Alcohol use as predictor for infertility in a representative population of Danish women

BACKGROUND: Our aim was to examine the association between use of alcohol and subsequent incidence of primary infertility. METHODS: The study subjects were chosen from a population-based cohort of Danish women aged 20-29 years. Eligible women were nulliparous and not pregnant (n = 7760). Information on alcohol intake and potential confounders (age, education, marital status, diseases in the reproductive organs, and cigarette smoking) was assessed at enrollment. The incidence of fertility problems during follow-up was obtained by record linkage with the Danish Hospital Discharge Register and the Danish Infertility Cohort Register. Main outcome measures were hazard ratios of infertility according to alcohol intake at baseline estimated in a multivariate Cox proportional hazards model. RESULTS: During a mean follow-up of 4.9 years, 368 women had experienced infertility. Alcohol intake at baseline was unassociated with infertility among younger women, but was a significant predictor for infertility among women above age 30. In this age group, the adjusted hazard ratio for consuming seven or more drinks per week was 2.26 (95% confidence interval: 1.19-4.32) compared with women consuming less than one drink per week. CONCLUSIONS: These findings suggest that alcohol intake is a predictor for infertility problems among women in the later reproductive age group.     

Detection of cytomegalovirus in semen from a population of men seeking infertility evaluation

Objective: To determine the incidence of cytomegalovirus in the ejaculates of infertile men who were seropositive for IgG antibodies to cytomegalovirus.Design: Prospective study.Patient(s): We tested cytomegalovirus infected in the semen of men participating in an IVF-ET program.Main Outcome Measure(s): IgG and IgM antibodies to cytomegalovirus were measured in sera. We used polymerase chain reaction (PCR) and cell culture to look for both cytomegalovirus DNA and infectious virus in the semen of 70 men with cytomegalovirus-specific antibodies detected in sera.Result(s): Human cytomegalovirus was present in the semen from a population of IgG antibodies to cytomegalovirus in male serum only and not in female serum) and constituted a potential risk for cytomegalovirus transmission. Cytomegalovirus was identified in the semen of two patients who were positive for IgG antibodies to cytomegalovirus. Cytomegalovirus DNA also was detected in one positive sample after centrifugation through a three-layer Percoll gradient.Conclusion(s): Human cytomegalovirus was present in the semen from a population of infertile men. Rapid detection can be achieved by molecular techniques such as PCR combined with a hybridization assay. Even though cytomegalovirus was infrequently detected in semen, these data must be considered in determining the risk of transmission and developmental anomalies in infected fetuses.     

Racial and economic demographics of couples seeking infertility treatment

OBJECTIVE: We characterized new infertility patients on the basis of race and economic factors. STUDY DESIGN: A retrospective chart review was performed of all patients seeking infertility evaluation from 1998 to 1999 at two infertility centers in Cincinnati, Ohio. Patients were categorized by race (white, black, or other). Statistics were analyzed by chi2 and logistic regression. RESULTS: Of 756 patients, 85.2% were white, 10.2% were black, and 4.4% were other. Infertility diagnoses were placed into the following 7 categories: ovarian, salpingitis, surgical sterilization, male factor, endometriosis, unexplained, and other. Black women had significantly more salpingitis than did nonblack women (P <.001) regardless of insurance status. However, surgical sterilization was more prevalent in patients without insurance regardless of race (P <.001). CONCLUSIONS: Our findings are consistent with previous studies showing that black women have more risk factors for salpingitis. Surgical sterilization risk factors were concordant with those of the National Center for Health Statistics.     

Infertility, infertility treatment, and fetal growth restriction

OBJECTIVE: To examine the association between infertility, with or without treatment, and fetal growth, as well as perinatal and infant mortality. METHODS: From the Danish National Birth Cohort (1997-2003), we identified 51,041 singletons born of fertile couples (time to pregnancy 12 months or less), 5,787 born of infertile couples conceiving naturally (time to pregnancy more than 12 months), and 4,317 born after treatment. We defined small for gestational age (SGA) as the lowest 5% of birth weight by sex and gestational age. RESULTS: Crude estimates suggested an increased risk of perinatal mortality and SGA among infertile couples (treated and untreated), but the odds ratios (ORs) of perinatal mortality among infertile couples were attenuated after adjustment for maternal age and body mass index (1.32, 95% confidence interval [CI] 0.95-1.84 among untreated and 1.26, 95% CI 0.86-1.85 among treated couples). The elevated risk of SGA among infertile couples persisted after adjustment for maternal age, parity, and smoking (OR 1.24, 95% CI 1.10-1.40 among untreated, and OR 1.40, 95% CI 1.23-1.60 among treated). The risk of SGA increased with time to pregnancy, and a longer time to pregnancy was associated with a small reduction in birth weight across the whole distribution. CONCLUSION: The increased risk of SGA observed among infertile couples with or without infertility treatment suggests that infertility may be a risk factor for intrauterine growth restriction. Treatment per se may have little effect on fetal growth. A small-to-moderate increased risk of perinatal mortality in infertile couples cannot be ruled out due to the small number of cases. LEVEL OF EVIDENCE: II.     

Exposure to environmental toxins in males seeking infertility treatment: a case-controlled study

This case-control study explored the role of environmental toxins in male infertility in patients attending an assisted reproduction clinic in southeastern Spain. Exposures were compared by questionnaire for 30 infertile oligoasthenoteratozoospermic males (cases) and 31 normozoospermic controls residing in the area. Odds ratios and 95% confidence intervals (CI) were used to estimate differences in lifestyle and chemical occupational exposures. More than two-thirds of the cases (23/30), compared with less than one-third of controls (10/31), had been exposed occupationally to at least one toxin or pollutant (OR = 6.9; 95% CI: 2.2-21.4) and were also more exposed to them currently (OR = 5.2; 95% CI: 1.6-17.2). Exposure to glues, solvents or silicones (OR = 22.9; 95% CI: 2.8-190.9), metals (OR = 8.8; 95% CI: 1.4-54.2) and physical agents (OR = 7.3; 95% CI: 1.4-36.7) in the past, as well as current exposure to glues, solvents or silicones (OR = 10.4; 95% CI: 2.6-42.5) and physical agents (OR = 4.7; 95% CI: 1.1-19.2), were significantly higher in cases than in controls. Average duration of exposure was also significantly higher in cases (P < 0.001). This study suggests that male infertility in patients attending infertility clinics may often be the result of occupational exposure.     

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.     

Sexual desire in a nationally representative Danish population

IntroductionThere are only a few studies on the frequency of sexual desire in the general population, whereas studies investigating the frequency of disordered sexual desire are more common.AimThe aim of this study was to describe the frequency of sexual desire in a representative sample of the adult Danish population and to analyze the relationships between a number of relevant variables and sexual desire.MethodsThe study population (N = 10,458, response rate 84.8%) answered a questionnaire with questions on sexual matters. The representativity of the population was examined. The frequency of self‐reported sexual desire and decrease in sexual desire over a 5‐year period was calculated for the two genders across age cohorts. Multiple logistic regression analysis was used to analyze the relationship between potential determinants and sexual desire.Main Outcome MeasuresThe frequency of self‐reported sexual desire and decrease in sexual desire was examined. Factors of importance for sexual desire were tested using two outcome measures: (i) often having sexual desire; and (ii) seldom having sexual desire.ResultsA significant association between gender and sexual desire was found in all age groups, as men had a significantly higher level of sexual desire than women. In both genders, the frequency of sexual desire was significantly reduced with increasing age. Among the 45‐ to 66‐year‐olds, 57% of the men and 47% of the women reported no change in the level of sexual desire over the past 5 years. In general terms, factors related to seldom having sexual desire were age and social, psychological, and physical distress in both genders.ConclusionThis study shows that overall, men have a higher level of sexual desire than women; sexual desire decreases with increasing age; and social, psychological, or physical distress are associated with low level of sexual desire in both genders. Eplov L, Giraldi A, Davidsen M, Garde K, and Kamper‐Jørgensen F. Sexual desire in a nationally representative Danish population. J Sex Med 2007;4:47–56.     

Failure of intrauterine insemination in a refractory infertility population

Intrauterine insemination by itself for multiple and/or severe infertility factors had no benefit over cervical cap with whole ejaculate or coitus in this study. The PRs for IUI and cervical cap with whole ejaculate or coitus were similar and low, suggesting that IUI by itself has limited, if any, utility in enhancing PRs in this type of infertility population. Couples attempting IUI should be advised about the low probability of achieving pregnancy. Ovulation stimulation and/or heterologous donor insemination, IVF, or gamete intrafallopian transfer may be beneficial therapeutic options.     

HPV infection among women in a representative rural and suburban population of the USA

Objective

To study the prevalence of low-risk and high-risk HPV genotypes in a largely suburban, non-Hispanic, white female population of the USA, and to determine the positive predictive value of one-occasion HPV detection and genotyping using high-grade squamous intraepithelial lesion (HSIL) cytology as the endpoint for clinical evaluation.

Methods

HPV DNA present in liquid-based cytology specimens collected by gynecologists in private practice was amplified using nested polymerase chain reaction. HPV DNA was validated by signature DNA sequencing for accurate genotyping.

Results

Of 2633 specimens, 278 were positive for HPV DNA of any genotype. Among 255 single HPV infections, the most prevalent genotype was HPV-16 (n = 50; 19.6%), followed by HPV-52 (n = 24; 9.4%). Only 10 specimens, all positive for a high-risk HPV, were associated with an HSIL cytology result. Among them were 6 of the 50 specimens (12%) tested positive for HPV-16. One novel HPV-39 variant was detected in repeat testing in a patient with persistent HPV infection.

Conclusion

DNA sequencing is a useful method for increasing the specificity of HPV genotyping as an aid to follow persistent high-risk HPV infections to reduce excessive colposcopies in populations with low cancer prevalence.     

Estimation of the prevalence and incidence of infertility in a population: a pilot study

A pilot study was undertaken to investigate the use of a mailed questionnaire to estimate the prevalence and incidence of infertility in a population, and the demand for medical advice about infertility. The objectives were to investigate the response rate, the acceptability and comprehensibility of the questionnaire, and to provide initial results. After elimination of undelivered questionnaires, a response rate of 82% was obtained. One question was found to be misleading in its wording: this question can be clarified before the questionnaire is used more widely. The results from analysis of the pilot study indicate that 20% to 35% of couples take more than 1 year to conceive, at some stage in their reproductive history. A much larger study, with a sample of approximately 3,500, is required to provide more accurate information.     

Infertility treatment in Poland

Journal of Assisted Reproduction and Genetics -     

Infertility treatment in Klinefelter syndrome

Until few years ago, Klinefelter syndrome with a homogenous 47.XXY caryotype was considered a model of absolute male sterility. In this review, we will discuss the fertility issue following TEsticular Sperm Extraction-IntraCytoplasmic Sperm Injection (TESE-ICSI) and the potential advantage of searching for and cryopreserving spermatozoa in adolescent instead of adult patients.     

Infertility and the use of infertility treatments in Finland: prevalence and socio-demographic determinants 1992-2004

OBJECTIVE: To examine changes in the use of infertility treatments by time, the causes of infertility, lifetime prevalence of subfertility, and the use of infertility treatments by socio-demographic factors. STUDY DESIGN: Aggregate IVF statistics (1992-2004) and two nationally representative cross-sectional surveys (1997 and 2002). RESULTS: Total number of IVF, ICSI and FET treatments initiated more than tripled between 1992 and 2004. The proportion of tubal injury as a cause of infertility treatment decreased over time while other female factors, male factor and multiple causes became more common. Self-reported lifetime subfertility was 16.0% in 2002 among women aged 25-64 years. Subfertility differed notably by age and education: young less educated women and older more educated women more frequently reported subfertility. Use of hormone therapy to treat subfertility (1997 and 2002) and participation in infertility treatments or medical examinations (2002) was more common among urban, highly educated and affluent women. CONCLUSIONS: The use of infertility treatments increased and the proportions of causes of infertility have changed over time. Self-reported subfertility differed by age and education. There are socio-demographic differences in the use of infertility treatments.     

Genital tuberculosis: a leading cause for infertility in women seeking assisted conception in North India

INTRODUCTION: Genital tuberculosis is a major cause of tubal factor infertility in developing countries. Data regarding the current prevalence of tuberculosis in the infertile population are sparse. AIMS: To determine the incidence of tubal factor infertility in an infertile population seeking assisted reproduction and the prevalence of genital tuberculosis in this sub-group of patients and their symptomatology. MATERIALS AND METHODS: A retrospective analysis of case records of infertile patients registered for in-vitro fertilization (IVF) between January 2007 and June 2007. RESULTS: Hundred and forty women with an indication for IVF were analyzed. Of these, 70 patients (50%) had tubal factor infertility. The prevalence of genital tuberculosis in tubal factor infertility was 34 out of 70 (48.5%). 82.8% of patients with tubal factor had history of prior treatment for tuberculosis. Menstrual abnormalities were seen in only 8 patients: hypomenorrhea (7) and secondary amenorrhea (1). A diagnostic hysteroscopy showed that 11 had uterine adhesions (18.9%) and 1 patient had pale endometrium. Twenty patients out of 70 cases (28.5%) showed evidence of extra genital tuberculosis. CONCLUSION: Genital tuberculosis is the major causative factor for severe tubal disease requiring assisted reproduction in developing countries like India.