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PubMed2001

Correlations between two markers of sperm DNA integrity, DNA denaturation and DNA fragmentation, in fertile and infertile men.

OBJECTIVE: To evaluate two different assays of human sperm DNA integrity, DNA denaturation (DD) and DNA fragmentation (DF), and to correlate these with standard semen parameters. DESIGN: Prospective, observational study. SETTING: University infertility clinic. PATIENT(S): Forty consecutive semen samples from 33 nonazoospermic men presenting for infertility evaluation and 7 fertile men presenting for vasectomy. INTERVENTION(S): Assessment of sperm concentration, motility, morphology, DD and DF. MAIN OUTCOME MEASURE(S): Sperm DD and DF in fertile and infertile men. RESULT(S): The mean (+/-SE) rates of DD and DF were significantly higher in infertile subjects compared to fertile controls, respectively: 25.4 +/- 3.0 vs. 10.2 +/- 2.3 (P=.028) and 27.6 +/- 2.5 vs. 13.3 +/- 2.5% (P=.016). DF and DD correlated strongly (r = 0.71, P<.0001). Also, DD and DF correlated negatively with standard semen parameters (concentration, motility, and morphology), the strongest correlation being with sperm motility. CONCLUSION(S): The strong correlation between sperm DD and DF, and the higher levels of sperm DNA damage in infertile compared with fertile men, indicate that male infertility is associated with poor sperm DNA integrity. Although infertile men may father children with assisted conception, fertilization with DNA-damaged spermatozoa may increase the risk of genetic disease in the offspring.

Biomarkers↗
PubMed2001

A one-year experience with a capitated health care plan for infertility.

OBJECTIVE: To report on a one-year experience participating in a capitated healthcare plan for infertility. DESIGN: Prospective study. SETTING: University population. PATIENT(S): Reproductive-age women 15 to 50 years. INTERVENTION(S): The first-generation Lewin infertility algorithm and CATHI software were used to negotiate infertility services under a capitated arrangement for $0.50 per member per month. The following reports our experience for the fiscal year 1997. MAIN OUTCOME MEASURE(S): Infertility services rendered, pregnancy rate, cost of services, collection rates. RESULT(S): Five thousand forty-six women representing 39,689 member months generated 39 new and 198 return visits. Thirty-two percent of the patients required three visits or less; six patients generated 22% of the visits. Fifty-one percent listed infertility as one of their chief complaints; 31% had mixed diagnoses. Eight (7.6%) patients required surgery, 11 (10.5%) patients underwent either IVF or GIFT cycles. Total charges submitted were $176,636; the amount assigned to specialty care was $135,277, and to IVF/GIFT, $33,433. Total capitated payments, including copayments, was $126,256 under the reproductive medicine agreement and $32,891 under the infertility rider. This resulted in a 71% gross collections rate. CONCLUSION(S): This study indicates that entering into a capitated health care plan to provide an infertility benefit can produce a successful result.

Adolescent↗
PubMed2002

Differences between husbands' and wives' approach to infertility affect marital communication and adjustment.

OBJECTIVE: To test a theoretical model of the effect on marital communication and adjustment of men's and women's approach to infertility. DESIGN: A cross-sectional research design involving interviews, questionnaires, and a marital discussion task. SETTING: Volunteers from practices of fertility specialists. PATIENT(S): Forty-eight couples currently seeking infertility treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Quality of marital communication during a marital discussion task and effect of infertility on the marriage. RESULT(S): Having children was more important to wives than husbands; wives were more involved in trying to have a baby, wanted to talk with their partner more about trying to have a baby, and experienced a greater loss of self-esteem than did their husbands. To the extent that husbands saw having children as important, were involved in trying to have a baby, or wanted to talk with their wives about trying to have a baby, the quality of marital communication when discussing infertility was less negative, and in turn, wives perceived a more positive effect of infertility on their marriage. CONCLUSION(S): Increases in husbands' interest and involvement in fertility treatment may lead to positive changes in couple communication about infertility and to a more positive effect of infertility on the marriage.

Adaptation, Psychological↗
PubMed2002

Increased sperm nuclear DNA damage in normozoospermic infertile men: a prospective study.

OBJECTIVE: To evaluate levels of sperm nuclear DNA damage in infertile men with normal and abnormal standard semen parameters. DESIGN: Prospective study. SETTING: Male infertility clinic. PATIENT(S): Ninety-two men seeking infertility treatment and 16 fertile volunteers. INTERVENTION(S): Standard semen analysis was performed according to the World Health Organization guidelines. MAIN OUTCOME MEASURE(S): Sperm DNA damage was assessed by sperm chromatin structure assay and the results expressed as %DFI. RESULT(S): Of the 92 patients, 21 (23%) had normal standard sperm parameters (concentration, motility, and normal sperm forms), while 71 (77%) had an abnormality in one or more of these parameters. The %DFI [median (25th and 75th percentiles)] in infertile men with normal sperm parameters [23 (15, 32)] was significantly higher than fertile donors [15 (11, 20)] (P=.02), but not significantly different from infertile men with abnormal sperm parameters [28 (18, 41)] (P=.27). CONCLUSION(S): The results of this study indicate that a significant increase in SCSA-defined DNA damage can be found in sperm from infertile men with normal standard sperm parameters. Therefore, sperm DNA damage analysis may reveal a hidden abnormality of sperm DNA in infertile men classified as idiopathic based on apparently normal standard sperm parameters.

Cell Nucleus↗
PubMed2003

Elevated early follicular gonadotropin levels in women with unexplained infertility do not provide evidence for disordered gonadotropin-releasing hormone secretion as assessed by luteinizing hormone pulse characteristics.

OBJECTIVE: To determine whether women with rigorously defined unexplained infertility demonstrated altered GnRH secretion, as reflected by serum LH secretion patterns. DESIGN: Prospective observational study. SETTING: National Center for Infertility Research at Michigan. PATIENT(S): Nine women with rigorously defined unexplained infertility and 11 healthy, parous age-matched control women.Gonadotropin-releasing hormone (25 ng/kg) as a bolus injection. MAIN OUTCOME MEASURE(S): Daytime pulse patterns of LH secretion measured every 10 minutes; mean serum concentrations of LH, FSH, E(2), P, PRL, and cortisol; and response to a physiologic dose of GnRH in the early follicular, late follicular, mid-luteal, and late luteal phases of the same menstrual cycle. RESULT(S): Serum LH pulse frequency and pulse amplitude and LH secretion in response to a physiologic bolus of GnRH were not significantly different in unexplained infertility patients at any phase of the cycle. Luteinizing hormone pulse frequency and amplitude, as well as response to GnRH, varied significantly across the cycle. Mean early follicular serum LH and FSH concentrations were significantly higher in unexplained infertility patients than in fertile control subjects (LH: 5.31 +/-.51 vs. 4.03 +/-.33 [mIU/mL +/- SEM]; FSH: 5.81 +/-.63 vs. 3.80 +/-.45) but were not different at any other phase of the cycle. CONCLUSION(S): These data do not support the hypothesis that unexplained infertility is caused by an abnormality in pulsatile GnRH secretion or abnormal pituitary sensitivity to GnRH. However, the results are consistent with a difference in negative feedback from the ovary to the pituitary in unexplained infertility patients that is suggestive of diminished ovarian reserve.

Adult↗
PubMed1978

Endometritis and infertility.

Endometrial biopsy is an essential tool in the evaluation of the infertile couple. Among the various causes of infertility which may be elucidated by such a biopsy, endometritis plays a significant role. In this review endometritis has been subdivided into three distinct pathologic entities: acute, chronic, and fibrotic. Detailed histologic features are discussed separately for each of these varieties. Most of the acute inflammations of the endometrium are cauased by bacteria. They are usually of short duration, respond well to treatment, and only rarely are associated with long-standing infertility. Chronic endometritis, on the other hand, can be caused by a variety of agents such as bacteria, viruses, and parasites. However, in the majority of cases with chronic endometritis the etiology cannot be determined and these are then considered nonspecific. Tuberculous endometritis, which is discussed under the heading of chronic endometritis, constitutes a common cause of infertility in certain countries but much less so in the United States. Other less common conditions such as mycoplasma infection and cytomegalic virus infection, have also been associated with reproductive failure. However, chronic endometritis, especially the most common so-called nonspecific type, is a relatively uncommon cause of infertility. The syndrome of intrauterine adhesions or synechiae has been classified here as fibrotic endometritis because of the pathogenesis and histopathology of this lesion. This entity is commonly associated with infertility and may constitute the end result of a long-standing inflammatory process in the endometrium. The diagnosis of endometritis is not a simple one and necessitates close cooperation between the clinician and pathologist. Pertinent clinical and detailed histopathologic data have to be exchanged between the treating physician and pathologist, especially in cases of infertility, in order for the patient to have benefit from the examination of endometrial tissue obtained.

Acute Disease↗
PubMed1985

Peritoneal macrophages and infertility: the association between cell number and pelvic pathology.

Increased numbers of peritoneal macrophages have been repeatedly associated with infertility. Because the factors contributing to this intraperitoneal exudate are unknown, this study was carried out to determine which anatomic or endocrinologic abnormalities in infertile women might be associated with an increase in leukocyte numbers. The peritoneal fluid from 103 women was analyzed. Nonparametric data analysis demonstrated significantly greater cell counts in infertile women with endometriosis, compared with other infertile women (P less than 0.01) or fertile control subjects (P less than 0.005). Multiple regression analysis was then used to determine the relationship of individual variables to cell number without the influence of confounding factors. These data demonstrate that the best correlation with elevated macrophage number is in women who have infertility and no mechanical fertility factors (of which mild endometriosis is a subgroup). Thus, an increase in peritoneal macrophage number is not restricted to women with endometriosis but, rather, is seen in a subset of infertile women generally without mechanical or endocrinologic infertility factors.

Ascitic Fluid↗
PubMed1991

Guidelines for the provision of psychological evaluations for infertile patients at the University of Connecticut Health Center.

OBJECTIVE: Because of the psychologically demanding nature of infertility treatment, it has been recommended that psychological services be made available to infertile patients. However, no specific guidelines for the scope or usage of those services has been proposed. Our objective was to formulate guidelines to be used at our institution to provide psychological evaluations to infertility patients. DESIGN: The guidelines were formulated through discussions between the division psychologist and attendings and then presented to and modified by the University Ethics, Risk Management, Legal, and Institutional Review Board departments. SETTING: The University of Connecticut Health Center Division of Reproductive Endocrinology and Infertility provides tertiary level care to infertility patients. Services include assisted reproductive technologies and donor gamete programs. Surrogate parenting is not a provided service. RESULTS: Guidelines for the provision and use of psychological services for infertility patients were formulated. CONCLUSIONS: These guidelines are preliminary in nature and intended to provide a starting point for discussion among physicians, nurses, and mental health professionals regarding the psychological needs of infertility patients.

Culture↗
PubMed1992

Transvaginal peritoneal oocyte and sperm transfer for the treatment of nontubal infertility.

OBJECTIVE: To investigate if peritoneal oocyte and sperm transfer (POST) performed transvaginally is an effective treatment for nontubal infertility. DESIGN, SETTING, AND PATIENTS: Prospective study of 18 patients (4 with unexplained infertility, 13 with failed donor insemination, and 1 with male factor infertility) having 20 cycles of transvaginal POST in a specialist infertility unit. INTERVENTIONS: Ovarian stimulation was achieved with human menopausal gonadotropin (hMG) alone, hMG and clomiphene citrate, or gonadotropin-releasing hormone agonist with hMG. Oocyte recovery was performed transvaginally under ultrasound guidance, the pouch of Douglas rinsed repeatedly and an embryo transfer catheter used to transfer 4 x 10(6) progressively motile sperm in 1 mL and up to four oocytes into the pouch of Douglas. Luteal support was provided with human chorionic gonadotropin injections given 2 and 5 days later. RESULTS: The mean age of the patients was 32.65 +/- 5.0, and the mean length of infertility 5.07 +/- 2.32 years. The mean number of oocytes transferred was 3.53 +/- 0.87. Three pregnancies were achieved in the failed donor insemination group and 1 each in those with unexplained and male factor infertility, giving overall clinical pregnancy and live birth rates of 25% and 20% per initiated cycle. All pregnancies were achieved in those who had three or four oocytes transferred. CONCLUSION: Transvaginal POST is a useful assisted conception technique for the treatment of nontubal infertility.

Adult↗
PubMed1992

Defective function of a nongenomic progesterone receptor as a sole sperm anomaly in infertile patients.

OBJECTIVE: To compare the function of a novel nongenomic progesterone (P) receptor on the human sperm surface (mediating the P-induced acrosome reaction) in spermatozoa from fertile donors and from infertile patients. To examine the possible implication of defective P receptor function as an etiologic factor in unexplained male infertility. DESIGN: Progesterone binding and P effects were assessed in sperm from infertile patients and compared with corresponding parameters for sperm from healthy donors. SETTING: Private hospital, medical research center, and a university-based andrological laboratory. PATIENTS, PARTICIPANTS: Sperm samples were from infertile patients (no pathology detected in their wives) attending our infertility clinic and from healthy sperm donors. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Progesterone binding sites were visualized with a fluorescein-labeled protein-P conjugate. Indo 1-AM (a fluorescent indicator of intracellular free Ca2+) was used to measure P-induced Ca2+ influx. Progesterone-induced acrosome reaction was monitored after acrosomal staining with Pisum sativum agglutinin. RESULTS: Among 8 patient sperm samples with normal spermiogram values (of 53 examined), 5 showed a reduced percentage of P-binding spermatozoa and an abnormal response to the hormone in terms of Ca2+ influx and the acrosome reaction. CONCLUSIONS: Defective function of a sperm surface P receptor is described in some cases of male infertility. The observed fluorescence microscopic patterns of hormone binding may be used to further investigate receptor activity in unexplained male infertility.

Acrosome↗
PubMed1993

Infertility: a non-event transition.

OBJECTIVE: To determine the predictive validity of four transition variables and seven individual variables in differentiating between individual responses to infertility. DESIGN: Forty-three primary infertile women and 28 men attending a general infertility treatment clinic voluntarily agreed to participate in this cross-sectional study and completed five standardized instruments on a one-time-only basis. RESULTS: Adjustment to infertility was related to positive self-esteem, internal locus of control, higher socioeconomic status, and moderate age. High levels of anxiety and distress were related to low self-esteem, undifferentiated sex role identity, and advanced age. Actual and perceived duration of infertility were factors also related to participants' responses to infertility. CONCLUSION: Results highlight the importance of psychological assessment and continuing support in the management and treatment of infertility, with concerns being raised regarding the advisability of protracted medical intervention.

Adaptation, Psychological↗
PubMed1996

Ovulation induction, infertility, and ovarian cancer risk.

OBJECTIVE: To review critically the published data regarding the proposed association of ovulation induction, infertility, and an increased risk of ovarian cancer. DESIGN: A medline search was conducted to identify all case reports, epidemiologic studies, and clinical investigations containing data relevant to infertility, treatment of infertility, and the associated risk of ovarian cancer. Additional sources were obtained from reference lists of original research and review articles. Particular emphasis was placed on the most recently published reports examining these associations. RESULTS: Four case-control studies and three retrospective cohort studies, as well as a large meta-analysis of three additional case-control studies were identified as presenting the most pertinent clinical data. CONCLUSION: Currently available data in the literature suggest that an association between ovulation induction and ovarian cancer does not indicate necessarily a causal effect. Infertility alone is an independent risk factor for the development of ovarian cancer. Nulliparous women with refractory infertility may harbor a particularly high risk of ovarian cancer, irrespective of their use of fertility drugs. Furthermore, the apparent association between fertility drug use and ovarian cancer may arise because these women are the most likely to have used ovulation-stimulating agents as part of their infertility treatment. Close clinical surveillance of patients before, during, and after treatment of infertility is warranted.

Female↗
PubMed1987

Association of scrotal hyperthermia with impaired spermatogenesis in infertile men.

Scrotal temperatures, testicular volumes, and sperm characteristics were studied in 150 infertile, nonazoospermic men and in 37 fertile men, used as a control group. The mean scrotal temperature values of the infertile men were significantly greater than those observed in the fertile men (+0.4 degrees C for the right; +0.5 degrees C for the left). In the infertile men, it was found that the higher the scrotal temperature, the more alterated the sperm characteristics. The only clinical element that seemed to be linked to the existence of scrotal hyperthermia in the infertile men was testicular hypotrophy. Although the scrotal temperatures of the infertile men with varicocele were significantly higher than those of the fertile men, they did not significantly differ from those of the infertile men without varicocele. No other specific pathologic factor, infectious or surgical urogenital history was found to be responsible for the scrotal hyperthermia observed in the infertile men.

Body Temperature↗
PubMed1997

Importance of reactive oxygen species in the peritoneal fluid of women with endometriosis or idiopathic infertility.

OBJECTIVE: To determine whether reactive oxygen species in peritoneal fluid might be a factor in infertility. DESIGN: Prospective study. SETTING: Andrology laboratory and gynecology clinic at a tertiary care facility. PATIENT(S): Women with endometriosis (n = 15) or idiopathic infertility (n = 11) who underwent laparoscopy for infertility. Patients undergoing tubal ligation served as controls (n = 13). INTERVENTION(S): Aspiration of peritoneal fluid. MAIN OUTCOME MEASURE(S): Reactive oxygen species levels, presence of polymorphonuclear granulocytes, and leukocyte distribution in peritoneal fluid. RESULT(S): Reactive oxygen species were present in the peritoneal fluid of patients with endometriosis, idiopathic infertility, and tubal ligation. Levels of reactive oxygen species did not show a statistically significant difference between patients with endometriosis and the control group in either unprocessed or processed (cell-free) peritoneal fluid, but did differ significantly between patients with idiopathic infertility and controls in processed peritoneal fluid. Polymorphonuclear granulocytes (> 1 x 10(6)/mL) were not present in the peritoneal fluid of any patient. Macrophage concentrations of peritoneal fluid did not differ significantly between controls and patients with endometriosis or idiopathic infertility. CONCLUSION(S): Reactive oxygen species in the peritoneal fluid may not affect fertility directly in women with endometriosis; however, they may have a role in patients with idiopathic infertility.

Adult↗
PubMed1998

A new molecular variant of luteinizing hormone associated with female infertility.

OBJECTIVE: To investigate whether the newly described G1502 to A1502 mutation in exon 3 of the LH beta-subunit gene, causing the amino acid substitution of Ser102 for Gly102, is related to female infertility. DESIGN: Screening of fertile and infertile women for the G1502 to A1502 mutation in the LH beta-subunit gene. SETTING: Clinics and laboratories of the National University Hospital obstetrics and gynecology department, Singapore. PATIENT(S): Two hundred twelve healthy fertile women; 40 infertile women with menstrual disorders, polycystic ovary syndrome, and endometriosis; and 12 women with idiopathic infertility. INTERVENTION(S): Exon 3 of the LH beta-subunit gene was analyzed using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), and PCR-mediated direct DNA sequencing. MAIN OUTCOME MEASURE(S): The PCR products of patients were analyzed by RFLP, and the results were compared with those of fertile controls. DNA sequencing radiographs were compared between two mutation-bearing patients and four controls. RESULT(S): The mutation was identified in only two infertile women with endometriosis; other women studied were found to be negative for this mutation. CONCLUSION(S): The missense mutation in the LH beta-subunit gene may be implicated in female infertility, possibly endometriosis-associated infertility in some women.

Adult↗
PubMed1997

Endometrial pathology and infertility.

OBJECTIVE: To call attention to endometrial pathologies, which in addition to causing menstrual problems, are a cause of infertility. DESIGN: Controlled clinical study. SETTING: Specialized unit in the management of infertile patients. PATIENT(S): Fifteen infertile women between the ages of 26 and 39 years and suffering infertility from endometrial problems for a period of 4 to 18 years were included in the study. Six patients had primary infertility and nine others had secondary infertility. INTERVENTION(S): Once the endometrial pathology was diagnosed, treatment was initiated according to the type of problem: hysteroscopy, curettage, and hormonal replacement with or without corticoids or antiphymic drugs. MAIN OUTCOME MEASURE(S): Clinical studies, laboratory tests, hormonal serum levels, and endoscopy. RESULT(S): After initiating specific treatment for each of the pathologies, menstruation was re-established in 14 of 15 patients. Nine patients became pregnant (8 of 10 cases with bone, squamous cell, or muscular metaplasia). CONCLUSION(S): Pathological changes of the endometrium are causes of infertility. These problems are not as rare as thought. They must be searched for carefully and diagnosed promptly. The majority carry a good prognosis when adequately treated.

Adult↗
PubMed2001

Infertility in American college alumnae.

OBJECTIVE: The objective of this paper is to present data on prevalence of infertility, causes and treatments based on self-reports of a sample of American college alumnae. METHODS: A sample of 3940 American college alumnae, ages 37 to over 70 years, completed a self-administered questionnaire relating to infertility, its causes, treatment and treatment outcomes. RESULTS: Of the entire sample (n=3940), 3.1% (n=121) had primary infertility; 14.0% (n=548) had secondary infertility and were treated; 4.7% (n=184) tried for more than 1 year without success but had pregnancies without treatment; and 62.4% had no problems with infertility; and 16% (n=616) did not try to get pregnant. The major causes were 'unexplained infertility' reported by 43.5%; low sperm count or low motility, 21.4%; and anovulatory cycles, 20.3%. Treatment by clomid was reported by 39.5%. The overall success rate, resulting from treatment was 45%. The highest success rate occurred when anovulatory cycles were treated with clomid. CONCLUSION: Prevalence of primary and secondary infertility in this sample of American women is approximately 17%, similar to that observed for Sub-Saharan Africa.

Adult↗
PubMed2003

Factors influencing the quality of life of infertile women in United Arab Emirates.

OBJECTIVES: To measure the quality of life in a representative sample of infertile women and evaluate their sociocultural attitude to this condition. METHODS: Two hundred sixty-nine infertile women attending the Assisted Reproduction clinic, Tawam Hospital were consecutively selected. They were interviewed about the effect of infertility on their quality of life using a structured, measurement-specific and pre-tested questionnaire. RESULTS: Parameters mostly affected were mood-related mainly in women above 30 years, with primary and female factor infertility and those in polygamous marriages. Quality of life did not affect sexual performance and was not affected by duration of infertility or cost of treatment. CONCLUSION: The results highlight the importance of bearing children and the stresses exerted on infertile women in Eastern societies. Thorough counseling and continuing support of infertile women is therefore indicated to improve their quality of life.

Adolescent↗