Physical activity and body mass index among women who have experienced infertility

Association of fat distribution differences in infertile women with assisted reproductive outcomes: A prospective cohort study

OBJECTIVE

To investigate the impacts of fat distribution on assisted reproductive outcomes in infertile women.

METHODS

The study randomly recruited 576 infertile women who underwent assisted reproductive technology treatment at the Reproductive Medicine Center of the First Affiliated Hospital of Anhui Medical University between July and October 2022. Questionnaires and body composition measurements were administered to assess baseline information and fat distribution. The numbers of oocytes, zygotes presenting with two pronuclei (2PN), and available embryos were tracked at the end of the cycle. Multifactorial logistic regression models and restricted cubic spline (RCS) curve models were used to explore the relationships between fat distribution and reproductive outcomes while controlling for confounding factors.

RESULTS

The study found that the participants had a mean age of 30.82 years. The analysis showed that there was a significant difference between the amount of leg body fat mass (LBFM) and the distribution of reproductive outcomes. However, there was no significant correlation between the level of visceral fat and reproductive outcomes. After taking confounding factors into account, the multifactorial regression analysis showed that the total body fat mass and the number of oocytes (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.84-0.99), 2PN (OR 0.92, 95% CI 0.84-0.99), and embryos available for transfer (OR 0.90, 95% CI 0.82-0.99) were negatively correlated. RCS modeling revealed a linear dose-response relationship between LBFM and assisted reproductive outcomes.

CONCLUSION

Fat distribution varies among infertile women, and higher amounts of fat are associated with poorer assisted reproductive outcomes.

Factors associated with infertility among the Lebanese population: a cross-sectional study

The incidence of female infertility is growing worldwide and its rate varies across countries. . The goal of this study is to assess the rate of female infertility and identify its associated factors among Lebanese women. This cross-sectional study was conducted between January to May 2019, enrolling a total of 952 females. The mean age was 34.8 ± 8 years and the rate of infertility was 34.3%. The multivariable analysis taking presence vs absence of infertility as the dependent variable, showed that patients with advanced age (aOR = 1.04), endometriosis (aOR = 2.175) and polycystic ovarian syndrome (aOR = 1.41) were significantly associated with higher rate of infertility. On the other hand, having a college level of education compared to a school level was significantly associated with lower odds of infertility (aOR = 0.511). The study highlights that the rate of infertility is high in Lebanon and is mainly associated with various sociodemographic factors and disease states. The findings raise the need to establish awareness campaigns that focus on early diagnosis of infertility, control the associated factors, and treat underlying comorbid conditions.

Impact of Physical Activity and Sedentary Behavior on Spontaneous Female and Male Fertility: A Systematic Review

BACKGROUND

Before pregnancy is recognized, ovulation, fertilization, and implantation must all occur. Physical activity and sedentary behavior may impact pregnancy success by altering each or all of these processes. The aim of this review was to review the association between physical activity and sedentary behavior with spontaneous female and male fertility.

METHOD

PubMed/MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Embase were searched from inception to August 9, 2021. Eligible studies included randomized controlled trials or observational studies, published in English, describing an association between physical activity or sedentary behavior (exposures) and spontaneous fertility (outcome) among women or men.

RESULTS

Thirty-four studies from 31 unique populations were included in this review (12 cross-sectional studies, 10 cohort studies, 6 case-control studies, 5 randomized controlled trials, and one case-cohort study). Of the 25 studies among women, the majority identified mixed results (n = 11) or no association (n = 9) between physical activity and female fertility. Seven studies reported on female fertility and sedentary behavior, and 2 found sedentary behavior was associated with decreased female fertility. Of the 11 studies among men, most of the studies (n = 6) found that physical activity was associated with increased male fertility. Two of the studies reported on male fertility and sedentary behavior, and neither identified an association.

CONCLUSIONS

The association between spontaneous fertility and physical activity in both men and women remains unclear, and the association with sedentary behavior remains largely unexplored.

Knowledge, attitudes, and practices toward exercises among women visiting an infertility clinic: A cross-sectional study

Globally, there is a rising prevalence of infertility, and it has a negative consequence on the quality of life of women. The researchers aimed to understand the knowledge, attitude, and practice of women with infertility toward exercises. A cross-sectional study was conducted on 332 women aged between 18 and 45 years attending an infertility clinic in a tertiary hospital in Southern India. Participants filled a self-developed, content validated, pilot-tested questionnaire. Informants perceived stress and weight gain to be the major causes of infertility. Exercise was believed to improve fertilization by 55.4% of the participants, and walking and yoga were the preferred mode of exercises.

No association between infant growth and adherence to the dietary approaches to stop hypertension (DASH) diet in lactating women

OBJECTIVE

Breastmilk is considered an optimal food for infant development especially during the first 6 months of life. However, little evidence exists regarding maternal dietary intake and infant growth. We evaluated how adherence to the DASH diet in lactating women is associated with the infant weight, height and head circumference at birth, 2 and 4 months of age.

STUDY DESIGN

A cross-sectional study.

METHODS

The present study was conducted with 292 lactating mothers and their infants. A validated and reliable 168-item food frequency questionnaire (FFQ) was used to assess mothers' dietary intakes. To evaluate adherence to the DASH diet among lactating mothers, we scored food items based on the Fung method.

RESULT

Lactating mothers in the highest tertile of adherence to the DASH diet consumed significantly lower amounts of fat, cholesterol, salt, red and process meats and higher amounts of vitamin C, B1, B9, whole grains, low-fat dairy, fruits, vegetables and dietary fiber compared to lactating mothers in the lowest tertile (P < 0.05). No significant association was found between mothers' adherence to the DASH dietary pattern and any of the infant growth indices (P > 0.05).

CONCLUSION

Lactating mothers' adherence to the DASH diet was not associated with growth indices among exclusively breastfed infants.

Investigating the association between infertility and psychological distress using Australian Longitudinal Study on Women's Health (ALSWH)

Infertility affects millions of people globally. Although an estimated 1 in 6 couples in Australia are unable to conceive without medical intervention, little is known about the mental health impacts of infertility. This study investigated how infertility impacts the mental health of women. The study used nationally representative Australian Longitudinal Study on Women's Health (ALSWH) data. We analysed data from survey periods 2-8 conducted every three years between 2000 and 2018 for 6582 women born in 1973-78. We used a Generalised Equation Modelling (GEE) method to investigate the association of primary, secondary and resolved fertility status and psychological distress over time. Multiple measures were used to measure psychological distress: the (1) the mental health index subscale of the 36-item short form survey (SF-36), (2) the Center for Epidemiological Studies Depression Scale (CESD-10), (3) the Goldberg Anxiety and Depression Scale (GADanx) anxiety subscale; and a (4) composite psychological distress variable. About a third (30%) of women reported infertility at any of the survey rounds; a steady increase over 18 years from 1.7% at round 2 to 19.3% at round 8. Half of the women reporting primary or secondary infertility reported psychological distress, with the odds of having psychological distress was higher in women reporting primary (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06-1.45), secondary (OR 1.27, 95% CI 1.10-1.46) or resolved infertility (OR 1.15, 95% CI 1.05-1.26) compared to women reporting normal fertility status. Women with partners, underweight or higher BMI, smoking, and high-risk alcohol use had higher odds of psychological distress, whereas women in paid work had significantly lower odds of psychological distress (p < 0.001). Diabetes, high blood pressure, asthma, and other chronic physical illness were independently associated with higher odds of psychological distress. Infertility has a significant impact on mental health even after it is resolved. Frequent mental health assessment and a holistic approach to address the lifestyle factors should be undertaken during the treatment of infertility.

Association between physical activity and infertility: a comprehensive systematic review and meta-analysis

Background

Physical activity (PA) may protect against infertility by modulating the hypothalamic-pituitary–gonadal axis, thereby reducing gonadotropin levels, elevating immune function, and inhibiting inflammation and circulating sex hormones. However, whether PA reduces the risk of infertility remains largely unknown. We therefore conducted a systematic review and meta-analysis to determine the preventive effects of PA on infertility.

Methods

We searched PubMed, Cochrane Library, EMBASE, and CINAHL databases to retrieve published epidemiologic studies on the relationship between PA and infertility. Following the PRISMA guidelines, we selected English literature publishedprior to 11 April 2022, and assessed study quality using the Newcastle–Ottawa Scale. Our protocol, including the full methods employed for this review, is available on PROSPERO (ID = CRD42020143344).

Results

Six cohort studies and four case–control studies based on 708,965 subjects and 12,580 cases were eventually screened and retained. High levels of PA were shown to reduced risk of infertility relative to low levels (cumulative relative risk [RR] = 0.59, with a 95% confidence interval CI 0.49–0.71), and we reported results for cohort studies (RR = 0.63, 95% CI 0.50–0.79) and case–control studies (RR = 0.49, 95% CI 0.35–0.67). Our findings were comparable for men (RR = 0.65, 95% CI 0.41–1.04) and women (RR = 0.56, 95% CI 0.47–0.66). The meta-analysis of six risk estimates from five studies of low, moderate, and high PA levels showed that moderate PA may also reduce the risk of infertility compared with low PA (RR = 0.54, 95% CI 0.38–0.77). However, high PA also appeared to slightly augment the risk of infertility compared with moderate PA (RR = 1.31, 95% CI 1.08–1.59).

Conclusions

This present systematic review comprehensively reflected an inverse relationship between different levels of PA and infertility, and our meta-analysis showed that a moderate-to-high PA level significantly reduced the overall risk of infertility, and that this level of PA activity was a common protective factor. In addition, limited evidence suggested that compliance with international PA guidelines would greatly lower the risk of infertility (RR = 0.58, 95% CI 0.45–0.74; I2 = 0.0%). Future studies, however, need to be executed to further determine the frequency, optimal dosage, and duration required to effectively attenuate the risk of infertility.

Secular changes in human reproduction and assisted reproductive technologies

Since the middle to late 20th century the majority of children born in the developing world have been likely to enter into post-reproductive age. Currently, child mortality is at its lowest level in human history. While more children are living to post reproductive age, approximately 15% of couples are experiencing infecundity. This is either a result of one or both members of the couple being infecund, or, despite both being fecund, the interaction between them prevents fertility for some reason. Assisted reproductive technologies have provided many infertile couples an opportunity to have children. Assisted reproductive technologies operate by intervening and manipulating gametic and intrauterine natural selection. This paper discusses the possible influence of assisted reproductive technologies on child development. This paper outlines some of the reported changes in children resulting from assisted reproductive technologies. Although, few people are either aware or care about possible long term consequences of relaxed natural selection contributed by medical intervention (i.e. assisted reproductive technologies) we have little understanding to what extent such medical interference may affect long term fitness in humans.

The association of types, intensities and frequencies of physical activity with primary infertility among females in Gaza Strip, Palestine: A case-control study

INTRODUCTION

Physical activity and energy state balance have fundamentally been related to reproductive system and health. This study explored the relationship between different types, intensities and frequencies of physical activity with primary infertility among women in Gaza Strip, Palestine.

METHODS

A case-control study was conducted in Gaza Strip with the participation of 320 married couples. 160 infertile couples were chosen from five fertility centers registries from 2016 to 2018 and matched residentially with 160 fertile couples. Cases were selected through systematic stratified sampling of five lists categorized according to residency and the determined percentage selected from each list was proportional. Data were collected through a self-administered questionnaire extended by the short form of international physical activity questionnaire and analyzed through SPSS program version 22 by using descriptive analysis, independent T-test, cross-tabulation, and binary logistic regression.

RESULTS

Low frequency, intensity and duration of physical activity were associated with 3.1 risk of primary infertility (95% CI, 1.60-5.99, P < 0.001). Adjustment for age, marital age, age of menarche, refugee status and monthly income provided 3.2 risk (95% CI, 1.55-6.60, P = 0.002). Women spending more than 300 minutes a day sedentarily were 2.3 times more likely to have fertility problems than physically active females. Measuring energy expenditure in MET-min/w (Metabolic Equivalent) showed vigorous MET-min/w as negatively associated with the infertility status of females (Interquartile range IQR: 480 for cases and 720 for controls, P = 0.010). On the basis of energy expended in kilocalories in relation to weight, results showed the same association (IQR: 564 for case and 864 for controls, P = 0.011). No associations were found between moderate activity levels and primary infertility.

CONCLUSION

Low levels of physical activity and sedentary lifestyle endanger the fertility status of females in Gaza Strip. This may offer the need for endorsing and formalizing adequate physical activity education and awareness protocols in the national reproductive health guidelines and empowering environmental capacity building to alter physical activity-related cultural norms.

Infertility and physical activity: A cross-sectional study of women living in Yazd aged 20-49 yr, 2014-2015

Background

Changes in the state of energy balance owing to changes in physical activity (PA) may affect the reproductive system.

Objective

the aim of this study was to assess the association between PA and infertility of women living in Yazd 2014 - 2015.

Materials and Methods

The study method was analytical cross-sectional on the Yazd Health Study (YaHS) data which was conducted on 10,000 people. We studied 2,611 women (20 and 49 yrs old), living in Greater Yazd area. PA information was collected using a physical activity questionnaire (IPAQ) short form. The standardized instruments were used for anthropometrics measurement.

Results

Totally 135 cases of infertility were documented. The overall prevalence of infertility was 4.73% (95% CI: 3.94-5.59%). The median of PA scores (METs) in women was 746.66 and 25-75% interquartile range was 361.25-1277.25. The relationship according to the Chi-square test between infertility and PA, as categorized variables, was significant (p = 0.015). It showed over 90% of those who suffered from infertility had a low or moderate PA.

Conclusion

The results of our study showed that there is a significant relationship between infertility and PA level in women living in Greater Yazd area. Also, women with infertility had lower activity levels, consistent with most previous studies.

Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990-2017: results from a global burden of disease study, 2017

To provide comprehensive estimates of the global, regional, and national burden of infertility from 1990 to 2017, using findings from a 2017 study on the global burden of disease (GBD), we assessed the burden of infertility in 195 countries and territories from 1990 to 2017. DisMod-MR 2.1 is a Bayesian meta-regression method that estimates non-fatal outcomes using sparse and heterogeneous epidemiological data. Globally, the age-standardized prevalence rate of infertility increased by 0.370% per year for females and 0.291% per year for males from 1990 to 2017. Additionally, age-standardized disability-adjusted life-years (DALYs) of infertility increased by 0.396% per year for females and 0.293% per year for males during the observational period. An increasing trend to these burden estimates was observed throughout the all socio-demographic index (SDI) countries. Interestingly, we found that high SDI countries had the lowest level of prevalence and DALYs in both genders. However, the largest increasing trend was observed in high-SDI countries for females. By contrast, low-SDI countries had the largest increasing trend in males. Negative associations were observed between these burden estimates and the SDI level. The global disease burden of infertility has been increasing throughout the period from 1990 to 2017.

Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women

BACKGROUND

Physical activity (PA) and sedentary behavior have inconsistent effects on fertility. High body mass index is associated with infertility but to our knowledge, very few studies have explored body composition in association to fertility.

OBJECTIVE

To assess the association between physical inactivity, sedentary behavior, body composition and idiopathic infertility in French men and women.

DESIGN

We conducted a case-control multicentric observational study. 159 infertile (79 men and 80 women) and 143 fertile (72 men and 71 women) were recorded in four fertility centers.

MAIN OUTCOME MEASURES

Participants completed self-administered questionnaires on sociodemographic and lifestyle characteristics, dietary intake, physical activity and sedentary behavior. Anthropometrics were measured, and bioelectrical impedance analysis was used to estimate body composition. Multivariable logistic regression was used to analyze the association of fertility with PA level and sedentary behavior.

RESULTS

In men, being physically inactive (Odd ratio [OR] 2.20; 95% confidence interval [CI], 1.06, 4.58) and having fat mass greater than the reference values for their age (OR 2.83; 95%CI, 1.31, 6.10) were positively associated with infertility. Sedentary behavior and fat-free mass were not related to infertility in men. In women, sedentary behavior (OR 3.61; 95%CI, 1.58, 8.24), high body fat (OR 3.16; 95%CI, 1.36, 7.37) and low fat-free mass (OR 2.65; 95%CI, 1.10, 6.37) were associated with infertility. PA level was not associated with fertility in women.

CONCLUSIONS

This study suggests that sedentary behavior and physical inactivity would represent two independent risk factors associated with infertility. The various elements that make up physical activity (frequency, intensity, time, and type of exercise) and the interrupting time spent sitting should be considered. Body composition variation should be explored further in relation to the biological pathways involved in idiopathic infertility. Moreover, the improvement of lifestyle factors should be considered in infertility treatment.

A prospective study of physical activity and fecundability in women with a history of pregnancy loss

STUDY QUESTION

Is physical activity (PA) associated with fecundability in women with a history of prior pregnancy loss?

SUMMARY ANSWER

Higher fecundability was related to walking among overweight/obese women and to vigorous PA in women overall.

WHAT IS KNOWN ALREADY

PA may influence fecundability through altered endocrine function. Studies evaluating this association have primarily utilized Internet-based recruitment and self-report for pregnancy assessment and have yielded conflicting results.

STUDY DESIGN, SIZE, DURATION

This is a secondary analysis of the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial (2007-2011), a multisite, randomized controlled trial of preconception-initiated low-dose aspirin.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Healthy women (n = 1214), aged 18-40 and with 1-2 prior pregnancy losses, were recruited from four US medical centers. Participants were followed for up to six menstrual cycles while attempting pregnancy and through pregnancy for those who became pregnant. Time to hCG detected pregnancy was assessed using discrete-time Cox proportional hazard models to estimate fecundability odds ratios (FOR) adjusted for covariates, accounting for left truncation and right censoring.

MAIN RESULTS AND THE ROLE OF CHANCE

The association of walking with fecundability varied significantly by BMI (P-interaction = 0.01). Among overweight/obese women, walking ≥10 min at a time was related to improved fecundability (FOR = 1.82, 95% CI: 1.19, 2.77). In adjusted models, women reporting >4 h/wk of vigorous activity had significantly higher fecundability (FOR = 1.69, 95% CI: 1.24, 2.31) compared to no vigorous activity. Associations of vigorous activity with fecundability were not significantly different by BMI (P-interaction = 0.9). Moderate activity, sitting, and International Physical Activity Questionnaire (IPAQ) categories were not associated with fecundability overall or in BMI-stratified analyses.

LIMITATIONS, REASONS FOR CAUTION

Some misclassification of PA levels as determined by the short form of the IPAQ is likely to have occurred, and may have led to non-differential misclassification of exposure in our study. Information on diet and change in BMI was not collected and may have contributed to some residual confounding in our results. The generalizability of our results may be limited as our population consisted of women with a history of one or two pregnancy losses.

WIDER IMPLICATIONS OF THE FINDINGS

These findings provide positive evidence for the benefits of PA in women attempting pregnancy, especially for walking among those with higher BMI. Further study is necessary to clarify possible mechanisms through which walking and vigorous activity might affect time-to-pregnancy.

STUDY FUNDING/COMPETING INTEREST(S)

This work was funded by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors report no conflicts of interest in this work.

TRIAL REGISTRATION NUMBER

#NCT00467363.

Prevalence of Infertility Among Patients With Isthmocele and Fertility Outcome After Isthmocele Surgical Treatment: A Retrospective Study

Background: An isthmocele is a diverticulum on the anterior wall of the uterine isthmus at the site of a cesarean delivery scar. We evaluated the prevalence of infertility among patients with isthmocele, the resolution of symptoms, and infertility outcomes after hysteroscopic isthmoplasty. Methods: We conducted a retrospective study of 35 consecutive patients with symptomatic isthmocele between 2010 and 2015 at Hospital Piero Palagi in Florence, Italy. Patients with symptomatic isthmocele had postmenstrual abnormal uterine bleeding, sovrapubic pain, and infertility. Results: The study population was divided into Group A - Fertile Patients (n=19) and Group B - Infertile Patients (n=16) according to the prevalence of infertility after the diagnosis of isthmocele. Group B was subdivided into Group B1 (became pregnant, n=9) and B2 (did not become pregnant, n=7) according to infertility resolution after isthmocele treatment. We found statistically significant differences between Groups A and B regarding the number of cesarean sections (P=0.0205), the grade of isthmocele (P=0.0421), and body mass index (P=0.0001). In the subgroup analysis, we found statistically significant differences between Groups B1 and B2 for age (P=0.0151), grade of isthmocele (P=0.0361), and cervical dilatation (P=0.0293). Conclusion: We identified a subgroup of patients at higher risk of being infertile after the diagnosis of isthmocele and a subgroup of patients who could benefit the most in terms of fertility after minimally invasive hysteroscopic surgery.

The prevalence of infertility in 20-49 years women in Yazd, 2014-2015: A cross-sectional study

BACKGROUND

Infertility is a serious health problem that affects the individual, her/his family, and the community. Infertility is defined as failure to achieve clinical pregnancy after at least 12 months of unprotected coitus.

OBJECTIVE

The purpose of this study was to investigate the prevalence of primary and secondary infertility and the associated factors in Yazd Greater Area during 2014-2015.

MATERIALS AND METHODS

This is a cross-sectional analytic study using Yazd Health Study data which was conducted on 10,000 people. We studied 2611 women between 20-49 yr old who lived in Yazd Greater Area. Data were collected using a validated questionnaire. Anthropometrics were collected using standardized instruments.

RESULTS

Among women participating in the study, 135 cases of infertility were documented and the overall prevalence of infertility was 4.73% (95% CI: 3.94%-5.59%), among them 2.6% (95% CI: 2.4-3.8%) had primary and 2.1% (95% CI: 1.8-3.4%) had secondary infertility. In this study, infertility was significantly correlated with age (r=0.051, p=0.032), educational level (r=-0.41, p=0.001), body mass index (r=-0.012, p=0.018), waist circumference (r=0.027, p=0.022), history of abortion (r=0.099, p=0.026), and family history of infertility (r=0.121, p=0.001).

CONCLUSION

The results of our study showed that the prevalence of infertility among women living in Yazd was lower compared to the other regions in Iran. Female factors were the main cause of infertility in central part of Iran.

Identification of toxic metals in human embryonic tissues

INTRODUCTION

The cause of a significant number of miscarriages remains unexplained. There is a need to identify the potential role of environmental, dietary and lifestyle factors in the risk of pregnancy loss. The present study was the first to investigate the content of miscarried embryonic material with respect to eight metals (aluminium, cadmium, chromium, copper, manganese, nickel, lead and zinc).

MATERIAL AND METHODS

Embryonic tissue samples (n = 20) were obtained from women undergoing misoprostol-induced removal of the embryo between the 6^th and 9^th week of gestation. The content of metals was analyzed using microwave-induced nitrogen plasma atomic emission spectrometry. Based on a short questionnaire, the smoking habits, dietary patterns and place of living of the investigated women were determined.

RESULTS

The general mean content of metals (μg/g) decreased in the order copper (33.9) > manganese (24.7) > chromium (13.6) > zinc (13.3) > aluminium (6.5) > nickel (3.0) > lead (2.9) > cadmium (2.5). Profoundly increased concentrations (p < 0.05) of the toxic elements aluminium (over 5-fold), cadmium (over 2-fold) and lead (over 2-fold) were observed in samples obtained from former smoking women. The miscarried material in urban populations also revealed higher levels of cadmium (over 1.5-fold) and lead (over 2-fold) compared to that obtained from women living in rural areas (p < 0.05). No associations with age or diet were found (p > 0.05).

CONCLUSIONS

This study identified increased levels of aluminum, cadmium and lead in miscarried embryonic material and suggests some causative factors.

The role of lysosomes in the phenomenon of concentration of aluminum and indium in the female reproductive system. An ultrastructural study

The female reproductive system is one of the most complex systems in the body taking into account the hormonal fluctuations associated with ovarian and uterine menstrual cycles. The purpose of this work was to study the impact of aluminum nitrate and indium sulfate on the uterus and the ovary of a pregnant rat. The experiment was performed on adult female rats of Wistar strain weighing approximately 250g. The Transmission Electron Microscopy (TEM) showed the presence of electron-dense material in lysosomes of both uterine cells (myometrium and endometrium cells) and in the cells of the ovary (internal theca and granulosa cells). In addition to the presence of aluminum and indium deposits in the uterine and ovarian tissue, impaired endoplasmic reticulum, mitochondria and vacuolation were also identified. We concluded that lysosomes of uterus and ovary cells had the function to extract aluminum and indium introduced into the body in a soluble form. Then, the two elements were sequestrated within these organelles in an insoluble form most probably as phosphate salts such as reported for other kind of cells; kidney, liver, bone morrow Berry, 1996 [1]. This mechanism seems to be a defense one in which the lysosome would play a central role. Our results concerning the impact of the aluminum or indium presence in the lysosome of female reproductive system will be further used in order to assess their effects on the fertility and viability of oocytes in the pregnant treated rats.

Superfertility is more prevalent in obese women with recurrent early pregnancy miscarriage

OBJECTIVE

To investigate the effects of obesity on superfertility.

DESIGN

Retrospective observational study.

SETTING

A tertiary referral implantation clinic.

POPULATION

Four hundred and fourteen women attending a tertiary implantation clinic with a history of recurrent miscarriage (RMC), over a 4-year period.

METHODS

Pattern of pregnancy loss and time to pregnancy intervals for each pregnancy were collected by medical staff from women with RMC. The women were categorised into normal, overweight and obese according to their body mass index (BMI). Kaplan-Meier curves were constructed estimating the cumulative probability of a spontaneous pregnancy over time. The pregnancy loss patterns were correlated with BMI and data were compared between the categories using the Kruskal-Wallis test.

MAIN OUTCOME MEASURES

Pregnancy loss pattern and time to pregnancy intervals.

RESULTS

Overall, 23.2, 51.4 and 64.2% of women conceived within first 1, 3 and 6 months, respectively. Obese women had cumulative pregnancy rates of 65.2 and 80% by three and 6 months, respectively, which was more than the cumulative pregnancy rates for women with normal BMI (49.2 and 65.8%). Comparison of survival curves indicated a significant difference in time to conceive for obese when compared with normal and overweight women (*P = 0.01), suggesting a higher prevalence of superfertility in obese women with RMC.

CONCLUSIONS

Our findings suggest that obese women may have a greater efficacy to achieve pregnancy, but with an increased risk of miscarriage, which may suggest the possible metabolic effects of obesity on endometrium.

Prevalence and Risk Factors of Infertility at a Rural Site of Northern China

Objective

To investigate and analyze prevalence and risk factors of infertility at a representative rural site of Northern China.

Method

This is a cross-sectional study. We conducted a face-to-face questionnaire survey from July 2014 to October 2014 involving 5,131 women who were at childbearing age in Suizhong, a medium-sized, representative county located in Northern China. Finally, data from 4,232 valid questionnaires were analyzed.

Definition

Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regularly unprotected sexual intercourse.

Results

Infertility prevalence in Suizhong County was 13.09% (95% CI, 12.09%-14.1%), of which the primary infertility incidence was 0.99% (95% CI, 0.72%-1.34%), and the secondary infertility incidence was 12.10% (95% CI, 11.13%-13.12%). For women, the infertility incidence of underweight women (Body Mass Index, BMI<18.5 kg/m²) was 1.5-fold higher than that of women with moderate BMI (18.5–24.9 kg/m²). The infertility incidence of women with little exercise was 4 times more than that of women with regular exercise, and 2 times more than that of women with heavy exercise. The group with moderate menstrual flow had the lowest prevalence of infertility, while both scant and excessive menstruation led to increased infertility incidence. Number of pregnancies (OR = 0.63; 95% CI, 0.51–0.79) was a protective factor for infertility, while the number of abortions (OR = 2.15; 95% CI, 1.58–2.93) was a risk factor for infertility. For men, those who stayed up late at night more than 3 times per week showed a significantly higher infertility incidence. Men who engaged in occupations with high-temperature working environment also suffered from an infertility incidence of about four times more than the others.

Conclusions

We found significant association between women's infertility incidence with their BMI, state of exercise, amount of menstrual flow, number of pregnancies and number of abortions. As for men, both staying up late and engaging in high-temperature occupations are independent factors affecting their fertility.

Comparison of lifestyle in fertile and infertile couples in Kermanshah during 2013

BACKGROUND

Infertility is a major reproductive health in gynecology. According to the world health organization, there are currently 50-80 million infertile couples in the world.

OBJECTIVE

Considering the critical effects of lifestyle on reproductive health, this study aimed to compare the lifestyle of fertile and infertile couples in Kermanshah during 2013.

MATERIALS AND METHODS

This research is a descriptive cross sectional study that was done on 216 fertile and infertile couples attending Infertility Center and six medical centers that were selected through the convenience sampling. Data were collected using a researcher-made questionnaire containing demographic and fertility-related information and also lifestyle items on nutrition, physical activity, perceived social support, responsibility for health, and inappropriate health behaviors. Descriptive statistics, logistic regression analysis, independent t, chi-square and Generalized Estimating equation were performed to analyze the data.

RESULTS

Fertile and infertile women (86.1% and 73. 1% respectively, p= 0. 03) as well as fertile and infertile men were significantly different in terms of physical activity (87% and 96.3% p<0.001, respectively) and perceived social support (p<0.001). Moreover, there was a significant difference between fertile and infertile women in nutrition (p<0.001). Similar differences were observed in responsibility for health and inappropriate health behaviors between fertile and infertile men. However, all of the dimensions of lifestyle, except nutrition, were significantly different between fertile and infertile couples.

CONCLUSION

As lifestyle plays a crucial role in reproductive health, the inappropriate lifestyle of infertile couples has to be modified through effective measures such as awareness promotion, behavioral changes, and development of a healthy environment.

Health-promoting Lifestyle and its Demographic Predictors in Infertile Couples Referred to Infertility Clinic of Tabriz Al-Zahra Hospital, 2013

INTRODUCTION

Improving the lifestyle of infertile couples led to the preservation of their performance, increase their quality of life, and reduce health cost. So, the aims of this study were to determine the health-promoting lifestyle and its predictors among infertile couples.

METHODS

In a cross-sectional, analytical study 322 infertile couples referred to an infertility clinic in Tabriz was participated with convenience sampling method. The demographic and the standard Health Promoting Lifestyle-II (HPLP II) questionnaires were completed by all couples individually. For determining the demographic predictors of health-promoting lifestyle, the multivariate linear regression was used.

RESULTS

The mean (standard deviation) score of health-promoting lifestyle in couples was 2.4 (0.4) of the achievable score ranged from 1 to 4. The highest mean score was for nutrition subscale 2.6 (0.5) in both men and women and the lowest mean score was for physical activity subscale in women 2.1(0.5) and men 2.3(0.5) and health responsibility subscale (2.3(0.5) in both men and women. Educational level, cause of infertility, adequacy of income for living expense, and living situation were predictors of health-promoting lifestyle.

CONCLUSION

The results showed that participants do not carry out all health-promoting behaviors, especially physical activity and health responsibility, in an acceptable level. These behaviors have an important role in improving the quality of life, health maintenance, and fertility. Thus, the provision of strategies, including those in accordance with predictors of health-promoting behaviors, is important for improving the health status of infertile couples.

Effects of sub-chronic aluminum chloride exposure on rat ovaries

AIMS

This experiment investigated the effects of sub-chronic aluminum chloride (AlCl3) exposure on rat ovaries.

MAIN METHODS

Eighty female Wistar (5weeks old) rats, weighed 110-120g, were randomly divided into four treatment groups: control group (CG), low-dose group (LG, 64mg/kg BW AlCl3), mid-dose group (MG, 128mg/kg BW AlCl3) and high-dose group (HG, 256mg/kg BW AlCl3). The AlCl3 was administered in drinking water for 120days. The ovarian ultrastructure was observed. The activities of acid phosphatase (ACP), alkaline phosphatase (ALP), succinate dehydrogenase (SDH), Na(+)-K(+)-ATPase, Mg(2+)-ATPase and Ca(2+)-ATPase, the contents of Fe, Cu and Zn, and the protein expression of follicle-stimulating hormone receptor (FSHR) and luteinizing hormone receptor (LHR) in the ovary were determined.

KEY FINDINGS

The results showed that the structure of the ovary was disrupted, the activities of ALP, ACP, SDH, Na(+)-K(+)-ATPase, Mg(2+)-ATPase and Ca(2+)-ATPase, the contents of Zn, Fe and the protein expression of FSHR and LHR were lowered, and the content of Cu was increased in AlCl3-treated rats than those in control.

SIGNIFICANCE

The results indicate that sub-chronic AlCl3 exposure caused the damage of the ovarian structure, the disturbed metabolism of Fe, Zn and Cu and the decreased activities of Na(+)-K(+)-ATPase, Mg(2+)-ATPase and Ca(2+)-ATPase in the ovary, which could result in suppressed energy supply in the ovary. A combination of suppression of energy supply and reduction of expression of FSHR and LHR could inhibit ovulation and corpus luteum development, leading to infertility in female rats.