Quality of life of infertile Tunisian couples and differences according to gender

Objective

To compare quality-of-life gender differences within infertile couples from Tunisia and between infertile couples and controls.

Methods

The present case–control study included 100 couples with primary infertility who, during 2009, underwent assisted reproductive technology at Farhat Hached Hospital in Sousse, Tunisia, and 100 control couples. The 36-item Short-Form Health Survey (SF-36) was administered to assess quality of life.

Results

Compared with male controls, men in the infertility group had lower scores in the mental dimension (P = 0.020), social functioning (P = 0.007), and role–emotional (P < 0.001) categories of the SF-36. Women in the infertility group had lower mental and physical dimension scores (P < 0.001) and lower vitality (P = 0.022), social functioning (P < 0.001), role–emotional (P < 0.001), and mental health (P < 0.001) scores than female controls. Within infertile couples, female partners had lower total (P = 0.01) and mental dimension (P < 0.001) scores than their spouses. Delay of the first consultation was correlated with bodily pain, vitality, and mental health among women in the infertility group.

Conclusion

Women in infertile couples had a lower quality of life than their spouses, and infertile couples had a lower quality of life than controls. These findings confirm the need for psychological support for infertile couples.     

Predictors of fertility quality of life (FertiQoL) in infertile women: analysis of confounding factors

Objective

Infertility may adversely influence quality of life (QoL). The aim of this study was to compare QoL in women with primary and secondary infertility, and identify factors associated with poor and good QoL.

Study design

Quality of life was measured using the FertiQoL tool in 273 patients attending an infertility clinic, and demographic and clinical characteristics of the patients were recorded. Patients with primary and secondary infertility were compared for QoL subscales, and other confounding factors were investigated using multiple regression analysis.

Results

Women with secondary infertility obtained higher scores in emotional, mind/body, and social domains of the core subscale, tolerability domain of the treatment subscale, and total QoL (p < 0.05). Women desiring psychological support showed lower scores in all domains except environment. Prolonged duration of infertility was associated with lower scores of mind/body, social, tolerability domains and total QoL score (p < 0.05). Multiple regression analysis showed that the status of education and secondary infertility had a positive impact, whereas prolonged duration of infertility and desire for psychological support had a negative impact on total QoL scores.

Conclusion

QoL scores were better in patients with secondary infertility and higher educational status, whereas scores were negatively affected by prolonged duration of infertility and desire for psychological support.     

Expression of the imprinted IGF2 and H19 genes in the endometrium of cases with unexplained infertility

Objective

As genomic imprinting plays a critical role in the development of the placenta, the aim of this study was to detect whether the expression levels of the imprinted genes IGF2 and H19 in the endometrium differ between infertile and fertile women.

Study design

: Total RNA was extracted from 30 (15 unexplained infertile and 15 fertile) women's endometrial tissue. cDNA was synthesized from total RNAs of each sample. IGF2 and H19 mRNA expression levels were measured quantitatively using the Real Time PCR method. In order to determine the allelic expression of IGF2 and H19, genomic DNA was extracted from endometrial tissues.

Results

When compared with the control group, increased mRNA expression of IGF2 was detected (1.5-fold change, P = 0.015) in the unexplained infertility group. In contrast, H19 expression was lower in the infertility group as compared to the control group (4-fold change, P < 0.0001). Restriction analysis of cDNA-derived PCR product showed that all patients and controls indicated monoallelic expression of IGF2 and H19.

Conclusion

Our results showed that altered expression of these imprinted genes might affect implantation and that their timely and appropriate activation is important for proper functioning. To understand the molecular epigenetic basis of implantation and placental development, genomic imprinted genes should be further investigated.     

Bacterial vaginosis and infertility: cause or association?

Objectives

To estimate the prevalence of bacterial vaginosis (BV) in infertile women and evaluate the effect of treatment of BV on the pregnancy rate in patients with polycystic ovarian disease (PCOD) and unexplained infertility.

Study design

Cohort study conducted at the Department of Obstetrics and Gynecology in collaboration with the Microbiology Department of Sohag University Hospital, Egypt. All eligible women with female factor infertility (n = 874) were enrolled and all asymptomatic fertile women (n = 382) attending the family planning clinic of the study hospital were recruited as a control group. The study was in two phases: the first included screening all participants for BV after Gram-staining of the vaginal discharge. The second phase was concerned with evaluating the effect of treatment of BV on the cumulative pregnancy rate (CPP) in patients with PCOD (group I; n = 278) and unexplained infertility (group II; n = 170). Each group was divided into three sub-groups: groups Ia (n = 129) and IIa (n = 73) were BV positive and treated for BV; groups Ib (n = 61) and IIb (n = 49) were BV positive and did not receive treatment for BV, and groups Ic (n = 88) and IIc (n = 48) were BV negative. The prevalence of BV was compared using the Chi-square. The long rank test of Kaplan-Meier life table analysis was used to compare the CPR. A multivariate regression model was designed to define the most significant variable which affected the pregnancy rate in patients with PCOD.

Results

The prevalence of BV was significantly higher in infertile than fertile women (45.5% vs 15.4%). The highest prevalence was found in patients with PCOD (60.1%) and unexplained infertility (37.4%). The CPR in both patients with PCOD and unexplained infertility were significantly higher in the patients who were treated for BV. Regression model showed that BV was one of the significant factors interfering with pregnancy.

Conclusions

BV is strongly implicated in female infertility and is probably an underestimated cause of unexplained infertility. Screening and treatment of BV in patients with PCOD and unexplained infertility improved the pregnancy rate considerably.     

A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles

Objective(s)

To compare the clinical pregnancy rates between intrauterine insemination (IUI) simultaneously or 34–36 h following hCG injection in gonadotropin-stimulated IUI cycles.

Study design

Randomized, prospective, controlled, study conducted in a university infertility clinic. Of 923 infertile couples, 220 couples with unexplained infertility or mild male factor infertility were included to the study. Before ovarian stimulation patients were randomized into two groups: IUI at 34–36 h after hCG injection (group I) (n = 106) and IUI simultaneously with hCG administration (group II) (n = 98). The primary outcome was clinical pregnancy rates.

Results

There was no significant difference between the groups according to baseline patient and cycle characteristics. Clinical pregnancy rates were 9.4% and 12.2% in group I and group II, respectively (p = 0.523). Although group II had better outcomes there was no statistically significant difference in clinical pregnancy rates between the different timing methods: IUI simultaneously with hCG versus IUI at 34–36 h after hCG (odds ratio (OR) = 1.35, 95% CI 0.53–3.42).

Conclusion(s)

There is no difference in simultaneous use of hCG injection compared to cycles in which IUI is performed after 34–36 h following hCG injection. Prospective randomized trials with larger sample sizes or meta-analyses are required.     

Evaluation of FAS and caspase-3 in the endometrial tissue of patients with idiopathic infertility and recurrent pregnancy loss

Objective

To investigate expression of BcL-2, FAS, FAS ligand (FASL) and cleaved caspase-3 in the endometrial tissue of women with idiopathic infertility (with two consecutive failed cycles of in vitro fertilization) and women with idiopathic recurrent pregnancy loss. The control group consisted of fertile women.

Study design

Endometrial tissue samples from fertile women (n = 25), women with idiopathic infertility (n = 25) and women with idiopathic recurrent pregnancy loss (n = 25) were collected on the seventh or eighth postovulatory day of their menstrual cycles for evaluation. Expression of BcL-2, FAS, FASL and cleaved caspase-3 was assessed using immunohistochemical methods.

Results

Expression of BcL-2 and FAS was significantly higher and lower, respectively, in the women with idiopathic infertility than in the other groups (p < 0.01). Expression of cleaved caspase-3 was significantly lower in the women with idiopathic infertility than in the other groups (p < 0.01). Expression of FASL was similar in all three groups.

Conclusion

Disturbances in endometrial apoptosis may be a contributing factor in patients with idiopathic infertility and recurrent pregnancy loss.     

Psychological impact of single and multiple courses of assisted reproductive treatments in couples: a comparative study

Objective

To analyze the psychological impact on levels of anxiety and depression in couples who, confronted with the diagnosis of infertility, propose to carry out ART; to evaluate and compare state-trait anxiety and depression levels in couples undergoing ART treatments for the first time and repeatedly, and to verify gender differences.

Study design

In this prospective study in the Medically Assisted Reproduction Unit of the Centro Hospitalar de São João, Porto, Portugal, 89 couples diagnosed with infertility were divided into two groups: (1) couples starting ART for the first time (43), and (2) couples pursuing ART repeatedly (46). Participants completed the Beck Depression Inventory-II (BDI-II) and the State-Trait Anxiety Inventory-Form Y (STAI-Y), prior to their first or subsequent treatment cycle.

Results

Couples pursuing ART for the first time show higher levels of state-anxiety compared to couples who repeatedly carry out ART (p < 0.05). Levels of depression are higher in couples who repeatedly carry out ART (p < 0.05). In both study groups, women and men have higher levels of state-anxiety compared to trait-anxiety (p < 0.05). With respect to depression, there are significant differences between genders in both groups, showing higher values in women compared to men (p < 0.01).

Conclusions

The results show that there is room to tailor psychological interventions for the specific story of each couple, but we emphasize the importance and need for more studies to support these findings.     

Doppler study of uterine hemodynamics in women with unexplained infertility

Objective

To evaluate uterine artery blood flow using pulsed Doppler, and endometrial and subendometrial microvascularization using three-dimensional (3D) power Doppler, in women with unexplained infertility.

Study design

In a prospective clinical trial at a university teaching hospital, 40 women with unexplained infertility were compared to 40 fertile parous controls. In the mid-luteal (peri-implantation) phase, the endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were measured in both groups.

Results

The uterine artery PI (P = 0.003) and RI (P = 0.007) were significantly increased and the endometrial VI (P = 0.029), FI (P = 0.031), and VFI (P = 0.001) and subendometrial VI (P = 0.032), FI (P = 0.040), and VFI (P = 0.005) were significantly decreased in the unexplained infertility group. The endometrial thickness and volume and serum estradiol and progesterone levels, however, were not significantly different between the two groups.

Conclusion

Peri-implantation endometrial perfusion is impaired in women with unexplained infertility: Doppler study of uterine hemodynamics should therefore be considered in infertility work-up.     

Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis

Objective

The aims of this prospective study were to evaluate fertility, pregnancy outcomes and their determinant factors after laparoscopic segmental colorectal resection for endometriosis.

Study design

We studied 83 women who underwent colorectal resection for endometriosis. Thirty-nine women (47%) had an associated infertility and 51 (61.4%) wished to conceive after surgery. Surgical route was exclusive laparoscopy in 77 cases (92.7%) and laparoconversion in 6 (7.3%).

Results

Twenty-nine pregnancies were obtained in 24 patients (43.6%) including 20 spontaneous (69%) and 9 by IVF (31%). The median time to conceive spontaneously was 6 months and 20 months by IVF. Among the 39 infertile women, 18 (46%) conceived during the study period. A relation was found between pregnancy rate and patient age (p = 0.02). Reduction in pregnancy rate was correlated to the presence of adenomyosis (p = 0.04) and high ASRM total score (p < 0.001) as well as exclusive laparoscopy compared to conversion to laparotomy for colorectal resection (p = 0.01).

Conclusion

Adenomyosis and conversion to laparotomy as well as patient age, ASRM score appeared determinant factors of fertility outcome.     

A preliminary study of the relationship between the long arm of the Y chromosome (Yqh+) and reproductive outcomes in IVF/ICSI-ET

Objective

To compare the reproductive outcomes of Yqh+-carrying and control couples undergoing IVF/ICSI treatments.

Study design

Retrospective analysis of 72 Yqh+ carriers and 986 Yqh+ non-carriers undergoing their first cycle of ART in a single centre between August 2005 and May 2011.

Results

Yqh+ carrying couples had significantly worse reproductive outcomes compared with control couples undergoing IVF treatment. There were a significantly higher cancellation rate (20.69% vs 7.9%; P < 0.05; OR, 3.03; CI, 1.18–7.79) and a significant lower fertilisation rate (50.05% vs 66.01%; P < 0.05; OR, 0.61; CI, 0.49–0.57), implantation rate (8.33% vs 20.87%; P < 0.05; OR, 0.35; CI, 0.14–0.87), good quality embryo ratio (44.70% vs 57.89%; P < 0.05; OR, 0.59; CI, 0.43–0.80) and clinical pregnancy rate (17.39% vs 39.59%; P < 0.05; OR, 0.32; CI, 0.11–0.96) in Yqh+ group compared with control group undergoing IVF treatment. Yqh+ carrying couples had similar reproductive outcomes compared with control couples undergoing ICSI treatment.

Conclusions

The Y chromosome polymorphic variant Yqh+ most likely plays a role in infertility. Yqh+ couples with poor reproductive outcomes in IVF treatment can be advised to undergo ICSI to improve their reproductive results in the next cycle.     

Intracytoplasmic morphologically selected sperm injection (IMSI) after repeated IVF or ICSI failures: a prospective comparative study

Objective

Sperm morphology plays a significant role in assisted reproductive technologies and is associated with high implantation rates. The objective of this study was to evaluate the outcome of intracytoplasmic morphologically selected sperm injection (IMSI) after repeated failures of conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) techniques.

Study design

In a prospective study in which couples acted as their own controls, 75 infertile couples were offered IMSI after at least two previous IVF or ICSI failures. The main outcome measures were embryo quality and number of blastocysts obtained.

Results

The percentage of top quality embryos obtained at day 2 was increased in IMSI compared to IVF/ICSI cycles (89.8% versus 79.8%; p = 0.009). Extended embryo culture was possible in 41.3% of IMSI cycles versus 26.7% of IVF/ICSI cycles (p = 0.04), and the mean number of blastocysts obtained was higher in IMSI cycles (1.5 ± 1.9) than in IVF/ICSI cycles (1.0 ± 1.2) (p = 0.03). Moreover, IMSI resulted in clinical pregnancy and birth rates of respectively 29.3% and 18.6%.

Conclusion

After two or three IVF/ICSI failures, IMSI seems to give better embryo quality and more blastocysts, which allow more embryo transfers at the blastocyst stage. This study supports the use of sperm ultramorphology examination as an independent test to be proposed after repeated IVF or ICSI failures.     

Long term outcome in subfertile couples with isolated cervical factor

Objective

A previous randomized clinical trial (RCT) compared immediate treatment with intrauterine insemination (IUI) to expectant management for six months in subfertile couples with an isolated cervical factor. That study showed higher ongoing pregnancy rates in couples receiving intrauterine insemination. The current study compared the long-term effectiveness and costs of this intervention.

Study design

We followed all couples (N = 99) who were previously included in the RCT for three years after randomization and registered pregnancies and treatments. After the initial trial period, couples in both groups were offered further treatment according to local protocol. The primary outcome was an ongoing pregnancy after three years.

Results

After three years, there were 36 ongoing pregnancies in the immediate IUI group (N = 51 couples) and 38 ongoing pregnancies in the expectant management group (N = 48 couples). The ongoing pregnancy rates were 71% and 79% respectively (RR 0.89 (95% confidence interval (CI) 0.7–1.1)).

Conclusions

In couples with an isolated cervical factor, a treatment strategy including immediate treatment with IUI does not result in higher ongoing pregnancy rates on the long term. Initial expectant management is therefore justified in these couples and identifying a cervical factor by a post-coital test is unnecessary.     

Luteinizing hormone β-subunit gene (LHβ) polymorphism in infertility and endometriosis-associated infertility

Objective

To establish the frequency of LHβ G1502A polymorphism in infertile women with endometriosis, infertile women without endometriosis and a control group.

Study design

Case-control study including 110 infertile women with endometriosis, 84 infertile women without endometriosis and a control group consisting 209 healthy fertile women recruited from the ABC School of Medicine. The LHβ G1502A polymorphism was studied by RPLP-PCR (restriction fragment length polymorphism-polymerase chain reaction).

Results

Genotypes GG, GA and AA of the LHβ G1502A polymorphism presented frequencies of 54.6%, 31.8% and 13.6%, respectively, in the women with endometriosis (p = 0.0398); of 52.4%, 38.1% and 9.5% (p = 0.0123), respectively, in the infertile women without endometriosis; and of 68.9%, 21.5% and 9.6%, respectively, in the control group. In patients with minimal/mild endometriosis and moderate/severe endometriosis, the GG, GA and AA genotype frequencies were, respectively, 47.3%, 36.4% and 16.3% (p = 0.0118); and 61.8%, 27.3% and 10.9% (p = 0.5975). Considering the alleles, allele G was present in 70.5% of the patients with endometriosis, 71.4%% of the infertile women without endometriosis and in 79.7% of the controls, whereas allele A was present in 29.5%, 28.6% and 20.3%, respectively, in the infertile women with endometriosis (p = 0.0121), infertile women without endometriosis (p = 0.0409) and controls. Alleles G and A presented frequencies of 65.5% and 34.5% and 75.5% and 24.5%, respectively, in minimal/mild endometriosis (p = 0.0026) and moderate/severe endometriosis (p = 0.4062).

Conclusion

The data suggest that LHβ G1502A polymorphism may be involved in the predisposition to infertility and minimal/mild endometriosis-associated infertility, although endometriosis might be only a coincidental finding along with infertility.     

General psychopathology,anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women

Objective

To compare measures of psychological distress between men and women undergoing ART in the Unit of Reproductive Medicine “UMR” in the Department of Obstetrics and Gynecology at “Farhat Hached” Hospital in Sousse, Tunisia.

Study design

We conducted a gender comparative study of psychological profile in infertile couples. Recruitment was done during period from January to May 2009. 100 infertile couples with primary infertility were recruited. Scores of general psychopathology, depression, anxiety and self-esteem were evaluated. We administrated questionnaires on psychological factors among infertile couples before starting a new infertility treatment cycle. Psychological factors included the symptom check-list (SCL-90-R), the hospital anxiety and depression scale (HAD-S) and the Rosenberg self-esteem scale (RSE).

Result(s)

Infertile women had higher scores than their spouses in the three global scores of the SCL-90-R and in several items such as somatisation, obsessive symptoms, interpersonal sensitivity and phobias. Scores of HADS were higher among women for both depression and anxiety. Scores of self-esteem were lower among women.

Conclusion(s)

Women endorsed higher psychological distress than men across multiple symptoms domains: general psychopathology, anxiety, depression and self esteem.     

Polymorphic variants of DNMT3A and the risk of endometriosis

Objective

Overexpression of DNA methyltransferase 3A (DNMT3A) and aberrant methylation of various genes in eutopic endometrium have been demonstrated in women with endometriosis. We aimed to study whether DNMT3A polymorphisms could be a genetic risk factor for endometriosis and endometriosis-related infertility.

Study design

We studied 5 SNPs (rs2289195, rs7590760, rs13401241, rs749131 and rs1550117) located in the DNMT3A gene in 357 women with endometriosis and 640 controls.

Results

We did not observe significant differences between genotype and allele frequencies of rs2289195, rs7590760, rs13401241, rs749131 and rs1550117 SNPs in women with endometriosis, endometriosis-related infertility, and controls. The lowest p values of the trend test were observed for DNMT3A rs1550117 in endometriosis and endometriosis-related infertility (p_trend = 0.049 and p_trend = 0.055, respectively).

Conclusions

Our results did not supply evidence for the contribution of SNPs located in DNMT3A to either endometriosis or endometriosis-related infertility.     

Follow up of infertile patients after failed ART cycles: a preliminary report from Iran and Turkey

Objectives

Assisted reproductive technology (ART) has become an established and increasingly successful form of treatment for infertility. However, significant numbers of cycles fail after embryo transfer (ET) and it becomes necessary to follow up the infertile couples after failed ART treatments. The main goal was to follow up the infertile patients after failed IVF/ICSI+ET treatments in Iran and Turkey.

Study design

198 infertile couples from Iran and 355 infertile couples from Turkey were followed up after IVF/ICSI failures. The patients’ demographic data, the couples’ decisions about continuation of treatment and the spontaneous pregnancy rates were compared in the two countries.

Results

The drop-out rate was higher in Iran (28.3%) than in Turkey (23.4%). The reasons for treatment discontinuation in Iran and Turkey were: financial problem (33.9% vs. 41%), hopeless (10.7% vs. 22.9%), fear of drug side-effects (7.1% vs. 12%), achieving pregnancy (37.5% vs. 19.6%), child adoption (5.4% vs. 2.4%), lack of spouse cooperation (5.4% vs. 2.4%), and divorce (0% vs. 2.4%). Spontaneous pregnancy was significantly higher in Iran (10.1%) than in Turkey (3.9%). There was correlation between duration of infertility and female factor infertility with spontaneous pregnancy.

Conclusions

Since the majority of couples that discontinued treatment had financial problems, it is essential for health professionals to support infertile couples during their childlessness crisis.     

Quality of life in women with vulvar cancer submitted to surgical treatment: a comparative study

Objectives

To investigate the occurrence and severity of lymphoedema of the lower extremities (LLE), quality of life (QoL), and urinary and sexual dysfunction in women with vulvar cancer submitted to surgical treatment.

Study design

Twenty-eight patients with vulvar cancer submitted to vulvectomy and inguinofemoral lymphadenectomy and 28 healthy, age-matched women (control group) were evaluated. The occurrence and severity of LLE were determined by Miller's Clinical Evaluation. QoL, urinary function and sexual function were assessed by the EORTC QLQ-C30, SF-ICIQ and FSFI questionnaires, respectively. The differences between groups and correlations were assessed using Student's t-test, Chi-squared test, Mann–Whitney U-test and Spearman's rho test.

Results

The groups were similar in terms of marital status, educational status, menopausal status, hormone therapy and height. The occurrence and severity of LLE were higher in women with vulvar cancer compared with the control group (p < 0.001 and p = 0.003, respectively). A significant association was found between the severity of LLE and advanced age (p = 0.04), and the severity of LLE and higher body mass index (BMI; p = 0.04) in patients with vulvar cancer. In the patients with vulvar cancer, there was a significant correlation between the severity of LLE and worse QoL in the following domains: physical, cognitive, emotional, social, fatigue, pain, sleep and financial questions (p < 0.05). There was no difference in urinary function between the two groups (p = 0.113). Age and number of deliveries were the only variables associated with the occurrence of urinary incontinence (p = 0.01). Urinary incontinence was present in women with a mean age of 74.9 ± 4.6 years and a mean of 7.3 ± 1.3 normal deliveries. There was no difference between the groups in terms of the sexual function. Multivariate analysis showed an association between sexual function and age (p = 0.01), and sexual function and being in a stable relationship (p = 0.02).

Conclusion

Patients submitted to vulvectomy or inguinofemoral lymphadenectomy for vulvar cancer are at higher risk of developing LLE compared with healthy, age-matched women. This has a negative effect on QoL, but does not interfere with urinary or sexual function.     

The relationship between the number of CGG repeats and serum level of anti-Müllerian hormone in women without FMR1 premutation

Objective

To investigate the relationship between the number of CGG repeats in the fragile X mental retardation 1 (FMR1) gene and serum levels of anti-Müllerian hormone (AMH) in Korean infertility patients without premutation.

Study design

A retrospective study of 228 infertile women who received fertility treatment in a single private in vitro fertilization (IVF) clinic from May 2010 to August 2012 was performed. Serum FSH and AMH were measured on menstrual day 3 and the number of CGG repeats was evaluated.

Results

The mean age of the study population was 33.3 ± 3.8 years. No significant correlation was observed between CGG repeat count in both alleles and the serum FSH, AMH or multiples of median (MoM) of AMH in whole study subjects. In women with age ≥35 years, however, there was an increasing tendency in the MoM of AMH with increasing number of CGG repeats in allele 2 (R² = 0.075, p = 0.008). This correlation was not observed in patients aged less than 35 years.

Conclusion

We observed a positive correlation between MoM of AMH and number of CGG repeats in allele 2 in women aged over 35 years. Our findings are discordant with other reports, and therefore further studies are needed to determine whether this discrepancy is due to ethnic differences.     

Compliance and diagnostic efficacy of mini-hysteroscopy versus traditional hysteroscopy in infertility investigation

Objective

The aim of this study was to compare traditional hysteroscopy with mini-hysteroscopy in terms of compliance, side effects and diagnostic efficacy.

Study design

We prospectively considered 950 female candidates for an IVF programme. All women underwent outpatient hysteroscopy; in 602 cases (Group A) a mini-hysteroscope was employed; in 348 women (Group B) a 5-mm hysteroscope was adopted.

Results

Cavity findings were similar in both groups. Endometrial polyps and uterine septum seem to be more frequent in our infertile patients than in the general population. No significant differences in terms of side effects were found between the groups. Mean visual analogue pain scale score was significantly lower in the patients of Group A than in those of Group B (p < 0.001).

Conclusions

Office mini-hysteroscopy is a very effective diagnostic tool in an infertility work-up and is more widely accepted than traditional hysteroscopy. Routine use of the technique should be considered.     

Glycodelin in endometrial flushing fluid and endometrial biopsies from infertile and fertile women

Objective

To investigate in the natural cycle just before IVF, whether glycodelin levels in endometrial flushing fluid obtained days LH + 1 and LH + 7 can be used in predicting pregnancy in the following IVF cycle, and whether there are differences in women with tubal factor infertility compared to women with unexplained infertility and fertile controls.

Study design

A prospective observational multicentre study of 21 fertile and 75 infertile women (25 showed abnormal tubes with no signs of hydrosalpinges, 18 had uni- or bi-lateral hydrosalpinges, 17 were salpingectomised because of hydrosalpinges, and 15 women had unexplained infertility). Endometrial flushing at days LH + 1 and LH + 7, endometrial biopsy, and blood sampling at day LH + 7 were performed before down-regulation for IVF. Glycodelin levels in endometrial flushing fluids (EFF), biopsies, and plasma samples were related to tubal pathology, endometrial dating and IVF outcome. Furthermore, total protein concentration was measured in EFF to investigate the influence of normal endometrial maturation on protein concentrations from days LH + 1 and LH + 7.

Results

At day LH + 1, EFF glycodelin levels were higher in infertile women with abnormal tubes compared to fertile women, particularly in women conceiving after the following IVF. For women with unexplained infertility, a higher level at day LH + 1 was present only in women not conceiving after the following IVF. ROC curve analysis showed that at day LH + 1 EFF glycodelin levels had no predictive value for IVF outcome. At day LH + 7, glycodelin levels in endometrial flushing fluids and biopsies depended on endometrial dating.

Conclusions

At day LH + 1, glycodelin concentration is increased in endometrial flushing fluid from infertile women with abnormal tubes compared to fertile controls without being a valuable predictor of subsequent pregnancy. At day LH + 7 the glycodelin level depends on endometrial dating.