Effects of life events on infertility diagnosis: comparison with presumably fertile men and women

Objective: To compare the occurrence and degree of stress attributed to life events during childhood/adolescence and adulthood between individuals diagnosed with infertility and presumably fertile individuals, and to examine the effect of life events occurrence and stress levels on an infertility diagnosis.

Background: Although stress has been explored as a consequence of the experience of infertility, its role as a predictor of this disease still lacks research, particularly regarding the use of adequate control groups composed of non-parents.

Methods: The final sample had 151 infertile subjects (74 males and 77 females) and 225 presumably fertile participants (95 males and 130 females), who completed a questionnaire indicating occurrence (y/n) and degree of stress of life events (1–5) during childhood/adolescence and adulthood.

Results: Significant differences regarding occurrence were found in seven stressful life events in men and in nine events in women, with infertile groups presenting higher occurrence than presumably fertile groups. Eleven stressful life events were rated differently by men and women regarding the degree of stress, with group significant differences observed in both directions. While most events were rated as more stressful by infertile men, infertile women reported less stress resulting from these events than presumably fertile women. After controlling for age, the degree of stress induced by life events in childhood/adolescence and adulthood were not significant predictors of infertility diagnosis, for both men and women.

Conclusion: The amount of stress associated with earlier or concurrent life events does not seem to be related with infertility. Further prospective research is needed to validate these findings.     

Diagnostic Laparoscopy in Primary and Secondary Infertility

Purpose: Our purpose was to compare the diagnostic efficacy of laparoscopy between primary and secondary infertility and to define a subgroup in which the positive findings are low. Methods: A retrospective review of the cases of 206 infertile women who underwent laparoscopy was conducted. Results: Eighty-two (39.8%) patients were found to have evidence of pelvic disease—20 (22.2%) with primary infertility and 62 (54.3%) with secondary infertility. The ratio of positive findings in secondary infertility was significant in comparison with the positive findings in primary infertility. In only 3 of the 20 patients with primary infertility was there no history of an abdominal operation, pelvic inflammatory disease, or an abnormal hysterosalphingography. Of the 62 women who suffered secondary infertility and had positive findings in laparoscopy, 15 had no history of suspect findings. Conclusions: The diagnostic yield of laparoscopy for primary infertility in the absence of indications of mechanical factors is low. Therefore the need for diagnostic laparoscopy in these cases should be reconsidered.     

子宫内膜异位症对输卵管的损伤

子宫内膜异位症与女性不孕症密切相关，但其机制尚未完全阐明。据文献报道，子宫内膜异位症可造成输卵管阻塞、积水、周围粘连及微观结构改变，异位病灶的存在使输卵管黏膜纤毛摆动障碍、肌层收缩减弱、输卵管内液成分异常，最终造成女性生育力下降。文章从输卵管结构和功能两个方面，深入分析子宫内膜异位症对输卵管的损伤。     

Unmet needs, beliefs and treatment-seeking for infertility among migrant Ghanaian women in the Netherlands

Studies on infertility in the Netherlands have little information on migrant Ghanaian women, even though Ghanaians are the third largest migrant group in Amsterdam. An exploratory study on the unmet needs, attitudes, and beliefs of migrant Ghanaian women with infertility problems living in the Netherlands, and the kinds of treatment they sought was undertaken in 1999. Qualitative data were collected from 12 women with primary or secondary infertility through narratives and 20 key informant interviews. The women described seeking treatment for infertility in Ghana, the Netherlands and other European countries, included use of infertility drugs, surgery, donor insemination and in vitro fertilisation. Illegal migrant women are not entitled to treatment paid by the national health system, and being of low income they cannot afford to pay directly for this or to obtain private health insurance. Herbalists and spiritual healers in both Amsterdam and Ghana were regularly consulted, especially for their willingness to address the social and spiritual aspects of infertility. To produce a pregnancy where male infertility was suspected, transfer of sexual rights to another man in the husband/partner's family, or a healer or priest, was a practical remedy that kept male infertility hidden. This study revealed difficulties experienced in clinical settings due to language barriers and cultural differences. Ghanaian women living in the Netherlands need much more information on the causes of infertility and their options.     

The examination and investigation of the subfertile couple

The World Health Organization (WHO) defines infertility as the ‘inability of a sexually active, non-contracepting couple to achieve pregnancy in one year’. It is estimated that this can affect 8–12% of couples worldwide Many couples will demonstrate female and male causes for infertility and will seek assistance from clinicians to achieve pregnancy. The assessment of the infertile couple should include detailed history, focused examination and appropriate investigations prior to any intervention. Clinicians with a specialist interest in infertility should perform this evaluation, as part of their regular practice. The aetiology of female and male infertility is broad and can provide a challenge for experienced clinicians. It is important that patients are evaluated in a structured and sequential manner. This article will review and discuss the evaluation of both the infertile female and infertile male.     

Endometriosis-associated infertility: a decade's trend study of women from the Estrie Region of Quebec,Canada

Endometriosis (ENDO) has been believed to increase during the last years, but recent data supporting this trend are lacking. The aim of this study was to verify whether the incidence of ENDO, infertility (INF) and the both increased during the last 10 years among women living in the Estrie region of Quebec. This retrospective cross-sectional study was realised using data from the CIRESS (Centre Informatisé de Recherche Évaluative en Services et Soins de Santé) system, the database of the CHUS (Centre Hospitalier Universitaire de Sherbrooke), Sherbrooke, Canada. Among the 6845 studied patients, 2564 had ENDO, 4537 were infertile and 256 suffered from both. According to the last 10 years, a significant increase in the number of cases with ENDO (r²?=?0.717, p?=?0.001) and endometriosis-associated infertility (r²?=?0.601, p?=?0.003) was noted, while INF remained stable (r²?=?2813 e?005, p?=?0.987). We showed a prevalence of ENDO of 10.91%. Women with ENDO were at increased risk for being infertile (OR?=?2.30; 95% CI?=?2.014–2.626, p?<0.0001). An increase of ENDO in women 18–24 years of age has been shown (r²?=?0.418, p?=?0.023), suggesting an earlier onset of the disease.     

159对接受助孕治疗不孕症夫妇支原体和衣原体感染情况分析

目的探讨接受助孕治疗的不孕症夫妇支原体和衣原体携带情况及其与体外受精／卵细胞质内单精子注射结局的关系。方法选择2009年3月至2011年9月北京大学第一医院生殖与遗传医疗中心无下生殖道感染症状且接受助孕治疗的159对不孕症夫妇,在取卵日或人工授精日分别取宫颈分泌物和精液,采用聚合酶链反应（PCR）法进行支原体和衣原体的检测。结果女性患者支原体阳性29例（18．200,29／159）,其中解脲支原体（ureaplasma urealyticum,UU）和人型支原体（mycoplasma hominis,Mh）分别为26例（16．4％,26／159）和3例（1．9％,3／159）,未检出衣原体。男性患者支原体阳性4例（2．5％,4／159）,均为UU;衣原体阳性3例（1．9％,3／159）。输卵管性不孕症患者支原体阳性10例（16．9％,10／59）,非输卵管性不孕症患者支原体阳性19例（19．0％,19／100）,两者比较,差异无统计学意义（P〉0．05）。女性支原体阴性组和阳性组的获卵数[（11．8±6．0）个,（14．6±6．2）个]、优质胚胎率（37．6％,43．2％）和临床妊娠率（48．2％,30．0％）比较,差异无统计学意义（P〉0．05）。结论进入助孕治疗周期的不孕症夫妇仍有一定的生殖道支原体和衣原体携带率,支原体携带与临床妊娠结局无明显关系。     

After the FLUSH trial: a prospective observational study of lipiodol flushing as an innovative treatment for unexplained and endometriosis-related infertility

OBJECTIVES: To assess the demographics, efficacy and safety of lipiodol flushing fertility treatment. DESIGN: Prospective observational study. SETTING: Secondary level care infertility clinic and radiology centre based in Auckland, New Zealand. POPULATION: The first cohort of 100 New Zealand women with infertility to undergo lipiodol flushing as an innovative fertility treatment. METHODS: Women received lipiodol flushing performed by a hysterosalpingogram technique and were followed up at 6 months. MAIN OUTCOME MEASURES: Clinical pregnancy at 6 months post-treatment; and live birth or ongoing pregnancy. RESULTS: The overall pregnancy rate was 30% and the live birth or ongoing pregnancy rate 27%. For women under 40 years old, a 32% pregnancy rate and a 25% live birth or ongoing pregnancy rate were seen in women with unexplained infertility, and a 50% pregnancy rate and a 47% live birth or ongoing pregnancy rate were seen in women with endometriosis. Of women aged 40 years and older, the pregnancy rate was 13% and the live birth or ongoing pregnancy rate was 13%. The pregnancy rates included those occurring after additional interventions, such as intrauterine insemination and in vitro fertilisation, accounting for 12 of the 30 pregnancies. There were no treatment complications. CONCLUSION: This study provides further evidence of the efficacy and safety of lipiodol flushing fertility treatment.     

A protocol for ovulation delay in women who cannot use estrogen,including Jewish women with Niddah issues and a pilot study

Orthodox Jewish women abstain from sexual intercourse from the commencement of menstruation until seven days after the end of menstrual bleeding at which point they can immerse themselves in a ritual bath and recommence relations. For women who ovulate prior to commencing intercourse this results in religious infertility. The traditional treatment for religious infertility is oral estrogens in the early follicular phase to delay ovulation. However, certain groups of women have contraindications to oral estrogens. In this group, no treatment options have existed until now. In this study we proposed a treatment protocol substituting the use of gonadotropin releasing hormone-antagonists in the early follicular phase for the oral estrogens. In a small pilot study, we demonstrate that these two protocols have similar outcomes in terms of ovulation delay (p?=?1.0) and likelihood of ongoing pregnancy (p?=?1.0). This protocol for ovulation delay also has applications in non-Jewish women who need to delay ovulation due to life constraints.     

Timed intercourse after intrauterine insemination for treatment of infertility

Objective: To compare the pregnancy rates, between intrauterine insemination (IUI) followed by timed intercourse and IUI only for treatment of the infertile couples. Study design: A prospective study of two different protocols of intrauterine insemination in two hundred and one infertile couples with a normal spermiogram was carried out. Of these, 101 couples were treated with IUI alone and 100 couples had both IUI and timed intercourse within a 12-18 h period. The pregnancy rates were compared between groups. Results: The characteristics of the two groups were similar in terms of the mean age, as well as the duration and causes of infertility. The cycle characteristics following follicular stimulation were also similar between two groups. The pregnancy rate per cycle increased with increasing numbers of total motile sperm per insemination in the IUI alone group (P=0.045). Timed intercourse increased pregnancy rate in patients with lower motile sperm number (<40×10⁶) (27.7% versus 10.5%, P=0.023), but not in patients with higher sperm number (≥40×10⁶) (25.7% versus 22.7%, P=0.671). Conclusions: In IUI with low number of motile sperm inseminated, timed intercourse significantly increases the pregnancy rates over IUI alone in infertile couples with a normal sperminogram. This alternative treatment appears to be a practical, simple, and inexpensive addition that improves the pregnancy rate in patients receiving ovulation induction and intrauterine insemination program.     

Cassandra’s prophecy and the trend of delaying childbearing: is there a simple answer to this complex problem?

There is a trend to later childbearing, but is the solution offered by Jane Everywoman appropriate or proportionate? Her case is, as she says herself, not necessarily representative and in describing it in such painful detail, might she alarm many women unnecessarily?     

Semen quality in middle-aged males: associations with prostate-specific antigen and age-related prostate conditions

Luteal phase defect (LPD) or short luteal phase is a controversial entity that has been variously defined over the years. There are a number of potential causes for LPD all of which are associated with inadequate progesterone secretion throughout the luteal phase which impairs endometrial development and is thus thought to cause infertility. However, the relationship between LPD and infertility is complex, with LPD found in both fertile and infertile women. Attempts have been made at treating LPD with a number of regimens including progesterone supplementation and ovulation induction using clomiphene citrate, however, problems with study design have prevented conclusive evidence for the efficacy of these treatments being drawn. Practically, with the more interventionalist and aggressive approaches to managing couples with unexplained infertility, LPD may have become an irrelevant entity.     

Semen parameters and pregnancy rates after microsurgical varicocelectomy in primary versus secondary infertile men

In a prospective study, the outcomes of microsurgical varicocelectomy in men with primary versus secondary infertility were compared. Ninety-two infertile men with a varicocele were included. They were classified into those with primary infertility (n?=?57) and secondary infertility (n?=?35). Clinical data, semen parameters and scrotal ultrasound finding were available for all patients and microsurgical varicocelectomy was performed on all of them. Spontaneous pregnancy rates and improvement in semen parameters in those men with primary versus secondary infertility were recorded 1 year after surgery. Preoperatively, there was no significant difference in the mean semen parameters in both groups (p?>?0.05) and the mean semen parameters showed no significant difference between men with primary and secondary infertility. After microsurgical varicocelectomy, the mean semen parameters improved significantly in both group (p?p?>?0.05 for each). After adjustment for patient and partner ages, the pregnancy rate at the end of the follow-up period did not significantly differ between the primary (24/57, 42.1%) and secondary (11/35, 31.4%) infertility group (Pearson’s Chi-squared?=?1.05). We concluded from this study that semen parameters and pregnancy rates after microsurgical varicocelectomy were similar between men with primary and secondary infertility.     

What does having a fertility problem mean to couples?

The meaning of fertility problems for couples and how partners differed in their appraisals of their fertility problems were the main areas of interest in this research. Ten couples recruited via an infertility clinic took part in semi‐structured interviews, which were analysed using inductive thematic analysis. Two super‐ordinate themes emerged: ‘Expectations of life – “What's it all about?”’ highlighted the lifecycle expectations people have and the reflections infertile couples undertake about parenthood and their relationship. ‘Dealing with ongoing fertility problems – “When it doesn't happen how we expect”’ presented perceptions of fertility treatment alongside differing responses to ongoing infertility, with feelings of resentment and acceptance emerging. Communication was revealed to play an important yet complex role in the experience of continued fertility problems. Gender differences were highlighted in the meaning of infertility and the importance of biological parenthood and also in the amount, nature and purpose of communication. The implications for research and counselling which is focused on ‘couples’ are discussed.