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PubMed1993

Why are couples satisfied with infertility treatment?

OBJECTIVE: To determine which factors relate to satisfaction with infertility treatment. DESIGN: A prospective structured interview research design was used. SETTING: In-person and telephone interviews were conducted. PARTICIPANTS: Wives and husbands from 185 couples in southeastern Michigan with primary infertility were studied. MAIN OUTCOME MEASURES: There were two main outcome measures: how satisfied people were with the infertility treatment they received and why they were satisfied. RESULTS: Both men and women were satisfied with the infertility treatment they had received. The most frequently mentioned reasons for satisfaction were the technical skills and the emotional support of infertility specialists. Both men and women advised infertility specialists to be compassionate and share information with their patients. Spouses' satisfaction with treatment was the greatest predictor for both men and women. For men, using escape as a coping skill was a negative predictor for treatment satisfaction. For women, personal control and the number of infertility treatments received were other predictors for treatment satisfaction. CONCLUSIONS: As hypothesized, a variety of psychosocial factors were related to treatment satisfaction. Contrary to expectation, treatment costs and how long respondents had been trying to have a child were not related to treatment satisfaction. This study's results suggest that physicians and their staff should pay particular attention to their patients' emotional needs, to their patients' understanding of procedures explained to them, to discussing adoption with their patients, to involving men more in the infertility treatment, and to assisting women to have more control over their course of treatment.

Adaptation, Psychological↗
PubMed1996

Infertility services in a managed care environment.

Managed care schemes are replacing traditional fee-for-service reimbursement to physicians and hospitals in the United States. Managed care schemes take the form of discounted fee-for-service, utilization review, global fee reimbursement, and capitated reimbursement schemes with funds to be distributed among providers. Reimbursement for infertility services has been excluded from many managed care plans as infertility is viewed as a social condition, not a medical condition, and coverage for infertility diagnosis and treatment is viewed as unnecessary in the bundle of services offered by insurers and other managed care organizations. However, some states mandate infertility coverage and some managed care organizations realize that provision of care for infertile couples makes their product more attractive. Large managed care organizations such as Blue Cross/Blue Shield of illinois and some entrepreneurial organizations are developing managed care plans that incorporate infertility services. Comprehensive services--including in-vitro fertilization--can be offered at a lower cost than traditional fee-for-service care. Newer technologies such as in-vitro fertilization are replacing fallopian tube surgery and surgical treatment for male infertility. These can be implemented at a lower cost and with better outcome for infertile couples than traditional services.

Comprehensive Health Care↗
PubMed1997

The epidemiology of infertility in a rural population.

BACKGROUND: To study the prevalence of infertility, outcome of pregnancy, and uptake of medical services in a rural population. METHODS: 1000 women aged 45-54 years, randomly selected from the Shropshire FHSA primary care register were sent a postal questionnaire. OUTCOME MEASURES: Response rate, time to pregnancy, pregnancy outcome, medical advice sought, diagnoses, and any treatments. RESULTS: Of the initial one thousand women, two had to be excluded by age and 142 women were excluded because of wrong address. A total of 728 completed questionnaires were returned leading to a response rate of 85.0%. A total of 74.6% women reported no infertility and 8.1% women were voluntarily sterile. The prevalence of infertility at 12 months was 17.3% and 12.0% at 24 months. The prevalence of primary infertility was 10.6%, of whom 77.9% eventually conceived, and 6.7% had secondary infertility, of whom 71.4% eventually conceived. There were a total of 1680 pregnancies, of which 8.6% ended in spontaneous abortion. The highest proportion of spontaneous abortions (11.4%) was amongst women who had experienced primary infertility. Of all infertile women 51.6% did not seek any advice or treatment and only 34.1% attended for hospital appointments. Ovulatory disorder was the commonest diagnosis. There appeared no association between occupation and infertility, outcome of pregnancy, or uptake of services. CONCLUSION: These findings are similar to other epidemiological studies, although in this population the uptake of medical services is low.

Abortion, Spontaneous↗
PubMed2025

Education, socioeconomic status, leisure sedentary behaviors and female infertility: mendelian randomization study.

BACKGROUND: Previous studies have indicated that education, socioeconomic status, and leisure sedentary behavior may be associated with female infertility. However, it remains unclear whether these associations imply causal relationships. METHODS: Genetic variants from genome-wide association studies (GWAS) of education, socioeconomic status, and leisure sedentary behaviors were obtained from the UK Biobank and MRC-IEU database (Medical Research Council Integrative Epidemiology Unit), female infertility data was acquired from the FinnGen Biobank. Univariable and multivariable MR analyses were performed to explore the relationships between these traits and female infertility. RESULTS: The results of the univariate MR analysis indicated that age of full-time education had a protective effect on female infertility (odds ratio [OR] 0.471; 95% confidence interval [CI] 0.24 to 0.93; p = 0.03). Multivariable MR and reverse MR studies support the existence of a relationship between them. However, no causal correlation was found between other traits and female infertility. No significant heterogeneity or horizontal pleiotropy was detected, and the stability of the results was confirmed through sensitivity analysis and the leave-one-out test. CONCLUSIONS: A later age of completion of full-time education may be causally related to a reduced risk of female infertility, but no causality is established between other educational levels factors, socioeconomic status, or sedentary behaviors and infertility risk.

Humans↗
PubMedDate not supplied

Psychological aspects of infertility due to various causes--prospective study.

SUBJECTS AND METHODS: One hundred and twenty infertile couples (30 each among unexplained infertility, anovulation, tubal factor, and male factor groups) and 30 fertile couples as controls were evaluated for psychological assessment by different psychological test instruments. Initial evaluation was done at recruitment, followed by reassessment at 3, 6, 9 and 12 months during the infertility work-up, and at the end when the specific diagnosis and the management and prognosis were disclosed. RESULTS: Psychological components were found to play a significant role in infertility of unknown etiology, especially in the male partner. They affected the personality and social behavior of the male partner and caused anxiety, but led to depression in the female partner. In cases of organically caused infertility, partners were worried about the other's reaction. Anxiety was significantly greater in the partner with the fertility problem than in the other partner. Life events were significant in the partner in whom the fertility problem was detected. Periodic psychological assessment was not affected by infertility work-up on the male partner in any of the groups, whereas anovulation and tubal factor infertility showed a significant psychological effect on the female partner at the end of work-up. Depression and anxiety in the female partner were evident soon after the investigation started.

Adaptation, Psychological↗
PubMed2005

Relationship of serum and seminal plasma zinc levels and serum testosterone in oligospermic and azoospermic infertile men.

OBJECTIVE: To measure the zinc level in fertile and infertile population and to find out relationship of serum and seminal plasma zinc levels and serum testosterone in oligospermic and azoospermic infertile men. DESIGN: Comparative study. PLACE AND DURATION OF STUDY: The Infertility Clinic, Jinnah Postgraduate Medical Center (JPMC), Karachi, from January 2002-July 2003. PATIENTS AND METHODS: Fifty-eight primary infertile male subjects, without any treatment, who had regular unprotected intercourse for at least 12 months without conception with their partners, aged 20-40 years, having normal and regular menstrual cycles without any uterine pathology or hormonal disturbance were selected from Infertile Clinic, Jinnah Postgraduate Medical Center, Karachi. After semen analyses, they were grouped as, oligospermic (30), and azoospermic (28). Twentyfive known fertile male selected from general population (their spouse had given birth to a child within one year) and after semen analysis were taken as normospermic control group . Semen analyzed according to WHO criteria and serum and seminal plasma zinc was estimated by 5Br. PAPS colorimetric method. Serum testosterone, LH, and FSH were measured by ELISA, using kits supplied by Diagnostic System Laboratories (DSL), U.S.A. RESULTS: The mean value for testosterone was significantly low in oligospermic, (8.04 -/+ 0.76) and azoospermic subjects (7.14 -/+ 0.27) as compared to normospermic (9.90 -/+ 0.14) control groups (p<0.05, p<0.001 respectively), serum LH (p<0.05, p<0.001 respectively) and FSH (p<0.05) were significantly higher than normospermic control group. Serum and seminal plasma zinc levels was low in oligospermic, and azoospermic subjects when compared with normospermic control groups (p<0.05, p<0.001 respectively). This suggests its involvement in spermatogenesis and infertility in such patients. Seminal zinc level has weak correlation with testosterone in oligospermic (r=0.44, p<0.05) and with serum zinc in azoospermic subjects (r=0.49, p<0.05) while no correlation was observed with LH and FSH in all the groups. CONCLUSION: In this study, there was significant decrease in serum and seminal plasma zinc levels in oligospermic and azoospermic infertile males with significantly low androgen. It indicates zinc has a possible role for spermatogenesis and steroidogenesis. Therefore, zinc concentration in seminal plasma should be considered as one of the factors responsible for decreased testicular function in infertile male subjects.

Adult↗
PubMed1994

Prevalence of genital chlamydia and mycoplasma infection in couples attending a male infertility clinic.

To investigate the prevalence of genital mycoplasma (Ureaplasma urealyticum and Mycoplasma hominis) and Chlamydia trachomatis infections in infertile and fertile couples, 135 infertile couples from a male infertility clinic and 88 fertile couples from a prenatal care clinic were randomly screened. Semen, urethral and cervical smears were cultured for genital mycoplasma and chlamydia. Antichlamydia IgA, IgG and IgM antibodies were tested in blood and semen. Although the overall prevalence of Ureaplasma urealyticum was higher than that of Mycoplasma hominis, the prevalence of Mycoplasma hominis was significantly higher in the infertile men and women. The prevalence of Chlamydia trachomatis, positive culture was higher in infertile couples, but this difference was not significant. The prevalence of serum-specific IgG was significantly higher in infertile than in fertile women (11.9 vs 3.4%, p < 0.05). Specific semen IgA was significantly higher in infertile than in fertile men (8.9 vs 1.1%, p < 0.015). A low rate of concordance between partners was found in Mycoplasma and Chlamydia culture, and in the same patient between seminal IgA and urethral culture. In conclusion it is necessary to check both culture and serology findings in both partners.

Adult↗
PubMed2001

Molecular insights into the causes of male infertility.

Infertility is a reproductive health problem that affects many couples in the human population. About 13-18% of couple suffers from it and approximately one-half of all cases can be traced to either partner. Regardless of whether it is primary or secondary infertility, affected couples suffer from enormous emotional and psychological trauma and it can constitute a major life crisis in the social context. Many cases of idiopathic infertility have a genetic or molecular basis. The knowledge of the molecular genetics of male infertility is developing rapidly, new "spermatogenic genes" are being discovered and molecular diagnostic approaches (DNA chips) established. This will immensely help diagnostic and therapeutic approaches to alleviate human infertility. The present review provides an overview of the causes of human infertility, particularly the molecular basis of male infertility and its implications for clinical practice.

Female↗
PubMed2002

Controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis: a retrospective analysis.

OBJECTIVE: To evaluate the efficacy of controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis. MATERIAL AND METHODS: A retrospective analysis of 260 patients with the only diagnosis of endometriosis, or male factor, or tubal factor, or unexplained infertility were performed: a total of 56 patients with different stages of endometriosis, a control group consisting of 38 patients with male factor infertility, a group of 26 patients with tubal factor infertility and a group of 140 patients with others (unexplained infertility, ovulation disorders, cervical factor). Pregnancy rate, hormone levels, endometrial thickness and number of follicles were analyzed. RESULTS: Clinical pregnancy rates per patient were similar between endometriosis, male factor, tubal factor, and others including unexplained infertility, ovulation disorders and cervical factor groups (10.7%, 5.4%, 11.5%, 17.9%, respectively; p>0.05). Clinical pregnancy rates per patient were not effected between the 2 subgroups of endometriosis as minimal to mild and moderate to severe [5.1% (2/39) versus 23.5% (4/17), p=0.19]. CONCLUSION: Endometriosis did not affect the clinical pregnancy rate per patient compared to the other infertility factors. Endometriosis of various stages have no effect on the success of controlled ovarian hyperstimulation combined with intrauterine insemination.

Adult↗
PubMed1987

Outcome of pregnancy following investigation and treatment of infertility.

We studied 500 women who conceived after investigation and treatment for different infertility problems and compared the outcome of the 5 infertility groups (Group 1 to 5), the ovulatory dysfunction (Group 1), male infertility (Group 2), A.I.D. (Group 3), tubal surgery and IVF (Group 4) and no treatment (Group 5) with the outcome in the hospital group during a period of 3 years. The incidence of abortion in Group 3 is significantly higher (13.8%), the incidence of ectopic pregnancy is significantly higher in Group 4 (21.7%) as compared with the incidence in the hospital group (P less than 0.01). The rate of pre-existing hypertension and gestational diabetes is significantly higher in all the 5 infertility groups as compared with the incidence in the hospital group (P less than 0.05). The incidence of preterm labor in general is less in the infertility group as compared with the incidence in the hospital group (P greater than 0.05). The incidence of older women, multiple pregnancy, induction of labor, operative deliveries, fetal distress, low Apgar score, babies with birth weight below the tenth centile were higher in the infertility groups (P less than 0.05). But the perinatal mortality or major or minor fetal anomalies were not significantly different in the infertility groups as compared with the rate in the hospital groups (P greater than 0.05).

Abortion, Spontaneous↗
PubMed1982

Correlation between serum antichlamydial antibodies and tubal factor as a cause of infertility.

Although salpingitis frequently produces tubal damage and infertility, many women with tubal factor as a cause of their infertility do not have a clinical history of salpingitis. In order to investigate whether or not some such cases might be due to subclinical chlamydial infections, we measured antichlamydial antibodies in the serum of 172 women consecutively undergoing evaluation for infertility. Only 16 (9.3%) had a prior history of salpingitis. Sixty-one (35%) had antichlamydial antibodies (S+), and of these 75% had tubal factor as a sole or contributing cause of their infertility, versus 28% of the seronegative (S-) women (x2 - 34, P less than 0.001). There was no association between chlamydial seropositivity and any infertility factor other than tubal factor in multivariant analyses. Subclinical infections with Chlamydia trachomatitis may be a major cause of tubal infertility in the United States, and chlamydial serologic studies may be useful in identifying the subset of infertile women likely to have tubal factor.

Adult↗
PubMed1984

Evidence of chlamydial infection in infertile women with and without fallopian tube obstruction.

This study investigates the prevalence of Chlamydia trachomatis antibodies in 164 infertile women who underwent diagnostic laparoscopy and dye insufflation as part of routine infertility investigations. C. trachomatis antibodies were found in 36 (22%) of 164 infertile women, which was significantly more than the prevalence of antibodies in a control group (22 of 200, 11%). C. trachomatis antibodies were found in 25 (35.7%) of 70 infertile women who had laparoscopically verified peripheral tubal disease. This was significantly more than the prevalence of C. trachomatis antibodies in infertile women with normal fallopian tubes (6 of 52, 11.5%). The prevalence of C. trachomatis antibodies in infertile patients with laparoscopically verified cornual disease was similar to those without cornual disease. C. trachomatis was not isolated from any of the patients studied. This study confirms that past chlamydial salpingitis is associated with the development of peripheral fallopian tube obstruction with resultant infertility.

Adult↗
PubMed1991

The prevalence, risks, and management of Chlamydia trachomatis infections in fertile and infertile patients from the high socioeconomic bracket of the South African population.

OBJECTIVE: The main objective of the study was to evaluate the prevalence of Chlamydia trachomatis endocervicitis in an infertile population. DESIGN: Forty consecutive patients were enrolled in the study group and 41 in the control group. SETTING: The study was undertaken in the Department of Obstetrics and Gynaecology of the University of the Orange Free State, Bloemfontein, Republic of South Africa. PATIENTS: Infertile white females, visiting an infertility clinic in an academic hospital and fertile white female patients visiting an antenatal clinic. INTERVENTIONS: Endocervical swabs were taken, and monoclonal direct immunofluorescence for C. Trachomatis were done on each. MAIN OUTCOME MEASURES: A difference was expected between the prevalence of C. trachomatis infection in the fertile and infertile population. RESULTS: In the study group, 14(35.9%) positive, 25(64.1%) negative, and 1 fallout were obtained. In the control group, 3 patients (7.32%) tested positive. CONCLUSION: Although no correlation was found between C. trachomatis infection of the female genital tract and the clinical history, it showed a significant correlation with infertility. This justifies routine screening tests and antibiotic treatment of positive infertile couples. Analysis of cost-effectiveness showed that empirical treatment of new infertile couples is justified in some populations.

Chlamydia Infections↗
PubMed1993

Fertility prognosis for infertile couples.

OBJECTIVE: To develop a fertility prognosis model for infertile couples. DESIGN: Prospective follow-up study. PARTICIPANTS: In the period November 30, 1977 to June 1, 1985, 321 consecutive couples were investigated for infertility at Hvidovre University Hospital. Investigation of the female included detection of ovarian, cervical, and anatomic disorders, whereas in the male semen analysis and sperm penetration test (P-test) were performed. Altogether, 108 couples (34%) conceived, whereas 213 (66%) were observed for an average of 2.3 years without having achieved pregnancy. MAIN OUTCOME MEASURE: The Cox regression model was used to predict the time required to conceive based on informations provided by fertility investigations. RESULTS: Three of 16 prognostic variables (the period of infertility, the female infertility factor, and the P-test) possess significant prognostic information. The period of infertility and the P-test are best scored as continuous variables, whereas the female infertility factor are best categorized in four classes, i.e., normal, ovulation or cervical disorder, anatomic disorder, or a combination of disorders. CONCLUSIONS: The three prognostic variables are combined to form a prognostic index that predicts the fecundability of the individual infertile couple.

Adult↗
PubMed1998

Updated projections of infertility in the United States: 1995-2025.

OBJECTIVE: To project the number of infertile women aged 15-44 every 5 years from 2000 to 2025. DESIGN: Data are used from Cycle 5 of the National Survey of Family Growth conducted by the National Center for Health Statistics. Population projections prepared by the U.S. Bureau of the Census are used as the base population for 2000-2025. Prospective demographic projections are used to estimate the number of infertile women. PARTICIPANTS: The National Survey of Family Growth (Cycle 5) interviewed 10,847 women aged 15-44 in 1995. MAIN OUTCOME MEASURE(S): Number of infertile women. RESULT(S): The number of women experiencing infertility will range from 5.4-7.7 million in 2025, with the most likely number to be just under 6.5 million. CONCLUSION(S): This is a substantial revision (upward) in the number of infertile women, largely a result of the increase in the observed percentage of infertile women in 1995. This is the base population of concern to providers; of particular interest is the percentage of infertile women who seek medical treatment.

Adolescent↗
PubMed2001

Haemodynamic evaluation of tubal and male factors of infertility in natural and ovarian stimulation cycles.

PURPOSE: To determine the haemodynamic parameters in women with tubal and male factors of infertility and to investigate the effect of ovarian stimulation on the blood flow indices of the uterine and ovarian arteries. METHODS: Prospective evaluation of the pulsitility index (PI) and resistance index (RI) of the uterine and ovarian arteries in the tubal and male factors of infertility was done. Comparisons were made between the natural and ovarian stimulation cycles. RESULTS: In natural cycles, uterine PI was 3.55 +/- 1.39 and RI was 0.95 +/- 0.05 in tubal infertility. These were significantly lower (uterine PI = 4.13 +/- 0.08; uterine RI = 0.99 +/- 0.06) than the corresponding indices in patients with male factor infertility. After ovarian stimulation in tubal factor, uterine PI and RI were 2.62 +/- 0.73 and 0.88 +/- 0.08 and were similar (PI = 2.55 +/- 0.62, RI = 0.87 +/- 0.06) to male factor infertility. CONCLUSIONS: The data points to measurable differences in the uterine PI and RI between the tubal infertility and male infertility in the natural cycles. These differences were abolished after ovarian stimulation.

Adult↗
PubMed1985

Tubal infertility and the intrauterine device.

To study the association between intrauterine devices (IUDs) and pelvic inflammatory disease, we compared contraceptive histories in 4185 while women--283 nulliparous women with primary tubal infertility, 69 women with secondary tubal infertility, and 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with IUD use was calculated by means of multivariate logistic regression to control for confounding factors, including region, year of menarche, religion, education, smoking, and reported number of sexual partners. The adjusted risk of primary tubal infertility associated with any IUD use before a first live birth was 2.0 (95 per cent confidence limits, 1.5 to 2.6) relative to nonuse. Users of the Dalkon Shield had an adjusted risk of 3.3 (1.7 to 6.1), users of the Lippes Loop or Saf-T-Coil had a risk of 2.9 (1.7 to 5.2), and users of copper IUDs had a risk of 1.6 (1.1 to 2.4). Women who reported having only one sexual partner had no increased risk of primary tubal infertility associated with IUD use. The adjusted risk of secondary tubal infertility associated with use of a copper IUD after a first live birth was not statistically significant (1.5; 95 per cent confidence limits, 0.8 to 3.0), whereas the risk from similar use of noncopper devices was significant (2.8; 1.3 to 5.9). We conclude that tubal infertility is associated with IUD use, but less so with copper IUDs.

Adult↗
PubMed2026

Association between hepatic steatosis index and female infertility: a cross-sectional study using NHANES 2013-2018.

Female infertility is a major reproductive health concern. Hepatic steatosis index (HSI), a non-invasive marker of liver-related metabolic burden, has not been well studied in relation to infertility across its distribution. We analyzed women aged 20-49 years from three NHANES cycles (2013-2018). HSI was examined as both a continuous variable and in quartiles, and restricted cubic spline models were used to assess potential nonlinearity. Sensitivity analyses using alternative infertility definitions and exploratory interaction analyses were also performed. Among 3,007 women, 416 (13.8%) were classified as having infertility. In the fully adjusted model, women in the highest HSI quartile had higher odds of infertility than those in the lowest quartile (OR 1.66, 95% CI 1.08-2.57; P = 0.031), with a significant trend across quartiles (P for trend = 0.010). Restricted cubic spline analysis showed a nonlinear association between HSI and infertility (P for overall association = 0.005), which was more evident at higher HSI levels. Higher HSI was associated with greater odds of infertility among reproductive-aged women.

Humans↗