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PubMedDate not supplied

Factors related to infertility in the United States, 1965-1976.

Although the overall rate of infertility among American women of reproductive age remained fairly constant between 1965 and 1976, the percentage of young black women who were infertile increased very sharply. In 1976, 18% of black women of reproductive age were infertile, whereas only 9% of white women of the same age were infertile. With use of national data bases, the relationships between sexual activity, complications of pregnancy, sexually transmitted diseases, pelvic inflammatory disease, use of contraception, and infertility were examined. Available evidence shows a strong association between sexually transmitted diseases, pelvic inflammatory disease, and infertility trends. Our projections indicate that sexually transmitted diseases operating through pelvic infections account for much of the race differential in infertility as well as for one-half to one-third of the increase. In 1976 5-8% of 20-29-year-old black women were estimated to suffer infertility attributable to sexually transmitted diseases. Among white women the estimated incidence of infertility caused by sexually transmitted diseases was 0.7-1%.

Adolescent↗
PubMed1995

Contribution of the male factor to unexplained infertility: a review.

The more exhaustive the evaluation of couples with unexplained infertility, the more likely is the opportunity for detecting the aetiological factor responsible for infertility. Transport of spermatozoa through the upper genital tract and their ability to fertilize the oocyte are two obscure areas for the conventional evaluation of infertility. Although research in the former area is limited, there is indirect evidence that impaired sperm transport could be one of the causes of infertility in some couples with otherwise unexplained infertility. on the other hand, the availability of sperm function tests and the correlation of their results with in-vitro fertilization rates have allowed the detection of a previously hidden male factor in couples with unexplained infertility. It has been demonstrated that couples suffering unexplained infertility have significantly lower in-vitro fertilization rates in comparison with patients with tubal problems. These results can be explained because of several case control studies in patients with unexplained infertility have reported defects in capacitation and sperm motion characteristics, binding of the spermatozoa to the zone pellucida, acrosome reaction, acrosin activity of the spermatozoa, and the ability of the spermatozoa to penetrate zona-free hamster oocytes. These observations suggest that methods for assessing the fertilizing capacity of the spermatozoa have to incorporated in the evaluation of couples with unexplained infertility in order to amplify the scope of the workup and to better decide the appropriate treatment for these couples.

Animals↗
PubMed2000

Reproductive outcome after laparoscopic myomectomy in infertile women.

OBJECTIVE: To assess reproductive outcome after laparoscopic myomectomies for interstitial and/or subserosal myomas in infertile women with or without associated infertility factors. STUDY DESIGN: In this observational study, 91 women with infertility for one year and at least one interstitial and/or subserosal myoma > 20 mm were treated with laparoscopic myomectomy. All patients were mailed questions about fertility and pregnancy outcome. Cumulative pregnancy rates were calculated by the Kaplan-Meier method. The log rank test and Cox's model were used for comparing the spontaneous pregnancy rate in patients with and without associated infertility factors. RESULTS: The mean age of the patients was 35 +/- 4 years. The mean duration of infertility was 44 +/- 33 months. Twenty-five patients (27.5%) had no associated infertility factors, and 66 (72.5%) had one or more. The mean size of the largest myomas was 45 +/- 19 mm. The mean number of myomas removed was 2.0 +/- 1.4. Eighty-six patients had laparoscopic myomectomy (94.5%), and five had laparoscopically assisted myomectomy (5.5%). There were no conversions to laparotomy. Ten patients were lost to follow-up (11.0%). Among the 91 patients treated surgically, 81 (89.0%) of them were evaluated. Forty-three (53.1%) conceived, resulting in a total of 51 pregnancies. The two-year overall cumulative conception rate was 51.2% (95% confidence interval [CI], 39.2-63.2%). The two-year spontaneous pregnancy rate was 43.9% (95% CI, 32.1-55.7%). This rate was 69.9% (95% CI, 50.3-89.5%) for patients with no associated factors and 31.5% (95% CI, 18.4-44.6%) for patients with associated factors (P < .001). This result was not affected by adjusting for age or duration of infertility. CONCLUSION: Laparoscopic myomectomy seems to be a good procedure for patients with myomas and no other infertility factors. In cases with associated infertility factors, the need for myomectomy has to be studied.

Adult↗
PubMed1995

Primary infertility and oral contraceptive steroid use.

OBJECTIVE: To determine the association between combined monophasic oral contraceptive (OC) use and primary infertility. DESIGN: Case-control. SETTING: Women serving as controls of the Cancer and Steroid Hormone Study. PARTICIPANTS: Women were 19 to 40 years of age at first conception or infertility diagnosis. Based on 24 consecutive months of unprotected intercourse without a recognized conception, 419 nulligravid women had primary infertility; controls were 2,120 fertile women. A calendar of each women's reproductive history was used to determine fertility status and contraceptive use before infertility diagnosis or first conception. MAIN OUTCOME MEASURE: Primary infertility. RESULTS: Combined monophasic OC use was associated with a lower frequency of primary infertility, particularly among younger (age 20 years) compared with older women (age 30 years) after adjusting for barrier method use and education. A similar association was found for duration of OC use. When adjusted for age at first conception or infertility and barrier method, both higher (> 50 micrograms) and lower (< or = 50 micrograms) estrogen dose use were associated with decreased risk of primary infertility. CONCLUSION: Combined monophasic OC use was associated with a lower frequency of primary infertility.

Adult↗
PubMed1993

A randomized and longitudinal study of human menopausal gonadotropin with intrauterine insemination in the treatment of infertility.

OBJECTIVE: To study in a randomized and longitudinal manner the efficacy of human menopausal gonadotropin (hMG) superovulation combined with intrauterine insemination (IUI) versus IUI alone in the treatment of various causes of infertility in the presence of normal ovulation. METHODS: An initially randomized and subsequently longitudinal study of infertile couples was performed at a university-based clinical research center. One hundred nineteen couples with longstanding infertility (average duration 3.7 years) associated with male factor infertility, unexplained infertility, and/or endometriosis were enrolled. All patients were randomized in the initial cycle to treatment with either hMG/IUI or urine LH-timed IUI alone. They were then followed longitudinally as they alternated subsequent cycles between the two modalities. Outcome indices measured were cycle fecundity, pregnancy outcome, and cumulative pregnancy rates evaluated by life-table analysis. RESULTS: Human menopausal gonadotropin/IUI therapy was consistently more effective than IUI alone in the treatment of endometriosis, male factor infertility, and unexplained infertility, with cycle fecundities ranging from 7.1-19.0% versus 0-6.7%, respectively, during the first seven cycles. CONCLUSION: Human menopausal gonadotropin/IUI is a more effective therapy for enhancing fertility than is IUI alone for the treatment of endometriosis, male factor infertility, and unexplained infertility.

Adult↗
PubMed1999

Ovarian autoimmunity: greater frequency of autoantibodies in premature menopause and unexplained infertility than in the general population.

The objective of this study was to: (1) assess the relative prevalence of ovarian, thyroid, nuclear, and cardiolipin antibodies associated with premature menopause and unexplained infertility and (2) compare ovarian and thyroid antibodies in premature menopause, unexplained infertility, and the general population. Autoantibodies were evaluated in women with premature menopause (n = 30), unexplained infertility with (n = 38) or without (n = 15) prior gonadotropin-induced ovulation, and normal cycling controls (n = 12) and in a population of women obtained from a blood bank (n = 53). Antibodies to ovary (OVAB), thyroid (THYAB; thyroid peroxidase and thyroglobulin), cardiolipin, and eight nuclear antigens were assessed by enzyme immunoassay. Organ-specific antibodies (ovary and thyroid) were present with significantly greater frequency than non-organ-specific antibodies (nuclear and cardiolipin) in premature menopause and unexplained infertility (60% (50/83) vs 16% (13/83) respectively; P < 0.0001). OVAB (53%, 44/83) were significantly more frequent than THYAB (30%, 25/83) in premature menopause and unexplained infertility (P = 0.0030). THYAB did not differ among all groups (P = 0.78). In premature menopause and treated or untreated unexplained infertility OVAB frequencies were 53, 61, and 33%, respectively, and were significantly more frequent than in the population (17%) (P = 0.0001). In unexplained infertility, individuals with no prior gonadotropin-induced ovulation had a lower frequency of OVAB than treated individuals (P = 0.07). The frequency distribution of optical density values for OVAB was significantly higher for premature menopause and unexplained infertility than for population or normal cycling women (P < 0.0001). Thus, only ovarian antibodies were significantly more frequent than other antibody markers of autoimmunity in premature menopause and unexplained infertility.

Adult↗
PubMed1996

Risk of breast cancer in a cohort of infertile women.

The purpose of this study was to assess: (1) the risk of breast cancer associated with use of ovulation-inducing agents (such as clomiphene citrate) as treatment for infertility; and (2) the risk associated with ovulatory abnormalities that result in infertility. We performed a case-cohort study among 3837 women evaluated for infertility at clinics in Seattle, Washington, at some time during 1974-1985. Computer linkage with a population-based tumor registry was used to identify women diagnosed with breast cancer before January 1, 1992. Data regarding infertility testing and treatment were abstracted from the infertility clinic medical records for women who developed breast cancer and a randomly selected subcohort. Twenty-seven women in the cohort developed in situ or invasive breast cancer, in comparison with an expected number of 28.8 cases (standardized incidence ratio, 0.9; 95% confidence interval (CI), ).6-1.4). Infertile women with evidence of an ovulatory abnormality were at a risk of breast cancer similar to that of women whose infertility was believed to be due to other causes. The risk among women who had taken clomiphene was reduced relative to infertile women who had not used this drug (adjusted relative risk, 0.5; 95% CI, 0.2-1.2), but the reduction in risk did not increase with duration of use. The possibility that use of clomiphene as treatment for infertility lowers the risk of breast cancer should be examined in other, larger studies.

Adolescent↗
PubMed2006

Comparing the pregnancy rates of one versus two intrauterine inseminations (IUIs) in male factor and idiopathic infertility.

PURPOSE: To compare the effectiveness of double IUI with single IUI in male factor and idiopathic infertility patients undergoing controlled ovarian hyperstimulation (COH). METHODS: A prospective randomized study of 1257 COH-IUI cycles was performed. Total 1270 patients with mild or moderate male factor infertility (n = 776) and idiopathic infertility (n = 494) were enrolled in this study, and 767 with male factor infertility and 490 with idiopathic infertility completed clomiphene citrate (CC)/human menopausal gonadotrophin (hMG) COH cycles and IUI. Categorized on the basis of the causes of infertility (male factor, M; idiopathic infertility, I), patients were randomized into one of the following groups: Single IUI group (M(1)/I(1)) received single insemination 34 h post hCG administration, and double IUI group (M(2)/I(2)) received two inseminations 18-24 and 36-48 h post hCG injection, respectively. RESULTS: The overall pregnancy rates were 15.43%. Pregnancy rate for single and double IUI group was 11.06 and 19.87% (p < 0.05), respectively. There was a significant statistical difference in cycle fecundity between M(1) and M(2) group (11.34% vs. 24.93%, p < 0.05), and between I(2) and M(2) group (11.93% vs. 24.93%, p < 0.05), but there was no significant difference between I(1) and I(2) (10.53% vs. 11.93%, p > 0.05). CONCLUSIONS: Double IUI increases the pregnancy rate significantly in patients with male factor infertility, and single IUI acts as efficient as double IUI in patients with idiopathic infertility.

Female↗
PubMed2005

Semen profile, testicular volume, and hormonal levels in infertile patients with varicoceles compared with fertile men with and without varicoceles.

OBJECTIVE: To assess semen analysis, testicular volume, and hormone levels in fertile and infertile patients with varicoceles and fertile men without varicoceles. DESIGN: Retrospective study. SETTING: Academic medical center. PATIENT(S): Patients were divided into three groups: fertile men with varicoceles (n = 79), infertile men with varicoceles (n = 71), and fertile men without varicoceles (n = 217). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Levels of LH, FSH, and total T and testicular volume in fertile and infertile men with varicoceles and fertile controls without varicoceles. RESULT(S): LH (IU/L) and T (ng/dl) levels were not statistically different across the three groups. FSH levels were significantly higher in infertile men with varicoceles (7.8 +/- 7.6 IU/L) than in the fertile men with varicoceles (3.5 +/- 2.1 IU/L) or in fertile men without varicoceles (3.5 +/- 1.9 IU/L). The right testicle was smaller in infertile patients with varicoceles (18.7 +/- 8.3 cm(3)) than in fertile men with varicoceles (25.2 +/- 13 cm(3)) or in fertile men without varicoceles (24.9 +/- 10.7 cm(3)). In addition, the left testicle was smaller in infertile men with varioceles (17.6 +/- 8.9 cm(3)) than in fertile men with varicoceles (21.6 +/- 7.8 cm(3)) or in fertile men without varicoceles (23.4 +/- 8.3 cm(3)). Sperm concentration was lower in infertile men with varicoceles (33.7 +/- 23.3 x 10(6)/mL) than in fertile men with varicoceles (101.8 +/- 76.6 x 10(6)/mL) or in fertile men without varicoceles (111.8 +/- 74.2 x 10(6)/mL). In addition, sperm motility was lower in infertile men with varicoceles (37.2% +/- 23.9%) than in fertile men with varicoceles (53.9% +/- 17.4%) or fertile men without varicoceles (58.9% +/- 15.8%). CONCLUSION(S): Infertile patients with varicoceles have higher levels of FSH, smaller testes, and lower sperm concentration and motility compared with controls with or without varicoceles. No statistical differences were seen in the variables evaluated among the fertile men with incidental varicoceles detected at physical examination and those without varicoceles.

Adult↗
PubMed2006

Socioeconomic and racial disparities among infertility patients seeking care.

OBJECTIVE: To examine sociodemographic differences based on patient race/ethnicity among infertility patients seeking care in a state with mandated coverage of infertility treatment. DESIGN: Cross-sectional survey. SETTING: University-hospital-based fertility center. PATIENT(S): A total of 1,500 consecutive women who presented for infertility care. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Self-report questionnaire assessing patient race/ethnicity, diagnosis, income, education level, and duration of infertility before seeking care. RESULT(S): African American women experienced a significantly longer duration of infertility before seeking care compared with Caucasian women (4.3 vs. 3.3 years, respectively; P=.03). With regard to infertility diagnosis, a significantly greater proportion of African American and Hispanic women had tubal factor infertility compared with Caucasian women (24.0% and 27.3% vs. 5.3%, respectively; P=.001). Looking at the highest level of education attained by patients, a significantly greater proportion of African American and Hispanic women had less than a 4-year college degree compared with Caucasian women (48% and 40.9% vs. 13.2%, respectively; P<.001). Examining the gross annual household income of patients, a significantly greater proportion of African American and Hispanic women had household incomes below $100,000 compared with Caucasian women (72% and 68.2% vs. 37.3%, respectively; P<.01). CONCLUSION(S): African American women are more likely to seek infertility treatment after a longer duration of failed conception compared with Caucasian women. Furthermore, African American, and Hispanic women are more likely to have tubal factor infertility, a lower education level, and a lower household income compared with Caucasian women.

Adult↗
PubMed2006

Health disparities and infertility: impacts of state-level insurance mandates.

OBJECTIVE: To determine whether important racial, ethnic, or socioeconomic status (SES) health disparities exist in infertility, impaired fecundity, or infertility treatment. DESIGN: Four waves of the National Survey of Family Growth (NSFG) were pooled. Measures were compared across various race/ethnicity, education, and age groups. PARTICIPANT(S): Data for 31,047 women 15-44 years old from the NSFG were pooled. INTERVENTION(S): Outcomes were compared by whether the women's states of residence had a mandate in place (at least 1 year before the interview) to compel insurers to cover or offer to cover infertility treatment. MAIN OUTCOME MEASURE(S): Infertility status, impaired fecundity, ever having sought infertility treatment. RESULT(S): Infertility is more common for non-Hispanic black women, non-Hispanic other race women, and Hispanic women than for non-Hispanic white women, and both infertility and impaired fecundity are more common for high school dropouts and high school graduates with no college than for 4-year college graduates, and for older women compared with women 29 and younger. Older women, non-Hispanic white women, and women who are more educated (with at least some college) are more likely to have ever received treatment. No evidence has been found that the racial, ethnic, or education disparities are ameliorated by the health insurance mandates. CONCLUSION(S): Racial, ethnic, and educational disparities exist in infertility status and treatment, and educational disparities in impaired fecundity. More study of the impact of infertility treatment mandates on these disparities is needed.

Adolescent↗
PubMed1996

Are there any clinical signs and symptoms that are related to endometriosis in infertile women?

OBJECTIVE: Our purpose was to assess the physical signs and clinical symptoms associated with endometriosis in infertile women. STUDY DESIGN: This case-control study was carried out in an academic tertiary hospital. There were 174 infertile women with endometriosis and 174 infertile women without endometriosis, all of them studied by laparoscopy. Before laparoscopy a standard interview and a standard physical examination were performed. RESULTS: Cul-de-sac nodularity was more frequent in infertile women with endometriosis than in infertile women without endometriosis (6.3% vs 0%). Although uterosacral tenderness was also more frequent in infertile women with endometriosis (7.5% vs 1.7%), uterosacral tenderness without nodularity was similar in both populations. Uterine retroversion and cul-de-sac obstruction frequencies were somewhat higher in the endometriosis group (p<0.10). The remaining signs and symptoms analyzed, including pelvic pain and dysmenorrhea, were similarly frequent in both populations. Symptoms were similarly frequent in all American Fertility Society stages, although adnexal mass was higher in stage IV. CONCLUSION: Uterosacral nodularity was pathognomonic of endometriosis in infertile women. Uterosacral nodularity and uterosacral tenderness (associated with uterosacral nodularity) were the only symptoms or signs of value to indicate endometriosis in infertile patients. The remaining clinical signs, as well as clinical symptoms, were of no value in diagnosing endometriosis in infertile women.

Biopsy↗
PubMed2002

Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: a prospective study.

OBJECTIVE: To investigate levels of seminal oxidative stress (OS) and sperm quality in a group of infertile men with a history of cigarette smoking. DESIGN: A prospective clinical study. SETTING: Male infertility clinic, Urological Institute, the Cleveland Clinic Foundation, Cleveland, Ohio. PATIENT(S): Infertile men who smoked cigarettes (n = 20), infertile men who were nonsmokers (n = 32), and healthy nonsmoking donors (n = 13). INTERVENTION(S): Genital examination, standard semen analysis, sperm DNA damage. MAIN OUTCOME MEASURE(S): Levels of seminal reactive oxygen species (ROS) and total antioxidant capacity (TAC) measured by a chemiluminescence assay and seminal OS assessed by calculating a ROS-TAC score. Sperm DNA damage was measured by sperm chromatin structure assay. RESULT(S): Smoking was associated with a 48% increase in seminal leukocyte concentrations (P<.0001), a 107% increase in ROS levels (P=.001), and a 10-point decrease in ROS-TAC scores (P=.003). Differences in standard sperm variables and DNA damage indices between the infertile smokers and infertile nonsmokers were not statistically significant. CONCLUSION(S): Infertile men who smoke cigarettes have higher levels of seminal OS than infertile nonsmokers. Given the potential adverse effects of seminal OS on fertility, physicians should advise infertile men who smoke cigarettes to quit.

Analysis of Variance↗
PubMed1978

On the etiologic role of ureaplasma urealyticum (T-mycoplasma) infection in infertility.

Two hundred consecutive infertility patients and sixty-seven controls subjects were studied for the incidence of infection with Ureaplasma urealyticum (T-mycoplasma). On the basis of a complete infertility investigation, the infertility patients were subdivided into those with explained infertility and those with unexplained infertility. Of the patients with unexplained infertility, 55% had a positive culture for T-mycoplasma as compared with a 32% incidence of positive cultures in the control population. The differences were statistically significant. The 6-month pregnancy rate following successful antibiotic treatment in patients with unexplained infertility was 42%. The 6-month pregnancy rate in a comparable group of patients with unexplained infertility, seen during a 3-year period prior to mycoplasma culture and treatment, was 32%. The difference in pregnancy rates between the two groups was not statistically significant. No correlation was found between a poor postcoital test and the presence of T-mycoplasma infection nor between T-mycoplasma infection and poor cervical mucus. The role of T-mycoplasma infection in infertility was neither proven nor disproven by this study.

Cervix Uteri↗
PubMed1993

The contribution of a hidden male factor to unexplained infertility.

OBJECTIVE: To assess sperm function in patients with unexplained infertility in comparison with normal fertile men. DESIGN: Prospective study. SETTING: Infertility outpatient clinic and donor insemination program, University Department of Obstetrics and Gynecology at the Jessop Hospital for Women, Sheffield, United Kingdom. PATIENTS: Nineteen patients with unexplained infertility and nineteen normal fertile men from a donor insemination program. MAIN OUTCOME MEASURES: Monitoring of reactive oxygen species generation; computerized assessment of the hyperactivated motility pattern of the spermatozoa under capacitating conditions, with and without the addition of follicular fluid (FF); evaluation of sperm-zona pellucida (ZP) binding. RESULTS: Reactive oxygen species generation was not significantly different between the study and control group. Follicular fluid-induced hyperactivation (HA) was significantly lower in patients with unexplained infertility than in the donors, but no difference was found comparing spontaneous HA (without FF) between the two groups. Follicular fluid-induced HA was completely absent in 39% of infertile men and only one fertile man. A low sperm-ZP binding ratio (< or = 0.3) was observed in 28% (5/18) of patients with unexplained infertility. In all, nine infertile men (47%) had 0% FF-induced HA and/or low sperm-ZP binding ratio. CONCLUSIONS: Assessing FF-induced HA and sperm-ZP binding may have clinical significance in distinguishing a subgroup of men with unexplained infertility with sperm function abnormalities in which the fertilizing capacity of the spermatozoa might be reduced. These patients cannot be identified by the conventional semen analysis. Both tests may also be useful in planning the appropriate treatment for couples with unexplained infertility.

Female↗
PubMed1994

Chlamydia trachomatis antibody testing is more accurate than hysterosalpingography in predicting tubal factor infertility.

OBJECTIVE: To compare the likelihood of abnormal Chlamydia trachomatis antibody test results with that of abnormal hysterosalpingography (HSG) test results in patients with tubal factor infertility. DESIGN: Anti-C. trachomatis immunoglobulin G antibodies were determined prospectively in 211 consecutive infertility patients by means of an indirect fluorescent antibody technique. The results were compared with the results of HSG with respect to their predictive value of tubal factor infertility. Likelihood ratio calculations were used. SETTING: University hospital-based, tertiary care infertility clinic. PATIENTS: A series of 211 consecutive infertility patients. INTERVENTIONS: C. trachomatis antibody testing, HSG, laparoscopy. MAIN OUTCOME MEASURES: Likelihood ratios for abnormal C. trachomatis antibody test results and abnormal HSG results in infertility patients, as assessed by laparoscopy. RESULTS: The positive likelihood ratio for C. trachomatis antibody testing was 9.1, indicating a patient with tubal factor infertility to be 9.1 times more likely to have abnormal serology results than a patient without tubal factor infertility. This was superior to HSG, which had a positive likelihood ratio of 2.6 in our study and of 1.6 to 6.1 in the literature. The odds ratio of C. trachomatis antibody testing was 31.5 in our study. Its 90% confidence interval (8.3 to 138.5) did not overlap that of HSG as calculated from a meta-analysis of literature reports (5.3 to 7.9). CONCLUSIONS: C. trachomatis antibody testing is simple, inexpensive, and causes minimal inconvenience to the patient. It is more likely than HSG to be abnormal in patients with tubal factor infertility. C. trachomatis antibody testing deserves to become an integral component of the initial fertility work-up.

Antibodies, Bacterial↗
PubMed1994

Association of elevated estradiol with remote testicular trauma in young infertile men.

OBJECTIVE: To determine the incidence of remote testicular trauma and of possible related permanent hormonal and seminal changes in infertile men. DESIGN: Retrospective clinical study of hormonal and seminal parameters in a subpopulation of infertile men. SETTING: Andrology Clinic in an academic research environment. PARTICIPANTS: Infertile men, with and without history of remote testicular trauma, and fertile volunteers. MAIN OUTCOME MEASURES: Percentage of infertile men with history of blunt testicular trauma, concentrations of reproductive hormones, and semen parameters. RESULTS: Significant remote blunt testicular trauma was reported by 16.8% of infertile men. This had occurred 2 to 17 years (mean, 16.4 years) before evaluation, mostly with contact sports at adolescent age. Estradiol concentrations after testicular trauma were 19% and 25% higher than in infertile men without history of testicular injury and in fertile controls. Elevated E2 levels did not correlate with T. Infertile men with and without history of testicular trauma showed changes in seminal parameters. CONCLUSION: The incidence of remote blunt testicular trauma in infertile men is unexpectedly high. After injury, FSH-stimulated aromatization of T may increase testicular E2 production, interfere with spermatogenesis, and cause infertility. Consistent use of protective devices in contact sports is recommended.

Adult↗
PubMed1999

The Fertility Problem Inventory: measuring perceived infertility-related stress.

OBJECTIVE: To develop a reliable, valid instrument to evaluate perceived infertility-related stress. DESIGN: Prospective study. SETTING: University-affiliated teaching hospital. PATIENT(S): Consecutively referred patients (1,153 women and 1,149 men) seen for infertility treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants' infertility-related stress was assessed by written questionnaire using the Fertility Problem Inventory. Current levels of anxiety, depression, and marital satisfaction also were determined. RESULT(S): Women described greater global stress than men and higher specific stress in terms of social concerns, sexual concerns, and need for parenthood. Both men and women facing male infertility reported higher global stress and more social and sexual concerns than men and women experiencing female infertility. Social, sexual, and relationship concerns related to infertility were more effective predictors of depression and marital dissatisfaction than expressed needs for parenthood or attitudes toward child-free living. CONCLUSION(S): The Fertility Problem Inventory provides a reliable measure of perceived infertility-related stress and specific information on five separate domains of patient concern. Patterns of infertility-related stress differed depending on gender, fertility history, and infertility diagnosis. Among patients receiving treatment, social, sexual, and relationship concerns appear central to current distress. Counseling interventions that target these domains appear likely to offer maximal therapeutic benefit.

Adult↗