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PubMed1995

Serologic responses of infertile women to the 60-kd chlamydial heat shock protein (hsp60).

OBJECTIVE: To determine whether women with Chlamydia trachomatis-associated tubal infertility are more likely than other infertile women to have antibodies to a particular region of the 60-kd chlamydial heat shock protein, hsp60. DESIGN: Serologic responses to the chlamydial hsp60 were examined in 43 infertile women seropositive for Chlamydia trachomatis, including 21 women with tubal infertility, 13 women with endometriosis, and 9 women with other causes of infertility. Antibody responses were localized to regions of hsp60 using five nonoverlapping recombinant polypeptides. RESULTS: Sixteen women with tubal infertility had anti-hsp60 antibodies compared with seven women with endometriosis and two women with other causes of infertility. Antibodies of 11 women with tubal infertility reacted predominantly with a region of hsp60 containing amino acids (201 to 300) compared with 1 women without tubal infertility. In contrast, antibodies that localized to the carboxyl terminus, amino acids (401 to 544), were seen equally in all groups. CONCLUSIONS: Among seropositive infertile women, antibodies that localized to amino acids (201 to 300) were immunodominant in those with tubal infertility but not in those with infertility due to other causes.

Adult↗
PubMed1985

Chlamydia trachomatis: its role in tubal infertility.

We compared the prevalence of antibody to Chlamydia trachomatis among 88 women undergoing an evaluation for infertility and 49 women attending an antenatal clinic. Demographic data regarding sexual behavior were also collected. Eighteen women had tubal infertility and 70 had infertility due to a variety of other reasons. In comparison with women who had other causes for infertility, women with tubal infertility began coitus sooner (17.7 +/- 2.2 years vs. 19.5 +/- 3.4 years, P less than .05) and had more lifetime sex partners (4.5 vs. 1.33, P less than .001). Women with tubal infertility had a higher prevalence of antibody to C. trachomatis (13 of 18) than did women with nontubal causes for infertility (6 of 70, P less than .0001) or pregnant women (11 of 49, P = .0003). This high prevalence of antibody to C. trachomatis among women with tubal infertility was independent of sexual experience. By immunoblot analysis, an antigen of approximately 57,000 Da was immunodominant in 11 of 13 seropositive subjects with tubal infertility vs. 2 of 6 seropositive subjects with nontubal infertility (P = .046) and 1 of 11 seropositive pregnant women (P = .0003). Thus, women with tubal infertility frequently have serological evidence of prior infection with C. trachomatis and have a distinctive antigen-specific humoral immune response. These results further support the etiologic role of infection with C. trachomatis in tubal infertility.

Antibodies, Bacterial↗
PubMed2005

Causes of infertility as predictors of subsequent cancer risk.

BACKGROUND: Although studies have found elevated risks of certain cancers linked to infertility, the underlying reasons remain unclear. METHODS: In a retrospective cohort study of 12,193 U.S. women evaluated for infertility between 1965 and 1988, 581 cases of cancer were identified through 1999. We used standardized incidence ratios (SIRs) to compare cancer risk with the general population. Analyses within the cohort estimated rate ratios (RRs) associated with infertility after adjusting for other risk predictors. RESULTS: Infertility patients demonstrated a higher cancer risk than the general population (SIR = 1.23; 95% confidence interval [CI] = 1.1-1.3), with nulligravid (primary infertility) patients at even higher risk (1.43; 1.3-1.6). Particularly elevated risks among primary infertility patients were observed for cancers of the uterus (1.93) and ovaries (2.73). Analyses within the cohort revealed increased RRs of colon, ovarian, and thyroid cancers, and of melanomas associated with endometriosis. Melanomas were linked with anovulatory problems, whereas uterine cancers predominated among patients with tubal disorders. When primary infertility patients with specific causes of infertility were compared with unaffected patients who had secondary infertility, endometriosis was linked with distinctive excesses of cancers of the colon (RR = 2.40; 95% CI = 0.7-8.4), ovaries (2.88; 1.2-7.1), and thyroid (4.65; 0.8-25.6) cancers, as well as melanomas (2.32; 0.8-6.7). Primary infertility due to anovulation particularly predisposed to uterine cancer (2.42; 1.0-5.8), and tubal disorders to ovarian cancer (1.61; 0.7-3.8). Primary infertility associated with male-factor problems was associated with unexpected increases in colon (2.85; 0.9-9.5) and uterine (3.15; 1.0-9.5) cancers. CONCLUSIONS: The effects of infertility may extend beyond gynecologic cancers. Thyroid cancers and melanomas deserve specific attention, particularly with respect to endometriosis.

Adult↗
PubMed2004

Coping with infertility among Kuwaiti women: cultural perspectives.

BACKGROUND: Although previous studies conducted in western countries have reported that psychological factors are part of the experience of infertility, no study has assessed this relationship in Arab women. AIMS: To examine psychological distress among Kuwaiti women with infertility problems and explore the perceived causes of infertility. METHODS: An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group. RESULTS: Compared with age-matched pregnant control sample. The infertile women exhibited a significant higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes such as evil spirits, witchcraft and God's retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were considered as the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness results in social stigmatization for infertile women and places them at risk of serious social and emotional consequences. CONCLUSIONS: The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicates the appropriateness of referring these patients for psychological evaluation. Successful programmes in dealing with infertility in Kuwait need to include the establishment of a community based intervention strategy to educate people about infertility and to give guidelines for treatment options.

Adaptation, Psychological↗
PubMed2002

Thyroid and infertility.

Infertility is defined as the inability to conceive after one year of regular intercourse without contraception. The prevalence of infertility is estimated between 12 and 14% and remains stable in recent years. It thus represents a common condition, with important medical, economic and psychological implications. According to a standard protocol infertility evaluation usually identifies different causes, including, male infertility (30%), female infertility (35%), the combination of both (20%), and finally unexplained or "idiopathic" infertility (15%). Female causes of infertility comprise endometriosis, tubal damage and ovulatory dysfunction (OD). Thyroid dysfunction is a condition known to reduce the likelihood of pregnancy and to adversely affect pregnancy outcome. Data on the relationship between thyroid disorders and infertility remain scarce and the association with a particular cause of infertility has not thoroughly been analyzed. In a case-control study we have shown that the relative risk of positive TPO-Abs in infertility due to a female cause and in particular related to endometriosis is significantly increased. Thyroid dysfunction itself is a condition interfering with normal ovarian function and was more frequent in women with positive anti-TPO Abs. We therefore propose that a systematic screening of TSH, free T4 and TPO-Ab could be considered in all women with a female cause of infertility. Prospective follow-up of a cohort of infertile women undergoing assisted reproduction shows a significant increased risk of miscarriage in women with positive anti-TPO Abs compared to women without thyroid auto-immunity after clinical pregnancy is established by the ART procedure. The frequent association of the presence of anti-TPO-Abs and miscarriage is hypothetical explained by the fact that organ specific autoimmune diseases may be secondary to some basic cellular abnormality that directly affects pregnancy outcome. Alternatively, women with thyroid autoimmunity, may experience greater changes in free thyroxine levels during ART and subsequent pregnancy interfering with genital tract physiology and fetal development. Determining the presence of thyroid antibodies before ART procedure is thus useful in identifying women at risk for subsequent clinical miscarriage.

Abortion, Spontaneous↗
PubMed1992

The prevalence and predictability of depression in infertile women.

OBJECTIVE: To determine the prevalence, severity, and predictability of depression in infertile women compared with a control sample of healthy women. DESIGN: Subjects were assessed while waiting to see their physician: infertility patients before a visit with an infertility specialist and control subjects before seeing either a gynecologist or internist for a routine gynecological examination. Subjects completed a demographic form and two depression scales. SETTING: A group infertility practice affiliated with an academic medical center, a hospital-based gynecology practice, and a health maintenance organization internal medicine clinic. PARTICIPANTS: 338 infertile women and 39 healthy women. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale. RESULTS: The infertile women had significantly higher depression scores and twice the prevalence of depression than the controls; women with a 2- to 3-year history of infertility had significantly higher depression scores compared with women with infertility durations of < 1 year or > 6 years; women with an identified causative factor for their infertility had significantly higher depression scores than women with unexplained or undiagnosed infertility. CONCLUSIONS: Depressive symptoms are common in infertile women. Psychological interventions aimed at reducing depressive symptoms need to be implemented, especially for women with a definitive diagnosis and for those with durations of 2 to 3 years of infertility.

Depression↗
PubMed2004

Anticardiolipin antibodies in women with unexplained infertility.

Concept of autoimmune basis of infertility is still controversial, particularly regarding the presence of non-organ specific autoantibodies. Non-organ specific anticardiolipin (aCL) and antithyroglobulin (TgAt) antibodies were detected in infertile women. Both partners were evaluated according to the criteria of The American Society for Reproductive Medicine. All the results were normal in cases of unexplained infertility. Antisperm antibodies (ASA) were determined by a mixed antiglobulin reaction (MAR) and the Kibrick agglutination assay, aCL by commercial ELISA, TgAt by commercial RIA. Fertile women had children. Subjects were grouped in fertile (n=27), infertile (n=65), and cases of unexplained infertility (n=42). In fertile women, aCL was below the negative cut-off value (100 %), while women with unexplained infertility were positive in 23.8 %. Anticardiolipin (aCL) antibodies were detected in 21.5 % of infertile patients, most of them with unexplained infertility (15.4 %). Other positive women had partners with ASA (4.6 %), or exhibited a negative postcoital test (1.5 %). In this study aCL were not detected in women with ASA. TgAt incidence was increased in infertile (20 %) and unexplained infertility group (21.4 %) compared to the fertile controls (18.5 %). Increased incidence of aCL and TgAt in infertile women supports the contention that these autoantibodies contribute to the infertility

Adult↗
PubMed2006

Epidemiology of depression among infertile and fertile couples in Shiraz, southern Iran.

BACKGROUND: Depression is considered as one of the main psychological disorders associated with infertility. Depression may play a significant role in the life of infertile individuals, their infertility treatment follow-up and in their hopefulness for the future; it may also influence the intensity and continuousness of the mutual relationship of the affected couple. AIMS: This study was done to determine the depression rate and make a comparison between infertile and fertile couples with respect to the same. SETTING AND DESIGN: The depression rate was evaluated between two groups--infertile couples (case group) and fertile couples (control group). MATERIALS AND METHODS: Ninety-one infertile couples (cases) and 9l fertile ones (controls) were randomly enrolled in our study. Beck depression inventory (BDI) and demographic information were provided. STATISTICAL ANALYSIS: We used Chi-square, t-test; and one-way Analysis of Variance (ANOVA) was performed to find out significant difference between infertility duration in various couples and its effect on the score of depression. RESULTS: The BDI mean difference between infertile and fertile couples was significant (P=0.015). It was significantly more among couples with infertility from 1-3 years' duration compared to those with infertility of 1-year duration or less. CONCLUSION: Regarding the high rate of depression among infertile couples, it seems necessary to pay more attention to infertility centers that offer psychological and psychiatric services.

Adult↗
PubMed2026

The importance of integrating genetic testing into reproductive medicine: a retrospective observational study investigating the monogenic causes of human infertility in couples considering ICSI.

The genetic landscape of human infertility is complex with diverse etiologies. Identifying the underlying etiology is crucial for guiding reproductive decisions and improving management for infertile couples. Here, we aim to report on the molecular spectrum of monogenic genetic causes of reproductive failure. Over a 3-year period, we recruited all infertile couples considering assisted reproductive technologies (ART) for whom the underlying genetic cause had been identified, in either partner, using exome sequencing (ES). Clinical data of all participants along with their hormonal profiles, sonographic findings and spermograms were recorded. The study included 50 couples with primary infertility. Clinically, male factor infertility was documented in 26 patients, female factor infertility in 10, while reproductive failure was unexplained in the remaining 14 couples. All participating couples had potentially disease-causing variants in infertility genes. ES identified variants related to male infertility in 26 men, while variants in female infertility-related genes were detected in the remaining couples (n&#x2009;=&#x2009;24). According to ACMG classification criteria, 78% (39/50) of couples harbored pathogenic/likely pathogenic (P/LP) variants, whereas 22% (11/50) carried variants of uncertain significance (VUS). In view of the identified genetic etiologies, the cohort was stratified into two groups based on the predicted reproductive outcome: (1) couples with significantly impaired reproductive potential, and (2) couples who can have biological children using appropriate medical interventions. However, classifications involving VUS were interpreted cautiously and considered exploratory. This study provides further evidence for the molecular heterogeneity of human infertility and highlights the usefulness of genetic testing for infertile couples pursuing ARTs.

Humans↗
PubMed2001

The effect of an infertility diagnosis on the distress, marital and sexual satisfaction between husbands and wives in Taiwan.

BACKGROUND: Few studies have explored the effect of a gender-specific infertility diagnosis on the responses of couples in Taiwan. The purpose of this research was to compare the differences in distress, marital and sexual satisfaction in husbands and wives based on an infertility diagnosis. METHODS: Three structured questionnaires were used. RESULTS: Female members of couples in which both partners were infertile expressed less marital and sexual satisfaction than their husbands. No differences in marital and sexual satisfaction were found between wives and husbands with unexplained infertility. Only wives with a diagnosed female infertility expressed higher distress to infertility than their husbands. Although no differences in psychosocial responses were found among husbands, regardless of the diagnosis, wives with a diagnosed female infertility experienced higher distress in self-esteem and less satisfaction in acceptance by in-laws than wives experiencing a diagnosed male infertility. CONCLUSIONS: These findings suggest that the diagnosis of infertility is an important factor in assessing the differences in infertility distress and marital and sexual satisfaction between husbands and wives. Health professionals can explain the gender differences when counselling infertile couples and encourage them to share each other's feelings, which may help couples to cope with the communication problems they may experience.

Adult↗
PubMed2001

Free amino acid concentration in hydatid cyst fluids from fertile and infertile human and animal Echinococcus granulosus.

The aim of this study was to search and compare free amino acid composition of fertile and infertile cyst fluids obtained from humans and animals infected naturally with Echinococcus granulosus, by using automated analysis based on cation-exchange chromatography with post-column ninhydrin derivatization system. 11 free amino acids from fertile (sheep origin), nine from infertile (cattle origin), 13 from infertile (human origin) hydatid cyst fluids and 19 amino acids from sera of patients with hydatid infection were detected. The levels of glycine, alanine, valine and lyrosine in fertile and infertile hydatid cysts fluids were significantly higher than in sera from patients with hydatid cysts. Glycine level in the fertile hydatid cyst fluids (sheep origin) was significantly higher than those of infertile cysts fluids (cattle and human origin) and sera with hydatid patients. Glycine level in fertile hydatid cyst fluids was about two times more concentrated in infertile cattle cyst fluids, 10 times more concentrated in infertile human hydatid cyst fluids and 13 times more concentrated in sera with hydatid patients. On the other hand, alanine and valine concentration in the fertile and infertile cyst fluids were at similar level with the exception that valine level in fertile cyst fluids was 12 times more concentrated in infertile human cyst fluids. The levels of tyrosine, citrulline, leucine, isoleucine and lysine amino acids in fertile and infertile hydatid cyst fluids were similar. Our findings with respect to fertile and infertile cysts fluids showed that free amino acids concentrations in cyst fluids were significantly, higher in sera from patients with hydatid cyst. Total amount of free amino acids content in fertile and infertile cyst fluids was three to eight times higher from that of human sera with hydatid patients.

Amino Acids↗
PubMed2001

Coping with male infertility. Gender differences.

Infertility is a stressor that affects the infertile couple. Coping of infertile couples with the unfulfilled desire for a child is affected by numerous variables. Depending on the diagnose is the patients were assigned to four groups: Group 1: female infertility (infertile women of fertile men), Group 2: infertility of the men, Group 3: infertility of both partners, Group 4: idiopathic sterility). One hundred and ten infertile couples were investigated with the Freiburg questionnaire of Coping with Illness. Compared to their partners, the women of infertile couples report a higher feature rating in the cales "depressional coping" and "self-distraction and self-stabilisation". Women of infertile couples show lower feature ratings compared to the standardised collective of patients with chronic somatic disease only on the scale "religiousness and search for meaning". Involuntarily childless men activate all coping strategies to a smaller extent than the reference sample. The experience of infertility is greatly affected by gender and the associated role expectations.

Adaptation, Psychological↗
PubMed2004

Present concept of unexplained infertility.

Despite improvements in both diagnostic assessment and treatment of infertile couples, many couples still have no explanation for their infertility. Unexplained infertility (the failure to conceive of a couple in whom no definitive cause for infertility can be found) has an incidence of 10-20% in all infertile couples. The incidence varies with the population studied and with the criteria used. Unexplained infertility is not an absolute condition but rather a relative inability to conceive, and many of these couples may conceive without treatment. The treatment options for unexplained infertility are several and the treatment results are promising. Expectant management can be recommended if the woman is under 28-30 years of age and the infertility duration is less than 2-3 years. In vitro fertilization (IVF) has revolutionized the treatment of infertile couples, as well as profoundly increasing the basic understanding of human reproduction. IVF can be used as both a diagnostic and a therapeutic tool in couples with unexplained infertility. The pregnancy rates with IVF are good, at 40% per treatment cycle. In addition, the outcome of pregnancies among women with unexplained infertility is generally comparable to that of spontaneous and other pregnancies using assisted reproductive technologies.

Adult↗
PubMed1992

Fertilization rate in couples with unexplained infertility.

A group of 24 couples with unexplained infertility was scheduled for in-vitro fertilization and tubal embryo transfer between May 1989 and September 1990. In the same period, in-vitro fertilization and intrauterine transfer of embryos was planned in a control group of 44 women with tubal infertility. The mean age and duration of infertility were similar in both groups and the same scheme of ovarian stimulation was used. No statistically significant difference was obtained comparing oestradiol levels and numbers of mature oocytes retrieved between the group of patients with unexplained infertility and those with tubal infertility. The fertilization rate of the oocytes obtained from women with unexplained infertility (60.4%) was significantly lower (P less than 0.001) than that of the oocytes obtained from patients with tubal infertility (87.3%). There was no statistically significant difference in the cleavage rates between patients with unexplained infertility and those with tubal infertility. It is concluded that lack of fertilization is an unexplored cause of infertility in couples with unexplained infertility.

Adult↗
PubMed1994

[Psychological aspects of infertile couples in China].

From March 1991 to February 1992, a psychological interview survey was performed among 652 women and 425 of their husbands who came to the Female Infertility Clinic in PUMC Hospital to seek consultation and treatment for their infertility. The results showed that more than 80 percent of the couples had been tolerating various psychological stresses caused by infertility. Disapproval was the most common feeling. The couples' emotion was influenced by each other. Emotional scores of husbands and wives were significantly positive correlated (P < 0.001). However, men are more capable to cope with this problem than women. Men's attitude to infertility is more positive and optimistic than women. There is no significant difference between women and men in their attitude to the treatment and forecasting of prognosis. Cultural background is a major factor associated with psychological stresses of infertile couples. Infertility has more severe impact on people living in rural areas as well as ones with lower level education. Infertility also affected couple's sexual and marital relationships. The relationship between women and their parents in-laws became worse among 8.6 percent of infertile women. About one-third of female participants thought the examination and the treatment for infertility also developed some emotional stresses and psychological burdens. Infertility may create various psychological stresses and influence the effect of treatment. Therefore, the management of infertility should not only include physical treatment but also understanding, sympathy and support, all above should not be neglected.

Adult↗
PubMed1997

[Infertility and treatment in a representative population].

The objective was to investigate lifetime prevalence of infertility, the seeking of infertility treatment and outcomes of treatment. A random sample of 3,743 women, 15 to 44 years old, were asked about infertility, their seeking of infertility treatment, diagnosis provided by their doctors and subsequent parenthood in a postal questionnaire. Response rate was 78%. Of the women who had attempted to have a child, 26.2% had experienced infertility; 4.1% af the women aged 25 to 44 years were currently primary infertile and 8.6% had involuntarily never delivered a child; 47.4% of the infertile women had sought infertility treatment. Significant predictors for seeking treatment were over nine years of school education and not having delivered a child. Of the treated infertile women 54.9% subsequently had a child. Only 30% of these reported that the successful delivery was treatment-related. The health care system should ensure that infertile couples from lower social classes are offered information on the possibility of infertility treatment.

Adolescent↗
PubMed1999

Gender differences in psychological reactions to infertility among couples seeking IVF- and ICSI-treatment.

BACKGROUND: Gender differences and similarities in psychological reactions related to infertility, perception of social support, the effect of infertility on the marital relationship and coping-style were investigated among Swedish couples seeking in vitro fertilization -- or intracytoplasmic sperm injection - treatment. METHODS: Ninety-one couples entering treatment completed the Infertility Reaction Scale, a self-report questionnaire with structured and open-ended questions and the Miller Behavioral Style Scale. RESULTS: The women reacted more strongly to their infertility than the men as measured by the Infertility Reaction Scale (p<0.05). Factor analysis of the Infertility Reaction Scale produced three factors for men and women respectively. The first factor that emerged for the men was 'The male role and social pressure' and the second factor was 'The major focus of life'. For the women the two first factors were reversed compared to those of the men. The third factor 'Effect on sexual life' was similar for men and women. Significantly more men than women had not confided in anyone about their infertility problem (p<0.001). The information-seeking coping style was significantly correlated with infertility distress only among men (p<O.05). CONCLUSION: The women reacted more strongly to their infertility than the men and they felt an intense desire to have a child. They received more social support than their partners, who experienced the fulfillment of the male role as well as the social role to become a parent as the most central aspects of infertility. The information-seeking coping style was significantly correlated with infertility distress only among men.

Adult↗
PubMed2006

Development and validation of the Infertility Self-Efficacy scale.

OBJECTIVE: To develop and validate a scale of perceived self-efficacy for people coping with infertility treatment. DESIGN: Self-efficacy scale development involved: [1] item generation with medical experts in reproductive health; [2] a principal components analysis with varimax rotation to identify underlying item components; [3] test-retest reliability and construct (convergent and discriminant) validity with infertility patients, who were administered the Infertility Self-Efficacy (ISE) scale with other measures; and [4] expert acceptability, as determined by reproductive health professionals. SETTING: Recruitment at a fertility center, a national infertility organization, and medical trials web pages. PATIENT(S): A total of 213 participants (159 women; 54 men) with a diagnosis of infertility in the past 2 years were recruited for the various study phases. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants' infertility self-efficacy was assessed with an online assessment battery using the ISE scale; comparison mental health measures assessed current levels of fertility problem distress, perceived stress, and coping style. Reliability, validity, and component structure of the ISE was assessed. RESULT(S): Measurement development yielded a brief 16-item ISE scale that taps an infertility patient's perception about his or her ability to engage in a set of cognitive, emotional, and behavioral skills related to the medical treatment of infertility. The single component of "cognitive/affect regulation" suggests this core set of skills is relevant to successfully managing the experience of infertility. The ISE correlations with comparison mental health measures were as expected, suggesting good convergent and discriminant validity. CONCLUSION(S): The ISE scale appears to be a reliable and valid measure of an individual's self confidence in areas related to health promotion during infertility treatment. Assessing an infertility patients' self-efficacy with the ISE may be useful in clinical research and as a counseling tool to help guide patients in actively managing their fertility treatment.

Adaptation, Psychological↗