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Li T, Yuan Y, Liu H, Lu Q, Mu R. Glucocorticoids Improve the Pregnancy Rate and Outcome in Women With Unexplained Positive Autoantibodies: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:819406. [PMID: 35646975 PMCID: PMC9131042 DOI: 10.3389/fmed.2022.819406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
The effect of glucocorticoid therapy on women with unexplained positive autoantibodies is under debate. This systemic review and meta-analysis were performed to evaluate whether glucocorticoid administration can improve the pregnancy outcome of this population. Relevant publications were searched from databases, and a total of seven prospective and retrospective cohort studies that investigated the effects of glucocorticoid administration on women with unexplained positive autoantibodies, were included. The outcomes of our systematic review and meta-analysis were measured in terms of risk ratios (RR) with 95% confidence intervals (CI) using fixed or random effect models. We found that glucocorticoid treatment improved the clinical pregnancy rate (RR 2.19, 95% CI 1.64–2.92) and live birth rate (RR 1.92, 95% CI 1.17–3.16), especially when glucocorticoid administration was started before pregnancy (clinical pregnancy rate: RR 2.30, 95% CI 1.58–3.34; live birth rate: RR 2.30, 95% CI 1.58–3.34). However, no effect of glucocorticoids on the miscarriage rate was found (RR 0.75, 95% CI 0.55–1.02) regardless of the time of drug administration. Our systematic review and meta-analysis support the rational use of glucocorticoids in women with unexplained positive autoantibodies.
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Affiliation(s)
- Ting Li
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Yilin Yuan
- Department of Psychiatry, Peking University Sixth Hospital, Beijing, China
| | - Huixin Liu
- Department of Clinical Epidemiology and Biostatistics, Peking University People's Hospital, Beijing, China
| | - Qun Lu
- Reproductive Medical Center, Peking University People's Hospital, Beijing, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
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Kamel S, Tag HM, Ebeid H, Khaled HE, Almallah AA, El-Naggar MS. Adverse effect of rheumatoid arthritis on male Wistar rat's fertility: protective role of Costus extract. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:4193-4205. [PMID: 34403061 DOI: 10.1007/s11356-021-16001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune complaint. Advanced treatments resort to the traditional herbal therapy. The aim of this study is to assess the protective effect of Costus extract on the fertility of male rats with Freund's adjuvant-induced rheumatoid arthritis. Thirty male adult Wistar rats (190-200 g) were divided into six groups. They were subdivided into three groups; group I was the control group that received distilled water, and groups II and III received two various doses of Costus extract (200 and 400 mg/kg, respectively) for 60 days. Another three groups were subjected to RA induction via Freund's adjuvant. Rats were injected a dose of 0.1 ml of Freund's complete adjuvant (FCA) in the planter area of the left hind paw and then subdivided into 3 groups. Group I of RA-induced rats were given distilled water. The other two groups were given orally (200 and 400 mg/kg dosage of extract, respectively) from the 2nd day of RA induction for 60 days. Sex organ relative weight, sperm concentration assay, testicular histopathology and immunohistochemistry of androgen receptors, TNF α, and BAX protein were determined. The results showed that RA caused a significant decrease in the relative weight of sex organs and sperm count, which were relatively improved by doses of Costus (200, 400 mg/kg). RA induction caused testicular degeneration which markedly enhanced with Costus treatment as shown in histopathological sections. RA caused a reduction in %IHC of androgen receptors and increased expression level of both TNF α and BAX protein. Using IHC, it was revealed that RA caused a reduction in the expression level of androgen receptors and an increase in the expression of both TNF α and BAX protein. We can conclude that Costus speciosus had a potentially valuable role in improving fertility disorders caused by RA.
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Affiliation(s)
- Samar Kamel
- Department of Physiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.
| | - Hend M Tag
- Zoology Department, Faculty of Sciences, Suez Canal University, Ismailia, 41522, Egypt
| | - Hala Ebeid
- Zoology Department, Faculty of Sciences, Suez Canal University, Ismailia, 41522, Egypt
| | - Howayda E Khaled
- Department of Zoology, Faculty of Sciences, Suez University, Suez, Egypt
| | - Amani A Almallah
- Department of Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohamed S El-Naggar
- Zoology Department, Faculty of Sciences, Suez Canal University, Ismailia, 41522, Egypt
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3
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Li Q, Zheng D, Wang Y, Li R, Wu H, Xu S, Kang Y, Cao Y, Chen X, Zhu Y, Xu S, Chen ZJ, Liu P, Qiao J. Association between exposure to airborne particulate matter less than 2.5 μm and human fecundity in China. ENVIRONMENT INTERNATIONAL 2021; 146:106231. [PMID: 33171380 DOI: 10.1016/j.envint.2020.106231] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Whether exposure to airborne particulate matter less than 2.5 μm (PM2.5) could impact human fecundity is unclear. We aimed to evaluate the potential impact of PM2.5 exposure on time to pregnancy (TTP) and the prevalence of infertility in the general Chinese population. METHOD We collected reproductive information, sociodemographic characteristics, and lifestyle data of 10,211 couples at risk of pregnancy from a large-scale community-based fertility survey in China. Then, we estimated each participant's 1-year, 3-year, and 5-year average PM2.5 exposure levels based on remote sensing information. After adjusting for demographic, lifestyle, and environmental co-variables, discrete-time Cox regression models were used to estimate the fecundability odds ratio (FOR) per 10 μg/m3 change of PM2.5. We also estimated the odds ratio (OR) of infertility per 10 μg/m3 change of PM2.5, using logistic regression models. FINDINGS Among the 10,211 couples, 6,875 (67%) had conceived spontaneously, with a median TTP of 5 months (interquartile range: 2-10 months). The median PM2.5 exposure was 56.8 μg/m3, with a wide range of 9.2-93.5 μg/m3. In Cox regression models, each increase of 10 μg/m3 in the 1-year average PM2.5 exposure was associated with a significant decrease in fecundity by 11% (FOR: 0.89; 95% confidence interval [CI]: 0.86-0.92). In logistic regression models, it was also associated with an 20% increased likelihood of infertility (OR: 1.20; 95% CI: 1.13-1.27). CONCLUSION PM2.5 exposure was associated with reduced human fecundity, presented by a longer TTP and higher odds of infertility, which might explain the increased infertility rates in areas with heavy PM2.5 pollution.
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Affiliation(s)
- Qin Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Danni Zheng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Yuanyuan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Hongping Wu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Suxin Xu
- Reproductive Medical Center, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yuefan Kang
- Reproductive Medical Center, Maternal and Children's Health Hospital of Fujian Province, Fuzhou 350001, China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, Reproductive Medical Center, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xiujuan Chen
- Reproductive Medical Center, Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010059, China
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Shuguang Xu
- Population and Family Planning Research Institute of Heilongjiang Province, Harbin 150020, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, China
| | - Ping Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China.
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Daniilidis A, Nisolle M, Papandreou P, Gordts S, Krentel H, Pados G. A European survey on treatment of hydrosalpinges in infertile women on behalf of the European Society for Gynaecological Endoscopy (ESGE) Special Interest Group (SIG) on Reproductive Surgery. Facts Views Vis Obgyn 2020; 12:241-244. [PMID: 33123698 PMCID: PMC7580267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A questionnaire-based survey was conducted among members of the European Society for Gynaecological Endoscopy (ESGE), with the aim of increasing awareness of the diagnosis and surgical treatment of tubal disease as an alternative to in-vitro fertiliszation (IVF). Seventeen participants (34%) occasionally used a test for prediction of the ovarian reserve before surgery, and the most commonly used test was anti-mullerian hormone assay (39/50; (80%). Laparoscopy was the preferred method for staging tubal disease (43/50; 86%).Thirty-seven (76%) participants always performed salpingectomy or tubal occlusion before the first IVF attempt. Thirty (60%) of the gynaecological surgeons considered the outcome with tubal surgery and IVF to be similar in mild tubal disease, whereas for severe disease, 31/50 (62%) felt that surgery had worse outcome. Among other factors to be considered in choosing a strategy for treating infertility, 20/50 (40%) of respondents listed the stage of disease. The findings of this survey suggest that first-line treatment for women younger than 35 years old with minor tubal pathology, is tubal surgery. IVF appears to be offered if there are other infertility factors, if the patient is >38 years old and if moderate to severe tubal disease is present.
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Affiliation(s)
- A Daniilidis
- 2nd Dept. OB-GYN, ‘Hippokratio’ General Hospital, Aristotle University of Thessaloniki, Greece
| | - M Nisolle
- OB-GYN clinic, Citadelle hospital. Liege, Belgium
| | - P Papandreou
- 2nd Dept. OB-GYN, ‘Hippokratio’ General Hospital, Aristotle University of Thessaloniki, Greece
| | - S Gordts
- Life Expert Centre, Leuven, Belgium
| | - H Krentel
- OB-GYN clinic, Bethesda Hospital, Duisburg, Germany
| | - G Pados
- 1st Dept. OB-GYN, “Papageorgiou” General Hospital, Aristotle University of Thessaloniki and Centre for Endoscopic Surgery “Diavalkaniko” Hospital, Thessaloniki, Greece
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5
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Infertility: Practical Clinical Issues for Routine Investigation of the Male Partner. J Clin Med 2020; 9:jcm9061644. [PMID: 32486230 PMCID: PMC7356539 DOI: 10.3390/jcm9061644] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023] Open
Abstract
About one-fifth of couples has fertility problems in Western countries. Male factors are present in about half of them, either alone or in combination with female causes. Therefore, both partners should be evaluated simultaneously. The fertility status and/or specific conditions of each partner influence the clinical and treatment approach. This article summarizes in a practical way when, how, and why the male partner of an infertile couple should be investigated. The available evidence and international guidelines were used, interpreting, discussing, and expanding them from personal decades-long experience in this field. The aim is to delineate the most appropriate clinical approach for the male partner of infertile couples, considering traditional and emerging technologies and laboratory analyses in the context of their clinical significance. Components of the initial evaluation in men without known risk factors for infertility should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, scrotal ultrasound, and transrectal ultrasound are suggested in most men and are mandatory when specific risk factors for male infertility are known to be present or when the initial screening demonstrated abnormalities. Full examination, including genetic tests, testicular histology, or additional tests on sperm, is clinically oriented and/or suggested after the results of initial investigations.
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6
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Zhou Z, Zheng D, Wu H, Li R, Xu S, Kang Y, Cao Y, Chen X, Zhu Y, Xu S, Chen ZJ, Mol BW, Qiao J. Epidemiology of infertility in China: a population-based study. BJOG 2017; 125:432-441. [PMID: 29030908 DOI: 10.1111/1471-0528.14966] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Z Zhou
- Department of Obstetrics and Gynaecology; Reproductive Medical Centre; Peking University Third Hospital; Beijing China
- Key Laboratory of Assisted Reproduction; Ministry of Education; Beijing China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology; Beijing China
| | - D Zheng
- Department of Obstetrics and Gynaecology; Reproductive Medical Centre; Peking University Third Hospital; Beijing China
- Key Laboratory of Assisted Reproduction; Ministry of Education; Beijing China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology; Beijing China
| | - H Wu
- Department of Obstetrics and Gynaecology; Reproductive Medical Centre; Peking University Third Hospital; Beijing China
- Key Laboratory of Assisted Reproduction; Ministry of Education; Beijing China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology; Beijing China
| | - R Li
- Department of Obstetrics and Gynaecology; Reproductive Medical Centre; Peking University Third Hospital; Beijing China
- Key Laboratory of Assisted Reproduction; Ministry of Education; Beijing China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology; Beijing China
| | - S Xu
- Reproductive Medical Centre; The Second Hospital of Hebei Medical University; Shijiazhuang China
| | - Y Kang
- Reproductive Medical Centre; Maternal and Children's Health Hospital of Fujian Province; Fuzhou China
| | - Y Cao
- Department of Obstetrics and Gynaecology; Reproductive Medical Centre; First Affiliated Hospital of Anhui Medical University; Hefei China
| | - X Chen
- Reproductive Medical Centre; Affiliated Hospital of Inner Mongolia Medical University; Huhhot China
| | - Y Zhu
- Department of Reproductive Endocrinology; Women's Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - S Xu
- Population and Family Planning Research Institute of Heilongjiang Province; Harbin China
| | - Z-J Chen
- Centre for Reproductive Medicine; Shandong Provincial Hospital Affiliated to Shandong University; Jinan China
| | - BW Mol
- The Robinson Research Institute; School of Medicine; University of Adelaide; Adelaide SA Australia
- The South Australian Health and Medical Research Institute; Adelaide SA Australia
| | - J Qiao
- Department of Obstetrics and Gynaecology; Reproductive Medical Centre; Peking University Third Hospital; Beijing China
- Key Laboratory of Assisted Reproduction; Ministry of Education; Beijing China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology; Beijing China
- Beijing Advanced Innovation Centre for Genomics; Beijing China
- Peking-Tsinghua Centre for Life Sciences; Peking University; Beijing China
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Daniilidis A, Balaouras D, Chitzios D, Theodoridis T, Assimakopoulos E. Hydrosalpinx: Tubal surgery or in vitro fertilisation? An everlasting dilemma nowadays; a narrative review. J OBSTET GYNAECOL 2017; 37:550-556. [PMID: 28325120 DOI: 10.1080/01443615.2017.1287685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The decision on how to treat tubal diseases, specifically hydrosalpinx, is a difficult one. Ιt involves surgical, medical, social, emotional and economic factors. This narrative review aims to increase awareness of tubal disease diagnosis and treatment, to compare between tubal surgery and in vitro fertilisation (IVF) for tubal factor infertility, and to investigate the effect of the combination of both. This way, we can be more effective, safe and provide our patients with better treatment results. The review analysed randomised studies, trials and meta-analysis, which give new aspects on the treatment methods for tubal pathology before IVF. Recent papers published in English have been studied, alongside guidelines and committee opinions from previous years. Tubal surgery and IVF aim to exploit a woman's reproductive potential. IVF and endoscopic tubal surgery must be thought of as complementary, rather than competing techniques in tubal disease cases, in order to improve fertility outcome. The first-line treatment for young women less than 35 years old with minor tubal pathology, is tubal surgery. IVF should be offered if there are other factors in a couple's subfertility, if the patient is >38 years old, if moderate to severe tubal disease is present, and if it has been more than 12 months post-surgery.
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Affiliation(s)
- A Daniilidis
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
| | - D Balaouras
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
| | - D Chitzios
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
| | - T Theodoridis
- b 1st University Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki , Greece
| | - E Assimakopoulos
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
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Abstract
American dietary patterns have shifted over the past 100 years, resulting in a diet based on animal foods and highly processed carbohydrates. This shift has produced the current epidemics of obesity, type 2 diabetes, heart disease, as well as many cancers. In addition, the Western diet is also negatively affecting the reproductive capacity of the population. The birth rate is in decline and infertility and subfecundity are on the rise secondary to both ovulatory infertility and declining sperm quality. Pregnancy outcomes and maternal morbidity and mortality are also being affected. This diet, high in fat and sugar, is also contributing to the epidemic levels of autism.
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Affiliation(s)
- Amanda McKinney
- Beatrice Community Hospital and Health Center, Beatrice, Nebraska (AM)
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9
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Effect of aflatoxin B1 on the seminiferous tubules and the possible protective role of curcumin in adult albino rats (Light and electron microscopic study). ACTA ACUST UNITED AC 2015. [DOI: 10.1097/01.ehx.0000481141.52450.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Lasa JS, Zubiaurre I, Soifer LO. Risk of infertility in patients with celiac disease: a meta-analysis of observational studies. ARQUIVOS DE GASTROENTEROLOGIA 2015; 51:144-50. [PMID: 25003268 DOI: 10.1590/s0004-28032014000200014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/03/2014] [Indexed: 12/20/2022]
Abstract
CONTEXT Celiac disease is an autoimmune disorder of the small intestine associated with several extra-intestinal features, such as reproductive disorders. The relationship between celiac disease and infertility has been previously assessed, with conflicting results. OBJECTIVES We seek to determine the relationship between celiac disease and infertility. METHODS Data was extracted from case-control or cohort design studies from 1966 to December 2013 using the MEDLINE-Pubmed, EMBASE, LILACS and Cochrane Library databases. We analyzed two kinds of trials: those assessing the risk of infertility in subjects with already diagnosed celiac disease, and those evaluating the prevalence of undiagnosed celiac disease in subjects with a diagnosis of infertility. RESULTS The search yielded 413 potentially relevant studies for revision, 12 of which were finally included for analysis. A significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]. When considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)]. CONCLUSIONS Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients.
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Affiliation(s)
- Juan Sebastian Lasa
- Gastroenterology Division, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica - CEMIC, Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Zubiaurre
- Gastroenterology Division, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica - CEMIC, Buenos Aires, Buenos Aires, Argentina
| | - Luis Oscar Soifer
- Gastroenterology Division, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica - CEMIC, Buenos Aires, Buenos Aires, Argentina
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11
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Dhalwani NN, West J, Sultan AA, Ban L, Tata LJ. Women with celiac disease present with fertility problems no more often than women in the general population. Gastroenterology 2014; 147:1267-74.e1; quiz e13-4. [PMID: 25157666 DOI: 10.1053/j.gastro.2014.08.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/14/2014] [Accepted: 08/15/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Studies have associated infertility with celiac disease. However, these included small numbers of women attending infertility specialist services and subsequently screened for celiac disease, and therefore may not have been representative of the general population. We performed a large population-based study of infertility and celiac disease in women from the United Kingdom. METHODS We identified 2,426,225 women with prospective UK primary care records between 1990 and 2013 during their child-bearing years from The Health Improvement Network database. We estimated age-specific rates of new clinically recorded fertility problems among women with and without diagnosed celiac disease. Rates were stratified by whether celiac disease was diagnosed before the fertility problem or afterward and compared with rates in women without celiac disease using Poisson regression, adjusting for sociodemographics, comorbidities, and calendar time. RESULTS Age-specific rates of new clinically recorded fertility problems in 6506 women with celiac disease were similar to the rates in women without celiac disease (incidence rate ratio, 1.12; 95% confidence interval, 0.88-1.42 among women age 25-29 years). Rates of infertility among women without celiac disease were similar to those of women with celiac disease before and after diagnosis. However, rates were 41% higher among women diagnosed with celiac disease when they were 25-29 years old, compared with women in the same age group without celiac disease (incidence rate ratio, 1.41; 95% confidence interval, 1.03-1.92). CONCLUSIONS Women with celiac disease do not have a greater likelihood of clinically recorded fertility problems than women without celiac disease, either before or after diagnosis, except for higher reports of fertility problems between 25-39 years if diagnosed with CD. These findings should assure most women with celiac disease that they do not have an increased risk for fertility problems.
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Affiliation(s)
- Nafeesa N Dhalwani
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom.
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom
| | - Alyshah Abdul Sultan
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom
| | - Lu Ban
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom
| | - Laila J Tata
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom
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12
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O'Neill SM, Kearney PM, Kenny LC, Henriksen TB, Lutomski JE, Greene RA, Khashan AS. Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013; 13:165. [PMID: 23981569 PMCID: PMC3765853 DOI: 10.1186/1471-2393-13-165] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 08/13/2013] [Indexed: 11/25/2022] Open
Abstract
Background Caesarean delivery has increased worldwide, however, the effects on fertility are largely unknown. This systematic review aims to compare subsequent sub-fertility (time to next pregnancy or birth) among women with a Caesarean delivery to women with a vaginal delivery. Methods Systematic review of the literature including seven databases: CINAHL; the Cochrane Library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge (1945 - October 2012), using detailed search-strategies and reference list cross-checking. Cohort, case–control and cross-sectional studies were included. Two assessors reviewed titles, abstracts, and full articles using standardised data abstraction forms and assessed study quality. Results 11 articles were eligible for inclusion in the systematic review, of these five articles which adjusted for confounders were combined in a meta-analysis, totalling 750,407 women using fixed-effect models. Previous Caesarean delivery was associated with an increased risk of sub-fertility [pooled odds ratio (OR) 0.90; 95% CI 0.86, 0.93]. Subgroup analyses by parity [primiparous women: OR 0.91; 95% CI 0.87, 0.96; not limited to primiparous women: OR 0.81; 95% CI 0.73, 0.90]; by publication date (pre-2000: OR 0.80, 95% CI 0.68, 0.94; post-2000: OR 0.90, 95% CI 0.86, 0.94); by length of follow-up (<10 years: OR 0.81, 95% CI 0.73, 0.90; >10 years: OR 0.91, 95% CI 0.87, 0.96); by indication for mode of delivery (specified: 0.92, 95% CI 0.88, 0.97; not specified: OR 0.81, 95% CI 0.73, 0.90); by cohort size (<35,000: OR 0.79, 95% CI 0.67, 0.92; >35,000: OR 0.90, 95% CI 0.87, 0.95), by definition of sub-fertility used divided into (birth interval [BI]: OR 0.89, 95% CI 0.84, 0.94; inter-pregnancy interval [IPI]: OR 0.91, 95% CI 0.85, 0.97; and categorical measures: OR 0.81, 95% CI 0.73, 0.90); continuous measures: OR 0.91, 95% CI 0.87, 0.96) were performed. Results of the six studies not included in the meta-analysis (which did not adjust for confounders) are presented individually. Conclusions The meta-analysis shows an increased waiting time to next pregnancy and risk of sub-fertility among women with a previous Caesarean delivery. However, included studies are limited by poor epidemiological methods such as variations in the definition of time to next pregnancy, lack of confounding adjustment, or details of the indication for Caesarean delivery. Further research of a more robust methodological quality to better explore any underlying causes of sub-fertility and maternal intent to delay childbearing is warranted.
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Affiliation(s)
- Sinéad M O'Neill
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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Corbett S, Morin-Papunen L. The Polycystic Ovary Syndrome and recent human evolution. Mol Cell Endocrinol 2013; 373:39-50. [PMID: 23352610 DOI: 10.1016/j.mce.2013.01.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 12/24/2012] [Accepted: 01/03/2013] [Indexed: 01/03/2023]
Abstract
The Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder characterised both by reproductive and metabolic disturbance, and is the most common cause globally of ovarian infertility. It is also a familial polygenic condition, linked genetically to both Type 2 diabetes and the metabolic syndrome. The striking evolutionary paradox of this prominent genetically-based condition, which impairs fertility, is that not only should it have diminished in prevalence, but it should have done so rapidly - unless there has been some form of balancing selection. The emerging discipline of evolutionary medicine can provide important insights into the causes and patterns of occurrence of common diseases such as PCOS. In this paper we review the impacts of PCOS on infertility, fecundability and lifetime reproductive success and then critically appraise published hypotheses about the evolutionary origins of PCOS and related conditions.
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Affiliation(s)
- Stephen Corbett
- Population Health, Clinical Support Division Western, Gungurra Building 68 Cumberland Hospital, Locked Bag 7118, Parramatta, BC NSW 2124, Australia.
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Dhalwani NN, Fiaschi L, West J, Tata LJ. Occurrence of fertility problems presenting to primary care: population-level estimates of clinical burden and socioeconomic inequalities across the UK. Hum Reprod 2013; 28:960-8. [DOI: 10.1093/humrep/des451] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study. Br J Gen Pract 2012; 62:e438-45. [PMID: 22687237 DOI: 10.3399/bjgp12x649133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Infertility affects 9% of couples in the UK. Most couples who visit their GP because they are worried about their fertility will ultimately conceive, but a few will not. Treatment usually happens in secondary care, but GPs can have an invaluable role in starting investigations, referring, and giving support throughout treatment and beyond. AIM To inform clinical practice by exploring primary care experiences of infertility treatment among females and males, and discussing findings with a reference group of GPs to explore practice experience. DESIGN AND SETTING A qualitative patient interview and GP focus group study. Interviews were conducted in patients homes in England and Scotland; the focus group was held at a national conference. METHOD An in-depth interview study was conducted with 27 females and 11 males. A maximum variation sample was sought and interviews were transcribed for thematic analysis. Results were discussed with a focus group of GPs to elicit their views. RESULTS Feeling that they were being taken seriously was very important to patients. Some felt that their concerns were not taken seriously, or that their GP did not appear to be well informed about infertility. The focus group of GPs highlighted the role of protocols in their management of patients who are infertile, as well as the difficulty GPs faced in communicating both reassurance and engagement. CONCLUSION Simple things that GPs say and do, such as describing the 'action plan' at the first consultation, could make a real difference to demonstrating that they are taking the fertility problem seriously.
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Silva CA, Cocuzza M, Borba EF, Bonfá E. Cutting-Edge Issues in Autoimmune Orchitis. Clin Rev Allergy Immunol 2011; 42:256-63. [DOI: 10.1007/s12016-011-8281-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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17
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Light and electron microscopic study of the toxic effect of prolonged lead exposure on the seminiferous tubules of albino rats and the possible protective effect of ascorbic acid. Food Chem Toxicol 2011; 49:734-43. [DOI: 10.1016/j.fct.2010.11.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/07/2010] [Accepted: 11/23/2010] [Indexed: 11/20/2022]
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18
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Silva CA, Bonfa E, ØStensen M. Maintenance of fertility in patients with rheumatic diseases needing antiinflammatory and immunosuppressive drugs. Arthritis Care Res (Hoboken) 2010; 62:1682-90. [DOI: 10.1002/acr.20323] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Wex-Wechowski J, Abou-Setta AM, Kildegaard Nielsen S, Kennedy R. HP-HMG versus rFSH in treatments combining fresh and frozen IVF cycles: success rates and economic evaluation. Reprod Biomed Online 2010; 21:166-78. [PMID: 20541471 DOI: 10.1016/j.rbmo.2010.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 02/18/2010] [Accepted: 05/06/2010] [Indexed: 11/30/2022]
Abstract
The economic implications of the choice of gonadotrophin influence decision making but their cost-effectiveness in frozen-embryo transfer cycles has not been adequately studied. An economic evaluation was performed comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) using individual patient data (n=986) from two large randomized controlled trials using a long agonist IVF protocol. The simulation model incorporated live birth data and published UK costs of IVF-related medical resources. After treatment for up-to-three cycles (one fresh and up to two subsequent fresh or frozen cycles conditional on availability of cryopreserved embryos), the cumulative live birth rate was 53.7% (95% CI 49.3-58.1%) for HP-HMG and 44.6% (40.2-49.0%) for rFSH (OR 1.44, 95% CI 1.12-1.85; P<0.005). The mean costs per IVF treatment for HP-HMG and rFSH were pound5393 ( pound5341-5449) and pound6269 ( pound6210-6324), respectively (number needed to treat to fund one additional treatment was seven; P<0.001). With maternal and neonatal costs applied, the median cost per IVF baby delivered with HP-HMG was pound11,157 ( pound11,089-11,129) and pound14,227 ( pound14,183-14,222) with rFSH (P<0.001). The cost saving using HP-HMG remained after varying model parameters in a probabilistic sensitivity analysis.
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Affiliation(s)
- Jaro Wex-Wechowski
- PharmArchitecture, Quatro House, Lyon Way, Camberley, Surrey GU167ER, UK.
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Variation in guideline adherence in intrauterine insemination care. Reprod Biomed Online 2009; 20:533-42. [PMID: 20129823 DOI: 10.1016/j.rbmo.2009.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 08/13/2009] [Accepted: 11/30/2009] [Indexed: 11/23/2022]
Abstract
Health-care delivery according to clinical practice guidelines is thought to be critical in achieving optimal outcomes. This study aimed to assess the extent to which practice performance in intrauterine insemination (IUI) care is consistent with guideline recommendations and to evaluate the association between guideline adherence and outcome of IUI care. In a retrospective cohort study, 1100 infertile couples who underwent IUI treatment at 10 Dutch hospitals were asked to grant access to their medical record for assessment of guideline adherence using 25 systematically developed guideline-based performance indicators. A total of 558 couples who started 2334 IUI cycles participated. Guideline adherence regarding 20 process and five structure aspects of IUI care was often substandard and varied considerably between hospitals. Out of 10 possible associations investigated, guideline adherence regarding sperm quality and guideline adherence regarding the total number of IUI cycles were associated with improved ongoing pregnancy rates after IUI. Thus, guideline adherence in IUI care is far from optimal and varies substantially between hospitals. As associations between guideline adherence and ongoing pregnancy after IUI were mainly non-significant, further research is needed to evaluate associations between guideline adherence and other outcomes of IUI care besides ongoing pregnancy, such as patient safety and cost effectiveness.
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Benoff S, Hauser R, Marmar JL, Hurley IR, Napolitano B, Centola GM. Cadmium concentrations in blood and seminal plasma: correlations with sperm number and motility in three male populations (infertility patients, artificial insemination donors, and unselected volunteers). Mol Med 2009; 15:248-62. [PMID: 19593409 DOI: 10.2119/molmed.2008.00104] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To investigate a possible common environmental exposure that may partially explain the observed decrease in human semen quality, we correlated seminal plasma and blood cadmium levels with sperm concentration and sperm motility. We studied three separate human populations: group 1, infertility patients (Long Island, NY, USA); group 2, artificial insemination donors (AID) (Rochester, NY, USA); and group 3, general population volunteers (Rochester, NY, USA). Information about confounding factors was collected by questionnaire. Seminal plasma cadmium did not correlate with blood cadmium (Spearman correlation, n = 91, r = -0.092, P = 0.386, NS). Both blood and seminal plasma cadmium were significantly higher among infertility patients than the other subjects studied (for example, median seminal plasma cadmium was 0.282 microg/L in infertility patients versus 0.091 microg/L in AID and 0.092 microg/L in general population volunteers; Kruskal-Wallis test, P < 0.001). The percentage of motile sperm and sperm concentration correlated inversely with seminal plasma cadmium among the infertility patients (r = -0.201, P < 0.036 and r = -0.189, P < 0.05, respectively), but not in the other two groups. Age (among infertility patients) was the only positive confounder correlating with seminal plasma cadmium. To validate our human findings in an animal model, we chronically exposed adolescent male Wistar rats to low-moderate cadmium in drinking water. Though otherwise healthy, the rats exhibited decreases in epididymal sperm count and sperm motility associated with cadmium dose and time of exposure. Our human and rat study results are consistent with the hypothesis that environmental cadmium exposures may contribute significantly to reduced human male sperm concentration and sperm motility.
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Affiliation(s)
- Susan Benoff
- Fertility Research Laboratories, The Feinstein Institute for Medical Research, Manhasset, New York 11030, United States of America.
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Mikkelsen EM, Hatch EE, Wise LA, Rothman KJ, Riis A, Sørensen HT. Cohort profile: the Danish Web-based Pregnancy Planning Study--'Snart-Gravid'. Int J Epidemiol 2008; 38:938-43. [PMID: 18782897 DOI: 10.1093/ije/dyn191] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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Drug insight: insulin-sensitizing drugs in the treatment of polycystic ovary syndrome--a reappraisal. ACTA ACUST UNITED AC 2008; 4:272-83. [PMID: 18364705 DOI: 10.1038/ncpendmet0787] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 01/02/2008] [Indexed: 12/30/2022]
Abstract
The recognition that insulin resistance has a pivotal role in the pathogenesis of polycystic ovary syndrome (PCOS) revolutionized our understanding of this complex disorder. PCOS causes major metabolic and reproductive morbidities, including substantially increased risk for type 2 diabetes mellitus and the metabolic syndrome. Insulin-sensitizing drugs (ISDs) ameliorate reproductive abnormalities, restore ovulation and regular menses, increase pregnancy rates and reduce androgenic symptoms in affected women with PCOS. Accordingly, ISDs, specifically metformin, have been widely adopted as therapy for this condition. A recent, large, randomized, multicenter, clinical trial that assessed live-birth rates rather than surrogate end points suggested that metformin alone is inferior to clomiphene citrate in treating infertility associated with PCOS. There is, furthermore, no evidence to support the use of metformin during pregnancy to prevent spontaneous abortions or gestational diabetes mellitus in women with PCOS. Renewed safety concerns about thiazolidinediones followed recent studies that reported increased cardiovascular morbidity with these agents. These concerns might preclude thiazolidinedione use in otherwise healthy women with PCOS. Finally, although ISDs improve insulin action and cardiovascular disease risk, there is no evidence that they provide long-term health benefits in PCOS. This article discusses the role of ISDs in PCOS in light of these new data.
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