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PubMed1999

The pattern of infertility diagnoses in women of advanced reproductive age.

OBJECTIVE: Our intention was to determine whether there is a unique pattern of infertility diagnoses in older infertile couples. STUDY DESIGN: The design of this study was a retrospective chart review study. It was performed in a tertiary referral reproductive medicine unit. There were 2 groups of patients-couples: group 1, female partner aged 20-29 (n = 105) at presentation; group 2, female partner aged 40-45 (n = 112) at presentation. All women underwent infertility evaluations between 1989 and 1994. There were no interventions. The prevalence of standard infertility diagnoses was the main outcome measure. RESULTS: The prevalence of 8 major infertility diagnoses in the younger and older groups (each couple could have >/=1 diagnosis) was as follows: (1) ovulatory factor-younger group, 56%; older group, 30%; (2) tubal factor-younger group, 34%; older group, 29%; (3) endometriosis-younger group, 13%; older group, 17%; (4) uterine factor-younger group, 1%; older group, 5%; (5) cervical factor-younger group, 4%; older group, 1%; (6) luteal deficiency-younger group, 4%; older group, 10%; (7) male factor-younger group, 32%; older group, 45%; (8) unexplained-younger group, 5%; older group, 10%. The only significant difference was an increase in ovulatory factor in the younger group. CONCLUSIONS: There is no unique pattern of infertility diagnoses in women of advanced reproductive age as seen at a tertiary referral center. We speculate that a high false-positive rate associated with standard infertility tests and a different referral pattern for older couples obscures any real differences in the etiology of infertility in older couples.

Adult↗
PubMed1990

Psychiatric morbidity in the infertile population: a reconceptualization.

The understanding of psychiatric morbidity in the infertile population relies to a great extent upon the instruments used to measure psychopathology. The present study investigated the distinction between psychiatric morbidity and infertility strain reactions in a sample of 104 infertile couples using the SCL-90-R. Some symptoms ordinarily indicative of psychopathology can represent normal side effects or reactions to infertility treatment, thus causing spurious estimates of pathology. Alternately, item analyses revealed a profile of infertility strain reflecting tension, depressive symptoms, worry, and interpersonal alienation frequently occurring among both male and female infertility patients. The concept of infertility strain is suggested as a vehicle for understanding the functioning of infertile patients and to circumvent the stigmatizing effects of psychiatric labels while providing appropriate intervention.

Adult↗
PubMed2000

Infertility: etiologies, evaluation and treatments.

Approximately 12-15% of couples are considered infertile and seek medical care. This review will delineate the current etiologies of infertility and outline a detailed evaluation. Treatment of the infertile couple should be targeted towards specific causes with empiric therapies reserved for those with unexplained infertility. Currently, great advances in the area of assisted reproductive technology allow physicians to treat couples with severe male factor infertility and tubal disease who previously had little hope of conceiving. The most common etiologies of infertility include tubal and peritoneal disorders, ovulatory dysfunction and male factor. Other conditions causing infertility are mentioned in this review for completeness sake. Surgery often corrects infertility due to tubal and peritoneal disease while a variety of medications exist to successfully manage ovulatory dysfunction. Couples who fail to conceive with those conservative measures are candidates for assisted reproductive technology such as in vitro fertilization (IVF). Recent advances in IVF lab techniques allow for correction of severe male factor infertility through use of intracytoplasmic sperm injection.

Journal Article↗
PubMedDate not supplied

Psychosocial response of Chinese infertile husbands and wives.

Some 15% or 1 in 6 American couples in the childbearing years have infertility problems. Numerous studies have demonstrated that both infertile men and women have negative emotional responses, such as stress, anxiety and depression. In Europe, Canada, and the United States the response of infertile husbands was different from that of their wives in self-image, marital adjustment, and sexual relations. The differences in psychological distress, marital satisfaction, and sexual satisfaction between Chinese infertile husbands and wives were evaluated. Fifty-nine infertile couples participated in this study. The subjects completed an Infertility Questionnaire, Marital Satisfaction Questionnaire, and Sexual Satisfaction Questionnaire as measures of gender differences in facing infertility problems. Paired t tests revealed that husbands expressed significantly less distress than that of the wives. The husbands' self-esteem was higher than that of the wives. The husbands' marital and sexual satisfaction was also higher than that of the wives. These results propose that although differences exist in cultural, ethnic, and religious norms between Chinese society and Western society, the Chinese couples' response to infertility is similar to that of Western couples. The major difference is that the in-laws play an important role in Chinese society, especially in marital satisfaction.

Adult↗
PubMedDate not supplied

Development of the coping scale for infertile couples.

Infertility treatment involves more complicated, uncomfortable, and humbling medical procedures for women, so the coping strategies used by wives may differ from those used by husbands. The purpose of this study was to develop and test a Coping Scale for Infertile Couples that would be sensitive to the differences in gender. What couples actually do to cope with infertility and whether these strategies are different between couples were also addressed. A total of 138 infertile couples participated in this study. The Coping Scale for Infertile Couples was administered with the Infertility Questionnaire, the Perceived Stress Scale, and the Jalowiec Coping Scale as measures of concurrent validity. Factor analysis extracted 4 subscales from the Coping Scale for Infertile Couples. Test-retest and internal consistency reliability were high. Paired t tests revealed that wives used the "Increasing space and Sharing the burden" strategies to a greater degree than their husbands. Husbands used the "Being the best" strategy to a greater degree than the wives. A significant correlation with distress, stress, and coping measures provided evidence of concurrent validity. Preliminary results suggest that this measure has good reliability and validity, which can contribute toward the elucidation of coping strategies used by infertile couples and assist in planning effective interventions.

Adaptation, Psychological↗
PubMed1999

The prevalence of polycystic ovaries in women with infertility.

Polycystic ovaries (PCO) are highly prevalent in women presenting with hirsutism or recurrent miscarriage but the functional significance of PCO in ovulatory women presenting with infertility remains unclear. We examined the prevalence of PCO, on ultrasonography, among women presenting with infertility. Among 289 couples classified in four main diagnostic categories, PCO were found in 81 (83%) of 98 anovulatory patients, 40 (53%) of 76 patients whose partners had sperm dysfunction, 26 (50%) of 52 patients with tubal disease and in 28 (44%) of 63 patients with unexplained infertility. By comparison, in a control group of 67 parous volunteers, 19 (28%) were found to have PCO. PCO patients with unexplained infertility had higher midfollicular luteinizing hormone and testosterone compared with the group with normal ovaries. The prevalence of PCO was significantly higher in each of the infertility groups than in controls, and a similar tendency (not significant) was observed among women with unexplained infertility. Ovulatory PCO women with infertility had higher testosterone concentrations in comparison with PCO controls. In summary, the prevalence of PCO among ovulatory women with infertility is higher than that in the normal population, suggesting that PCO may, perhaps by virtue of an effect of hyperandrogenaemia, contribute to the causes of subfertility in women with regular menses.

Adult↗
PubMed1987

Cancer incidence in a cohort of infertile women.

To explore further the relation between infertility and breast and female reproductive cancers, cancer incidence among 2,632 Israeli women treated for infertility between 1964 and 1974 was evaluated. Cancer incidence through December 1981 was determined by matching the study cohort to the Israel Cancer Registry. The observed number of cancers was compared with sex-age-ethnic and calendar-year, site-specific national cancer rates. There were 42 cancers observed compared with 37.4 expected, yielding a standardized incidence ratio of 1.1 (95% confidence interval (CI) = 0.8-1.5). Analysis by infertility diagnosis demonstrated no significant excess of total cancer incidence; the standardized incidence ratio was 1.3 (95% CI = 0.8-1.8) for infertility due to hormonal deficiency, 0.7 (95% CI = 0.3-1.4) for mechanical infertility, 1.6 (95% CI = 0.6-3.6) for infertility of the male partner, and 1.1 (95% CI = 0.5-2.2) for unclassified diagnosis. Site-specific analyses revealed a significantly increased risk (8.0; 95% CI = 2.5-19.3; four cases observed, 0.50 expected) of endometrial cancer for the hormonal group and a nonsignificant excess of breast cancer and melanoma. Although numbers were small, women with disorders causing unopposed estrogen production had a risk of 1.4 (95% CI = 0.8-2.2) for all cancer sites, which reached 10.3 (95% CI = 2.6-28.2; three cases observed, 0.29 expected) for endometrial cancer and 1.8 (95% CI = 0.8-3.4; eight cases observed, 4.43 expected) for breast cancer. Among women with nonhormonal infertility, there was a suggestion of increased risks of carcinoma of the ovary (3.2; 95% CI = 0.3-32.9; two cases observed, 0.63 expected) and thyroid (3.0; 95% CI = 0.3-24.6; two cases observed; 0.67 expected). No evidence of an association between ovulation-inducing drugs and cancer was found. This study supports the hypothesis that infertility caused by hormone deficiency is a risk factor for uterine cancer, but is inconclusive regarding breast cancer.

Adult↗
PubMed1985

Population study of causes, treatment, and outcome of infertility.

Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1.2 couples for every 1000 of the population. At least one in six couples needed specialist help at some time in their lives because of an average of infertility of 21/2 years, 71% of whom were trying for their first baby. Those attending gynaecology clinics made up 10% of new and 22% of all attendances. Failure of ovulation (amenorrhoea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (two year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0-27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilisation could benefit 80% of cases of tubal damage and 25% of unexplained infertility--that is, 18% of all cases, representing up to 216 new cases each year per million of the total population.

Adolescent↗
PubMed1990

White cell subpopulations in autoimmune infertile men and their wives with cytotoxic sperm antibodies.

Sixty six infertile men with cytotoxic sperm antibodies had fewer and lower percentages of OKT4-positive helper/inducer T lymphocytes p = 0.004 and 0.003, respectively), than the fertile (n = 14) and infertile (n = 12) antibody-negative controls. Ratio of OKT4/OKT8 was decreased (p less than 0.01), while numbers of OKDR and BD-Leu12 positive predominantly B lymphocytes were increased (p less than 0.0001) in infertile men with sperm antibodies. T lymphocytes positive for OKT3, OKT11 and OKT4 and the OKT4/OKT8 ratio were decreased in infertile women with sperm antibodies, while B lymphocytes positive for OKDR and BD-Leu12 were increased in infertile women with or without sperm antibodies (p less than 0.0001, versus fertile controls). Lymphocyte responses to phytohemagglutinin (PHA), concanavalin A (ConA) and pokeweed mitogen (PWM), however, were similar in 20 fertile and 136 infertile couples. Lymphocytes from infertile men with sperm antibodies had an enhanced stimulatory response to autologous sperm and seminal plasma. It is concluded that sperm antigens from autoimmune infertile men stimulate heightened immune responses to sperm antigens and altered distribution of white cell populations in both partners.

Adult↗
PubMed1998

[Infertility and some of its psychosocial aspects].

The paper gives account of several psychosocial aspects of infertility. Firstly, the author deals with a fact that infertility impede the desire to produce a child and the socially created need to become a parent. The M. Hunter's model of biopsychosocial aspects of reproductive problems is used as a framework for analysing the complexity of factors which influence single person's reactions to infertility and its treatment. Secondly, the authors gives a summary of feminist critique of reproductive technologies. These technologies are widely used and accepted as a way to overcome infertility, but they create some additional problems. These problems are discussed using four types of arguments: anti-biological, anti-medical, eugenic and those considering women's reactions to reproductive technologies. All of these arguments are based on feminist publications. Thirdly, the author discusses the similarities and differences in male and female reactions to infertility. It is argued that two tendencies are observed while reactions to infertility are researched: the first is see those reactions as entirely different while the second is to see them as very similar. These controversy can be explained on the ground of different research methodology, the notion of infertile persons as a homogeneous group, the lack of proper theoretical model to contain all aspects of gender differences in reactions to infertility.

Female↗
PubMed1999

Outcome of stimulated in vitro fertilisation (SIVF) using clomiphene citrate and human menopausal gonadotropin in different infertility groups.

A prospective study was undertaken to evaluate the efficacy of stimulated in vitro fertilization (SIVF) using Clomiphene Citrate and hMG in different infertilities. The analysis was applied to the first 81 cycles over a period of 9 months in the years 1994-1996 in Sheffield Fertility Centre (SFC). The female patients included in this study were under 40 years of age, and their FSH and LH values were < 10IU/L. Mild and moderate male factor infertilities were included. For tubal factor infertility 16 cases were included with an implantation rate of 0%. The unexplained factor infertility included 33 cases with an implantation rate per embryo transfer (ET) of 41%. For male factor infertility there were 18 cases with an implantation rate per ET of 42%. Out of 3 cases in the ovulatory factor group none reached ET with 0% implantation. For multiple factor infertility 11 cases were included with a 0% implantation rate. The overall implantation per embryo transfer was 27%, while the implantation per cycle started was 15%. We conclude that there are certain infertility factors, i.e. unexplained infertility and mild male factor, which can have good results in IVF using CC/hMG only.

Adult↗
PubMed1992

The effects of gender-specific diagnosis on men's and women's response to infertility.

OBJECTIVE: To determine if differences could be distinguished between men's and women's emotional response to infertility based on the assignment of a gender-specific diagnosis. DESIGN: Gender-specific diagnoses were examined in relation to stigma, perception of loss, role failure, and self-esteem, using structured interviews. SETTING: Tertiary clinical care in private practice settings. PARTICIPANTS: Thirty-six self-selected volunteer couples undergoing infertility treatment. MAIN OUTCOME MEASURES: Stigma, perception of loss, role failure, and lowered self-esteem emerged from content analysis of structured interview data. RESULTS: No differences were found among women in their emotional response to infertility regardless of whether a female or male infertility factor was present, whereas men with a male factor experienced more negative emotional response to infertility than men without a male factor. CONCLUSIONS: Although both women and men are affected by infertility, their emotional response is significantly influenced by a gender-specific diagnosis. Men's response to infertility closely approximates that of women if the infertility has been attributed to a male factor but differs considerably if a male factor is not found.

Emotions↗
PubMed1991

[A case-control study of dangerous factors related to infertility].

This paper reports the case-control study of dangerous factors related to infertility in Henan province during 1987-1988. There were two groups. One was a primary infertility group with 319 couples. The other was a normal fertility group with 714 couples, who were neighbours of the first group, among whom the women's age range was within 6 years old. The survey materials were analyzed by SAS programmes in the computer. The methods of analysis were single factor and logistic regression analysis of factors. The results of single factor analysis showed that in male, infertility had a close relationship with eating edible rude cotton seed oil; suffering from Varicocele; hydrocele of tunica vaginalis; sex dysplasia; breast dysplasia; puberty enuresis; parotitis after puberty; familial infertility and working under high temperature conditions. In female, menstrual disorder; a sexuality or pain during coitus; familial infertility; TB and other chronic diseases might be major contributors to the incidence of infertility. The results of logistic regression analysis of the factors related to infertility suggested that in male, eating edible rude cotton seed oil, suffering form varicocele; sex dysplasia; puberty enuresis; and in female, menstrual disorder; TB; consanguineous marriage, lower rate of coitus, frequent contact with pernicious substances might be major dangerous factors causing infertility. The results of the logistic regression analysis were different from those of the single factor analysis because the former not only analyzed the major influence of each factor but also considered the comprehensive effects of the relevant factors.

Adult↗
PubMed1999

Infertility following pelvic inflammatory disease.

OBJECTIVE: To assess the frequency of infertility after pelvic inflammatory disease (PID) and factors important in postinfectious tubal damage in an urban population at high risk for sexually transmitted diseases. METHODS: From a cohort of 213 women with PID documented by laparoscopy and/or endometrial biopsy, 58 women (27% of the initial cohort) were interviewed by phone 2 to 9 years after an index episode of PID. Data regarding the initial history, physical examination, microbiology, laparoscopic, and serologic findings, and data concerning interval contraception, subsequent pregnancy, subsequent infection, and chronic pelvic pain were compared among those with and without infertility at follow up. RESULTS: Nineteen (40%) of the 48 women not using contraception were involuntarily infertile after the index episode of PID. Compared with those who had an interval pregnancy, infertile women were older (P = 0.02), more likely to have a history of infertility prior to the index episode of PID (P = 0.001), and were more likely to have occluded or partially occluded fallopian tubes (P = 0.03), peritubal adhesions (P = 0.007), or perihepatic adhesions (P = 0.02) seen by laparoscopy performed during the index episode. Surprisingly, recovery of Chlamydia trachomatis was negatively related to infertility (P = 0.001), although a similar proportion of both groups had chlamydia immunoglobulin M antibody (40% vs. 31%). Chlamydia heat shock protein was weakly related to infertility (P = 0.08). The isolation of Neisseria gonorrhoeae was not significantly different between groups (53% vs. 57%). CONCLUSIONS: The high rate of postinfection infertility found was probably related to a combination of tubal damage before and during the index episode of PID. Prevention of recurrent PID and better understanding of the pathophysiology of postinfection tubal damage (which may differ between chlamydia and gonorrhea) is needed to develop more effective strategies to reduce permanent tubal damage.

Adolescent↗
PubMed2003

Eating behaviors and attitudes in women with infertility: a controlled study.

OBJECTIVE: Infertility arises from a complex pathogenic process in which it is often difficult to identify etiology. Psychological and behavioral factors may play a role in some cases of infertility. The extent to which eating behaviors and attitudes contribute to infertility is unknown. METHOD: In this study, 120 subjects with infertility, 80 fertile women, and 90 patients suffering from anorexia nervosa, restricting subtype (AN-R), were assessed with the Eating Disorder Inventory (EDI-2). RESULTS: The EDI-2 highlights differences among patients with AN-R and fertile and infertile subjects. Infertile patients had higher scores on the Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears EDI-2 subscales than fertile subjects. Logistic regression identifies the independent variables of interpersonal distrust, interoceptive awareness, maturity fears, and asceticism as predictors of infertility. DISCUSSION: Infertile patients without eating disorders share some psychological features of women with AN. These features do not include disturbed eating attitudes and behaviors, but rather feelings of inadequacy, insecurity, and maturity fears.

Adolescent↗
PubMed2006

No increase in sperm DNA damage and seminal oxidative stress in patients with idiopathic infertility.

The most common cause of male infertility is idiopathic. Standard investigations reveal no abnormality in such cases. The aim of the study was to investigate the levels of sperm DNA damage and seminal oxidative stress and their relationships with idiopathic infertility. The study included 30 normozoospermic infertile men seeking infertility treatment and 20 fertile donors. Semen analysis was performed according to the World Health Organization guidelines. Sperm DNA damage was assessed by alkaline single cell gel electrophoresis (comet assay) after preparation with two-step discontinuous Percoll gradient. Seminal oxidative stress was measured by a novel automated method. DNA damage score, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) were not different in idiopathic infertile men compared with controls. No correlations were also found between DNA damage score and TAS, TOS levels and OSI in idiopathic infertile group. We did not find any relationship between sperm DNA damage and oxidative stress in normozoospermic infertile men. We think that the pathophysiology of idiopathic infertility cannot be explained by sperm DNA damage or seminal oxidative stress.

Comet Assay↗
PubMed2006

Prevalance of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women.

OBJECTIVE: To prospectively investigate the prevalence of Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in the cervical canal and pouch of Douglas in unexplained infertile women and compare it to healthy controls in the Turkish population. MATERIALS AND METHODS: A total of 31 women presenting with a history of infertility [n = 24 (77%) primary infertility, n = 7 (23%) secondary infertility] between 20 and 38 years of age and 31 women willing to have tubal ligation between 30 and 41 years of age were consecutively included into this study. Specimens were taken from intra-abdominal washings and from the cervical canal. CT, MH and UU were detected with polymerase chain reaction (PCR). RESULTS: Results of 62 women were analyzed. None of the participants met the criteria for salpingitis during laparoscopy. The most common infection in the cervical canal in both groups was UU, which was detected in 13 cases of infertile patients and 11 controls (P = 0.602). Cervical chlamydial and mycoplasmic infection was detected in one case each in infertile and control patients. Neither MH nor UU were obtained from the pouch of Douglas in both groups. Only CT was present in peritoneal fluid of an infertile woman who had also a concomitant chlamydial infection in the cervical canal. CONCLUSION: Demonstration of cervical colonization of CT by PCR may be a promising method for the detection of asymptomatic pelvic infection in patients with unexplained infertility. However, screening for MH and UU is not cost-effective due to similar low rates of detection.

Adult↗
PubMed2000

Genetic causes of male infertility: current concepts.

Infertile men with severe spermatogenic defects and low or no sperm counts have a significantly higher rate of genetic abnormalities than fertile men. The fact that intracytoplasmic sperm injection can potentially bypass natural selection barriers to genetic disease transmission has brought a sobering but important impetus to recent research in the area of genetic infertility. Recent studies have focused on examining the prevalence of certain genetic defects in infertile men, analyzing the molecular basis of infertility in genetic disorders, and detecting new causes of genetic infertility. Several novel research findings deserve mention for their potential impact on genetic infertility. It has been demonstrated that elongated and round spermatids can be successfully injected into human oocytes and viable births obtained. Likewise, significant advances have been made in the arena of interspecies germ cell transplantation. Of some concern is the finding of a relationship between faulty DNA repair and infertility in men with severe testis failure. This review summarizes the recent genetic advances in these areas of male genetic infertility.

Chromosome Disorders↗