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PubMed1995

Restoration of normal sperm characteristics in hypoprolactinemic infertile men treated with metoclopramide and exogenous human prolactin.

We investigated the effects of induced increase in prolactin levels on spermatogenesis in 20 infertile men with hypoprolactinemia using exogenous human prolactin (hPRL) and metoclopramide. The subjects were selected from a population of 175 infertile men in whom the prevalence of hypoprolactinemia was 33.14%. Mean basal plasma prolactin was 2.79 +/- 0.62 ng.ml-1 in the infertile men and 9.57 +/- 2.14 ng.ml-1 in the normal control subjects. At the sixteenth week, mean plasma prolactin was 9.41 +/- 1.3 ng.ml-1 in subjects treated with exogenous hPRL and 5.2 +/- 0.7 ng.ml-1 in subjects treated with metoclopramide. Mean basal sperm concentration was approximately 8.8 million per milliliter in the infertile men and 41.5 million per milliliter in the normal control subjects. Mean sperm concentration was approximately 37 million per milliliter in subjects treated with exogenous hPRL, whereas the peak mean value was 23 million per milliliter in subjects treated with metoclopramide for 16 weeks. At basal conditions, the mean percentages of abnormal sperm were 66.75% +/- 14.93% and 21.36% +/- 4.78% in infertile and normal subjects, respectively. In subjects treated with exogenous hPRL and metoclopramide, the mean percentage of abnormal sperm were 24.7% and 31%, respectively, at week 16. Mean plasma prolactin, mean sperm concentration and the mean percentage of abnormal sperm were 3.3 +/- 1.4 ng.ml-1, 7 million per milliliter, and 60.5, respectively, in the infertile subjects after drug withdrawal at week 14. In normal control subjects, there was no significant difference (p = 0.01) in the plecebo effect. We therefore conclude that the low prolactin levels in this group of infertile men may be one of the primary causes of their infertility.

Adult↗
PubMed1996

Infertility treatment dropout and insurance coverage.

OBJECTIVE: To assess early patient dropout rates during infertility treatment as a potential measure of wasted resources. METHODS: The study involved multifaceted population cohorts, including a prospectively observed captive health maintenance organization (HMO) population and retrospectively selected preferred provider organization (PPO) patients. One hundred twenty-eight HMO couples were followed prospectively for 6 months. The insurance carrier retroactively selected 96 couples from their PPO population who were believed to be infertility patients. They were matched by date, age, and time of hysterosalpingography to infertility patients in the carrier's HMO population. Patients were considered treatment dropouts if they either requested their provider to abandon further work-up or treatment, or if they failed to return for an appointment for 3 months. RESULTS: Forty-six of 128 (36%) HMO patients followed prospectively discontinued care within 180 days, with only eight (6.3%) providing defined reasons. Preferred provider organization patients uniformly demonstrated significantly higher dropout rates than HMO patients, a finding already apparent at 60 days (P < .002; odds ratio [OR] 3.67, 95% confidence interval [CI] 1.47-9.97) and 120 days of treatment (P = .002; OR 2.87, 95% CI 1.39-6.06). Among PPO patients, dropout rates were especially pronounced if infertility care was provided by generalists. At billing levels of at least $2000, HMO patients also demonstrated less dropout than PPO patients (P < .001; OR 6.14, 95% CI 2.72-14.79), with generalists again demonstrating a significantly larger patient loss than infertility specialists (P < .001; OR 0.18, 95% CI 0.66-0.49). CONCLUSION: Infertility patients demonstrate a surprisingly large early dropout rate, which is significantly larger if patients receive infertility care from generalists rather than specialists. Newly presenting infertility patients should be carefully evaluated, especially in indemnity situations, before expensive diagnostic and therapeutic interventions are ordered.

Adult↗
PubMed2005

Peritoneal fluid cytokines and sICAM-1 in minimal endometriosis: search for discriminating factors between infertility and/or endometriosis.

OBJECTIVE: To evaluate cytokine levels (IL-1beta, TNF-alpha, IL-6, IL-8), soluble intercellular adhesion molecule-1 (sICAM-1) and number of macrophages in peritoneal fluid (PF) of women with no minimal endometriosis and associated (or not) infertility in order to discriminate between infertility and/or endometriosis. STUDY DESIGN: Cytokines and sICAM-1 were measured by using quantitative enzyme-linked immunosorbent assay (ELISA) while the macrophages were identified by May-Grunwald-Giemsa and non-specific esterase staining and presented as medians. The measurements were performed in 78 women belonging to four selected subgroups according to their endometriosis and/or infertility status. Statistical analysis was performed using Kruskal-Wallis non-parametric ANOVA test. Additionally, discriminant function analyses were performed. RESULTS: We have found the most elevated macrophage numbers in the groups of women with endometriosis. IL-1beta did not present any statistically significant values differentiating the analysed subgroups. IL-6 (110.0 pg/ml) and TNF-alpha exhibited the highest concentrations (statistically significant) in a group of fertile women with endometriosis. IL-8 clearly differentiated between the subgroups with infertility and sICAM-1 was statistically significantly elevated in the subgroups of infertile women. In the forward discriminant analysis, when subdividing the studied population according to its infertility status (we considered macrophages, IL-8 and IL-6 in order of probability values), we have found striking probability value of 92% for the correct classification into an infertile population. CONCLUSION: Out of the range of the analysed factors we have found only the sICAM-1 to be singled out between the standard discriminant analysis and the forward one. However, this important flagging molecule might be of considerable value for discrimination between different types of pathology at the level of immune effector function. The increased levels of TNF-alpha and IL-6 signified a group of fertile women with endometriosis; however only IL-6 presented a discriminating value in multifunctional analysis of examined subgroups. The analysed range of factors had a greater tendency to discriminate between infertility status rather than endometriosis.

Adult↗
PubMed2004

The desire of infertile patients for multiple births.

OBJECTIVE: To determine the proportion of infertile women who prefer a multiple birth over a singleton, patient characteristics associated with this desire, and patient knowledge about the risks of multiple births. DESIGN: Prospective analysis. SETTING: Academic university hospital-based infertility center and private general gynecology clinic. PATIENT(S): Four hundred sixty-four female patients with infertility who presented for their initial visit. MAIN OUTCOME MEASURE(S): Demographic characteristics, infertility history, desire regarding multiple births, knowledge of the risks of multiple births, and goals of infertility evaluation and treatment were determined by using a 41-question survey. Univariate analysis was performed to assess patient characteristics associated with the desire for multiple births. Independent factors associated with this desire were assessed by multivariable logistic regression analysis. RESULT(S): 20.3% of women desired multiples over a singleton gestation. Nulliparity, lower family income, younger patient age, prior evaluation for infertility, longer duration of infertility, and lack of knowledge regarding risks of twin gestations were associated with this desire. Only nulliparity and lower family income were independently associated. CONCLUSION(S): A sizable minority of infertility patients prefers a multiple birth as their treatment outcome. Patient education may be an effective strategy to reduce the incidence of twin and higher-order multiple pregnancies.

Adult↗
PubMed2004

Characterizing the endometrium in unexplained and tubal factor infertility: a multiparametric investigation.

OBJECTIVE: To characterize endometrial development in unexplained and tubal factor infertility. DESIGN: Prospective study of 20 women with unexplained infertility, 22 with tubal factor infertility, and 21 fertile controls in the midproliferative, periovulatory, and midluteal phases of the menstrual cycle. SETTING: Reproductive Medicine Department of St. Mary's Hospital, Manchester, United Kingdom. PATIENT(S): Women awaiting assisted conception. INVESTIGATION(S): Serum hormone assays, transvaginal ultrasound, Doppler, and midluteal endometrial biopsies. MAIN OUTCOME MEASURE(S): Serum levels of E2, P, and LH, endometrial ultrasound morphometry, uterine and subendometrial artery Doppler, and endometrial histology and biochemistry. RESULT(S): Women with unexplained infertility demonstrated significantly reduced uterine artery flow velocity in all phases, significantly elevated uterine and subendometrial artery impedance in the periovulatory and midluteal phases, and significantly reduced endometrial texture in the midproliferative phase. Women with tubal factor infertility demonstrated significantly reduced uterine artery flow velocity, without a concomitant increase in impedance, and significantly greater expression of endometrial glandular and luminal keratan sulphate. CONCLUSION(S): Unexplained infertility is associated with a profound impairment of endometrial perfusion that might be amenable to treatment by perfusion enhancers. Tubal factor infertility is associated with endometrial developmental defects that might be corrected by salpingectomy. Endometrial ultrasound and Doppler studies are likely to become a vital tool in the investigation of infertility.

Adult↗
PubMed2006

Arab Americans, African Americans, and infertility: barriers to reproduction and medical care.

OBJECTIVE: To compare barriers to infertility care among African Americans and Arab Americans. DESIGN: Qualitative study using semi-structured reproductive histories and open-ended ethnographic interviews. SETTING: Infertile volunteers in a private IVF clinic in Dearborn, Michigan, an Arab American ethnic enclave community in metropolitan Detroit. PATIENT(S): Arab American men presenting for infertility diagnosis and treatment, including assisted reproductive technologies. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Perceived barriers to effective infertility care. RESULT(S): Arab Americans and African Americans living in metropolitan Detroit are at increased risk of infertility and share similar histories of poverty, racism, and cultural barriers to medical treatment. This study, which focused on infertile Arab American men living in or near Dearborn (an ethnic enclave community composed mainly of recent immigrants and war refugees), revealed significant barriers to effective infertility care, including economic constraints, linguistic and cultural barriers, and social marginalization in mainstream U.S. society, particularly after September 11, 2001. CONCLUSION(S): Arab Americans experience disparities in access to infertility care, largely because of poverty and social marginalization in post-September 11th America.

Adult↗
PubMed2006

Identification of novel polymorphisms in the nuclear protein genes and their relationship with human sperm protamine deficiency and severe male infertility.

OBJECTIVE: To screen populations of fertile men, severely infertile men, and infertility patients with aberrations in the protamine-1-to-protamine-2 ratio (P1/P2) for clinically relevant alterations in the P1, P2, transition protein 1 (TP1), and transition protein 2 (TP2) genes. DESIGN: Prospective case-control study. SETTING: University-based infertility clinic. PATIENT(S): Ninety-six fertile men, 96 severely infertile men, and 96 infertility patients with aberrations in the sperm P1/P2 ratio. INTERVENTION(S): Sperm nuclear protein extraction, gel electrophoresis, and densitometry to evaluate the P1/P2 ratios of infertility patients. DNA extraction, polymerase chain reaction (PCR), and gene sequencing to screen the nuclear protein genes. MAIN OUTCOME MEASURE(S): Sperm P1/P2 ratios and single nucleotide polymorphisms (SNPs) in the sperm nuclear protein genes (P1, P2, TP1, and TP2). RESULT(S): Fifteen SNPs were identified in the nuclear protein genes, 12 of which were previously unreported. Five variants were identified that resulted in amino acid changes (one in P1, one in TP1, and three in TP2). The frequency of the 15 SNPs was similar in protamine-deficient patients, severely infertile patients, and fertile controls. CONCLUSION(S): A number of SNPs are present in the testis-specific nuclear protein genes. However, the gene variants do not appear to underlie protamine deficiency and severe male infertility.

Adult↗
PubMed2006

A prospective evaluation of uterine abnormalities by saline infusion sonohysterography in 1,009 women with infertility or abnormal uterine bleeding.

OBJECTIVE: To evaluate the role of saline infusion sonohysterography (SIS) in the investigation of uterine abnormalities and malformations in patients referred for infertility work-up compared with women with abnormal uterine bleeding (AUB). DESIGN: Prospective cohort study. SETTING: Academically oriented private practice. PATIENT(S): One thousand nine consecutive women examined by SIS for infertility work-up (n = 600, infertility group) or AUB investigation (n = 409, AUB group). INTERVENTION(S): SIS. MAIN OUTCOME MEASURE(S): Intracavitary abnormalities and uterine anomalies. RESULT(S): Among the women in the infertility group, 16.2% (n = 97) were found to have intracavitary abnormalities, including polyps (13.0%), submucous fibroids (2.8%), and adhesions (0.3%). Significantly, more patients in the AUB group (39.6%, n = 162) revealed intracavitary abnormalities, including polyps (29.8%), submucous fibroids (9.0%), and adhesions (0.7%). In contrast, significantly more uterine anomalies were found in the infertility group (20%, n = 120) compared with the AUB group (9.5%, n = 39). Arcuate uterus was the most common finding (15% vs. 6.4% of patients, respectively). CONCLUSION(S): An SIS procedure for infertility work-up revealed a substantial percentage of infertile patients with intracavitary abnormalities and uterine anomalies. Because the technique is safe, well tolerated, and feasible in an outpatient setting, SIS should be considered routinely in the early stage of infertility and AUB investigation.

Administration, Intravaginal↗
PubMed2005

Benefits of microsurgical repair of adolescent varicocele: comparison of semen parameters in fertile and infertile adults with varicocele.

OBJECTIVES: To compare preoperative semen parameters and the effect of microscopic varicocele repair on semen parameters in adolescents, fertile adults, and infertile adults with varicocele. METHODS: A total of 96 patients (35 adolescents, 20 fertile adults, and 41 infertile adults) were included in the primary analysis. RESULTS: The fertile adults had a higher sperm count than did the adolescents or infertile adults (P <0.001). In infertile adults, the percentage of normal sperm increased from 14.9% +/- 1.0% preoperatively to 21.2% +/- 2.2% at 3 months (P = 0.013) and 22.1% +/- 2.2% (P = 0.003) at 6 months. The infertile adults had a lower sperm count than did the adolescents and fertile adults at both 3 (P = 0.014) and 6 (P = 0.003) months. The postoperative sperm motility in adolescents was significantly greater than that in the infertile adults at 3 (P = 0.009) and 6 (P = 0.003) months. The proportion of sperm with normal morphology was not statistically different at either 3 or 6 months among the groups. No significant differences were detected in the increase in semen parameters at 3 or 6 months among patients before or after surgery. CONCLUSIONS: The results of our findings suggest that after varicocele repair the degree of improvement in semen parameters is not different. However, because the baseline values of the semen parameters in adolescents were better than those in infertile adults, the postoperative values in the adolescents were superior to those in infertile adults and at least as good as those in fertile adults.

Adolescent↗
PubMed1998

Glycosidases in the peritoneal fluid from infertile women with and without endometriosis.

OBJECTIVES: To investigate the activity and biochemical properties of glycosidases in the peritoneal fluid of infertile patients with or without endometriosis in comparison with fertile women. DESIGN AND METHODS: Peritoneal fluid was collected from 29 women undergoing a laparoscopy. The sample was separated into the following groups: fertile women (n = 11), infertile with endometriosis (n = 11), and infertile without endometriosis (n = 7). The activity of glycosidases was determined with specific p-nitrophenylglycosides as colorimetric substrates. RESULTS: The activity of alpha-fucosidase, alpha-glucosidase, alpha-mannosidase, beta-galactosidase, beta-glucuronidase, and beta-N-acetylhexosaminidase was investigated. Enzymatic activities of alpha-fucosidase and beta-N-acetylglucosaminidase were detected in higher amounts than other glycosidases. The activities of alpha-fucosidase and N-acetylglucosaminidase were increased in the case of infertile patients without endometriosis, while beta-galactosidase was increased in endometriosis patients. Enzyme properties as pH optimum, pH stability, thermal stability and inhibition by specific carbohydrates were similar for both control and infertile samples. Analysis of kinetic parameters indicate that Vmax values of glycosidases were higher for infertile samples than their respective controls. CONCLUSIONS: The results indicate that higher amounts of glycosidases are present in the peritoneal fluid from infertile patients. The elevated activity of these hydrolytic enzymes suggest possible deleterious effect on gametes, and could explain some cases of infertility.

Ascitic Fluid↗
PubMed2001

Antizona and antisperm antibodies in women with endometriosis and/or infertility.

OBJECTIVE: To measure the levels of antigamete antibodies in serum and peritoneal fluid of women with endometriosis and/or infertility. DESIGN: Antibody activity against human sperm and porcine oocytes was analyzed in selected subgroups of women. SETTING: Clinic of reproduction. PATIENT(S): Women with endometriosis and/or infertility. INTERVENTION(S): No treatment was implemented before peritoneal fluid and blood sample collection. MAIN OUTCOME MEASURE(S): Quantitative ELISA. RESULT(S): Four groups of women (n = 98) were analyzed for the presence of antizona and antisperm antibodies: infertile with endometriosis (n = 30), idiopathic infertility (n = 28), fertile with endometriosis (n = 20), and healthy fertile controls (n = 20). Antibodies were analyzed simultaneously in serum and peritoneal fluid. No statistically significant differences in antibody levels were detected in serum samples among the analyzed groups. The median values for antizona and antisperm antibodies in peritoneal fluid were significantly higher in women with idiopathic infertility than in the control group. In women with unexplained infertility, a high degree of correlation (Spearman) was found between the presence of antizona antibodies in peritoneal fluid and serum (r = 0.579). A positive predictive value of 80% was calculated for the presence of antizona antibodies (>5 ng/oocyte) in the peritoneal fluid of patients with infertility. CONCLUSION(S): Antizona antibodies locally produced in the peritoneal fluid have diagnostic value for infertility status; however, they cannot be treated as a marker or prognostic factor for minimal endometriosis and/or its treatment.

Adult↗
PubMed2001

Women who are not exposed to spermatozoa and infertile women have similar rates of stage I endometriosis.

OBJECTIVE: To compare the prevalence of endometriosis and its different stages in infertile women and women not exposed to spermatozoa. DESIGN: Prospective study. SETTING: Artificial insemination donor program at a university hospital. PATIENT(S): One hundred fifty women unable to conceive because they had not been exposed to spermatozoa (134 with azoospermic partner, 10 with an HIV-positive partner, and 6 without a male partner). Controls were 750 women in infertile couples in which the male partner had normal sperm. INTERVENTION(S): Laparoscopy was systematically performed in a blinded manner in both groups as part of the infertility work-up. MAIN OUTCOME MEASURE(S): Diagnosis of endometriosis. RESULT(S): In unexposed women and controls, the prevalence of endometriosis was similar (32% and 34.5%). Rates of stage I disease were also similar in both groups (26% and 19.3%). There was a significant trend toward higher stages of endometriosis in infertile women (stage II disease, 3.3% vs. 5.7%; stage III disease, 1.3% vs. 3.1%; stage IV disease, 1.3% vs. 6.4%). Endometriosis was not associated with the few demographic characteristics that differed between groups. CONCLUSION(S): From an epidemiologic point of view, stage I endometriosis is not more common in infertile women than in unselected women. However, stage II to IV endometriosis was more frequent in infertile women. Whereas a relation between stage I endometriosis and infertility seems unlikely, the relation between stages II to IV endometriosis and infertility seems possible.

Adult↗
PubMed1983

A comparative study of zinc, copper, cadmium, and lead levels in fertile and infertile men.

Eighty infertile men and 38 men of known fertility were studied for investigation of both the importance of zinc, copper, cadmium, and lead to fertility and the possible interrelationships between these trace elements. The infertile men had higher mean concentrations of plasma copper than those of proven fertility. The difference was statistically significant (P less than 0.01) but was of small magnitude (approximately 1.5 mumol mean difference). The concentrations of plasma zinc, erythrocyte zinc, whole blood lead and cadmium, and seminal plasma zinc and copper did not differ significantly between infertile and fertile men. There was a significant positive relationship between sperm density and seminal plasma zinc concentration in the fertile, but not in the infertile, men. The infertile men with antisperm antibodies or counts greater than 20 million/ml had significantly higher mean levels of seminal plasma zinc than infertile men with oligospermia. The higher semen zinc in these two groups may reflect an abnormal fragility of the spermatozoa, resulting in the release of zinc, but the absence of significant overall differences between fertile and infertile men suggests that measurement of the concentration of zinc in plasma or zinc and copper in seminal plasma has little value in the routine investigation of infertility.

Adult↗
PubMed1995

Some cases of human male infertility are explained by abnormal in vitro human sperm activation.

OBJECTIVE: To determine if a human sperm activation assay can be used to evaluate males exhibiting otherwise unexplained infertility. DESIGN: Sperm from age-matched fertile and idiopathic infertile males were assayed in the human sperm activation assay and the results were compared. A portion of the sperm from the idiopathic infertile males also was used in assisted reproductive technology (ART) attempts at pregnancy. PATIENTS: Idiopathic infertile couples who had extensive fertility testing with no identified problems that would explain their infertility. Fertile males that had fathered one or more children. MAIN OUTCOME MEASURES: Sperm nuclear decondensation-recondensation and DNA synthesis. Pregnancies resulting from ART using semen from a male whose sperm responded abnormally in the human sperm activation assay. RESULTS: Thirteen (22%) of 59 idiopathic infertile males produced sperm that responded abnormally in the human sperm activation assay. Only 1 (1.7%) of 59 fertile males produced sperm that responded abnormally in the human sperm activation assay. The percentage of abnormal responders in the patient group exhibiting unexplained infertility was significantly higher than in the fertile male group. No sperm samples that responded abnormally in the human sperm activation assay resulted in pregnancies when used in ART. CONCLUSIONS: The human sperm activation assay is a new and independent indicator for some cases of infertility that otherwise would be unexplained. The human sperm activation assay appears to have utility in determining a sperm sample's efficacy for fertilization in ART attempts at pregnancy.

Cell Nucleus↗
PubMed1987

Infertility and chlamydial infection.

The prevalence of humoral IgG and IgM antibodies to Chlamydia trachomatis was determined in 105 infertile women who underwent laparoscopy and/or laparatomy, and 90 pregnant women without any known fertility problems (control group). For chlamydial culture, cervical and urethral specimens were collected both from the infertile and the pregnant women, whereas specimens from the fallopian tubes were collected from the infertile women only. Among infertile subjects with abnormal fallopian tube findings, the prevalence of IgG as well as IgM antibodies to C. trachomatis was significantly higher than in the control group (P less than or equal to 0.001). Similar statistically significant differences in antichlamydial geometric mean titer (GMT) also were observed in sera from infertile subjects with fallopian tube abnormalities and the controls. The chlamydial isolation rate from lower genital samples was low both among the infertile and pregnant women. All tubal samples were culture negative. The present study indicates a close connection between infertility of tubal etiology and an immune response to C. trachomatis. The possibility of active or recent chlamydial activity in at least some of these infertile subjects is discussed.

Adult↗
PubMed1998

Radionuclide hysterosalpingography is not predictive in the diagnosis of infertility.

OBJECTIVE: To investigate whether radionuclide hysterosalpingography (radionuclide HSG), which has been suggested as a more functional approach to the diagnosis of tubal infertility than conventional patency tests, is predictive in the diagnosis of infertility. DESIGN: A retrospective analysis of data from an inquiry form containing questions about pregnancy outcome after radionuclide HSG. SETTING: University hospital-based, tertiary care infertility clinic. PATIENT(S): Two hundred sixteen women had an infertility work-up including radionuclide HSG performed between April 1986 and April 1993. Forty-one (18.9%) women were excluded from the study; 9 had moved to unknown addresses, 16 did not answer the inquiry, and 16 gave answers that were not interpretable. There were 175 (81.1%) women in the final study group. INTERVENTION(S): An inquiry form containing questions regarding pregnancy was sent to 207 women who undergone radionuclide HSG as a routine procedure in their infertility workup. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy related to outcome of radionuclide HSG and its test properties calculated. RESULT(S): Bilateral or unilateral tubal transport was demonstrated by radionuclide HSG in 129 women, of whom 66 (51%) later became pregnant. Of the pregnant women, 36 (55%) had successful infertility treatment, whereas 30 (45%) reported spontaneous pregnancy. Forty-six women showed no transport at radionuclide HSG. Twenty-five (54%) of these women became pregnant, 14 (56%) with infertility treatment and 11 (44%) without infertility treatment. The predictive values of transport and no transport radionuclide HSG were 0.51 and 0.46, respectively. The sensitivity of radionuclide HSG was 0.25, and the sensitivity was 0.73. Likelihood ratios for pregnancy when radionuclide HSG showed transport and no transport were 1.03 and 0.93, respectively. CONCLUSION(S): Our data strongly indicate that a single radionuclide HSG investigation is not able to predict fertility potential.

Adult↗
PubMed1999

Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility.

OBJECTIVE: To determine whether IVF or a standard infertility treatment algorithm results in better outcome and/or lower cost when used as first-line therapy for couples with infertility. DESIGN: Prospective, randomized clinical study. SETTING: University-affiliated infertility clinic. PATIENT(S): Couples with newly diagnosed infertility and no prior treatment. INTERVENTION(S): Couples were randomized to undergo either IVF (group 1, n = 46) or a standard infertility treatment algorithm (group 2, n = 50) as initial therapy for infertility. MAIN OUTCOME MEASURE(S): Pregnancy rates and costs per couple, per month of treatment, and per pregnancy. RESULT(S): Pregnancy rates were higher in group 2 than in group 1. Costs per couple were not statistically different, although a trend toward higher costs was apparent in group 1, reflected by a higher median cost per clinical pregnancy established and a higher cost per month of treatment. Whereas cost differences between the groups diminished over time, pregnancy rates remained the same. CONCLUSION(S): In vitro fertilization currently does not represent an appropriate first-line treatment option for couples with infertility. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should be the preferred treatment approach.

Adult↗
PubMed2002

Infertility and pregnancy outcome in female genital tuberculosis.

OBJECTIVES: The aim of the study is to determine the prevalence rate, identify risk factors not conducive to pregnancy, and outcomes with regard to follow-up treatment. METHODS: This prospective study was carried out from 1988 to 2001, in the Department of Obstetrics and Gynecology in the S.C.B. Medical College, Cuttack, and in the private clinics of both the authors in Cuttack, India. The incidence of tuberculosis in infertility and tubal factor infertility cases were determined. The incidence of infertility in genital tuberculosis (GT) was examined and a total of 97 cases of infertility with genital tuberculosis were studied. The patients were given short course chemotherapy and prednisolone (wherever feasible). The risk factors not conducive to pregnancy were identified. RESULTS: The incidence of GT in infertility and tubal factor infertility were 3 and 41%, respectively. The incidence of infertility in GT was 58%. All patient were symptom free and no evidence of tuberculosis was detected after the end of the chemotherapy. The risk factors not conducive to pregnancy were secondary amenorrhea, no endometrium on curettage, and negative chromopertubation. The conception rate is low, i.e. 19.2%, the live birth rate being still low, i.e. 7.2%. CONCLUSION: The outcome of infertility in GT is not very optimistic. IVF and ET offers some hope to these unfortunate women.

Adult↗