自然周期IVF／IVM技术治疗输卯管因素和男性不育患者的临床疗效分析

目的比较自然周期IVF结合未成熟卵母细胞IVM（自然周期IVF／IVM）治疗输卵管因素不育、男性不育和输卵管／男性混合不育的临床疗效,进一步确立自然周期IVF／IVM技术在不孕症治疗中的临床价值。方法回顾性分析自然周期IVF／IVM536个取卵周期,将输卵管因素不育（T）、男性不育（MF）和输卵管／男性混合不育（T／MF）患的临床结局进行详细比较．结果209例输卵管因素不孕患者开始248个周期,完成245个移植周期;142例男性不育患者开始164个周期,完成160个移植周期;53例输卵管／男性因素混合不孕患者开始并完成53个移植周期。三组之间均获卵数在9．8±5．3（T／MF组）至10．9±5．3（T组）之间,无显著差异,受精率和卵裂率均无显著差异。T、MF和T／MF三组之间的的临床妊娠率（分别为31．4％、36．3％和35．3％）、胚胎着床率和流产率均无显著差异。结论从本研究可以看出,自然周期IVF／IVM用于临床妊娠率输卵管因素不育、男性不育和输卵管／男性混合不育的治疗,可以获得较好的临床结局。     

Current use of medical eponyms – a need for global uniformity in scientific publications

Background  

Although eponyms are widely used in medicine, they arbitrarily alternate between the possessive and nonpossessive forms. As very little is known regarding extent and distribution of this variation, the present study was planned to assess current use of eponymous term taking "Down syndrome" and "Down's syndrome" as an example.     

Patient and professional views of open access hysterosalpingography for the initial management of infertility in primary care

Background

Hysterosalpingography (HSG) is recommended as a first-line investigation for tubal assessment of infertile women. This investigation is not routinely available to GPs.

Aim

To explore the perceptions and attitudes of patients and health professionals to open access HSG for the initial management of infertile couples in general practice.

Design of study

A nested qualitative study using in-depth interviews with GPs, fertility specialists, and infertile couples.

Setting

Northumberland, Newcastle upon Tyne, North Tyneside, South Tyneside, and Gateshead.

Method

Participants were 39 interviewees: 12 GPs, five fertility specialists, and 13 infertile couples (nine interviewed with their partner).

Results

Four themes emerged: personal factors; will it benefit patients, GPs, and fertility specialists?; professional factors; does it fit the role of a GP?; local context; do the skills exist in general practice?; and wider context; will it benefit the NHS? GPs who had used open access HSG, felt it was appropriate for general practice and would continue to use the service. All GPs, fertility specialists, and infertile couples who had experienced open access HSG wished the service to remain in place. The main barriers to its uptake were: infrequency with which infertility presents; lack of clarity on perceived responsibilities; difficulty keeping up to date, including assimilating guidelines; low clinical priority; and lack of support in authoritative guidance.

Conclusion

Providing GPs with open access to HSG would allow a full initial assessment of the infertile couple and refer women with blocked tubes directly to tertiary care. While there is general support for the provision of such a facility, the majority of GPs perceive its use as being by a limited number of GPs who have a special interest in infertility. The study findings can inform future development of infertility services at the interface between primary and secondary/tertiary care.     

The feasibility of a web-based counselling program for occupational physicians and employees on sick leave due to back or neck pain

Background  

The objective of this feasibility study was to gain insight into occupational physicians' (OPs) and employees' use of, and attitudes towards, 'Snelbeter' (Get Well Fast), a new web-based counselling program for employees on sick leave due to non-specific back or neck pain and their OPs.     

Vasectomy related infertility: a major and costly medical problem

Of a group of 860 men who attended a private infertility clinic in Western Australia, 80 (9.3%) presented with vasectomy-related infertility. Of these men, 73 (91%) requested treatment due to re- marriage. The median age of the men was 42.5 years and their present partners were approximately 10 years younger. The median vasectomy interval in the men in this study was 9 years. Treatment of vasectomy- related infertility included vasectomy reversal procedures, donor insemination and both in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). It is suggested that care must be taken in counselling such patients prior to a vasectomy. The cryopreservation of semen prior to vasectomy would also make much of this type of infertility treatment unnecessary.      

The Effect of Relaxation on Mother's Anxiety and Maternal–Fetal Attachment in Primiparous IVF Mothers

Objectives

Infertility is one of the main stressful events of life and a crisis affecting various dimensions of infertile couples' lives. Relaxation, as a strategy, can be effective in the individuals' resistance to stress and anxiety. Therefore, the present study aimed to assess the effect of relaxation on mother's anxiety and maternal–fetal attachment in primiparous women who used In Vitro Fertilization (IVF) to get pregnant.

Counselling in infertility: individual, couple and group interventions

Objective

Infertility is considered a biopsychosocial crisis and infertility counselling is recommended as an integral part of a multidisciplinary approach. This article will outline the theoretical background and describe common interventions used in infertility counselling for individuals, couples and in a group setting.

Methods

This article summarizes the proceedings of the first campus workshop of the Special interest group of Psychology and Counselling of the European Society for Human Reproduction and Embryology (ESHRE).

Results

Infertility counselling offers the opportunity to explore, discover and clarify ways of living more satisfyingly and resourcefully when fertility impairments have been diagnosed. The Heidelberg Fertility Consultation Service is presented as a framework for individual and couples counselling and highlights important issues in counselling patients. For group work a number of steps to set up a group within an infertility framework are discussed.

Conclusion

In recent years, infertility counselling has become a specialist form of counselling requiring professional expertise and qualification. Key issues and common interventions are presented to raise awareness for the specific counselling needs of individuals and couples experiencing infertility and undergoing medical treatment.

Practice implications

Mental health professionals new to the field of reproductive technologies as well as those in other areas of mental health counselling clients with fertility disorders can benefit from the topics addressed.     

A hierarchy of needs? Embryo donation, in vitro fertilisation and the provision of infertility counselling

Objective

The aim of the paper is to examine how those working in, using and regulating assisted conception clinics discussed infertility counselling and its provision within the context of embryo donation and in vitro fertilisation.

Method

35 participants were recruited for semi-structured, face-to-face interviews. All data were analysed using thematic analysis.

Results

The thematic analysis revealed recurring themes based upon the portrayals of infertility counselling, embryo donation and in vitro fertilisation.

Conclusions

This paper suggests that an implicit hierarchy exists around those using assisted conception techniques and their infertility counselling requirements, which was dependent upon the assisted conception technique used. As a result, some people using assisted conception techniques felt that their needs had been overlooked due to this covert hierarchy.

Practice implications

Those working in, using or regulating assisted conception clinics should not view infertility counselling as restricted to treatments involving donation, or solely for people within the clinical system.     

Counselling in infertility: Individual,couple and group interventions

ObjectiveInfertility is considered a biopsychosocial crisis and infertility counselling is recommended as an integral part of a multidisciplinary approach. This article will outline the theoretical background and describe common interventions used in infertility counselling for individuals, couples and in a group setting.MethodsThis article summarizes the proceedings of the first campus workshop of the Special interest group of Psychology and Counselling of the European Society for Human Reproduction and Embryology (ESHRE).ResultsInfertility counselling offers the opportunity to explore, discover and clarify ways of living more satisfyingly and resourcefully when fertility impairments have been diagnosed. The Heidelberg Fertility Consultation Service is presented as a framework for individual and couples counselling and highlights important issues in counselling patients. For group work a number of steps to set up a group within an infertility framework are discussed.ConclusionIn recent years, infertility counselling has become a specialist form of counselling requiring professional expertise and qualification. Key issues and common interventions are presented to raise awareness for the specific counselling needs of individuals and couples experiencing infertility and undergoing medical treatment.Practice implicationsMental health professionals new to the field of reproductive technologies as well as those in other areas of mental health counselling clients with fertility disorders can benefit from the topics addressed.     

Seeking conception: experiences of urban Indian women with in vitro fertilisation

OBJECTIVES: This paper reports on a study of involuntarily childless Indian women/couples seeking in vitro fertilisation (IVF). The focus is on the social context of infertility and on women's perceptions of and experiences with IVF. METHODS: Twenty-two childless women/couples who sought IVF. The sample was drawn from consenting clients of clinics in two major Indian cities, viz. New Delhi and Mumbai. RESULT: In-depth interviews revealed that infertility is deeply feared, women's status and security are affected, and they experience stigmatisation and isolation. IVF was pursued after less intrusive avenues had been exhausted. Inadequate information/counselling is provided, success rates are low, IVF is commercialised and the process is physiologically, emotionally and financially stressful. CONCLUSION: In Indian society fertility defines womanhood and motherhood, and infertility is stigmatised. Women faced a lot of pressures to produce a biological child, and go through all kinds of treatments, including the expensive ARTs, to have a child. PRACTICE IMPLICATIONS: Integration of infertility services into the state's reproductive health programme and disseminate information on infertility and to offer other appropriate choices, such as adoption. Effective counselling on coping with psychosocial/sexual problems. Monitoring of the prevalence of sex preselection.     

Structural findings at hysterosalpingography in patients with infertility at two private clinics in Kampala, Uganda

Introduction

Hysterosalpingography (HSG) is still a commonly used investigation in the evaluation of the female genital tract and the main indication for HSG is infertility.

Objective

The purpose of this study was to find the pathology detected at HSG in patients with infertility in our setting.

Materials and Methods

A retrospective review of 289 consecutive patients who underwent hysterosalpingography using ionic water-soluble contrast media was done at 2 private x-ray units in Kampala. Clinical notes and radiological findings were analysed for demographic data, uterine status, tubal and pelvic pathology.

Results

The commonest age group seen was 26 – 30yrs. Most were of low parity. Secondary infertility was commoner than primary infertility. Abnormal findings at hysterosalpingography were found in 83.4%. The commonest finding was tubal blockage.

Conclusion

The commonest pathology found on HSG in women presenting with infertility in Kampala is tubal blockage possibly secondary to chronic pelvic inflammation. The fact that secondary infertility is common points to pelvic infection complicating mismanaged pregnancies, septic abortions or sexually transmitted infections. A study toestablish associated factors is recommended.     

Consequences of infertility in developing countries: results of a questionnaire and interview survey in the South of Vietnam

Background  

This study explores the psychological, socio-cultural and economic consequences of infertility on couples' life. The purpose of this research is to improve knowledge about the potentially serious implications of infertility in the South of Vietnam.     

Pregnancy outcome after IVF and ICSI in unexplained, endometriosis-associated and tubal factor infertility

BACKGROUND: This study was undertaken in order to compare pregnancy outcome after IVF and ICSI in unexplained and endometriosis-associated infertility using tubal factor infertility as controls. METHODS: This was a retrospective cohort study of early IVF/ICSI pregnancies verified by serum hCG measurement, comparing the subsequent outcome in unexplained (n = 274) and minimal endometriosis-associated (n = 212) with tubal factor (n = 540) infertility as controls. From January 1990 to December 2002, 1026 conception cycles after treatment with IVF or ICSI complied with the inclusion criteria. RESULTS: Live birth rate, twin birth rate after transfer of two embryos and abortion rate prior to 6 weeks of gestation were superior for the unexplained (78.8, 23.5 and 11.7%) compared to endometriosis-associated (66.0, 15.0 and 19.3%) and tubal factor (66.7, 18.1 and 18.0%) infertility groups (P < 0.05). Compared to the endometriosis-associated, the unexplained infertility group attained a higher pregnancy rate after the first treatment cycle (P < 0.05). CONCLUSIONS: The overall better outcome for the unexplained infertility group with respect to live birth rate, twin birth rate and early abortion rate compared to the minimal peritoneal endometriosis-associated and tubal factor infertility groups might be a guide to select diagnostic groups for single embryo transfer and be useful in patient counselling.     

Monitoring of IVF birth outcomes in Finland: a data quality study

Background  

The collection of information on infertility treatments is important for the surveillance of potential health consequences and to monitor service provision.     

Intracytoplasmic sperm injection (ICSI) in 2006: evidence and evolution

The introduction of intracytoplasmic sperm injection (ICSI)in 1992 has dramatically changed the management of severe maleinfertility. In severe male infertility, live birth rates withICSI are superior to those with other non-donor treatments.In non-male infertility, however, pregnancy rates are not betterwith ICSI than with in vitro fertilization (IVF). With obstructiveor non-obstructive azoospermia, reasonable pregnancy rates arenow possible with ICSI after recovery of sperm from the testesfollowed by ICSI. Genetic counselling is indicated for severemale infertility, whether or not ICSI is considered. ICSI isindicated in preimplantation genetic diagnosis (PGD) to avoidcontamination by extraneous DNA in the case of PCR-based testingand to increase the number of embryos available for testing.In turn, PGD may be indicated in pregnancies that are at highrisk of aneuploidy because of genetic factors associated withazoospermia. As with IVF, not all couples succeed, but 2% ofcouples with failed ICSI cycles will conceive without treatment.ICSI outcome studies indicate that there is a significant increasein prematurity, low birthweight, and perinatal mortality associatedwith single and multiple births, similar to the outcomes ofconventional IVF. However, as evidenced in long-term follow-upstudies, the higher rates of urogenital abnormalities and increaseduse of healthcare may be associated with paternal characteristics.     

Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life

Background  

Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months) on estimates of lower-extremity bone strength from childhood to older age.     

Young age does not protect against the adverse effects of reduced ovarian reserve--an eight year study

BACKGROUND: Ovarian reserve significantly influences IVF outcome. Low response to ovarian stimulation due to reduction of ovarian reserve is occasionally encountered in young women. The aim of this study was to evaluate the outcome of IVF treatment in young patients with reduced ovarian reserve. METHODS AND RESULTS: Between January 1993-2001, 762 consecutive patients satisfied the definition of reduced ovarian reserve (raised early follicular phase FSH or gonadotrophin stimulation cycles where three or fewer oocytes were retrieved after routine FSH stimulation) and were included in the study. They were classified into three age groups: young (< or = 30 years), intermediate (31-38 years) and older (>38 years). The three age groups were similar with respect to basal (day 3) serum FSH and estradiol concentrations, cause of infertility and number of previous treatment cycles. Implantation (13, 9.6 and 9.8%), clinical pregnancy (11.8, 10.2 and 10%) and live birth (7.4, 7.3 and 6.8%) rates were not significantly different in the three age groups respectively (P > 0.05). CONCLUSION: This study shows that younger patients with reduced ovarian reserve have a poor outcome of IVF treatment similar to their older counterparts. Such information may be helpful in counselling these patients who otherwise might anticipate an outcome related to their chronological age.     

Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based,randomised study

Background  

The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service.     

Searching for observational studies: what does citation tracking add to PubMed? A case study in depression and coronary heart disease

Background  

PubMed is the most widely used method for searches of the medical literature, but fails to identify many relevant articles. Electronic citation tracking offers an alternative search method.