on personhood of human embryo. The questionnaire had been developed following qualitative research and had satisfied face and content validity tests

Results: At the pre-implantation stage the majority of participants in all three groups considered the human embryo as "not a human being". Also, at the post-implantation stage of development, the majority of infertile couples and clinic staff considered the embryo as "not a human being" but, half the researchers [51%] considered the embryo in this stage as a "potential human". Half of the infertile couples considered the human fetus before ensoulment time [19th week of pregnancy according to the Shiite Islamic scholars] as "not-human being", while more than half of researchers [55.1%] considered it as a "potential human"

Conclusion: Ensoulment time is a major and important border for personhood. Most infertile couples and clinic staff consider the human embryo as "not a human being" but majority of all study participants considered the human fetus to be a complete human after ensoulment time

Evaluating the factor structure, item analyses, and internal consistency of hospital anxiety and depression scale in Iranian infertile patients

Background: The hospital anxiety and depression scale [HADS] is a common screening tool designed to measure the level of anxiety and depression in different factor structures and has been extensively used in non-psychiatric populations and individuals experiencing fertility problems

Objective: The aims of this study were to evaluate the factor structure, item analyses, and internal consistency of HADS in Iranian infertile patients

Materials and Methods: This cross-sectional study included 651 infertile patients [248 men and 403 women] referred to a referral infertility Center in Tehran, Iran between January 2014 and January 2015. Confirmatory factor analysis was used to determine the underlying factor structure of the HADS among one, two, and three factor models. Several goodness of fit indices were utilized such as comparative, normed and goodness of fit indices, Akaike information criterion, and the root mean squared error of approximation. In addition to HADS, the Satisfaction with Life Scale questionnaires as well as demographic and clinical information were administered to all patients

Results: The goodness of fit indices through CFAs exposed that three and one factor model provided the best and worst fit to the total, male and female datasets compared to the other factor structure models for the infertile patients. The Cronbach's alpha for anxiety and depression subscales were 0.866 and 0.753 respectively. The HADS subscales significantly correlated with SWLS, indicating an acceptable convergent validity

Conclusion: The HADS was found to be a three-factor structure screening instrument in the field of infertility

Psychometric properties of the fertility quality of life instrument in infertile Iranian women

Background: Infertility and its treatment can have a considerable effect on a person's quality of life [QoL]. The Fertility QoL [FertiQoL] questionnaire is currently the most frequently used instrument to measure QoL in people with fertility problems. This study aims to examine the reliability and validity of the FertiQoL in infertile Iranian women

Materials and Methods: This cross-sectional study included 155 women with fertility problems in a referral fertility clinic in Tehran, Iran from January to March 2014. A battery of instruments was used: FertiQoL, Satisfaction with Life Scale [SWLS], Hospital Anxiety and Depression Scale [HADS], and a demographic questionnaire. Construct validity of the scale was evaluated using confirmatory factor analysis [CFA]. We assessed internal consistency with Cronbach's alpha and convergent validity was examined by correlating the FertiQoL with SWLS and HADS

Results: The results of the CFA generally supported the four-factor model of Core FertiQoL and two-factor model of Treatment FertiQoL. Both FertiQoL modules and their subscales revealed acceptable internal consistency that ranged from 0.643 to 0.911. However, the FertiQoL might be improved if Q15 and T2 items were removed from the scale. These items had low loadings on the Relational and Environment factors which decreased their internal consistency. The FertiQoL and their subscales significantly correlated with both SWLS and HADS, which confirmed convergent validity

Conclusion: The Persian version of the FertiQoL is a valid, reliable instrument to measure QoL in infertile women and seems to perform as well as the original English Version

Prevalence and Determinants of Preterm Birth in Tehran, Iran: A Comparison between Logistic Regression and Decision Tree Methods

OBJECTIVES: Preterm birth (PTB) is a leading cause of neonatal death and the second biggest cause of death in children under five years of age. The objective of this study was to determine the prevalence of PTB and its associated factors using logistic regression and decision tree classification methods. METHODS: This cross-sectional study was conducted on 4,415 pregnant women in Tehran, Iran, from July 6–21, 2015. Data were collected by a researcher-developed questionnaire through interviews with mothers and review of their medical records. To evaluate the accuracy of the logistic regression and decision tree methods, several indices such as sensitivity, specificity, and the area under the curve were used. RESULTS: The PTB rate was 5.5% in this study. The logistic regression outperformed the decision tree for the classification of PTB based on risk factors. Logistic regression showed that multiple pregnancies, mothers with preeclampsia, and those who conceived with assisted reproductive technology had an increased risk for PTB (p < 0.05). CONCLUSION: Identifying and training mothers at risk as well as improving prenatal care may reduce the PTB rate. We also recommend that statisticians utilize the logistic regression model for the classification of risk groups for PTB.

Psychometric properties of the satisfaction with life scale [SWLS] in Iranian infertile women

Background: Infertility is a global public health issue and may adversely affect life satisfaction. One of the most widely instruments used to assess life satisfaction is the Satisfaction with Life Scale [SWLS]

Objective: The objective of this study was to examine the psychometric properties of the SWLS in Iranian infertile women

Materials and Methods: In this descriptive cross-sectional study, a total of 125 infertile women referring to Royan Institute in Tehran were selected by convenience sampling method. The participants were administered the SWLS, the Hospital Anxiety and Depression Scale [HADS], and a demographic questionnaire. The psychometric properties of the SWLS were examined: construct validity using confirmatory factor analysis [CFA], reliability using Cronbach's alpha and convergent validity by examining the relationship with HADS

Result: Results of the CFA indicated that a single-factor model provides a good fit to the data [X[2]/df= 1.58; GFI= 0.975; CFI= 0.995; NFI= 0.985; RMSEA= 0.069 and SRMR= 0.027]. The Cronbach's alpha coefficient for SWLS was 0.887. Significant negative correlations were found between SWLS and HADS scores for anxiety [r= -0.410] and depression [r= -0.434], indicating an acceptable convergent validity

Conclusion: The SWLS has adequate psychometric properties for assessing life satisfaction in Iranian infertile women

efficient trio-based mini-haplotyping method for genetic diagnosis of phenylketonuria

Background: In 1993, Muller developed the Prenatal Attachment Inventory [PAI] which has been used widely in many studies and translated into several languages. The current study aimed to translate the PAI into Persian, assess the underlying structure of the PAI, and the appropriateness of the one-factor solution proposed by Muller

Materials and Methods: In this cross-sectional study, we recruited a total of 322 primigravidae in their 27th to 34th gestational weeks that referred to private and governmental prenatal clinics in Tehran, Iran. All participants completed the Persian versions of the PAI and a demographic questionnaire. Participants were re-tested 2 weeks after the initial testing The following psychometric properties of the PAI were investigated: construct validity by confirmatory factor analysis [CFA], internal consistency reliability with Cronbach's alpha, and test-retest reliability according to the intraclass correlation coefficient [ICC]

Results: The CFA results indicated that a single-factor model provided good fit to the data, which confirmed the original model by its developer. The Cronbach's alpha coefficient for PAI was 0.856 and the test-retest reliability with ICC was 0.784. Considering the duration between marriage and pregnancy, women with low duration scored significantly higher than women with high duration on PAI [P=0.043]

Conclusion: The Persian version of the PAI showed that one factor structure was ad- equate and could be used for measuring psychological affectionate attachment between Iranian mothers and their fetuses

Development and validation of attitude toward gestational surrogacy scale in iranian infertile couples

Background: Surrogacy is one of the most challenging infertility treatments engaging ethical, psychological and social issues. Attitudes survey plays an important role to disclosure variant aspects of surrogacy, to help meeting legislative gaps and ambiguities, and to convert controversial dimensions surrounding surrogacy to a normative concept that eliminates stigma. The aim of this study is to develop a comprehensive scale for gestational surrogacy attitudes

Materials and Methods: Development process of gestational surrogacy attitudes scale [GSAS] performed based on a descriptive cross-sectional study and included a rich data pool gathered from literature reviews, a qualitative pilot study on 15 infertile couples [n=30], use of expert advisory panel [EAP] consisting of 20 members, as well as use of content validity through qualitative and quantitative study by the means of content validity ratio [CVR] and content validity index [CVI]. Also internal consistence using Cron-bach's alpha and test-retest reliability using intracalss correlation coefficient [ICC] were evaluated. Application of GSAS was tested in a cross-sectional study that was conducted on 200 infertile couples [n=400] at Royan Institute, Tehran, Iran, during 2014

Results: Final version of GSAS had 30 items within five subscales including [acceptance of surrogacy], [Surrogacy and public attitudes], [Child born through surrogacy] [Surrogate mother], and "Intentional attitude and surrogacy future attempt". Content validity was represented with values of CVR=0.73 and CVI =0.98. Cronbach's alpha value was 0.91 for the overall scale, while ICC value due to test-retest responses was 0.89

Conclusion: Acceptable level of competency and capability of GSAS is significantly indicated; therefore, it seems to be an appropriate tool for the evaluation of gestational surrogacy attitudes in Iranian infertile couples

[Prognostic factor for patients with gastric cancer using the Aalen's additive hazards model]

Gastric cancer is the second leading cause of cancer death worldwide and is the most common type of cancer in Iran. The objectives of this study were to assess the effects of prognostic factors on survival of patients with gastric cancer using the Aalen additive hazards model, and to illustrate the advantage of Aalen's plot. Information of total of 213 patients with gastric cancer who underwent surgery in the gastroenterology ward of Taleghani hospital in Tehran between 2003 and 2008 were included in this historical cohort study. Age at diagnosis, sex, presence of metastasis, tumor size, histology type, lymph node metastasis, and pathologic stages were entered into analysis using the Aalen additive hazard model. To visualize a covariate effect over time, the estimated cumulative regression function by the Aalen's model is examined. The univariate and multivariate analysis identified that age at diagnosis, tumor size and pathologic stage were independent prognostic factors for the survival of patients with gastric cancer [p<0.05]. Moreover, pathologic stage has a late or delayed effect according to the Aalen's plot. Other clinicopathological characteristics were not statistically significant [p>0.05]. In spite of using Cox model in survival analysis by many researchers, Aalen's model may yield new insights in prognostic studies of survival time of patients with gastric cancer over time. Our results suggest that early detection of patients in younger age and in primary stages is important to increase survival from gastric cancer