The effect of an infertility diagnosis on the distress, marital and sexual satisfaction between husbands and wives in Taiwan

BACKGROUND: Few studies have explored the effect of a gender-specific infertility diagnosis on the responses of couples in Taiwan. The purpose of this research was to compare the differences in distress, marital and sexual satisfaction in husbands and wives based on an infertility diagnosis. METHODS: Three structured questionnaires were used. RESULTS: Female members of couples in which both partners were infertile expressed less marital and sexual satisfaction than their husbands. No differences in marital and sexual satisfaction were found between wives and husbands with unexplained infertility. Only wives with a diagnosed female infertility expressed higher distress to infertility than their husbands. Although no differences in psychosocial responses were found among husbands, regardless of the diagnosis, wives with a diagnosed female infertility experienced higher distress in self-esteem and less satisfaction in acceptance by in-laws than wives experiencing a diagnosed male infertility. CONCLUSIONS: These findings suggest that the diagnosis of infertility is an important factor in assessing the differences in infertility distress and marital and sexual satisfaction between husbands and wives. Health professionals can explain the gender differences when counselling infertile couples and encourage them to share each other's feelings, which may help couples to cope with the communication problems they may experience.     

Evaluation of the needs of spouses of female carriers of mutations in BRCA1 and BRCA2

The process of genetic testing involves the entire family, including spouses. The objective of this study was to measure the specific needs and to describe the experiences of spouses of women who received genetic counseling for a positive BRCA1/2 result. We surveyed 59 spouses of female mutation carriers. The mean length of relationships was 26 years (range: 2.5-50 years). All were supportive of their spouses' decision to undergo genetic testing and counselling. Four respondents stated that they wished that they had received additional support at the time of test disclosure and 20% felt that their wives had received inadequate support. One-quarter of the spouses believed that their relationship had changed because of genetic testing; most felt that they had become closer to their wives. Husbands were most concerned about the risk of their wife dying of cancer (43%), followed by the risk of their spouse developing cancer (19%) and the risk that their children would test positive for the BRCA mutation (14%). Distress levels, measured by the Impact of Event scale, suggest that few spouses were experiencing clinical levels of distress.     

Mar法检测抗精抗体与经典试验方法的比较

本文采用混合抗球蛋白试验法（Mar）检测不育夫妇的抗精抗体，52例不育夫妇的检测结果如下：男方精子表面抗体阳性：3．8％（2／52），男女双方血清阳性率：14．42％，同时采用经典方法（SIT、TSAT、GAT）作对比，其百分率均低于Mar法。     

台山市HIV／AIDS配偶间感染状况分析

目的了解台山市HIV感染者／病人配偶间HIV感染状况,为制定有效干预措施提供科学依据。方法从艾滋病综合防治信息管理系统筛选出2012年存活可随访到的现住址为台山市、有配偶且配偶为阴性或阳性的HIV／AIDS病例资料,建立数据库进行分析。结果共有164对HIV双阳或单阳配偶,HIV双阳率为61．59％（101／164）,HIV单阳率38．41％（63／164）。男方HIV感染阳性率为58．11％,高于女方的41．89％,差异有统计学意义（X2=13．95,P〈0．01）,30～39岁年龄段的人数最多占49．06％（130／265）。传播途径为注射毒品感染占80．49％（132／164）。配偶中以男方先检出的占64．63％（106／164）,其中52．83％为羁押场所检出,而以女方为先检出的配偶中47．73％为孕产期检查检出。双阳配偶中。44．55％的夫妻检测阳性时间间隔在3个月以内。单阳家庭接受抗病毒治疗的比例比双阳家庭高,差异有统计学意义（X2=38．88,P〈0．01）。结论台山市配偶间HIV传播率较高,开展监测早期发现感染者。加强30～39岁年龄段人群干预工作力度,是阻断家庭内性传播的重点工作。     

The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection

Factors other than spermatozoa could be the major determinant of the success of assisted reproduction treatment in cases of male infertility. Our aim was to evaluate the effect of the wife's age and ovarian reserve on assisted reproduction success rates in the most severe type of male infertility, i.e. azoospermia. A total of 249 consecutive couples suffering from male infertility caused by azoospermia underwent microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI). Of these men, 186 had irreparable obstructive azoospermia, and 63 had non-obstructive azoospermia due to testicular failure. Neither the pathology, the source, the quantity, nor the quality of spermatozoa had any effect on fertilization or pregnancy rates. Maternal age and ovarian reserve (number of eggs) had no effect on fertilization or embryo cleavage, but did dramatically affect the embryo implantation, pregnancy and delivery rates. Wives of azoospermic men who were in their 20s had a 46% live delivery rate per cycle, wives aged 30-36 years had a 34% live delivery rate per cycle, wives aged 37- 39 years had a 13% live delivery rate per cycle, and wives > or = 40 years had only a 4% live delivery rate per cycle. The number of eggs retrieved also affected pregnancy and delivery rate, but to a lesser extent than age. In virtually all cases of obstructive azoospermia, and in 62% of cases with non-obstructive azoospermia caused by germinal failure, sufficient spermatozoa could be retrieved to perform ICSI, with normal fertilization and embryo cleavage. However, the pregnancy rate and the live delivery rate were dependent strictly on the age of the wife, and on her ovarian reserve. Unfortunately, exaggerated claims of high pregnancy rates can thus easily be made by manipulating, in a very simple way, selection for female factors.      

The psychological influence of gender infertility diagnoses among men about to start IVF or ICSI treatment using their own sperm

BACKGROUND: The aim of the present study was to investigate the psychological influence of gender infertility diagnoses among men in couples about to start their first IVF or ICSI treatment. METHODS: The study was a part of a prospective study of 65 men with male infertility diagnosis and 101 men in couples with female, mixed and unexplained infertility diagnoses. Of the 200 men invited, 166 agreed to participate (83% response rate). The men answered questionnaires concerning psychological and social factors on three occasions, at the information meeting held 2-4 weeks prior to first treatment, 1 h before oocyte retrieval and 2 weeks after the pregnancy test. RESULTS: The main findings of this study gave no indication that male infertility influenced men negatively concerning their experience of infertility, view of life and relationships and psychological well-being. We found that men with a male factor infertility diagnosis reacted in a similar way as compared with men in couples where the diagnosis was female, mixed or unexplained infertility. CONCLUSIONS: In general, men are well adjusted with regard to a first IVF/ICSI treatment cycle, independent of gender infertility diagnoses.     

Immunological assessment of infertility by estimation of antisperm antibodies in infertile couples.

160 clinical samples were collected from 40 infertile couples with unexplained infertility. The samples collected included serum and seminal plasma of the male partners and serum and cervical mucus samples of the female partners. 25 fertile healthy couples were investigated as controls. All the samples collected were then tested for class-specific antisperm antibodies by an Enzyme linked immunosorbent assay (ELISA). Antisperm antibodies were detected in 30% of the infertile couples which included 25% female and 10% male partners. Amongst the cases positive for antisperm antibodies, antibodies were detected most frequently in female sera 58.4% followed by male sera 33% and 25% in cervical mucus. The isotyping of antisperm antibodies in various samples showed IgG to be the most frequent type specific antibody followed by IgM & IgA types of antibodies. ELISA has provided a relatively simple, reliable and highly reproducible method of detection of antisperm antibodies. Thus application of antisperm antibody testing especially in cervical mucus should become an integral part of the investigation of immunologic infertility.     

135例男性不育症的细胞遗传学分析

目的研究男性染色体异常与男性不育症的关系。方法用常规方法制备外周血淋巴细胞标本,对135例男性不育症患者进行染色体G显带核型分析。结果检出异常核型74例,占全部被检者55％。其中性染色体异常40例。占全部被检者30％,占异常核型54％;常染色体异常34例,占全部被检者25％,占异常核型46％。结论对男性不育症的患者进行染色体检查能对不育夫妇的诊断和治疗提供指导性依据。     

The prognostic power of the post-coital test for natural conception depends on duration of infertility

Controversy about the value of the post-coital test (PCT) has prompted us to re-analyse data from 207 couples, originally studied between 1982 and 1983, with at least 12 months' infertility at presentation, complete diagnostic information and exclusion of female factors, to clarify the effect of duration of infertility on the prediction of conception. In couples with less than 3 years infertility and a positive PCT, 68% conceived within 2 years compared with 17% of those with a negative result. After 3 years, corresponding rates were 14% and 11%. The relative risks of conception [95% confidence interval (CI)] calculated using the Cox's proportional hazards model were 0.23 (0.12-0.43) for a negative PCT (reference positive PCT) and 0.25 (0.13-0.51) for more than 36 months infertility (reference 12-23 months). Semen analysis had no extra predictive power given the duration of infertility and the PCT. The PCT is an effective predictor of conception where defined female causes of infertility are absent and duration of infertility is less than 3 years. Once infertility is prolonged (beyond 3 years) the conception rate is low even with a positive test because a large proportion of couples remaining childless so long have true unexplained infertility. Use of the PCT will enable clinicians to allocate scarce, expensive and invasive resources effectively.     

不孕不育患者的抗精子抗体分析

目的分析抗精子抗体(AsAb)与不孕不育的关系。方法采用ELISA方法检测1086例不孕不育症患者血清中的抗精子抗体(总抗)。结果1086例患者血清中,AsAb阳性313例,占28.82%,其中男性阳性率为24.16%(115/476),女性阳性率为32.46%(198/610),男女之间差异极显著(P<0.01)。结论进行抗精子抗体检测对不孕症的诊断和治疗具有重要意义。     

152例男性不育患者细胞遗传学研究

目的研究男性不育患者的遗传缺陷与精子生成障碍的关系。方法采用G显带分析152例患者外周血染色体核型,并采用计算机辅助精液分析,瑞吉染色检测精子凋亡情况,并采用聚合酶链式反应对其中染色体核型正常的患者进行Y染色体微缺失的检测。结果在152例不育患者中,检出异常核型29例,异常核型发生率为19.08%;其中60例染色体核型正常的不育患者精子凋亡率为（18.26±9.34）%,正常组为（3.52±2.11）%,两组比较有显著性差异;53例染色体核型正常的不育患者有Y染色体微缺失6例,缺失率11.3%,正常对照组未检出Y染色体微缺失。结论染色体核型异常、Y染色体微缺失以及精子凋亡是引起男性不育的重要原因。同时采用这三种遗传学检测方法可以更全面的评价男性不育患者的遗传缺陷情况,更好的为患者提供病因诊断、遗传咨询和治疗方案。     

822例不孕症宫腔镜诊治的临床意义

目的探讨宫腔镜手术在不孕症患者诊治中的应用价值。方法回顾性分析应用宫腔镜诊治不孕症822例的临床资料。结果 822例不孕症患者行宫腔镜检查,宫腔及输卵管近端异常检出率为83.5%(686/822)。其中:宫腔大致正常者136例(16.6%);子宫内膜病变45l例(54.9%);宫腔粘连125例(15.2%);输卵管近端阻塞69例(8.4%);子宫畸形34例(4.1%);子宫粘膜下肌瘤5例(0.6%);宫内异物2例(0.2%)。822例不孕患者经宫腔镜治疗后随访,有204例正常宫内妊娠,术后妊娠率为24.8%(204/822)。其中:宫腔大致正常者25/136(18.4%,);子宫内膜病变103/451(22.8%,);宫腔粘连39/125(31.2%,);输卵管近端阻塞20/69(29%,);子宫畸形15/34(44.1%,);子宫粘膜下肌瘤2/5(40.0%,);宫内异物0/2(0%,)。结论宫腔镜诊治不孕症准确、有效、简单、微创、并发症少,是目前诊治女性不孕症最有效的手段之一,值得临床应用、推广。     

腹腔镜诊治不孕症患者盆腔病变临床分析

目的探讨应用腹腔镜手术诊治不孕症的临床价值。方法对126例女性不孕症患者行腹腔镜诊断和治疗,观察术后妊娠率。结果 126例中发现盆腔病变117例,占92.86%;慢性盆腔炎是不孕症的第1位病因;其次为子宫内膜异位症、多囊卵巢综合征。腹腔镜手术术后妊娠率为47.50%,1例发生异位妊娠。结论腹腔镜手术对女性不孕症盆腔病变的诊治具有重要的价值。     

河南地区311例男性不育症患者的细胞遗传学研究

目的探讨男性不育症与细胞遗传学异常的关系。方法选取311例男性不育症患者进行外周血淋巴细胞染色体G显带核型分析。结果检出异常核型74例,占全部被检者23.79%。其中性染色体异常57例,占全部被检者18.33%,占异常核型77.03%;染色体结构异常17例,占全部被检者5.47%,占异常核型22.97%。结论性染色体数目异常是男性不育症的主要原因之一,对男性不育症患者进行染色体检查能对不育夫妇的诊断和治疗提供指导性依据。     

9号染色体臂间倒位的遗传效应探讨

目的 研究人类9号染色体臂间倒位的遗传效应,分析9号染色体臂间倒位与自然流产、不育、不孕的关系.方法 采取患者外周血进行淋巴细胞培养,按常规方法制备染色体,应用G显带和C显带技术进行核型分析;对3组患者分别与正常对照组进行比较.结果 在3117例受检患者中,共检出9号染色体臂间倒位66例,发生率为2.1%,其中自然流产组为2.1%,不育组为2.6%,不孕组为2.0%,正常对照组为0.9%,经统计学分析几组之间差异存在统计学意义.结论 9号染色体臂间倒位可导致异常生育.     

Clinical adaptation of the sperm ubuquitin tag immunoassay (SUTI): relationship of sperm ubiquitylation with sperm quality in gradient-purified semen samples from 93 men from a general infertility clinic population

BACKGROUND: The proteolytic chaperone peptide ubiquitin accumulates in defective human spermatozoa. Immunodetection of ubiquitin in human sperm samples correlates with semen quality and male fertility. METHODS: Semen samples from 93 men from couples seeking infertility treatment were separated on a PureSperm density gradient and screened by immunofluorescence microscopy with anti-ubiquitin antibodies. The percentage of spermatozoa with head ubiquitylation was recorded and compared with clinical semen evaluation and embryo development data after IVF or ICSI. Subjects were divided into the following four groups based on the initial clinical diagnosis of the couples; group 1, male factor; group 2, idiopathic infertility; group 3, female infertility with neither partner having children previously; and group 4, female infertility with male partners having children from previous relationships. RESULTS: The percentage of sperm with ubiquitylated heads remaining after PureSperm separation in the respective groups was 4.0% (male factor), 2.5% (idiopathic infertility), 0.7% (female infertility and presumed fertile male) and 0.9% (female infertility with established fertile male). Negative correlations between sperm ubiquitin and several parameters reflective of embryo development after assisted fertilization were found within the male factor group. CONCLUSIONS: Use of this simplified ubiquitin-based sperm quality assay is feasible in a clinical environment. Since the gradient separation does not completely deplete the defective spermatozoa, the modified light microscopic sperm ubiquitin tag immunoassay could add a new level of stringency to the selection of human spermatozoa for ICSI.     

Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989).

To estimate the prevalence and main causes of infertility, a multicentre survey was conducted over 1 year (July 1988-June 1989) in three regions of France. All the 1686 couples in these regions, who consulted a practitioner for primary or secondary infertility during this period, were included in the investigation. The prevalence rate of infertility was found to be 14.1%, indicating that one woman out of seven in France will consult a doctor for an infertility problem during her reproductive life. The main causes of female infertility were ovulation disorders (32%) and tubal damage (26%), and of male infertility oligo-terato-asthenozoospermia (21%), asthenozoospermia (17%), teratozoospermia (10%) and azoospermia (9%). Infertility was also found to be caused by disorders in both the male and female partners together; thus in 39% of cases both the man and woman presented with disorders. The woman alone was responsible for infertility in one-third of cases and the man alone in one-fifth. Unexplained infertility was found in 8% of the couples surveyed.     

SRY基因在性发育异常诊断中的应用

目的为SRY在临床分子诊断中的应用提供参考,并对性发育异常机制进行探讨。方法通过对32例性发育异常患者和男性不育症患者进行SRY基因的检查分析,应用聚合酶链式反应（PCR）对性发育异常患者和男性不育症患者进行SRY检测。结果检出成功率为93.75%（30/32）,异常率为28.13%（9/32）,其中女性SRY扩增阳性率为9.38%（3/32）,男性SRY扩增阴性率为18.75%（6/32）。结论SRY基因是性别分化的关键基因,SRY基因的缺失或突变是造成性发育异常的主要原因,研究也表明人类的性别决定和分化还有其他相关基因的参与。对性发育异常患者进行SRY基因检测,有利于了解该类患者的遗传学病因,为其诊断和治疗提供科学依据。     

免疫性不育伴精囊炎微电脑脉冲式水囊按摩药渗仪治疗及机理

介绍微电脑脉冲式水囊按摩药渗仪的研制及研究其对男性免疫性不育伴慢性精囊炎的疗效及机理。根据免疫性不育伴慢性精囊炎的病理特点，在临床实验的基础上，结合生物医学工程技术和现代中医药理论，研制出微电脑脉冲式水囊按摩药渗仪。用于治疗免疫性不育伴慢性精囊炎病人181例。慢性精囊炎临床治愈135例(74．6％)，显效37例(20.4％)，好转9例(5．0％)。精浆中抗精子抗体(AsAb)转阴率为85．6％，配偶受孕率为49．1％。无任何副作用。     

Couples coping with chronic illness: Women with rheumatoid arthritis and their healthy husbands

Effects of a chronic disease, rheumatoid arthritis, upon the psychological adjustment of 103 women and their healthy husbands were examined. Husbands completed scales assessing perceived vulnerability to illness and coping efficacy, burden of caring for their wives, and level of psychological adjustment. Wives completed the Ways of Coping scale, rated attributions about arthritis, and rated criticalness and supportiveness of their husbands. Husbands were also interviewed and their responses coded for critical remarks about the wife. The same variables were used to predict each partner's adjustment in order to compare factors associated with each. Hierarchical regression indicated that negative marital interaction surrounding the wife's illness was a determinant of both partners' psychological adjustment. Apart from this variable, different factors predicted husbands' and wives' mental health. Husbands were most affected by their own perceived vulnerability to disease and coping inefficacy. Wives were most affected by pain severity and how they coped with arthritis.