The Prevalence and Causes of Primary Infertility in Iran: A Population-Based Study

Royal jelly a promising therapeutic intervention and functional food supplement: A systematic review

Royal jelly (RJ), a secretion produced by honeybees, has garnered significant interest for its potential as a therapeutic intervention and functional food supplement. This systematic review aims to synthesize current research on the health benefits, bioactive components, and mechanisms of action of RJ. Comprehensive literature searches were conducted across multiple databases, including PubMed, Scopus, and Web of Science, focusing on studies published from 2000 to 2024 (April). Findings indicate that RJ exhibits a wide range of pharmacological activities, including anti-inflammatory, antioxidant, antimicrobial, and anti-aging effects. Beneficial biological properties of RJ might be due to the presence of flavonoids proteins, peptides, fatty acids. Both preclinical and clinical studies have reported that RJ improves the immune function such as wound healing, and also decreases the severity of chronic diseases including diabetes and cardiovascular disorders. The molecular mechanisms underlying these effects involve modulation of signalling pathways such as NF-κB, MAPK, and AMPK. Despite promising results, the review identifies several gaps in the current knowledge, including the need for standardized dosing regimens and long-term safety assessments. Furthermore, variations in RJ composition due to geographic and botanical factors necessitate more rigorous quality control measures. This review underscores the potential of RJ as a multifunctional therapeutic agent and highlights the necessity for further well designed studies to fully elucidate its health benefits and optimize its use as a functional food supplement.

Does insulin-like growth factor-I level associate with pregnancy outcomes in primary and secondary infertile women undergoing in vitro fertilization? A prospective cohort study

BACKGROUND

Infertility, which affects 8%-12% of couples worldwide and 21.9% of couples in Pakistan in particular, is a major reproductive health issue. In vitro fertilization (IVF) has emerged as a prevalent therapeutic intervention. Recent studies have identified insulin-like growth factor-I (IGF-I) as a promising biomarker for assessing embryo viability and predicting implantation outcomes in IVF procedures.

Downward trend in male reproductive health and fertility in Eastern Iran

This study aimed to assess the ten-year trend in semen quality among couples referred to the Infertility Center in Kerman between 2008 and 2017. The study included 2952 semen samples from men 18 to 60 years old referred to the infertility center as infertile couples living in Kerman province, Iran, whether they had normal or abnormal semen analysis. A total of 2952 sperm samples were included. Statistically significant changes were observed in semen parameters. Particularly, significant changes were observed for volume (-0.08 mL/year), sperm concentration (-2.34 (mio/mL)/year), total sperm count (-13.17 (mio/ejaculate)/year), progressive motility (-2.62%/year), non-progressive motility (-0.59%/year), immotile sperm (2.49%/year), and normal morphology (-0.134%/year). In bivariate analysis, the prevalence of oligozoospermia in this study showed a statistically significant association with age (OR = 1.019; 95% CI = 1.007-1.032; p = 0.003). Likewise, there was a statistically significant association with the year (OR = 1.087; 95% CI = 1.050-1.125; p = 0.000). Semen quality parameters showed a downtrend during the last 10 years in this study, emphasizing the importance of male reproductive health monitoring and warning public health coordinators to pay more attention to this important issue.

Effect of alternative and complementary medicine on male infertility: An umbrella review

Background and Aims

There is increasing interest worldwide in using alternative and complementary approaches for treating male infertility. This interest has spawned a multitude of published systematic reviews and meta-analyses. The aim of this Umbrella review was to consolidate the available evidence regarding the effect of complementary and alternative medicine on male infertility to inform clinical decision-making processes.

Methods

A comprehensive search was conducted to identify systematic reviews and meta-analyses pertaining to the effects of complementary and alternative medicine on male infertility. This search encompassed various databases including MEDLINE, CINAHL, PubMed, Scopus, Proquest, Google Scholar, SID, EMBASE, Magiran, Cochrane Library, Iranmedex, ScienceDirect, SAGE. Subsequently, two researchers independently extracted the data from the selected meta-analyses and systematic reviews, and evaluated their methodological quality using the assessment of multiple systematic reviews 2 (AMSTAR2).

Results

This analysis encompassed 11 studies, with four originating from Iran, two from Korea and five from China. The results regarding the effectiveness of complementary and alternative medicine are controversial, indicating a need for further research. The methodological quality of the systematic reviews and meta-analyses appraised by AMSTAR 2 was rated as low or critically low. This assessment is attributed to inadequate examination of publication biases in the reviews and a lack of discussion regarding the effect of risk of bias.

Conclusion

The existing evidence regarding the effectiveness of alternative and complementary medicine in addressing male infertility is limited. Furthermore, the overall methodological quality of the published systematic reviews and meta-analyses may have been underestimated as the use of AMSTAR2 appears to be a more precise appraisal instrument compared to its predecessor.

The effect of L-carnitine on oocyte mitochondrial health and biomarkers on cyclophosphamide chemotherapy drug in mice

Improving oocyte competence during chemotherapy is widely known as a contributing factor to increasing the probability of fertility. Additionally, the role of cumulus cells in oocyte quality is of utmost importance. Therefore, this study was designed to simultaneously probe into the relative gene expression of oocytes and cumulus cells as biomarkers of oocyte quality with cyclophosphamide and L-carnitine treatment. A total of 60 adult NMRI mice were divided into four groups: control, L-carnitine (LC), cyclophosphamide (CP), and cyclophosphamide+L-carnitine (CP+LC). The relative mRNA expression levels of oocyte quality genes including growth differentiation factor 9 (Gdf9), hyaluronan synthase 2 (Has2), and mitochondrial sirtuin 3 (Sirt3) in oocytes, and genes involved in bilateral communication between cumulus cells and between the oocyte and its neighboring cumulus cells including connexin 37 (Cx37) and connexin 43 (Cx43) were detected by Real-time-PCR. DCFH-DA staining analyzed the level of intracellular ROS in oocytes. Under the influence of L-carnitine, Gdf9, Has2, Cx43, and Cx37 were significantly up-regulated (p ≤ 0.05). However, cyclophosphamide considerably reduced the expression of all these genes (p ≤ 0.05). The expression of the Sirt3 gene in the CP group increased significantly compared to the other groups (p ≤ 0.05). Analysis of fluorescent images revealed that the level of intracellular ROS in the cyclophosphamide group was significantly increased compared to the other groups (p ≤ 0.05), while it plummeted in the L-carnitine group (p ≤ 0.05). L-carnitine as an antioxidant can reduce the destructive effects of cyclophosphamide and enhance bilateral communications between oocytes and cumulus cells, and it may ultimately lead to an increase in the fertility rate.

Relationship between long non-coding RNA MALAT1 and HOTAIR expression with sperm parameters, DNA and malondialdehyde levels in male infertility

BACKGROUND

Sperm quality is a complex index used to evaluate the fertility potential of men. The long non-coding RNA (lncRNA) MALAT1 participate in sperm development and HOTAIR have critical roles in the regulation of oxidative stress responses. This study aimed to evaluate the relationship of lncRNA MALAT1 and HOTAIR expression with sperm parameters, DNA fragmentation and malondialdehyde (MDA)levels in sperm fertility.

METHODS

In this experimental study, semen samples (n = 30 fertile, n = 30 infertile) men were collected and evaluated for sperm parameters by computer-aided sperm analysis(CASA). Sperm DNA integrity quality was assessed by the Acridine orange(AO) test. MDA levels were determined by the Thiobarbituric acid reaction method. The expression of MALAT1 and HOTAIR was detected by RT-PCR.

RESULTS

We observed a decreased level of MALAT1and HOTAIR expression in the infertile men (p < 0.001). The relative expression level of MALAT1and HOTAIR showed a positive correlation with motility and morphology (p < 0.001). Subsequently, we found the DNA damage and MDA levels was negatively correlated with expression level of genes of sperm (p < 0.001).

CONCLUSION

In this study the low expression of MALATI and HOTAIR resulted in the high level of MDA, DNA damage, and reduced motility of sperm. This study suggests the therapeutic opportunities in respect to MALATI and HOTAIR expression in the sperm function.

The relationship between microbial contaminations of embryo transfer catheters with pregnancy outcome after embryo transfer

Background

Different stages of assisted reproductive technologies are susceptible to contamination by various microorganisms.

Objective

The aim of the study was to investigate the relationship between microbial contamination of embryo transfer catheters and the pregnancy outcome after embryo transfer.

Methods

This cohort study was conducted on 60 patients candied for in vitro fertilization and embryo transfer cycles from 2021 to 2022. All embryos were transferred using a sterile syringe. The catheter contamination was checked by the microbial culture method, and in the case of microbial culture that were negative, polymerase chain reaction was done to confirm the result. The data analyzed using STATA 17 to determine the impact of catheter contamination on the clinical pregnancy rate.

Results

The average age of peoples whose microbial culture was positive was lower than that of people whose microbial culture was negative (P<0.05). Also the results showed that people who live in villages have more positive microbial cultures than people who live in cities (P<0.05). Also there is no difference between the number of successful implantations and the pregnancy outcome between people whose microbial culture results were positive or negative.

Conclusion

The results of the current study showed that the contamination of the embryo transfer catheter with microorganisms under our investigation did not affect the pregnancy outcome.

Patients' perception about polycystic ovarian syndrome (PCOS) in Sub-Himalayan region of India-A facility-based cross-sectional study

Background

In modern times, metabolic disorders are most common and one of them is polycystic ovarian syndrome (PCOS) in women, which causes high morbidity and complications. PCOS has largely been a neglected and less researched area; however, it is gaining importance in recent times as PCOS is increasing as well as it can be prevented to a considerable extent.

Methods

A cross-sectional study was conducted to assess knowledge among females in government hospitals in Northern India. Data were collected using a pretested structured questionnaire on 300 women (completed 270), selected by proportionate sampling technique, and admitted in government hospitals. Data were analyzed by SPSS version 23.

Results

The results showed that the mean age of respondents was 33.02 ± 9.039 years, the mean age at menarche was 12.33 ± 2.13 years, and the mean of gravida status was 1.82 ± 0.78 years. Only half of the respondents had good knowledge about PCOS.

Conclusion

This study suggests that efforts are needed to reinforce women's knowledge through setting-based awareness campaigns and health education in this context to enable them to identify and seek timely treatment and improve their quality of life.

Interventions promoting mental health dimensions in infertile women: a systematic review

BACKGROUND

Scientific developments have brought hope to infertile couples; however, the results are not always favorable. This makes women suffer psychological pressure. Therefore, previous studies have investigated the effectiveness of many psychological interventions but no research identified the most common psychological interventions. In this regard, the present review aimed to investigate different psychological interventions that promote mental health in infertile to identify the most frequent (common) ones.

METHODS

In the present study, the search was carried out using appropriate keywords Infertility, psychological interventions, mental health, stress, anxiety, depression and women in the Google Scholar، Magiran، SID، Pubmed، Scopus، Science Direct، ProQuest، Web of Science databases and One of the leading websites in health- WHO with Persian and English languages and two operators of "AND" and "OR" between 2000 and 2021.

RESULTS

First, 7319 articles were searched, 6948 articles of which were removed due to irrelevant subjects, and 31 articles were removed due to duplication. 340 abstracts were examined and the results of 60 articles were extracted. Two approaches (examining the type and content of intervention) were used to extract findings. The first approach indicated high diversity in psychological interventions, leading to the categorization of the interventions into 4 categories of cognitive behavioral therapy (CBT), mind-body interventions (MBI), stress management skills, and others. CBT and MBI and stress management skills were found as the most frequent promoting interventions for mental health in infertile women. The second approach indicated the differences in protocols (number of sessions and time of interventions).

CONCLUSION

Despite differences in protocol of interventions under study, the results of all articles revealed the effectiveness of interventions in improving infertile women's mental health; therefore, it is suggested to apply the most common psychological interventions based on scientific evidence (CBT, MBI, and stress management skills) along with infertility treatment methods. The results will help the specialists, policy-makers, and planners to select and implement the most appropriate psychological interventions for infertile women.

High incidence of AZF duplications in clan-structured Iranian populations detected through Y chromosome sequencing read depth analysis

The ampliconic region of the human Y chromosome consists of large duplicated sequences that can undergo non-allelic homologous recombination (NAHR), resulting in structural rearrangements that may cause infertility, especially when they occur in the azoospermia factor b/c (AZFb/c) region. Although AZF duplications have long been neglected due to the technical limitations of STS-based studies that focused mainly on deletions, recent next generation sequencing (NGS) technologies provided evidence for their importance in fertility. In this study, a NGS read depth approach was used to detect AZFb/c rearrangements in 87 Iranians from different ethnic groups. The duplication frequency in Iran proved to be twice as high as in the "1000 Genomes" dataset. Interestingly, most duplications were found in patrilineal ethnic groups, possibly as a consequence of their lower male effective population size which can counteract negative selection. Moreover, we found a large 8.0 Mb duplication, resulting in a fourfold increase in the copy number of AZFc genes, which to our knowledge is the largest duplication ever reported in this region. Overall, our results suggest that it is important to consider not only AZF deletions but also duplications to investigate the causes of male infertility, especially in patrilineal clan-based populations.

Association between dietary inflammatory index and infertility of women; Results from RaNCD Cohort Study

BACKGROUND

In recent decades, more and more attention has been paid to the influence of nutrition on reproductive health. Nevertheless, the imminent association between diet-related inflammation and the risk of infertility has not yet been established. The aim of the current study was to investigate the ability of the Dietary Inflammatory Index (DII) to estimate infertility incidence in women.

METHODS

This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 4437 participants. The DII was calculated based on the reported consumption of up to 31 food parameters measured via a validated and reproducible 118-item food-frequency questionnaire (FFQ). Multiple logistic regression analysis was applied to estimate the multivariable odds ratio (OR) adjusted for potential confounding variables.

RESULTS

Out of all participants, 411 women (9.26%) were infertile. The mean ± SD age and weight of infertile women were 43.67 ± 7.47 years and 72.86 ± 13.02 kg, respectively. Statistical analyses showed the odds ratio of infertility in the fourth quartile (pro-inflammatory diet) was 1.76 times higher than in the first quartile (anti-inflammatory diet) of DII (95% CI: 1.57-2.02).

CONCLUSIONS

The findings of this study provide compelling evidence about the association between infertility and the quality of diet in women. Therefore, interventions and programs aimed at promoting a healthy lifestyle and using healthy diets can be considered as one of the effective approaches in the prevention and treatment of infertility in women.

Spouse's coping strategies mediate the relationship between women's coping strategies and their psychological health among infertile couples

Social problems and suffering from the treatment process for infertile couples, especially for women, require the couples to cope with them to balance the infertility crisis. According to the close interactions of the couples with each other, the objective of the present study was to explore a theoretical framework for the relationships between women's coping strategies, spouses' coping strategies, and women's psychological health in infertile couples who were candidates for assisted reproductive technology (ART). This cross-sectional study was carried out on 212 couples undergoing ART. The couples' coping strategies were evaluated using a validated self-report questionnaire. The women's psychological health was assessed using a 21-item stress, anxiety, and depression scale (DASS-21). Statistical analysis was performed using the plug-in application PROCESS macro for SPSS. The direct effect of the women's self-blame and self-focused rumination strategies (p < .0001), and the indirect effect of the women's self-blame on stress and depression by mediating spouses' self-blame and self-focused rumination strategies, was significant. The indirect effect of the women's self-focused rumination on the anxiety and depression levels by mediating spouses' self-blame strategy was significant. The women's self-blame and self-focused rumination strategies had a negative effect on the women's psychological health who were undergoing ART. This negative effect was mediated by the spouse's coping strategies.

Self-reported Male Infertility and Metabolic Disturbance: A Cross-Sectional Study

Background

Male infertility is a growing health problem. It is proposed that infertility is associated with some metabolic abnormalities.

Objectives

This study aimed to examine the prevalence of self-reported male infertility and related metabolic disturbances.

Methods

This is a cross-sectional analysis of the Tehran Lipid and Glucose Study (TLGS). A total of 1526 males participated in the study. Logistic regression was used to examine metabolic factors associated with self-reported male infertility.

Results

The total prevalence of self-reported male infertility was 6.42%. The mean (SD) body mass index (BMI) of participants among fertile and infertile males was 26.80 (3.93) and 26.92 (4.36), respectively. The majority of participants in both groups were in the age group of 40-50 years old. In the fully adjusted model, the odds of infertility were significantly increased by each unit increase in total cholesterol [TC; odds ratio (OR), 1.01; 95% CI, 1.01 - 1.01; P = 0.03] and hip circumference (HC; OR, 1.06; 95% CI, 1.00 - 1.12; P = 0.02), respectively.

Conclusions

The prevalence of self-reported male infertility was 6.42%. Male infertility was positively associated with TC and HC, indicating that knowledge about these risks might assist health care professionals and governments in developing and executing measures to change the status quo.

A Meta-Analysis of The Prevalence and Etiology of Infertility in Iran

Infertility is a serious health issue in the world affecting approximately 8-10% of couples worldwide. The meta-analysis study was performed to assess the prevalence and etiologic factors associated with infertility in Iran. We made sure that the implementation of study and reporting the results were consistent with the MOOSE and PRISMA guidelines, respectively. All stages of the research were conducted by two authors, and the disagreement at each stage of the research was resolved by consensus. On January 1, 2020, we started a detailed literature search on international online databases, and Iranian Online databases, as well as specialized journals, several authentic international publishers and Google Scholar. We reviewed the reference list of identified articles for missed articles and then searched online for them. Data analysis was performed to estimate the prevalence using a random effects model. The lifetime infertility prevalence was found to be 11.3% [95% confidence interval (CI): 8.6-14.7] and the current infertility was evaluated to be 3.7% (95% CI: 3.2-4.3). The prevalence of primary infertility (based on 45 articles consisting of 51,021 samples) as well as secondary infertility (based on 13 articles consisting of 35,683 samples) in Iran were estimated to be 18.3% (95% CI: 15.4-21.6) and 2.5% (95% CI: 1.6-4.0), respectively. The prevalence of female, male, both and unexplained causes was estimated to be 32.0% (95% CI: 27.6-36.8), 43.3% (95% CI: 38.2-48.6), 12.5% (95% CI: 9.6-16.2) and 13.6% (95% CI: 10.2-17.8), respectively. The prevalence of causes related to ovulation, uterine tubes, and endometriosis in infertile women was estimated to be 54.0% (95% CI: 45.6-62.2), 15.5% (95% CI: 11.3-21.0), 6.2% (95% CI: 3.5-10.6), and 5.4% (95% CI: 2.5-11.3), respectively. In summary, the estimate of infertility burden in Iran did not change between 1990 and 2017 and its prevalence remains high. This research presents a unified and up-to-date overview regarding the burden of infertility in Iran.

Prevalence and distribution of causes of infertility according to women's age - a cross-sectional study in a tertiary healthcare hospital setup

OBJECTIVES

Infertility has disastrous consequences, particularly for women. Causes of infertility in developed countries have been investigated but there is a significant lack of data among Indian female population. The aim of the present study was to analyze the causes and the proportion of the individual factors contributing to infertility, considering the age factor.

METHODS

The data of 204 infertile women (18-45 years) were collected from the files in tertiary care hospitals. Causes and age of infertile women were grouped. The prevalence of each cause was evaluated. Data analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0.

RESULTS

Polycystic ovarian syndrome (PCOS) was the most common (14.71%) cause of female infertility. Ovulatory dysfunctions (25.55%) were the foremost cause in primary infertility, whereas in secondary infertility, uterine factors (26.86%) were most common. The incidence of primary and secondary infertility was more evident in patients who were more than 30 years of age.

CONCLUSIONS

Causes of infertility vary according to the age. The causes of female infertility were unexplained infertility, ovulatory disorders and uterine factors most commonly affecting women at ≤30 years.

Environmental and occupational factors and higher risk of couple infertility: a systematic review study

Background

Infertility is a global health problem that represents an increasing trend due to new lifestyles following technological advances since individuals are facing more risk factors than before. The present systematic review study aimed to investigate the impact of environmental and occupational factors on reproductive parameters and increased risk of couple infertility.

Main body

Scopus, PubMed, SID, and Web of Science databases were searched for the available observational (i.e., cohort, case-control, and cross-sectional) systematic review, meta-analysis, and clinical trial studies between 2007 and 2019. To this end, keywords such as ‘Environmental exposure’, ‘Occupational exposure’, ‘Environmental pollutants’, ‘Environmental pollution’, ‘Couple infertility’, ‘Sterility’, and ‘Sub-fertility’ were used. The retrieved investigations examined the impact of environmental and occupational risk factors on reproductive indices and increased infertility risk. Totally, 66 out of 9519 papers were evaluated after considering the inclusion and exclusion criteria. The reported risk factors in the reviewed studies were heavy metals, cigarette smoking, and exposure to chemicals through consumer goods, urban life, and proximity to main roads. In addition, occupational factors included heavy physical activity, prolonged sitting, exposure to a hot environment, contact with formaldehyde, pesticides, insecticides, mechanical vibration, and contact with ionizing radiation, all of which affected the reproductive parameters. However, some researchers found no significant associations in this regard.

Short conclusion

In general, individuals with known impairments in reproductive parameters were more exposed to risk factors. Nonetheless, more studies are needed to determine the risk of infertility in the population.

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Objective: The aim of the study was to explore the evidence of JWRJD in the treatment of cryptozoospermia.

Methods: A total of 162 cryptozoospermia patients with varicocele who refused to undergo surgery were included from January 2021 to December 2021. They were divided into the Jiawei Runjing Decoction group (group A), tamoxifen group (group B), and no treatment group (group C), and after the follow-up for 3 months, therapeutic effectiveness was compared. Network pharmacology was used to analyze and validate the effects and mechanisms of JWRJD.

Results: Fifty-eight patients were treated with JWRJD, 55 with tamoxifen, and 49 without any treatment. After treatment, five patients were lost: one in group A, one in group B, and three in group C. The sperm count and the decrease of FSH in group A were significantly higher, but the degree of decline in the testicular volume and the degree of vein expansion have decreased significantly, which were closely related to the testicular volume (TV) [especially changes in the left testicular volume (ΔL-TV)], citric acid (CC) and its changes (ΔCC), and the vein width (VW) [especially left spermatic vein width (L-VW) and mean vein width (M-VW) and their changes (ΔL-VW and ΔM-VW)], as well as the sperm count before the treatment (bSC), which were the significant indexes to predict the therapeutic effect, especially for patients >35 years old and with grade III varicoceles. Network pharmacological analysis verifies that it can be regulated by fluid shear stress and the atherosclerosis pathway to improve the testicular microenvironment for spermatogenesis.

Conclusion: JWRJD may promote spermatogenesis in cryptozoospermia patients with varicocele, which may be closely related to improving the testicular microenvironment, especially for >35 year olds and grade III varicocele patients.

Incidence and risk factors of infertility among couples who desire a first and second child in Shanghai, China: a facility-based prospective cohort study

BACKGROUND

With the implementation of the two-child policy in China, more couples have expressed the desire to have another child. We conducted this study to evaluate the incidence of infertility and risk factors in couples intending to have a first and second child.

METHODS

From 2013 to 2017, a prospective cohort study was conducted at the pre-pregnancy center of the International Peace Maternal and Child Health Hospital. The participants were selected by screening and random sampling couples who came to the pre-pregnancy center. Data regarding patient sociodemographic characteristics, reproductive and gynecological history, male disease history, and laboratory and imaging examination results were collected. Couples were followed up every 3 months until pregnancy or for 12 months, whichever came first. Multi-factor logistic regression was used to analyze risk factors for infertility. Adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors.

RESULTS

The overall infertility incidence was 16.95% (369/2177). The infertility incidence of "first child intention" and "second child intention" was 19.30% (355/1839) and 4.14% (14/338), respectively. This study found great differences in both infertility rate (P < 0.001) and risk factors between the two groups. Risk factors for "first child intention" infertility included advanced age (> 35 years) (aOR = 1.70, 95% CI 1.27-2.28), abnormal body mass index (BMI) (aOR = 1.58, 95% CI 1.31-6.26), longer menstrual periods (aOR = 4.47, 95% CI 2.25-8.88), endometrial polyps (aOR = 2.52, 95% CI 1.28-4.97), polycystic ovarian syndrome (PCOS) (aOR = 6.72, 95% CI 1.79-7.39), salpingostomy (aOR = 3.44, 95% CI 1.68-7.07), and history of mycoplasma (aOR = 1.54, 95% CI 1.09-2.40). However, in the "second child intention" group, clinical risk factors slightly differed and included leiomyoma (aOR = 5.60, 95% CI 1.06-29.76), and higher age (> 40 years) (aOR = 7.36, 95% CI 1.01-53.84).

CONCLUSION

The overall infertility rate in Shanghai is similar to that of other large cities in China. Marriage at advanced ages has become increasingly common. As such, the government must consider subsidies to encourage childbirth at childbearing ages, which can improve fertility levels.

Trying for a second chance: Iranian infertile couples' experiences after failed ART

INTRODUCTION

Despite significant advances, only 35% infertile couples conceive after ART. If IVF is unsuccessful, couples will need to decide whether to proceed again with assisted conception. The aim of this study was to explore Iranian infertile couples' experiences after failed ART to continue treatment.

METHODS

In this qualitative study participants were selected using purposeful sampling method. Data were collected using 29 semi-structured face-to-face in-depth interviews at a regional Infertility Center from April 2016 to June 2017. All interviews were recorded, transcribed verbatim, and analyzed with conventional content analysis method using MAXQDA software.

RESULTS

Our findings suggest that couples' decisions to continue treatment after unsuccessful ART is shaped by their social, emotional and financial circumstances. We have constructed two themes to describe their experiences: support to continue and trying for a second chance.

CONCLUSION

Our findings suggest that good marital and family support networks can support infertile couples during this period of decision making. Considering the depression and anxiety caused by failed ARTs, which itself could affect the success rate of any further ARTs, the clinical team should effectively assess psychological readiness of couples who decide to continue with another ART after unsuccessful treatment.

The Dose-Related Efficacy of Acupuncture on Endometrial Receptivity in Infertile Women: A Systematic Review and Meta-Analysis

Background

Progress has been achieved by using acupuncture widely for poor endometrial receptivity (PER). However, different acupuncture dosages may lead to controversy over efficacy.

Objective

To evaluate the evidence-based conclusions of dose-related acupuncture on infertile women with PER.

Method

References were retrieved from nine databases from inception to 26 February 2022. This meta-analysis included randomized controlled trials (RCTs) that investigated the dose-related efficacy of acupuncture for PER with outcomes of endometrium receptivity (ER) parameters by transvaginal sonography (TVS) and the subsequent pregnancy outcomes in three acupuncture-dose groups: the high-dosage group (three menstrual cycles), the moderate-dosage group (one menstrual cycle), and the low-dosage group (two or four days). Since there remained sufficient heterogeneity among the three subsets, we prespecified seven subgroup variables (four clinical and three methodological) to investigate the heterogeneities.

Results

A total of 14 RCTs (1,564 women) of moderate or low overall quality were included. The results were different when the dosage of acupuncture was restricted. For the moderate or high-dosage group, CPR and part of ER parameters were improved in the acupuncture group (i.e., CPR: OR = 2.00, 95% CI [1.24, 3.22], p = 0.004, I ² = 0% in one menstrual cycle; OR = 2.49, 95%CI [1.67, 3.72], p < 0.05, I ² = 0% in three menstrual cycles). However, for the low-dosage group, no statistical difference was observed in CPR (OR = 0.07, 95% CI [-0.10, 0.23], p = 0.44, I ² = 82%) and a part of the ER parameters. In subgroup analysis, four subgroup variables (the routine treatment, risk of performance bias, duration of acupuncture treatment, and the age of participants) could explain some of the heterogeneities across all trials.

Conclusion

The finding indicated that the trend of relatively more acupuncture dosage showed better effects for poor endometrial receptivity among PER women. It remains a potential heterogeneity in our studies. Further high-quality trials with a homogeneity trial design need to be conducted.

Evaluation the relationship between social health and stress of assisted reproductive techniques in infertile women

BACKGROUND

Fertility is highly valued in most cultures. In contrast, infertility as a crisis has the potential to threaten the stability of individuals, relationships, and communities. Many infertile people are at risk in the early stages of infertility treatment for health and mental health problems and severe stress. The present study was conducted to assess the relationship between the social health of infertile women and the stress of infertility treatment.

MATERIALS AND METHODS

This study was performed descriptively longitudinal correlation on 2020 women in infertility canters in Isfahan. Data collection tool in this study was three parts questionnaire. The first contained demographic information, the second was stress, and the third was the social health dimension questionnaire. Analyze the data was performed using the descriptive statistical methods for the quantitative variables Pearson correlation coefficient. P < 0.05 was considered significant.

RESULTS

The results showed that the mean standard deviation (SD) of social health was 155.1 (16.46), and the mean (SD) score of treatment stress was 22.91 (7.93). Pearson correlation coefficient showed that treatment stress score was not significantly related to overall social health score and its dimensions (P > 0.05).

CONCLUSIONS

In this study, no statistically significant relationship was identified between these two variables. Probably, due to the living conditions of the people of our country in these years and the existence of stress and their great concern about economic issues, etc. The results were not observed contrary to the researcher's expectations.

Prevalence and associated factors of infertility among 20-49 year old women in Henan Province, China

Background

Infertility is a reproductive health problem which affects not only individuals, families and social populations. Recently, the infertility rate in China has a trend of increase year by year, and few studies have reported the infertility rate in Henan Province, China. The aim of this study was to investigate the current prevalence and associated factors of infertility among women of childbearing age in Henan Province, China.

Methods

This cross-sectional study was conducted from March 2019 to October 2019. We sampled 765 women who were 20–49 years old in eight hospitals of four cities in Henan Province, China. This survey included a questionnaire, physical examination, vaginal ultrasound examinations, and serum anti-Mullerian hormone (AMH) assessment, all of which were conducted under uniform standards by trained personnel. According to the data collected from questionnaire, participants were divided into infertile and fertile groups and analyzed associated factors.

Results

Among all the 765 participants in this study, the prevalence of infertility was 24.58%. The prevalence of primary infertility was 6.54%, and the prevalence of secondary infertility was 18.04%. In logistic multivariate regression analyses, infertility was associated with age (p < 0.001), history of gynecological surgery (p < 0.001), sweet food (p = 0.003) and decreased ovarian reserve (DOR) (p < 0.001). After further analyses, factors associated with primary infertility were age of marriage (p = 0.006), age of first sexual intercourse (p = 0.003), long-term air-conditioning environment (p < 0.001), decreased ovarian reserve (p = 0.005) and age (p = 0.002). And factors associated with secondary infertility were history of gynecological surgery (p < 0.001), decreased ovarian reserve (p = 0.002), waist-to-hip ratio (WHR) above 0.85 (p = 0.043), delivery times (p = 0.001) and ages (p < 0.001).

Conclusion

The prevalence of infertility among women aged 20–49 was 24.58% and only 61.17% infertile women sought medical help in Henan Province, China. Age, history of gynecological surgeries and DOR may increase the risk of infertility. Local public health departments and medical professionals need to discharge their duty of reducing the high incidence of infertility and protecting women’s reproductive health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01298-2.

Infertility prevalence rate has increased in the past 30 years. Infertility plagues thousands of women of childbearing age. Although not life-threatening, the detrimental influence of infertility to patients, their families, and society should not be underestimated, especially in China. In order to investigate the prevalence of infertility, determine the associated factors, and promote disease prevention and treatment, we conducted a cross-sectional study among 20–49 year old women in Henan, one of the central provinces of China.

This study distributed 920 questionnaires and collected 803 completed questionnaires. Interviews, questionnaires, and physical and ultrasound examinations were done.

Among all the 765 participants in this study, the prevalence of infertility was 24.58%. The prevalence of primary infertility was 6.54%, and the secondary infertility was 18.04%. Age, history of gynecological surgeries and DOR may increase the risk of infertility.

In conclusion, among women aged 20–49 years in Henan Province, China, the prevalence of infertility in 2019 was 24.58% and 61.17% of infertile women sought medical help.

Association Between Serum Vitamin D Concentration with Spermiogram Parameters and Reproductive Hormones Among Infertile Iranian Males: a Cross-sectional Study

Infertility is a health concern affecting more than 186 million people globally, and male factors play a role in almost half of cases. Recently, the possible impact of vitamin D on male reproduction has become the center of attention. Our study intended to assess the correlation between serum vitamin D concentrations with sperm parameters and sex hormones in infertile Iranian men compared to fertile men. This cross-sectional study was performed among the 114 couples who were referred to the Urology Clinic of Imam Reza hospital in Mashhad, Iran. According to the inclusion criteria, 57 patients were entered into the infertility group, and 57 cases entered into the fertile group. Semen quality assessment was performed based on WHO guidelines, and the serum was analyzed for 25-hydroxy vitamin D, LH (luteinizing hormone), FSH (follicle-stimulating hormone), and testosterone by ELISA method. Vitamin D level was significantly higher in the fertile group compared with infertile males (p < 0.001). Moreover, vitamin D level was positively correlated with some fertility indicators assessed by spermiogram test including sperm motility (p < 0.001, r = 0.483) and sperm count (p = 0.019, r = 0.216). Additionally, vitamin D was positively associated with testosterone level (p = 0.025, r = 0.210). There was no significant correlation between vitamin D concentrations with sperms morphology, LH, and FSH level. Our study showed a significantly lower vitamin D level in infertile males compared to the fertile group. In conclusion, our study results showed a positive correlation between serum vitamin D with sperm motility, sperm count, and serum testosterone level in fertile males compared to infertile men and suggest the beneficial effects of vitamin D on male reproduction.

A Systematic Review and Meta-Analysis of Male Infertility and the Subsequent Risk of Cancer

Objectives

The primary objective of this systemic review and meta-analysis was to investigate the risk of developing composite outcome of all cancers, regardless of the type of cancer among men with infertility diagnosis compared to fertile counterparts. The secondary objective was to compare the pooled risk of developing individual specific cancers between two groups.

Methods

A systematic literature search was performed on the databases of PubMed (including Medline), Scopus, and Web of Science to retrieve observational studies published in English language from 01.01.1990 to 28. 02. 2021. They assessed cancer events in males with an infertility diagnosis compared to controls without infertility. The outcomes of interest were a composite outcome of cancers including all known cancer types, and also specific individual cancers. The fixed/random effects model was used to analyze heterogeneous and non-heterogeneous results. Publication bias was assessed using the Harbord test, Egger test, Begg test, and funnel plot. The pooled odds ratio of cancers was calculated using the DerSimonian and Laird, and inverse variance methods. Studies’ quality and risk of bias were assessed using structured standard tools.

Results

We included eight cohort studies involving 168,327 men with the diagnosis of infertility and 2,252,806 men without it. The total number of composite outcome of cancers as well as individual cancers including prostate, testicular and melanoma were 1551, 324, 183 and 121 in the infertile men and 12164, 3875, 849, and 450 in the fertile men, respectively. The pooled OR of the composite outcome of cancers, regardless of the type of cancer, in men with infertility was 1.4 folds higher than those without infertility (pooled OR = 1.43, 95% confidence interval [CI]: 1.25-1.64). Meta-analysis of individual cancers including prostate, testicular and melanoma between two groups was carried out. The pooled ORs of testicular and prostate cancers in men with the diagnosis of infertility were significantly higher than controls without infertility (pooled OR = 1.91, 95% CI: 1.52-2.42 and pooled OR = 1.48, 95% CI: 1.05-2.08, respectively). Additionally, the pooled OR of melanoma in men with infertility was 1.3 folds higher than those without infertility (pooled OR = 1.31, 95% CI: 1.06-1.62).

Conclusion

A greater risk of cancers in men with male infertility was found suggesting that the history of male infertility might be an important risk factor for developing cancers in later life. Further well-designed long-term population-based prospective studies, considering all known cancers and their accompanying risk factors should be conducted to support our findings.

Vitamin D3 Supplementation Effects on Spermatogram and Oxidative Stress Biomarkers in Asthenozoospermia Infertile Men: a Randomized, Triple-Blind, Placebo-Controlled Clinical Trial

The objective is to evaluate the effects of vitamin D3 (VD3) on sperm parameters and seminal and serum oxidative stress (OS) biomarkers in asthenozoospermia infertile men. This randomized, triple-masking, placebo-controlled clinical trial conducted on 86 asthenozoospermia infertile men with serum 25 hydroxy vitamin D3 (25-OH-D3) < 30 ng/ml in the infertility clinic of Ahvaz Jahad Daneshgahi, Iran. Patients were randomly allocated to groups A and B, who received daily 4000 IU vitamin D3 (VD3) and matching placebo respectively for 3 months. Demographic data, dietary intake, physical activity, sun exposure, anthropometric indices, serum and seminal levels of MDA (Malondialdehyde), 8-hydroxy-2- Dioxy Guanosine (8-OHDG), total antioxidant capacity (TAC) and calcium, sperm DNA fragmentation index (DFI), serum 25-OH-D3, parathyroid hormone (PTH), phosphorus, and sperm parameters were assessed. VD3 supplementation had no significant effects on body weight, body mass index (BMI), waist circumference (WC), body fat (BF), 8-OHDG, DFI, semen volume, sperm count, and normal sperm morphology, but increased post-intervention mean and mean change of serum 25-OH-D3 (P < 0.001, P < 0.001), PTH (P < 0.001, P < 0.001) and phosphorus (P = 0.009, P = 0.049) and seminal calcium (P = 0.035, P = 0.038) and serum calcium (P = 0.008, P = 0.009), seminal TAC (P < 0.001, P < 0.001), and serum TAC (P = 0.007, P = 005), total sperm motility (P < 0.001, P < 0.001) and progressive sperm motility (P < 0.001, P < 0.001) and decreased seminal MDA (P = 0.017, P = 0.004) and serum MDA (P = 006, P = 0.005) significantly compared to the baseline and placebo group respectively. VD3 supplementation may modulate OS and affect sperm motility in men with asthenozoospermia and serum 25-OH-D3 < 30 ng/ml. Iran Clinical Trials Registry, ID: IRCT20151128025274N4, registered on 28 March 2018, URL of trial registry record: https://www.irct.ir/trial/29983.

The factors affecting male infertility: A systematic review

Background

In recent years, the incidence of male infertility has increased worldwide. It is necessary to study the factors that influence male infertility in each area/region for better management.

Objective

To determine the factors affecting male infertility in the Iranian male population.

Materials and Methods

An online search was conducted in electronic databases including PubMed, Google Scholar, SID, and Scopus to identify articles on the factors associated with male infertility, published in English and Persian. The keywords used to perform the search included "factor", "epidemiology", "causes of infertility", and "male infertility". The search was conducted without a time restriction, up to April 2020.

Results

The search resulted in a total number of 691 studies. After an assessment of the articles, finally 14 studies were included in this study with a total number of 26,324 infertile males. The factors associated with male infertility included semen abnormalities, varicocele and testis disorder, smoking, exposure to heat, obesity, anabolic steroids, vascular abnormalities, anti-spermatogenesis factors, antidepressants, taking ranitidine and cimetidine, penile discharge and genital ulcers, painful micturition, occupational factors, alcohol, chronic disease, sexual disorder, Surgical and urological diseases, genetic factors and herpes infection. Among these, the semen and varicocele disorders were common in most studies.

Conclusion

The present review suggests that the factors affecting male infertility in Iran are similar to those reported from other countries. The results of this study can be used in adopting appropriate strategies for infertility management in Iran.

Impact of Thyroid Autoimmunity in euthyroid women on the outcomes of In Vitro Fertilization

OBJECTIVE

Infertility is inadequately acknowledged as a problem in developing countries. Thyroid Autoimmunity (TAI) has been neatly investigated for its association with unfavorable pregnancy and reproductive consequences. We aim to evaluate Clinical Pregnancy Rate (CPR) as a primary outcome following In Vitro Fertilization/Intra Cytoplasmic Sperm Injection (IVF/ICSI) in women with Thyroid Autoimmunity (TAI).

METHODS

A Retrospective cohort study included 584 women who underwent IVF/ICSI treatment between November 2012 and April 2017 in Orient Hospital, Damascus, Syria. Patients were tested for TAI before IVF/ICSI procedure.

RESULTS

CPR did not significantly differ between TAI positive and TAI negative groups (p > 0.05). Subgroup analysis for only primary infertility patients showed a statistically significant difference in CPR between TAI positive and TAI negative groups.

CONCLUSION

Although several arguments were in favor of the relation between IVF/ICSI outcomes and Thyroid autoimmune disease, the presence of TAI positivity did not adversely affect the clinical pregnancy rate.

The association between subclinical hypothyroidism and TPOAb positivity with infertility in a population-based study: Tehran thyroid study (TTS)

BACKGROUND

Thyroid autoimmunity(TAI) is the most prevalent autoimmune condition in women of fertile age. There are increasing data regarding the association of thyroid dysfunction and thyroid autoimmunity with adverse pregnancy outcomes but there is no consensus regarding infertility and TPOAb positivity; thus we aimed to evaluate the association between thyroid TPOAb positivity and infertility in females and males in a population-based study (TTS).

METHODS

Cross-sectional study of 3197 female and male participants in Tehran Thyroid Study (TTS) at the framework of the Tehran Lipid and Glucose Study (TLGS). Data included biochemical measurements and a self-administered questionnaire.

RESULTS

A total of 12,823 cases in phase 4, 3719 cases (2108 female and 1611 male) were analyzed. The mean TSH of the infertile female and male was 2.52 ± 2.68 μIU/ml and 3.24 ± 10.26 μIU/ml respectively. The TPO median(IQR) of women with and without a history of infertility were 6.05 (3.30-13.96)and 6.04 (3.17-11.15);(P = 0.613), they were 5.08 (3.20-125.68) and 5.31 (3.93-125.68);(P = 0.490) in male participants, respectively. Results of crude and adjusted logistic regression analysis of the development of infertility by thyroid function and TPOAb, except for fT4 in male subjects, depicted no association between infertility and other variables in both crude and adjusted models.

CONCLUSION

Based on the result, thyroid autoimmunity was not associated with infertility in both females and males.

The Association Between Male Infertility and Cardiometabolic Disturbances: A Population-Based Study

BACKGROUND

Further studies are needed to extend our knowledge about the association between male infertility and cardio-metabolic disorders.

OBJECTIVES

We aimed to assess the association between male infertility and cardiometabolic disturbances using a population-based design.

METHODS

In total, 1611 participants of the Tehran-Lipid and Glucose-Study (phase III) were categorized into two groups of men with documented male infertility (n = 88) and those with at least one live birth and no history of primary infertility (n = 1523). Logistic regression was applied to explore the association between male infertility and cardiometabolic disturbances, including diabetes mellitus, pre-diabetes, hypertension, metabolic syndrome, dyslipidemia, obesity, central obesity, and chronic kidney disease, following adjustment for age and body mass index (BMI).

RESULTS

The unadjusted model revealed a significant association between infertility and hypertension and CKD (OR = 1.8; 95% CI: 1.2, 2.9, P-value = 0.006 and OR = 1.9; 95% CI: 1.1, 3.6, P-value = 0.033), respectively. However, after adjusting for age and BMI, as potential confounders, this association was not significant. Moreover, there was no association between infertility and other cardiometabolic disturbances, including diabetes and pre-diabetes, metabolic syndrome, dyslipidemia, obesity, and central obesity in both unadjusted and adjusted models.

CONCLUSIONS

Our study revealed no association between male infertility and cardiometabolic disturbances. The findings can pave the way for further studies to extend our knowledge in this field. More population-based studies with a large sample size are warranted to confirm these findings.

Adjustment toward infertility mediates the relationship between coping, depression and anxiety in men: A confirmatory analysis

OBJECTIVE

The aim of the present study was to develop a theoretical framework for the relationships between coping, adjustment toward infertility, depression and anxiety and to present a confirmatory analysis of the developed theoretical framework in men who, together with their spouses, were candidates for assisted reproductive technology (ART) treatment.

STUDY DESIGN

This cross-sectional study was conducted on 212 men selected from the couples who were candidate for ART. Depression and anxiety, adjustment toward infertility, and coping strategies were assessed using self-report questionnaire. Statistical analysis was performed using the plug-in application PROCESS macro and AMOS software.

RESULTS

The results showed that higher depression and anxiety scores were related to lower adjustment to infertility. Higher adjustment score was associated with lower self-blame, self-focused rumination, active confronting and avoidance coping strategies scores significantly. In the depression and anxiety pathway models, the positive relationship between active confronting and elf-focused rumination coping strategies were mediated by adjustment. However, the effect of active confronting on depression and anxiety was significant only with mediating role of adjustment. The direct and indirect relationship of self-focused rumination and the indirect relationship of active confronting with depression and anxiety had a good fitness (CMIN/ DF = .419).

CONCLUSION

The self-focused rumination and active confronting coping strategies, having negative association with adjustment to infertility, and may increase depression and anxiety in men undergoing ART; however, higher adjustment is associated with decreased depression and anxiety. Therefore, mental health programs for men undergoing ART may need to focus on improving the skills of adaptive coping strategies.

Effect of a Health-Education Program Based on the BASNEF Model of Overall Sexual Health Satisfaction and Satisfaction with Quality of Sexual Relationship among Women with Infertility

Introduction

Female infertility is increasing in Iran, encompassing all dimensions of women's lives. One of the most important effects of infertility is on sexual function. All women have the right to sexual health. Using educational models, one can see a positive effect on women's sexual function. The present study aimed to investigate the effect of an education program based on the beliefs, attitudes, subjective norms, and enabling factors (BASNEF) model on promoting overall sexual health satisfaction and satisfaction with the quality of sexual relationships among women with infertility.

Methods

This was a quasiexperimental study conducted on 80 infertile women referred to an infertility center affiliated with Tehran University of Medical Sciences, in Tehran, Iran in 2016-2017. Infertile women with primary infertility were divided into experimental and control groups based on odd and even days. The intervention was carried out based on the BASNEF model over four sessions. Data were collected using a demographic questionnaire, the BASNEF questionnaire, and items on overall sexual health satisfaction and satisfaction with their sexual relationship. The questionnaires were completed before and 4 and 8 weeks after the intervention in the two groups. Friedman, χ², and t-tests were used for data analysis.

Results

After the educational intervention, BASNEF values and overall sexual function and satisfaction with the quality of sexual relationships had significantly improved in the experimental group (p<0.05), while changes were not significant in the control group.

Conclusion

The results showed that the BASNEF model-based educational invention improved overall sexual health and satisfaction among intertitle women. Indeed, it seems that using theory-based educational interventions in infertility centers might be helpful.

Women with Autoimmune Thyroiditis have Lower Reproductive Life Span or Not? A Cross- Sectional Study

Background:

Autoimmune diseases are a main cause of primary ovarian insufficiency. This study was designed to elucidate the relationship between ovarian reserve and anti-thyroid peroxidase antibodies in women of different ages.

Methods:

98 women in a cross-sectional study was conducted at the infertility Center of Shiraz University of Medical Sciences, Hazrate Zeinab Hospital, from September 2018 to March 2019. Women with infertility and thyroid-stimulating hormone (TSH) &gt; 3mIU/L were included in the study with convenience sampling. Data were collected by a form containing demographic characteristics, thyroid hormones, and ovarian reserve data. Participants were categorized based on the negative or positive anti-thyroid peroxidase (anti-TPO) antibodies. According to a pilot sample, and possible dropout of 20%, the sample size was determined to be 49 cases in each group. The results were compared between groups using SPSS, version 22. All statistical comparisons were performed using the t-test, and the data are presented as the mean±SD. P-values less than 0.05 were considered significant.

Results:

49 women were analyzed in each group. There was no significant difference between the groups in the mean age (P=0.42), body mass index (BMI) (P=0.34), duration of infertility (P=0.99), mean prolactin (P=0.66), TSH (P=0.17), thyroxine (T4) (P=0.87) and follicle-stimulating hormone (FSH) levels (P=0.14). Ovarian reserve characteristics: antral follicular count (AFC) and anti-Müllerian hormone (AMH) levels in anti-TPO positive group were 10.61±7.29 and 1.98±2.38, respectively, and AFC and AMH in anti- TPO negative group were 16.46±6.38 and 2.94±2.22, respectively. There were significant differences between the two groups on AFC (P <0.001) and AMH (P=0.04).

Conclusion:

Patients with autoimmune thyroiditis were at higher risk for decreased ovarian reserve. They should consider their lower reproductive life span during their childbearing years.

The Male Is Significantly Implicated as the Cause of Unexplained Infertility

Male infertility is recognized as a relatively common, complex condition, generated by a broad array of environmental and genetic factors. Historical reliance on the conventional semen profile has tended to underestimate the true contribution of "the male factor" to human infertility. This review highlights the importance of genetic and epigenetic factors in the etiology of male infertility, identifying a range of mutations responsible for primary testicular failure and impaired fertilizing potential. More than three quarters of all de novo mutations arise in the male germline via mechanisms that involve the inefficient or defective repair of DNA damage. Understanding the range of factors capable of creating genetic turmoil in the paternal germline is essential, if we are to gain a deep understanding of the causes of male infertility, rather than just the symptoms that characterize its presence. High levels of DNA fragmentation induced by oxidative stress are part of this equation. Oxidative stress is, in turn, driven by biological (age, ejaculation frequency, varicocele, infection), lifestyle (smoking, obesity), and environmental factors (heat, other forms of electromagnetic radiation, and toxins) that can impair the fertilizing potential of the spermatozoa and influence the incidence of spontaneous mutations that may cause infertility in the offspring.

The search for assisted reproduction: profile of patients seen in the fertility outpatient clinic of a public hospital

OBJECTIVE

To analyze the epidemiological profile of patients treated at the Fertility Outpatient Clinic of a tertiary public hospital in Juiz de Fora.

METHODS

This cross-sectional study analyzed the medical records of 448 patients who sought fertility treatment at a tertiary public hospital. The data collected from the medical records were used to assess the main causes of infertility, find the most frequently performed procedures, and the cases eligible to therapeutic or prophylactic intervention.

RESULTS

Of the 448 patients included in the study, 385 (86%) sought fertility consultation, 49 (10%) came in for repeated miscarriages, and 14 (3%) for other reasons. Of the 438 infertile patients, 280 (63.9%) had primary and 158 (36.1%) had secondary infertility. The top-three conditions of the 295 patients with established diagnoses were chronic anovulation (n=98; 33%); tubal factor infertility (n=86; 29%); and male factor infertility (n=59; 20%).

CONCLUSIONS

Improving care in reproductive health requires a more profound comprehension of the epidemiological profile of patients seeking treatment. There are alternative cost-effective means to contain the development of infertility. Additional expenditure in public healthcare is needed to accommodate the growing number of individuals seeking fertility treatment in Brazil.

Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among women with genitourinary infection and pregnancy-related complications in Tehran: A cross-sectional study

The present study investigates the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) among women with genitourinary infection and pregnancy-related complications in Tehran. It also evaluates the demographic information, symptoms, and sequelae. Endocervical samples were obtained over a period of eight months from 360 women including 180 symptomatic patients and 180 patients with pregnancy-related complications and infertility. CT, NG, and TV were detected in 10.8%, 6.9%, and 8.3% of all patients, respectively. The prevalence of CT, NG, and TV among women in the symptomatic group was 11.1%, 7.2%, and 13.3%, respectively, and among women with pregnancy-related complications and infertility was 10.6%, 6.7%, and 3.3%, respectively. Associations between chlamydia and ectopic pregnancy (p = 0.001), and infertility (p < 0.001) were observed. Abortion (p = 0.008), infertility (p = 0.005), and ectopic pregnancy (p < 0.001) were associated with gonorrhea. Abnormal vaginal discharge (p = 0.02) and vulvar itching (p = 0.02) were associated with trichomoniasis. Overall, the prevalence rates of CT, NG, and TV were high in these patient groups. These high prevalences suggest that screening programs are required to reduce the burden of these sexually transmitted infections and their effects on genitourinary symptoms, pregnancy-related complications, and infertility.

The Success Rate and Factors Affecting the Outcome of Assisted Reproductive Treatment in Subfertile Men

BACKGROUND

This study was conducted to evaluate the success rate of male infertility treatment and the factors affecting its outcome.

METHODS

In a historical cohort study, from Mar 2013 to Mar 2014, 323 couples with male factor were investigated. Couples had treated with IUI or/and ICSI were included randomly. Assisted reproduction technology (ART) outcome (treatment success) was defined as a live birth. Age, duration of infertility, type of infertility, treatment history and clinical examination results were investigated. The logistic regression and survival analysis were applied.

RESULTS

The average of men age, duration of infertility and BMI were 33.5, 4.7 (yr) and 26.6 (kg/m2) respectively. 87.9% of men have primary infertility and average duration of treatment was 14.1(month). Previous treatment, type of infertility, treatment method, man's BMI, normality of sperm and sperm head were important variable that affecting outcome. The rate of live birth in the first attempt was 29.7%, and 44.9% of the couples succeeded to give live birth after several treatment cycles. Couples who had no previous history of treatment were 8.5 times more successful in live birth. The Cox analysis showed that "BMI of man" and percentage of "Sperm with normal head" are predictors that had a significant effect on live birth.

CONCLUSION

Live birth in the first treatment cycles was influenced by four variables but two other variable were affecting several treatment cycles outcome. The chances of successful treatment were higher with taking into account the length of time and having live birth was determined as 78% for five years of continuous treatment.

Effect of counseling based on the choice theory on irrational parenthood cognition and marital quality in infertile women: A randomized controlled trial

PURPOSE

This study evaluated the effect of counseling based on the choice theory on irrational parenthood cognition (IPC)- and marital quality in infertile women.

DESIGN AND METHODS

This randomized controlled trial was conducted on 50 primary infertile women in Zanjan, Iran. Stratified block randomization was used to allocate participants to groups. The intervention group received counseling, but the control group received routine care. Data were collected using the IPC and marital relationships quality based on the Glasser's choice theory.

FINDINGS

A statistically significant difference was found between the groups in IPC (P = 0.005), but the difference in marital quality was not statically significant ( P = 0.085).

PRACTICE IMPLICATIONS

Counseling can be used for decreasing IPC, but more interventions are needed to increase marital quality.

Psychosocial Consequences of Female Infertility in Iran: A Meta-Analysis

Background: Although not a life-threatening condition, infertility does influence various aspects of life. Based on a meta-analysis of the relevant literature, the aim of this study is to identify the psychosocial consequences of infertility in Iranian women. Methods: Comprehensive Portal of Human Sciences, Magiran, Scientific Information Database, Noormags, MEDLIB, ScienceDirect, Google Scholar, Medline, and ProQuest were the databases searched from inception (1999) to 2018. To maximize the comprehensiveness of the search, the reference lists of all the relevant papers identified were manually examined. The evaluation of the content was based on PRISMA guidelines, and Comprehensive Meta-Analysis software was used for data analysis. Results: Based on the analysis of 124 quantitative papers, the psychosocial consequences of infertility in women in Iran can be classified into 14 categories: psychological well-being (effect size = 3.10), adaptation to infertility (effect size = 2.71), quality of life (effect size = 1.83), depression (effect size = 1.80), anxiety (effect size = 1.72), marital relationships (effect size = 1.37), personality disorders (effect size = 1.37), violence (effect size = 1.31), social support (effect size = 0.90), self-efficacy (effect size = 0.90), coping strategies (effect size = 0.84), irrational thoughts (effect size = 0.77), somatization disorders (effect size = 0.65), and sexual dysfunction (effect size = 0.55). Conclusion: Considering the wide-ranging psychosocial consequences of infertility in women, it is necessary for treatment to account for psychological factors.

Infertility and Psychological and Social Health of Iranian Infertile Women: A Systematic Review

Objective: Infertility influences various emotional, psychological, social, and relational aspects of women's lives. By employing a systematic review on the papers published in this field, this study aimed to identify the consequences of infertility on psychological and social health of women in Iran. Method : This was a descriptive study, conducted through a systematic review according to the directions denoted by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) in 2018. To investigate the entirety of the published studies on the sociopsychological consequences of women's infertility in Iran, various databases, including Comprehensive Human Science Portal, Scientific Information Databases (SID), Magiran, National Library and Archives of I. R. IRAN, Noormags, MEDLIB, Science Direct, Google Scholar, Medline, and ProQuest, were explored for the studies published between 1991 and 2018. The selected papers were evaluated according to the content analysis method. Results: Out of the 53 papers investigated, 27 were published in domestic journals (51%), while the remaining 26 papers were published in international journals and were in English (49%). The results revealed that sociopsychological consequences of women's infertility are categorized in 6 main categories: (1) quality of life, (2) depression, (3) anxiety, (4) social support, (5) violence, and (6) sexual function. Conclusion: The results of this study can be used to design psychocognitive interventions and assist women in decreasing the emerging psychological pain and pressure.

Quality of Life and General Health in Pregnant Women Conceived with Assisted Reproductive Technology: A Case-Control Study

Background

Infertility affects different aspects of life including the quality of life (QOL) in infertile couples. Many infertile couples conceive via using assisted reproductive technology (ART). However, the effect of pregnancy and childbearing on QOL is not known in these couples. This study aimed to evaluate QOL and general health during pregnancy and after successful treatment of infertility, in women conceived with ART.

Materials and Methods

In this case-control study, QOL and general heath were evaluated in 40 women conceived with ART and 40 women who conceived spontaneously and served as the control group. WHO quality of life- BREF (WHOQOL-BREF) inventory was used to evaluate QOL and General Health Questionnaire-28 (GHQ-28) was applied to evaluate general health. These two questionnaires were completed in the first and second trimester of pregnancy and results were compared between the two groups.

Results

Mean age of women was 29.4 ± 4.4 and 29.6 ± 5 years in ART and control group, respectively. QOL in women conceived with ART was similar to QOL in the control group in the first and second trimester of pregnancy while general health score (distress level) in women conceived with ART was significantly higher than that of the control group in both trimesters. Although distress level decreased in the second trimester in ART group, but yet, it was higher than that recorded for the control group.

Conclusion

After pregnancy, QOL in women conceived with ART is similar to women conceived spontaneously. However, these women experience higher distress level in the first and second trimester of pregnancy compared to women conceived spontaneously.

Iranian infertile couples' strategies to manage social interactions after unsuccessful treatment with assisted reproductive technologies

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances.

Race and Length of Time Pursuing Pregnancy Among Women Who Utilized Medical Help to Get Pregnant

Objective: The evaluation of racial disparities in access to and use of infertility services in the U.S. has been documented. The aims of this study were to: 1) investigate racial differences in length of time women report attempting to become pregnant until seeking medical help; and 2) determine the predictors of seeking medical help to achieve pregnancy. Materials and methods: The National Survey of Family Growth 2011-2015 was used to analyze the duration women attempted to get pregnant among those who sought medical help. Results: 563 women reported seeking medical help to achieve pregnancy. The majority 422 (81%) were white. Multiple linear regression showed that age (β = .93; p = .00), having less than high school education (β = 14.64; p = .01), and higher body mass index (β = .59; p = .00) are significantly associated with an increased length of time for seeking medical help to get pregnant. Religions other than Catholic or Protestant (β = -8.63; p = .04) is significantly associated with a decreased length of time for seeking medical help to get pregnant. Race was not associated with a significant difference in the length of time attempting to become pregnant (β = -1.80; p = .44). Conclusion: Age, education attainment, religious affiliation, and body mass index are significantly associated with the length of time pursuing pregnancy. Once women have utilized medical resources, racial differences in the length of time pursuing pregnancy are not apparent.

Practical Difficulties in Estimating The Prevalence of Primary Infertility in Iran

Background

According to the World Health Organization (WHO)'s clinical, epidemiological and demographic defi- nitions, infertility is an inability to become pregnant within one, two or five years of exposure to pregnancy, respec- tively. Inconsistent infertility-related definitions and various methodological approaches make it difficult to compare quantitative data in this regard and consequently, have negatively influenced estimating the prevalence of infertility. The present study reviewed the results of a large population-based survey on how the clinical, epidemiological and de- mographic definitions of infertility produce different results in terms of infertility prevalence in Iran and subsequently, compared the findings in order to find the right time of treatment-seeking by couples.

Materials and Methods

This community-based, cross-sectional study was carried out by Avicenna Research Insti- tute in the urban and rural parts of Iran between 2010 and 2011. Using cluster sampling, the reproductive history of 17,187 married women aged 20-40 years, was recorded. Totally, 1011 clusters were randomly selected according to post office codes, proportional to the population of the province. Descriptive and inferential statistical analysis of the data was carried out by SPSS statistical software.

Results

The prevalence of primary infertility based on the WHO’s clinical, epidemiological and demographic definitions were 20.2, 12.8 and 9.2%, respectively. In addition, secondary infertility rate was 4.9%.

Conclusion

Infertility estimates over a two-year exposure period made a 50% decrease in infertility rate; however, increasing exposure period to five years made no significant difference in infertility rate. The findings showed that most of the couples will get pregnant within two years of unprotected sexual intercourse and thus, need no treatment. Due to practical difficulties in estimating the prevalence of primary infertility, the reference limit for time to pregnancy, should be reconsidered and giving more time to younger women to become pregnant, seems reasonable.

Jurisprudence Study of Muslim Rules and Effects of Ovarian Transplants in Women with Infertility; A Review

Background:

The use of assisted reproductive techniques, in addition to mental and emotional stress in different stages, made some jurists, as fatwa authorities, to investigate and evaluate the problems of this type of transplantation.

Objective:

The aim of this study was the jurisprudence investigation of the rules and effects of ovarian transplants in women with infertility.

Methods:

This study was conducted through review and library studies using the keywords ovarian transplants, infertility, jurists’ opinions and religious rules as to ovarian transplantation.

Results:

Permission for transplanting one’s own ovarian tissue was issued through the consent of most scholars of Islamic schools and according to some verses, traditions, legal rules, and logical reasons. Although some of the Ancient religious scholars have dissenting opinions about transplantation, for some jurists, ovarian transplant from a woman to an infertile woman has no legal problem and the infant belongs to the recipient. However, some other jurists oppose this fatwa. They believe that there is a problem in the oocytes and ovarian transplantation due to mixed parentage and the holy legislator does not agree with this transplantation. So, they had opposing fatwa in this regard.

Conclusion:

According to the consensus of some Muslim jurists on ovarian transplant from one’s own ovary or from another woman, there is a new hope for infertile couples to use this method which is done from a woman to another woman.</P>

The effect of a natural vaginal product based on honey on the success of intrauterine insemination (IUI) in infertility treatment

OBJECTIVE

Due to high prevalence of infertility and increasing tendency towards complementary medicine, this study was conducted to investigate the effect of a vaginal natural product based on honey and 1% extract of Myristica fragrans on the extent of success of intrauterine insemination (IUI).

MATERIALS AND METHODS

This non-randomized clinical trial study with a historic control group, was performed on infertile women. In this trial, 159 patients were assigned to the intervention group, and 288 patients were recruited to the control group. All the participants received clomiphene or letrozole from the third up to seventh day of menstruation, and on days 6, 7, and 8, they received human menopausal gonadotrophin (HMG) injections. IUI was performed 36 hours after human chorionic gonadotrophin (HCG) injection. In the intervention group, a natural vaginal product was used besides the above treatments, from menstruation day 7 until the day before performing IUI. Sixteen days after IUI, serum beta HCG was measured to investigate chemical pregnancy, and six weeks following IUI, vaginal sonography was performed to investigate clinical pregnancy.

RESULTS

Analysis showed that the pregnancy rate was higher in the group that receiving the natural product compared to the control group. Chemical pregnancy rate was 18.1% vs. 15.4%, and clinical pregnancy rate was 15.2% vs. 13.8% for intervention and control groups, respectively; but, this difference was not significant.

CONCLUSION

It seems that the use of this vaginal product for a longer period of time and across several menses cycles before IUI, may produce more positive results. Further studies, however, are needed to be done.

Effects of Group Counseling on Stress and Gender-Role Attitudes in Infertile Women: A Clinical Trial

BACKGROUND

Infertility stress can have a devastating impact on the lives of couples and influence their physical and psychological health. The purpose of this study was to investigate the effects of group counseling on female stress and gender-role attitudes in infertile women.

METHODS

The present study is a randomized clinical trial conducted on 90 infertile women referred to Rooyesh Infertility Treatment Center in the city of Karaj, Iran. The convenience sampling method was used. Samples were divided into intervention and control groups through four-block random allocations. Accordingly, the intervention group received five-session group counselling and the control group only received routine care. Newton's fertility problem inventory (FPI) and gender role questionnaire (GRQ) were used for collecting data before, after, and one month after the intervention. The significance level was set at 0.05.

RESULTS

The result showed a significant relationship between gender role attitude and stress in infertile women (p=0.03) and indirect association between of them (r=0.13). And also repeated measures test indicated that length of time had affected the total scores of infertility stress (p<0.001) and gender role attitude scores (p= 0.001) and there was a significant difference between the two groups in infertility stress scores (p<0.001) and gender role attitude scores (p=0.001).

CONCLUSION

Group counseling can be used in stress reduction and also improved gender role attitude of infertile women.

Tobacco Smoking: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

Smoking is a global public health priority and accurate data of the local population is essential to improve the health policies against its use. Hence, this study aimed to summarize the important findings available on the prevalence of smoking and its association with non-communicable diseases, documented by one of the largest prospective community-based studies of Iran.

EVIDENCE ACQUISITION

All articles derived from the Tehran Lipid and Glucose Study (TLGS) in the last two decades, from the earliest publications until 30 January 2018 were reviewed for their findings on tobacco smoking.

RESULTS

The prevalence of smoking in non-diabetic adults ≥ 20 years increased between baseline (phase I, 1999 - 2001) and follow-up (phase V, 2008 - 2011) from 25.5% to 35.4% among men and from 3.4% to 6.8% among women. In TLGS adolescents (10 - 18 years) water pipe use increased between 2003 and 2005 from 35.5% to 40.9% among boys and from 19.7% to 26.1% among girls. Regarding health hazards, smoking in men was associated with increased risk of combined impaired fasting glucose/impaired glucose tolerance [hazard ratio (HR) 1.69; confidence interval (CI) 95% 1.15 - 2.48] and hypertension (HR 1.26; CI 95% 0.98 - 1.63). Moreover, men, even smoking less than 10 cigarettes per day, were at increased risk for cardiovascular diseases by HR 2.12 (CI 95% 1.14 - 3.95). For women, the risk of chronic kidney disease dramatically increased 5.74-fold (CI 95% 2.71 - 12.15) among smokers. In the whole population, smoking contributed to 7.7% of all-cause mortality with HR 1.75 (CI 95% 1.38 - 2.22). Other health aspects of tobacco smoke, including its impact on metabolic status, thyroid function, female reproductive system and life style have also been reviewed.

CONCLUSION

Considering hazards of smoking, there is the urgency for more effective preventive measures in Iran; emphasizing the need for further local studies on the hazards of smoking with special attention to women and adolescents and the independent hazards of water pipe use.

Development and Psychometric Properties of The Delayed Childbearing Questionnaire (DCBQ-55)

The comprehensive assessment of delayed childbearing needs a valid and reliable instrument. Therefore, the aim of the present study was to develop an instrument to evaluate factors influencing delayed childbearing among women and to assess its psychometric properties. The current methodological study was performed in two phases of (i) qualitative instrument development, and (ii) quantitative psychometric assessment of the developed instrument. Face and content validity of the instrument was assessed by eligible women and a panel of experts. Construct validity was assessed using the exploratory factor analysis (EFA). For reliability, internal consistency reliability and intra-rater reliability analysis were used. The initial instrument developed from the qualitative phase consisted of 60 items, which were reduced to 55 items after the face and content validity processes. EFA (n = 300) using the Kaiser criteria (Eigenvalues > 1) and the scree plot led to a six-factor solution accounting for 61.24% of the observed variance. The Cronbach’s alpha coefficient, Spearman’s correlation, test–retest and intra-class correlation coefficients for the whole instrument were reported as 0.83, 0.86 and 0.81, respectively. The final instrument entitled the delayed childbearing questionnaire (DCBQ-55) included 50 items with six domains of ‘readiness for childbearing’, ‘stability in the partner relationship’, ‘awareness about the adverse outcomes of pregnancy in advanced maternal age’, ‘attitude toward delayed childbearing’, ‘family support’, and ‘social support’ on a five-point Likert scale. The DCBQ-55 as a simple, valid and reliable instrument can assess factors influencing delayed childbearing. It can be used by reproductive healthcare providers and policy makers to understand factors influencing delayed childbearing and devise appropriate strategies.