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Ashrafi M, Sadatmahalleh SJ, Akhoond MR, Talebi M. Evaluation of Risk Factors Associated with Endometriosis in Infertile Women. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:11-21. [PMID: 27123195 PMCID: PMC4845520 DOI: 10.22074/ijfs.2016.4763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 06/07/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endometriosis affects women's physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women. MATERIALS AND METHODS A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis (cases) and 332 infertile women with a normal pelvis (comparison group). Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis. RESULTS Gravidity [odds ratio (OR): 0.8, confidence interval (CI): 0.6-0.9, P=0.01], parity (OR: 0.7, CI: 0.6-0.9, P=0.01), family history of endometriosis (OR: 4.9, CI: 2.1-11.3, P<0.001), history of galactorrhea (OR: 2.3, CI: 1.5-3.5, P=0.01), history of pelvic surgery (OR: 1.9, CI: 1.3-2.7, P<0.001), and shorter menstrual cycle length (OR: 0.9, CI: 0.9-0.9, P=0.04) were associated with endometriosis. Duration of natural menstruation and age of menarche were not correlated with subsequent risk of endometriosis (P>0.05). Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis. CONCLUSION Endometriosis is a considerable public health issue because it affects many women and is associated with the significant morbidity. In this study, we built a prediction model which can be used to predict the risk of endometriosis in infertile women.
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Affiliation(s)
- Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Shahideh Jahanian Sadatmahalleh
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Akhoond
- Department of Statistics, Mathematical Science and Computer Faculty, Shahid Chamran University, Ahwaz, Iran
| | - Mehrak Talebi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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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.
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Affiliation(s)
- Isao Tsuji
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan.
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3
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Sundström I, Ildgruben A, Högberg U. Treatment-related and treatment-independent deliveries among infertile couples, a long-term follow-up. Acta Obstet Gynecol Scand 2010. [DOI: 10.1111/j.1600-0412.1997.tb07852.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Kenney SH, Bromwich PD, Barlow DH. Paraneoplastic cerebellar degeneration associated with uterine leiomyomata. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618909151107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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5
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Haylen BT. The retroverted uterus: ignored to date but core to prolapse. Int Urogynecol J 2006; 17:555-8. [PMID: 16341460 DOI: 10.1007/s00192-005-0051-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 10/20/2005] [Indexed: 10/25/2022]
Abstract
The retroverted uterus has been largely ignored in urogynaecological research to date. The prevalence of the retroverted uterus is 79% more common in the urogynaecological patient population (34%) than in the general gynaecological population (19%). Its diagnosis requires the use of (a) transvaginal ultrasound with (b) an empty bladder. Recent data demonstrate that the prevalence of grade 2-4 uterine prolapse for a retroverted uterus is 4.5 times that for an anteverted uterus. Alternatively, 69% grade 2-4 uterine prolapse involves the retroverted uterus. The retroverted uterus, when diagnosed by transvaginal ultrasound (bladder empty), is far more common in urogynecology patients due to their higher incidence of prolapse.
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Affiliation(s)
- Bernard T Haylen
- St. Vincent's Clinic, Suite 904, 438 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia.
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6
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Abstract
PURPOSE The hypothesis of this review is that the role of psychological factors as the sole cause of infertility is generally overrated. METHODS A review is given of studies concerning the influence of psychological factors on the development of infertility. RESULT A prevalence of psychogenic infertility of 10-15 per cent must be discussed critically. A value of approximately 5 per cent is more realistic. Equating unexplained infertility with psychogenic infertility is not justified. A definition of psychogenic infertility according to the German guidelines Psychosomatics in Reproductive Medicine is presented. Spontaneous pregnancies following adoption or the decision to remain childless are the absolute exception. The association of stress and infertility in humans is still unclear. For many women the effect of infertility and notably of medical therapy is a considerable emotional stress. This may make psychosocial counseling necessary in certain cases. CONCLUSIONS An exclusive psychological/psychodynamical point of view on the complexity of infertility is as inadequate as a strictly somatic point of view. Infertility should always be treated as a psychosomatic entirety.
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Affiliation(s)
- Tewes H Wischmann
- Department of Medical Psychology, Heidelberg University Medical School, Bergheimer Strasse 20, D-69115 Heidelberg, Germany.
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7
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Abstract
A causal relationship between minor endometriosis and infertility or subfertility has not yet been demonstrated, although a significant association is shown by prevalence studies. This article critically reviews the evidence for pituitary-ovarian dysfunction as a cause for subfertility in women with minor endometriosis. The lack of fertile controls with endometriosis presents a methodological problem. Group comparison in studies using tubal infertility cases as controls has demonstrated impaired follicular growth, reduced circulating oestradiol concentrations during the preovulatory phase and oestradiol and progesterone during the early luteal phase, and disturbed luteinizing hormone (LH) surge patterns. LH concentration in preovulatory follicular fluid is also reduced, and granulosa cells collected at the same time have impaired steroidogenic capacity in vitro. However, these findings are not consistent in published studies. Significantly lower oocyte fertilization rates (49%) are found compared with controls (69%), even after maximum stimulation with exogenous follicle-stimulating hormone and human chorionic gonadotrophin (52% versus 69%). The implantation rate is also lower (11% versus 13%). An inherent disorder of follicular function seems likely, and LH surge impairment is probably a secondary effect. Impairment of oocyte fertilization would thus contribute substantially to the natural subfertility associated with endometriosis, but in vitro fertilization is still successful as excess numbers of oocytes are available.
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Affiliation(s)
- Johanna Trinder
- Centre for Reproductive Medicine, University of Bristol Division of Obstetrics and Gynaecology, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK
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Fatum M, Laufer N, Simon A. Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin? Hum Reprod 2002; 17:1-3. [PMID: 11756351 DOI: 10.1093/humrep/17.1.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traditionally, a diagnosis of unexplained infertility is established only when all standard clinical investigations yield normal results. When tubal patency has been established by hysterosalpingography (HSG), laparoscopy has been suggested as a mandatory step to preclude the existence of peritubal adhesions and endometriosis as causes of infertility. In women without a previous history suggestive of tubal disease and who have a normal HSG, it was demonstrated that the probability of clinically relevant tubal disease or endometriosis is very low and that laparoscopy does not seem justified or cost effective. In the minority of these cases, laparoscopy might reveal minimal or mild endometriosis or peritubal adhesions. In these cases, either surgery or medical treatment has not been proven to improve fecundity. With the current success rates of assisted reproductive technologies (ART) and the relatively low contribution of diagnostic laparoscopy to the decision-making process of treating patients with a normal HSG, we suggest that laparoscopy should be omitted in couples suspected of having unexplained infertility. These patients should be treated by 3-6 cycles of combined gonadotrophins and intrauterine insemination, and if unsuccessful switched to ART.
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Affiliation(s)
- Mohammad Fatum
- Department of Obstetrics and Gynecology, Hadassah University hospital, Ein Kerem, Jerusalem, Israel.
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Dammann O, Leviton A, Allred EN. What explains away the increased risk of histological chorioamnionitis in African-American mothers of very-low-birthweight infants? Developmental Epidemiology Network Investigators. Paediatr Perinat Epidemiol 2000; 14:20-9. [PMID: 10703031 DOI: 10.1046/j.1365-3016.2000.00235.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We sought explanations for African-American mothers' increased risk of chorioamnionitis by sequentially adjusting for confounder variables both individually and in groups. We searched for a subset of covariates that had the most influence on the chorioamnionitis odds ratio (OR) of these women. The sample consisted of 305 African-American and 520 White mothers who gave birth to a very-low-birthweight (< or = 1500 g) infant between 1991 and 1993, whose placenta was examined according to protocol and whose hospital chart was reviewed. Histologically proven chorioamnionitis was present in 43% of the placentas from African-American women and in 27% of those from Whites (crude OR 2.1, 95% confidence interval 1.5, 2.8). Singleton status appeared to be the most important effect modifier, with significant crude ORs of 1.5 among singletons and 3.4 among non-singletons. Using logistic regression models in the whole sample and in subgroups, we sought to 'explain away' this increased risk. Indeed, addition of information about confounder variables resulted in considerable reduction in the ORs to 1.1 among singletons and 1.9 among non-singletons. Particularly important among the confounders were singleton birth, Medicaid insurance, duration of ruptured membranes and gestational age. We discuss the possibility that this set of confounding variables conveys, in part, the same information as the variable African-American, and also perhaps information about the availability and/or utilisation of prenatal health care.
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Affiliation(s)
- O Dammann
- Neuroepidemiology Unit, Children's Hospital, Boston, MA 02115, USA.
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10
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The Management of Unexplained Infertility. Obstet Gynecol Surv 1999. [DOI: 10.1097/00006254-199911001-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Abstract
UNLABELLED Unexplained infertility is a diagnosis made by exclusion after all of the standard investigations have revealed no abnormality (1). The range of the prevalence is from 6 to 60 percent (23), depending on the diagnostic criteria. This article reviews the literature in the management of unexplained infertility; published data suggest no benefit of danazol or bromocriptine. The empirical use of clomiphene citrate suggests that ovarian stimulation using clomiphene citrate can double the spontaneous pregnancy rate (52, 58, 59). Induction of ovulation with human menopausal gonadotrophin (hMG) yields an overall pregnancy rate between 2 and 26 percent per cycle (68, 74). These results seem to be lower than those reported for in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) procedures in similar patients (25-30 percent (92, 95)). Based on the literature, a rational treatment plan for treating infertility in couples with unexplained infertility includes up to four cycles of clomiphene citrate with or without intrauterine insemination (IUI). Superovulation with hMG and IUI or stimulated intrauterine insemination (SIUI) is the next step for three-cycle treatments and if unsuccessful, one of the variants of assisted reproductive techniques (ART) should be considered. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader will understand the appropriate tests and work up for unexplained infertility, the various treatment options for the unexplained infertility couple including which drugs are effective and not effective, and to be able to outline an appropriate treatment plan for such patients.
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Affiliation(s)
- F Zayed
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Amman, Jordan.
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12
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Cahill DJ, Wardle PG, Philip G, Meadowcroft J. Autoantibodies and embryo implantation rates. Fertil Steril 1996; 65:208-9; author reply 209-10. [PMID: 8557147 DOI: 10.1016/s0015-0282(16)58058-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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13
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Shushan A, Eisenberg VH, Schenker JG. Subfertility in the era of assisted reproduction: changes and consequences. Fertil Steril 1995; 64:459-69. [PMID: 7641895 DOI: 10.1016/s0015-0282(16)57777-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To review the major changes that have occurred during the last decade of assisted reproduction technology (ART) practice, looking at the various conditions that cause subfertility. DESIGN A short review describing the progress that has been made during the last decade of ART practice, analyzing the various conditions that cause subfertility, is presented. The efficacy of ART as a treatment of these conditions is discussed. CONCLUSIONS Assisted reproductive technology currently is used for a wide range of indications and has become an acceptable tool in the treatment of subfertile couples. Yet, there is an ongoing debate regarding the effectiveness of ART versus conventional treatment for the various conditions that cause subfertility. The effectiveness of IVF in terms of pregnancy rate (PR) was demonstrated only for patients with severe bilateral tubal disease and male subfertility. For couples with other causes of infertility the differences in PRs do not reach statistical significance, and the efficacy of IVF has not been demonstrated clearly to date. Moreover, much of the discussion about management of subfertility has centered on costs of ART and the cost-benefit of ART versus conventional therapy for subfertility. It has been shown that, in women with unexplained infertility, menotropin treatment is as successful, less expensive, and carries a smaller risk than the surgical approach used in ART. However, the exact role of ART in the management of polycystic ovarian syndrome, immunological infertility, and endometriosis still is to be determined. Yet, as embryo implantation after ART still is considerably lower than that of fertile couples who conceive naturally, we expect that the next major thrust improving the effectiveness of ART will occur after future elucidation of factors influencing embryonic implantation.
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Affiliation(s)
- A Shushan
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel
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14
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Gregoriou O, Vitoratos N, Papadias C, Konidaris S, Gargaropoulos A, Louridas C. Controlled ovarian hyperstimulation with or without intrauterine insemination for the treatment of unexplained infertility. Int J Gynaecol Obstet 1995; 48:55-9. [PMID: 7698384 DOI: 10.1016/0020-7292(94)02268-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate whether there are any benefits from intrauterine insemination (IUI) as opposed to timed intercourse (TI) in stimulated ovarian cycles in couples with longstanding, unexplained infertility. METHODS Forty-six couples with diagnoses of unexplained infertility were evaluated in a crossover study after a total of 141 cycles. Sixty-seven cycles were with IUI after controlled ovarian hyperstimulation (COH) while 74 cycles were after COH and TI. RESULTS The pregnancy rate after COH/TI was 16.7% and after COH/IUI 45.2%. Cycle fecundity however was 8.9% after COH/TI and 25.7% after COH/IUI, which is a statistically significant difference (P < 0.05). CONCLUSIONS A trial of human menopausal gonadotropin and IUI is justified in couples with prolonged infertility of unknown cause.
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Affiliation(s)
- O Gregoriou
- 2nd Department of Obstetrics and Gynecology, University of Athens, Areteion Hospital, Greece
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15
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Demyttenaere K, Nijs P, Evers-Kiebooms G, Koninckx PR. Personality characteristics, psychoendocrinological stress and outcome of IVF depend upon the etiology of infertility. Gynecol Endocrinol 1994; 8:233-40. [PMID: 7709762 DOI: 10.3109/09513599409023626] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Personality characteristics, psychoendocrinological stress responses and course and outcome of treatment were investigated in 40 women undergoing in vitro fertilization (IVF). In addition to classification by the major causes of infertility (mechanical infertility or male infertility), the subjects were also divided in two subgroups of 17 women with completely 'normal' menstrual cycles and 23 women with subtle disturbances of their menstrual cycle. These disturbances were due to either minimal endometriosis, luteinized unruptured follicle (LUF) syndrome or luteal phase insufficiency. Women with subtle cycle disturbances have been shown to have a lower pregnancy rate in IVF than women with normal cycles. The correlation of the state anxiety level of the patient in the early follicular phase with negative outcome in IVF is seen to be higher in women with subtle cycle disturbances. Furthermore, prolactin concentrations are always higher in women with subtle cycle disturbances. Our data contribute to the hypothesis that subtle cycle disturbances, i.e. LUF syndrome, luteal phase insufficiency and endometriosis, could be associated with higher psychoendocrinological stress levels.
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Affiliation(s)
- K Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Catholic University of Leuven, Belgium
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16
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Randall JM, Templeton A. Direct intraperitoneal insemination for unexplained infertility. J OBSTET GYNAECOL 1992. [DOI: 10.3109/01443619209029919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Gürgan T, Kişnişçi H, Yarali H, Aksu T, Zeyneloğlu H, Develioğlu O. The value of human menopausal gonadotropin treatment in patients with unexplained infertility. Int J Gynaecol Obstet 1991; 35:327-30. [PMID: 1682180 DOI: 10.1016/0020-7292(91)90666-s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The role of multiple ovulation with human menopausal gonadotropin (HMG) in the treatment of unexplained infertility is evaluated. Of a total 73 patients with unexplained infertility, 39 received four cycles of HMG, whereas, 34 were left untreated. Eight (20.5%) women conceived during HMG treatment, in comparison to only 1 (2.9%) in the control group (P less than 0.05). This study gives further credit to the value of HMG treatment for unexplained infertility.
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Affiliation(s)
- T Gürgan
- Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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18
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Abstract
In this article we have reviewed many aspects of donor insemination. The deficiencies in the screening of semen donors especially for sexually-transmitted diseases has been discussed and importance of a rational protocol for recruitment and screening of potential donors has been emphasized. Factors influencing the success and outcome of donor insemination have been reviewed with particular emphasis on providing prognostic guidelines to potential donor insemination couples as to the success and outcome of the treatment. The importance of accurate timing of inseminations in determining the success of donor insemination has also been discussed. However, as has been highlighted throughout this review, there is a lack of specific prospective controlled trials, which are clearly necessary to answer specific important questions. Also emphasized has been the need of these trials to answer such basic questions as the influence of accurate timing on conception rates in specific groups of insemination recipients.
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Affiliation(s)
- C L Barratt
- Harris Birthright Research Centre for Reproductive Medicine, Jessop Hospital for Women, Sheffield, United Kingdom
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19
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20
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Balasch J, Jové I, Ballescá JL, Moreno V, Mulet J, Fuster J, Vanrell JA. Human in vitro fertilization in couples with unexplained infertility and a poor postcoital test. Gynecol Endocrinol 1989; 3:289-95. [PMID: 2626977 DOI: 10.3109/09513598909152468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The results of in vitro fertilization (IVF) with the husband's semen were compared in 3 groups of fully investigated infertile couples. In those with tubal infertility (n = 43) 194 out of 273 (71.1%) oocytes were fertilized, at least 1 oocyte being fertilized in 42 of the 43 couples (97%). In couples with unexplained infertility and a 'good' postcoital test (PCT) (n = 9), 39 out of 64 (61.5%) oocytes were fertilized in 8 of the 9 (88%) couples. In couples with unexplained infertility and a 'poor positive' PCT despite normal semen analysis, 16 out of 44 (36.3%) oocytes were fertilized in 5 of the 6 (83%) couples. These results show a good correlation between in vivo sperm penetration of cervical mucus and human IVF in couples with unexplained infertility.
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Affiliation(s)
- J Balasch
- Department of Obstetrics and Gynecology, Hospital Clínic i Provincial, Barcelona, Spain
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21
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Finn MM, Gosling JP, Tallon DF, Joyce LA, Meehan FP, Fottrell PF. Follicular growth and corpus luteum function in women with unexplained infertility, monitored by ultrasonography and measurement of daily salivary progesterone. Gynecol Endocrinol 1989; 3:297-308. [PMID: 2626978 DOI: 10.3109/09513598909152469] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Ovarian function was evaluated over a minimum of 3 consecutive menstrual cycles from each of 41 women with unexplained infertility. Follicular development and ovulation were monitored using real time ultrasonography and luteal function was evaluated by daily salivary progesterone measurement. In 129 spontaneous cycles, normal single ovulations were detected in 121 (93.8%). Luteal phase insufficiency was identified in 21 (17.4%) of these 121 cycles and this was a recurrent phenomenon in the cycles of 5 of the 41 women (12.2%). A successful pregnancy was seen only in association with consistently normal salivary progesterone profiles or where the empirical use of clomiphene citrate therapy had corrected previously diagnosed luteal phase insufficiency. Basal body temperature records or mid-luteal serum progesterone measurements were less satisfactory indices of luteal function than a salivary progesterone profile.
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Affiliation(s)
- M M Finn
- Department of Obstetrics and Gynecology, University College, Galway, Ireland
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22
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Chauhan M, Barratt CL, Cooke SM, Cooke ID. Differences in the fertility of donor insemination recipients--a study to provide prognostic guidelines as to its success and outcome. Fertil Steril 1989; 51:815-9. [PMID: 2707456 DOI: 10.1016/s0015-0282(16)60672-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Data on 207 couples attending for donor insemination (DI) were analyzed to determine the differences in fertility of insemination recipients and to provide prognostic guidelines as to its success. This study has shown that DI recipients with no infertility factors whose partners were azoospermic had the highest fecundability (0.178), whereas those with no infertility factors whose partners were subfertile had the lowest fecundability (0.036). Donor insemination recipients with treated endometriosis and ovulatory dysfunction have significantly higher fecundability (0.093 and 0.091, respectively) than those with other infertility factors (0.021) such as fibroids, tubal disease, or a combination of infertility factors. This study provides prognostic guidelines for DI recipients as to its success.
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Affiliation(s)
- M Chauhan
- Harris Birthright Research Centre for Reproductive Medicine, University Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Sheffield, United Kingdom
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23
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Mandelbaum SL, Diamond MP, DeCherney AH. Relationship of antibodies to sperm head to etiology of infertility in patients undergoing in vitro fertilization/embryo transfer. Am J Reprod Immunol 1989; 19:3-5. [PMID: 2765131 DOI: 10.1111/j.1600-0897.1989.tb00539.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Antibodies to sperm head (ASA-H) are believed to impair reproduction, probably because of a reduction in fertilization of human oocytes. However, the incidence of ASA-H in couples with different etiologies of infertility undergoing in vitro fertilization/embryo transfer (IVF/ET) is unestablished. To examine this question, the semen, serum, and follicular fluid of 11 couples with unexplained infertility and 25 couples with tubal infertility undergoing IVF/ET were tested with the immunobead binding assay to identify ASA-H of IgA, IgG, and IgM isotypes. Comparing couples with unexplained vs. tubal infertility, 46% vs. 4% had ASA-H of at least one isotype in female serum (P = .006), 36% vs. 4% had ASA-H in follicular fluid (P = .023), 27% vs. 0% had ASA-H in semen (P = .023), and 18% vs. 4% had ASA-H in male serum (P = .022), respectively. ASA-H were present in one or more fluids tested in 55% of patients with unexplained infertility, compared to 8% of patients with tubal infertility (P = .005). Of the six women with ASA-H in their serum, 83% (5/6) were undergoing IVF/ET for unexplained infertility compared to 17% (1/6: P = .08) undergoing IVF/ET for tubal infertility. In summary, clinically significant ASA-H are present in a substantial number of infertile women undergoing IVF/ET, particularly those whose infertility is unexplained. Based on these findings, we conclude that it is efficacious to screen all women with unexplained infertility undergoing IVF/ET for ASA-H.
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Affiliation(s)
- S L Mandelbaum
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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Navot D, Muasher SJ, Oehninger S, Liu HC, Veeck LL, Kreiner D, Rosenwaks Z. The value of in vitro fertilization for the treatment of unexplained infertility. Fertil Steril 1988; 49:854-7. [PMID: 3360174 DOI: 10.1016/s0015-0282(16)59896-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In 54 patients referred with the diagnosis of unexplained infertility (UI), the diagnosis was confirmed in 26 (strict UI) (48%). Minimal abnormalities (MA) were found in 19 (35%); 9 (17%) had gross abnormalities and were excluded from analysis. Fifty patients with tubal infertility were randomly assigned to form a control group. Mean age and type of stimulation did not differ in the two groups. Peak follicular estradiol (E2) and terminal follicular E2 patterns were comparable. There was no difference in the mean number of oocytes retrieved per cycle. However, the control group had significantly more preovulatory oocytes: 3.6 +/- 2.0 standard deviations versus 2.8 +/- 2.1 in the overall UI group (strict UI + MA groups) and 2.7 +/- 2.2 in the strict UI group. Significantly more fertilized oocytes per cycle were obtained in the control group (P less than 0.05). The per-cycle and per-embryo transfer (ET) pregnancy rates were 32.4 and 37.3% in the overall UI group and 24 and 24.5% in the control group. The miscarriage rate was 12% in the strict UI group, 22% in the overall UI group, and 25% in the control group. It is concluded that patients with UI constitute a favorable group for in vitro fertilization and ET.
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Affiliation(s)
- D Navot
- Eastern Virginia Medical School, Jones Institute for Reproductive Medicine, Norfolk
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Welner S, DeCherney AH, Polan ML. Human menopausal gonadotropins: a justifiable therapy in ovulatory women with long-standing idiopathic infertility. Am J Obstet Gynecol 1988; 158:111-7. [PMID: 3122578 DOI: 10.1016/0002-9378(88)90789-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Long-standing infertility of unknown etiology is currently an indication for in vitro fertilization. Because of the prolonged waiting time, expense, and operative risk, we have treated a group of women with empiric human menopausal gonadotropins/human chorionic gonadotropin before in vitro fertilization. A study group of 97 couples with well-documented, long-standing idiopathic infertility received up to four cycles of empiric human menopausal gonadotropin therapy before in vitro fertilization. This group was compared with a control group of 48 couples who did not receive human menopausal gonadotropin before in vitro fertilization. The 12 (12.4%) conceptions and eight (8.2%) term births resulting from empiric human menopausal gonadotropin therapy in the study group was significantly higher than the number of spontaneous conceptions and births (1%) in the study group (p less than 0.003) and was also greater than the spontaneous conception and birth rate (4%) in the control group (p less than 0.07). The conception rate with empiric human menopausal gonadotropin (12.4%) compared favorably with that after in vitro fertilization (7.9%) and 8 of 12 (66.7%) of empiric human menopausal gonadotropin conceptions resulted in term births, compared with two of seven (28.6%) of the in vitro fertilization conceptions. Preovulatory serum estradiol levels were similar for all study patients undergoing empiric human menopausal gonadotropin therapy, control patients undergoing in vitro fertilization, and patients receiving empiric human menopausal gonadotropin during conception cycles. It therefore appears appropriate to offer a 4-month trial of empiric human menopausal gonadotropin to that specific group of couples with long-standing idiopathic infertility.
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Affiliation(s)
- S Welner
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510
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Bendvold E, Gottlieb C, Svanborg K, Bygdeman M, Eneroth P. Concentration of prostaglandins in seminal fluid of fertile men. INTERNATIONAL JOURNAL OF ANDROLOGY 1987; 10:463-9. [PMID: 3610357 DOI: 10.1111/j.1365-2605.1987.tb00220.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Semen samples from 31 men, all of whom had fathered a child within the preceding year, were analysed for sperm characteristics and for the content of prostaglandins (PGs). Mean concentrations (mg/l) for the four main groups of PGs were 67.1 for PGE, 3.2 for PGF, 245.7 for 19-hydroxy-PGE and 13.3 for 19-hydroxy-PGF. The individual values were distributed over a relatively wide range but the extremely wide ranges reported by previous authors were not confirmed. Information is also presented concerning the relative proportions of the four isomers of PGF, as well as those of 19-hydroxy-PGF. Only sperm density was related to PG concentration in fertile men. Polyzoospermia was associated with a low PGE concentration.
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Bell EJ, Riding MH, Grist NR. Paralytic poliomyelitis: a forgotten diagnosis? BMJ : BRITISH MEDICAL JOURNAL 1986; 293:193-4. [PMID: 3015321 PMCID: PMC1340919 DOI: 10.1136/bmj.293.6540.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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