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PubMed2004

[Evaluation of sperm samples from infertile men by flow cytometry].

INTRODUCTION: Human spermatogenesis begins at adolescence and continues throughout life. This process includes morphologic, cytologic and biological changes, leading to the formation of mature spermatozoa. Male infertility may be caused by several reasons, including oligozoospermia at variable degrees and complete absence of mature spermatozoa. Routine spermatogram, measuring sperm counts, motility and morphology, might not provide complete information in the evaluation of these cases. This study is aimed to evaluate the possible use of flow cytometry in the identification of different sperm cell populations in sperm samples obtained from infertile men, and in determining the different cell types in various groups of infertile men. MATERIALS AND METHODS: Sperm samples from normal and infertile men (the latter were azoospermic or oligoteratozoospermic OTA) underwent flow cytometry analysis, after preparation with TNE buffer and staining with Propidium Iodide. The separation of germinal cells into different populations, according to their DNA content and chromatin condensation, was evaluated. The WINMDI (http://fac.-scripps.edu, J. Trotter) software was used for data analysis. RESULTS: Flow cytometric analysis enabled identification of several cell populations in sperm samples, including haploid, diploid and tetraploid cells. Certain cellular distribution patterns were observed in sperm samples from infertile men: mature haploid cells, diploid cells, domination of tetraploid or non-mature haploid cells, and combination of these patterns. These patterns appeared in a statistically different manner among fertile and infertile men; the median value of mature haploid cells was higher in normal men (91%, compared to 85% in the OTA group and 0% in the azoospermic men), while the median value of diploid and tetraploid cells was higher in azoospermic men (72% and 8.5% respectively, compared to only 1% and 0% in normal men). CONCLUSIONS: These findings suggest that flow cytometry of sperm samples may serve as a non-invasive tool for investigations of male infertility and for identification of appropriate candidates for interventional treatment.

Flow Cytometry↗
PubMedDate not supplied

Use of Xenopus laevis frog egg extract in diagnosing human male unexplained infertility.

Approximately one in six married couples find themselves involuntarily infertile. This ratio translates to between two and four million U.S. couples. Although numerous tests are available for diagnosing infertility problems, 5-10 percent of all couples who seek medical treatment are diagnosed with unexplained infertility. Several tests are presently available for diagnosing male infertility; however, none of the present procedures test for activation of the sperm nucleus following entry into the fertilized egg, a series of events critical for the entry of the zygote into the developmental program. We have developed an in vitro human sperm activation assay, using Xenopus laevis frog egg extract. When normal human sperm is permeabilized and then mixed with frog egg extract, the sperm nuclei decondense, synthesize DNA, and recondense during a three-hour time course. We have tested this assay's utility in diagnosing previously unexplained infertility. We found that 20 percent of the male infertility patients produced sperm that responded abnormally in the assay (95 percent confidence interval, 4-48 percent; n = 15), while sperm samples from 15 fertile males showed no abnormal responses (p = 0.0112). These preliminary results indicate that the human sperm activation assay may be a useful tool for diagnosing some cases of human infertility.

Animals↗
PubMed1992

KTP/532 laser laparoscopy in the treatment of endometriosis-associated infertility.

OBJECTIVE: To determine the clinical effectiveness of the KTP/532 laser in treating endometriosis-associated infertility and to analyze the impact of additional infertility factors on outcome. DESIGN: Prospective cohort analysis of 74 consecutive patients followed up to 24 months after surgery. SETTING: Tertiary institutional infertility clinic. MAIN OUTCOME MEASURES: Cumulative pregnancy rates (PRs), monthly fecundity rates, monthly probability of pregnancy, crude PRs, and cure rates. RESULTS: Thirty-eight percent (28) of patients conceived with a mean +/- SE time to conception of 7.2 +/- 0.8 months. The cure rates were 74% for the total patient sample, 51% for stage I, 69% for stage II, and 64% for stage III disease. Patients who had a cervical factor (P = 0.05), who underwent intrauterine insemination (P = 0.03), who received human menopausal gonadotropin (P = 0.03), or who had additional infertility factors (P = 0.02) had significantly lower crude PRs. The presence of additional infertility factors (P less than 0.02) and intrafimbrial adhesions (P less than 0.01) had a significant impact on cure rates. In the absence of additional factors, 60% (12) of patients with stage I and II conceived. When additional factors were excluded, the overall cure rate was 80%. CONCLUSION: The results indicate that the KTP/532 laser is an effective tool for the treatment of endometriosis-related infertility. The high prevalence of subtle adhesions may lend further impetus to operative laparoscopy for stage I and II disease. Additional infertility factors may adversely affect outcome.

Adult↗
PubMed2004

[Feelings and emotions in women treated for infertility].

The aim of this study was an assessment of women's moods and emotions during infertil-ity treatment. Sixty married women diagnosed and treated for primary infertility at Division of Infertility and Reproductive Endocrinology Department of Gynecology and Obstetrics University of Poznan Medical Sciences from January to April 2003 were included in this study. The average age of women was 28.5 years. Control group consisted of 30 female students at similar age, single, not planning pregnancy in the nearest future. Depression was assessed using Beck scale. The special questionnaire was made to evaluate women's different psychological features connected with infertility. The interviews had a personal character and every question was filled in the questionnaire by the investigator. The first reaction most patients experienced when they found out about infertility was: 1) astonishment 2) sadness 3) anger, and similar was the opinion from the control group. Both the patients and the control group consider that having a baby is: 1) goal of their lives 2) sense of marriage 3) providing a woman with a sense of fulfillment. More than 25% of both groups of women think that infertility is the most important problem for their couples. Economic difficulties seem to be the biggest problem for patients during their treatment of infertility. What is very interesting patients average Beck scale depression score was significantly higher that of control respondents (8,6 points for patients and 4,4 for control group).

Adult↗
PubMed2004

Experience of tubal surgery for infertility at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.

The magnitude of fallopian tube disease and their contribution to infertility in Nigeria and in Africa are gross among the cohorts of women presenting with difficulty in childbearing. The objective of the study is to assess the trend and pattern of tubal disease in infertility and pregnancy rate among patients undergoing tubal surgery at the Obafemi Awolowo University Teaching Hospital Complex. A descriptive retrospective study of all cases of tubal disease in infertility who admitted for surgery between January 1st 1993 and December 31st, 2000 at the Obafemi Awolowo University Teaching Hospital Complex. There were 6144 infertile women among 29,011 females of reproductive age group attending the hospital during the study period giving an overall incidence of infertility of 21.2%. Among this group, 1352(22%) were due to tubal disease. One hundred and twenty five (125) of these patients showed up for surgery and thirteen pregnancies were recorded giving an overall pregnancy rate of 10.8%. About one in four of these patients had had previous tubal surgery for infertility. Salopingolysis had the best pregnancy rate with about 19.3% success. Tubal disease is a common cause of infertility in South Western Nigeria and success rates following surgery are low. We advocate the establishment of regional fertility centres as a cost effective way of improving access to modern assisted conception techniques.

Adult↗
PubMed2005

[Incidence of endometriosis in infertile women: clinical and laparoscopic characteristics].

BACKGROUND: The incidence and symptomatology of endometriosis vary according to the different populations. OBJECTIVES: To determine the incidence of endometriosis as well as the clinical and laparoscopic characteristics in infertile women with endometriosis. PATIENTS AND METHODS: This study included 68 infertile patients with endometriosis diagnosed by laparoscopy; in all of them we analyzed the demographic and clinical characteristics. RESULTS: In 68 out of 197 medical files that were analyzed, endometriosis was reported (34.5%). The average age was 30.3 +/- 3.9 years. Forty patients had primary infertility (58.8%) and 28 (41.29%) secondary infertility. In 34 patients endometriosis (50%) was mild, moderate in 16 (23.5%) and severe in 18 (26.5%). Only one endometriosic foci was found in 25% of the patients and multiple foci in 75% of them. The most common sites in which it was found were the uterosacral ligaments, Douglas pouch and the ovaries. In patients with primary infertility it predominated the medium-high socioeconomic level and in those with secondary infertility the low one. In severe endometriosis the predominant symptom was the moderate or severe dysmenorrhea, while in mild and moderate endometriosis was mild dysmenorrhea (p < 0.007). Six out of 16 patients with severe endometriosis had endometrioma. CONCLUSIONS: The endometriosis incidence in infertile women was similar to that reported in literature, as well as age of presentation. It was also observed a direct relationship between endometriosis severity and dysmenorrhea intensity.

Adult↗
PubMed2006

[Analyse of zinc and acid phosphatase in seminal plasma and sperm parameters of infertile male].

OBJECTIVE: This study was to investigate the relationship among zinc, acid phosphatase levels in seminal plasma and sperm parameters in infertile male. METHODS: The activities of zinc and acid phosphatase in seminal plasma were detected and leucocytes was stained and counted in 169 infertile men and 21 normal fertility as control. RESULTS: Acid phosphatase levels in infertile groups were significantly lower than those in the normal control when grouped both in terms of sperm vitality and density( P < 0.01), but no statistical differences were observed among infertile groups (P > 0.05). Further, zinc levels in necrospermia groups were lower than those in the control (P > 0.05). The leucocyte numbers in infertile groups were larger than those in the control when grouped according to sperm density (P < 0.001), and the same results were obtained when grouped in terms of sperm vitality except in the necrospermia group (P > 0.05). Acid phosphatase and zinc levels were not correlated with leucocyte counting (r = 0.088, P = 0.162; r = 0.119, P = 0.057). CONCLUSION: The descent of acid phosphatase and ascent of leucocyte number in seminal plasma can result in the fall of sperm vitality and density, and can be used to be diagnostic indexes of male infertility. Seminal zinc levels in infertile groups were lower than those in the control, but there was no statistical significance.

Acid Phosphatase↗
PubMed2006

Sperm output in patients with primary infertility and hepatitis B or C virus; negative influence of HBV infection during concomitant varicocele.

AIM: The aim of this study was to evaluate the sperm abnormalities in young infertile patients with hepatitis B (HBV) or C (HCV) virus infection and to evaluate the additional negative influence of varicocele on sperm parameters in these patients. METHODS: Part I. Forty-two infertile patients in Child-Pugh classification A with HBV (n=23) or HCV (n=19) infection, underwent sperm analysis and quantitative detection of HBV-DNA or HCV-RNA in blood serum. Sperm parameters were compared to those of a group of 30 patients with primary infertility due to causes different from liver diseases and/or varicocele). Part II. Twenty-one infertile patients with varicocele associated to HBV (n=11) or HCV (n=10) infection were also enrolled and underwent semen analysis: a group of 39 patients without liver disease, but with varicocele alone served as matched-control group. RESULTS: Part I. HBV patients (with a median HBV-DNA load of 6x10(5) copies/mL, range 1x10(5)-10x10(6)) showed median sperm parameters (sperm density, total number, forward motility and morphology, viability) significantly worse than those found in patients with HCV (with a median HCV-RNA load of 2.3x10(6) copies/mL, range (2x10(5)-12x10(6)). Sperm parameters showed no significant correlation with the duration of infertility neither with the duration of viral infection. Sperm morphology only, exhibited a trend (P=0.06) of negative correlationship (r=-0.59) with the viral HBV-DNA load, whereas the other sperm parameters studied showed no correlation with the viral load. Part II. The group of infertile patients with HBV and varicocele showed median values of all sperm parameter evaluated significantly worse than those found in infertile patients with varicocele alone, or with HCV infection plus varicocele. CONCLUSIONS: Patients with HBV infection show worse sperm parameters compared with HCV patients. The additional presence of varicocele further impairs sperm output in HBV patients.

Adult↗
PubMed2006

Depression and anxiety levels in infertile Turkish women.

OBJECTIVE: To investigate the levels of anxiety-depression in women with infertility and to investigate the relationship between psychologic symptoms, course of treatment and cultural factors. STUDY DESIGN: The study included 107 women with primary infertility in the index group and 63 healthy women in the control group. The Hospital Anxiety Depression Scale was applied to both groups to evaluate psychologic symptoms. The same scale was applied once more after 3 months to the infertility group. RESULTS: There was no significant difference in the level of depression-anxiety between the 2 groups. The severity of psychologic symptoms was greater in those in the infertility group who had attempted nonmedical solutions, who were under pressure from their husbands' families because of their infertility and who reported "bad" relations with their husbands. At the end of the 3 months, the group of patients who achieved pregnancy showed significantly lower levels of anxiety and depression scores than the group of patients who did not. Age, attempts at nonmedical solutions, pressure from the husband's family because of infertility and anxiety level at the start of the study were variables that predicted pregnancy negatively. CONCLUSION: It can be useful to take cultural factors into account in evaluating the mental health of infertile women.

Adult↗
PubMed2006

[Infertility: a global perspective].

Infertility has always existed; however, today it has a different meaning because the possibility exists, not only to treat it in some three quarters of all cases, but also, in a number of instances, to prevent it. At the same time, this improved scenario created a number of important new issues concerning public health policies and the social impact of infertility; these issues can be summarized with two words: equity and ethics. Indeed, there are intolerable differences in access to infertility care, depending on the social-economic status, as well as the country in which a couple lives. It is generally believed that, overall, in the general population a persistent form of infertility affects some 7-8% of all couples; in Europe the prevalence of infertility has been estimated at around 14%. There are important regional differences in the incidence and causes of sterility. Whereas the best known factor in western countries is an increase in the age in which women attempt to conceive, in Africa, the most important cause is represented by sexually transmitted infections. Over the last fifty years there have been major break-throws in the diagnosis and treatment of infertility, although it must be stressed that the importance and validity of therapy must be in all cases evaluated against expectant management. This is because in couples without clear signs of functional or organic pathology, conception will occur spontaneously in between 80 and 90% of the cases. At the same time, if attempts to conceive fail over a period of three years, even in women 30 years or younger, the probability of pregnancy decreases to about 40%. Finally, it must be stressed that advances in assisted reproductive technology have created not only important successes, but also significant ethical problems: on the one hand, the debate is open on the limits of artificial interventions in the field of reproduction; on the other the possibility exists that a partner may ''impose'' an infertility on the other.

Female↗
PubMed1991

Assisted reproductive technics for the treatment of male factor infertility.

Several treatment choices remain for the couple with male factor infertility due to idiopathic male infertility or in couples in which specific therapy has failed. Empiric medical therapy continues as a viable option; however, the physician and patient must understand that the success rates with any of the pharmacological therapies remain suboptimal. In addition, this therapy should only be used for patients with idiopathic male infertility. It is not indicated for other classes of infertile males. Another option is that of IVF and related technologies. These technics continue to improve and we can expect more specific technics to be developed to optimize fertilization and pregnancy rates in those couples with male factor infertility. At the present time, the pregnancy rates achieved with this technology in male factor couples are less than those in non-male factor patients. In addition, all of these technics entail considerable expense, often not covered by insurance. The third alternative for the patient with idiopathic male infertility is that of therapeutic insemination with the husband's sperm. Recent studies combining ovarian hyperstimulation with IUI suggest a clear advantage of this technic over other insemination approaches. As this treatment is significantly less expensive and time-consuming than the prior therapies, it should be considered when choosing therapy. Additional choices the couple with male factor infertility should consider are adoption and therapeutic donor insemination. It is only after careful consideration of all the available options that an appropriate decision can be made. This will vary, depending on the particular clinical characteristics of the couple as well as their social and financial situation.

Humans↗
PubMed1991

Prevalence and type of infertility in Gabon.

The prevalence and type of infertility based on the WHO criteria were determined in a rural and semi-rural population in south-eastern Gabon. The prevalence rate of infertility in the rural population was 5.7% for primary infertility and 20.0% for secondary infertility. In the semi-rural area, 3.0% suffered from primary infertility and 22.4% from secondary infertility. Pregnancy wastage and home delivery were risk factors for secondary infertility. An evaluation of the WHO criteria for fertility surveys was made.

Abortion, Spontaneous↗
PubMed1991

The prevalence of infertility in a rural Nigerian community.

The prevalence of infertility in a rural Nigerian community is determined by a systematic random sampling of the population. The overall prevalent rate was 30.3%, giving indices of 9.2% for primary infertility and 21.1% for secondary infertility. Primary infertility is rare after the age of 30 years and acquired causes of infertility are responsible for the high prevalence rate. Genital infections (post-abortal and puerperal) are major contributory factors to the high rate of infertility. Liberal abortion laws, improved socio-economic status and elimination of harmful socio-cultural beliefs and practices would reduce the problem of infertility to the barest minimum in the developing countries.

Adolescent↗
PubMed1988

Uterine adenomyoma associated with infertility. A report of three cases.

Adenomyosis and its localized, tumorlike variant, the adenomyoma, usually afflict multiparous, perimenopausal women and are not considered to cause infertility. Three cases of adenomyoma occurred in young, infertile women. The adenomyoma was not deemed solely responsible for the infertility, although in two cases it could have been contributory. The preoperative diagnosis was leiomyoma, and adenomyoma was not even considered; it was recognized during "myomectomy" in one case. Adenomyoma should be included in the differential diagnosis of a localized uterine tumor in an infertile woman. This preoperative recognition allows the gynecologist to discuss the lesion with the patient, pointing out that the operation may be technically difficult and may result in incomplete removal or hysterectomy and that excision of the tumor may not cure her infertility. It also prepares the gynecologist for the technical problems that may arise intraoperatively. Additional cases of adenomyoma in infertile women need to be reported on before light is shed on its causal relationship to infertility as well as on its diagnosis and management.

Adult↗
PubMed1986

Bromocriptine therapy in normoprolactinemic women with unexplained infertility and galactorrhea.

Forty-three women with unexplained infertility and 16 women who ovulated with clomiphene citrate therapy, yet failed to conceive, were evaluated because of the presence of expressible galactorrhea and normal random prolactin levels. The overall mean duration of infertility for these women was 5.68 +/- 0.33 years (mean +/- standard error) and their mean age was 30.20 +/- 0.46 years. Fifty-two of these women had primary infertility. Three treatment protocols were evaluated. Twenty-five women with unexplained infertility (Group A) received low-dose bromocriptine (1.25 to 2.5 mg) at bedtime for the first 18 days of the cycle; 18 women with unexplained infertility (group B) received 100 mg of pyridoxine continuously; and 16 women receiving clomiphene citrate (group C) also received bromocriptine in a manner similar to that for group A. All subjects were followed for six treatment cycles or until pregnancy occurred. The estimated cumulative pregnancy rate after six treatment cycles was 65% for groups A and C, which is significantly higher than the 22% rate for group B (Lee-Desu statistic = 4.66, P = 0.03). Women treated with bromocriptine were 2.3 times more likely to conceive than women treated with pyridoxine. Furthermore, those infertile galactorrheic women whose random prolactin level was greater than or equal to 15 ng/ml were most likely to conceive. Expressible galactorrhea in women with unexplained infertility and high normal prolactin concentrations may serve as a clinical sign indicating those women who may benefit from low-dose bromocriptine treatment administered at bedtime.

Adult↗
PubMed1985

Plasma concentrations of pituitary and testicular hormones of fertile and infertile men.

The serum concentrations of prolactin (PRL), follicle stimulating hormone (FSH) and luteinizing hormone (LH) and the plasma concentrations of testosterone, 5-alpha-dihydrotestosterone (DHT) and oestradiol were measured in 80 infertile men and 38 men of known fertility. The infertile men had a lower mean concentration of prolactin and a higher mean concentration of FSH than the fertile controls. The mean FSH was particularly high in infertile men without antisperm antibodies but with oligospermia (sperm density up to 20 million/ml), who also had a higher mean serum LH level than the fertile controls. Both FSH and LH showed an inverse relationship with sperm density. There were no significant differences in plasma testosterone, DHT or oestradiol between fertile and infertile men. In both the fertile and infertile groups strong positive associations were found between the concentrations of FSH and LH, and between testosterone and DHT. Weaker relationships were found between DHT and oestradiol, and between testosterone and PRL. In the fertile men, positive associations were also found between LH and testosterone, and between oestradiol and both FSH and LH. Testosterone and oestradiol were associated only in infertile men. The relevance of these findings to the aetiology of male infertility is discussed.

Dihydrotestosterone↗
PubMed1984

Correlations between laparoscopic and hysteroscopic findings in 497 women with otherwise unexplained infertility.

Laparoscopy and hysteroscopy were undertaken simultaneously in 497 women presenting with otherwise unexplained infertility. Of them, 285 complained of primary infertility and 212 of secondary infertility. Laparoscopic evidence of pelvic inflammatory disease in the absence of endometriosis was noted in 103 patients with primary and in 108 women with secondary infertility. Lesions were noted on hysteroscopy in both groups as well as in 34% of women with normal laparoscopic examinations. No specific dependency could be demonstrated between any laparoscopically detected lesion and hysteroscopically detected lesion. A significant dependency was demonstrated only between a history of secondary infertility and uterine adhesions (chi 2 = 12.03, 1 df, p less than 0.01). While the combined endoscopic findings did not demonstrate any dependency, the findings of this study demonstrate the importance of hysteroscopy in assessing all patients with infertility, especially those with secondary infertility.

Adolescent↗
PubMed1984

Antibodies to A19 and Bw35 complexes of human leukocyte antigens are present in infertile subjects with sperm antibodies.

Sera and secretions from 100 couples with unexplained infertility were tested for sperm antibodies by cytotoxicity and passive hemagglutination and also for antibodies to human leukocyte antigen (HLA) by cytotoxicity assays. Lymphocytes of the study subjects were typed for 61 HLA-A and B alleles. Thirteen of 30 (43%) men with sperm autoimmunity also had HLA antibodies in their serum and/or seminal plasma samples, in contrast to 2 of 35 (6%) nonautoimmune males (P = 0.0003). Twenty-five of 35 (71%) sperm antibody-positive infertile women had HLA antibodies in their sera and/or secretions, while only 7 of 31 (23%) women without sperm antibodies were positive (P = 0.00007). Antibodies to HLA-A19 (A26, A29, AW30, AW31, AW32, AW33, and AW34) and Bw35 (B5, B15, B17, and B18) complexes were present in 19 of 22 (86%) infertile men and 44 of 48 (92%) infertile women positive for HLA antibodies (P less than 0.01). The presence of antibodies to HLA-A19 and/or Bw35 in the infertile subjects did not correlate with the presence of HLA-A19 and/or Bw35 in the husbands. The presence of antibodies to HLA-A19 and/or Bw35 in the cervical mucus of the infertile women correlated with their presence in the seminal plasma of their husbands. It is suggested that antibodies to sperm antigens cross-reactive with HLA-A19 and/or Bw35 may be relevant to infertility.

Adult↗