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PubMedDate not supplied

Feeling normal. Women's experiences of menopause after infertility.

PURPOSE: To explore women's experiences of menopause after infertility. DESIGN: Grounded theory METHOD: Nine menopausal women, ranging in age from 48 to 72, with previous infertility, at various stages of the menopausal transition, including postmenopause, were interviewed in-depth. Three women had conceived a child after infertility treatment, three had adopted children, and three did not have children. The interviews were audiotaped and transcribed verbatim for data analysis. Data were constantly compared against other data, including previous transcripts, to look for evidence of data saturation. RESULTS: A core concept was generated, referred to as "finally feeling normal." After feeling abnormal during infertility, these women viewed menopause as a normal transition. They were able to reconcile some aspects of their infertility and embrace a feeling of normalcy. CLINICAL IMPLICATIONS: Menopause can be positive for women after infertility. Infertility contributed to a unique way of making meaning of menopause that was almost paradoxical: the notion that they can feel normal at the end of their "reproductive" years when they have struggled so long to actually be reproductive. Healthcare providers need to be cognizant of this possible response to menopause, and not automatically "pathologize" these women.

Adaptation, Psychological↗
PubMedDate not supplied

Is a history of depressive symptoms associated with an increased risk of infertility in women?

Researchers have reported an association between self-reported antidepressant use and increased risk of ovulatory infertility but could not control for confounding by the drug indication. We evaluated the role of depressive symptoms in the development of infertility. We recontacted a population-based sample of Pawtucket Heart Health Program (PHHP) health survey respondents to perform this case-control study. Self-reported infertility was defined as an inability to conceive after 12 months of unprotected intercourse. Controls were women who reported at least one pregnancy. The index age for infertile women was the age at which they first experienced fertility problems, and for the fertile women it was the age of their first pregnancy. History of depressive symptoms was based on self-report before the index age. Women with a history of depressive symptoms were nearly twice as likely to report infertility relative to women without a history of depressive symptoms before the index age after controlling for potential confounders (90% confidence interval: 0.9-3.2). Our data suggest that depressive symptoms as well as the drugs used to treat these conditions may play an important role in the pathogenesis of infertility. The association between depressive symptoms and infertility should be explored further.

Adolescent↗
PubMed1997

Occupational exposure to antineoplastic agents and self-reported infertility among nurses and pharmacists.

Although infertility has been identified as an effect of chemotherapy for some cancer patients, the association of infertility with occupational exposure has not been investigated. This case-control study investigated the relationship of infertility with occupational handling of chemotherapy drugs by nurses and pharmacy personnel. Data were gathered by questionnaire from 4659 staff at facilities participating in the National Surgical Adjuvant Breast and Bowel Project collaborative clinical trials network of the National Cancer Institute. The 405 subjects reporting infertility were each matched by sex and age with three control subjects and compared for history of chemotherapeutic drug handling. Results for the total sample and for women showed a significantly elevated odds ratio (OR = 1.5; CI = 1.1 to 2.0) for self-reported infertility associated with occupational handling of chemotherapeutic drugs prior to onset of infertility. For men, the odds ratio was similar but not statistically significant. This worker population, with a mean age of 37, is in the prime of reproductive life. Prevention of chemotherapy side effects by use of available protection is preferable to risking infertility.

Adult↗
PubMed2002

Potential association between male infertility and occupational psychological stress.

The purpose of this work was to investigate the influence of working conditions, occupational exposures to potential reproductive toxic agents, and psychological stress on male fertility. The study population consisted of 202 consecutive male patients attending a fertility clinic. Of those, 106 patients had attended the clinic because of a male infertility problem (case group), 66 patients had attended the clinic because of a female infertility problem (control group), and 30 patients had a combined infertility problem (male and female). Male infertility was associated with working in industry and construction as compared with other occupations (78.6% vs 58.3%, P = 0.044). Industry and construction workers were of lower educational level than the other workers (mean: 12.1 vs 13.4 years, P = 0.021). These patients also tended to smoke more than the other workers (OR = 2.53, 95% CI = 1.08 to 5.98), more often worked in shifts (OR = 3.12, 95% CI = 1.19 to 8.13), reported physical exertion in work (OR = 3.35, 95% CI = 1.44 to 7.80), and were more exposed to noise and welding (OR = 3.84, 95% CI = 1.63 to 9.14, OR = 4.40, 95% CI = 1.11 to 1.76, respectively). Male infertility (case group) was found to be statistically related to higher marks in all four measures of burnout as compared with the controls. The largest difference was obtained in the measure of cognitive weariness (mean: 2.9 vs 2.1, P < 0.001). In a multiple logistic regression analysis, industry and construction jobs (adjusted OR = 2.2, 95% CI 1.2 to 2.7) and cognitive weariness (adjusted OR = 1.8, 95% CI = 1.03 to 4.6) were found to be independent risk factors for male infertility problems. Male infertility was independently associated with industry and construction jobs as well as job burnout.

Adult↗
PubMed2002

Evaluations of emotional reactions and coping behaviors as well as correlated factors for infertile couples receiving assisted reproductive technologies.

The purpose of this research was to explore the following objectives for infertile couples receiving infertility treatment: Differences between wives and husbands in their emotional reactions and coping behaviors. This research, using structured questionnaires, was based on 120 infertile couples attending the Intrauterine Insemination (IUI) or the In Vitro Fertilization-Embryo Transfer (IVF-ET) program. The research instruments consisted of Demographic Data Form, Profile of Mood States (POMS), and Ways of Coping Questionnaire. The research results showed that infertile wives experienced more emotional disturbance than husbands did, as shown in the four subscales of Tension-Anxiety, Depression-Dejection, Anger-Hostility, and Fatigue-Inertia, as well as the total scale of POMS. It was also shown that wives adopted more coping behaviors to deal with infertility and treatment than husbands did, as revealed in the subscales of Self-Controlling, Seeking Social Support and Escape-Avoidance and the total scale of the Ways of Coping Questionnaire. All of the above reached significant statistical differences. The emotional reactions of infertile couples varied with the differences in education levels, duration of treatment, number of treatments received, and numbers of existing children. The emotional reactions of infertile husbands had a significantly positive correlation with the factors Confronting, Accepting Responsibility, and Escape-Avoidance. The emotional reactions of wives had a significantly negative correlation with Positive Reappraisal. The research results can provide clinical staff with a correct understanding of the differences between husbands and wives in emotional reactions and coping behavior, as well as related factors, to help them to provide better medical treatment.

Adaptation, Psychological↗
PubMed2003

Effects of using a nursing crisis intervention program on psychosocial responses and coping strategies of infertile women during in vitro fertilization.

Infertility and its treatment may cause life crises in infertile women. The purpose of this study is to evaluate the effects of a crisis intervention program on improving psychosocial responses and enhancing coping strategies for infertile women attending different stages of an In-Vitro Fertilization V Embryo Transfer (IVF-ET) treatment program. Using an experimental study design, infertile women attending an IVF-ET treatment program were randomly assigned to experimental and control groups. In the experimental group, infertile women completed and answered a questionnaire and received nursing crisis intervention at the initial stage of treatment (day 3). This included (1). viewing a video explaining the therapeutic process of IVF-ET, (2). self-hypnosis and muscle relaxation training, and (3). provision of cognitive-behavioral counseling. The same questionnaire was used again for subjects at the stage of embryo transfer and before taking a pregnancy test. The women in the control group were only interviewed using the same questionnaire and at the same times as the experimental group. Analysis by repeated measurement ANOVA demonstrated that there was a reduction in psychosocial response in terms of interpersonal relationships, and there was an interaction between intervention effects and stage of treatment. However, there was no statistically significant difference in the level of psychosocial responses between the experimental and control groups although some meaningful findings were made. However, in terms of state of anxiety, confrontational problems, and isolated mind/body relaxation, there were significant differences between the two groups of infertile women at some stages of IVF-ET treatment. The women in the experimental group perceived a positive effect of the nursing intervention in relieving their psychosocial responses. The results of this nursing crisis intervention could be helpful in nursing practice when dealing with infertile women attending IVF treatment programs.

Adaptation, Psychological↗
PubMed2005

Erectile dysfunction and andropause symptoms in infertile men.

PURPOSE: We evaluated the prevalence of andropause symptoms and erectile dysfunction in our infertile population. MATERIALS AND METHODS: A total of 302 consecutive men presenting for infertility evaluation and 60 consecutive men with proven fertility seeking vasectomy (controls) were administered the Androgen Deficiency in the Aging Male and Sexual Health Inventory for Men (SHIM) questionnaires. Information regarding other clinical parameters, including seminal parameters, was collected by review of patient charts. RESULTS: Of the 302 infertile men screened, 38% reported significant andropause symptoms and 28% had abnormal SHIM scores. Of the subgroup of infertile men with nonobstructive azoospermia, 25% reported andropause symptoms and 27% had an abnormal SHIM score. In the fertile group 21% reported andropause symptoms and only 11% had an abnormal SHIM score. The prevalence of erectile dysfunction in infertile men was significantly higher than in the fertile controls (p = 0.007). CONCLUSIONS: Andropause symptoms and erectile dysfunction are common among infertile men, affecting approximately 38% of this population. This finding suggests that the population of infertile men should be carefully screened to identify and treat those with erectile dysfunction.

Adult↗
PubMed1988

Male factors and the likelihood of pregnancy in infertile couples. II. Study of clinical characteristics--practical consequences.

A prospective study of 394 infertile men was conducted over 3 years following a primary semen analysis. Simple comparisons between the groups of men whose partners conceived and those that did not, showed that the mean duration of infertility in the primary infertile group was significantly shorter when a pregnancy was observed, while age differed significantly between the two populations in the secondary infertile group. Multivariate analyses, taking these variables and sperm characteristics into account, showed that prognostic variables for the occurrence of pregnancy were the duration of infertility, sperm motility and the multiple anomalies index in the primary infertile group, and age of the male partner and percentage of normal sperm in the secondary infertile group. Tables for estimating the probability of observing a pregnancy as a function of these criteria are presented. In this study no positive influence of treatment on the occurrence of a pregnancy was found during the 3 years following the first semen analysis.

Age Factors↗
PubMed1996

Reproductive parameters of older compared to younger men of infertile couples.

In order to evaluate possible age-dependent influences on male infertility, semen parameters, sex hormone levels and pregnancy rates were compared retrospectively in three groups of men attending our fertility clinic: group A: 39 patients > 50 years. Group B (39 patients < 30 years) was established as the 'standard infertile patient' seen in our Institute. These patients were matched with patients of group A according to the year of their first visit to the clinic. Group C: 39 young patients (< 30 years) who were selected on the basis of their wives' advanced age. The frequency of sexual intercourse in group A was significantly lower compared to group C. The period of sexual abstinence was longer in group A than in group B. Ejaculate volume and sperm motility in group A were lower compared to groups B and C. The differences in other semen parameters were only minor. The differences in serum levels of testosterone and FSH were significant between group A and groups B and C. Pregnancies were reported in 6 of 26 couples from group A (duration of infertility: mean 79 months, range 16-187), in 17 of 28 couples from group B (duration of infertility; mean 54 months, range 16-104) and in nine of 30 couples from group C (duration of infertility; mean 66 months, range 25-125). Since the infertility pattern of the older patients desiring offspring was not significantly different from that of younger patients, it is concluded that the age of the female partner, rather than the age of the husband, is most important in determining the fertility chances of couples presenting with infertility.

Adult↗
PubMed1996

Couples' experiences of infertility: a phenomenological study.

If nurses are to work effectively with families in contemporary society, their practice activities must be appropriately informed. Families exposed to new technologies, such as in vitro fertilization (IVF) require care that is sensitive to their particular experience. Infertile couples have been the subject of a substantial body of research, however, most studies to date focus on the physiological effects of infertility and do not take into account the context in which the experience takes place, or the meanings that people assign to this experience. The purpose of this study was to examine in-depth the experience of couples undergoing IVF treatment for infertility. A phenomenological approach was adopted for the study. A purposive sample of six couples was selected for interview. Data were generated from taped interviews and the researcher's observational field notes. Data analysis was in accordance with the procedure outlined by Colaizzi (1978). Interview responses were categorized by examining the participants' transcripts and identifying significant statements and meanings. Themes which emerged from the statements were then identified, and cross-case comparisons were made to confirm or modify these themes. Four key themes emerged from the data: life changes; powerlessness; hope-disappointment cycle; and social isolation. All couples undergoing infertility treatment experienced life changes which included: lifestyle changes, various physical and emotional changes, and changes in their relationships. There was a perceived loss of control over many aspects of their lives. Couples also described a cycle, alternating feelings of hope and disappointment. Most of the couples reported feelings of social isolation associated with being infertile, that were intensified by having to deal with the inappropriate responses of others. Findings from this study will add to the knowledge base on infertility, and contribute to recommendations for improving the way nurses guide, counsel, and support infertile couples.

Adult↗
PubMed1997

The immunotherapy during in vitro fertilization and embryo transfer cycles in infertile patients with endometriosis.

OBJECTIVE: To investigate if the immunotherapy with corticosteroids would improve the pregnancy rate in infertile patients with endometriosis who undergo in vitro fertilization and embryo transfer (IVF-ET). METHODS: Forty-two infertile patients with endometriosis plus tubal factor and 87 pure tubal infertility patients who underwent IVF-ET in our unit were allocated randomly to the corticosteroid treatment group and the control group. RESULTS: The prevalence of autoantibodies (antinuclear antibody, lupus anticoagulant, anticardiolipin antibody, rheumatoid factor) was elevated significantly in patients with endometriosis plus tubal factor compared with pure tubal infertility patients (38.1% vs 2.3%). Twenty-one patients with endometriosis plus tubal factor underwent 54 cycles of IVF-ET, receiving corticosteroids. Forty-three patients with pure tubal factor underwent 81 cycles of IVF-ET, receiving corticosteroids. Twenty-one patients with endometriosis plus tubal factor who underwent 57 cycles of IVF-ET and 44 patients with pure tubal factor who underwent 84 cycles of IVF-ET served as controls, not receiving corticosteroids. In patients with endometriosis plus tubal factor, there was a significantly higher clinical pregnancy rate per cycle in the treatment group, with 42.6% (23/54) compared with 22.8% (13/57) in the control group but no differences between 2 groups in spontaneous abortion rate (21.7% vs 15.4%) and multiple pregnancy rate (17.4% vs 15.4%). In patients with pure tubal infertility, there were no significant differences between the treatment group and control group in clinical pregnancy rate (40.7% vs 34.5%), spontaneous abortion rate (12.1% vs 10.3%) or multiple pregnancy rate (18.2% vs 10.3%). In the endometriosis plus tubal infertility group with autoantibodies, the clinical pregnancy rate per cycle was significantly higher in the treatment group at 40.9% compared with 14.8% in the control group. In endometriosis plus tubal infertility group without autoantibodies, there was no significant difference between 2 groups with respect to the clinical pregnancy rate per cycle (43.8% vs 30.0%). CONCLUSIONS: This study suggests that immunotherapy with corticosteroids could improve the clinical pregnancy rate in endometriosis patients undergoing IVF-ET and may be more effective in patients with positive autoantibodies.

Adrenal Cortex Hormones↗
PubMedDate not supplied

The long-term psychosocial effects of infertility.

OBJECTIVE: To explore the psychosocial effects of infertility and the role that social support plays over time. The major hypothesis was that although infertile persons report less contentment, lower levels of marital and sexual satisfaction, and lower self-esteem over time, those with higher levels of social support will be less affected. DESIGN/SETTING: Four questionnaires were completed in subjects' own homes, one every 9 months. PARTICIPANTS: Subjects, all of whom perceived themselves as infertile, were recruited through the national newsletter for an infertility support group. Ninety-four subjects entered the study, and 41% of the sample completed it. MAIN OUTCOME MEASURES: Contentment, marital satisfaction, sexual satisfaction, self-esteem, sex-role identity, press (the measure of perceived internal and external pressures), and social support. RESULTS: Perceived support (F[3, 111] = 4.77, p < 0.004), as well as contentment and self-esteem, significantly increased over time (F[3, 111] = 12.03, p < 0.0001, and F[3, 111] = 5.378, p < 0.002, respectively). Social support was positively correlated with all dependent measures. CONCLUSIONS: Contrary to what was hypothesized, infertile persons experienced increased social support and greater contentment over time. As hypothesized, there was a significant positive relationship between social support and all dependent measures. The positive impact of social support, counseling, and the adoption of strategies to deal with the stress of infertility lends credence to the crucial role nurses can play in helping infertile couples cope.

Adaptation, Psychological↗
PubMedDate not supplied

Association between infertility and spontaneous abortion.

Women experiencing recurrent spontaneous abortion have a higher frequency of infertility than that expected in the general population. To further define the relationships between infertility and spontaneous abortion, the obstetrical histories of 43 women with unexplained secondary infertility were evaluated for the frequency of spontaneous abortion. Of the 88 pregnancies studied, 39 (44%) resulted in spontaneous abortion. Women with unexplained secondary infertility experienced a three-fold increase (P less than 0.0001) in the frequency of spontaneous abortions and half the number of live births (P less than 0.0001) compared with the general population. We conclude that the association between infertility and spontaneous abortion includes a higher frequency of spontaneous abortion among infertile couples as well as a higher prevalence of infertility among recurrent spontaneous aborters compared with the general population.

Abortion, Habitual↗
PubMedDate not supplied

Evaluation of immunological infertility.

To evaluate the frequency with which immunological factors are associated with infertility, 92 couples with unexplained infertility were studied by using assays to detect anti-sperm antibodies (ASA), human leukocyte antigen tissue types (HLA), lymphocytotoxic antibodies (LCA), and inhibitors of mixed lymphocyte culture (MLC) and mouse blastocyst assay (MBA). Seventy-three of the women had blood assayed for antiphospholipid antibodies (APA). The frequencies of APA, ASA, LCA, inhibitors of MLC and MBA, as well as HLA associations previously reported to be related to infertility (B locus blanks, single DQ locus in offspring, greater than 1 DR sharing between mates) among 92 infertile couples were compared with those observed among 41 fertile control couples. No significant differences in the frequencies of APA, ASA, MBA, and HLA associations between fertile and infertile couples were observed. Fertile couples demonstrated the presence of wife anti-husband LCA and MLC inhibitors more frequently than did infertile couples (51% vs. 8%, P = 0.0001 and 29% vs. 4%, P = 0.002, respectively). While APA, ASA, HLA tissue typing, LCA, and MLC and MBA have been previously reported as being markers of autoimmune and alloimmune responses relating to reproductive outcome, the current data suggest that more specific markers are necessary to diagnose immunological components of infertility.

Adult↗
PubMed1996

Infertility and coeliac disease.

BACKGROUND: Coeliac women may suffer from gynaecological and obstetric complications. It is possible that these complications are the first symptom of coeliac disease. AIMS: To investigate the occurrence of subclinical coeliac disease in patients with infertility or recurrent miscarriages. SUBJECTS: Women of reproductive age who were attending the hospital because of either primary or secondary infertility, or two or more miscarriages. Women undergoing sterilisation served as control subjects. METHODS: The diagnostic investigation for infertility included the endocrine status, diagnostic laparoscopy, investigation of tubal patency, postcoital test, and semen analysis of the partner. Circulating antibodies against IgA class reticulin and gliadin were used in screening for coeliac disease. In positive cases, the diagnosis was confirmed by small bowel biopsy specimens. RESULTS: Four (2.7%) of 150 women in the infertility group, and none of the 150 control subjects were found to have coeliac disease (p = 0.06). All four women with coeliac disease suffered from infertility of unexplained origin. Altogether 98 women had no discoverable reason for infertility. Thus, in this subgroup the frequency of coeliac disease was 4.1% (four of 98), the difference from the control group being statistically significant (p = 0.02). None of the coeliac women had extensive malabsorption, but two had iron deficiency anaemia. One women with coeliac disease has had a normal delivery. None of the 50 women with miscarriage had coeliac disease. CONCLUSION: Patients having fertility problems may have subclinical coeliac disease, which can be detected by serological screening tests. Silent coeliac disease should be considered in the case of women with unexplained infertility.

Abortion, Habitual↗
PubMed1994

Primary infertility: characteristics of women in North America according to pathological findings.

STUDY OBJECTIVE: To determine, in women with primary infertility, whether specific characteristics or behavioural factors are associated with the various pathological conditions identified as contributing to the infertility. DESIGN: Case-control study. SETTING: Seven institutions in the USA or Canada. PARTICIPANTS: Study subjects were 1750 women who presented with primary infertility, among whom the main pathological cause of infertility was male factor (417), tubal obstruction (231), endometriosis (194), luteal phase defects (153), other ovulatory problems (193), cervical abnormalities (92), and polycystic ovarian disease (84) and 1765 control women who delivered their first child at the same institution. MAIN RESULTS: Except for tubal obstruction and polycystic ovarian disease, the characteristics and behaviours of the women with infertility did not differ appreciably according to the pathological conditions recorded. Women with tubal obstruction had had more sexual partners, an earlier age at first intercourse, were more likely to have used an intrauterine device but less likely to have used a condom, and were more likely to have smoked cigarettes and to have used various recreational drugs than the other women. Women with polycystic ovarian disease were more obese, had had fewer sexual partners, and were less likely to have used cigarettes, contraceptives, and recreational drugs than the other women. CONCLUSIONS: Sexually transmitted infections seem to increase the risk of tubal obstruction but not other causes of infertility. Obesity is associated with polycystic ovarian disease. These data offer few clues to the aetiology of infertility attributed to endometriosis, cervical abnormalities, luteal phase defects, other ovulatory defects, or to male factors.

Age Factors↗
PubMed2005

An SNP in protamine 1: a possible genetic cause of male infertility?

Gene targeting of the sperm nuclear proteins, the protamines, in mice leads to haploinsufficiency, abnormal chromatin compaction, sperm DNA damage, and male infertility. In order to investigate whether changes in amount or structure of the protamines could be a cause of human infertility, we sequenced the protamine genes of infertile men whose sperm appeared phenotypically similar to those of protamine deficient mice. We identified a heterozygous single nucleotide polymorphism (SNP) in the protamine (PRM1) gene in three infertile men (10% of the total infertile men analysed). This SNP disrupts one of the highly conserved arginine clusters needed for normal DNA binding. To rapidly screen for this SNP in infertile patients, we developed a simple PCR restriction fragment length polymorphism assay. This is the first report of a SNP in the PRM1 gene that appears associated with human male infertility.

Amino Acid Sequence↗
PubMed2000

Incidence of chromosome 8,10,X and Y aneuploidies in sperm nucleus of infertile men detected by FISH.

We studied the frequency of aneuploidy in sperm nuclei of six infertile men with abnormal semen profile and normal karyotype, using fluorescence in situ hybridization (FISH) with DNA probes for chromosomes 8, 10, X and Y. The control group consisted of four healthy fertile men with normal karyotype and semen profiles. The purpose of this study was to determine whether there are differences between infertile male donors and control donors for: (1) the incidence of sex chromosome aneuploidy, and (2) the number of disomies for chromosomes 8, and 10 cosegregating with chromosomes X and Y. FISH analysis showed no significant differences of sex ratios of the sperm nuclei in and between infertile and control groups. The most significant abnormalities in the infertile group were clusters of sperm nuclei bearing XY and XYY. In addition, the incidence of disomic sperm nuclei for chromosomes 8 and 10 consegregating with sex chromosomes was not significantly different between the patient and control groups, nor within them. However, the total frequency of aneuploid sperm nuclei was significantly different between the infertile group and the control group. We observed a significant excess of sperm nuclei bearing chromosome 10 along with disomy for chromosome Y (10YY). In conclusion, our results from FISH analysis demonstrate a significantly increased frequency of aneuploidy for the sex chromosomes in sperm nuclei from infertile men. Therefore it may be concluded that infertility is a risk factor for sex chromosome aneuploidy in sperm nuclei.

Adult↗