Intrauterine insemination in fertility disorders

The success of intrauterine insemination with in HAM-F10 washed spermatozoa was evaluated during a clinical study of two years, in 32 couples with male infertility, male and female infertility and unexplained infertility. Six women of the 16 treated couples with male infertility achieved pregnancy. In this group no spontaneous pregnancies occurred. In couples with male and female and unexplained infertility the usefulness of the treatment is not proven. Further careful evaluation is needed.     

Amniocentesis in the context of infertility

The encounter with amniocentesis compels infertile couples to experience again the mix of adversity, uncertainty, and hope characterizing both infertility and prenatal testing. Findings from open‐ended interviews of 38 couples, 25 infertile and 13 fertile, participating in an ongoing longitudinal field study of infertile childbearing and adopting couples suggest that amniocentesis both reprises elements of the infertility experience and interrupts elements of the pregnancy experience.     

Comparison of different counting chambers using a computer-assisted semen analyzer

Abstract

A routine computer-assisted sperm analysis is an important diagnostic test in the andrology laboratory. To evaluate the accuracy and precision of the different types of counting chambers for human semen analysis in combination with a computer-assisted semen analyzer (CASA), a quality-control study that compared human sperm analysis results obtained using different counting chambers (Makler chamber, disposable 8-cell GoldCyto chamber, disposable 4-cell Leja chamber, a plain glass slide, and a tissue culture dish cover with a 24?×?24?mm² coverslip) in conjunction with the CASA systems was performed. Significantly higher counts of sperm concentration were obtained from the reusable Makler chamber than from the other counting chambers. Sperm motility from drop loaded counting chambers was significantly higher than that of capillary-loaded chambers. A plain glass slide and a tissue culture dish cover used with a coverslip showed rather better performance in semen assessment. Disposable chambers are suitable for routine semen analysis with CASA in a diagnostic andrology setting. With the proper workflow and quality control, a plain glass slide and the tissue culture dish cover are acceptable alternatives for routine counting chambers with CASA as necessary. The type of counting chamber should be specified in test reports.     

The relationship of Chlamydia trachomatis infection and male infertility.

OBJECTIVES. Infertility affects at least 2 million couples in the United States. One third of infertility is attributed to male causes, but the etiology of most male infertility remains obscure. This study was designed to investigate the relationship between Chlamydia trachomatis and unexplained infertility in men. METHODS. Questionnaires and serum were collected prospectively from 52 case subjects (men from couples with explicitly defined idiopathic infertility) and 79 control subjects (first-time expectant fathers). RESULTS. Case subjects were significantly more likely than control subjects to be seropositive for antibody to C trachomatis at a titer of 1:64 or higher. By test of trend, higher titers were associated with higher odds ratios. Adjustment for age of either partner at initiation of pregnancy attempt, race, income, previous genitourinary symptoms or diagnoses, number of previous sexual partners, and barrier contraceptive use had no significant effect on the estimate of the odds ratio. One half of the men who were antibody positive had no history of genitourinary symptoms. CONCLUSIONS. Our results suggest an association between infection with C trachomatis in men and unexplained infertility and imply that infection is frequently asymptomatic.     

Sophie's choice: A metaphor for infertility

“Sophie's choice”; provides a useful metaphor for understanding the continuing plight of the infertile. Infertile couples are increasingly viewed not only as choosing controversial medical treatments to cure their infertility, but also as having chosen the dysfunction itself. A combination of factors, including heightened expectations for reproductive control, the association between infertility and women's and sexual liberation, and medical needs for patients, account for the reconstruction of infertility as a disorder associated with freedom and choice. The changing context of infertility and changing perspectives on its causes and treatment are reviewed.     

Infertility and Assisted Reproductive Technology

SUMMARY

The inability to conceive a pregnancy can cause disruption and anguish to individuals and couples sharing that experience. The treatments for infertility, especially those involving assisted reproductive technology such as in vitro fertilization, can be physically, financially and emotionally stressful for participants. The impact of infertility and its treatment has introduced a new venue for perinatal social worker services to counsel, educate and support these patients.     

Sperm Chromatin Heterogeneity as an Infertility Factor

Semen samples from husbands with a history of unexplained infertility (n = 33), of women with habitual abortion (n = 36), or normal fertile donors (n = 20) were subjected to conventional semen analysis (SA), Acridine orange test (AOT), and zona-free hamster egg penetration test (HEPT). The three tests operate independently. The most discriminatory test was AOT (p = 0.0001) followed by HEPT (p = 0.019). The frequency of sperm chromatin heterogeneity as detected by AOT red fluorescence was highest in habitual abortion (39.4%), followed by unexplained infertility (16.4%), and, last, donors (9.4%). However the percentage of penetration was highest in habitual abortion (50.7%), followed by donors (43.1%), and least in unexplained infertility (33.9%). Conventional semen parameters (sperm density, motility, abnormality, and vitality) were the least to discriminate between the three groups. The presence of abnormal sperm chromatin may lead to infertility as a result of early pregnancy loss.     

Value of hysteroscopy in management of unexplained infertility

ObjectiveTo assess the value of hysteroscopy in unexplained infertility.Methods200 infertile women in whom standard infertility investigations revealed no abnormalities were included in the study between January 2009 and December 2013. All women underwent hysteroscopy for diagnosis and treatment of any uterine lesion which was previously undetected by hysterosalpingography (HSG). Treated women were followed up for one year during which pregnancy rate was determined. As all other causes that contribute to infertility (other than the subtle uterine lesions) were excluded. No other infertility treatment was performed during this period.ResultsOf the 200 women studied, hysteroscopy revealed abnormalities in 65 (33%) women. Most uterine abnormalities were mild adhesions, small submucous myomas and polyps and their incidence was greater in women aged ≥ 30 years and women with secondary infertility. The overall pregnancy rate in the treated women within one year of follow up was 46%.ConclusionAs a cause of unexplained infertility, subtle uterine abnormalities are diagnosed only during hysteroscopy and they are relatively common in infertility women. Although the presence of these abnormalities is not detected by the basic investigations for infertility, their correction seems to be necessary when infertility is desired and other infertility causes are excluded.     

Recent advances in chlamydia trachomatis

Chlamydia trachomatis is an obligate intracellular energy parasitic bacterium with a genome of 660 × 10⁶ daltons, possessing a plasmid and unique life cycle which includes the differentiation of the infective elementary body to a replicative reticulate body. C. trachomatis is the etiological agent of trachoma, which affects approximately 500 million people in developing countries. Recently it became evident that in industrialised Western nations certain strains of C. trachomatis are the most common cause of sexually transmitted infections such as non-gonoccocal urethritis, cervicitis, endometritis, salpingitis and subsequent ectopic pregnancies or infertility, perihepatitis, neonatal conjunctivitis and pneumonia, adult conjunctivitis and epididymitis. Since C. trachomatis infections are often asymptomatic, widespread screening of sexually active young people is needed in order to initiate early antibiotic treatment which may prevent serious complications such as ectopic pregnancies and infertility. Development of sensitive and simple techniques for mass screening for detection of Chlamydia in excretions as well as techniques for detection of specific markers of chronic internal infections (such as Chlainydia specific IgA antibodies) is of great importance.     

Coping with infertility in couples: Gender differences

Despite the fact that the incidence of infertility is increasing, health care professionals know very little about gender differences in responses to infertility. This study was designed to (1) explore gender difference in the problems of infertile women and men, (2) compare and contrast how women and men cope with the problems, and (3) explore gender differences in personal and social resources available for coping with infertility. Sixty‐six individuals, 39 females and 27 males, responded to a self‐administered questionnaire. Results of this study confirmed that women and men experience infertility differently. Women had significantly more problems in the areas of self‐esteem, personal life, health care systems, and occupation. There were no gender differences in social support ratings or in access to a confidant. Both women and men used a similar number of problem‐focused coping strategies. Women, however, also employed significantly more emotion‐focused coping strategies than did men. Results of this study suggest directions for nurses and others providing support and counseling for infertile couples.     

The increasing demand for infertility treatment.

At present NHS services for infertile couples are under-developed compared with those available in the private sector. Health care planners should be aware that the demand for infertility treatment is likely to increase. The average age at first child birth has increased and presumably also the average age at the first attempt to conceive. The rise in divorce rates and second marriages has resulted in increasing numbers of couples wishing to start a second family at a comparatively advanced age. If, as it appears, the time taken to conceive increases with age, the higher average age of women attempting to conceive could cause an increase in the prevalence of infertility, and the demand for treatment. Divorce and remarriage of sterilised people has resulted in a demand for reversal of sterilisation and for in vitro fertilisation (IVF). The age of onset of sexual activity has fallen. This, combined with later marriage, has led to an increase in the number of sexually active single people, with an increase in the incidence of sexually transmitted disease of which infertility is a possible sequel. The opportunity to adopt is now available for very few couples because of the decreasing proportion of illegitimate babies available for adoption. Recent publicity given to developments such as gamete intra fallopian transfer (GIFT) and IVF may have increased the demand for treatment.     

Solvent Exposures at Shoe Factories and Workshops in Hebron City,West Bank

Abstract

Exposure to organic solvents has been reported to increase the risks for acute and chronic health effects among shoe industry workers. In developing countries, protection against chemical exposures is often not provided. The study was conducted to identify working conditions and estimate the concentrations of organic solvents used in shoe factories and workshops in Hebron City. Personal interviews containing questions related to personal protective equipment (PPE) were used to identify working conditions, and samples collected from factories and workshops were analyzed using gas chromatography. Geometric means (GMs) were calculated for the solvents. Six major organic solvents were detected in the factories. Acetone (GM = 51.5 mg/m³, GSD = 3.82) was common in gluing tasks. Dichloromethane (GM = 47 mg/m³, GSD = 2.62) was common in cleaning tasks. Heptane, methylethyl ketone, n-hexane, and toluene were common in gluing tasks. Four major organic solvents were detected in the workshops: acetone (GM = 32.3 mg/m³, GSD = 6.33), toluene (GM = 70.3 mg/m³, GSD = 3.06), nhexane (GM = 19.4 mg/m³, GSD = 2.65), and methylethyl ketone (GM = 130 mg/m³, GSD = 1.5). 81% of the factory workers had never used respiratory protective equipment, and 92% had never used work clothes. 97% of the workers in the workshops had never used respiratory protective equipment, 94% had never worn gloves, and 90% had never used work clothes. Exposures to solvents in the absence of personal Protective equipment, tasks barriers, and mechanical ventilation can adversely affect health.     

The role of Tadalafil in treatment of infertility

ObjectiveIt was the aim of this research to assess whether Tadalafil 5 mg once daily can improves the sperm count of unexplained infertile males with erectile deficiency induced by the emotional stress of attempting to father children.MethodsTwo groups, each made up of 30 unexplained infertile males with psychogenic erectile deficiency related to attempts to father children received Tadalafil 5 mg once daily (Group 1) or a placebo (Group 2) for one month. Unexplained infertile men are intended as normospermic men who could not father children over a one year period and whose female partner is free of factors causing infertility. The endpoints were: differences between the groups in restoring erectile response, modifying sperm count, side effects and modifications of sperm analyses with respect to resolution or not of the erectile deficiency irrespective of the substance (Tadalafil or placebo) used. The means were compared using analysis of variance and the percentages using the chi square test.ResultsThe patients who received Tadalafil had their sperm volume, concentration and motility increased, but not the percentage of typical forms. Patients who received a placebo had no significant improvement. Additional analyses indicated that sperm volume, concentration and motility (but not morphology) significantly increased only in the patients who restored erectile response to sexual stimulation, independently of Tadalafil or placebo administration. No significant side effects were present.ConclusionsIt is thought that therapies aimed at removing emotional stress linked to the performance anxiety of fathering children might improve sperm count in unexplained infertile couples.     

Intrauterine insemination with conjoint semen. How to increase the success rate?

BACKGROUND: Intrauterine insemination is usually proposed as the first line therapy for infertility related to cervical hostility, male factor, unexplained infertility or mild endometriosis. The overall succes rate of IUI is about 10-20% clinial pregnancy per cycle. The Aim of this study is to evaluate factors that increase the succes rate of IUI. METHODS: we restrospectively analysed 206 cycles of IUI with partner's semen in 138 infertile couples. The clinical and laboratory factors that may influence the pregnancy rates were analysed: women's age, etiology of infertility, duration of infertility, ovarian stimulation, day of hCG and sperm parametres. RESULTS: The per-cycle clinical pregnancy rate was of 14.56%. Optimal pregnancy rates were observed in less than 38 years old women (18.29% vs 9.52%, p<0.05). The succes rate was statistically depending of the number of IUI cycles until three (p<0.05), the day of hCG (p<0.05) and the sperm count after conventionally prepared semen (p<0.05). Sperm parameters was of no value in predecting the pregnancy rates, and neither seam's to be the total dose of administrated Gonadotrophin or the etiology of infertility, but it seams that, when a cervical factor or PCO were involved, the succes rate is higher. Besides, getting three or more than three follicles may increase the succes rate but expose to a warrying risk of multiple pregnancy. CONCLUSION: According to this study, the only statitically significant factors that are associated with successful IUI were, women partner's age (<38 ans), number of IUI cycles (during the first three IUI cycles), day of hCG (>J13) and sperm count after conventional semen preparation (>1.106/mL).     

Sexual satisfaction among involuntarily childless women: A cross-cultural study in Italy and Brazil

ABSTRACT

Infertility has been negatively associated with sexual satisfaction. This study aimed to estimate the relation of infertility to sexual satisfaction from a cross-cultural perspective, comparing Italian and Brazilian women. Between June 2012 and January 2013, 528 women seeking assisted reproduction technology (ART) treatment in Italy (39%) or Brazil (61%) completed self-reports of sexual satisfaction (ISS) and infertility-related stress in the marital domain (IRS). IRS was the same across countries. ISS differed, with 34.31% of the Italians and 43.52% of the Brazilians being sexually dissatisfied at a clinical level (ISS score >30). Multiple logistic regression models showed that being sexually dissatisfied at a clinical level was associated with lower education and higher IRS among Italian women, regardless of having a diagnosed cause of infertility. It was instead associated with higher IRS only among the Brazilian women who had a diagnosed cause of infertility. These findings suggest that, regardless of nationality, sexual satisfaction and infertility-related stress need to be addressed in the treatment of infertile women turning to ART. However, as factors associated with these dimensions vary across countries, interventions to promote sexual satisfaction among infertile women should be adapted to their specific socio-cultural context.     

青海省1483对不孕不育患者发病因素分析

目的分析青海省不孕不育患者的发病因素,为提高青海省受孕率和生育率提供理论依据。方法收集2015年1月-2017年12月在青海省人民医院生殖医学中心就诊的1 483对不孕不育夫妇的临床病历资料,进行整理和统计分析。结果1 483对不孕不育夫妇中,女性因素不孕1 240人,占83. 61%;男性因素不育505人,占34. 05%;双方共同因素333对,占22. 45%;不明原因100对,占6. 74%。在女性因素导致的1 240例不孕患者中,原发性不孕558例(45. 00%),继发性不孕682例(55. 00%),输卵管因素是最主要的因素,其次是结核病史。在男性因素导致的505例不育患者中,原发性不育311例,占61. 58%;继发性不育194例,占38. 42%,少弱精子症是最主要的因素。结论输卵管因素和结核杆菌感染是导致女性不孕的主要因素。     

Transforming growth factor beta 1 (TGFβ1) polymorphisms and unexplained infertility: A genetic association study

ABSTRACT

The prevalence of infertility is increasing and worrisome. About 10 to 30% of infertility is classified as idiopathic or unexplained infertility (UI).TGF-β is multifunctional and immunoregulatry cytokine which regulates both implantation and adhesion of trophoblasts to the extracellular matrix during pregnancy. The aim of the current study was to investigate the association between two polymorphisms rs1800470 (C29T) and rs1800471 (G74C) of the TGF-β1 gene in Iranian patients with unexplained infertility. A total of 250 UI patients and 484 healthy individuals with no history of infertility were included in the study. The amplification and sequencing of target DNA fragments were done using PCR and automated sequencing methods, respectively. The effects of these polymorphisms on both TGF-β1 structure and function of mRNA and protein were analyzed using new in-silico tools. The frequency distribution of the alleles, genotypes, and haplotypes of both rs1800470 and rs1800471 polymorphisms had a statistically significant difference between subjects and controls. CC genotype of TGF-β1 rs1800470 (29C→T) increase the risk of UI in male UI patients. Moreover, C alleles of TGF-β1 rs1800471 was associated with increased risk of UI in female UI patients. Couples, subgroup analysis revealed a significant association between TGF-β1 polymorphisms (rs1800470, rs1800471) and the risk of UI in male, female, and all UI patients. The frequency of TG and CG haplotypes were statistically different in both UI and healthy subjects group (P < 0.05). RS1800471 polymorphisms changed the secondary structure of TGF-β1 mRNA and resulted in the removal of one mRNA arm and creation of two new arms. Taken together, the results of the current study suggest that TGF-β1 functional polymorphisms may play an important role in the susceptibility to UI in Iranian population. According to in silico analysis, polymorphisms in TGF-β1 can reduce mRNA half-life and, therefore, reduced TGF-β1 expression.     

Case-control study of leatherwork and male infertility

OBJECTIVES—To test the hypothesis that leatherwork is associated with male infertility mediated through the development of oligozoospermia. The basis of any association was postulated, at the outset, to be with exposure to the solvents used in leatherwork.
METHODS—All new referrals with infertility presenting in Leicestershire hospital clinics between November 1988 and September 1992 and Kettering District General Hospital from August 1990 were eligible to participate; 88.5% agreed to be interviewed. Exposure to leatherwork and work with solvents was defined by job title. Comparisons were made with fertile controls and in an analysis within men from infertile couples with oligozoospermia as the primary outcome. Effects on sperm motility and deformity were investigated secondarily. Analyses used logistic regression for binary outcomes and multilevel modelling for continuous outcomes.
RESULTS—1906 men were interviewed. Compared with the fertile controls the men from infertile couples were 1.10 times (95% confidence interval (95% CI) 0.46 to 2.63; p=0.99) more likely to be leatherworkers and 1.73 times (95% CI 1.26 to 2.38; p<0.001) more likely to work with solvents. Compared with other men, leatherworkers were 1.20 times (95% CI 0.43 to 3.33; p=0.73) more likely to present with oligozoospermia and 1.65 times (95% CI 0.37 to 7.30; p=0.51) more likely to present with teratozoospermia. Being a leatherworker was associated with only a 6% reduction in sperm concentration; motility and deformity were similarly unaffected by this exposure. Work with solvents did not statistically, nor clinically, increase the risk of oligozoospermia, teratozoospermia, or asthenozoospermia.
CONCLUSIONS—There was little evidence to support the hypothesis that leatherwork is associated with an increased risk of presenting with infertility or oligozoospermia. There was limited evidence that leatherwork is a risk factor for teratozoospermia. Workers with solvents were at an increased risk of presenting with infertility, although this was not mediated through effects on standard measures of semen quality; this finding merits further investigation.


Keywords: leatherwork; solvents; male infertility     

不明原因不孕夫妇行IVF-ET时机的探讨

目的 :探讨对不明原因不孕妇女进行辅助生殖技术的最佳时机及方法。方法 :将 2 5 6例不明原因的不孕妇女分成 A、 B、C3组 ,A组为经历 1～ 3个 COH/ IUI周期的妇女 2 5 6人 ,共 475周期。B组为经历第 4、第 5、第6 COH/ IUI周期的妇女 41人 ,共 74周期。C组为经历前 3个 COH/ IUI周期失败后 ,进行 IVF和 ICSI治疗 1周期的5 9人。结果 :A组 75人获得妊娠 ,平均每周期妊娠率为 15 .8%,累积妊娠率为 2 9.2 %。B组 4人获得妊娠 ,平均每周期的妊娠率为 5 .4%,累积妊娠率为 38.9%,与 A组相比妊娠率明显降低 ,有统计学上的差异 ( P<0 .0 5 ) ,进一步增加的妊娠率为 9.7%。C组 2 2人获得妊娠 ,妊娠率为 37.2 %,明显高于 B组 ,有统计学上的差异 ( P<0 .0 1)。结论 :对于原因不明的妇女首先应进行 COH/ IUI周期治疗 ,当 3周期 COH/ IU I失败后 ,应进行 IVF和 ICSI治疗。     

Chlamydia trachomatis Prevalence in Unselected Infertile Couples

Chlamydia (C.) trachomatis, an obligate intracellular bacterium, is responsible for the most common sexual transmitted disease and infertility. The purpose of this study was to evaluate: a) the frequency of chlamydial infection in unselected infertile couples and b) whether chlamydial infection could be identified in the semen sample as effectively as in the urethral swab of infertile patients. To accomplish this, 73 unselected, consecutive infertile couples were enrolled. Both male and female partners underwent a complete work-up to identify the cause of their infertility. A PCR method was used to detect C. trachomatis in urethral swabs and the semen samples of the male partners and in the cervical swabs of the female partners. C. trachomatis infection was found in 6 couples (8.2%). Three couples had both partners infected, 2 couples had only the male partner infected, and 1 only the female partner. C. trachomatis infection was found in the urethral swab of all 5 men infected, whereas the bacterial DNA was found in the semen sample of 2 of them. These findings suggest that C. trachomatis infection is present in about 8% of unselected infertile couples and that the bacterium should be searched in the male partner urethral swab which has a higher sensitivity.