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Management of the infertile couple: an evidence-based protocol

Department of Obstetrics and Gynaecology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
Reproductive Biology and Endocrinology (Impact Factor: 2.41). 03/2010; 8:21. DOI: 10.1186/1477-7827-8-21
Source: PubMed

ABSTRACT Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility.
The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload.
A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib) by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Canadian Fertility and Andrology Society (CFAS), and Royal College of Obstetricians and Gynaecologists (RCOG).
A simple guide for the clinicians to manage the infertile couples.
The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.

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    ABSTRACT: المقدمة: يسبب العقم عبئا نفسيا كبيرا على الأزواج الذين يعانون منه وخصوصا النساء. و قد تساعد زيادة المعرفة بالعوامل المؤثرة على الخصوبة في تقليل حدوث العقم وذلك بتجنب الأزواج لعوامل الخطر للعقم. الهدف: تتمثل أهداف هذه الدراسة في: (1) تقييم معارف وتوجهات المشاركين السعوديين المصابين بالعقم وغير المصابين به تجاه العقم وعوامل الخطر المحتملة والتبعات الإجتماعية، و (2) تحديد ممارسات الأزواج السعوديين لتقوية الخصوبة قبل التردد على عيادات الإخصاب وتأخر الإنجاب. المنهج. أجريت دراسة مستعرضة على 277 مشارك طبيعيي الخصوبة من مراجعي العيادات الخارجية و104 مريض ممن يعانون من العقم من مراجعي عيادة الإخصاب بمدينة الملك عبدالعزيز الطبية في الفترة بين 24 يونيو 2012 و 4 يوليو 2012 بإستخدام استبيان معتمد في دراسات سابقة. تم تطبيق مقاييس الإحصاءات الوصفية والتحليلية مع درجة معنوية p≤0.05 النتائج: أظهرت النتائج درجة معرفة ضعيفة (59%) وتوجهات محايدة (76%) تجاه العقم من قبل المشاركين. وكانت المعتقدات الخاطئة الشائعة بين المشاركين بشأن أسباب العقم تتعلق بالجن والأمور الخارقة للطبيعة بنسبة (58.8%) والسحر والشعوذة بنسبة (67.5%) واستخدام اللولب المانع للحمل بنسبة (71.3%) واستخدام حبوب منع الحمل بنسبة (42.9%). تم تسجيل معالج/شيخ كمرجع أولي وثانوي لتلقي علاج العقم بنسبة (6.7%) و (44.2%) على التوالي من مرضى العقم. بينت الدراسة أن مرضى العقم أقل تفضيلا للطلاق مقارنة بغيرهم (38.5% مقابل 57.6%; p=0.001) أو للزواج بأخرى (62.5% مقابل 86.2%; 0.001p<) في حال إذا كانت الزوجة لا تستطيع الإنجاب. كما تبين أن لدى مرضى العقم توجهات إيجابية أكثر تجاه أدوية الإخصاب (87.5% مقابل 68.4%; 0.003p=) والإنجاب بواسطة أطفال الأنابيب (92.4% مقابل 70.3%; 0.001p<). كان تبني طفل كخيار علاجي أمرا مقبولا لدى غالبية مرضى العقم (60.6%) والأشخاص طبيعيي الخصوبة (71.5%). كانت طرق العلاجة البديلة التي تم تجربتها سابقا من قبل مرضى العقم تتمثل في: ممارسة الرقية (61%) واستخدام الطب الشعبي (42%) وممارسة الرياضة (39%) وتناول أغذية معينة (22%) والتوقف عن التدخين (12%). الخلاصة: هذه النتائج يمكن أن يكون لها تأثير إيجابي على مقدمي الرعاية الصحية بشأن التردد الذي قد يحدث للأزواج الذين يواجهون مشاكل العقم، على الأقل بداية بقبول الزوجين لبعض التدخلات الطبية المطلوبة للحمل. كلمات استدلالية: عقم، معارف، سلوك، ممارسات، مفاهيم خاطئة، السعودية.
    Health Issues Conference in Gulf Countries, Kuwait; 04/2014
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    ABSTRACT: Introduction. This study aims to evaluate the effectiveness of Tualang honey on sperm parameters, erectile function, and hormonal and safety profiles. Methodology. A randomized control trial was done using Tualang honey (20 grams) and Tribestan (750mg) over a period of 12 weeks. Sperm parameters including sperm concentration, motility, and morphology were analyzed and erectile function was assessed using IIEF-5 questionnaire. Hormonal profiles of testosterone, FSH, and LH were studied. The volunteers were randomized into two groups and the outcomes were analyzed using SPSS version 18. Results. A total of 66 participants were involved. A significant increment of mean sperm concentration (𝑃 < 0.001), motility (𝑃 = 0.015) and morphology (𝑃 = 0.008) was seen in Tualang honey group. In Tribestan group, a significant increment of mean sperm concentration (𝑃 = 0.007), and morphology (𝑃 = 0.009) was seen. No significant differences of spermconcentration, motility, and morphology were seen between Tualang honey and Tribestan group and similar results were also seen in erectile function and hormonal profile. All safety profiles were normal and no adverse event was reported. Conclusion. Tualang honey effect among oligospermic males was comparable with Tribestan in improving spermconcentration, motility, and morphology. The usage of Tualang honey was also safe with no reported adverse event.
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    ABSTRACT: In developed countries, rising rates of union disruption have induced an increase in the share of people experiencing several fertile partnerships during their fertile life-span. However, from the large-scale 1999 French Family Survey, in the 1939–1954 birth cohorts it appears that completed fertility of repartnered men is slightly higher than that of never-separated men while repartnered women have fertility levels similar to those who remain in a first intact partnership. Following this observation, this article aims to study whether people, and especially women, have enough time to have children in the context of second union before they become limited by the “biological clock”. Using a cure model, we find that once age-related sterility is controlled for, the decrease in risk of having children with age is not visible anymore up to age 40. This offers some evidence that people in their second partnership, especially women, are constrained in their childbearing by the decline in fecundity with age. Additionally, childless women seem to respond proactively to the decline in fecundity with age by accelerating childbearing.
    European Journal of Population 02/2012; 29(1). DOI:10.1007/s10680-012-9271-4 · 1.75 Impact Factor

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