Depression in primary versus secondary infertility egg recipients

Women with primary infertility and their husbands were significantly more depressed than women with secondary infertility and their husbands, and the difference in levels of depression of women compared with their husbands was significantly greater for primary than for secondary infertility. Depressive symptomology for childless individuals is greater for wives than for their husbands.     

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

Objective: To test a theoretical model of the effect on marital communication and adjustment of men’s and women’s approach to infertility.

Design: A cross-sectional research design involving interviews, questionnaires, and a marital discussion task.

Setting: Volunteers from practices of fertility specialists.

Patient(s): Forty-eight couples currently seeking infertility treatment.

Intervention(s): None.

Main Outcome Measure(s): Quality of marital communication during a marital discussion task and effect of infertility on the marriage.

Result(s): Having children was more important to wives than husbands; wives were more involved in trying to have a baby, wanted to talk with their partner more about trying to have a baby, and experienced a greater loss of self-esteem than did their husbands. To the extent that husbands saw having children as important, were involved in trying to have a baby, or wanted to talk with their wives about trying to have a baby, the quality of marital communication when discussing infertility was less negative, and in turn, wives perceived a more positive effect of infertility on their marriage.

Conclusion(s): Increases in husbands’ interest and involvement in fertility treatment may lead to positive changes in couple communication about infertility and to a more positive effect of infertility on the marriage.     

An evaluation of immunologic factors of infertility

This paper reviews earlier studies identifying 3 possible immunologic causes of infertility: autoimmunity, ABO blood group incompatibility, and isoagglutination, and presents results of recent studies, including an analysis of the incidence of isoagglutinations, autoagglutinations, and ABO incompatibility in a group of couples with unexplained primary or secondary infertility and couples with an organic cause of infertility; incidence of antibodies in postpartum women, women in early pregnancy, unmarried women, and prostitutes; the relationship between ABO incompatibility and/or sperm-agglutinating antibodies to postcoital testing of cervical mucus; results of condom therapy in couples with positive isoagglutinins; a comparison of hemagglutination test with the microagglutination test; and preliminary studies of the immunoglobulin responsible for a positive microagglutination reaction. Results obtained from 292 women and 176 men indicated that in the 64 couples with primary unexplained infertility, 24 wives had isoagglutinins and 5 of the husbands had autoagglutinins. Among 32 couples with secondary unexplained infertility, 16 wives had isoagglutinins and only 1 husband had autogglutinins. 50 couples with organic causes of infertility and 25 unmarried women had a 20% incidence of isoagglutinins. Positive serologic reactions were found in 35 of 48 prostitutes. 15 of 44 women in the 1st trimester of pregnancy had isoagglutinins to at least 1 of 3-5 donor semen specimens, but serums of 7 of the women gave negative reactions when tested against the husband's ejaculate. The 2 women in the group who aborted had negative antibody titers. Only 1 of 29 serums from postpartum women gave positive agglutination reaction. Among 68 couples, 19 subjects had positive microagglutination test reactions but only 7 had positive hemagglutination reactions. No specific relationship was found between ABO incompatibility and the results of postcoital testing of cervical mucus in 58 women tested or positive circulating issoagglutinins in 62 women tested. 27 of 68 couples with primary unexplained infertility, 18 of 33 with secondary unexplained infertility, and 13 of 46 with organic causes of infertility had ABO incompatiblity. Autoagglutination, unless massive, was not incompatible with pregnancy. Circulating antisperm antibodies fell to undetectable levels after 2-12 months of condom therapy. Careful timing of ovulation is essential because of the increase in antibodies after reexposure. Results of condom therapy in terms of pregnancies were disappointing.     

Conception rates in couples where autoimmunity to sperm is detected

In men with autoimmunity to sperm, a varying proportion of spermatozoa in the ejaculate are found to have surface-bound immunoglobulins. We asked whether the extent of autoimmunity, as judged by this criterion, would have predictive value in determining the chance of conception. Infertile couples where husbands were found to have antisperm antibodies were treated for other factors leading to impaired reproduction, but no specific treatment was offered for reduction of these antibodies. The chance of pregnancy for those couples where autoimmunity to sperm was the sole definable factor leading to infertility was 15.3% when most spermatozoa were antibody-bound. A significantly greater number of wives whose husbands had less than 50% of their sperm bound by immunoglobulins conceived (66.7%; P less than 0.005).     

Exploring couple attributes and attitudes and marital violence in Vietnam

Using a couple-centered approach, this study focuses on the relative attributes and attitudes of spouses as predictors of marital violence. Analysis of data from Vietnam showed that 37% of married women have ever been hit by their husbands. Regression results found that husbands with lower resources or status than their wives were more likely to have abused. Results also found that the association between husbands' gender attitudes and marital violence depends on the level of equity of wives'attitudes. The decline in violence among couples in which husbands expressed gender equitable attitudes was greater when wives also expressed equitable attitudes.     

The relationship between males' attitudes to partner violence and use of contraceptive methods in Turkey

Interventions have been carried out to improve the reproductive health and status of women in Turkey. However, these efforts are limited due to lack of male involvement. Lifestyle risks such as partner violence need to be evaluated in terms of any effects on the use of contraception. Data collected from interviews of married women and their husbands for the 1998 Turkish Demographic and Health Survey and 1971 husbands were included in the study. The percentage of husbands who were against partner violence was 20.4%. However, 22 (0.9%) husbands had an attitude toward the use of violence against their wives. The frequency of contraceptive use was increased from the group of men who had unfavorable attitudes towards violence to the group of men who had favorable attitudes. A similar trend was found in the percentages of condom use for men, with multiple factors influencing contraceptive use. The study suggests that further investigations are needed for couple-related issues to improve the status of women in the community and to empower women for sexual health.     

The relationship between males' attitudes to partner violence and use of contraceptive methods in Turkey.

Interventions have been carried out to improve the reproductive health and status of women in Turkey. However, these efforts are limited due to lack of male involvement. Lifestyle risks such as partner violence need to be evaluated in terms of any effects on the use of contraception. Data collected from interviews of married women and their husbands for the 1998 Turkish Demographic and Health Survey and 1971 husbands were included in the study. The percentage of husbands who were against partner violence was 20.4%. However, 22 (0.9%) husbands had an attitude toward the use of violence against their wives. The frequency of contraceptive use was increased from the group of men who had unfavorable attitudes towards violence to the group of men who had favorable attitudes. A similar trend was found in the percentages of condom use for men, with multiple factors influencing contraceptive use. The study suggests that further investigations are needed for couple-related issues to improve the status of women in the community and to empower women for sexual health.     

Coping strategy in infertile couples undergoing assisted reproduction treatment

Objective

The purpose of the study was to determine whether infertility is associated with coping processes and is there a difference between infertile women and men in the use of coping strategies?

Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples.

OBJECTIVE: To compare the dynamics of fertility-problem stress experienced by wives and husbands in infertile couples with the dynamics of stress from other sources experienced by members of couples presumed to be fertile. DESIGN: Relationships of stress to four marriage factors and four aspects of life quality (subjective well-being) are examined within a causal modeling framework using data from structured interviews. SETTING: Face-to-face interviews were conducted in study participants' homes. PARTICIPANTS: Wives and husbands from 157 couples with primary infertility and from 82 presumed-fertile couples were studied. MAIN OUTCOME MEASURES: Final outcome measures were four multi-item scales assessing life quality with regard to the marriage, own self-efficacy, own health and appearance, and life as a whole. Intervening outcome scales measured four marriage factors: marital conflict, sexual self-esteem, sexual dissatisfaction, and frequency of intercourse. RESULTS AND CONCLUSIONS: Higher levels of stress, regardless of whether that stress was from attempting to solve a fertility problem or another problem, were related to reduced marital functioning and decreased life quality. For husbands, the strengths of the linkages did not depend on the source of the stress. For wives, however, the causal model suggested that fertility-problem stress had stronger negative impacts on sense of sexual identity and self-efficacy than did stress from other problems (P less than 0.05). Stress from any source had more impact on the lives of wives than of husbands, more impact on satisfaction with self and general well-being than on satisfaction with the marriage or health, and affected life quality mostly indirectly through its impacts on the marriage factors.     

Gender Differences and Perceptions About Childbearing Among Infertile couples

Objective: To explore gender dierences and responses of in fertile couples to childbearing issues.
Design: Data analysis from the first wave of a larger three wave prospective panel study. Face-to-face tnterviews with both husbands and wives were conducted.
Setting: Husbands and wives were interviewed separately in their homes. One was generally interviewed immediately after the other.
Participants: One hundred sixty-one infert ile couples in southeastern Michigan were interviewed in 1988.
Measures: Variables of interest included the self recognized source of the fertility problem, the tmportance of children to individuals, stress associated with infertility treatment, the number of tests and treatments received, the acceptabiltty of indicated treatments, the length of time couples expected it would take to have a child, and the ideal and expected number of children.
Results: Women experienced signijcantly more stress from tests and treatment, placed greater importance on havtng children, were more accepting of indicated treatments, and wanted more children than men did.
Conclusions: Implications for nurses working with in fertile couples are discussed, including provision of emotional support, evaluation of perceptions of success, assessment of couples' expectations, and inclusion of husbands in decision making.     

Sperm-agglutinating antibodies in 236 infertile couples

19 wives of 236 couples had positive sperm agglutination tests. (SPAT) 6 of the 19 belonged to the 70 couples (9.4%) with no no known cause for infertility; 11 belonged to the group of 154 couples (7.1%) with a known cause; and 2 to the 12 couples inadequately investigated (15.7%). 6 of these 19 women (31.6%) became pregnant without condon therapy; of these 6, 3 had no known cause for infertility and 3 had a known cause. 11 husbands had positive sperm aggluatination tests. 4 of these 11 were among the 70 couples (5.6%) with no known cause for infertility, while the other 7 were among the 154 couples (4.5%) with a known cause. 5 of their wives (45.5%) became pregnant without any treatment. Outcomes of 8 of 11 pregnancies were normal deliveries and no abortioons, which showed that positive SPAT had no apparent effect on the pregnancies. There was no relationship between postitive SPAT and history of venereal disease, allergy, autoimmune disease, abortioon, postcoital tests, or ABO imcompatability.     

Disclosure issues and decisions of couples who conceived via donor insemination

Disclosing the use of donor insemination (DI) to family, friends, and offspring poses a quandary for many DI patients. A cross-sectional survey was conducted to determine whether couples opted to share information about conception via donor sperm with their children, as well as the issues and concerns that arose for parents once infertility treatment was completed.

Twenty-seven married heterosexual infertile husbands and wives who had used DI to conceive completed a follow-up questionnaire asking them about disclosure decisions as well as thoughts about DI as a reproductive option.

Results revealed that nearly three-quarters of the sample had not disclosed to their child and did not plan to, although 85% had told at least one other person about conception via DI. With few exceptions, husbands and wives agreed about how to handle disclosure. Notably, 32% of the mothers reported not knowing when or how to disclose. However, the majority of couples were not offered psychological counseling prior or subsequent to DI. It is suggested that mental health professionals should be aware of the divergence of opinion between what they believe about the benefits of disclosure/counseling, the beliefs of infertile couples about disclosure and what is actually known about the benefits of foil disclosure among all involved parties.     

The pregnant couple

Although the husband's reactions to and feelings about his wife's pregnancy are frequently overlooked, his wife is always concerned about his perception of her. She often feels unattractive and is most interested in how satisfied her husband is with her pregnant body. The present study attempts to determine whether the husband or wife viewed the wife's body more positively, whether the husbands and wives could accurately predict each other's satisfaction or dissatisfaction with the pregnant body, and whether husbands' and wives' attitudes about important perinatal issues differed significantly. The data were analyzed by multivariate analysis of variance, comparing the husbands' and wives' satisfaction or dissatisfaction with the pregnant body. The body cathexis scale was used to measure such satisfaction and Osgood's semantic differential measured attitudes toward "pregnancy", "spouse", "unborn baby", and "labor and delivery". Findings show that husbands were more satisfied with their wives' pregnant bodies than the wives themselves were. The wives were not able to predict their husbands' levels of satisfaction, although the men accurately predicted their wives' responses. Husbands also tended to hold more positive attitudes toward perinatal issues.     

Mexican women's reasons for accepting or declining HIV antibody testing in pregnancy

OBJECTIVE: To determine pregnant women's reasons for accepting or declining the HIV test in Leon, Mexico. DESIGN: A cross-sectional study using a face-to-face questionnaire. SETTING: The antenatal clinic at a tertiary-care referral hospital in Leon, Mexico. PARTICIPANTS: 1184 pregnant women. DATA COLLECTION: Reasons for accepting or declining the HIV antibodies test, socio-economic characteristics and risk factors for HIV were recorded. Blood samples were obtained from women who accepted to be tested, and positive serologies to HIV on duplicate enzyme-linked immunosorbent assay testing were confirmed by Western Blot assay. FINDINGS: 1009 (85.2%) women accepted the HIV antibodies test. The main reason for accepting it was that women felt the test could be beneficial to their babies (45.1%). The two main reasons for rejecting the HIV antibodies test were that women felt the test was unnecessary because their husbands did not have sexual intercourse with other women (32.6%), and because they did not have permission from their husbands for accepting the test (23.5%). None of the women tested positive for HIV antibodies (0 per 1009). KEY CONCLUSIONS: The reasons for accepting the HIV test were similar to those reported in developed countries. One important reason for declining the test was that women did not have their husband's permission. IMPLICATIONS FOR PRACTICE: The acceptance rate for HIV testing in pregnant women could be improved by counselling men on the value of their wives being tested in pregnancy.     

Modern and traditional practices of Turkish infertile couples.

OBJECTIVE: This investigation was carried out to determine modern and traditional practices of infertile couples in Kayseri, Turkey. METHODS: Two hundred and fifty-two infertile couples were selected from the study area. Modern and traditional practices of the infertile women and their husbands were investigated through a questionnaire. The effects of some factors on the utilization of traditional methods were analysed through the logistic regression method. RESULTS: It was found out that 92.5% of the infertile women and 71.8% of their husbands had consulted a physician for infertility and 92.1% of the women and 32.6% of their husbands had applied for medical or surgical intervention. However, only 11.1% of the couples had attempted in vitro fertilization. In contrast, 61.5% of the infertile couples admitted to carrying out traditional practices. All traditional practices were more prevalent among the women than the men. CONCLUSION: It was concluded that traditional practices were more prevalent in the rural areas and among the older couples.     

结合计划生育服务开展性病/艾滋病预防的效果评估

目的 :评估发放宣传折页和提供咨询两种干预方法对提高育龄夫妇 STI/HIV/避孕套知识水平、改变对待 STI/AIDS病人的不良态度及增加避孕套使用意愿的效果 ,探讨结合计划生育开展 STI/HIV预防的有效方案。方法 :选取上海市 7个区 1 4个街道的 40 5对育龄夫妇 ,分为咨询干预组 (1 99对 )和折页发放组 (2 0 6对 )。基线调查后 ,咨询组进行咨询的同时提供免费避孕套并演示用法 ,折页组发放折页的同时提供免费避孕套 ,干预后一个月进行随访 ,以此评估干预效果。结果 :1 .基线无差异的两组 ,干预后咨询组夫妇 STI/AIDS/避孕套知识综合得分分别提高了 2 0 %和 2 4% ,折页组仅提高 2 %和 3% ;咨询组有93%的丈夫和 76 %的妻子消除了对 STI病人的偏见 ,73%的丈夫和 78%的妻子转变了歧视 AIDS病人或害怕与其接近的态度 ;避孕套使用意愿丈夫提高了 6 8% ,妻子提高了6 4% ;折页组对待 STI/AIDS病人的态度及避孕套使用意愿三项指标干预前后均无差别。2 .干预后得分及对待 STI/AIDS病人的态度主要与干预方式有关 ;避孕套使用意愿则受干预方式和获取方便程度的影响。结论 :1 .良好的咨询既能显著提高知识水平又能使不良态度得到明显转变 ;2 .提供有效咨询和增加可获得性是推广避孕套使用的重要因素 ;3.将咨询纳入计生门诊     

Evaluation of serum antisperm antibodies in infertility

Aims and Objective

To evaluate the role of serum antisperm antibody (ASA) in infertility.

Method and Material

This study was conducted in the Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College, Raipur (C.G.), India, from December 2006 to July 2008 over 105 selected couples with primary and secondary infertility attending the infertility clinic. Their detailed clinical history was taken. Physical examination and routine as well as special investigations like pelvic USG, follicular study, and hysterosalpingography were done in the female. Complete physical examination and semen analysis of male partners were done. Couples were subjected to post coital test (PCT) 2–6 hours after intercourse to rule out cervical factor. Serum ASA titer in both partners was detected by ELISA. Results were interpreted for qualitative evaluation. ASA-positive cases were treated with low-dose daily oral prednisolone for 3 months and evaluated in terms of ASA titer, semen analysis, PCT result, and conception rate. The results were analyzed by statistical methods.

Results

Out of 105 couples, serum ASA-positive males were 38 (39.19%), of which definite serum ASA positive were 9 (8.57%), borderline (equivocal) were 29 (27.61%), and negative were 67 (63.08%). Among females serum ASA positive were 42 (40%), in which definite ASA positive were 19 (18.09%), borderline 23 (21.9%), and negative 63 (60%). Asthenospermia was found more common in ASA-positive men (55.56%, p=0.0001). Poor PCT was most commonly associated in husband ASA negative and wife ASA positive. Treatment with low-dose oral prednisolone resulted in significant increase in motility of sperms in male partners and decrease in ASA titer in both the patients. Pregnancy was achieved in 45.23% ASA-positive females, while among couples with ASA-positive husbands, 31.57% of wives conceived.

Conclusion

Serum ASA are considered to be cause of unexplained infertility and unexplained abnormal PCT. Antibodies against sperm prevent their motility through female reproductive tract and hamper the process of fertilization. Low-dose prednisolone was useful in infertility associated with ASA by improving sperm quality and giving rise to pregnancies.     

HLA antigens-antibodies system and its association with severe toxemia of pregnancy

HLA antigens and antibodies were investigated in order to study the relationship between severe toxemia of pregnancy (toxemia) and the HLA system, which is in a close relationship with the immune response. The frequencies of 8 HLA-A antigens, 21 HLA-B antigens, 10 HLA-DR antigens and 4 HLA-MT antigens were determined in 21 patients with toxemia and their husbands and some of their children, 45 fertile couples without a history of abnormal pregnancy and 206 healthy adult controls (DR were in 106 controls). Sera from toxemias and normal pregnant women in the 3rd. trimester and postpartum intra-uterine blood in women with normal deliveries were tested for Warm-T and Warm-B cell antibody against 30 panel lymphocytes. Results obtained were as follows: In toxemic couples there is a much higher incidence of HLA-DR and MT sharing between wives and husbands, mothers and children. In those sera with toxemias, there is a higher incidence of Warm-T antibody and a lower incidence of Warm-B antibody compared with those with a normal pregnancy. From the immunogenetic point of view, when the HLA-DR X MT locus of a certain fetus is homozygous, the mother tends to manifest toxemia. These results indicated that matching of HLA-DR X MT loci in parents possibly plays a role in causing severe toxemia, and genetic prediction of its onset and prognosis can be carried out through HLA typing.