Depression and anxiety levels in infertile Turkish women

OBJECTIVE: To investigate the levels of anxiety-depression in women with infertility and to investigate the relationship between psychologic symptoms, course of treatment and cultural factors. STUDY DESIGN: The study included 107 women with primary infertility in the index group and 63 healthy women in the control group. The Hospital Anxiety Depression Scale was applied to both groups to evaluate psychologic symptoms. The same scale was applied once more after 3 months to the infertility group. RESULTS: There was no significant difference in the level of depression-anxiety between the 2 groups. The severity of psychologic symptoms was greater in those in the infertility group who had attempted nonmedical solutions, who were under pressure from their husbands' families because of their infertility and who reported "bad" relations with their husbands. At the end of the 3 months, the group of patients who achieved pregnancy showed significantly lower levels of anxiety and depression scores than the group of patients who did not. Age, attempts at nonmedical solutions, pressure from the husband's family because of infertility and anxiety level at the start of the study were variables that predicted pregnancy negatively. CONCLUSION: It can be useful to take cultural factors into account in evaluating the mental health of infertile women.     

Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: results of 612 patients

AIM: To clarify the role of a combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility in developing countries. METHODS: In a prospective study, 612 consecutive infertile women underwent complete fertility evaluation at a tertiary university infertility clinic: 300 complained of primary infertility, 221 of secondary infertility, and 91 were requesting reversal of a previous tubal ligation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of their routine infertility evaluation. Focused hysteroscopic evaluation of the region of utero-tubal junction was attempted. RESULTS: Laparoscopy was successful in 608 and hysteroscopy in 597 patients. The most frequent pathologies detected hysteroscopically in the infertile group were adhesive in nature and believed to be post-traumatic and/or post-phlogistic. The number of intrauterine abnormalities found by hysteroscopy was significantly greater than by hysterosalpingography. The rate of diagnosis of significant lesions by laparoscopy of 64.3% rose to 76.6% when the hysteroscopic findings were included. A significant number of women with secondary infertility had abnormal hysteroscopic findings when compared to either women with primary infertility or those requesting sterilization reversal. Hysteroscopic evaluation of the region of utero-tubal junction revealed significant lesions believed to have caused infertility in comparison with those requesting sterilization reversal. CONCLUSION: The combined diagnostic approach of laparoscopy and hysteroscopy is recommended in the evaluation of female infertility in communities where the risk of pelvic infections is great.     

Immune abnormalities in endometriosis compromising fertility in IVF-ET patients.

OBJECTIVE: To evaluate the incidence of immune abnormalities in patients with endometriosis and primary or secondary infertility. STUDY DESIGN: This study analyzed the incidence of alloantibodies and autoantibodies in 100 women with endometriosis and 62 patients with unexplained infertility without endometriosis who enrolled in an assisted reproduction program at the Colombian Fertility and Sterility Center from January 1, 1996, to May 30, 1997. The alloimmune status of the women was determined by testing for the presence or absence of antileukocyte antibodies. The autoimmune studies included antinuclear antibodies, antiphospholipid antibodies and lupus anticoagulant antibody. RESULTS: Negative titers of IgG antipaternal antibodies were identified in 34% of patients with primary infertility and in 34% of women with secondary infertility and a history of pregnancy losses. Positive titers of antinuclear antibodies were found in 27% (27/100) of the group of patients with endometriosis; of them, 30% (15/50) had primary infertility and 24% (12/50), secondary infertility. The average titer was 1/80. Forty-eight percent of the infertile patients (48/100) showed titers of antiphospholipid antibodies for IgG and IgM; 46% of these patients had primary infertility (23/50) and 50% (25/50), secondary infertility. This was significantly higher than in controls (P < .05). Two patients were positive for lupus anticoagulant antibody. In the group of patients with unexplained infertility without endometriosis, the incidence of antinuclear antibodies was 17.7% and of antiphospholipid antibodies, 30.6%. CONCLUSION: For women with endometriosis, alloimmune and autoimmune evaluation is recommended prior to their undergoing assisted reproduction in order to provide appropriate therapy for each case.     

Characteristics of infertile women in the United States and their use of infertility services

National estimates of demographic characteristics are shown for infertile women compared with those who were fecund, women with primary versus secondary infertility, and infertile women who had, and had not, sought infertility services. Overall, 30% of infertile women had primary infertility, and 70% had secondary infertility. Women with primary infertility were twice as likely to seek services as women with secondary infertility. Many demographic characteristics of women with secondary infertility who sought services differed from those of women who had not sought services. There were fewer differences among women with primary infertility. These findings have implications for the generalizability of results from clinic-based studies and suggest that more research is needed on the barriers to service among infertile couples.     

An evaluation of immunologic factors of infertility

This paper reviews earlier studies identifying 3 possible immunologic causes of infertility: autoimmunity, ABO blood group incompatibility, and isoagglutination, and presents results of recent studies, including an analysis of the incidence of isoagglutinations, autoagglutinations, and ABO incompatibility in a group of couples with unexplained primary or secondary infertility and couples with an organic cause of infertility; incidence of antibodies in postpartum women, women in early pregnancy, unmarried women, and prostitutes; the relationship between ABO incompatibility and/or sperm-agglutinating antibodies to postcoital testing of cervical mucus; results of condom therapy in couples with positive isoagglutinins; a comparison of hemagglutination test with the microagglutination test; and preliminary studies of the immunoglobulin responsible for a positive microagglutination reaction. Results obtained from 292 women and 176 men indicated that in the 64 couples with primary unexplained infertility, 24 wives had isoagglutinins and 5 of the husbands had autoagglutinins. Among 32 couples with secondary unexplained infertility, 16 wives had isoagglutinins and only 1 husband had autogglutinins. 50 couples with organic causes of infertility and 25 unmarried women had a 20% incidence of isoagglutinins. Positive serologic reactions were found in 35 of 48 prostitutes. 15 of 44 women in the 1st trimester of pregnancy had isoagglutinins to at least 1 of 3-5 donor semen specimens, but serums of 7 of the women gave negative reactions when tested against the husband's ejaculate. The 2 women in the group who aborted had negative antibody titers. Only 1 of 29 serums from postpartum women gave positive agglutination reaction. Among 68 couples, 19 subjects had positive microagglutination test reactions but only 7 had positive hemagglutination reactions. No specific relationship was found between ABO incompatibility and the results of postcoital testing of cervical mucus in 58 women tested or positive circulating issoagglutinins in 62 women tested. 27 of 68 couples with primary unexplained infertility, 18 of 33 with secondary unexplained infertility, and 13 of 46 with organic causes of infertility had ABO incompatiblity. Autoagglutination, unless massive, was not incompatible with pregnancy. Circulating antisperm antibodies fell to undetectable levels after 2-12 months of condom therapy. Careful timing of ovulation is essential because of the increase in antibodies after reexposure. Results of condom therapy in terms of pregnancies were disappointing.     

Primary infertility in women exposed to diethylstilboestrol in utero

In a selected group of 40 women who had been exposed to diethylstilboestrol in utero, 18 conceived without difficulty and 22 had primary infertility. Among those with primary infertility there was a significantly higher rate of anatomical structural defects and a greater tendency for menstrual disorders than in those without infertility. Thirteen (59%) of the women with primary infertility conceived, most after treatment with ovulation stimulating drugs. Spontaneous abortion and tubal pregnancy were frequent (47% and 10% respectively) and similar in both fertility groups. Of 13 infertile women examined, 4 (31%) had mild hyperprolactinemia--a hithero unreported finding for such women.     

Primary infertility in women exposed to diethylstilboestrol in utero

Summary. In a selected group of 40 women who had been exposed to diethylstilboestrol in utero , 18 conceived without difficulty and 22 had primary infertility. Among those with primary infertility there was a significantly higher rate of anatomical structural defects and a greater tendency for menstrual disorders than in those without infertility. Thirteen (59%) of the women with primary infertility conceived, most after treatment with ovulation stimulating drugs. Spontaneous abortion and tuba1 pregnancy were frequent (47% and 10% respectively) and similar in both fertility groups. Of 13 infertile women examined, 4 (31%) had mild hyperprolactinemia—a hithero unreported finding for such women.     

Primary infertility in women exposed to diethylstilboestrol in utero

Summary. In a selected group of 40 women who had been exposed to diethylstilboestrol in utero , 18 conceived without difficulty and 22 had primary infertility. Among those with primary infertility there was a significantly higher rate of anatomical structural defects and a greater tendency for menstrual disorders than in those without infertility. Thirteen (59%) of the women with primary infertility conceived, most after treatment with ovulation stimulating drugs. Spontaneous abortion and tuba1 pregnancy were frequent (47% and 10% respectively) and similar in both fertility groups. Of 13 infertile women examined, 4 (31%) had mild hyperprolactinemia—a hithero unreported finding for such women.     

Ovarian cancer risk associated with varying causes of infertility

OBJECTIVE: To evaluate the risk of ovarian cancer as related to underlying causes of infertility. DESIGN: Retrospective observational cohort study. SETTING: Five large reproductive endocrinology practices. PATIENT(S): A total of 12,193 women evaluated for infertility between 1965 and 1988. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ovarian cancer ascertained through 1999. RESULT(S): With 45 identified ovarian cancers, this cohort of infertility patients demonstrated a significantly higher rate of ovarian cancer than the general female population (standardized incidence ratio [SIR] = 1.98; 95% confidence interval [CI], 1.4-2.6). The risk was higher for patients with primary infertility (SIR = 2.73) than for those with secondary infertility (SIR = 1.44), and it was particularly high for patients who never subsequently conceived (SIR = 3.33). Women with endometriosis had the highest risk (SIR = 2.48; 95% CI, 1.3-4.2), with a further elevated risk among those with primary infertility (4.19, 2.0-7.7). Comparisons among the infertile women, which allowed calculation of rate ratios (RRs) after adjustment for multiple factors, also showed links with endometriosis. Compared with women with secondary infertility without endometriosis, patients with primary infertility and endometriosis had a RR of 2.72 (95% CI, 1.1-6.7). CONCLUSION(S): Determination of ovarian cancer risk should take into account the type of infertility (primary vs. secondary) and underlying causes. Further study of endometriosis may provide insights into ovarian carcinogenesis.     

Association between secondary infertility and fallopian tube obstruction on hysterosalpingography

OBJECTIVE: To determine whether women with secondary infertility have a lower prevalence of tubal pathology as evidenced by hysterosalpingographic (HSG) analysis. STUDY DESIGN: A cross-sectional study was performed on 551 women seen for evaluation of infertility at an academic medical center. Each patient's chart was reviewed for the presence of primary vs. secondary infertility. History of sexually transmitted infection, prior surgery and details of prior pregnancies were recorded. HSG reports and films were evaluated for evidence of tubal disease. RESULTS: Controlling for 5-year age category, history of sexually transmitted disease and history of surgery, the adjusted risk ratio for abnormal HSG in women with secondary vs. primary infertility was 1.75 (95% CI 1.16-2.64). Among patients with secondary infertility, there was no difference between mode of delivery in the prior pregnancy (vaginal vs. cesarean delivery) and abnormal HSG. CONCLUSION: In the population we studied, accounting for confounding variables, women with secondary infertility had a higher likelihood of having fallopian tube obstruction on hysterosalpingography than did those with primary infertility. Our study supports continued routine evaluation for tubal patency in patients with secondary infertility. Among parous women, there is no evidence that cesarean delivery places patients at increased risk of abnormal hysterosalpingograms.     

不育夫妇的心理状态分析

对６５２例不盲妇女和其中４２５例妇女的丈夫进行心理咨询调查。结果显示：８０．０％以上的夫妇承受着不育所致的各种心理压力，最普遍的心情是不甘认可。女方的压力略显严重，但与其丈夫间差异无显著性。然而男方对这种精神压力的自我调节能力明显优于女方。对不育治疗的信心及预后的态度，男女比较差异尤显著性。农民和文化水平较低的不育夫妇心理压力更大。不育使１２．０％～１５．０％的夫妇性生活受到影响，７．０％～８．０％婚姻关系恶化甚至濒临破裂，８．６％因不育而家庭关系紧张。约３０．０％的妇女表示不育检查和治疗过程本身亦带来一定的精神紧张和心理负担。提示：对要求治疗的不育夫妇，除药物治疗外．精神上的同情理解及心理支持，是不可忽视的。     

Self‐Report of Eating Disorder Symptoms Among Women With and Without Infertility

ObjectiveTo compare eating disorder (ED) symptoms in women seeking treatment for infertility to women receiving routine primary care.DesignA cross‐sectional comparative design.SettingWomen were recruited from two infertility centers and a general hospital primary care setting.ParticipantsParticipants included 51 women seeking treatment for ovulatory and unexplained infertility and 34 women attending routine primary care.MeasuresParticipants completed a battery of standardized rating scales measuring self‐reported ED symptoms, drive for thinness, bulimic symptoms, body dissatisfaction, and related clinical characteristics.ResultsMultivariate analysis of covariance confirmed that women seeking treatment for infertility had significantly greater scores on measures of drive for thinness (p = .001) and bulimic symptoms (p = .002) than those receiving routine primary care. However, the comparison group had significantly greater scores on measures of body dissatisfaction (p < .001) and dietary restraint (p = .001) than the infertility group. Both groups had elevated rates of lifetime ED diagnoses compared to national prevalence rates.ConclusionsResults demonstrated that women seeking treatment for ovulatory and unexplained infertility have greater drive for thinness and bulimic symptoms but not body dissatisfaction or dietary restraint compared to women seeking primary care. The results suggest that infertility and routine health care visits may provide opportunities for early identification and treatment of women with ED symptomatology. Future studies may benefit from further elucidation of the potential role of ED symptoms in the etiology and maintenance of infertility in, particularly, normal‐weight women.     

Mixed lymphocyte culture responses in infertile couples.

Twenty couples suffering from unexplained infertility have been tested in mixed leucocyte culture to determine if the wives were preimmunized against their husbands. The wives were tested against their husbands and four unrelated persons, and thymidine incorporation was measured on the third and fifth days of culture. No evidence was found that would indicate a preimmunization of the wife against her husband as an explanation for their infertility. A slight MLC stimulatory capacity was found in sera from infertile women.     

Infertility in a rural area of Jiangsu Province: an epidemiological survey

Using a random stratified, multistage, and probability sampling procedure, the rate of infertility in the rural area of Jiangsu Province was determined through interviews with 2,578 married women of reproductive age. The overall infertility rate was 5.0%. A significantly higher rate was found for couples in which the husbands were engaged in cotton farming. The study also confirmed the higher infertility rate among smokers found in other studies. The infertility rate was much higher in the Northern Jiangsu Distinct than in the Southern District, suggesting a relationship between infertility and economic/educational conditions.     

Plasma copper and zinc concentrations and infertility

Plasma copper concentration was significantly lower in 48 infertile women than in 35 control subjects and somewhat lower in women with secondary rather than primary infertility. Plasma zinc concentration was not appreciably different in infertile and fertile women. Low plasma copper concentration may influence normal human female fertility.     

Plasma copper and zinc concentrations and infertility

Summary. Plasma copper concentration was significantly lower in 48 infertile women than in 35 control subjects and somewhat lower in women with secondary rather than primary infertility. Plasma zinc concentration was not appreciably different in infertile and fertile women. Low plasma copper concentration may influence normal human female fertility.     

Correlations between laparoscopic and hysteroscopic findings in 497 women with otherwise unexplained infertility

Laparoscopy and hysteroscopy were undertaken simultaneously in 497 women presenting with otherwise unexplained infertility. Of them, 285 complained of primary infertility and 212 of secondary infertility. Laparoscopic evidence of pelvic inflammatory disease in the absence of endometriosis was noted in 103 patients with primary and in 108 women with secondary infertility. Lesions were noted on hysteroscopy in both groups as well as in 34% of women with normal laparoscopic examinations. No specific dependency could be demonstrated between any laparoscopically detected lesion and hysteroscopically detected lesion. A significant dependency was demonstrated only between a history of secondary infertility and uterine adhesions (chi 2 = 12.03, 1 df, p less than 0.01). While the combined endoscopic findings did not demonstrate any dependency, the findings of this study demonstrate the importance of hysteroscopy in assessing all patients with infertility, especially those with secondary infertility.     

Analysis of female infertility structural factors

The study was aimed to evaluate, within the population of infertile women, the interrelations between such characteristics as patient's age, duration and type (primary, secondary) of infertility, its etiologic factor as well as the treatment outcome (pregnancy rate). Retrospective analysis was performed in 176 women aged 20-43 years (mean age 29.5 years). Primary infertility was less common in older women (above 35 years). Duration of primary infertility was independent of age, on an average 1.5 years shorter compared to secondary infertility. Participation of all causal factors in the structure of infertility was steady--11.6-20.2%. The most frequent reasons of secondary infertility were unexplained infertility 55.3% and tubal pathology--19.1%. The pregnancy rate was 30% in all treated women. In the studied population of women, pregnancy rate was not significantly influenced by the patients's age, type of infertility and its cause.     

Modern and traditional practices of Turkish infertile couples.

OBJECTIVE: This investigation was carried out to determine modern and traditional practices of infertile couples in Kayseri, Turkey. METHODS: Two hundred and fifty-two infertile couples were selected from the study area. Modern and traditional practices of the infertile women and their husbands were investigated through a questionnaire. The effects of some factors on the utilization of traditional methods were analysed through the logistic regression method. RESULTS: It was found out that 92.5% of the infertile women and 71.8% of their husbands had consulted a physician for infertility and 92.1% of the women and 32.6% of their husbands had applied for medical or surgical intervention. However, only 11.1% of the couples had attempted in vitro fertilization. In contrast, 61.5% of the infertile couples admitted to carrying out traditional practices. All traditional practices were more prevalent among the women than the men. CONCLUSION: It was concluded that traditional practices were more prevalent in the rural areas and among the older couples.