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PubMed1998

Hormonal profile of infertile Makkans.

Male factor infertility, being a complex and heterogeneous disorder, precludes any reliance on a single laboratory test and requires broad spectrum assessment. Sociobiological factors also influence the parameters. In this context we examined serum concentrations of nine hormones in infertile and fertile male Makkans. Infertility was implicated in 21% of the population with correlated abnormalities of gonadotrophins, thyroid, thyroid stimulating hormone (TSH), and testosterone. Hypothyroidism was established in 35% and hyperthyroidism in 14% of the infertile population, where 28% of thyroid abnormality constituted an independent infertile group. Hyperprolactinaemia associated with low levels of luteinizing hormone (LH) and testosterone signifies a cluster of 28%, while 14% of testosterone deficiency alone was causal for infertility. However, infertility in 9% of the patients examined might have been psychogenic in nature. We present a responder panel based on cluster analysis.

Adult↗
PubMed2002

Diagnosis and management of unexplained infertility: an update.

Unexplained infertility constitutes around 15% of patients presenting with infertility. A lack of agreement exists among infertility specialists with regard to the diagnostic tests to be performed and their prognostic value as well as criteria of normality. It seems that serum progesterone for detection of ovulation, hysterosalpingography and or laparoscopy for tubal patency and semen analysis are the basic tests for diagnosis of unexplained infertility. Expectant treatment is the option of choice for young patients with short period of infertility. The spontaneous pregnancy rate is very high in this group of patients. The world literature have shown that controlled ovarian hyperstimulation and intrauterine insemination (COH and IUI) is an effective treatment of unexplained infertility. According to the available data, this procedure could be limited to three trials. There is evidence that both COH and IUI are important independent positive factors in achieving better pregnancy rate in unexplained infertility. If the above measures fail to achieve pregnancy, GIFT or IVF/ICSI could be performed as it yields a high pregnancy rate.

Female↗
PubMed1982

Sperm phagocytosis by human peritoneal macrophages: a possible cause of infertility in endometriosis.

The mechanism of infertility in women with endometriosis is unknown, but it is independent of mechanical factors that affect fallopian tube function. Increased numbers of peritoneal macrophages are present in women with endometriosis and have access to the female reproductive tract via the oviducts. To determine whether peritoneal macrophages might phagocytize sperm and thereby contribute to infertility in women with endometriosis, we examined peritoneal macrophages from 32 fertile and infertile women; the infertile group was separated into those with and those without visible endometriosis. Peritoneal macrophages from infertile patients with endometriosis phagocytized more normal sperm in vitro (84% +/- 4%) than did those from fertile women (43% +/- 4%) or infertile women without endometriosis (46% +/- 8%) (p less than 0.002). The sperm phagocytosis occurred rapidly and reached a peak by approximately 6 hours. Incubation at 0 degrees C, lysing the macrophages by freezing and thawing, or fixing the macrophages with glutaraldehyde inhibited the sperm uptake by macrophages. The process occurred in cultures with or without serum, thereby indicating that the sperm phagocytosis was not dependent on sperm opsonization with a serum factor. Electron microscopy showed internalization of the spermatozoa into phagosomes with subsequent intravacuolar degradation. These data demonstrate that: (1) peritoneal macrophages phagocytize and degrade sperm in vitro and (2) peritoneal macrophages isolated from women with endometriosis exhibit greater phagocytosis in vitro than do macrophages from fertile women or infertile women without endometriosis. These results suggest that, if peritoneal macrophages from women with endometriosis enter the reproductive tract via the oviducts, they might adversely influence fertilization by phagocytizing sperm.

Adult↗
PubMed1994

Adolescent body mass index and infertility caused by ovulatory disorder.

OBJECTIVE: Our aim was to examine the association between body mass index at age 18 and subsequent primary ovulatory infertility. STUDY DESIGN: A nested case-control study was conducted within a cohort of 116,678 female registered nurses residing in 14 U.S. states. Cases comprised 2527 married nulliparous nurses unable to become pregnant for at least 1 year because of ovulatory disorder; controls comprised 46,718 married parous nurses with no history of infertility. The risk of ovulatory infertility for women at different levels of body mass index at age 18 was compared with that for women whose body mass index at age 18 was 20 to 21.9 (median for the cohort). Logistic regression was used to adjust for age at infertility or first birth, year of birth, age at menarche, physical activity during ages 18 to 22, smoking at ages 15 to 19, ethnicity, alcohol use at ages 18 to 22, use of oral contraceptives before age 22, and diagnosis of diabetes mellitus. RESULTS: Multivariate relative risks for infertility were: 1.2 (body mass index < 16), 1.1 (body mass index 16 to 17.9), 1.0 (body mass index 18 to 19.9), 1.0 (referent body mass index 20 to 21.9), 1.1 (body mass index 22 to 23.9), 1.3 (body mass index 24 to 25.9), 1.7 (body mass index 26 to 27.9), 2.4 (body mass index 28 to 29.9), 2.7 (body mass index 30 to 31.9), and 2.7 (body mass index > or = 32). The relative risks for all categories of body mass index above 23.9 were statistically significantly elevated. Greater body mass index at age 18 was a predictor of ovulatory infertility in women with and without a diagnosis of polycystic ovary syndrome. CONCLUSION: These findings suggest that elevated body mass index at age 18, even at levels lower than those considered to be obese, is a risk factor for subsequent ovulatory infertility.

Adolescent↗
PubMed1993

A randomized comparison of intrauterine and intraperitoneal insemination in the treatment of infertility.

OBJECTIVE: To compare the pregnancy rates (PRs) between intrauterine insemination (IUI) and intraperitoneal insemination (IPI) in women receiving comparable ovarian stimulation in couples who were infertile for various infertility conditions. METHOD: Fifty-four couples were treated. Of these, 25 were diagnosed as having unexplained infertility, 21 as having male infertility and 8 as having cervical mucus hostility. RESULT: Nine pregnancies occurred with 89 cycles of IUI and 6 pregnancies with 85 cycles of IPI, giving an overall PR of 28%. Twelve of the 15 pregnancies occurred during the first treatment cycle and three during the second treatment cycle. There was no significant difference in the (PRs) between the IUI and IPI (P > 0.25). CONCLUSION: Both procedures combined with superovulation proved to be simple, inexpensive safe and worthwhile for infertile couples with unexplained infertility, male infertility and cervical mucus hostility.

Adult↗
PubMed1994

Score prognosis for the infertile couple based on historical factors and sperm analysis.

OBJECTIVE: To identify variables, obtained from historical factors and sperm analysis, associated with greater chances of pregnancy in infertile couples. METHODS: The study was carried out in Córdoba, Argentina. The characteristics of 247 couples consulting for infertility who achieved pregnancy within 3 years of their first visit were compared with those of 312 couples who did not become pregnant. We evaluated the relationship between the age of the woman and her partner, the type and duration of infertility, length of the last three menstrual cycles, history of pelvic surgery in the woman, and testicular volume, sperm density, motility and morphology in her partner, and the achievement of pregnancy. For the analysis, logistic regression was used. RESULTS: Six variables had a predictive value: sperm morphology, the woman's age, type and duration of infertility, her history of pelvic surgery, and duration of menstrual cycles. CONCLUSIONS: The best prognosis for future fertility in infertile couples is correlated with a higher percentage of normal sperm morphology, younger woman's age, secondary infertility, fewer years of infertility, negative history of pelvic surgery, and abnormal menstrual cycles.

Adolescent↗
PubMed1982

Clinical significance of the luteinized unruptured follicle syndrome as a cause of infertility.

The luteinized unruptured follicle syndrome (LUF) exists and is cause of infertility. Although the data of the laparoscopic inspection of the ovaries and the corpora lutea and of steroid hormone concentrations in peritoneal fluid constitute strong evidence that the syndrome exists, its role as a cause of infertility is less clear. The only evidence available that the LUF syndrome is a cause of infertility, is the finding that the syndrome occurs statistically more frequently in women with unexplained infertility than in a control group of women. It still has to be proven whether the LUF syndrome occurs repetitively in each cycle and causes infertility, or whether the syndrome occurs intermittently and only reduces the probability of conception. Diagnosis of the syndrome can be made by laparoscopic inspection of the ovaries and by the assay of 17 beta-estradiol and progesterone, in peritoneal fluid between day 14 and 20 of the cycle. The relationship between the LUF syndrome and pelvic endometriosis and luteal phase insufficiency is discussed. We suggest that the LUF syndrome might be the cause of endometriosis thus explaining the statistical association between both syndromes, and the infertility of women with only mild endometriosis. We favor the hypothesis that the LUF syndrome might be caused by stress thus constituting a "psychological infertility" and we suggest that the syndrome could explain the spontaneous cure rate. Therefore, before any therapy can be accepted as the treatment of the LUF syndrome, it should be strictly assessed with adequate controls.

Ascitic Fluid↗
PubMed1991

Prevalence of infertility: international data and problems of measurement.

This paper discusses the various research options open for measuring the prevalence of infertility. National and regional surveys are both population-based studies but with different methodological approaches. National surveys give information on the various parameters of a couple's reproductive life and indicate the main trends concerning infertility. They give an approximate estimate of the prevalence of infertility, depending on the validity of the collected data. Regional studies can measure the prevalence, incidence, causes and distribution of primary and secondary infertility. When properly carried out, i.e., when the census of infertile couples can be considered as almost exhaustive and when the population studied is representative of the general population, their results can then be inferred on a national scale. Epidemiologists working in infertility have a duty to design appropriate methodologies, thus making public health policymakers aware of the aspects and implications of different types of infertility surveys.

Adolescent↗
PubMed1995

Ideal residency curriculum in reproductive endocrinology and infertility.

OBJECTIVE: Knowledge in reproductive endocrinology and infertility is fundamental to the delivery of quality women's health care. In 1991, the American Fertility Society formed a resident education committee to gather data on the current status of reproductive endocrinology and infertility training and develop an ideal curriculum. METHODS: Program directors and reproductive endocrinology and infertility faculty from 288 residencies in obstetrics and gynecology were surveyed about training in reproductive endocrinology and infertility; 257 (89%) of the program directors (survey I) and 203 (82%) of the reproductive endocrinology and infertility faculty (survey II) responded. An ideal curriculum has been developed from consensus discussions, review of survey data, and polling of experienced educators. The curriculum was reviewed and approved by the board of directors of both the Society for Reproductive Endocrinologists and the American Fertility Society. RESULTS: The curriculum is divided into subject matter and therapeutics, which are prioritized into three levels of knowledge: critical core curriculum, less critical material, and material with which residents should have familiarity and general knowledge. In addition, other recommendations and suggestions are made regarding the number of rotations, duration of rotations, and teaching methods. CONCLUSION: The ideal curriculum may serve as a guide to assist program directors in the formulation of the most effective residency training in reproductive endocrinology and infertility. The curriculum can help prioritize what should be taught and where an emphasis can be placed. There is not enough time or resources to teach residents all aspects of reproductive endocrinology and infertility.

Curriculum↗
PubMed2005

Changed Bcl:Bax ratio in endometrium of patients with unexplained infertility.

Apoptosis has been shown to be an important regulator of endometrial function during the menstrual cycle and implantation. Recently, some possible implantation defects were identified in patients with unexplained infertility. In this study, we investigated the role of spontaneous apoptosis, which is regulated by death regulatory genes, such as Bcl-2, Bax, p53, and isoenzymes of nitric oxide synthases; eNOS and iNOS during the implantation window in women with unexplained infertility. Endometrial samples were evaluated from fertile (n=15) and unexplained-infertile women (n=15) during post-ovulatory 7th or 8th day of their menstrual cycles. Apoptotic cells were detected using the dUTP nick-end labelling assay and Bcl-2, Bax, p53, iNOS and eNOS were assessed immunohistochemically. Reduced apoptotic cells, weak immunoreactivity of p53 and strong immunoreactivity of Bcl-2 were observed in the unexplained-infertile group compared with the fertile group (p<0.001). Bax intensity was similar in both groups. While weak iNOS immunoreactivity was detected in both groups, moderately increased eNOS immunoreactivity was observed in infertile cases. Spontaneous apoptosis is reduced in the endometrium of unexplained-infertile women, and is associated with the changed Bcl-2:Bax ratio. This finding may be a contributing factor to defective implantation causing infertility in this group of patients.

Adult↗
PubMed2005

Evaluation of monocyte chemotactic protein-1 levels in peripheral blood of infertile women with endometriosis.

OBJECTIVE: To test whether serum monocyte chemotactic protein-1 (MCP-1) chemokine levels correlate with endometriosis in infertile women. STUDY DESIGN: A group of women with endometriosis (n = 18, infertile) was compared with patients with uterine leiomyoma (n = 16, fertile), unexplained infertility (n = 5, infertile), and healthy women (n = 16, fertile). MCP-1 expression levels were evaluated by ELISA assay. The data obtained were statistically analyzed using the Mann-Whitney test. P-Values <0.05 were considered as significant. RESULTS: MCP-1 concentrations (median; range of values) in serum were as follows: women with endometriosis (221; 101-635 pg/ml), women with unexplained infertility (167, 114-234 pg/ml), women with uterine leiomyoma (137; 88-200 pg/ml), and healthy donors (123; 98-194 pg/ml). Significant differences were observed in the women with endometriosis compared with those with uterine leiomyoma (p = 0.02) and healthy donors (p = 0.002). Among the women with endometriosis, the level of significance in MCP-1 level at rAFS stages III-IV was higher than that at rAFS stages I-II compared with healthy donors and women with leiomyoma (p = 0.002 and p = 0.02, respectively). CONCLUSIONS: These data show that an increased level of MCP-1 can characterize infertile women with endometriosis. However, further studies are needed to be able to determine whether increased MCP-1 chemokine expression can be related to infertility or is a result of endometriosis progress.

Adult↗
PubMed2006

Leukemia inhibitory factor gene mutations in the population of infertile women are not restricted to nulligravid patients.

OBJECTIVE: Leukemia inhibitory factor (LIF) is one of the key cytokines in the embryo implantation regulation. We investigated the prevalence of the LIF gene mutations in the population of infertile women that consisted of nulligravid and secondary infertile patients. STUDY DESIGN: We designed a LIF gene mutation screening method that is based on the Temperature Gradient Gel Electrophoresis (TGGE). The population to screen consisted of 176 infertile women including group A of 147 nulligravid women and group B of 29 women with secondary infertility that had a history of either miscarriage or an ectopic pregnancy but no live births. The control population was comprised of 75 healthy fertile subjects. The groups of fertile controls and infertile patients were compared for statistically significant differences using the t-test. RESULTS: Six potentially functional LIF gene mutations, the G to A transitions at the position 3400 leading to the valin to methionin exchange at codon 64 (V64M) in the AB loop region of the LIF protein, were detected. All of the six positive women were infertile. Four of them were nulligravid and two of them had history of spontaneous conception followed by early miscarriage. No positive TGGE samples were identified in the control group, which means that the frequency of functionally relevant mutations of the LIF gene in infertile women is significantly enhanced in comparison with controls (P<0.05, t-test). CONCLUSION: The results suggest that the LIF gene mutations affect fertility. Even though they occur infrequently, their impact on molecular events during early phases of pregnancy should be further established.

Adult↗
PubMed2004

A multimedia psychosocial support program for couples receiving infertility treatment: a feasibility study.

OBJECTIVE: To develop and test the feasibility of a theory-driven, psychosocial support CD-ROM prototype for couples in infertility treatment. DESIGN: Focus group meetings with reproductive health experts, semistructured interviews with infertility patients, and content analysis of an infertility message board to determine content domains of the CD-ROM. Usability and acceptance testing of prototype CD-ROM based on predetermined feasibility criteria. SETTING: Private offices and fertility centers. PATIENT(S): Expert panel of 5 reproductive health specialists; interviews with 62 individuals with infertility (35 women, 27 men); feasibility study with 12 patients and 12 experts in reproductive medicine and infertility support. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Product usability/acceptance test. RESULT(S): Participant feedback and content analysis informed the development of a prototype patient education CD-ROM that uses audio, video, interactive tasks, and personalized feedback. Over 80% of participants successfully completed usability tasks, and over 90% rated prototype satisfaction as "good" to "excellent." Some areas were noted for improvement in navigation and refinement in delivery of instructions. Results strongly indicate an interest in an infertility multimedia support tool. CONCLUSION(S): Multimedia methods may serve as an effective, innovative psychosocial intervention for infertility patients and overcome barriers of limited local access to educational and support services.

CD-ROM↗
PubMed2006

Alterations of sexual desire and satisfaction in male partners of infertile couples.

OBJECTIVE: To clarify the state of sexual desire and satisfaction, with relevant parameters in men, of couples with infertility. DESIGN: Cross-sectional study. SETTING: University outpatient clinic. PATIENT(S): Two hundred infertile couples referred to a reproductive health research clinic. INTERVENTION(S): Patients were investigated by a self-administered structured questionnaire about demographic data, infertility history, and several relevant psychological variables. In addition, clinical and andrological examinations were completed to find predictors for sexual state. MAIN OUTCOME MEASUREMENT(S): Sexual desire and satisfaction status were scaled, and the relative factors were analyzed statistically. RESULT(S): Subjects reported a reduction in sexual desire in 41.5% of cases and reduction of satisfaction in 52.5% compared with recalled sexual satisfaction before diagnosis of infertility. No relationship was found between andrological findings and the present status of sexual desire (P>.05). Education level, mutual understanding between couples, and recalled state of sexual satisfaction had a direct influence, but the duration of infertility and duration of desire for a child showed a significant inverse impact on sexual satisfaction (P<.05). CONCLUSION(S): Less than 50.0% of patients mentioned a reduction in sexual desire and satisfaction after infertility diagnosis, and the frequency of coitus could be regarded as an acceptable indicator of sexual satisfaction in male partners of infertile couples.

Adult↗
PubMed2006

International disparities in access to infertility services.

OBJECTIVE: To characterize the international availability of infertility services. DESIGN: A PubMed computer search to identify relevant articles. SETTING: Academic medical center. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): None. RESULT(S): Epidemiological data suggests that approximately 80 million people worldwide are infertile. Most countries in the industrial west have declining fertility rates marked by late marriage, postponed childbearing, and primary infertility. In contrast, in the developing world, there is little voluntary effort to postpone childbearing and early first marriage is common. However, a high prevalence of sexually transmitted infections and infections acquired as a result of inadequate health care result in increased rates of secondary infertility. In developing societies, childlessness is often highly stigmatized and leads to profound social suffering for infertile women in particular, yet most infertile people in the developing world have virtually no access to effective treatment. Internationally, a minority of countries offer IVF, and even where it is available, on average it is prohibitively expensive and utilized by a fraction of those who could benefit from its use. CONCLUSION(S): Wide disparities exist in the quality, availability, and delivery of infertility services between the developed and developing nations of the world.

Female↗
PubMed2006

Declining estimates of infertility in the United States: 1982-2002.

OBJECTIVE: To determine if the decline in infertility has been uniform across subgroups. DESIGN: Periodic data from the National Fertility Survey and the National Survey of Family Growth were used to determine which factors contributed to the decline in 12-month infertility in the United States. SETTING: National Survey of Family Growth, a periodic US nationally representative study. PATIENT(S): A nationally representative sample of married women aged 15-44 years, N = 15,303 for pooled data across 4 survey years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Estimates of infertility prevalence among married women aged 15-44 years. RESULT(S): The decline in 12-month infertility in the United States from 8.5% in 1982 and 7.4% in 2002 was significant. This decline was evident in nearly all subgroups of married women. In the multivariate analysis, 12-month infertility was more likely among women who were older and nulliparous, were non-Hispanic black or Hispanic, and did not have a college degree. The decline in 12-month infertility was observed even after controlling for the compositional differences of the population over time. CONCLUSION(S): Among married women in the United States, there has been a significant decline in 12-month infertility, which cannot be explained by changes in the composition of the population from 1982-2002.

Adolescent↗
PubMed2007

Psychological characteristics and marital quality of infertile women registered for in vitro fertilization-intracytoplasmic sperm injection in China.

OBJECTIVE: To assess the psychological health status and marital quality of Chinese women who were referred for IVF-intracytoplasmic sperm injection (ICSI), to compare the results with a control group, and to test the impact of clinical and sociodemographic determinants on psychological health status and marital quality in this cohort. DESIGN: A descriptive study of psychological health status and marital relationships, comparing infertile women who are registered for IVF or IVF-ICSI with fertile controls. SETTING: An assisted reproductive center of a science and technology institute of family planning. PATIENT(S): Two groups of infertile women (100 registered for IVF, and 100 registered for ICSI), and a control group of 100 women attending a gynecology clinic, who have no known history of infertility. INTERVENTION: Psychometric tests were administered at the first visit of the treatment cycle. MAIN OUTCOME MEASURE(S): Psychological status measured by the Hopkins Symptom Checklist-90 (SCL-90), and marital quality measured by the ENRICH (Evaluating & Nurturing Relationship Issues, Communication & Happiness) marital inventory. RESULT(S): Infertile Chinese women planning to undergo IVF-ICSI scored significantly higher on all subscales of the SCL-90 than did controls. In addition, women in the IVF subgroup had significantly higher scores on depression scales than those in the ICSI subgroup. The study group displayed unstable relationships compared to the control group. Age, yearly income, duration of infertility, and history of unsuccessful IVF treatment had a negative correlation with psychological health status and marital quality. CONCLUSION(S): The stresses associated with infertility and IVF treatment had a negative impact on Chinese women's psychological health status and marital quality. These findings emphasize the need to include psychological and sociocultural considerations with any medical interventions for infertility.

Adult↗
PubMed2005

Male infertility in Zimbabwe.

OBJECTIVES: There are very few studies on male infertility in sub-Saharan Africa. Sub-Saharan countries tend not to research male infertility because of economic reasons and, possibly, the psychological denial of the problem. METHODS: The participants in the present study were 311 men with infertility problems who had been referred to the Andrology Clinic of the University of Zimbabwe. They were investigated by means of a clinical interview, a clinical examination, semen analysis and various endocrine tests. RESULTS: It was found that 78% of the respondents had ever had a sexually transmitted disease. Most of the respondents reported that their infertility caused them stress and reported signs of mild depression. Most men mentioned also to seek treatment based on traditional methods. Men blamed that their wife was the reason of their childlessness. CONCLUSION: This study shows the importance of understanding both the cultural and the medical aspects of male infertility. Male infertility is a significant medical and psychological problem in Zimbabwe. PRACTICE IMPLICATION: Men should promptly be diagnosed and treated for STIs. Health education and teaching people about STDs and HIV in general about this are essential to the process of preventing male infertility.

Adaptation, Psychological↗