1
|
Subedi SS, Bhansakarya R, Shrestha P, Sharma SK. Outcome of Laparoscopy in Infertile Couples attending a Teaching Hospital in Eastern Nepal: A Descriptive Cross-sectional Study. ACTA ACUST UNITED AC 2020; 58:889-892. [PMID: 34506402 PMCID: PMC7775028 DOI: 10.31729/jnma.5542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 11/14/2022]
Abstract
Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the outcome of laparoscopy in infertile females attending Nobel Medical College as laparoscopy is considered as a gold standard in investigation and treatment of infertility. Methods: A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology over a period of May 2018-April 2020, where the outcomes of laparoscopy in infertile females were studied. All the patients with abnormal HSG, unexplained infertility and adnexal mass in the background of infertility were enrolled. Results: Of the 100 infertile patients who underwent laparoscopy, 62 (62%) had evidence of tubal disease as documented by unilateral or bilateral block, 63 (63%) had peritubal adhesions and hydrosalpinx in 15 (15%). Associated pelvic pathology like endometriosis in 50 (50%) in the form of cyst, adhesions and complete and partial obliteration of Pouch of Douglas. Conclusions: Laparoscopy is definitely an effective diagnostic tool of tubal and pelvic pathology. Laparoscopy is recommended for all infertile females with suspected tubal factor and moreover it provides opportunity to correct the condition in possible cases.
Collapse
Affiliation(s)
- Shanti Sunuwar Subedi
- Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Rakina Bhansakarya
- Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Prajmi Shrestha
- Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Sajjan Kumar Sharma
- Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| |
Collapse
|
2
|
Lemmens L, Kos S, Beijer C, Braat DDM, Jonker MA, Nelen WLDM, Wetzels AMM. Optimization of laboratory procedures for intrauterine insemination: survey of methods in relation to clinical outcome. Andrology 2018; 6:707-713. [PMID: 29959833 DOI: 10.1111/andr.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a wide practice variation of used methods and outcomes in IUI in fertility laboratories. Standardization of the IUI procedure is important for reducing inconsistency among laboratories in counseling infertile couples and in pregnancy results. The aim of the study was to evaluate the currently used laboratory procedures of IUI in Dutch fertility laboratories and their effect on IUI pregnancy results. Additionally, the methods for semen analysis (SA) were evaluated, as SA is related to IUI in terms of inseminated sperm number and IUI counseling. MATERIAL AND METHODS This questionnaire survey study was sent to laboratories participating in the Dutch external quality control program for semen analysis (SKML) and consisted of 46 questions concerning laboratory management, methods for semen analysis and IUI, and clinical results. The results were analyzed using univariable and multivariable logistic regression models. RESULTS A total of 52 laboratories (out of 99) provided information on used methodologies for SA or laboratory procedures of IUI and the organization of the laboratory. A wide variability was confirmed in used methods for both SA and IUI. Evaluation of pregnancy results obtained during 3 years (2013-2015) showed that specific used laboratory methods have a significant effect on the probability of becoming pregnant. DISCUSSION AND CONCLUSION Important to remark is that in this survey study cycle-specific data, including variables of the individual couples (age, stimulation protocol, etc), were not included and may have effects on the results. The reported results provide an overview of the current practice performance; however, the organization of fertility laboratories is changing rapidly. The use of standardized methods in IUI is important for optimizing the performance of care and improving pregnancy results. The knowledge on used procedures, however, is limited, and further research on factors involving SA and the IUI procedure is necessary.
Collapse
Affiliation(s)
- L Lemmens
- Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| | - S Kos
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, The Netherlands
| | - C Beijer
- Department of Clinical Chemistry, Atalmedial, Medical Diagnostic Centre, Amsterdam, The Netherlands
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| | - M A Jonker
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - W L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| | - A M M Wetzels
- Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
3
|
Lemmens L, Kos S, Beijer C, Braat DDM, Nelen WLDM, Wetzels AMM. Techniques used for IUI: is it time for a change? Hum Reprod 2018; 32:1835-1845. [PMID: 28854719 DOI: 10.1093/humrep/dex223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/04/2017] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION Are the guidelines for the technical aspects of IUI (WHO, 2010) still in accordance with the current literature? SUMMARY ANSWER In general, the laboratory guidelines of the World Health Organization (WHO) are a suitable protocol, although the evidence is not always conclusive and some changes are advisable. WHAT IS KNOWN ALREADY Lack of standardization of the technical procedures required for IUI might result in inter-laboratory variation in pregnancy rates. Most centers still use their own materials and methods even though some guidelines are available. STUDY DESIGN, SIZE, DURATION A structural review focusing on the association between pregnancy rates and the procedures of semen collection (e.g. ejaculatory abstinence, collection place), semen processing (e.g. preparation method, temperature during centrifugation/storage), insemination (e.g. timing of IUI, bed rest after IUI) and the equipment used. PARTICIPANTS/MATERIALS, SETTING, METHODS A literature search was performed in Medline and the Cochrane library. When no adequate studies of the impact of a parameter on pregnancy results were found, its association with sperm parameters was reviewed. MAIN RESULTS AND THE ROLE OF CHANCE For most variables, the literature review revealed a low level of evidence, a limited number of studies and/or an inadequate outcome measure. Moreover, the comparison of procedures (i.e. semen preparation technique, time interval between semen, collection, processing and IUI) revealed no consensus about their results. It was not possible to develop an evidence-based, optimal IUI treatment protocol. LIMITATIONS, REASONS FOR CAUTION The included studies exhibited a lack of standardization in inclusion criteria and methods used. WIDER IMPLICATIONS OF THE FINDINGS This review emphasizes the need for more knowledge about and standardization of assisted reproduction technologies. Our literature search indicates that some of the recommendations in the laboratory guidelines could be adapted to improve standardization, comfort, quality control and to cut costs. STUDY FUNDING/COMPETING INTEREST(S) The Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands. S.K. and W.N. have no conflicts of interest to disclose. C.B. and A.W. are members of the board of the SKML. With a grant from SKML, L.L. was paid for her time to perform the research and write the publication. D.B. received grants from Merck Serono, Ferring and MSD, outside the submitted work. REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- L Lemmens
- Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S Kos
- Department of Clinical Chemistry, Maasstad Hospital Rotterdam, PO Box 9100, 3007 AC Rotterdam, The Netherlands
| | - C Beijer
- Department of Clinical Chemistry, Atalmedial, Medical Diagnostic Centre, PO Box 69641, 1060 CR Amsterdam, The Netherlands
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - W L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A M M Wetzels
- Fertility Laboratory, Department of Obstetrics and Gynaecology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | | |
Collapse
|
4
|
Abstract
Despite the development of in vitro fertilization (IVF) more than 30 years ago, the cost of treatment remains high. Furthermore, over the years, more sophisticated technologies and expensive medications have been introduced, making IVF increasingly inaccessible despite the increasing need. Globally, the option to undergo IVF is only available to a privileged few. In recent years, there has been growing interest in exploring strategies to reduce the cost of IVF treatment, which would allow the service to be provided in low-resource settings. In this review, we explore the various ways in which the cost of this treatment can be reduced.
Collapse
Affiliation(s)
- Pek Joo Teoh
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
| | - Abha Maheshwari
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
5
|
|
6
|
Curti G, Cánepa M, Cantú L, Montes J. [Diagnosis of male infertility: a need of functional and chromatin evaluation]. Actas Urol Esp 2013; 37:100-5. [PMID: 22710088 DOI: 10.1016/j.acuro.2011.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the incidence of functional and chromatin alterations on spermatozoids in patients grouped according to normality of standard semen parameters based on the 5th edition of the World Health Organization (WHO) guidelines. To identify and correlate the most frequently altered characteristics in the normal standard semen parameters sub-population. MATERIALS AND METHODS A prospective study was performed. It evaluated standard semen parameters (volume, sperm concentration, motility and morphology, round cells, peroxidase-positive cells) according to WHO guidelines, as well as functional tests (24 hours survival, hypoosmotic swelling test, modified stress test), and additional assays (aniline blue, nitroblue-tetrazolium, TUNEL) in 110 semen samples from patients and 6 from fertile donors (control). Based on standard semen parameters values, patients were divided into two groups (A: all standard parameters normal; B: one altered standard parameter at least). RESULTS At least one of the variables analyzed was altered in 96.61% of the samples. Groups A and B showed statistically significant differences in all the complementary tests. At least one of the complementary tests were altered in 93.68% of the samples in group A, and the most frequently affected variable was sperm DNA fragmentation (16.95%). CONCLUSIONS Performing a more in-depth seminal study within the routine functional and chromatin assays provides a more precise diagnosis of male infertility. The WHO standards should be considered as a primary approach.
Collapse
|
7
|
Tsuji I, Ami K, Fujinami N, Hoshiai H. The significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by hysterosalpingography. TOHOKU J EXP MED 2013; 227:105-8. [PMID: 22687706 DOI: 10.1620/tjem.227.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the possibility for fertility. The evaluation of the fallopian tube is necessary to determine the management plan of infertility. Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions; however, HSG has limitations in detecting tubal pathology. In the current study, we evaluated the significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by HSG. Between 1997 and 2009, 127 patients with suspected tubal pathology as demonstrated by HSG underwent laparoscopy at Kinki University Hospital, and a retrospective analysis was performed. Of 87 patients with unilateral tubal pathology revealed by HSG, 20 patients (23.0%) were given an indication for assisted reproductive technology (ART), based on the laparoscopic findings. Of 40 patients with bilateral tubal pathology revealed by HSG, 33 patients (82.5%) with bilateral tubal pathology detected by laparoscopy were given a high indication for ART. Laparoscopy enables exact evaluation of the fallopian tube and selection of the optimal management plan in infertile patients with suspected tubal pathology revealed by HSG. Therefore, laparoscopy should be performed in infertile patients with suspected tubal pathology revealed by HSG, as it is of diagnostic importance.
Collapse
Affiliation(s)
- Isao Tsuji
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan.
| | | | | | | |
Collapse
|
8
|
Milardi D, Grande G, Sacchini D, Astorri AL, Pompa G, Giampietro A, De Marinis L, Pontecorvi A, Spagnolo AG, Marana R. Male fertility and reduction in semen parameters: a single tertiary-care center experience. Int J Endocrinol 2012; 2012:649149. [PMID: 22319527 PMCID: PMC3272805 DOI: 10.1155/2012/649149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/19/2011] [Indexed: 11/24/2022] Open
Abstract
Background. Infertility is both a clinical and a public problem, affecting the life of the couple, the healthcare services, and social environment. Standard semen analysis is the surrogate measure of male fertility in clinical practice. Objective. To provide information about the relationship between semen parameters and spontaneous conception. Methods. We evaluated retrospectively 453 pregnancies that occurred among 2935 infertile couples evaluated at an infertility clinic of a tertiary-care university hospital, between 2004 and 2009. Results. Normal semen analysis was present only in 158 patients; 295 subfertile patients showed alterations in at least one seminal parameter. A reduction in all seminal parameters was observed in 41 patients. Etiological causes of male infertility were identified in 314 patients. Conclusion. Our data highlights the possibility of a spontaneous conception with semen parameters below WHO reference values. Therefore, we support the importance of defining reference values on a population of fertile men. Finally, we analyzed the related ethical issues.
Collapse
Affiliation(s)
- D. Milardi
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
- *D. Milardi:
| | - G. Grande
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - D. Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. L. Astorri
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - G. Pompa
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. Giampietro
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - L. De Marinis
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. Pontecorvi
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. G. Spagnolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - R. Marana
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| |
Collapse
|
9
|
Milardi D, Grande G, Vincenzoni F, Messana I, Pontecorvi A, De Marinis L, Castagnola M, Marana R. Proteomic approach in the identification of fertility pattern in seminal plasma of fertile men. Fertil Steril 2012; 97:67-73.e1. [DOI: 10.1016/j.fertnstert.2011.10.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 09/23/2011] [Accepted: 10/11/2011] [Indexed: 12/16/2022]
|
10
|
Jayakrishnan K, Koshy AK, Raju R. Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination. J Hum Reprod Sci 2011; 3:20-4. [PMID: 20607004 PMCID: PMC2890905 DOI: 10.4103/0974-1208.63117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 12/28/2009] [Accepted: 01/02/2010] [Indexed: 11/23/2022] Open
Abstract
CONTEXT: Women with primary infertility and no obvious pelvic pathology on clinical evaluation and imaging are either treated empirically or further investigated by laparoscopy. AIMS: The role of diagnostic laparoscopy in women who fail to conceive after empirical treatment with ovulation induction and intrauterine insemination was evaluated. SETTINGS AND DESIGN: Retrospective study at a private infertility center. MATERIALS AND METHODS: A study of patients who underwent diagnostic laparoscopy between 1st January 2001 and 31st December 2008 was performed. Those patients who had no detectable pathology based on history, physical examination, and ultrasound and had treatment for three or more cycles in the form of ovulation induction and IUI were included in the study. Moderate and severe male factor infertility and history of any previous surgery were exclusion criteria. STATISTICAL ANALYSIS USED: Data were statistically analyzed using Statistics Package for Social Sciences (ver. 16.0; SPSS Inc., Chicago). RESULTS: Of the 127 women who underwent diagnostic laparoscopy and hysteroscopy, 87.4% (n = 111) of patients had positive findings. Significant pelvic pathology (moderate endometriosis, pelvic inflammatory disease, and tubal pathology) was seen in 26.8% of cases. CONCLUSION: One in four women had significant pelvic pathology where treatment could possibly improve future fertility. Diagnostic laparoscopy has a role in infertile women with no obvious abnormality before they proceed to more aggressive treatments.
Collapse
Affiliation(s)
- K Jayakrishnan
- Fertility Research and Gynecology Centre, KJK Hospital, Trivandrum - 695 015, Kerala, India
| | | | | |
Collapse
|
11
|
Perquin DAM, Dörr PJ, de Craen AJM, Helmerhorst FM. Routine use of hysterosalpingography prior to laparoscopy in the fertility workup: a multicentre randomized controlled trial. Hum Reprod 2006; 21:1227-31. [PMID: 16476679 DOI: 10.1093/humrep/dei478] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A multicentre randomized controlled trial with or without hysterosalpingography (HSG) was conducted to assess the usefulness of HSG as a routine investigation in the fertility workup prior to laparoscopy and dye. METHODS From 1 April 1997 to 1 April 2002, subfertile women were allocated by a computer-based 1 : 1 ratio randomization procedure, either for an HSG followed by laparoscopy and dye (the intervention group) of for laparoscopy and dye only (the control group) as a part of their fertility workup. Cumulative pregnancy rate (CPR) within 18 months after randomization was the primary outcome of interest. RESULTS 344 women were randomized to the intervention group (n = 169) and the control group (n = 175). There was no significant difference in CPR at 18 months in the intervention group (49.1%) [95% confidence interval (CI) 41.6 to 56.6] and the control group (50.3%) (95% CI 42.8 to 57.8), a difference of -1.2% (95% CI -11.8% to 9.5%). CONCLUSION The routine use of HSG at an early stage in the fertility workup prior to laparoscopy and dye does not influence CPR, compared with the routine use of laparoscopy and dye without HSG.
Collapse
Affiliation(s)
- D A M Perquin
- Department of Obstetrics and Gynaecology, Medical Centre Haaglanden, The Hague, The Netherlands.
| | | | | | | |
Collapse
|
12
|
Ojha K, Philips Z, Darne FJ. Diagnosing infertility in a district general hospital: a case-note and cost analysis. HUM FERTIL 2005; 6:169-73. [PMID: 14614195 DOI: 10.1080/1464770312331369443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to observe diagnostic work-up and cost evaluation of infertile couples to identify opportunities for improvement. One hundred and seventy-four new referrals to the gynaecology clinic in a District General Hospital during 1996 and 1997 provided the cohort for analysis. Data from case notes were transferred on to data collection sheets. Data were inputted into SPSS for analysis. Primary infertility accounted for 62% of couples. One hundred and forty-two couples (81.6%) had a definitive diagnosis, and the analyses relate to these couples only. There was no single investigation performed on the whole cohort studied. Semen analysis was undertaken in 80.3% of the couples; couples with suspected male infertility were over four times more likely to have had more than two semen tests (P = 0.0005); 77.5% of couples had FSH and LH tests; and midluteal progesterone was tested in 76.1%. An increased intensity of FSH-LH hormone testing was associated with couples with anovulation (chi(2) = 6.79, P = 0.03). Serial repeat progesterone tended to be given to women with irregular or prolonged cycles (35 days or more), although this tendency was not statistically significant. The most common test for tubal patency was hysterosalpingography. Higher costs are generally associated with diagnosing endometriosis and tubal factor because of the relatively high cost of laparoscopy. The average cost of diagnosis for each patient was pound 365 and ranged from pound 64 to pound 851. In conclusion, a standard protocol of basic investigative procedures should be offered in secondary centres to all couples. Avoiding duplication and unnecessary investigations (for example, serial progesterone) may reduce costs, although offering all couples a standard protocol of tests would probably offset this observation.
Collapse
Affiliation(s)
- Kamal Ojha
- Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London SW17 0RE, UK
| | | | | |
Collapse
|
13
|
Abstract
Assisted reproductive technologies (ARTs) aim to increase a woman's chances of becoming pregnant by bringing many female and male gametes into close proximity. Techniques to achieve this objective include ovarian hyperstimulation by maturation of several oocytes, intrauterine insemination (IUI) of concentrated sperm, or in-vitro fertilisation (IVF) by bringing gametes together outside the female body. The very nature of ovarian hyperstimulation--with or without IUI--enhances the risk of multiple pregnancy (eg, two or more babies). In most IVF cycles, more than one embryo is transferred, again resulting in an increased chance of multiple pregnancy. Developed societies have witnessed a large rise in prevalence of twin, triplet, and higher order multiple births, mainly resulting from ARTs. The primary aim of this Review is to increase awareness of the many implications of the present iatrogenic epidemic of multiple births. The background of ovarian hyperstimulation, trends supporting current practice, and strategies to reduce the chance of multiple pregnancy are highlighted.
Collapse
Affiliation(s)
- Bart C J M Fauser
- Department of Reproductive Medicine, University Medical Centre, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | | | | |
Collapse
|
14
|
Ombelet W, Deblaere K, Bosmans E, Cox A, Jacobs P, Janssen M, Nijs M. Semen quality and intrauterine insemination. Reprod Biomed Online 2003; 7:485-92. [PMID: 14656412 DOI: 10.1016/s1472-6483(10)61894-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is good evidence in literature that intrauterine insemination (IUI) is the best first line treatment and most cost-effective procedure for moderate male factor subfertility. It seems very difficult to identify individual semen parameters predicting the likelihood of pregnancy after IUI. This can be explained by a lack of standardization of semen analysis, but many other methodological variables may also influence IUI success rates such as the patient selection, type of ovarian stimulation and number of inseminations per cycle. A review of the literature confirmed that sperm morphology using strict criteria and the inseminating motile sperm count (IMC) after sperm preparation are the two most important sperm parameters to assess the real impact of semen quality on IUI outcome. A universal threshold level above which IUI can be performed with acceptable pregnancy rates has not been determined yet, although IUI success seems to be impaired with <5% normal spermatozoa and an IMC of <1 x 10(6). Until now, no method of sperm preparation has been shown to be superior with regard to pregnancy rate after IUI. Whether supplementation of culture media with substances such as antioxidants and platelet activating factor may improve the results remains the subject of further research.
Collapse
Affiliation(s)
- Willem Ombelet
- Genk Institute for Fertility Technology, Schiepse Bos 6, 3600 Genk, Belgium.
| | | | | | | | | | | | | |
Collapse
|
15
|
Keel BA, Stembridge TW, Pineda G, Serafy NT. Lack of standardization in performance of the semen analysis among laboratories in the United States. Fertil Steril 2002; 78:603-8. [PMID: 12215340 DOI: 10.1016/s0015-0282(02)03296-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the level of standardization in performance of the semen analysis among clinical laboratories in the United States. DESIGN A survey was mailed to laboratories requesting information about the laboratory and performance of the semen analysis. Responses were received from 536 laboratories. SETTING Clinical laboratories enrolled in the American Association of Bioanalysts Andrology Proficiency Testing Program. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Agreement among laboratories. RESULT(S) Sixty-one percent of respondent laboratories were part of an assisted reproductive technology program. The laboratories perform less than 50 (53%), less than 10 (25%), or less than 5 (16%) andrology laboratory procedures per month. The laboratories routinely report sperm count (94% of laboratories), motility (95%), morphology (85%) and forward progression (69%), and semen volume (96%) as part of the semen analysis. Only 64% of laboratories routinely report abstinence, and 60% of laboratories indicate the criteria used for sperm morphology on the report form. The most common lower limits of normality for sperm count and motility were >20 x 10(6)/mL (77% of laboratories) and >50% (59% of laboratories), respectively. Few laboratories performed quality control for sperm counts (29%), motility (41%), and morphology (41%). CONCLUSION(S) These data indicate a significant lack of standardization in the performance and reporting of semen analyses among laboratories in the United States.
Collapse
Affiliation(s)
- Brooks A Keel
- Department of Obstetrics and Gynecology, Women's Research Institute, University of Kansas School of Medicine, Wichita, USA.
| | | | | | | |
Collapse
|
16
|
Murakami T, Terada Y, Yokomizo R, Nakamura S, Yaegashi N, Okamura K. The present status of management for infertility in Miyagi Prefecture, Japan. TOHOKU J EXP MED 2001; 194:175-80. [PMID: 11693666 DOI: 10.1620/tjem.194.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To summarize the current management of infertility in Japan, a questionnaire survey was administered. A mail-survey method was used, and surveys were sent to 126 obstetrical and/or gynecological medical facilities in Miyagi Prefecture. The respondents included 86 facilities (68.3%). The majority of participants employed routine assessments, and their records included basal body temperature (98.8%), semen analysis (88.8%), and tubal patency tests (78.8%). Laparoscopic diagnosis, however, was uncommon (15.8%). With respect to treatment, surgical procedures, especially endoscopic procedures, were not generally carried out in addition to medicinal treatment. Sixty-one percent of the respondents performed intrauterine insemination, however assisted reproductive technology (ART) was provided by a few participants, for example, in vitro fertilization-embryo transfer was available at 11.3% of facilities. In self-assessment, the median pregnancy rates for the group undergoing laparoscopy and that not were significant different (30% and 20%, respectively), and those of the group undergoing ART provided and that not were significant different (35% and 20%, respectively). In conclusion, there are various differentials in the methods of diagnosis and treatment of infertility in the medical facilities today, and the outcomes are not always satisfactory. For appropriate management of infertile couples, it will be necessary to more closely manage cooperation between primary care doctors and reproductive specialists.
Collapse
Affiliation(s)
- T Murakami
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan.
| | | | | | | | | | | |
Collapse
|
17
|
Royal College of Obstetrics and Gynaecologists. Clinical Guideline no 4. The management of infertility in tertiary care. BJU Int 2001; 87:213-7. [PMID: 11167644 DOI: 10.1046/j.1464-410x.2001.02049.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
Corson SL, Cheng A, Gutmann JN. Laparoscopy in the "normal" infertile patient: a question revisited. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2000; 7:317-24. [PMID: 10924624 DOI: 10.1016/s1074-3804(05)60473-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To determine the prevalence of reproductive pathology in a group of infertile women thought to be at low risk for altered pelvic anatomy. DESIGN Retrospective chart review and follow-up (Canadian Task Force classification II-2). SETTING Academic-affiliated, private reproductive endocrinology practice. PATIENTS One hundred infertile women. INTERVENTION Diagnostic and/or therapeutic laparoscopy. MEASUREMENTS AND MAIN RESULTS Of 100 patients with a negative reproductive work-up up to the point of laparoscopy, 68 had pathology of reproductive significance: intrinsic tubal disease 24, peritubal adhesive disease 34, and endometriosis 43, some in combination. Laparoscopy was especially helpful in establishing treatment protocols for older women, who were referred for assisted reproductive techniques earlier than otherwise might have been the case. Women conceived after hormone therapy and after operative intervention. Although the hysterosalpingogram was read as normal in all women, tubal disease was diagnosed laparoscopically, independent of endometriosis, in 27 patients, with 2 having complete obstruction. Endometriosis stage I-II was found in 22 patients, stage III in 13, and stage IV in 6. CONCLUSION Even in women thought to be at low risk for significant pelvic pathology affecting reproduction, the yield was high. Although some pregnancies were achieved after operative intervention, frequently laparoscopy was helpful in making a decision to go to assisted reproductive technology, particularly when infertility had been of long duration and in older women. Frequently the degree of pathology was such that a full operating suite was necessary to provide adequate instrumentation and anesthesia for operative intervention, which would not have been the case with office laparoscopy.
Collapse
Affiliation(s)
- S L Corson
- Women's Institute, 815 Locust Street, Philadelphia, PA 19107, USA
| | | | | |
Collapse
|