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PubMed2006

Iron intake and risk of ovulatory infertility.

OBJECTIVE: To evaluate whether iron supplement use or greater intake of total, heme and nonheme iron is associated with lower risk of ovulatory infertility. METHODS: We conducted a prospective cohort study among 18,555 married, premenopausal women without a history of infertility who attempted a pregnancy or became pregnant between 1991 and 1999 (mean baseline age+/-standard deviation 32.6+/-3.6). Diet was assessed twice during follow-up and prospectively related to the incidence of infertility due to ovulatory disorder. RESULTS: During the 8 years of follow-up, 438 women reported infertility due to ovulatory disorder. Women who consumed iron supplements had a significantly lower risk of ovulatory infertility than women who did not use iron supplements (relative risk 0.60, 95% confidence interval 0.39-0.92), after adjusting for potential confounders. Total nonheme iron intake, primarily consumed as multivitamins and iron supplements, was inversely associated with the risk of infertility (relative risk Quintile 1 compared with 5, 95% confidence interval 0.39-0.92; P, trend .005.) Heme iron intake was unrelated to ovulatory infertility in multivariable adjusted analyses. CONCLUSION: Consumption of iron supplements and nonheme iron from other sources may decrease the risk of ovulatory infertility. LEVEL OF EVIDENCE: II-2.

Cohort Studies↗
PubMed2004

Infertility and celiac disease: do we need more than one serological marker?

OBJECTIVES: Celiac disease (CD) prevalence is higher in women with infertility. Our study aims were to evaluate the prevalence of undiagnosed CD in Arab infertile women and to explore the usefulness of using more than one serological marker in the diagnostic screening for CD in this population. METHODS: Women with unexplained infertility (n = 192) and age-matched healthy controls (n = 210) were prospectively enrolled. Serum was tested for human tissue transglutaminase antibodies (TTG), antiendomysial antibodies (EMA), and immunoglobulin A. Intestinal biopsy was offered to women with positive serology or immunoglobulin A (IgA) deficiency. RESULTS: CD was diagnosed in five infertile women (2.65%) and in one control (0.5%) (p = 0.11). Gastrointestinal complaints were present in 60% (three of five) of women with CD and 11.8% (22 of 187) of women without CD (p = 0.017). Anemia was reported in 80% of infertile women with CD and 4.8% of infertile women without CD (p = 0.0001). CONCLUSIONS: Undiagnosed CD is prevalent in Arab infertile women as well as in Arab women in general. CD in Arab infertile women is frequently associated with gastrointestinal complaints and anemia. EMA testing is sufficient in suspected cases.

Adolescent↗
PubMedDate not supplied

Increased levels of interferon-gamma in seminal plasma of infertile men.

The role of the cell-mediated immunity in male infertility is still far from clear. Interferon-gamma (INF-gamma), a secretory product of activated T cells and natural killer cells, has been hypothesized to have a toxic effect on sperm function. The presence of INF-gamma was investigated in seminal plasma of fertile and infertile subjects, using a specific enzyme-linked immunosorbent assay, in order to study its role in male infertility. Forty-one subjects were studied; 20 had proven fertility and normal semen quality (fertile group) and 21 showed male infertility for at least 2 years and poor semen quality (infertile group). INF-gamma was present in significantly higher levels in the seminal plasma of infertile subjects (6.36 +/- 0.72 fmol ml-1) compared to fertile subjects (3.68 +/- 0.30 fmol ml-1). Moreover, a significant negative correlation between INF-gamma levels and sperm count, motility and morphology was detected, whereas no correlation between INF-gamma levels and leukocyte count was found. These findings (i) confirm INF-gamma to be present in seminal plasma; (ii) show increased INF-gamma secretion in the infertile group; (iii) demonstrate negative correlations of INF-gamma with the main spermiogram parameters and (iv) no correlation with leukocyte count. INF-gamma may therefore play an important role in male infertility.

Adult↗
PubMedDate not supplied

Psychological status of previously infertile couples after a successful pregnancy.

Potential long-term effects of psychological dysfunction associated with infertility were investigated in a descriptive study of 32 previously infertile couples. Comparison was made with the performance of 20 never infertile couples matched for age, number of children, education, and income level, using a standard psychological assessment tool, the Hopkins symptom check list. While infertile, women had slightly elevated mean scores on three subscales: depression, interpersonal sensitivity, and hostility. After resolution of infertility, these scores did not improve. In addition, depression scores were elevated among the previously infertile women compared with a matched, never infertile group. Infertile men scored within the normal range for depression and interpersonal sensitivity and had a borderline mean score for hostility, which was markedly reduced after a normal pregnancy.

Depression↗
PubMed1988

Special antigens on sperm from autoimmune infertile men.

Sera from three fertile men and four infertile men without sperm antibodies, 17 infertile men with sperm antibodies in serum and seminal plasma (S.P.), and 25 infertile men with sperm antibodies in S.P. were tested by Western Blot analysis against sperm membrane extracts and S.P. from fertile nonautoimmune men and infertile autoimmune men. Sera from fertile men reacted against common antigens with molecular weights (MW) of 28, 38, 48, 60, and 68 kD present on sperm from autoimmune and nonautoimmune men and special antigen of MW 76 kD on the sperm of fertile men. Sera from 15 of 17 (88%) autoimmune infertile men with sperm antibodies in serum and S.P. detected special antigens with MW of 58 kD (sera reactivity in 47% of these men), 43kD (in 29%), 30 kD (in 24%), 35 kD (in 18%), 52 kD (in 12%), 41 kD (in 6%), and 71 kD (in 6%) on the sperm of autoimmune men in addition to the common antigens. Sera from 15 of 25 (60%) men with sperm antibodies in their S.P. showed reactivity to special antigens with MW 52 kD (in 20%), 35 kD (in 16%), 41 kD (in 16%), 58 kD (in 8%), 70/71 kD (in 8%), 30 kD (in 8%), and 56 kD (in 4%). Sera from 18 of 42 (43%) infertile men with sperm antibodies also detected special antigens of MW 26, 46, and 76 kD present only in fertile men's sperm. Sera from only 15 of 42 (36%) autoimmune infertile men reacted against special antigens with MW 17, 20, 23, 30, 43, and 58 kD in the seminal plasma of autoimmune infertile men.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens↗
PubMed1997

The presence of antithyroid antibodies in euthyroid patients with unexplained infertility and tubal obstruction.

PROBLEM: The presence of antithyroid antibodies in euthyroid patients with unexplained infertility and tubal obstruction. METHOD: The presence of antithyroid autoantibodies (microsomal and thyroglobulin) was measured in 40 patients with unexplained infertility, and 40 patients with tubal obstruction infertility, and compared to 40 healthy nulligravidae. RESULTS: Eight patients (20%) in the unexplained infertility study group, seven (17.5%) in the tubal obstruction group and two (5%) in the healthy nulligravida group, were positive for antithyroid autoantibodies: five (12.5%) were positive for antimicrosomal antibodies, two (5%) were positive for antithyroglobulin antibodies, and one patient (2.5%) was positive for both. The tubal obstruction group comprised seven (17.5%) patients positive for antithyroid autoantibodies: four (10%) for antimicrosomal antibodies, two (5%) for antithyroglobulin antibodies, and one patient (2.5%) was positive for both. In the healthy nulligravidae group only two patients (5%) were positive for antithyroid antibodies: one for antimicrosomal and one for antithyroglobulin. No significant differences were found in the presence of antithyroid antibodies between patients with unexplained infertility and those with tubal obstruction infertility. Both groups differed significantly from the healthy controls with regard to the presence of antithyroid antibodies (P < 0.05). CONCLUSION: Subclinical presence of antithyroid autoantibodies is characteristic of both unexplained and mechanical infertility, as opposed to healthy controls. Further investigation of larger groups is needed to determine the prevalence of antithyroid antibodies in the unique population of infertile women.

Adult↗
PubMed2007

Increased oxidative damage of sperm and seminal plasma in men with idiopathic infertility is higher in patients with glutathione S-transferase Mu-1 null genotype.

AIM: To examine whether a relationship exists between glutathione S-transferase Mu-1 (GSTM1) gene polymorphism and the susceptibility of sperm and seminal plasma from patients with idiopathic infertility to oxidative stress. METHODS: Fifty-two men with idiopathic infertility and 60 healthy fertile men were recruited to this study. GSTM1 gene polymorphism was determined by polymerase chain reaction (PCR) and both the infertile and control individuals were divided into GSTM1 null and GSTM1 positive groups according to their GSTM1 gene structure. We compared reactive oxygen species (ROS) generation, malondialdehyde (MDA), protein carbonyls and glutathione (GSH) concentrations, and glutathione S-transferase (GST) activity in seminal plasma and spermatozoa from infertile patients and controls with respect to GSTM1 genotype. RESULTS: Significantly higher levels of oxidative stress and damage markers were found in idiopathic infertile men with the GSTM1 null genotype compared with those with the GSTM1 positive genotype. There was no significant difference in genotype distribution for the GSTM1 variant between the idiopathic infertile subjects and fertile subjects. Patients with the GSTM1 null genotype also had lower sperm concentrations than those with GSTM1 positive genotype. CONCLUSION: Our results suggest that the susceptibility of sperm and seminal plasma to oxidative stress is significantly greater in idiopathic infertile men with the GSTM1 null genotype compared with those possessing the gene. Therefore, in patients with idiopathic infertility, GSTM1 polymorphism might be an important source of variation in susceptibility of spermatozoa to oxidative damage.

DNA Primers↗
PubMed1990

An endometrial factor in unexplained infertility.

OBJECTIVE: To study a group of women with unexplained infertility to see whether they have a defect that is intrinsic to the endometrium. DESIGN: Evaluation of the functional response of the endometrium by examining endometrial biopsy specimens using immunohistochemical methods in a group of women with unexplained infertility and in a control group of women with normal fertility. PATIENTS: 27 Women with unexplained infertility (average age 33.2); median duration of infertility five years. A control group of 44 women with normal fertility (average age 33.8) who were requesting sterilisation or reversal of sterilisation. SETTING: Infertility clinic, Jessop Hospital for Women, Sheffield. INTERVENTION: Secretory phase endometrial biopsy specimens were taken, with informed consent, as an outpatient procedure. MAIN OUTCOME MEASURES: Immunohistochemistry with monoclonal antibody D9B1, was used to assess the production and secretion of an oligosaccharide epitope produced by endometrial gland cells between two and seven days after the luteinising hormone surge. A reflected light measuring system was used to assess the amount of epitope within the gland cells, and in the gland lumen. RESULTS: In the control group of women, mean reflected light measurements at the cell base and cell apex peaked at three and five days after the luteinising hormone surge respectively, and in the gland lumen the epitope accumulated rapidly from three days, reaching a peak at seven days. In the women with infertility the peaks of epitope at the cell base and cell apex were lower, broader, and delayed in onset, and the build up of epitope in the gland lumen was retarded. The synthesis and secretion of the epitope in the women with infertility was therefore significantly reduced and delayed, even in the presence of normal concentrations of circulating progesterone. CONCLUSIONS: The results suggest that a primary dysfunction of the endometrium might be associated with hitherto unexplained infertility.

Adult↗
PubMed1993

Induced abortions, miscarriages, and tobacco smoking as risk factors for secondary infertility.

STUDY OBJECTIVE: The aim was to determine whether induced abortions could increase the risk of secondary infertility. DESIGN: This was a case-control study; cases were women with secondary infertility, individually matched to two controls who were currently pregnant. Each participant was interviewed by one of two medical doctors using a questionnaire that sought information on their demographic, socioeconomic, medical, and reproductive status. The data were analysed by conditional logistic regression. SETTING: The study took place in the Alexandra Maternity Hospital in Athens, Greece, in 1987-88. PARTICIPANTS: 84 women consecutively admitted with secondary infertility and 168 pregnant controls took part. MAIN RESULTS: Eight cases and no controls reported a previous ectopic pregnancy, confirming that the occurrence of a pregnancy of this type dramatically increases the risk of secondary infertility. Furthermore, the occurrence of either induced abortions or spontaneous abortions independently and significantly increased the risk of subsequent development of secondary infertility. The logistic regression adjusted relative risks (and 95% confidence intervals) for secondary infertility were 2.1 (1.1-4.0) when there was one previous induced abortion and 2.3 (1.0-5.3) when there were two previous induced abortions. Tobacco smoking significantly increased the risk of secondary infertility, the adjusted relative risk being 3.0 (1.3-6.8). CONCLUSIONS: Legalised induced abortions, as currently practised in Greece, appear to increase slightly the relative risk of secondary infertility.

Abortion, Induced↗
PubMed2005

Fimbrio-ovarian relationship in unexplained infertility.

INTRODUCTION: The role of defective fimbrio-ovarian relation in cases of unexplained infertility has not been extensively studied. The aim of the study was to assess the role of fimbrio-ovarian relation as an investigative modality in women with unexplained infertility. We also aimed to evaluate the efficacy of superovulation and freeing the fimbria-ovarica in increasing the conception rate of women with unexplained infertility. MATERIALS AND METHODS: This was a prospective study where out of 80 infertile couples, 19 women with unexplained infertility were recruited as study group. Fifteen fertile women were recruited as control group. During laparoscopy the length of the fimbria-ovarica and the ovulation border was measured. The fimbrio-ovarian accessibility test was demonstrated by holding the tubal fimbria by a non-traumatizing grasper and their ability to reach or cover the ovulation site. The freeing of the fimbria-ovarica was done, if its length was less than 2 cm. All cases were given ovulation induction for consecutive six cycles and were followed up to document any conception. RESULTS: The mean length of the fimbria-ovarica was significantly less in patients with unexplained infertility (2.5 +/- 0.6 vs. 3.55 +/- 0.8 cm). The mean length of the ovulation border was not significantly different in cases and controls (2.95 +/- 0.6 vs. 3.55 +/- 0.5 cm). The fimbrio-ovarian accessibility test was positive in 6 (31.5%) cases and in 14 (93%) controls. The fimbrio-ovarian accessibility test was negative in 13 (68.4%) cases and in 1 (7%) control. Out of the 13 cases with negative FOAT, 7 had fimbrial length less than 2 cm and in whom the freeing of fimbria-ovarica was done because of severe resistance during stretching. Out of 7 patients in whom freeing of fimbria-ovarica was done 3 conceived (42.8%). Out of the 12 patients who got only ovulation induction 3 conceived (25%). CONCLUSION: Fimbrio-ovarian accessibility test appears to be a promising investigative modality to assess ovarian pick-up in patients with unexplained infertility. Correcting fimbrio-ovarian relation (freeing short fimbria-ovarica) improves pregnancy rate in women with unexplained infertility.

Adult↗
PubMed1980

Infertility. A psychiatrist's perspective.

This paper discusses issues relevant to psychiatrists working in a reproductive biology unit: 1. The couple's anxiety. 2. The question of whether psychological conflict can cause infertility. 3. Dealing with the outcome of the workup. 4. Donor insemination. The anxiety of couples applying for an infertility workup can usually be countered by supportive and educative measures. More problematic sources of anxiety that require psychiatric consultation are: 1) Fear that the workup may shatter a myth that explains the infertility, a myth reinforced by unconscious conflicts; 2) An untenable wish that having a child will repair problems in the marriage or in the sense of relief. The psychiatrist is often asked whether psychological conflicts can cause infertility. The most understandable manner in which they do is by their effect on sexual performance. Where there is no sexual performance problem, psychotherapy can be offered if one or both partners experiences psychological pain, but with the understanding that therapy cannot be expected to cure the infertility. Psychiatric consultation at the end of the workup is indicated 1) where irreversible infertility is discovered and mourning is excessive, 2) where a myth to explain the infertility has been shattered, 3) to reassess sexual performance and to deal with the uncertainty, where no physical cause has been discovered. Donor insemination (AID) is fraught with legal and ethical problems. There are no criteria for selecting donors or recipient families, and there is concern that AID may lead to genetic engineering. The psychological effects of AID are uncertain. A study at our clinic suggests that the pursuit of AID involves a two-stage process: first, dealing with the outcome of the infertility workup and second, confronting AID itself; and that the secrecy that surrounds AID obstructs resolution of conflict.

Adult↗
PubMed2000

Hypothyroidism among infertile women in Finland.

The main aim of this retrospective study was to evaluate the occurrence of hypothyroidism among Finnish women with infertility. For this purpose, the records of 335 women presenting for the first time with infertility at the outpatient clinic of reproductive endocrinology at Turku University Central Hospital during a 3-year period (January 1992 to December 1994) were reviewed. Due to missing data, 36 women were excluded from the analysis. Thyroid function was screened by measuring serum thyroid stimulating hormone (TSH) levels in conjunction with serum prolactin using immunoradiometric assays. Prior to enrolment in the infertility examinations, ten out of 299 women had used thyroxine substitution for primary hypothyroidism. In the TSH screening test, 12 women (4%) exhibited elevated serum TSH levels ranging from 5.7 to 32 mU/l. Three of these cases were previously diagnosed with hypothyroidism and were using an inadequate dose of thyroxine. The prevalence of abnormal TSH levels was highest in the ovulatory dysfunction (6.3%) and unknown infertility (4.8%) groups and lowest in the tubal infertility (2.6%) and male infertility (1.5%) groups, although no statistically significant differences between the groups were observed. Oligo/amenorrhea was present in 101 (34%) women in the whole study population and in eight (67%, p < 0.5) women with elevated serum TSH at screening. The relatively high occurrence of abnormal TSH levels in infertile women with ovulatory dysfunctions or unknown infertility, as well as with oligo/amenorrhea, emphasizes the importance of TSH screening in these patient groups.

Adult↗
PubMed2000

[Changes of the pulsatile index in ovarian and uterine arteries of infertile women. Case-control study].

BACKGROUND: This study was performed to evaluate the frequency of female pathology that cause infertility and to appraise the difference of pulsatility index in the ovarian and uterine arteries in infertile women and in a control group of healthy women. METHODS: In the period between January 1997 and March 1999 52 infertile couples were examined carrying out an accuracy anamnesis and objective examination. The dosing of FSH, LH, estrogens, progesterone, and an ultrasound examination for each woman was required. The pulsatility index in the ovarian and uterine vases was calculated with the color Doppler technique. RESULTS: A female pathology caused infertility in 24 couples, where only in nine couples the cause was masculine. In 14 couples there was a pathology in both the partners. In 5 couples any pathology was identified. The median of pulsatility index in healthy women was 1.8. Variations were observed in all the women with ovarian or uterine pathology unless in those with uterine malformations. An increase of the pulsatility index was observed also in 3 couples in which any cause of infertility was identified. CONCLUSIONS: Female pathology is a very common cause of infertility. The evaluation of the pulsatility index in ovarian and uterine arteries can be useful diagnosing the cause of infertility and in to explain an infertility due to unknown cause.

Adult↗
PubMed2000

[Sonographic evaluation of human male infertility].

The male partner is responsible for 50% of infertility in couples. Assessment of male infertility should include clinical examination, laboratory tests (semen analysis, dosage of gonadal and gonadotropic hormones) and sonographic examination of the urogenital tract. Male infertility is related to diverse abnormalities including testis lesions (infertility of secretory type) and obstructive disorders of the genital tract (infertility of excretory type). Sonographic examination with abdominal, scrotal and transrectal probes has become the major imaging modality to evaluate male infertility and especially to analyze infertility of excretory type related to inflammatory lesions, congenital agenesis of vas deferens and congenital cyst of the distal genital tract. The main purpose of this paper is to illustrate with sonography the normal anatomy of the male genital tract and to detail sonographic features of current pathologies responsible for human male infertility.

Diagnosis, Differential↗
PubMed2001

Detection of Chlamydia trachomatis in semen and urethral specimens from male members of infertile couples in Tunisia.

The sequelae to infection with Chlamydia trachomatis in women are an established cause of tubal infertility. However, little is known about chlamydial infection and male infertility. The main objective of this study was to evaluate the presence of asymptomatic C. trachomatis infections in urethral and semen specimens from the male members of infertile couples by means of four different methods: the direct fluorescence antibodies assay, cell culture, the Roche Cobas Amplicor polymerase chain reaction, and the presence of chlamydial local IgA antibodies by the recombinant antibody-enzyme-linked immunosorbent assay. One or more chlamydial infection markers were detected in 42 (45.7%) of the 92 examined urethral and semen specimens from the male partners of infertile couples. C. trachomatis was detected in 23.9% (22/92) of urethral specimens and in 35.9% (33/92) of semen specimens. Although there was a significant correlation between the detection of one or more chlamydial infection markers in urethral and semen specimens (p = 0.01), no significant correlation was found between the detection of C. trachomatis DNA in these samples. Furthermore, no significant association was found between the presence of chlamydial local IgA antibodies and the detection of C. trachomatis. The discrepancies in positive results found between some techniques for the detection of C. trachomatis in urethral and semen specimens might be explained by variations in the sensitivities and specificities of the tests carried out and the use of specimens from different anatomical locations. Our findings suggest that C. trachomatis seems to be widespread among the male partners of infertile couples in Tunisia. The detection of C. trachomatis in urethral or semen specimens can serve as a marker for the presence of this organism in the genital tract, which is not necessarily the cause of male infertility. The study of the correlation between the detection of chlamydial infection markers and the parameters of male fertility seems to be necessary in order to determine the direct link between chlamydial infection and male infertility and to choose the most efficient technique and most suitable specimen with which to diagnose C. trachomatis-associated male infertility.

Adult↗
PubMed2001

Increased nitric oxide in peritoneal fluid from women with idiopathic infertility and endometriosis.

OBJECTIVE: To verify whether nitric oxide in peritoneal fluid is associated with endometriosis and infertility. STUDY DESIGN: Twenty-five women with idiopathic infertility and 38 with endometriosis were recruited, and 18 cases of uterine myomata and 2 cases of ovarian cyst served as controls. Peritoneal fluid samples were aspirated from the pouch of Douglas during laparoscopy or laparotomy. Metabolites of nitric oxide (nitrite and nitrate) in peritoneal fluid were determined by a method using nitrate reductase and the Griess reaction. RESULTS: Peritoneal concentrations of nitrate/nitrite in both infertile women (42.02 +/- 12.98 mmol/L) and patients with endometriosis (41.75 +/- 16.42 mmol/L) were significantly higher than that in controls (33.96 +/- 13.07, P < .05 for both). No significant difference in peritoneal nitrate/nitrite level was found between infertile women and patients with endometriosis (P > .5). Peritoneal levels of nitrate/nitrite were comparable among patients with endometriosis at different stages (P > .5). Patients with endometriosis had more peritoneal fluid than controls and idiopathic infertile women, while controls and idiopathic infertile women had comparable amounts of peritoneal fluid. CONCLUSION: An increased peritoneal level of nitric oxide is a common alteration in endometriosis, endometriosis-associated infertility and idiopathic infertility and may be associated with the pathogenesis of these diseases.

Adult↗
PubMed2001

[Peritoneal fluid and plasma 4-hydroxynonenal and malonyldialdehyde concentrations in infertile women].

OBJECTIVES: To investigate the possible role of oxidative stress in the pathogenesis of female infertility, we examined the peritoneal fluid (PF) and plasma lipid peroxides levels in infertile women. MATERIALS AND METHODS: 4-hydroxynonenal (4-HNE) and malonyldialdehyde (MDA) concentrations were measured in peritoneal fluid and plasma samples obtained from: 10 infertile women with minimal and mild endometriosis, 24 patients with unexplained infertility, 11 women with PCOS and 14 patients with tubal infertility. RESULTS: PF lipid peroxides level was significantly higher in women with idiopathic infertility compared to other groups. Plasma 4-HNE and MDA concentrations did not differ significantly between the infertile groups. No significant difference or relationship was observed between peritoneal fluid and plasma lipid peroxides levels. CONCLUSIONS: Increased free radicals activity in the peritoneal fluid environment may be the factor responsible for some cases of "unexplained infertility".

Adult↗
PubMed2002

Stress and infertility.

This review highlights new directions for research on stress and infertility. The question of whether stress causes infertility is examined, using theoretical models derived from natural history and evolution, current models of the effects of chronic stress on the hypothalamic pituitary adrenal axis, and data relating the effects of stress on the reproductive cycle. Research on the stress of infertility treatment is reviewed, with the conclusion that there is a lack of solid evidence that infertility patients demonstrate more psychopathology than controls, and that there is modest evidence for an association between distress during treatment and the outcome of the treatment itself. The effects of infertility and infertility treatment on quality of life is discussed thematically, using previous literature and previously unpublished qualitative data from infertility patients. The effects of infertility on social, interpersonal, and identity aspects of quality of life are emphasized.

Adaptation, Psychological↗