358例不孕症患者心理因素的调查与研究

目的:了解不孕症患者的心理状况及其影响因素。方法:选取2014年3月至2015年3月就诊于山东中医药大学第二附属医院生殖中心的女性不孕症患者358例。釆用焦虑自评量表(SAS)、抑郁自评量表(SDS)调查不孕症患者的焦虑、抑郁情况,分析其相关影响因素。结果:不孕症患者的焦虑发生率为25.14%(90/358),抑郁发生率为35.75%(128/358)。患者压力程度以中度最多(221例,占61.73%),压力来源以生育因素最多(224例,占62.57%),其次为工作因素(154例,占43.02%)。患者的焦虑/抑郁评分与患者的年龄、职业、不孕症类型、不孕病程、不孕病因、流产次数均无明显相关性(P0.05),但与文化程度、压力程度有关(P0.05)。结论:不孕症妇女的焦虑、抑郁发生率均较高,其心理健康水平低于正常人群。患者的焦虑、抑郁评分与文化程度、压力程度有关。心理因素与不孕症关系密切,治疗时应结合心理疏导与生活指导,以提高疗效。     

女性不孕症门诊医患交流质量的现状调查

目的:通过调查女性不孕患者提供病史、接受诊疗信息、就诊态度和心理,了解女性不孕症门诊医患交流中的状况及问题,以便针对原因加强医患之间的人际交流,提高诊治水平。方法:用自编的《妇科不孕症门诊医患交流质量评估表》对2010年4～10月在我院妇科不孕症门诊就诊的女性患者进行评估,共308例。结果:原发不孕41.9%;继发不孕58.1%。308例患者中,69.2%的患者不能准确提供过去诊治中的资料;77.6%的患者对检查和治疗不能充分理解,55.5%的患者精神压力大、希望得到医生的更多关注。结论:大多数不孕患者不能准确地提供既往检查和治疗史,也不能清晰理解检查情况和治疗意见;受到家庭及社会等因素的影响,患者的心理需求需要通过加强医患之间人际交流,予以更多关注。     

宫腹腔镜联合诊治输卵管性不孕症40例分析

不孕症是影响男女双方身心健康的疾病。在女性因素所致的不孕症中，输卵管因素占1／3。既往常规行输卵管通液和子宫输卵管碘油造影来判断输卵管是否通畅，但准确率不高，且达不到有效治疗目的。近年来，多个研究中心推荐输卵管通液宫腹腔镜联合检查作为输卵管通畅度的检查治疗方法，我院应用宫腹腔镜联合检查和治疗不孕症患者40例，取得了良好效果，报道如下：     

不孕症患者心理问题的研究进展

由于人们生活方式的改变及环境污染等影响,不孕症的发病率日益提高,成为目前医学研究的热点。不孕症与心理、社会因素间的关系已日益受到重视,不孕症患者呈现出独特的心理学特征和心理问题,同时这些心理问题又能加重内分泌功能失调,导致不孕的恶性循环。因此,生殖医学的医护工作者在不孕患者的诊疗过程中应重视心理、社会因素的影响,运用适当的心理干预手段,以利于对患者全面综合治疗。     

宫腔镜下宫腔粘连分离术后行体外受精-胚胎移植的妊娠结局及影响因素

目的:分析不孕症合并宫腔粘连(IUA)患者在宫腔镜下行宫腔粘连分离术(TCRA)后行体外受精-胚胎移植(IVF-ET)的妊娠结局及相关影响因素。方法:选择2016年3月至2017年8月就诊于湖北医药学院附属人民医院生殖医学中心行宫腔镜检查的不孕患者,行IVF-ET助孕治疗的临床资料及妊娠结局,根据宫腔情况分为对照组:正常宫腔形态行IVF-ET助孕患者425例;IUA组:IUA经TCRA治疗后行IVF-ET助孕患者119例。比较两组患者一般资料及妊娠结局,分析影响术后妊娠的相关因素。结果:IUA组的临床妊娠率、活产率较低,流产率较高,但差异无统计学意义(P0.05)。根据年龄、BMI、流产次数、粘连程度分组比较,临床妊娠率差异有统计学意义(P0.05);多因素Logistic回归分析显示:年龄(≥35岁)、流产次数(≥3次)、粘连程度(中、重度)及BMI(≥24 kg/m~2)是影响TCRA术后妊娠结局的独立危险因素。结论:不孕症合并IUA患者,TCRA术后行IVF-ET助孕治疗的临床妊娠率接近于正常宫腔形态患者,年龄、粘连程度、流产次数及BMI是影响术后妊娠结局的主要因素。     

腹腔镜在卵巢性不孕患者治疗中的临床应用

目的:探讨腹腔镜在卵巢性不孕症治疗中的疗效及影响因素。方法:对450例不孕症患者行腹腔镜诊疗,术后确诊为单纯卵巢性不孕115例追踪随访,观察术后月经周期、排卵和妊娠情况。结果:术后115例,随访3～12个月,宫内妊娠率达57.4%(66/115)。结论:腹腔镜手术对卵巢性不孕症有良好的治疗效果,对不明原因的不孕症能尽早明确诊断并治疗。     

慢性输卵管炎引起不孕症150例临床治疗分析

目的:观察采用西医治疗输卵管阻塞性不孕症的疗效。方法:对150例慢性输卵管炎引起不孕症患者使用西医药物及手术治疗方法.结果:150例慢性输卵管炎引起不孕症患者,经治疗后受孕128例,受孕率85.33%,取得了较好的疗效。结论:西医治疗法是治疗输卵管阻塞性不孕症有效方法之一。     

负性情绪对多囊卵巢综合征不孕症的影响

多囊卵巢综合征（polycystic ovarian syndrome,PCOS）是育龄期女性常见的生殖内分泌疾病之一,受中国传统文化、生育观念、社会、经济、家庭及疾病本身等因素影响,PCOS不孕症患者常存在心理调节功能受损,表现出更明显的抑郁、焦虑等负性情绪特征。负性情绪与疾病互为因果,互相影响,形成恶性循环,影响或加重PCOS患者的临床特征、性激素水平和糖脂代谢紊乱情况,进而导致不孕的发生,并对妊娠结局造成不良影响。积极的心理干预及治疗可以改善患者的心理状态,消除或缓解焦虑等负性情绪,从而改善PCOS不孕症的治疗结局。对以上方面进行综述,以期为PCOS不孕症患者的临床治疗提供新思路。     

电视宫腔镜下两种输卵管疏通术的比较

女性不孕症中 ,由于输卵管因素所致的不孕占 2 5 %～5 0 % [1] ,宫腔注药、输卵管插管通液、理疗、中药等治疗方法 ,效果多不理想。我所自 2 0 0 1年 3月将ＣｏｏｋＲｏａｄｒｕｎｎｅｒ导丝应用于电视宫腔镜下治疗输卵管梗阻 ,效果满意 ,报告如下。1　资料与方法1.1　一般资料　 2 0 0 0年 6月至 2 0 0 1年 5月来我所就诊的不孕症患者 338例 ,其中经输卵管通液或子宫输卵管造影(ＨＳＧ)确诊为输卵管单侧或双侧梗阻 12 5例 ,经详细询问病史 ,排除结核病、盆腔炎及阴道炎 ,心、肺功能正常。其中原发性不孕症 74例 ,继发性不孕症 5 1例 ,2 6～…     

宫腔镜检查在不孕症诊治中的应用

目的探究宫腔镜在不孕症诊治中的应用效果。方法选取我院2013年1月~2015年1月收治的不孕症患者240例作为研究对象,患者行宫腔镜检查和宫腔镜手术治疗,治疗后对患者的预后情况进行评估,有效消除影响胚胎着床的相关病变。结果宫腔镜检查后,确诊了由宫腔因素导致不孕的患者共185例,其中子宫内膜炎性增生71例,宫腔黏连48例,子宫内膜偏薄34例,子宫内膜息肉30例,子宫粘膜下肌瘤28例,子宫畸形19例,胚胎残留10例。其中176例患者实施宫腔镜治疗后,85例患者宫内妊娠,占48.3%。结论宫腔镜检查在不孕症诊治中的应用有着十分重要的意义,选择宫腔镜治疗能促进患者的生殖预后,值得在临床上应用和推广。     

‘The bloke can be a bit hazy about what’s going on’: men and cross-border reproductive treatment

While social science research has begun to demonstrate the significant impact of infertility and involuntary childlessness for men, far fewer studies have specifically explored the male experience of, or men’s involvement in, infertility treatment-seeking and there are few published studies which specifically describe men’s experiences with cross-border reproduction. This paper presents data from the first UK study of transnational treatment-seeking and specifically explores men’s involvement in this process. Data from interviews with 10 men and 34 women who were seeking treatment abroad are organized according to three themes: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. The paper argues that gender is an important aspect of the cross-border treatment experience and that both traditional and emergent gender identities are expressed in the process of treatment-seeking. Healthcare providers need to actively explore men’s perspectives of the treatment process in all locations, to improve quality of care by reducing men’s feelings of marginalization and enhancing their experience of treatment, especially but not exclusively, around the issue of semen collection.There has been little research which has tried to understand more about men’s experiences and involvement in seeking medical help for infertility. There are no published studies which explore the experience of travelling abroad for infertility treatment from the male perspective. In this paper, we present findings from the first UK study of cross-border treatment-seeking and specifically explore men’s involvement in this process. We present findings from interviews with 10 men and 34 women who were seeking treatment in countries outside the UK. These findings are organised according to three themes drawn from the interviews with the men and women: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. This research shows that, as is often the case with treatment-seeking in their home country, men are less likely to get involved in the planning and organization of treatment, but take responsibility for supporting their female partner. Men found some aspects of the treatment process, especially giving a semen sample, particularly difficult. Infertility practitioners in the UK and in other countries need to take account of gender differences and include a consideration of men’s experiences in a more sensitive and proactive way.     

Psychological interactions with infertility among women

Despite the fact that various studies have demonstrated the importance of the mind-body connection and fertility, the psychosocial aspects of infertility have not been adequately addressed. Fertility treatments, ranging from medical monitoring, to hormonal remedies and in vitro fertilization (IVF), are both a physical and emotional burden on women and their partners. Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy. A couple that is trying to conceive will undoubtedly experience feelings of frustration and disappointment if a pregnancy is not easily achieved. However, if the difficulties progress and the man and or woman are labelled as having fertility problems, then this may result in a severe insult to self-esteem, body image, and self-assessed masculinity or femininity. Three types of relationships have been hypothesized between psychological factors and infertility. These include: (1) psychological factors are risk factors of subsequent infertility; (2) the experience of the diagnosis and treatment of infertility causes subsequent psychological distress; (3) a reciprocal relationship exists between psychological factors and infertility. The evidence for these three relationships is reviewed and an alternative approach to the treatment of infertility including stress evaluation that precedes or is concurrent to fertility treatment is suggested.     

Diagnosis and management of unexplained infertility: an update

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

Severe male infertility after failed ICSI treatment-a phenomenological study of men's experiences

Background  

Male-factor infertility underlies approximately 30% of infertility in couples seeking treatment; of which 10% is due to azoospermia. The development of assisted reproductive technology (ART), enabling the use of epididymal or testicular sperm for fertilization of the partner's oocytes, has made biological fatherhood possible for men with obstructive azoospermia. There is limited knowledge of men's experience of their own infertility. The aim of this study was to describe men's experiences of obstructive azoospermia infertility.     

Immunology of the sperm-egg interaction

Summary The study of immunologic factors in infertility is in its infancy, and many questions remain to be answered. Further studies using newer techniques are needed to elucidate the actual contributions of immune mechanisms to infertility. Understanding the role of immunologic factors should lead to more effective treatment of patients whose infertility is immunologic in etiology.     

Psychosocial trends in couples prior to commencement of in vitro fertilisation (IVF) treatment

Facing infertility and undergoing fertility treatment can create emotional turmoil in couples’ lives. It is essential for fertility therapy providers to assess the coping and communication strategies of couples before treatment in order to provide appropriate support. We performed a two time point (year 2003 & year 2009) cross-sectional study of patients attending our services to undergo in vitro fertilisation. All couples attending the Human Assisted Reproduction Ireland Unit, a tertiary referral academic centre at the Rotunda Hospital, were requested to complete a psychosocial questionnaire before commencing the treatment. The questions assessed couples’ understanding of their own infertility, family background and support, relationship traits and stress levels prior to commencing fertility treatment. A total of 180 patients participated in the study. Our findings showed that within a 6-year time span, couples’ attitudes have changed significantly. Compared to 6 years ago, couples now have a better understanding of infertility and are seeking treatment quicker. Interestingly, we showed higher stress levels nowadays with fewer couples following routine stress management. We also identified specific gender differences in that women have a more open attitude in discussing infertility and seeking more support from friends and family compared to men.     

Lifestyle factors in people seeking infertility treatment – A review

Background:  Clinical infertility is a prevalent problem with significant financial and psychosocial costs. Modifiable lifestyle factors exist that may affect a person's time to conception and their chance of having a healthy, live birth. However, no guideline delineates what preconception advice should be offered to people presenting for infertility treatment.
Aim:  The aim of this article is to review the literature regarding modifiable lifestyle factors in people seeking infertility treatment.
Results:  A person's time to pregnancy and their chance of having a healthy, live birth may be affected by factors such as weight, vitamin and iodine intake, alcohol and caffeine consumption, smoking, substance abuse, stress, environmental pollutants, vaccinations and oxidative stress.
Conclusions:  Advice on modifiable lifestyle factors should be given to people presenting for infertility treatment to help them make positive changes that may improve their chances of pregnancy and delivering a healthy, live baby. Developing a guideline for this would be a prudent step towards helping clinicians to implement this aspect of preconception care.     

Psychosocial trends in couples prior to commencement of in vitro fertilisation (IVF) treatment

Facing infertility and undergoing fertility treatment can create emotional turmoil in couples' lives. It is essential for fertility therapy providers to assess the coping and communication strategies of couples before treatment in order to provide appropriate support. We performed a two time point (year 2003 & year 2009) cross-sectional study of patients attending our services to undergo in vitro fertilisation. All couples attending the Human Assisted Reproduction Ireland Unit, a tertiary referral academic centre at the Rotunda Hospital, were requested to complete a psychosocial questionnaire before commencing the treatment. The questions assessed couples' understanding of their own infertility, family background and support, relationship traits and stress levels prior to commencing fertility treatment. A total of 180 patients participated in the study. Our findings showed that within a 6-year time span, couples' attitudes have changed significantly. Compared to 6 years ago, couples now have a better understanding of infertility and are seeking treatment quicker. Interestingly, we showed higher stress levels nowadays with fewer couples following routine stress management. We also identified specific gender differences in that women have a more open attitude in discussing infertility and seeking more support from friends and family compared to men.     

Where are all the men? The marginalization of men in social scientific research on infertility

There is a wealth of research exploring the psychological consequences of infertility and assisted reproduction technology, a substantial body of sociological and anthropological work on ‘reproductive disruptions’ of many kinds and a small but growing literature on patient perspectives of the quality of care in assisted reproduction. In all these fields, research studies are far more likely to be focused on the understandings and experiences of women than those of men. This paper discusses reasons for the relative exclusion of men in what has been called the ‘psycho-social’ literature on infertility, comments on research on men from psychological and social perspectives and recent work on the quality of patient care, and makes suggestions for a reframing of the research agenda on men and assisted reproduction. Further research is needed in all areas, including: perceptions of infertility and infertility treatment seeking; experiences of treatment; information and support needs; decisions to end treatment; fatherhood post assisted conception; and the motivation and experiences of sperm donors and men who seek fatherhood through surrogacy or co-parenting. This paper argues for multimethod, interdisciplinary research that includes broader populations of men which can contribute to improved clinical practice and support for users of assisted reproduction treatment.While much has been written about the psychological and social consequences of infertility and infertility treatment, most of this has focused on the experiences of women, with relatively little research with men as users of assisted reproduction technology. This paper discusses some of the reasons why this is the case. It comments on psychological and social research which has been carried out with men and discusses some of the limitations of the methods by which this research has been conducted. An argument is made for research to pay more attention to the ways in which men as well as women experience infertility and assisted reproduction, and the paper suggests using methods from both quantitative and qualitative traditions to more fully explore a range of issues relevant to men and to improving patient care. Further research with men is needed in all areas including: perception of fertility and infertility; treatment seeking; experiences of treatment; information and support needs; decisions to end treatment; fatherhood post assisted conception; and the motivation and experiences of sperm donors and men who seek fatherhood through surrogacy or co-parenting.     

The Spontaneous Cure Rate of Various Infertility Factors or Post Hoc and Propter Hoc

Summary
A prospective study has been made on 2,581 patients suffering from primary and secondary infertility.
secondary infertility. Thirty-five per cent of these patients became pregnant during the course of investigation and before any treatment could be given.
Half of the pregnancies followed the performance of tuba1 patency tests. Salpingograms were twice as effective in producing a pregnancy as were Rubin's tests (11% versus 5%).
Fifteen per cent of 1,177 patients became pregnant after the cause of the sterility was known and before any treatment was given.
Anovulation underwent a spontaneous cure in 25% of patients and 20% became pregnant.
The spontaneous cure rate amongst patients with tubo-ovarian adhesions was about 15%.
Tubal patency tests frequently have a curative effect where the post-coital test is
Only about 1 in every 7 patients with known infertility factors will become pregnant without treatment. Definitive attempts to cure specific infertility factors were successful in 47% of such patients.
If we give the reproductive tract of an infertility patient a good "spring cleaning" by plodding through the various tests for this condition, we can expect a third of the patients to become pregnant without our ever knowing what infertility factors were present.
Patients with infertility come to us because they want to be pregnant soon and not sometime. The way to achieve this is by early active investigation and treatment, and not by platitudes, placebos or procrastination.