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PubMed1997

Y-chromosome microdeletions and male infertility.

A genetic basis of infertility may exist in many men currently classified as having idiopathic infertility. Approximately 7% of infertile men harbour submicroscopic deletions of the Y chromosome that are not detectable on routine karyotype. Two candidate gene families, namely the RNA-binding motif-containing gene family, and the deleted-in-azoospermia gene family, have been cloned by deletion mapping of infertile men with Y microdeletions and proposed as candidates for the putative azoospermia factor. The precise function of these two gene families remains unclear. It is likely that additional Y-specific and autosomal genes will be implicated in other subsets of male infertility. Recognition of the association of Y deletions and other genetic defects with male infertility has implications for the diagnosis, treatment, and genetic counselling of infertile men, particularly those who are being considered for intracytoplasmic sperm injection.

Chromosome Deletion↗
PubMed2000

Evaluation and management of infertility in women: the internists' role.

Interventions for infertility have greatly increased in number and sophistication. Women with multiple medical problems and women near or beyond menopause are now able to conceive. The internist will be called on to assess the risk that infertility interventions pose and to counsel patients accordingly. Knowledge of the medical illnesses associated with infertility, the types of infertility treatments available, and the medical complications of these interventions are required to properly assess this risk. Medical complications of infertility interventions can be direct effects of related drugs and technologies and indirect consequences of the induced pregnancy, multiple gestation, or associated medical conditions. This article reviews the definitions and scope of infertility, the interventions used for treatment of infertility, the medical complications of these interventions, the potential risks of fertility treatment in women unable to conceive spontaneously, and important issues for preconception counseling.

Counseling↗
PubMedDate not supplied

Modulation of insulin-like growth factor-1 in the seminal plasma of infertile men.

It has been suggested that insulin-like growth factor (IGF)-1 plays an important role in the regulation of spermatogenesis in the testes. In the present study, concentrations of total IGF-1 were determined in the seminal plasma of fertile (n = 44), male-factor infertile (n = 34), and immunoinfertile (n = 10) men in order to investigate the role of IGF-1 in male infertility. Levels of IGF-1 were expressed both as nanograms per milliliter and as nanograms per milligram of protein. IGF-1 was detected in the seminal plasma of both fertile and infertile men. IGF-1 levels differed significantly between fertile and immunoinfertile groups (P < 0.035 to P < 0.0001), whether expressed as nanograms per milliliter or as nanograms per milligram of protein. The immunoinfertile group showed a 31.3-37.9% increase in the mean IGF-1 concentration over the fertile group. There was no statistical difference in the mean or median levels of IGF-1 between the fertile and male-factor infertile groups, whether expressed as nanograms per milliliter or as nanograms per milligram of protein. However, when the male-factor infertile subjects were divided into four subgroups based on which seminal parameter was defective, the subgroup having a low sperm count had IGF-1 levels that were significantly different from the fertile group, the immunoinfertile subgroup, and the other male-factor infertile subgroups. The low-sperm-count subgroup had the lowest mean and median IGF-1 levels of all the groups and subgroups tested. IGF-1 levels linearly correlated (r = 0.30-0.499) significantly (P = 0.023-0.027) with the total sperm count in the semen, whether analyzed with all groups together or in subgroups by condition. These findings suggest that IGF-1 has a role in fertility and that its derangement may be involved in male infertility, especially when mediated through low sperm count and immunologic factors.

Enzyme-Linked Immunosorbent Assay↗
PubMed1999

Screening for hypothyroidism in infertile women.

OBJECTIVE: To determine the frequency of an elevated thyroid-stimulating hormone (TSH) level in 704 patients seeking treatment for infertility. STUDY DESIGN: Sera from 704 women evaluated for infertility were assayed for TSH levels using radioimmunoassay (normal, 0.45-4.09 mIU/mL). All women had at least one year of infertility. Women with a known history of thyroid disease were excluded from the review. RESULTS: Sixteen of 704 patients (2.3%) had elevated TSH levels and were treated with levothyroxine to normalize TSH. None of these women had overt clinical signs or symptoms of hypothyroidism. Of these women, 11 of 16, or 69%, had ovulatory dysfunction, and 7 (64%) later became pregnant while on thyroid replacement. Five of 704 (0.7%) women with infertility who presented without a history of ovulatory dysfunction had elevated TSH levels, and none became pregnant with treatment. CONCLUSION: The prevalence of elevated TSH in 704 women with at least one year of infertility was 2.3%. The majority of women diagnosed with hypothyroidism (11 of 16, or 69%) had ovulatory dysfunction. With treatment for hypothyroidism, successful pregnancies resulted in 7 of 11 (64%) of patients. Women with infertility and ovulatory dysfunction should be screened for hypothyroidism. Screening for hypothyroidism as part of a routine infertility workup in women with normal ovulatory function will yield few abnormal tests.

Adolescent↗
PubMed1999

DNA strand breaks in human spermatozoa: a possible factor, to be considered in couples suffering from unexplained infertility.

BACKGROUND: The aim of this study was to assess the presence of DNA strand breaks and sperm cell morphology in men suffering from unexplained infertility, and to compare these results with normal fertile and oligozoospermic men. METHODS: One fresh sperm sample from proven fertile sperm donors (n=20) and from infertile men with oligozoospermia, (<20 x 10(6)/ml sperm cells) (n=74), and men suffering from unexplained infertility (>20 x 10(6)/ml sperm cells) (n=39) who delivered two sperm samples with 24 hours interval, were tested for the presence of DNA strand breaks in the spermatozoa by direct immunoperoxidase detection of digoxigenin-labeled genomic DNA. Correlations to other sperm parameters, sperm cell counts, motility, activation and Krüger's strict criteria were performed. RESULTS: DNA strand breaks in sperm cell nuclei were found significantly more often in sperm samples from men suffering from unexplained infertility compared to those from normal fertile men, and significantly more rarely compared with sperm samples from men with oligozoospermia. The percentages of normal spermatozoa (Krüger's strict criteria) were significantly lower in samples from men suffering from unexplained infertility compared to those of normal fertile men, but significantly higher compared to those of men with oligozoospermia. No difference was found between first and second day samples used for insemination, as regards DNA strand breaks, sperm cell morphology, total number of motile sperm cells, activation and motility degree. CONCLUSION: The present data suggest that a subgroup of men suffering from unexplained infertility have DNA strand breaks in their sperm cell DNA. This group might suffer from the same malfunction as many men with oligozoospermia, however, their apoptotic activated sites in the testis are different. Delivery of sperm samples with 24 hours interval does not affect any sperm cell counts, CASA, DNA strand breaks or morphology findings in sperm samples from men suffering from unexplained infertility.

Apoptosis↗
PubMed1999

Relationship between unexplained infertility and human leukocyte antigens and expression of circulating autogeneic and allogeneic antisperm antibodies.

PURPOSE: The association between unexplained infertility, human leukocyte antigens (HLA) and expression of circulating antisperm antibodies was studied in 52 couples with unexplained infertility and 15 infertile and 9 fertile couples. METHODOLOGY: Evaluation parameters included Terasaki's HLA microlymphocytotoxicity test, circulating antisperm antibodies using immunofluorescence technique. RESULTS: Fifty-two couples (8.7%) out of 600 consecutive clinic attendants had unexplained infertility. Unexplained infertility was associated with circulating antisperm antibodies (22 versus 13 and 0% for men and 18.5 versus 13 and 0% for women). HLA class 1 B6 and B52 and Cw7 and HLA class 2 DR4 and DR6 and sharing of HLA B6, DR4 and DR6 were found more in couples with unexplained infertility. Combined expression of antisperm antibodies by couples, demonstrated more homozygosity for HLA B6 and DR4. CONCLUSION: Homozygosity for these antigens, B6, DR4 and DR6, may enhance the expression of antisperm antibodies, and cause infertility.

Antibodies↗
PubMed2000

[Causes of male infertility. The contribution of the endocrine factor].

BACKGROUND: Male infertility is responsible for 35% of infertile couples. AIM: To investigate the causes of male infertility and the relative importance of endocrine factors. PATIENTS AND METHODS: Patients referred to an andrology clinic due to an abnormal spermiogram were studied. A testicular examination, spermiogram and determination of FSH, LH, testosterone and prolactin were done to all. Testicular biopsy was done to patients with severe oligospermia or azoospermia. Causes of infertility were defined and classified as pretesticular, testicular, posttesticular or unclassified. RESULTS: Two hundred fifty seven males were studied. In 3.5% of them, the cause of infertility was defined as pretesticular (that included hypothalamic and pituitary endocrine causes), in 66.9% it was classified as testicular, in 15.6% as posttesticular and in 14%, as unclassified. Thirty percent of infertility cases were idiopathic, 17.9% were associated to varicocele, 12.8% were associated to cryptorchidism, 8.9% to Klinefelter syndrome and 6.6% to exposure to toxic substances. In 50% of patients with cryptorchidism, this abnormality was found during the specialized andrological examination and referrals for surgical correction were made late. Two thirds of patients with Klinefelter syndrome were hypoandrogenic. CONCLUSIONS: Causes for male infertility should be investigated and diagnosed accurately. Primary hypoandrogenic testicular failures must be treated with hormone replacement therapy.

Adolescent↗
PubMed2000

[Antiphospholipid autoantibodies in women treated for infertility].

OBJECTIVE: To evaluate an occurrence of selected antiphospholipid antibodies (APL) in infertility women. STUDY DESIGN: An enzyme-linked immunoabsorbent assay (ELISA) has been used to determine a titre of anticardiolipin antibodies (ACA). APTT (activated partial thromboplastin time) and PT (prothrombin time) measurements and direct commercial assay have been also used to study occurrence of LAC (lupus anticoagulant antibodies). The group of 268 observed women has been divided into five subgroups according to the cause of infertility: I-endometriosis, II-tubal occlusion caused by others diseases than endometriosis, III-occurrence of antisperm antibodies (ASA), IV-polycystic ovariorum syndrome (PCOS) and V-unexplained etiology. Results have been compared to 44 healthy controls. RESULTS: Occurrence of ACA has been found statistically more often in patients suffering from infertility than in controls (17.9% vs 4.5%, p < 0.05). Moreover ACA have been statistically more often observed in patients with endometriosis (21 from 44, 47.7%). ACA were more common in patients with other cause of infertility (except PCOS) compared to controls, though statistically this was not significant. Frequency of ACA was also more common than LAC (17.9% vs 13.6%). Compared to controls LAC tests were more often positive in infertile women with endometriosis (I), tubal occlusion (II) and with the occurrence of antisperm antibodies (III) but results were not statistically significant. CONCLUSIONS: Antiphospholipid antibodies are observed more often in patients suffering from infertility compared to women with a regular fertility. This suggests a role of APL in etiology of infertility. The occurrence of anticardiolipin antibodies in almost every second woman suffering from endometriosis suggests existing of autoimmunologic disturbances in this disease.

Adult↗
PubMed2000

[Glutathione peroxidase concentration in the peritoneal fluid from infertile women].

OBJECTIVES: To assess the concentration of Plasma Glutathione Peroxidase (plGPx) in the peritoneal fluid (PF) of patients with unexplained infertility and infertile women with minimal and mild endometriosis. MATERIALS AND METHODS: 33 women were studied, including 8 infertile women with minimal or mild endometriosis, 15 patients with unexplained infertility and 10 patients with tubal occlusion (a reference group). Concentration of plGPx was measured in the PF using a commercially available ELISA kit (Oxis Inc.). RESULTS: The plGPx concentration was significantly (p = 0.04) lower in PF from women with unexplained infertility (846 +/- 177 ng/ml) compared to the reference group (1023 +/- 238 ng/ml), but did not differ significantly (p = 0.25) between women with endometriosis (918 +/- 81 ng/ml) and patients with tubal infertility. CONCLUSIONS: Our results suggest that low peritoneal plGPx concentration may play a role in the pathogenesis of infertility.

Adult↗
PubMed2000

Infertility treatment by in vitro fertilization in patients with minimal or mild endometriosis.

PURPOSE: To estimate the clinical effectiveness of in vitro fertilization treatment in patients with minimal or mild endometriosis (stages I and II) in comparison to the patients with tubal infertility in terms of fertilization, pregnancy and livebirth rates. METHODS: Retrospective analysis of the outcome of IVF-ET in 612 cycles of the patients with endometriosis (389 stimulated with HMG/HCG and 223 co-treated with GnRH-a) and in 7,339 cycles of the patients with tubal infertility (5,520 stimulated with HMG/HCG and 1,819 co-treated with GnRH-a). RESULLTS: Regardless of the type of ovarian stimulation, the fertilization rate per treated cycle was practically the same in both groups (endometriosis 81.4% vs tubal infertility 84.2%; p = 0.07). However, in the endometriosis group the pregnancy rate was higher (25.3% vs 18.9%; p = 0.000), and so was the livebirth rate (19.0% vs 14.2%; p = 0.003). Considering the type of ovarian stimulation, the fertilization rate in the endometriosis group was almost the same in the HMG/HCG (81.2%) and in the GnRH-a co-treated cycles (81.6%), and did not differ from that in the tubal infertility group (83.6% in the HMG/HCG vs 85.9% in the GnRH-a cycles). In the GnRH-a co-treated cycles the pregnancy rate and the livebirth rate were not significantly higher in the endometriosis group than in the tubal infertility group (27% and 20.2% vs 22.2% and 17.5%). In the HMG/HCG stimulated cycles the pregnancy rate was significantly higher in the endometriosis than in the tubal infertility group (24.3% vs 17.7%; p = 0.004), and so was the livebirth rate (18.4% vs 13.0%; p = 0.008). CONCLUSION: In patients with minimal or mild endometriosis the IVF-ET procedure is at least as effective as in patients with tubal infertility.

Adult↗
PubMed2001

Idiopathic infertility in married couples in the light of cytogenetic analysis and sperm penetration assay.

We have selected 47 couples with unexplained infertility in order to analyse a possible link between sperm dysfunction studied in males in in vitro conditions and karyotype analysis of somatic cells. In order to identify so called "idiopathically infertile" couples we had to exclude any change in reproductive organs in both partners or in spermiogram which would qualify any of spouses into known category of infertility. We have revealed chromosome aberrations (translocations and marker chromosomes) in 19% of infertile males and in 6% of infertile females. Idiopathically infertile males had an overall decreased ability of sperm function (measured by proportion of penetrated hamster oocytes by human sperm) in comparison to fertile controls, however, still well placed within physiological range of values. Only sperm from a patient with identified translocation was clearly below the normal level of penetration (20% of penetrated oocytes), however, also the patients with revealed chromosome variant polymorphisms presented statistically lower values of penetration in comparison to fertile controls (39% vs 57%, p<0.05). On the contrary, patients with marker chromosomes did not exhibit affected sperm function. It can be speculated that only particular chromosome aberration in group of idiopathically infertile males may affect sperm functional capability (measured in vitro), however, the intragonadal genetic analysis has to be recommended in order to confirm such a causative link.

Adult↗
PubMed2001

[Comparison of seminal vitamin B12, folate, reactive oxygen species and various sperm parameters between fertile and infertile males].

Vitamin B12(VB12), folate and reactive oxygen species(ROS) in human semen from both fertile and infertile males, and their relationships with other parameters were observed. Semen samples from 44 infertile and 176 fentile control subjects were collected and measured based on the guidelines issued by WHO. The results showed that no significant differences on semen VB12 and folate were observed between fertile and infertile groups(P > 0.05). However, the levels of ROS in infertile group were significantly higher than those in fertile group(P < 0.01). The morphological defects and low motility of sperm in infertile group was significantly higher than those in fertile group(P < 0.01). A positive relation was observed between the levels of ROS production and the morphological defect of sperm(P < 0.01). There was a significant negative correlation between the levels of VB12, folate and ROS(P < 0.01) in semen. It is interesting to note that the values of ROS also show a significantly positive correlation with sperm motility (P < 0.01). A significant differences of ROS levels between fertile and infertile group with negative white blood cells in sperm was also observed. It is concluded that the increase of ROS on the morphological defect of sperm is one of the most important factors related to poor sperm quality and human infertility.

Adult↗
PubMed2001

Significant medical pathology discovered during a male infertility evaluation.

PURPOSE: Because a pregnancy can be achieved without a male infertility evaluation, some have questioned its usefulness. However, by bypassing a urological evaluation the man might not learn the cause of infertility and not be offered specific corrective therapy. In addition, men with subfertility may have a serious underlying medical or genetic problem that could also be overlooked. We determine the incidence of significant medical pathology discovered during a male infertility evaluation at 2 academic infertility practices. MATERIALS AND METHODS: All men examined for either primary or secondary infertility were included in our study, while men seen for vasectomy reversal were not. All patients underwent evaluation, consisting of a complete history, physical examination, semen analysis, hormone testing, urinalysis and genetic testing when appropriate. RESULTS: Significant medical pathology was discovered in 33 of 536 (6%) patients. A total of 27 patients had genetic abnormalities, including cystic fibrosis mutations in 24 and karyotypic abnormalities in 3. Of the remaining 6 patients 1 had testis cancer, 1 prostate cancer, 3 diabetes mellitus and 1 hypothyroidism. CONCLUSIONS: Significant medical pathology can be detected by a male infertility evaluation. In addition to identifying the cause of infertility, the evaluation may uncover conditions that threaten the health of the male partner or any potential offspring.

Adenocarcinoma↗
PubMed2001

A study on Trichomoniasis vaginalis and female infertility.

A total of 280 patients, 240 infertile and 40 pregnant were subjected to thorough history taking, general and local examination for exclusion of organic lesion, laboratory investigations to exclude parasitic, bacterial and fungal infections. Sterile vaginal swab from the posterior fornix was taken, and examined by wet smear preparation, Giemsa staining and cultivation on C.P.L.M. medium for trichomoniasis infection. The mean age of the infertile group was 25.75+/-3.92, and of the control group was 21.6+/-2.38 (in years). The mean duration of infertility was 2.81+/-1.51 (years). Out of 240 infertile women, 18.75% complained of discharge, 17.5% itching, 15.42% dysuria, 14.58% dyspareunia, and 10% had cervical lesion. Of the 40 controls, 5% complained of discharge, 2.5% complained of itching, dysuria, dyspareunia, but none had cervical lesion. Of the total cases (280), 36 (12.9%) had T. vaginalis. The clinical data observed were significantly higher among the infertile group than the control group. Cultures were positive in 14.58% of the infertile group and 2.5% in the control group. The difference between the 2 groups was statistically significant. No doubt, T. vaginalis plays an important role in female infertility.

Adult↗
PubMedDate not supplied

[Structural and functional features of the ovaries as a risk factor for ovarian cancer in infertile women].

In examining 502 female patients with cancer of the ovaries (OC) infertility was identified in 21.9 percent of cases. The prevalent form of infertility was tubal infertility (92.7%), there were but a few instances of the endocrine form (1.8%). The infertile women were studied for their hormonal and receptorial status (receptors of estradiol and progesterone). It has been established that women with the endocrine variant of infertility present with more prominent hormonal inadequacies in the hypophysis-ovaries system and manifest changes in the receptorial status of the ovaries than those with tubal infertility; the findings in the latter have not been shown to be different from controls. In endocrine infertility OC is in fact not encountered, which fact can be related to morphological features of the ovaries giving origin to endocrine disturbances, and to a decline in the receptorial status and absence of ovulation.

Adult↗
PubMed2001

[Etiologic approach in infertile couples in Mahajanga].

In Madagascar, as in other places in the world, infertility is associated with social stigmatism and an underlaying long-term risk for separation of the couple. A 12 months prospective study was carried out in 1999 in the Department of Gynecology, Obstetrics and Reproductive Health at the University Hospital in Mahajanga in order to collect data related to possible causes of infertility. For the women, serologic tests for Treponema pallidum (syphilis) and Chlamydia trachomatis were performed. And, in addition to sonography and hysterosalpingography, cervico-vaginal smears were obtained as part of the pelvic examination. A semen sample was obtained from each male partner. Of the 37 couples enrolled in the study 35 were classified as primary infertile (n = 9) or secondary infertile (n = 28). The mean age of the women and the men was 30.7 years (ranged 20 to 41 years) and 34.3 years (ranged 24 to 46 years), respectively. Various potential causes of infertility among the women were observed, such as hormonal disturbance (76%), tubal occlusion (76%), genital infection (70%). The figures indicate that there seems to coexist the possibility of multiply causes of infertility. Of 37 semen samples 24 (65%) were found with abnormalities, predominantly of oligospermia type. In 21 couples a possibly cause of infertility was observed in both partners.

Adult↗
PubMed2003

Profiles of infertility in southern Nigeria: women's voices from Amakiri.

This paper advances understanding of the consequences of female infertility in sub-Saharan Africa on the individual level. It illustrates how local meanings of infertility are shaped by the social and cultural context and how they influence the life experiences and coping behaviours of infertile women in an Ijo community in the Niger Delta. Infertility in Amakiri is a stigma. Barren women cannot attain full womanhood and join appropriate age associations since they cannot be circumcised without having given birth. Uncircumcised women cannot be burried within the town, rather, their corpses are buried in a designated forest. The paper is based on over twenty years of ethnographic field work, a complete census of one of the town's quarters to estimate the level of infertility and on the life histories of infertile women. The life histories are used to illustrate how women of various ages, educational levels and occupations cope with their common experience of infertility.

Female↗
PubMed2003

Experiencing infertility--social work dilemmas in child adoption procedures.

The research deals with experiencing infertility and its consequences in the adoption of a child and focuses on infertile couples that have wished to adopt a child and joined a program preparing them to be foster parents. The results show that most of the infertile couples experience infertility very much as being different from couples with children as well as having to cope with the feelings of deep emotional loss resulting from the inability to reproduce biologically. There is therefore the question whether these facts should be taken into account by the profession (i.e. social workers) when dealing with child adoption as, according to most of the respondents of our survey, the process of coming to terms with infertility and its consequences is an important factor in establishing healthy family relationships and the child's identity within the adoptive family. We concluded from the results of the research that the infertile couples preparation program for adopting a child carried out by the Society of Adoptive Families "Deteljica", is a comprehensive autopoietic social workers' answer to the needs of participants for a successful adoption of a child, as it makes it possible to supply these future adoptive parents with the requisite information and experience and provides support to the entire family upon accepting a child in its midst, while its fundamental attribute is offering help to couples in overcoming the traumas resulting from their infertility.

Adaptation, Psychological↗