Magnitude of infertility and associated factors among women attending selected public hospitals in Addis Ababa, Ethiopia: a cross-sectional study

Health-related quality of life and its associated factors among infertile women compared with fertile women in public hospital Addis Ababa, Ethiopia: a comparative cross-sectional study

BACKGROUND

Infertility can have detrimental physical, psychological, and social effects that significantly impact health-related quality of life. Although the impact of infertility on quality of life is well established, there is a lack of research comparing the quality of life between fertile and infertile women in Ethiopia.

METHODS

A hospital-based comparative cross-sectional study was conducted among 287 infertile and 301 fertile women. Participants were selected using systematic random sampling. A structured, validated tool was used to collect data. An independent sample t-test was conducted to determine if there was a difference in the study participants' quality of life domains and the mean total quality of life score. Multiple linear regressions were used to correlate quality of life scores with significant predictor factors for the infertile group.

RESULTS

Infertile women had a mean total Herbal of 66.54 ± 10.18, and fertile women (72.68 ± 7.57) were found to be statistically different between the groups. All domains except the physical domain were significantly different between the groups. Duration of marriage (β = -0.529), number of previous sexual partners (β = -0.410), total number of working hours per day (β = -0.345), types of infertility (β = -0.34), and history of the sexually transmitted disease (β = -0.277), in decreasing order of effect, were found to be associated with the quality of life of infertile women (R2 = 0.725).

CONCLUSIONS

The study found that infertile women had a lower mean HRQoL score compared to fertile women, with all domains except for the physical domain being significantly different between the two groups. This suggests that infertility can have a significant impact on various aspects of a woman's life, including her emotional well-being, social functioning, and psychological health. The factors associated with the quality of life of infertile women were the duration of marriage, the number of previous sexual partners, the total number of working hours per day, the types of infertility, and the history of sexually transmitted diseases, with duration of marriage having the strongest association. These findings highlight the need for healthcare providers to address the psychological and social aspects of infertility.

The varying estimation of infertility in Ethiopia: the need for a comprehensive definition

BACKGROUND

Infertility is a marginalized sexual and reproductive health issue in low-resource settings. Globally, millions are affected by infertility, but the lack of a universal definition makes it difficult to estimate the prevalence of infertility at the population level. Estimating the prevalence of infertility may inform targeted and accessible intervention, especially for a resource-limited country like Ethiopia. This study aims to estimate the prevalence of female infertility in Ethiopia using the Demographic and Health Survey (DHS) through two approaches: (i) the demographic approach and (ii) the current duration approach.

METHODS

Data from 15,683 women were obtained through the 2016 Ethiopian DHS. The demographic approach estimates infertility among women who had been married/in a union for at least five years, had never used contraceptives, and had a fertility desire. The current duration approach includes women at risk of pregnancy at the time of the survey and determines their current length of time-at-risk of pregnancy at 12, 24, and 36 months. Logistic regression analysis estimated the prevalence of infertility and factors associated using the demographic approach. Parametric survival analysis estimated the prevalence of infertility using the current duration approach. All estimates used sampling weights to account for the DHS sampling design. STATA 14 and R were used to perform the statistical analysis.

RESULTS

Using the demographic definition, the prevalence of infertility was 7.6% (95% CI 6.6-8.8). When stratified as primary and secondary infertility, the prevalence was 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5-10.1), respectively. Using the current duration approach definition, the prevalence of overall infertility was 24.1% (95% CI 18.8-34.0) at 12-months, 13.4% (95% CI 10.1-18.6) at 24-months, and 8.8% (95% CI 6.5-12.3) at 36-months.

CONCLUSION

The demographic definition of infertility resulted in a lower estimate of infertility. The current duration approach definition could be more appropriate for the early detection and management of infertility in Ethiopia. The findings also highlight the need for a comprehensive definition of and emphasis on infertility. Future population-based surveys should incorporate direct questions related to infertility to facilitate epidemiological surveillance.

Infertile women of Ethiopia: Psychological challenges and coping strategies

Worldwide, an estimated 48 million couples and 186 million individuals are infertile, according to estimates from the World Health Organization. Ethiopia has a higher rate of infertility than the World Health Organization estimated for the entire world. Though research on the issue of infertility is growing both globally and in Ethiopia, not much has been studied. Therefore, the main objective of this study was to explore the psychological and coping strategies of infertile women in Bichena town, Ethiopia. The study followed a qualitative research approach and a descriptive phenomenological design. Data were collected through in-depth interviews with 15 infertile women using a purpose-sampling technique. Thematic analysis was the method of data analysis. The findings of this study indicated that stress, anxiety, depression, low self-esteem, and sexual dissatisfaction were the main psychological challenges that infertile women experience. Infertile women also used a variety of coping strategies, such as religious strategies, traditional strategies, medical strategies, and other strategies (marital separation and acceptance). The study concluded that infertile women in the study area were challenged by psychological factors and used different coping strategies to manage their ongoing problems. This study also has theoretical implications for the current literature and practical implications for infertile women, non-governmental organizations, community and health professionals.

Premature luteinization and pregnancy outcomes in depot goserelin-downregulated assisted reproductive technology cycles: A cross-sectional study from Ethiopia

OBJECTIVE

To compare the rate of premature luteinization in depot goserelin-downregulated in vitro fertilization (IVF) cycles with other IVF protocols at a teaching hospital in Ethiopia.

METHODS

We conducted a cross-sectional study on the effects of premature luteinization on IVF outcomes at St. Paul's Hospital Millennium Medical College, a tertiary teaching hospital in Ethiopia. Patients who had IVF at this hospital between 2019 and 2020 were included in the study. Patient records were reviewed and collected on Open Data Kit. We used Stata release 15 to analyze the data. A simple descriptive analysis and bivariate analysis  were performed as appropriate. A P-value less than 0.05 was considered as statistically significant.

RESULTS

A total of 305 patients (40 cases with premature luteinization and 265 without premature luteinization) were included. There was no difference in the rate of premature luteinization in the depot goserelin long protocol cycles (6.4%), compared to minimal stimulation (14.1%) and antagonist protocols (16.7%), P = 0.19. Embryo transfer was carried out in 27 (67.5%) patients in the premature luteinization group, which was lower than the 86.0% (228/265) in the non-premature luteinization group, P = 0.003. There was no difference in the median number of oocytes retrieved (8.5 [interquartile range 5.0, 13.0] per cycle in the premature luteinization group vs 5.0 [interquartile range 3.0, 10.0] in those without premature luteinization, P = 0.10).

CONCLUSION

A depot goserelin-downregulated long protocol for IVF is a cost-effective and convenient option for controlled ovarian hyperstimulation without increased risk of having premature luteinization compared to antagonist and minimal stimulation protocols.

Blastocyst telomere length predicts successful implantation after frozen-thawed embryo transfer

STUDY QUESTION

Do embryos with longer telomere length (TL) at the blastocyst stage have a higher capacity to survive after frozen-thawed embryo transfer (FET)?

SUMMARY ANSWER

Digitally estimated TL using low-pass whole genome sequencing (WGS) data from the preimplantation genetic testing for aneuploidy (PGT-A) process demonstrates that blastocyst TL is the most essential factor associated with likelihood of implantation.

WHAT IS KNOWN ALREADY

The lifetime TL is established in the early cleavage cycles following fertilization through a recombination-based lengthening mechanism and starts erosion beyond the blastocyst stage. In addition, a telomerase-mediated slow erosion of TL in human fetuses has been observed from a gestational age of 6-11 weeks. Finally, an abnormal shortening of telomeres is likely involved in embryo loss during early development.

STUDY DESIGN SIZE DURATION

Blastocyst samples were obtained from patients who underwent PGT-A and FET in an IVF center from March 2015 to May 2018. Digitally estimated mitochondrial copy number (mtCN) and TL were used to study associations with the implantation potential of each embryo.

PARTICIPANTS/MATERIALS SETTING AND METHODS

In total, 965 blastocysts from 232 cycles (164 patients) were available to investigate the biological and clinical relevance of TL. A WGS-based workflow was applied to determine the ploidy of each embryo. Data from low-pass WGS-PGT-A were used to estimate the mtCN and TL for each embryo. Single-variant and multi-variant logistic regression, decision tree, and random forest models were applied to study various factors in association with the implantation potential of each embryo.

MAIN RESULTS AND THE ROLE OF CHANCE

Of the 965 blastocysts originally available, only 216 underwent FET. While mtCN from the transferred embryos is significantly associated with the ploidy call of each embryo, mtCN has no role in impacting IVF outcomes after an embryo transfer in these women. The results indicate that mtCN is a marker of embryo aneuploidy. On the other hand, digitally estimated TL is the most prominent univariant factor and showed a significant positive association with pregnancy outcomes (P < 0.01, odds ratio 79.1). We combined several maternal and embryo parameters to study the joint effects on successful implantation. The machine learning models, namely decision tree and random forest, were trained and yielded classification accuracy of 0.82 and 0.91, respectively. Taken together, these results support the vital role of TL in governing implantation potential, perhaps through the ability to control embryo survival after transfer.

LIMITATIONS REASONS FOR CAUTION

The small sample size limits our study as only 216 blastocysts were transferred. The number was further reduced to 153 blastocysts, where pregnancy outcomes could be accurately traced. The other limitation of this study is that all data were collected from a single IVF center. The uniform and controlled operation of IVF cycles in a single center may cause selection bias.

WIDER IMPLICATIONS OF THE FINDINGS

We present novel findings to show that digitally estimated TL at the blastocyst stage is a predictor of pregnancy capacity after a FET cycle. As elective single-embryo transfer has become the mainstream direction in reproductive medicine, prioritizing embryos based on their implantation potential is crucial for clinical infertility treatment in order to reduce twin pregnancy rate and the time to pregnancy in an IVF center. The AI-powered, random forest prediction model established in this study thus provides a way to improve clinical practice and optimize the chances for people with fertility problems to achieve parenthood.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by a grant from the National Science and Technology Council, Taiwan (MOST 108-2321-B-006-013 -). There were no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Introducing assisted reproductive technologies in The Gambia, a survey on the perspectives of Gambian healthcare professionals and medical students

BACKGROUND

Infertility remains a global reproductive health burden with the highest prevalence in low and middle-income countries. In sub-Saharan Africa, the ability to procreate holds great societal importance. Couples, and particularly women, with infertility can face devastating challenges, leading to social stigma, isolation and/or divorce. However, attention to addressing infertility is lacking in sub-Saharan Africa. In The Gambia, where this study is based, little is known about the potential for introduction of assisted reproductive technologies (ART) in the public health sector.

METHODS

A quantitative survey was conducted using detailed questionnaires on infertility services available, staff knowledge, perceived barriers, and personal motivation to support assisted reproductive technologies. Data was collected electronically between April and June 2021 from healthcare providers (n = 70) in eleven health facilities throughout the country, as well as from medical students (n = 55) enrolled at The University of The Gambia.

RESULTS

Basic infertility services were found to be lacking in the rural areas. Furthermore, 39% of staff (n = 27) providing fertility care had not receive any formal training on the topic. However, 91% of staff (n = 64) showed interest in acquiring additional knowledge and had a positive attitude towards supporting the introduction of ART. Perceived challenges of doing so included: (i) the competing importance of other health priorities; and (ii) religious and cultural barriers.

CONCLUSION

This survey highlights that expansion of infertility services is needed, especially in rural areas. Staff perceived the introduction of ART as important, but this should be coupled with specialized training, as most medical staff had not received any formal infertility training. Future care providers (current medical students) showed both interest in ART and reported having received some basic training in infertility management. Given the reported lack of infrastructure and services, additional targeted investment in infertility care, including ART, will be needed to improve reproductive health for all, countrywide.

Anethole improves the developmental competence of porcine embryos by reducing oxidative stress via the sonic hedgehog signaling pathway

BACKGROUND

Anethole (AN) is an organic antioxidant compound with a benzene ring and is expected to have a positive impact on early embryogenesis in mammals. However, no study has examined the effect of AN on porcine embryonic development. Therefore, we investigated the effect of AN on the development of porcine embryos and the underlying mechanism.

RESULTS

We cultured porcine in vitro-fertilized embryos in medium with AN (0, 0.3, 0.5, and 1 mg/mL) for 6 d. AN at 0.5 mg/mL significantly increased the blastocyst formation rate, trophectoderm cell number, and cellular survival rate compared to the control. AN-supplemented embryos exhibited significantly lower reactive oxygen species levels and higher glutathione levels than the control. Moreover, AN significantly improved the quantity of mitochondria and mitochondrial membrane potential, and increased the lipid droplet, fatty acid, and ATP levels. Interestingly, the levels of proteins and genes related to the sonic hedgehog (SHH) signaling pathway were significantly increased by AN.

CONCLUSIONS

These results revealed that AN improved the developmental competence of porcine preimplantation embryos by activating SHH signaling against oxidative stress and could be used for large-scale production of high-quality porcine embryos.

Association of undernutrition and female infertility in East Africa: Finding from multi-country demographic and health surveys

Introduction

Infertility is one of the public health problems affecting a significant number of women in the reproductive age group. Although female fertility is predominantly affected by gynecological and systemic diseases, lifestyle and nutritional factors also play an important role in secondary female infertility. Therefore, this study aimed to determine the pooled prevalence of secondary female infertility and its association with undernutrition using nationwide data from the Demographic and Health Surveys (DHS) of eastern African countries.

Methods

The data of ten East African countries that comprise a weighted sample of 38,020 women data were accessed from measure DHS. Data processing and analysis were performed using STATA 15 software. A multilevel mixed-effect logistic regression model was fitted to examine the association between undernutrition and secondary infertility. Variables with a p-value < 0.05 were declared as significant factors associated with secondary infertility. Model comparison was done based on Akaike and Bayesian Information Criteria (AIC and BIC). To measure variation (random effects), Community-level variance with standard deviation and intra-cluster correlation coefficient (ICC) was used.

Result

The proportion of women who have secondary infertility was 16.32% with 95%CI (15.96, 16.69), of which 26.94% were undernourished. This study found that being undernutrition (AOR = 1.74; 95%CI: 1.54-1.98) and overweight (AOR = 1.72; 95%CI: 1.62-1.86) were significantly associated with secondary infertility. Women aged >35 years (AOR = 3.47; 95%CI: 2.66-4.55), and rural residents (AOR = 1.16; 95%CI: 1.02-1.37) are other factors that are positively associated with secondary infertility. However, primary education (AOR = 0.87; 95%CI: 0.77-0.97) and richer wealth index (AOR = 0.84; 95%CI: 0.73-0.97) are protective factors for secondary infertility.

Conclusion

This study indicated that there is a strong association between secondary infertility and undernutrition growing in Eastern Africa. Therefore, Health information dissemination and awareness creation on the impact of malnutrition on infertility should be given to the community and health care providers. Given this, it may lead to integrating nutrition counseling into both clinical settings for infertility management as well as national dietary guidelines for individuals of reproductive age.

Fractal methods applied to the seminiferous lumen images can quantify testicular changes induced by heat stress

Male infertility affects many couples around the world and can be related to environmental factors such as exposure to high temperatures. Even so, automated methods evaluating the seminiferous tubules to detect testicular damage are still scarce. In search of new approaches to automation in the microscopic analysis of the testis; the present study used the fractal dimension, lacunarity, multifractality and quantitative morphometry to quantify changes in microphotographs of the seminiferous lumen in testicles reversibly damaged by heat stress (43 °C, 12 min). The parameters fractal dimension, lacunarity, multifractality (Dq and α), perimeter, feret and circularity were able to detect changes in the seminiferous lumen at 7, 15 and 30 days after the testicular damage. These methods also detected the recovery of spermatogenesis at 60 days after heat stress. Area, f(α), centroid X and Y, roundness, rectangle height and width were unable to detect changes caused by heat stress. In conclusion, computer assisted methods applied to the seminiferous lumen images can be a useful new viewpoint to analyze microscopic changes in the testicles, a fast low-cost tool to assist in the automated quantification of testicular damage.

Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis

OBJECTIVES

To assess the prevalence, risk factors and psychological impact of infertility among females. This review summarises the available evidence, effect estimates and strength of statistical associations between infertility and its risk factors.

STUDY DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, CINAHL and ScienceDirect were searched through 23 January 2022.

ELIGIBILITY CRITERIA

The inclusion criteria involved studies that reported the psychological impact of infertility among women. We included cross-sectional, case-control and cohort designs, published in the English language, conducted in the community, and performed at health institution levels on prevalence, risk factors and psychological impact of infertility in women.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted and assess the quality of data using the Joanna Briggs Institute Meta-Analysis. The outcomes were assessed with random-effects model and reported as the OR with 95% CI using the Review Manager software.

RESULTS

Thirty-two studies with low risk of bias involving 124 556 women were included. The findings indicated the overall pooled prevalence to be 46.25% and 51.5% for infertility and primary infertility, respectively. Smoking was significantly related to infertility, with the OR of 1.85 (95% CI 1.08 to 3.14) times higher than females who do not smoke. There was a statistical significance between infertility and psychological distress among females, with the OR of 1.63 (95% CI 1.24 to 2.13). A statistical significance was noted between depression and infertility among females, with the OR of 1.40 (95% CI 1.11 to 1.75) compared with those fertile.

CONCLUSIONS

The study results highlight an essential and increasing mental disorder among females associated with infertility and may be overlooked. Acknowledging the problem and providing positive, supportive measures to females with infertility ensure more positive outcomes during the therapeutic process. This review is limited by the differences in definitions, diagnostic cut points, study designs and source populations.

PROSPERO REGISTRATION NUMBER

CRD42021226414.

Healthy birth in a case of total globozoospermia after intracytoplasmic sperm injection and assisted oocyte activation

Globozoospermia is a rare (incidence <0.1%) and very severe disorder, with major implications in male fertility. Total globozoospermia is represented by the presence of spermatozoa with 100% rounded heads and a lack of acrosomes. These specific morphological modifications seem to be connected to defects occurring in the last stage of spermatogenesis, spermiogenesis, and will result in anomalies of the acrosomal reaction and a defective adherence of the spermatozoa to the oocytes zona pellucida. This will result in a failure of natural fertilization. This article aims to present the case of a couple diagnosed and successfully treated for primary male infertility. The 26-year-old male partner underwent two semen analyses that revealed the presence of fully rounded spermatozoa heads (morphological abnormality) and consequently was proposed for in vitro fertilization treatment. Semen preparation and the use of assisted reproductive techniques, intracytoplasmic injection of sperm cells into the assisted oocyte activation, have resulted in the conceivement of a healthy child. The particularities of this case lie in the early recognition of the total abnormal globozoospermia morphology. This is the first case reported in Romania where specific assisted reproductive techniques and treatments have resulted in a successful pregnancy for a couple with male total globozoospermia.