This article provides an overview of international developments in the area of INFERTILITY counseling. It informs about the development of international organizations and relevant professional standards and describes the need to make counseling accessible to all patients, especially those who experience great distress or display previous vulnerability. Whereas in previous years counseling focused on psychopathology; research shows that on average, men and women experiencing INFERTILITY are as healthy as others. Therefore, the aim of counseling is to reduce the emotional burden of INFERTILITY, help couples to consider the implication of family building alternatives and provide therapeutic care where relevant. In some instances, counselors also have the task to carry out psychological assessments. For the sake of transparency, it is important to clearly differentiate between these two interventions. Last but not least, this article argues that much of our current knowledge is based on research carried out in Western societies, therefore lacking understanding and appreciation for the meaning of INFERTILITY in other cultures. Therefore we need more international debate across cultures to further our understanding and to honor different cultural values.

Congenital anomalies of the Mullerian ducts especially uterine abnormalities can affect negatively the different stages of fertility interfering with sperm migration, embryo implantation, normal placentation, fetal growth and achievement of a successful pregnancy. They are present in 2-10% of all women, three times greater in patients with recurrent pregnancy loss and lead to INFERTILITY and adverse pregnancy outcomes in 25% of cases. In general population mean incidence is 3-4%. In women with fertility problems, the incidence is slightly higher at 3-6%. In general, women with recurrent abortions have an incidence of 5-10%, with the highest incidence of Mullerian defects occurring in patients having third-trimester miscarriages (>25%). The most commonly reported anomalies are septate (35%), bicornuate (26%), arcuate (18%), unicornuate (2.4-13%), didelphys (10%). Beside pregnancy complications some uterine anomalies can lead to dysmenorrhea and endometriosis which could further lead to INFERTILITY issues. Anomalies mostly result from a defect of development or midline fusion of the Mullerian ducts, their failure to connect with the urogenital sinus or unsuccessful canalization during embryogenesis. These patients have usually normal ovaries and ovarian functions.The septate uterus results from failure of resorption of two fused ducts which leads to the formation of a partial or complete fibromuscular septum. Septate uterus is associated with the highest incidence of reproductive failure. Miscarriage rates up to 90% have been reported which are thought to be the result of poor blood supply in the septum. The preferred treatment modality is hysteroscopic metroplasty which can reduce the miscarriage rate to 14% with 80% term live birth rates compared to 3% before. Controversy exists regarding performing metroplasty in infertile women versus no treatment but in unexplained INFERTILITY and also in candidates for IVF with a septate uterus it can be beneficial.The arcuate uterus results from near-complete resorption of the uterovaginal septum. It is characterized by a small intrauterine indentation shorter than 1 cm and located in the fundal region. Compared with other Mullerian malformations, arcuate uterus is clinically benign despite an infrequent association with adverse obstetric outcomes, and may not affect reproductive outcomes. Nevertheless some studies in repeated IVF failures show beneficial effects of resection of the small septum which is thought to have a fibrous tissue structure and abnormal vascularization.The uicornuate uterus results when the Mullerian ducts fail to develop completely or partially. There are four types including unicornuate uterus with a communicating rudimentary horn, with a noncommunicating rudimentary horn, with or without a cavity and an isolated unicornuate uterus. They are usually associated with urinary tract and skeletal anomalies and also relatively poor reproductive results. The highest live birth rates are observed in women with a rudimentary horn with or without a cavity.The bicornuate uterus is the result of incomplete fusion in the Mullerian ducts. Most women have no fertility problem. There is higher mid-trimester pregnancy loss and preterm birth risk after conception. It rarely needs surgical treatment unless in patients with recurrent pregnancy loss, mid-trimester loss, premature birth and unexplained INFERTILITY.Uterus didelphys refers to the complete failure of fusion of the Mullerian ducts which results in duplication of the uterine corpus and cervix. It has a relatively good prognosis for fertility with some increase in adverse pregnancy outcomes.Uterine anomalies on the whole should be diagnosed and treated by different modalities not only to improve the patient’s fertility but to maintain the conception when it happens.

The last ten years witnessed major changes in practice of Obstetrics & Gynecology. In this talk, we will focus on patient oriented values mainly safety and live birth rate. For example, GnRHagonist long protocol remains the most successful regimn for IVF treatment but recent data with GnRH antagonists have demonstrated highly significant reduction in incidence of severe ovarian hyperstimulation syndrome compared to the GnRH agonist long protocol. More examples will be illustrated.

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine metabolic disorders of reproductive age women. The main signs of PCOS are as follows: androgen excess, menstrual dysfunction, INFERTILITY, obesity, and other numerous health problems. By different authors, the disorder affects 2-28% of reproductive age women. Materials and Methods: Polycystic ovary syndrome is characterized by presence of hyperandrogenism, anovulation, menstrual cycle disturbances, also by the other metabolic changes. The lack of well-defined and universally accepted diagnostic criteria makes identification of this syndrome confusing to many clinicians. There are only few studies concerning the correlations between phenotypic expression, body composition and PCOS, and relationship with the processes of growth and sexual maturation and various environmental factors (nutrition, physical activity, stress, and other factors). Results: There is a lack of knowledge about further PCOS development and prognosis, considering the individual and environmental factors. Variation in human body composition and shape ranges considerably: many body size and shape indices (height, weight, body composition, and proportions) are the result of long evolution process and adaptation to environment. Obviously, the morphological body parameters, physiological and biochemical indices are complex and compound the interdependent system. By current literature, more than 50% of women are overweight or obese. If waist circumference and waist-to-hip ratio of women with PCOS increase, reproductive function and metabolic state of a woman is altered more than in cases when there are no changes in these parameters. The investigations of the strongest sexual dimorphism sign—the subcutaneous and visceral fat topography--showed that women with PCOS have greater adipose tissue mass in the areas of the abdomen, waist, and upper arms than control women.Conclusion: It is known that some indices of sexual dimorphism may be considered as the morphological signs of hyperandrogenism, for example handgrip, waist-to-hip ratio, hand and foot length, 2nd-to-4th digit (finger length) ratio (2D:4D), certain facial characteristics. Only 2D:4D ratio was investigated for the women with PCOS. The early changes of certain morphological and other indices of physical status could help to predict some metabolic characteristics, development of PCOS, and outcome of this syndrome.

Background: INFERTILITY is one of the major problems in life which affects about 20% of couples in developed countries and a large population in the developing countries including Iran. Since not much has been discussed, published or talked about in the literature and INFERTILITY conferences in Iran, we have decided to conduct a review of literature and provide a summary of what is known in the world regarding this subject.Materials and Methods: We have conducted a thorough literature search using PubMed and other major search engines in the medical databases and collected the data and research results regarding INFERTILITY and stress.Results: INFERTILITY is often influenced by psychological factors and the two most commonly investigated psychological problems in INFERTILITY are anxiety and depression. In most studies, it is suggested that psychological distress is associated with INFERTILITY and INFERTILITY treatment. In some recent studies, it has been concluded that stress may be a causal factor that leads to INFERTILITY. Preexisting anxiety and/or depression have been reported in the literature to be negatively associated with successful conception. The reciprocal relationship exists between stress and INFERTILITY.Conclusion: We suggest that psychological treatments should be considered for infertile couples before INFERTILITY treatment is initiated in order to increase the possibility of spontaneous conception in women.