女性不孕症合并盆腔粘连腹腔镜诊治临床分析

目的探讨盆腔粘连与女性不孕症的关系，以及腹腔镜在诊治盆腔粘连相关的女性不孕症中的意义。方法回顾性分析2003年6月至2005年6月在我院因不孕症行腹腔镜诊治的481例不孕患者。其中原发不孕175例，继发不孕306例。分析腹腔镜下不孕症患者盆腔粘连、盆腔粘连合并输卵管阻塞发生率和盆腔粘连腹腔镜术后妊娠情况。结果腹腔镜检查发现原发和继发不孕患者盆腔粘连发生率分别为45．7％和65％，差异有显著性（P〈0．05）。盆腔粘连合并输卵管阻塞在原发不孕中发生率为65．0％，在继发不孕中发生率为58．7％。原发不孕盆腔粘连患者腹腔镜术后宫内自然妊娠率为32．5％（26／80），其中术后6个月内自然妊娠占76，9％（20／26）；继发不孕盆腔粘连患者腹腔镜术后宫内自然妊娠率为27.1％（54／199），其中术后6个月内自然妊娠占66．7％（36／54）。结论盆腔粘连是引起女性不孕症最常见盆腔病变之一。腹腔镜可及时准确地发现不孕症患者的盆腔粘连情况，并同时行镜下盆腔粘连的分离，是诊治不孕患者较为理想的方法。     

Sexual dysfunction in men undergoing infertility evaluation: a cohort observational study

OBJECTIVE: To study psychosexual problems in men undergoing infertility evaluation. DESIGN: A cohort observational study. SETTING: Male infertility diagnostic center. PATIENT(S): Four hundred twelve men undergoing infertility evaluation between 1999 and 2001. INTERVENTION(S): Baseline and follow-up data on sexual functions. Semen analysis for samples collected by masturbation. A second analysis was requested in 2 weeks upon finding an abnormality of semen parameters. Penile vibratory stimulation to help men who failed to collect semen on their second or subsequent appointments. MAIN OUTCOME MEASURE(S): Sexual functions (erection and orgasm) during the time of infertility evaluation. RESULT(S): Seven of 412 men were excluded from the analysis due to a past history of sexual dysfunction. Of the remaining 405 men, 46 (11%) failed to collect semen by masturbation for a second semen analysis after repeated (2-4 times) attempts at 2- to 3-day intervals. Nine of these men (20%) were able to collect semen using vibratory stimulation. All 46 men experienced problems with erection or orgasm and had severe anxiety during attempts to masturbate and during sexual contact with their partners. CONCLUSION(S): Our study indicates that some men may experience sexual dysfunction of a psychogenic nature in response to the diagnosis of infertility.     

Effect of mindfulness-based cognitive infertility stress therapy on psychological well-being of women with infertility

Objective

Infertility is a critical major life problem that has deleterious effects on the psychological well-being of infertile women. Infertile women experience greater stress in their life compared to fertile women and have a lower quality of life. The present study aimed to evaluate the effectiveness of mindfulness-based cognitive infertility stress therapy (MBCIST) for the promotion of the psychological well-being of women with infertility.

Time-specific effect of prenatal stressful life events on gestational weight gain

Objective

To investigate the time-specific effect of maternal exposure to prenatal stressful life events (SLEs) on gestational weight gain (GWG) and to determine whether pre-pregnancy body mass index (BMI) modifies the effect.

Methods

Between March and November 2008, data were collected from 1800 pregnant women who received prenatal check-ups in Hefei, China, after 32 completed weeks of gestation. Participants completed a structured interview on demographic characteristics and a checklist of SLEs during different stages of pregnancy. GWG during pregnancy was determined by self-reported pre-pregnancy weight and measured weight at delivery.

Results

There was a significant dose–response relationship between prenatal SLEs in the first, but not the second or third, trimester and GWG. For each 1-unit increase in SLEs during the first trimester, there was a reduction in GWG of approximately 0.497 kg (95% confidence interval, 0.176–0.817 kg). After stratification by pre-pregnancy BMI, a significant negative association between SLEs in the first trimester and GWG was observed among women with pre-pregnancy normal (β = − 0.796; 95% CI, − 1.291 to − 0.301) and low (β = − 1.066; 95% CI, − 2.180 to − 0.048) weight.

Conclusion

The effect of prenatal SLEs on GWG depends on the timing of maternal exposure to stress and varies according to pre-pregnancy BMI.     

生活事件对试管婴儿辅助助孕临床妊娠率的影响

目的 探讨生活事件对试管婴儿辅助助孕临床妊娠率的影响。方法 收集接受试管婴儿治疗不孕患者的一般情况、内膜厚度、内膜形态等生理因素以及生活事件,并追踪记录其临床妊娠结局。采用多因素Logistic回归,分析生活事件对妊娠结局的影响。结果 生活事件、内膜形态、内膜厚度、移植优质胚胎比例是妊娠率的重要影响因素。主观生活事件(SE)增加1分,成功妊娠的几率为原来的0.895;客观生活事件(OE)中第2类应激强度(OE2)增加1分,成功妊娠的几率为原来的0.894。结论 不孕患者经历的生活事件过多,应激水平过高,不利于妊娠。     

No partial <Emphasis Type="Italic">DAZ</Emphasis> deletions but frequent gene conversion events on the Y chromosome of fertile men

Purpose: Recently, partial DAZ deletions on the Y chromosome were identified in infertile men. To determine the clinical importance of partial DAZ deletion, we studied the number of DAZ copies in a well-defined population of 47 fertile men.Methods: The number of DAZ gene copies was determined by PCR assays, qualitative and quantitative DNA blot experiments.Results: Using semi-quantitative Southern blot, no partial DAZ deletion was detected in fertile men. In many cases, the results were discordant with the PCR assays and qualitative DYS1-blot experiments suggesting that the molecular events detected by the later methods could reflect gene conversion events. Many fertile men present four copies of the DAZ genes but an atypical organization of this DAZ locus. No difference in sperm concentration and motility in the fertile men were observed according to the different DAZ-haplotypes.Conclusion: The different DAZ-haplotypes are compatible with normal spermatogenesis.     

促性腺激素释放激素激动剂对子宫内膜异位症不孕患者在位内膜一氧化氮合酶表达的影响

目的探讨一氧化氮合酶(NOS)在子宫内膜异位症(内异症)不孕患者在位子宫内膜(在位内膜)中的表达及促性腺激素释放激素激动剂(GnRHa)对其表达的影响。方法采用免疫组化方法及蛋白印迹方法,对30例Ⅲ～Ⅳ期内异症不孕患者(内异症组)及19例有正常生育史的宫颈原位癌患者(对照组)的在位内膜进行内皮型NOS(eNOS)及诱生型NOS(iNOS)表达的定位及半定量检测,内异症组中18例行GnRHa治疗(治疗组);采用电化学发光法,同时测定患者血清雌二醇及孕酮水平。结果eNOS在子宫内膜的腺上皮、腔上皮及血管内皮细胞中均有表达;iNOS仅在子宫内膜的腺上皮和间质细胞中微弱表达。eNOS在增生期早、中、晚期和分泌期早、中、晚期在位内膜中的相对表达水平,内异症组分别为0.30±0.04,0.40±0.03,0.49±0.03,0.43±0.04,0.55±0.04和0.48±0.03,治疗组分别为0.22±0.03,0.37±0.03,0.45±0.04,0.35±0.05,0.50±0.03和0.41±0.00,对照组分别为0.21±0.03,0.33±0.03,0.45±0.04,0.40±0.03,0.47±0.05和0.41±0.03。在整个月经周期中,内异症组患者在位内膜eNOS相对表达水平持续性高于对照组患者,但仅在增生期早、中期及分泌期中、晚期两组比较,差异有统计学意义(P<0.05);与内异症组比较,治疗组在位内膜eNOS相对表达水平均有所下降,但仅在增生期早期及分泌期早、中期比较,差异有统计学意义(P<0.05)。3组子宫内膜中均未检出iNOS的表达。血清雌二醇或孕酮水平与子宫内膜eNOS表达水平均呈正相关(P<0.01)。结论eNOS在内异症患者在位内膜中的高表达,可能与其发病及其所致的不孕有关,GnRHa治疗可降低内异症患者在位内膜eNOS的表达。     

A comparative analysis of arterial blood flow in unexplained infertility,tubal infertility and fertile groups

We aimed to compare ovarian (O), uterine (U) and spiral (S) artery (A) resistance of patients diagnosed as fertile, unexplained infertility (UI) and tubal factor infertility (TFI) in the peri-implantation period and independent from the impact of the treatment. UI (n?=?70), TFI (n?=?75) and fertile (n?=?72) patients’ ovarian, uterine and spiral artery pulsatility index (PI), resistance index (RI) and the endometrial thickness, serum estradiol and progesterone levels were compared. The specificity and sensitivity values were calculated according to determined cutoff values. Both TFI and control groups’ UA PI values were significantly lower than the UI group’s PI values. The highest UA RI values were found in UI group and the lowest values were in the control group. UI and TFI groups’ OA PI/RI values were significantly higher than the control group. Both the control and TFI groups’ SA PI/RI values were significantly lower than UI group’s PI/RI values. UI patients’ uterine and spiral arteries PI values >1.86 and >0.85, RI values >0.80 and >0.53 can be used as a valuable test showing reduced uterine perfusion. Ovarian artery PI values >0.96 and RI values >0.58 can be used as tests showing decreased ovarian perfusion in patients with TFI. In these patients, embryo cryopreservation can be considered.     

Unexplained infertility categorization based on female laparoscopy and total motile sperm count,and its impact on cumulative live-births after one in-vitro fertilization cycle. A retrospective cohort study involving 721 cycles

PurposeTo determine how subcategorizing unexplained infertility based on female laparoscopy and total‐motile‐sperm‐count assessment would impact cumulative live‐births after one in‐vitro fertilization (IVF) cycle.MethodsSeven hundred twenty one IVF cycles from Jan 2014‐April 2019 performed at a single‐center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total‐motile‐sperm‐count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Controls were severe male factor, bilateral tubal block, and grade 3/4 endometriosis: n = 418. Primary Outcome was cumulative‐live‐birth‐per‐initiated‐IVF cycle (CLBR). Odds ratio for live‐births were adjusted for confounding factors.ResultsThe CLBR in UI1 cohort was significantly lower than controls (29.1% vs 39; OR = 0.62; 95%CI = 0.39‐0.98; P = .04); but similar in UI2 and UI3 vs. controls. (37.2% vs 39.95%; OR = 0.89, 95%CI = 0.55‐1.44; P = .89) and (38.6% vs 39.95%; OR = 0.98, 95%CI = 0.64‐1.55; P = .98). After adjusting for age, infertility duration, past live‐births, and AMH, the adjusted odds for CLBR in UI1 was 0.48 (95%CI = 0.28‐0.82; P = .007).ConclusionsUnexplained infertility when defined after a normal laparoscopy and TMSC significantly lowered cumulative‐live‐births‐per‐initiated‐IVF cycle when compared with traditional diagnosis of tubal, endometriosis, or male factor infertility. In UI subcategory with abnormal laparoscopy or TMSC, CLBR remained unaffected. This information could be useful for counseling couples prior to IVF. Large‐scale prospective studies are needed to confirm this observation.     

Oxidative stress and male infertility

BackgroundBetween 30% and 80% of patients with male infertility produce excessive reactive oxygen species (ROS) in their ejaculate even though the cause of male infertility is unexplained in approximately half of cases. The strong connection between oxidative stress (OS) and male infertility has led recent investigators to propose the term “Male Oxidative Stress Infertility (MOSI)” to describe OS‐associated male infertility.MethodsWe searched the PubMed database for original and review articles to survey the effects of OS on male infertility, and then verified the effects and treatments.Main findingsSeminal plasma contains many antioxidants that protect sperm from ROS, because low amounts of ROS are required in the physiological fertilization process. The production of excessive ROS causes OS which can lower fertility through lipid peroxidation, sperm DNA damage, and apoptosis. Several assays are available for evaluating OS, including the MiOXSYS® analyzer to measure oxidation‐reduction potential. Several measures should be considered for minimizing OS and improving clinical outcomes.ConclusionAccurately diagnosing patients with MOSI and identifying highly sensitive biomarkers through proteomics technology is vital for better clinical outcomes.     

Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression

Objective

to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we investigated whether the associations were affected by personality or childhood adversities.

Design

observational prospective cohort study

Setting

primary and secondary obstetric care centres in the Netherlands

Participants

1603 women during their first trimester of pregnancy between May 2010 and May 2012

Measurements and findings

we performed linear regression analyses to test the associations of pregnancy related, non-pregnancy related life events, childhood adversities and the personality traits neuroticism and extraversion with the change in symptoms of anxiety (State Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale) from week 12 to week 36.Life events during pregnancy were associated with increasing antenatal symptoms of anxiety and depression. Effect sizes associated with the highest numbers of events observed ranged from 0.59 to 1.31. Pregnancy related events were specifically associated with increasing symptoms of anxiety (p=0.009), whereas non-pregnancy related events were merely associated with an increase in symptoms of depression (p<0.001). Neither personality traits nor childhood trauma influenced the associations under study.

Key conclusions

the most important finding is that pregnancy related life events during pregnancy increase levels of antenatal anxiety, whereas depression levels increase when women experience life events that are unrelated to pregnancy. Furthermore, non-pregnancy related events show stronger associations with increases in symptoms of anxiety or depression compared to pregnancy related events.

Implications for practice

our findings may help midwives to tailor psychosocial care to the specific risks of the pregnant woman which may eventually have a positive impact on the health of mother and child.     

Quantifying the effectiveness and cost-efficiency of food supplementation with antioxidants for male infertility

In male infertility, complementary treatment with antioxidant-containing food supplements quadruples the spontaneous pregnancy rate and reduces the cost per pregnancy by 60%.     

Proteomics,oxidative stress and male infertility

Oxidative stress has been established as one of the main causes of male infertility and has been implicated in many diseases associated with infertile men. It results from high concentrations of free radicals and suppressed antioxidant potential, which may alter protein expression in seminal plasma and/or spermatozoa. In recent years, proteomic analyses have been performed to characterize the protein profiles of seminal ejaculate from men with different clinical conditions, such as high oxidative stress. The aim of the present review is to summarize current findings on proteomic studies performed in men with high oxidative stress compared with those with physiological concentrations of free radicals, to better understand the aetiology of oxidative stress-induced male infertility. Each of these studies has suggested candidate biomarkers of oxidative stress, among them are DJ-1, PIP, lactotransferrin and peroxiredoxin. Changes in protein concentrations in seminal plasma samples with oxidative stress conditions were related to stress responses and to regulatory pathways, while alterations in sperm proteins were mostly associated to metabolic responses (carbohydrate metabolism) and stress responses. Future studies should include assessment of post-translational modifications in the spermatozoa as well as in seminal plasma proteomes of men diagnosed with idiopathic infertility.Oxidative stress, which occurs due to a state of imbalance between free radicals and antioxidants, has been implicated in most cases of male infertility. Cells that are in a state of oxidative stress are more likely to have altered protein expression. The aim of this review is to better understand the causes of oxidative stress-induced male infertility. To achieve this, we assessed proteomic studies performed on the seminal plasma and spermatozoa of men with high levels of oxidative stress due to various clinical conditions and compared them with men who had physiological concentrations of free radicals. A variety of sperm and seminal plasma proteins were found to be expressed either in abundance (over-expressed) or in a lesser amount (underexpressed), while other proteins were found to be unique either to men with oxidative stress or to men with a balanced ratio of antioxidants/free radicals. Each study included in this review suggested several proteins that could possibly act as biomarkers of oxidative stress-induced male infertility, such as protein DJ-1, PIP, lactotransferrin and peroxiredoxin. Pathway analysis performed in these studies revealed that the changes in seminal plasma proteins in men with oxidative stress could be attributed to stress responses and regulatory pathways, while changes in sperm proteins were linked to stress responses and metabolic responses. Subsequent studies could look into post-translational modifications in the protein profile of men with idiopathic infertility. We hope that the information in this review will contribute to a better understanding of the main causes of idiopathic male infertility.     

影响男性不育官腔内人工授精妊娠率的因素分析

目的探讨影响男性不育患者行宫腔内人工授精（IUI）临床妊娠的相关因素。方法回顾性分析337对不孕夫妇因男性因素行IUI共667周期的资料,分析男女双方年龄、不孕年限、女方体重指数（BMI）、促排卵方案以及处理后前向运动精子总数（PTMS）对临床妊娠率的影响。结果女方年龄≥35岁者临床妊娠率为12．6％,显著低于年龄〈30岁者;男方年龄≥35岁者临床妊娠率为15．9%,显著低于年龄〈35岁者;克罗米芬联合促性腺激素周期临床妊娠率为25．5％,显著高于自然周期;PTMS〈5×10^6临床妊娠率为8．3％,显著低于PTMS≥10×10^6（P〈0．05）。结论男性不育患者行IUI治疗过程中需要充分考虑男女双方年龄对治疗结局的影响,适时选择促排卵方案,以提高临床妊娠率;当PTMS〈5×10^6,IUI妊娠率显著下降,建议行IVF-ET／ICSI—ET治疗以改善妊娠结局。