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PubMed1993

The demography of infertility in the United States.

"Some popular descriptions of infertility have suggested that there are nine or ten million infertile couples, that one in six couples is infertile, that infertility is increasing rapidly, or that there is an 'epidemic' of infertility in the USA.... The purpose of this chapter is to determine whether these perceptions are accurate and if not, to suggest why there is a perception that infertility is epidemic.... We report two measures of infertility here. The first is called 'impaired fecundity' and is derived from a series of direct survey questions...on the ability to have children. The second is 'infertility status' among married couples." Data are from the National Survey of Family Growth for 1976, 1982, and 1988. Data for 1965 are from the National Fertility Study.

Americas↗
PubMed2003

Lessons learned from infertility investigations in the public sector.

OBJECTIVES: To determine the main factors causing infertility in an urban, tertiary hospital population. To establish if any such major causal factor could be used to rationalise and improve the service for infertile couples in the public sector. DESIGN: A retrospective analysis of the hospital records of 206 women who had a tubal patency test (hysterosalpingogram) performed and the results of the investigations performed in the couples with infertility. RESULTS: Of the 206 women 38 (18.5%) had normal fallopian tubes on hysterosalpingogram; 33 (16%) had unilateral obstruction and 135 (65.5%) had bilateral tubal obstruction. Of the latter group 81 (60%) had significant hydrosalpinges. Semen analysis results in 148 partners (71.8%) demonstrated a normal count in 85 (62%), normal motility in 70 (51%) and normal morphology in only 25 (18%). Testing for ovulation (mid-luteal phase progesterone) was positive in 91 of 124 women tested (73%). Compliance, technical and logistical problems were encountered with both semen analysis and mid-luteal phase progesterone tests. CONCLUSIONS: Infertility is a major problem in South Africa, with limited resources for investigation and treatment in the public sector. Tubal factor infertility was the most common cause of infertility demonstrated in this study. In the presence of bilateral tubal obstruction with hydrosalpinges the prognosis is so poor that unless assisted reproductive techniques are available and affordable, further infertility investigations do not seem justified. Recommendations on an approach to the infertile couple in the public sector is outlined.

Adult↗
PubMed2003

[Frequency of altered male factor in an infertility clinic].

UNLABELLED: Infertility is the incapacity of a couple to conceive after a year of regular sexual life without using a method for family planning. The infertility state is dependent on the female factor as well as masculine factor; an altered masculine factor is designated when any cause or causes of infertility reside in the male. The masculine factor as a cause of infertility is present in 40 to 50% of cases hence the importance of an integral evaluation of male alterations and its fertility. The World Health Organization (WHO) has proposed to classify the masculine infertility based on semen features. OBJECTIVE: To determine the frequency of the masculine factor altered in association to diagnosed abnormalities, according to the number of affected seminal indexes based on seminograms performed in infertile patients seen at the department of Human Reproductive Medicine, Hospital Juárez de México. MATERIAL AND METHODS: An observational, descriptive, transverse, retrospective study was performed. SUBJECTS: the seminograms practiced were reviewed from 571 clinical files of couples that the consultation for infertility from January 1993 to February 2001. Collection and analysis of semen samples was based on standards settled by WHO. RESULTS: Of 571 seminogram informs, 371 (65%) showed alterations in the seminal indexes, the stocking of age of this group was of 31.89 years +/- SD 6.3 years. Our findings were: azoospermia in 89 (23.98%), astenonecrozoospermia in 44 (11.85%), hypospermia in 43 (11.59%), astenozoospermia in 33 (8.89%), oligoastenozoospermia in 31 (8.35%) hyponecrozoospermia in 30 (8.08%), oligozoospermia in 25 (6.73%), others in 21 (5.7%), necrozoospermia in 19 (5.12%), hypoastenozoospermia in 18 (4.85%), cryptozoospermia in 11 (2.97%), and hypooligoastenozoospermia in 7 (1.88%). In 62.6% of seminograms practiced there was an isolated alteration, in 34.4% two alterations and in the remaining 3% more than two alterations. CONCLUSION: We found masculine factor altered in 65% of couples who were requiring consultation for infertility. The three main alterations of seminal indexes were azoospermia, astenonecrozoospermia and hypospermia.

Adolescent↗
PubMed2003

[Diagnostic and therapeutic significance of small follicular ovulation in infertile women and recurrent spontaneous abortion patients].

OBJECTIVE: To investigate the clinical significance and therapeutic efficacy of small follicular ovulation (SFO) in infertile women and recurrent spontaneous abortion patients. METHODS: The clinic features of 103 infertile women and recurrent spontaneous abortion patients with SFO detected by transvaginal B-ultrasonography were retrospectively analyzed. Luteal support alone in natural cycles and ovulation induction were used for treatment, and the pregnant outcomes were compared. RESULTS: Among the 103 cases there were 74 infertile patients and 49 recurrent spontaneous abortion patients, of whom 20 had both complaints meanwhile. In the 74 infertile patients 31 were diagnosed as LPD (59.5%) and 30 as unexplained infertility (40.5%). The incidence of LPD was 58.1% (18/31) in the recurrent spontaneous abortion patients. The pregnant rate of both nature and induced ovulation cycles were 10.9% (5/46) and 31.0% (9/29) (P = 0.037) respectively in infertile patients, live birth rates were 2.2% (1/46) and 27.6% (8/29) respectively (P = 0.002), spontaneous abortion rates 80.0% (4/5) and 11.1% (1/9) respectively (P = 0.023). The pregnant rate was 28.6% (14/49) in the group of the diameter of follicle > or = 18 mm on HCG injection day, higher than that in the < 18 mm group (6.6%, 4/62) (P = 0.003). Spontaneous abortion rates were 14.3% (2/14) and 75.0% (3/4) respectively, P = 0.019. CONCLUSION: SFO may be the cause of infertility and spontaneous abortion. Because only about half patients were diagnosed as LPD, B-ultrasonography is the main method for diagnosis of SFO and we strongly suggest that B-ultrasonography should be a routine examination for unexplained infertility and recurrent spontaneous abortion patients. Pregnant rate is lower and spontaneous abortion rate is higher in the patient with SFO. Induced ovulation treatment can increase the pregnant rate and improve the pregnant outcome.

Abortion, Spontaneous↗
PubMed2003

Evidence of chlamydial infection in infertile women with fallopian tube obstruction.

The study was carried out to find the prevalence of Chlamydia trachomatis seropositivity among women with infertility of tubal origin. Forty women with tubal infertility (verified at hysterosalpingography and laproscopy), 20 women with infertility due to variety of other reasons and 20 healthy fertile women of reproductive age were enrolled in the study. It was found that the presence of Chlamydia specific IgG antibody was significantly higher (70%) in women with infertility of tubal origin as compared to 35% seropositivity in healthy fertile women and 55% seropositivity in infertile women with cause of infertility other than tubal factor. Seventy eight percent of women with frequency of coitus 3-4 times/week were seropositive as compared to 34.7% when frequency of coitus was 1-2 times/week. Study also showed the silent nature of this infection as history suggestive of past pelvic inflammatory disease (PID) was lacking in majority of the seropositive women (63.75%). In the study group, both the ends of the fallopian tubes (cornual and distal block) were involved with almost equal frequency. Eighty three percent of women with seropositivity had unilateral or bilateral hydrosalpinx and 75% of women had marked pelvic adhesions. These results support the fact that there is strong association between serum anti-Chlamydial antibodies and tubal factor as a cause of infertility in infertile women.

Adult↗
PubMed2004

Changes of soluble fas and soluble fas ligand in serum and peritoneal fluid of infertile patients with endometriosis.

OBJECTIVE: To evaluate the relationship between levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in serum and peritoneal fluid of endometriosis-associated infertility. METHODS: The soluble Fas ligand and soluble Fas levels in serum and peritoneal fluid of 20 infertile patients with endometriosis were assessed with enzyme-linked immunosorbent assay, and were compared with 14 infertile patients due to chronic pelvic infectious disease and 16 fertile controls. RESULTS: The sFasL levels were significantly higher in infertile patients with endometriosis (175.09 +/- 80.55 pg/mL in serum and 284.50 +/- 152.38 pg/mL in peritoneal fluid) than those of infertile controls (88.47 +/- 43.55 pg/mL in serum and 17.30 +/- 9.62 pg/mL in peritoneal fluid) and fertile controls (16.13 +/- 11.75 pg/mL in serum and 8.84 +/- 2.31 pg/mL in peritoneal fluid). In contrast, as for the sFas levels, infertile patients with endometriosis (828.60 +/- 429.65 pg/mL in serum and 349.61 +/- 288.89 pg/mL in peritoneal fluid) did not show any significant difference compared with those in infertile patients resulting from pelvic infectious disease (868.75 +/- 570.48 pg/mL in serum and 181.76 +/- 157.78 pg/mL in peritoneal fluid) and fertile control (822.26 +/- 129.12 pg/mL in serum and 318.42 +/- 145.16 pg/mL in peritoneal fluid). CONCLUSIONS: Based upon these results, high level of sFasL in serum and peritoneal fluid and thus apoptosis mediated by it may be implicated in the mechanism involved in endometriosis-related infertility.

Ascitic Fluid↗
PubMed1992

[Biological, cultural and social features of infertility].

Infertility have been studied mostly from the medical perspectives, because inconsiderate infertility includes often versatile examinations and treatments. On the other hand the psychosocial factors and crisis experience of the infertility clients have not been paid much attention. Also the meaning and consequences of infertility to clients have not been studied. It is, however, important to study infertility, since its incidence is 5-15% in Finnish fertile population. This article explains on the literature basis concepts free and inconsiderate infertility. In addition, cultural, biological and social features of infertility are described. Finally, further nursing research topics concerning infertility clients and their needs are emphasized.

Adult↗
PubMed2004

[Genetic causes of male infertility].

7% of all human males suffer from infertility. In at least 10% of these males infertility is due to genetic causes. Because modern reproduction techniques like ICSI (intracytoplasmic sperm injection) can help the couples to overcome infertility, it is mandatory to analyze underlying genetic causes of male infertility. If infertility in a male is due to a genetic defect, the risk of the respective couple for abortuses or malformed children is increased. The main and relevant causes for male infertility known to day are: numerical and structural chromosomal aberrations, meiotic defects, microdeletions in the region q11.21-23 of the Y-chromosome, mutations in the gene for cystic fibrosis and genetically determined syndromes in which infertility is a symptom. The present knowledge concerning these genetic causes of male infertility is pointed out.

Chromosome Aberrations↗
PubMedDate not supplied

Specific IgG and IgA antibodies to Chlamydia trachomatis in infertile women.

IgG, IgA, and IgM antibody titers to Chlamydia trachomatis were determined in sera of 80 infertile women and 100 controls by a single antigen (L-2) immunoperoxidase assay. The infertile women included 50 with unexplained infertility and normal hysterosalpingogram (HSG) and 30 with abnormal HSG. The control sera included 50 from primiparous and 50 from multiparous women. The prevalence of C. trachomatis IgG antibody was significantly higher in infertile women with abnormal HSG as compared with infertile patients with normal HSG and controls (87% v. 20% and 10%, respectively). The geometric mean titer (GMT) of C. trachomatis IgG antibodies of infertile women with abnormal HSG was significantly higher than those of controls (20.7 v. 5.6). A significantly higher prevalence of C. trachomatis IgA antibodies was found in infertile women with both abnormal and normal HSG than in controls (77% and 14% v. 3% respectively). No C. trachomatis IgM antibodies (less than 2) were found in any of the infertile or control groups. The possibility that serum C. trachomatis IgA antibodies may serve as a marker for early recognition of persistent C. trachomatis is discussed.

Adult↗
PubMed1984

Clinical selection of infertile patients for laparoscopy.

For a period of time routine hysterosalpingography and laparoscopy were carried out in every patient complaining of more than 2 years of primary infertility. The records of 433 such patients were retrospectively evaluated according to their clinical aspects. Complete agreement between the two diagnostic methods was found in 70.9% of this unselected population. Almost 50% of the population had some abnormalities in either hysterosalpingography or laparoscopy. According to the patient's past history, pelvic examination, and the duration of infertility, the unselected infertile population was classified into a) high risk infertility and b) low risk infertility. High risk infertility patients had (P less than 0.01) greater abnormal findings at both hysterosalpingography and laparoscopy. In this high risk group we recommend early laparoscopy and the postponement of hysterosalpingographic investigation for patients with suspected cornual occlusion or destruction of ampullary rugae (valuable in assessing tubal damage). Low risk infertility patients had (P less than 0.01) low abnormal findings at both hysterosalpingography and laparoscopy, and in these patients hysterosalpingography does not discriminate the group of higher abnormal laparoscopic findings. Hysterosalpingography can be initially indicated as a less invasive investigation in the low risk group. We conclude that clinical data are very valuable in the selection of infertile patients for early or late laparoscopy.

Fallopian Tube Patency Tests↗
PubMed1984

Clinical selection of infertile patients for laparoscopy.

For a period of time routine hysterosalpingography and laparoscopy were carried out in every patient complaining of more than 2 years of primary infertility. The records of 433 such patients were retrospectively evaluated according to their clinical aspects. Complete agreement between the two diagnostic methods was found in 70.9% of this unselected population. Almost 50% of the population had some abnormalities in either hysterosalpingography or laparoscopy. According to the patient's past history, pelvic examination, and the duration of infertility, the unselected infertile population was classified into a) high risk infertility and b) low risk infertility. High risk infertility patients had (P less than 0.01) greater abnormal findings at both hysterosalpingography and laparoscopy. In this high risk group we recommend early laparoscopy and the postponement of hysterosalpingographic investigation for patients with suspected cornual occlusion or destruction of ampullary rugae (valuable in assessing tubal damage). Low risk infertility patients had (P less than 0.01) low abnormal findings at both hysterosalpingography and laparoscopy, and in these patients hysterosalpingography does not discriminate the group of higher abnormal laparoscopic findings. Hysterosalpingography can be initially indicated as a less invasive investigation in the low risk group. We conclude that clinical data are very valuable in the selection of infertile patients for early or late laparoscopy.

Female↗
PubMed1983

Primary infertility and uterine anomalies.

During a 20-year period, 19 (9.1%) of 208 patients with uterine anomalies had primary infertility. Women with unicornuate uteri had the highest (15%) incidence of primary infertility, which was found in the other groups of uterine anomalies in 7% to 13% of the patients. The cause of infertility was a nonuterine factor in 12 cases: hormonal (8), endometriosis (2), tubal (1), or male (1). The reason for infertility remained unknown or the patient conceived during investigation in five cases. Malformation of the uterus was considered the sole reason for infertility, and metroplasty was performed in two cases. During the follow-up period, 14 patients (74%) achieved pregnancy: 6 spontaneously, 3 after curettage, 2 after metroplasty, 1 after clomiphene treatment, 1 after hysterosalpingogram, and 1 after conservative endometriosis surgery. Four of five cases without pregnancy had a nonuterine factor as the cause of infertility, and in one case it may have been a uterine anomaly--a unicornuate uterus with a rudimentary horn. The results indicate that uterine anomalies are rarely the reason for infertility. Nonuterine causes of infertility must be ruled out before metroplasty is performed, as a last resort.

Female↗
PubMed1995

[Psychosocial responses of infertile couples attending an assisted reproduction program].

The purpose of this study was to evaluate gender differences in the psychosocial responses of 85 couples who attended the assisted reproduction program at Chung Shan Medical & Dental College Hospital from September 1991 to February 1992. The infertile couples were investigated by a self-administered structured questionnaire about demographic data, infertility history, and psychosocial responses and 75 couples completed the questionnaire. The average age of husbands was 35.0 years/and wives, 31.6 years. The average duration of infertility and treatment was 52.7 and 34.6 months, respectively. Parental expectation was the leading source of stress for men, while women counted being unable to meet childbearing demands as the main source of stress. Infertile women showed a higher psychosocial distress than their partners on the global measures and all the subscales of the infertility questionnaire and psychiatric symptoms test. Except for hostility, the differences between couples in subscales of self-esteem/body image, guilty, and all psychiatric symptoms reached statistical significance (p < 0.05). Among varied psychosocial responses of infertile couples, concordant response was demonstrated only in response to sexuality and physical condition. We consistently conclude with previous reports that infertile women showed a higher level of distress than their spouses, and that men and women displayed different psychosocial responses to infertility.

Adult↗
PubMed1995

[Kinetic study of pulsatility of gonadotropin and testosterone secretion in normospermic fertile and infertile men with idiopathic oligo-asthenozoospermia].

Idiopathic oligo-asthenozoospermia is among the most frequent causes of male infertility and has a not very well understood etiopathogenesis. To obtain valuable information about the role of some endocrine factors in the etiology of this kind of infertility, information that is not easy obtain by the traditional analytical methods, we applied some recently proposed mathematical algorithms to analyze with more exactitude the importance of the secretory pulses of three hormones, luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T). Serum samples were obtained every 10 min for 12 h, from 15 fertile normospermic men and 14 infertile patients with idiopathic oligo-asthenozoospermia; the concentration profiles of FSH and T were analyzed by IRMA and RIA, and the immuno-and bioactive LH concentrations were quantified by IRMA and bioassay (JCEM 42:958, 1976). To assess the pituitary stores of LH and FSH, after 8 h of spontaneous secretion we administered (2 h apart) 2 intravenous pulses containing 10 micrograms of a GnRH analog, and the sampling continued as described. Hormonal pulsatility was assessed by a computerized cluster analysis method (Am J Phys 250:E486, 1986) an by the multiple parameters deconvolution method (JCEM 66: 1291, 1988). In the infertile patients we found a significant diminution in the length and frequency of LH pulses, compared with the normospermic men. However, LH half life, the interpulse interval, the amplitude and the mass secreted per pulse rose in the infertile males compared with the controls. The increase in the LH half life suggests the secretion of a more acidic isoform of this hormone in the infertile group. After the GnRH injection the LH secreted mass and mean concentration rose significantly in both groups; this effect was higher in the infertile oligo-asthenozoospermic men. In this group we also found a decrease in the bioactive LH interpulse interval and therefore more pulses during the sampling interval, that produced a higher concentration of this kind of hormone in these patients. Oligo-asthenozoospermic men secreted approximately 70% more bioactive LH as a response to the first GnRH injection than the normal controls. The desensitization observed with immunoactive LH (diminution in the mass secreted after the second GnRH bolus compared with the first one) was also observed with bioactive LH. In the infertile men group we found a significant reduction in the FSH half life compared with the normospermic controls; this fact suggests that, contrarily to the results observed with LH, a more basic isoform is secreted in these patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

[Mental status and personality of infertile women].

Mental status and personality were investigated in 130 infertile women from November 1992 to May 1993 in the infertility clinic of The Second Hospital of Hunan Medical University. Causes of their infertility attributed to female (n = 65), male (n = 53), unexplained infertility (n = 12). Fifty four fertile women were recruited as normal control. A women consulting questionnaire, Eysenck personality questionnaire (EPQ), symptom checklist-90 (SCL-90), self-rating anxiety scale (SAS) and Hamilton depressive scale (HDS) were used in this study. The result showed that any level of mental pressure were found in 83.8% of infertile women, and moderate and severe in 52%. In comparison with the control, the prevalence of psychiatric symptoms were significantly higher in infertile than fertile women (P < 0.01). Infertile women were more likely to suffer from severe depression and anxiety. Their mental status were more unstable than fertile women and correlated with their personality traits. Authors emphasized that not only the somatic treatment, but also the psychological consultation and mental support should be provided in the program of the infertility management.

Adult↗
PubMed1994

Identification of main risk factors for tubal infertility.

OBJECTIVE: To determine the relationship between some reproductive variables and infertility caused by tubal obstruction. DESIGN: A retrospective, case-control study. SETTING: A tertiary care university hospital that is a referral center for infertility patients. PARTICIPANTS: Subjects were interviewed between March 1990 and December 1991. Cases were 215 consecutively recruited infertile women with either evidence of tubal obstruction found at laparoscopy or hydrosalpinx diagnosed by hysterosalpingography. Women with a history of surgical sterilization were excluded. Controls, selected in the same hospital, were women in the puerperium who had no history of infertility. Two controls were matched by age at the time of tubal obstruction diagnosis to each case. RESULTS: History of pelvic surgery and use of alcohol were significantly associated with the risk of infertility caused by tubal obstruction. The use of barrier, oral, and medroxyprogesterone acetate (MPA) contraceptives was associated with a protective effect. When only women with secondary infertility were analyzed, history of pelvic surgery and number of lifetime sexual partners were significant risk factors, and the previous use of oral contraceptives was the only protective factor. CONCLUSIONS: History of pelvic surgery was the most important risk factor for tubal infertility. All precautions must be taken to avoid infection and adhesion formation when pelvic surgery is performed. In addition, women can be protected from tubal infertility by using barrier, oral, or MPA contraceptive methods.

Adult↗
PubMed1993

Long-term infertile couples: a study of their well-being.

The objective of the study was to investigate long-term infertile couples in regard to their well-being. The design of the study consisted of a structured questionnaire. Husband and wife answered a written questionnaire each in a different place in their home. Wives and husbands of 108 childless couples with a long-term infertility participated. Seven dimensions of (negative) well-being were measured: depression, anxiety, hostility, health complaints, guilt/blame, self-esteem and sexuality. Results showed that sexual behavior was (still) often ruled by the constraints of procreation. Also a third of the women reported as a consequence of infertility a low self-esteem concerning their womanhood. Infertile women were more anxious, more depressed, displayed more hostility and reported more health complaints. There was no similar difference between long-term infertile men and men in general. In conclusion long-term infertile women showed a significantly-lower level of well-being compared with women in general. A third of the infertile women and a fifth of the infertile men had serious well-being problems. This group can be considered as needing emotional help and counselling in learning to live with their childlessness.

Adaptation, Psychological↗
PubMed1994

Study of finger and palmar dermatoglyphics in primary infertile males.

Finger and palmar dermatoglyphic variations have been studied in 160 diagnosed primary infertile males (111 clinically abnormal primary infertile males and 49 clinically normal primary infertile males). It has been observed that loops occur most frequently in primary infertile males. Arches are found to be absent on digit IV and V. Among the clinically normal infertile males the mainline formula 7.5.5--succeeds 11.9.7--instead of 9.7.5--in the order of preponderance. Bilateral and inter-group differences among clinically abnormal and normal infertile males have been found to be statistically non-significant for finger and palmar comparison. The present findings are compared with the result on finger and palmar dermatoglyphics of controls (130 Punjabi males of Delhi). Clinically normal infertile males show statistically significant differences in the occurrence of various pattern types of finger balls when compared with controls. Similarly, clinically abnormal as well as normal primary infertile males reveal statistically significant results in the occurrence of patterns in the hypothenar and Thenar/I interdigital area of palms when compared with controls.

Adult↗