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Omidvar-Mehrabadi A, Ebrahimi F, Shahbazi M, Mohammadnia-Afrouzi M. Cytokine and chemokine profiles in women with endometriosis, polycystic ovary syndrome, and unexplained infertility. Cytokine 2024; 178:156588. [PMID: 38555853 DOI: 10.1016/j.cyto.2024.156588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
Numerous factors (including immunological, congenital, hormonal, and morphological disorders) can lead to infertility. In this regard, 3 specific diseases associated with infertility are discussed in this review study (i.e., polycystic ovary syndrome [PCOS], endometriosis [EMS], and unexplained infertility [UI]). PCOS is a common endocrine disorder characterized by chronic low-grade inflammation, and EMS is a benign disease characterized by the presence of ectopic endometrial tissue. UI refers to couples who are unable to conceive for no known reason. Conception and pregnancy are significantly affected by the immune system; in this regard, chemokines and cytokines play important roles in the regulation of immune responses. Patients with PCOS, EMS, and UI have altered cytokine and chemokine profiles, suggesting that dysregulation of these molecules may contribute to infertility in these conditions. Accordingly, the issue of infertility is addressed in this review study, a condition that affects approximately 16% of couples worldwide.
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Affiliation(s)
| | - Fateme Ebrahimi
- Department of Immunology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Shahbazi
- Department of Immunology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
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Wasilewski T, Wasilewska J, Łukaszewicz-Zając M, Mroczko B. Subfertility as Overlapping of Nutritional, Endocrine, Immune, and Cardiometabolic Dysregulations-A Study Focused on Biochemical Endophenotypes of Subfertile Couples. J Clin Med 2023; 12:6094. [PMID: 37763034 PMCID: PMC10531916 DOI: 10.3390/jcm12186094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Subfertility is a global health issue, and as many as 30% of cases are attributed to unexplained reasons. A hypercaloric, high-fat diet stimulates the expansion of pro-inflammatory gut microbiota with a consequent rise in circulating lipopolysaccharides. Adverse gut microbiota remodeling can exacerbate insulin resistance, while sex and thyroid hormones may influence the variability in gut microbiota. This cross-sectional study included 150 participants and was designed to determine a biochemical, nutritional-related pattern that may distinguish subfertile from fertile individuals and couples. A panel of 28 biomarkers was assessed. Four biochemical phenotypes of unexplained subfertility were found, including two metabolic and two immune, when assessed using binary logistic regression models. Two phenotypes were distinguished in women: cardio-metabolic with atherogenic dyslipidemia (LowHDL-cholesterol: OR = 10.9; p < 0.05) and autoimmune thyroid disorder (Highanti-thyroid-peroxidase: OR = 5.5; p < 0.05) and two in men: hepato-metabolic with elevated liver injury enzymes (HighHOMA-IR: OR = 6.1; p < 0.05) and immune type-2 response (HighIgE: OR = 6.4; p < 0.05). The chances of a couple's subfertility rose with the number of laboratory components of metabolic syndrome in the couple (OR = 1.7; p < 0.05) and if at least one partner had an elevated total IgE level (>100 kU/L) (OR = 6.5; p < 0.05). This study found that unexplained subfertility may be accompanied by mutually overlapping immune and metabolic dysregulations in individuals and couples. We propose one-time laboratory diagnostics taking into account the lipid profile, insulin resistance, anti-thyroid-peroxidase, and total IgE in both males and females with unexplained subfertility. This may allow for a one-time assessment of targeted medical and nutritional interventions and help optimize patients' health. The gut-organ axes related to subfertility are discussed in the context of the obtained results.
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Affiliation(s)
- Tadeusz Wasilewski
- Centre for Restorative Procreative Medicine, Napromedica, 15-741 Bialystok, Poland;
| | - Jolanta Wasilewska
- Centre for Paediatrics, Allergology, Psychodietetics, and Treatment of Children Diagnosed with Autism, IPM, 15-404 Bialystok, Poland
| | - Marta Łukaszewicz-Zając
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland;
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland;
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
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Joseph T, Karuppusami R, Kunjummen AT, Kamath MS. Impact of tubal patency test selection on the live birth rate following intrauterine insemination in couples with unexplained infertility: a retrospective cohort study. Arch Gynecol Obstet 2023; 308:621-629. [PMID: 37310451 DOI: 10.1007/s00404-023-07091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We planned a study to evaluate the impact of selecting hysterosalpingography (HSG) over diagnostic laparoscopy during initial fertility evaluation on IUI treatment outcomes in couples diagnosed with unexplained infertility. METHODS The study comprised a retrospective cohort and included couples evaluated for infertility at our tertiary level hospital between January 2008 and December 2019. Couples diagnosed with unexplained infertility based on tubal patency tests (either HSG or diagnostic laparoscopy) were included. We compared outcomes following ovarian stimulation (OS) and intrauterine insemination (IUI) between women who underwent HSG versus laparoscopy for up to three treatment cycles. RESULTS A total of 7413 women were screened, out of which 1002 women were diagnosed with unexplained infertility. We did not find a significant statistical difference in the clinical pregnancy (16.7% vs. 11.7%; OR (odds ratio) 1.51; 95% CI (confidence interval) 0.90-2.5) or live birth rate per IUI cycle (15.1% vs. 10.7%; OR 1.51, 95% CI 0.9-2.6) in women who underwent HSG for tubal evaluation as compared to laparoscopy. After adjustment for potential confounders through multivariate analysis, we found that outcomes were comparable between the HSG and laparoscopy. CONCLUSION The current study did not find any significant difference in treatment outcomes following OS and IUI in women with unexplained infertility who underwent HSG compared to laparoscopy for the assessment of the tubal patency during the initial fertility workup. The finding suggests minimal or no impact of selecting HSG over diagnostic laparoscopy as a tubal patency test on the subsequent IUI outcomes.
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Affiliation(s)
- Treasa Joseph
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002, India
| | - Aleyamma T Kunjummen
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India.
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Sezginer P, Elmas C, Yıldız F. The effect of controlled ovarian hyperstimulation on ovarian reserve via PTEN pathway. REPRODUCTION AND FERTILITY 2022; 3:187-197. [PMID: 35972314 PMCID: PMC9513659 DOI: 10.1530/raf-21-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/15/2022] [Indexed: 12/28/2022] Open
Abstract
Abstract This study was carried out to investigate whether repeated controlled ovarian hyperstimulation (COH) affects ovarian reserve. For this reason, we aimed to show possible changes in the expression of PTEN and FOXO3, which are involved in preserving the over-reserve, after applying the COH protocol methods. For this purpose, 18 young Wistar albino female rats (8 weeks old) were randomly assigned as group 1 (control), group 2, and group 3 as 6 subjects in each group. Experimental groups were treated with 10 IU/0.1 mL pregnant mare's serum gonadotropin and a COH protocol consisting of 10 IU/0.1 mL human chorionic gonadotropin injection after 48 h. This procedure was applied three and five times to group 2 and group 3, respectively. For the control groups, the same procedures were performed with 0.1 mL of 0.9% sodium chloride solution. At the end of the experiment, the ovarium tissues were placed in a 10% neutral formaldehyde solution for light microscopic examinations. In histological sections stained with hematoxylin and eosin, the number of ovarian follicles was determined using the physical dissector method. However, the expression of PTEN, FOXO3, and LH-R molecules was evaluated by immunohistochemical methods. As a result of our study, it was concluded that COH administration reduces the expression levels of PTEN and FOXO3 proteins and LH-R, which are among the essential components of the PIK3 intracellular signaling pathway and also increased the levels of hormones such as follicle-stimulating hormone, estradiol, and luteinizing hormone, which are over-reserve markers, and causes adverse effects on the histological structure, oocyte morphology, and number of ovaries. Lay summary Today, approximately 10-15% of couples experience fertility problems. However, assisted reproductive techniques help people with fertility problems to get pregnant. The main purpose of these techniques is to put the sperm and egg together outside the woman's body where the eggs are fertilized and then to return the fertilized eggs (embryos) to the womb. During a woman's menstrual cycle, several hormones influence the growth of the eggs. This process can be mimicked by using various medications. Medication is given to increase the number of eggs that develop. However, this method is not the same as normal ovulation. Therefore, in our study, we wanted to examine the effect that developing multiple follicles has on the number and quality of eggs remaining for the future.
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Affiliation(s)
- Perihan Sezginer
- Department of Medical Laboratory Techniques, Alanya Alaaddin Keykubat University, Health Services Vocational School, Alanya, Turkey
| | - Cigdem Elmas
- Department of Histology and Embryology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Fatma Yıldız
- Department of Medical Laboratory Techniques, Alanya Alaaddin Keykubat University, Health Services Vocational School, Alanya, Turkey
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Expectant Management Before In vitro Fertilization in Women Aged 39 or Above and Unexplained Infertility Does Not Decrease Live Birth Rates Compared to Immediate Treatment. Reprod Sci 2021; 29:1232-1240. [PMID: 34724170 PMCID: PMC8559689 DOI: 10.1007/s43032-021-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022]
Abstract
Unexplained infertile couples can have further expectant management before starting assisted reproductive treatments. However, ovarian reserve and in vitro fertilization (IVF) outcomes rapidly decline after 39 years or more. It is thus important to clarify whether a waiting policy is also appropriate for women of advanced age. Couples who had access to a waiting list for approximately 1 year before receiving reimbursed public IVF were compared with those paying for access to immediate treatment. To allow for comparisons between these two strategies, we followed up couples who opted to pay for 1 year after the last embryo transfer from their first cycle. We calculated the proportion of live births in both groups and compared these using logistic regression models and a two-sample Z test for equality of proportions. Six hundred thirty-five couples were evaluated. Out of 359 couples in the immediate group, 70 (19.5%) had a live birth of which 11 after natural conception and 59 after IVF. Out of 276 couples in the waiting group, 57 (20.7%) had a live birth of which 37 after natural conception and 20 after IVF. There was no statistically significant difference between the two strategies in terms of the crude cumulative live birth rate (cLBR). The adjusted odds ratio of 0.69 (95%CI:0.39–1.22) did not change this conclusion as our sensitivity analyses. The cLBR for the ‘waiting before IVF’ and the ‘immediate’ strategies were similar. Further studies are needed to better characterize couples affected by unexplained infertility in order to individualize treatment strategies.
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Satwik R, Kochhar M. Unexplained infertility categorization based on female laparoscopy and total motile sperm count, and its impact on cumulative live-births after one in-vitro fertilization cycle. A retrospective cohort study involving 721 cycles. Reprod Med Biol 2021; 20:190-198. [PMID: 33850452 PMCID: PMC8022093 DOI: 10.1002/rmb2.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine how subcategorizing unexplained infertility based on female laparoscopy and total-motile-sperm-count assessment would impact cumulative live-births after one in-vitro fertilization (IVF) cycle. METHODS Seven hundred twenty one IVF cycles from Jan 2014-April 2019 performed at a single-center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total-motile-sperm-count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Controls were severe male factor, bilateral tubal block, and grade 3/4 endometriosis: n = 418. Primary Outcome was cumulative-live-birth-per-initiated-IVF cycle (CLBR). Odds ratio for live-births were adjusted for confounding factors. RESULTS The CLBR in UI1 cohort was significantly lower than controls (29.1% vs 39; OR = 0.62; 95%CI = 0.39-0.98; P = .04); but similar in UI2 and UI3 vs. controls. (37.2% vs 39.95%; OR = 0.89, 95%CI = 0.55-1.44; P = .89) and (38.6% vs 39.95%; OR = 0.98, 95%CI = 0.64-1.55; P = .98). After adjusting for age, infertility duration, past live-births, and AMH, the adjusted odds for CLBR in UI1 was 0.48 (95%CI = 0.28-0.82; P = .007). CONCLUSIONS Unexplained infertility when defined after a normal laparoscopy and TMSC significantly lowered cumulative-live-births-per-initiated-IVF cycle when compared with traditional diagnosis of tubal, endometriosis, or male factor infertility. In UI subcategory with abnormal laparoscopy or TMSC, CLBR remained unaffected. This information could be useful for counseling couples prior to IVF. Large-scale prospective studies are needed to confirm this observation.
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Affiliation(s)
- Ruma Satwik
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
| | - Mohinder Kochhar
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
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Mathews DM, Johnson NP, Sim RG, O'Sullivan S, Peart JM, Hofman PL. Iodine and fertility: do we know enough? Hum Reprod 2021; 36:265-274. [PMID: 33289034 DOI: 10.1093/humrep/deaa312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/30/2020] [Indexed: 02/01/2023] Open
Abstract
Iodine is a vital micronutrient and its importance in thyroid function is well established. However, abnormalities in iodine intake may also have other effects. In particular, iodine is taken up avidly by the ovary and endometrium. Iodine deficiency is associated with reduced fertility. The use of high iodine concentration contrast media has recently been shown to improve conception rates in couples with unexplained infertility (UI). We hypothesize that this improvement could be related to the iodine excess and mechanisms independent of its action on thyroid. In this article, the metabolism of iodine and its potential role in fertility will be discussed, including the impact of both iodine deficiency and excess states and the importance of iodine in normal fetal development. This will include insights from animal studies on the effect of iodine in the uterine and ovarian structural environment, hormonal milieu and immunological factors affecting implantation. We speculate that iodine may well have a role as a potential therapy for UI.
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Affiliation(s)
- Divya M Mathews
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Neil P Johnson
- Robinson Research Institute, University of Adelaide, Australia and University of Auckland & Repromed Auckland, Auckland, New Zealand
| | | | - Susannah O'Sullivan
- Endocrinology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | | | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
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8
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Risk of major adverse cardiovascular and cerebrovascular events in Taiwanese women with endometriosis. J Formos Med Assoc 2021; 120:327-336. [DOI: 10.1016/j.jfma.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/05/2020] [Accepted: 10/04/2020] [Indexed: 12/27/2022] Open
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Abstract
Infertility is described as unexplained when pregnancy does not occur despite ovulation, patent Fallopian tubes, and normal semen parameters. Oocyte developmental competence (or quality) is rate-limiting for pregnancy success as oocytes provide virtually all the cellular building blocks including mitochondria required during embryogenesis. However, available tests estimate oocyte numbers (anti-Müllerian hormone, follicle-stimulating hormone and antral follicle count) and ovulation (luteal phase serum progesterone) but not the third, and most pivotal, oocyte-specific parameter, quality. Severe depletion of the follicular reserve manifests as premature ovarian insufficiency and is an obvious cause of anovulation with overt symptoms and clear diagnostic criteria. In contrast, there are no biomarkers of poor oocyte quality other than through in vitro fertilization when readouts of oocyte quality such as preimplantation embryo development can be assessed. The most common cause of poor oocyte quality is natural aging, which is strongly tied to reduced oocyte mitochondrial efficiency and increased oxidative stress. In younger women, quality may also be impaired due to accelerated aging or sporadic genetic mutations which cause severe defects during oocyte and embryo development. Thus, poor oocyte quality often provides an explanation for infertility, but because it cannot be measured using conventional tests, many cases of infertility are often incorrectly labeled "unexplained." Since female age remains the best predictor of oocyte quality, age over 37 years should be considered an independent diagnostic criterion.
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Affiliation(s)
- Hayden Anthony Homer
- Christopher Chen Oocyte Biology Research Laboratory, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Herston 4029, Queensland, Australia
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Kamath MS, Rikken JFW, Bosteels J. Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility? Semin Reprod Med 2020; 38:29-35. [PMID: 33080633 DOI: 10.1055/s-0040-1718942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The standard fertility workup includes assessment of ovulation, semen analysis, and evaluation of tubal patency. If the fertility workup is found to be normal, a diagnosis of unexplained infertility is made. The role of laparoscopy in fertility workup has been a matter of debate. The current review presents the evidence for and against laparoscopy and hysteroscopy during fertility workup and subsequently prior to fertility treatment. After appraising the literature, we found the role of diagnostic laparoscopy in fertility workup is limited and is dependent on factors like prevalence of pelvic infection, setting, and availability of expertise. Moreover, whenever a laparoscopy is planned as a part of the fertility workup, the preparation should include ability to carry out simultaneous therapeutic intervention to maximize the benefit. Similarly, the routine use of hysteroscopy in women with unexplained infertility cannot be recommended. There is a need to investigate the impact of choice of tubal test on chances of spontaneous conception and treatment outcomes in women with unexplained infertility. Our future research agenda should also include high-quality multicenter randomized trials assessing the cost-effectiveness of screening and operative hysteroscopy prior to intrauterine insemination or in vitro fertilization.
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Affiliation(s)
- Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Judith F W Rikken
- Center for Reproductive Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan Bosteels
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium.,Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, Gent University, Gent, Belgium
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Abdallah KS, Hunt S, Abdullah SA, Mol BWJ, Youssef MA. How and Why to Define Unexplained Infertility? Semin Reprod Med 2020; 38:55-60. [PMID: 33058088 DOI: 10.1055/s-0040-1718709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unexplained infertility represents up to 30% of all cases of infertility. It is a diagnosis of exclusion, where no cause for infertility may be identified in the investigation of the couple, be it anovulation, fallopian tube blockage, or severe male factor. Unexplained infertility therefore cannot be considered a diagnosis to which a specific treatment is directed, rather that it indicates a failure to reach a diagnosis of the true cause of infertility. In this review, we explore the evidence base and potential limitations of the current routine infertility assessment. We also aim to highlight the importance of considering the prognosis of each individual couple through the process of assessment and propose a reconsidered approach to treatment, targeted to the prognosis rather than the diagnosis. Ultimately, a better understanding of the mechanisms of infertility will reduce the number of couples diagnosed with "unexplained" infertility.
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Affiliation(s)
- Karim S Abdallah
- Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Monash University, Clayton, Australia
| | - Sarah Hunt
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash Health, Clayton, Australia.,Monash IVF, Richmond, Australia
| | - Sayed A Abdullah
- Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Mohamed A Youssef
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
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Siristatidis C, Pouliakis A, Sergentanis TN. Special characteristics, reproductive, and clinical profile of women with unexplained infertility versus other causes of infertility: a comparative study. J Assist Reprod Genet 2020; 37:1923-1930. [PMID: 32504303 DOI: 10.1007/s10815-020-01845-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/28/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate whether women with unexplained infertility (UI) demonstrate different demographic and IVF characteristics compared to those with other causes of infertility. METHODS Data on 245 couples that underwent a total of 413 IVF/ICSI cycles were analyzed (UI 114 cycles, 73 women; anovulation (PCO/PCOS) 83 cycles, 51 women; tubal factor 85 cycles, 47 women; male factor 131 cycles, 74 women). Features of UI were compared versus other infertility groups, after adjustment for multiple comparisons. Generalized least squares (GLS) and random-effects logistic regression analysis were also performed. RESULTS Live birth rates, consisting of the primary outcome, were similar in all compared infertility groups. Compared to male infertility, UI was associated with woman's older age at cycle, lower body mass index (BMI), and higher follicle-stimulating hormone (FSH). Compared to tubal infertility, UI was linked to lower endometrial thickness at oocyte retrieval and lower BMI; compared to anovulatory infertility related to PCO/PCOS, UI was linked to woman's older age, more frequent smoking, and poorer ovarian reserve tests (FSH and antral follicle count). After adjustment for other types of infertility, woman's age, age at menarche, and FSH levels, anovulatory infertility presented with higher odds of clinical pregnancy compared to UI (adjusted OR = 2.13, 95% C: 1.01-4.52). CONCLUSIONS Infertile women with UI undergoing assisted reproduction demonstrate different demographic and clinical characteristics compared to those of other causes of infertility, albeit live birth rates are similar.
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Affiliation(s)
- Charalampos Siristatidis
- Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Street, Chaidari, 12642, Athens, Greece.
- Assisted Reproducton Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Street, Chaidari, 12642, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, 80 Vas. Sofias Ave, 11528, Athens, Greece
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Wasilewski T, Łukaszewicz-Zając M, Wasilewska J, Mroczko B. Biochemistry of infertility. Clin Chim Acta 2020; 508:185-190. [PMID: 32446954 DOI: 10.1016/j.cca.2020.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023]
Abstract
Infertility affects approximately 186 million people worldwide and 8-12% of couples of reproductive age. Therefore, a comprehensive diagnostic evaluation of infertility is crucial to achieving improvements in targeted prevention and treatment outcomes. The aim of this review is to explore the biochemistry of infertility in order to properly diagnose and treat infertile couples. Recent studies indicate that routine measurement of biochemical parameters reflecting thyroid dysfunction, immunological disorders, autoimmune mechanisms, insulin resistance and malabsorption of selected micro- and macronutrients are required to assess infertility. Due to the complexity of this approach, algorithmic protocols that integrate these biochemical parameters in a dynamic test environment are necessary to provide a more comprehensive diagnostic assessment and more effective treatment strategy for infertile couples.
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Affiliation(s)
- T Wasilewski
- Centre for Restorative Procreative Medicine, Napromedica, Bialystok, Poland
| | - M Łukaszewicz-Zając
- Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | - J Wasilewska
- Centre for Paediatrics, Allergology, Psychodietetics, and Treatment of Children Diagnosed with Autism, IPM, Bialystok, Poland
| | - B Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland; Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Bialystok, Poland.
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14
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Qu T, Yan M, Shen WJ, Li L, Zhu P, Li Z, Huang J, Han T, Hu W, Zhou R, Li P, Xu L, Huang T, Zhong Y, Gu J. Predictive serum markers for unexplained infertility in child-bearing aged women. Am J Reprod Immunol 2020; 83:e13194. [PMID: 31585484 DOI: 10.1111/aji.13194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/20/2019] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
Abstract
PROBLEM Unexplained infertility (UI) represents about 25%-40% of all infertility and is a formidable obstacle for successful pregnancy for child-bearing aged women. However, up to now, there is no reliable method to predict this condition with high accuracy, thereby hindering early management of this condition. METHOD OF STUDY Our prospective study consists of 84 child-bearing aged women that were clinically diagnosed UI. Forty-four matched healthy fertility (HF) women were served as controls. We examined the profiles of 25 hormones and cytokines that were likely related to pathogeneses and molecular pathways involved in UI with the technique of protein array. The samples were randomly stratified 7:3 into a training set and a testing set. We used the SMOTEboost model with 10 serum proteins in a clinical verification study to identify UI cases. RESULTS The predictor had an area under the receiver operating characteristic curve (AUC) of 0.788 with 24 serum protein features. The predictive performance in terms of AUC of the model with the top 10 important serum proteins in the clinical verification study to classify UI cases was 0.809. Three most significantly differentially expressed proteins (DEPs) were prolactin, monocyte chemotactic protein-1 (MCP-1), and leptin. CONCLUSION Examination of serum-based protein profile changes could help to identify child-bearing aged women at risk of UI. This would enable early detection and facilitate development of clinical strategies to treat UI and guide their planned parenthood. It may also give clues to pathogeneses of the condition of test subjects.
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Affiliation(s)
- Ting Qu
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Meiling Yan
- Laboratory of Molecular Pathology, Provincial Key Laboratory of Infectious Diseases and Molecular Pathology, Center of Molecular Diagnosis and Personalized Medicine, Shantou University Medical College, Shantou, China
| | - Wen-Jun Shen
- Department of Bioinformatics, Shantou University Medical College, Shantou, China
| | - Lingxiao Li
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Ping Zhu
- Laboratory of Molecular Pathology, Provincial Key Laboratory of Infectious Diseases and Molecular Pathology, Center of Molecular Diagnosis and Personalized Medicine, Shantou University Medical College, Shantou, China
| | - Zhouxuan Li
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Jihua Huang
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Tingting Han
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Wenhui Hu
- Xi'nan Gynecological Hospital, Chengdu, China
| | | | - Penghao Li
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Lan Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Tianhua Huang
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Ying Zhong
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
| | - Jiang Gu
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu, China
- Laboratory of Molecular Pathology, Provincial Key Laboratory of Infectious Diseases and Molecular Pathology, Center of Molecular Diagnosis and Personalized Medicine, Shantou University Medical College, Shantou, China
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15
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Wang M, Hao C, Huang X, Bao H, Qu Q, Liu Z, Dai H, He S, Yan W. Aberrant Expression of lncRNA ( HOXA11-AS1) and Homeobox A ( HOXA9, HOXA10, HOXA11, and HOXA13) Genes in Infertile Women With Endometriosis. Reprod Sci 2017; 25:654-661. [PMID: 29017417 DOI: 10.1177/1933719117734320] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study aimed to study the expression of homeobox (HOX)A11-AS1 ( HOXA11 antisense RNA) long noncoding RNA (lncRNA) and the expression of homeobox A ( HOXA9, HOXA10, HOXA11, and HOXA13) genes in the eutopic (EU) and ectopic (EC) endometria of women with peritoneal endometriosis. A total of 30 women undergoing laparoscopic surgery for peritoneal endometriosis and 15 infertile women without endometriosis were enrolled in this study. Peritoneal EC tissue samples were obtained through surgery. The EU tissues were obtained by curettage. The EC and EU lncRNA and messenger RNA (mRNA) expression levels were measured using real-time reverse transcriptase-polymerase chain reaction. The HOXA11-AS1 lncRNA and HOXA9, HOXA10, HOXA11, and HOXA13 mRNA were expressed at significantly lower levels in the EU than in the EC, that is, in women with peritoneal endometriosis ( P < .05). The expression levels of HOXA10 and HOXA11 in the EU were significantly lower in women with peritoneal endometriosis compared to the control group participants ( P < .05), whereas the levels of lncRNA ( HOXA11-AS1), HOXA9, and HOXA13 did not differ significantly between the 2 patient groups ( P > .05). In conclusion, the study findings suggest that HOXA11-AS1 lncRNA may play a role in the development of peritoneal endometriosis, but HOXA11-AS1 may not influence endometrial receptivity in endometriosis-associated infertility.
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Affiliation(s)
- Meimei Wang
- 1 Shandong University School of Medicine, Jinan, People's Republic of China.,2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Cuifang Hao
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Xin Huang
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Hongchu Bao
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Qinglan Qu
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Zhenteng Liu
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Huangguan Dai
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Shunzhi He
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Wei Yan
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
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16
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Verit FF, Yildiz Zeyrek F, Zebitay AG, Akyol H. Cardiovascular risk may be increased in women with unexplained infertility. Clin Exp Reprod Med 2017; 44:28-32. [PMID: 28428941 PMCID: PMC5395549 DOI: 10.5653/cerm.2017.44.1.28] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/15/2022] Open
Abstract
Objective Growing evidence suggests that increased cardiovascular disease (CVD) risk is associated with female infertility caused by conditions such as polycystic ovarian disease, obesity, thyroid dysfunction, and endometriosis. The aim of this study was to evaluate whether any relationship exists between CVD and unexplained infertility. Methods Sixty-five women with unexplained infertility and 65 fertile controls were enrolled in the study. CVD risk markers such as low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglycerides (TG), insulin resistance (defined by the homeostasis model assessment ratio), and high-sensitivity C-reactive protein (hs-CRP) were assessed. Results TG, TC, LDL, and hs-CRP levels were higher and HDL levels were lower in patients with unexplained infertility than in fertile controls (p<0.05 for all). Positive associations were found between unexplained infertility and TG, TC, LDL, and hs-CRP levels, and a negative correlation was found for HDL (p<0.05 for all). Multivariate logistic regression analysis showed that TG, HDL, and hs-CRP were independent variables associated with unexplained infertility. Conclusion Our study showed that women with unexplained infertility had an atherogenic lipid profile and elevated hs-CRP levels, suggesting a higher risk of developing CVD in the future. Further studies with larger groups are needed to investigate the nature of this link.
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Affiliation(s)
- Fatma Ferda Verit
- Department of Obstetrics and Gynecology, Suleymaniye Maternity, Research, and Training Hospital, Istanbul, Turkey
| | - Fadile Yildiz Zeyrek
- Department of Microbiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ali Galip Zebitay
- Department of Obstetrics and Gynecology, Suleymaniye Maternity, Research, and Training Hospital, Istanbul, Turkey
| | - Hurkan Akyol
- Department of Obstetrics and Gynecology, Suleymaniye Maternity, Research, and Training Hospital, Istanbul, Turkey
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17
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Brazdova A, Senechal H, Peltre G, Poncet P. Immune Aspects of Female Infertility. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:1-10. [PMID: 27123194 PMCID: PMC4845518 DOI: 10.22074/ijfs.2016.4762] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 12/31/2014] [Indexed: 12/24/2022]
Abstract
Immune infertility, in terms of reproductive failure, has become a serious health issue involving approximately 1 out of 5 couples at reproductive age. Semen that is defined as a complex fluid containing sperm, cellular vesicles and other cells and components, could sensitize the female genital tract. The immune rejection of male semen in the female reproductive tract is explained as the failure of natural tolerance leading to local and/or systemic immune response. Present active immune mechanism may induce high levels of anti-seminal/sperm antibodies. It has already been proven that iso-immunization is associated with infertility. Comprehensive studies with regards to the identification of antibody-targets and the determination of specific antibody class contribute to the development of effective immuno-therapy and, on the other hand, potential immuno-contraception, and then of course to complex patient diagnosis. This review summarizes the aspects of female immune infertility.
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Affiliation(s)
- Andrea Brazdova
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
| | - Helene Senechal
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
| | - Gabriel Peltre
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
| | - Pascal Poncet
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
- Department of Infection and Epidemiology, Pasteur Institute, Paris, France
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18
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Krasnopol’skaya KV, Nazarenko TA, Ershova IY. Modern approaches to endometrial receptivity assessment (a review). ACTA ACUST UNITED AC 2016. [DOI: 10.17116/repro201622561-69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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19
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Boujenah J, Montforte M, Hugues J, Sifer C, Poncelet C. Y a-t-il une place pour la cœlioscopie dans le parcours en assistance médicale à la procréation ? ACTA ACUST UNITED AC 2015; 43:604-11. [DOI: 10.1016/j.gyobfe.2015.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
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20
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Sabbaghi M, Aram R, Roustaei H, Fadavi Islam M, Daneshvar M, Castaño AR, Haghparast A. IL-17A concentration of seminal plasma and follicular fluid in infertile men and women with various clinical diagnoses. Immunol Invest 2014; 43:617-26. [DOI: 10.3109/08820139.2014.909453] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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21
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The low expression of leukemia inhibitory factor in endometrium: possible relevant to unexplained infertility with multiple implantation failures. Cytokine 2013; 62:334-9. [PMID: 23541977 DOI: 10.1016/j.cyto.2013.03.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 11/21/2022]
Abstract
Unexplained infertility affects 25% of infertile couples. Cytokines and growth factors have been suggested to play an important role in the initial process of successful implantation in humans and failures in their production may be a cause of unexplained infertility. Leukemia inhibitory factor (LIF) and Interleukin-6 (IL-6) have demonstrated their importance in implantation in both animal and human studies. Lower expression of LIF is found in proliferative phase and maximal expression is found in secretory phase of the menstrual cycle. Lower expression of LIF is also found in secretory phase endometrium in patients with infertility. However, studies investigating whether the levels of LIF in proliferative phase are associated with multiple implantation failures (MIFs) are limited. 30 Endometrial biopsies in proliferative phase from unexplained infertile women with MIF with normal hormone levels were collected. The expression of LIF, IL-6 and its receptor gp130 were measured by immunohistochemistry and western blotting. Moderate expression of LIF in the proliferative phase and high expression of LIF in the secretory phase were found in fertile women. However, lower expression of LIF was found in unexplained infertile women with MIF compared to fertile women. There was no difference in endometrial IL-6 and gp130 expression between unexplained infertile women with MIF and fertile women. LIF expression is independent of the process of embryo and dependent partially on the maternal sex hormone levels. Our data suggest that the initial lower expression of LIF in proliferative phase may be one of the causes for multiple failure of implantation.
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22
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Kamath MS, Bhattacharya S. Demographics of infertility and management of unexplained infertility. Best Pract Res Clin Obstet Gynaecol 2012; 26:729-38. [DOI: 10.1016/j.bpobgyn.2012.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 08/08/2012] [Indexed: 11/30/2022]
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23
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Aisenberg Romano G, Ravid H, Zaig I, Schreiber S, Azem F, Shachar I, Bloch M. The psychological profile and affective response of women diagnosed with unexplained infertility undergoing in vitro fertilization. Arch Womens Ment Health 2012; 15:403-11. [PMID: 22847827 DOI: 10.1007/s00737-012-0299-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/18/2012] [Indexed: 11/24/2022]
Abstract
It has been hypothesized that unexplained infertility may be related to specific personality and coping styles. We studied two groups of women with explained infertility (EIF, n = 63) and unexplained infertility (UIF, n = 42) undergoing an in vitro fertilization (IVF) cycle. Women completed personality and coping style questionnaires prior to the onset of the cycle, and state depression and anxiety scales before and at two additional time points during the cycle. Almost no in-between group differences were found at any of the measured time points in regards to the Minnesota Multiphasic Personality Inventory-2 validity and clinical scales, Illness Cognitions and Life Orientation Test, or for the situational measures. The few differences found suggest a more adaptive, better coping, and functioning defensive system in women with EIF. In conclusion, we did not find any clinically significant personality differences or differences in depression or anxiety levels between women with EIF and UIF during an IVF cycle. Minor differences found are probably a reaction to the ambiguous medical situation with its uncertain prognosis, amplifying certain traits which are not specific to one psychological structure but rather to the common experience shared by the group. The results of this study do not support the possibility that personality traits are involved in the pathophysiology of unexplained infertility.
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Fatini C, Conti L, Turillazzi V, Sticchi E, Romagnuolo I, Milanini MN, Cozzi C, Abbate R, Noci I. Unexplained infertility: association with inherited thrombophilia. Thromb Res 2012; 129:e185-8. [PMID: 22425217 DOI: 10.1016/j.thromres.2012.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/10/2012] [Accepted: 02/19/2012] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Unexplained infertility represents one of the most common diagnoses in fertility care. Attention is being paid to the association between inherited thrombophilia and infertility causes. In this study we investigated the prevalence of inherited thrombophilia according to infertility causes. MATERIALS AND METHODS We studied Prothrombin gene G20210A mutation, Factor V Leiden, deficiencies in protein S and C and antithrombin in 930 Caucasian infertile women referred to Fertility Center of the Department of Sciences for Woman and Child's Health, University of Florence, of whom 230 with unexplained, 195 female and 283 male infertility, and in 240 women who have conceived naturally without hormonal stimulation therapy. RESULTS A significant relationship between inherited thrombophilia [OR 95%CI 1.97 (1.05-3.68), p = 0.03] and unexplained infertility was observed, whereas no association between thrombophilia and female and male infertility was found. Significantly higher prevalence of prothrombin gene mutation in unexplained infertile women in comparison to that observed in fertile women was observed (5.7% vs 2.1% p = 0.04); the prevalence of the other thrombophilia determinants was higher, even if not significantly, in the unexplained infertile group. CONCLUSIONS This study demonstrates the relationship between inherited thrombophilia and unexplained infertility, thus suggesting the contribution of genetic components in modulating unexplained infertility, behind anovulation, male and tubal factor.
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Affiliation(s)
- Cinzia Fatini
- Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Lee TH, Liu CH, Shih YT, Tsao HM, Huang CC, Chen HH, Lee MS. Magnetic-activated cell sorting for sperm preparation reduces spermatozoa with apoptotic markers and improves the acrosome reaction in couples with unexplained infertility. Hum Reprod 2010; 25:839-46. [DOI: 10.1093/humrep/deq009] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Body mass index is an independent risk factor for the development of endometrial polyps in patients undergoing in vitro fertilization. Fertil Steril 2009; 91:1056-60. [DOI: 10.1016/j.fertnstert.2008.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 01/02/2008] [Accepted: 01/02/2008] [Indexed: 11/18/2022]
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27
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Dechanet C, Brunet C, Anahory T, Reyftmann L, Hedon B, Dechaud H. [Investigation of the infertile couple]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38 Spec No 1-2:F9-F18. [PMID: 19268227 DOI: 10.1016/s0368-2315(09)70227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- C Dechanet
- Service de gynécologie obstétrique et département de médecine et biologie de la reproduction, CHU Arnaud-de-Villeneuve, Montpellier.
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Golubovsky M. Unexplained infertility in Charles Darwin's family: genetic aspect. Hum Reprod 2008; 23:1237-8. [DOI: 10.1093/humrep/den052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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