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Abstract

The prevalence of infertility is varies worldwide ranging from 3% to 7%. The consequences of infertility are societal repercussions, personal suffering, psychological effects, clinical depression and sexual dysfunction. Therefore, the aim of the present study was a systematic review of the literature to determine the main risk factors of female infertility. MEDLINE, EMBASE and Cochrane Database were searched from 1980-2013. Information about study objectives, participants and type of study were searched systematically with extensive key words to optimize the sensitivity of data collection. Eighty-two published articles were included in the overall review. Ovarian factors, tubal and peritoneal factors, anomalies, advanced ages (over 35 years), hormonal disorders, habits, genetic factors, medical conditions and life style are the main causes of infertility in women. Changes of lifestyle, identifying and controlling chronic diseases, rapid and suitable treatments for sexually transmitted diseases can increase the chance of women fertility process.

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... Infertility is divided into two groups; primary when a couple has not previously initiated a pregnancy and secondary when they have been successful with at least one previous pregnancy. It is reported to range from 0.6% to 3.4% for the primary infertility and 8.7% to 32.6% for secondary infertility over the past ten years [6] [7] [8]. ...
... Adamson et al reported that postponed marriage and delay in pregnancy can increase the risk of infertility in educated women. Business women and women working as artisans (seamstresses, hairdresser and farmer) representing 249 (22.4%) and 167 (15.0%) respectively are often associated with a lot of stress and stress-related factors leading to the release of more stress hormones and increase of the risk of infertility [8] [10]. ...
... Genital infections represent one of the most important causes of infertility, affecting fallopian tubes, endometrial mucosa and the pelvis. Chlamydia and gonorrhea are most common STIs which lead to infertility in men and women if left untreated [8]. ...
... The prevalence of infertility worldwide is not accurately estimated. From 10% to 20% of women experience infertility, and the rate is increasing 3 . According to epidemiological research, between 10 and 15 percent of all couples will have trouble getting pregnant (primary infertility) or having the number of children they desire (secondary infertility). ...
... Women who have endometriosis and polycystic ovarian syndrome are especially influenced by this. 3 The condition known as hyperprolactinemia (HP) is characterized by usually high prolactin levels in the blood. By raising the production and release of dopamine from the hypothalamus, hyperprolactinemia leads to the inhibition of the gonadotrophin-releasing hormone (GnRH), gonadal steroidogenesis, and ultimately sterility. ...
Research
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Background: Infertility is described as a lack of ability to achieve pregnancy after a long time of unprotected sexual intercourse. Infertility also known as sterility means incapable to conceive a pregnancy after a long time of intimacy. The first imaging modality of choice for evaluating possible causes of female infertility is ultrasound. Objective: The aim of the study is to evaluate female infertility by using ultrasonography. Methods: All the articles included in this study was taken from the PubMed, Google Scholars and Research gate was published after 2010. The selection criteria of these articles were based on the use of ultrasonography in the evaluation of infertility in women. Results: As a result, this review noted that polycystic ovarian syndrome (PCOS) was the most common cause of infertility that was found with ultrasound imaging. Conclusion: This review of literature concluded that in the diagnosis of female infertility, ultrasound is the most accessible and practical method for identifying female reproductive system abnormalities. Furthermore, when combined with transvaginal sonography, it can improve accuracy and be a useful screening tool.
... The WHO has stated that infertility influences approximately 50 -80 million women across the globe and the incidence is estimated to be around 10% -20% and up to 50% in developing countries [8] [9]. Surprisingly, many infertile women have a higher BMI as compared to their fertile counterparts and approximately 20% of all infertile women have extreme BMIs, either being underweight or overweight [10]. Since both the rates of obesity and female infertility are on the rise, many studies have been carried out to delineate the correlation between the two, with varying results. ...
... T. L. Joon et al.DOI:10.4236/oalib.1108817 13 Open Access Library Journal found to improve insulin resistance and reduce androgen levels in obese women with PCOS[37]. ...
... Infertility is defined as the inability for a couple to conceive a pregnancy following 1 year of unprotected vaginal intercourse [1]. The incidence of female infertility is rising and varies from 10% to 20% [2] . Primary infertility fails to conceive at all whereas secondary infertility fails to conceive after having borne a child or abortion [3] . ...
... Malformation cavity: Anomalies of the uterus are considered to be one of the reasons for infertility in women [10]. The prevalence of uterine malformation is estimated to be 6.7% in general population, 7.3% in infertile women, and 16% in women with a history of recurrent miscarriages [2] . We noted only 2 cases (3.1%) of malformation cavity in our study. ...
... Around 48 million couples and 186 million individuals are affected by infertility globally [3,4]. About 30% of infertility is due to female problems, 30% due to male problems, 30% due to combined male and female problems, and the remaining 10% is due to unrecognized causes [5]. In developing countries, women are blamed more for infertility [6]. ...
Preprint
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Background Infertility is the inability to attain a pregnancy in a woman (15–49 years) with regular unprotected sexual intercourse for one year. Globally, 10% − 15% of couples suffer from infertility. Infertility is a current threat to the social, economic, and psychological well-being of couples in most countries including Ethiopia. This research article aimed to assess the magnitude of secondary infertility and its associated factors among infertile women in two hospitals in Addis Ababa, Ethiopia. An institution-based cross-sectional study design was used to assess factors affecting fertility. The study enrolled 355 cases aged 15 to 49 years in two teaching hospitals. Results Secondary infertility accounts for 33.2% of cases in the study area. Low educational status (primary to secondary school level) (AOR = 2.67; 95% CI: (1.15, 6.22), history of abortion (AOR = 4.56; 95% CI: (1.54, 13.5), previous contraceptive utilization (AOR = 2.87; 95% CI: (1.37, 6.03), history of pelvic inflammatory disease (AOR = 3.49; 95% CI: (1.22, 10.2) and previous pelvic surgery (AOR = 9.3; 95% CI: (2.89, 30.14) were significantly associated with secondary infertility among the study participants. Conclusion Women who have low education, previous history of abortion, use of contraception, and pelvic inflammatory disease had increased risks of developing infertility.
... In 10-20% cases no cause is found (9). A case-control study was showed that advanced age, high body mass index, age of onset of sexual activity, prior pelvic surgeries and stress were the most signi cant risk factors associated with women's infertility (10). ...
Preprint
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Background The WHO ranks infertility in the young population as the fifth highest serious global disability. Infertility is worldwide problem affecting people of all communities, though the cause and magnitude may vary with geographical location and socioeconomic status. The objective of this study is to determine epidemiological profile of women with infertility attended at CliniquesUniversitaires de Mbujimayi (CUM). Methods This was a retrospective cross- sectional study carried out over a period of 9 months, from April 1, 2023 to December 31, 2023 at obstetrics and gynaecology of CUM including 83 patients who diagnosed with infertility. Results The frequency of female infertility is 23.6% in Mbujimayi, DRC. Uterine myomas followed by Sexual Transmitted Disease (STI) were the most causes of female infertility with 26.5% and 36.1% respectively. Secondary infertility (women who have conceived in their past history) was noted with 69.9%. Conclusion Study outlines that female infertility is a public health problem worldwide and particularly in low-income countries where STI is the main cause, with high prevalence among young adults. The high frequency of myomas in the sexually active group age and the delay of diagnosis are pointed to be associated with infertility. Anyway we recommend to CUM and Authorities to facilitate the diagnosis tools of infertility as well as possible to make it free.
... Worldwide prevalence of infertility is 10-15%, while in Pakistan infertility rate is 21.9% 4 . Relative abnormalities of infertility are found 50% in females, 40% in males and 10% in both partners 5 . Approximately 15% to 20% of couples are usually diagnosed with unexplained infertility after their complete diagnostic workups 6 . ...
Article
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Objective: To determine the frequency of disorders causing infertility in patients reporting to CMH Bahawalnagar. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pathology and Gynaecology/Obstetrics, Combined Military Hospital (CMH), Bahawalnagar in collaboration with Armed Forces Institute of Pathology (AFIP) and Pak Emirates Military Hospital (PEMH), Rawalpindi, from Apr 2013 to Apr 2015. Methodology: A total of 200 infertile couples who were married, living together and reported to CMH Bahawal-nagar for the workup of infertility were included. Serum follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, thyroid stimulating hormone, free thyroxin were performed in all patients. Serum estradiol, progesterone, liver function tests, plasma glucose, high vaginal swab and ultrasonography pelvis in all females. Semen analysis was performed in all males. Endocrinological profiles were analyzed by chemiluminescent enzyme immunoassay on Immulite 2000 at AFIP Rawalpindi. Results: Out of total 200 infertile couples, 156 with infertility due to different identified causes comprised of 18 percent because of male factors, 37% female factors and 23% contributed by both partners and age of 30 ± 5 years in males, 28 ± 5 years in females and mean duration of marriage 6 ± 4 years. Varicocele was the cause of infertility in 12.5% males while poly cystic ovarian syndrome was the most common cause of infertility in 12.5% females. Conclusion: Varicocele was found to be the commonest cause of infertility, followed by genital tract infection and immunological causes in males. Whereas polycystic ovarian syndrome was the commonest problem causing infertility in females.
... Кажущаяся степень нарушения структуры липидов в нем может быть связана с общим размером и степенью функциональности длинноцепочечного алкила. Терпены, имеющие преимущественно кольцевую структуру, такие как ментол, оказывают меньший эффект по сравнению с соединениями, содержащими длинноцепочечные алкилы, такими как нерол [67]. Одно из достоинств эфирных масел их легкость проникновения в кожу, поэтому целесообразно их использование в качестве вспомогательных веществ в составах для местного или трансдермального применения несомнена [68]. ...
Article
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The article examines a number of compounds with UV protective activity. Literature data on the use of organic synthetic compounds, mainly benzophenones, including dioxybenzone, sulisobenzone, oxybenzone and avobenzone, as well as cinnamates, salicylates, and PABA derivatives are described. It has been shown that, along with UV-protective activity, they also have side effects that are very harmful to the body. It is more advisable to use natural organic compounds. The possibility of using free fatty acids, their mono- and diglycerides and triglycerides is discussed in detail and justified. They contain certain amounts of lipids, carotenoids, flavonoids, polyphenols, phospholipids, free sterols, tocopherols and tocotrienols, triterpene alcohols, hydrocarbons, carotenoids, fat-soluble vitamins and a number of other compounds that exhibit activity against solar radiation. A similar effect is also considered when using essential oils oils. Along with similar activity, oils are used as promoters of the penetration of active substances through the skin and stratum corneum. When acids are applied to the skin, its permeability increases and the content of certain substances contained in medicinal and cosmetic forms for topical use increases in the lower layers of the skin. The data presented indicate the advisability of using organic acids.
... In Iran, the range of infertility has been reported from 3 to 20% (8)(9)(10)(11)(12)(13), and according to the available reports in Iran, infertility is increasing, and this rise is especially reported in the case of secondary infertility (10)(11)(12). On the other hand, Iran's fertility has sharply declined in recent decades. ...
Article
Objectives: Infertility is one of the reproductive health issues that not only affects infertile couple’s life, but it is a matter of demographic concerns on a vast scale. This study aims to examine the impact of socio-demographic factors on the incidence of infertility. Materials and Methods: We used data from our cross-sectional fertility survey conducted in 2017 in four selected provinces of Iran including Gilan, West Azarbaijan, Sistan and Baluchistan, and Yazd. Using a structured questionnaire, 4088 women of reproductive age were interviewed in the survey for their reproductive life history as well as their socio-demographic and economic condition. Bivariate (chi-square test), and multivariate (Multiple Logistic Regression) analyses are applied to the data to meet the aim of the study. P values less than 0.05 are considered statistically significant where differentials are tested. Results: The prevalence of current infertility according to clinical definition varied from 7.4% in Yazd, 8.6% in West Azerbaijan, 12.4% in Gilan, and 22.3% in Sistan and Baluchistan. Logistic regression analysis revealed a significant association between infertility and the age and age at marriage of women. Controlling for other socio-demographic variables probability of being infertile increases as women get married at an older age. In addition, women who lived in a household with the lowest socio-economic conditions were 80 percent more likely to experience infertility compared to those living in households with the highest socio-economic conditions. Living in Sistan and Baluchistan was also a strong predictor of infertility in the study resulting in a high odds ratio (3.050) compared with women living in Yazd province Conclusions: Women’s age and age at marriage are the most important demographic characteristics in explaining infertility and having a lower socio-economic condition trigger it. Since the age of marriage is increasing in Iran, it may affect primary infertility where childbearing is postponed to the late 30s and early 40s.
... Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration (Marcus et al., 2012;Eid et al., 2019;Sabic 2021). Treatment for infertility alters the lifestyle of women and puts a strain on their psychological life (Imeson & McMurray, 1996;Braverman et al., 1998;Direkvand-Moghadam et al., 2013). For the past few years, research in the field of emotional aspects of infertility has been growing. ...
Article
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Background: In a country such as India, for a woman to be socially acceptable, she should be able to bring forth an offspring of her own. The inability to have offspring is a devastating experience for a couple as a dyad. Infertility, and its perceived undesirability, upsets women’s lives in physical, mental, emotional, financial, social, and spiritual aspects. Anxiety and depression are the two major psychological disturbances reported to be prevalent among infertile women. Aim: The study aimed to assess the level of depression in childless women undergoing infertility treatment. Setting and Design: A total of 253 women undergoing infertility treatment in a tertiary care hospital in Pattambi, Palakkad District, Kerala from January 2016 to December 2019 were included in this study. The research is a cross-sectional study. Methods and Material: Beck Depression Inventory and socio-demographic data forms were used as tools. Statistical Analysis Used: Frequency and percentages were used for the analysis of descriptive data, and the Spearman correlation test was used for quantitative analysis. Results: This study found that depression was seen in 43.87% of women who participated in the study. Women who had 3–5 years of married life showed higher levels of depression than other groups. Conclusion: Infertile women have significant levels of depression, and this fact requires consideration in the management of infertility
... Prior to diagnosis, identical sex-life satisfaction score was reported by the infertile patients as well as the controls; however, their present sex-life satisfaction scores were considerably inferior to the control group [10]. ...
Article
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Recently, infertility has been affecting a large number of women than men. It is the male or female reproductive system’s disease. Consequently, after 12 months or more of usual insecure sexual intercourse, if they fail to attain pregnancy then that failure is defined as infertility. As per the National Institute of Child Health and Human Development, people in the USA have infertility issues that are found in 11% of women along with 9% of men. Women are more fertile in their 20s, while in their 30s it reduces to half of it. After 35 years, the probability of getting pregnant is diminished in women. For the woman to get pregnant, the proper functioning of the ovaries, fallopian tubes, and uterus is required. So, infertility occurs due to any issues with the above body parts. Women's infertility is caused by many factors, but the most vital cause is polycystic ovary syndrome (PCOS), which is a hormonal disorder commonly found among reproductive-aged women. So, women infertility, effects of women infertility, causes of women infertility, PCOS and detection of PCOS by general and machine learning (ML) techniques had been discussed in this paper. The accuracy attained in the detection of PCOS utilizing ML techniques is analyzed. Among people as of the top five responding countries that incorporate the USA, UK, Australia, India, together with the Philippines, the percentage of women with physician-assured PCOS against women exclusive of PCOS is analyzed.
... One of the reproductive health problems that occur at childbearing age is infertility. Infertility is the inability to conceive to give birth to a live baby after one years of having regular sexual intercourse and not using any contraception or after deciding to have children [17]. The failure of husband and wife (couple) in obtaining heredity, caused by problems in men or women. ...
Conference Paper
Due to the COVID-19 pandemic, the most widely used data in the field of research is health data. Research on health data can help the government in improving health services, overcoming health problems, National development, etc. One method that is currently being developed in the field of health statistics is classification. Classification is one of the popular sciences in data mining. One of the goals of classification is to predict data based on the model formed. The prediction was used to see the accuracy of the model in describing a data state. The classification method commonly used in the health sector is based on traditional statistical methods. It is expected to give ideal results when the sample size is infinite. However, in reality, the researchers only obtained a limited sample of data. In this study, a classification method was applied using Logistics Regression (LR) and the Support Vector Machine (SVM) method. Health data that has been used in this study is male fertility data based on lifestyle factors. The purpose of this study were to classify male fertility based on lifestyle and environmental factors as well as evaluate the most influential variables on the classification results with calculation accuracy. The results of the classification accuracy using the LR method was 65% meanwhile, using the SVM method with kernel polynomial accuracy of 95% was obtained. It means SVM method was stable in classifying a small amount of data. From 9 variables only 6 variables have a significant effect on male fertility classification. They are Season, Age, Accident Trauma, High Fever, Alcohol Consumption, Sitting per Day factors.
... This study focuses on women age 44-48 who are more likely to have higher levels of infertility. A study of 277 countries with DHS data found that secondary infertility (the inability to have a child after having one or more) ranged from 4% to 22% [17], and several studies have found that women of advanced age were more likely to experience infertility [18]. Therefore, postponement for various reasons could lead to more difficulty in reaching the ideal number of children. ...
Article
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Background There has been little research on women who have fewer than their ideal number of children toward the end of their childbearing years in low and middle-income countries (LMICs). We examine the level and distribution of unrealized fertility in LMICs across three geographical regions. We also examine the role of sex preference and other factors associated with unrealized fertility. Data and methods We used Demographic and Health Survey (DHS) data for women age 44–48 in 36 countries from the three geographical regions of Western and Central Africa, Eastern and Southern Africa, and South and Southeast Asia. We conducted descriptive analysis to examine the distribution of unwanted fertility and unrealized fertility, and fit adjusted logistic regressions of unrealized fertility. The main variables are number of living children (including by sex) and the sex composition of children. Other variables included education, marital status, age at first childbirth, wealth quintile, place of residence, exposure to family planning messages, contraceptive use, and country. Results Unrealized fertility was highest in Western and Central Africa, followed by Eastern and Southern Africa. In all regions, there was a decrease in unrealized fertility with an increasing number of children. Findings for sex preference varied with little sex preference in the African regions, and some limited evidence of preference for sons in South and Southeast Asia. In most regions, higher levels of education, higher wealth quintile, and use of contraceptive methods were associated with decreased unrealized fertility. Conclusion Family planning programs and messages should consider regional and socioeconomic differences in unrealized fertility in order to give women and families the right to achieve the family size they desire regardless of their status.
... The study conducted by Clark et al. [21] showed that females who endured a 6-month lifestyle fitness program experienced a significant increase in insulin sensitivity, which improved ovarian function and the chance of conception. Direkvand-Moghadam et al. [22] reviewed that females performing excessive workouts mayface a short luteal phase, whichis responsible for inadequate progesterone production, eventually resulting in infertility or spontaneous abortions. We have considered physically active females who are performing any form of workout > 3 times/week and found that the number of females complaining of infertility who are physically inactive is approximately double that of the females of the control group. ...
Article
Infertility affects 1 out of 6 couples of the world population and has multifactorial etiologies. The aim of the present study is to identify the correlation between some causative factors and female infertility. The detailed proforma with patient’s informed consent was filled out for total 120 females (42 control females and 78 case females, which included personal information, family history, lifestyle factors and serum hormone levels). Results showed that age, body mass index (BMI), previous history of miscarriage, and previous history of conception were significantly (p < 0.001) associated with female infertility. Similarly, independent t test results of clinical profile showed significant (p < 0.001) association of serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), progesterone, and anti-Mullerian hormone (AMH). There was a non-significant association of lifestyle factors (alcohol consumption, smoking, diet, caffeine consumption, and menstrual cycle regularity) and family history of consanguineous marriage with female infertility. Also, we have found a nonsignificant association between female infertility and complaint of infertility in other family members of probands. The present study confirms that these factors are important aspects for determining the etiology of female infertility and will further help in the management of disease and provide essential treatment if required.
... Although our study did not find a significant association between fertility status and psychological distress in women with cancers, previous studies have highlighted that fertility-related psychological distress is prevalent in cancer patients and survivors 54 . In another extensive epidemiological review that analysed 82 articles, Direkvand-M et al. iterated that modifying lifestyle factors such as smoking, alcohol and physical activity, and early diagnosis and management of chronic diseases can significantly help to improve the fertility status in women 55 . Lifestyle risk factors such as smoking, alcohol, unhealthy dietary habits and physical inactivity are responsible for several chronic diseases. ...
Article
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Abstract Infertility affects millions of people globally. Although an estimated 1 in 6 couples in Australia are unable to conceive without medical intervention, little is known about the mental health impacts of infertility. This study investigated how infertility impacts the mental health of women. The study used nationally representative Australian Longitudinal Study on Women's Health (ALSWH) data. We analysed data from survey periods 2–8 conducted every three years between 2000 and 2018 for 6582 women born in 1973–78. We used a Generalised Equation Modelling (GEE) method to investigate the association of primary, secondary and resolved fertility status and psychological distress over time. Multiple measures were used to measure psychological distress: the (1) the mental health index subscale of the 36-item short form survey (SF-36), (2) the Center for Epidemiological Studies Depression Scale (CESD-10), (3) the Goldberg Anxiety and Depression Scale (GADanx) anxiety subscale; and a (4) composite psychological distress variable. About a third (30%) of women reported infertility at any of the survey rounds; a steady increase over 18 years from 1.7% at round 2 to 19.3% at round 8. Half of the women reporting primary or secondary infertility reported psychological distress, with the odds of having psychological distress was higher in women reporting primary (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06–1.45), secondary (OR 1.27, 95% CI 1.10–1.46) or resolved infertility (OR 1.15, 95% CI 1.05–1.26) compared to women reporting normal fertility status. Women with partners, underweight or higher BMI, smoking, and high-risk alcohol use had higher odds of psychological distress, whereas women in paid work had significantly lower odds of psychological distress (p
... Diseases such as pelvic inflammation that block the fallopian tubes, psychosexual problems such as vaginismus that prevent fertilization, and cervical disorders such as surgery, infection, cancer, and trauma are other causes of infertility (Direkvand-Moghadam et al. 2013). Congenital malformations of the uterus and some uterine fibroids are involved in female infertility (Barbieri 2019). ...
Article
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Numbers of women worldwide face infertility, which will have a significant impact on a couple's life. As a result, assisting with the treatment of these individuals is seen as a critical step. Successful births following uterus and ovary donation have been reported in recent. When immunosuppressive drugs are used in patients who receive donated tissues, there are always problems with the drugs' side effects. In recent years, tissue engineering has mainly been successful in treating infertility using decellularization techniques. Engineered uterus and ovary prevent immunological reactions and do not require immunosuppressive drugs. The most important aspect of using decellularized tissue is its proper function after transplantation. These tissues must be able to produce follicles, secrete hormones and cause pregnancy. This study aimed to investigate research on decellularized tissues and transplanted into the female reproductive system. In this study, just tissues that, after transplantation, have the proper function for fertility were investigated.
... Among them, 55-75% suffer primary infertility, and 25-40% secondary infertility. These numbers are increasing gradually due to the career expectations of women and increased ages of having children (Direkvand-Moghadam et al., 2013;˙I slimye Taşkın et al., 2016;Tural & Çelik, 2019). ...
Article
This study was conducted to determine the relationship between the perceived social support, stigmatization and depression in infertile women and the influencing factors. The study was conducted on 298 infertile women at a private hospital between March and September 2019 using a Personal Information Questionnaire, Infertility Stigma Scale (ISS), Beck Depression Inventory (BDI), and Multidimensional Scale of Perceived Social Support (MSPSS). BDI had a significantly positive correlation with ISS and negative correlation with MSPSS. And MSPSS had a significantly negative correlation with ISS. Infertility leads women to suffer various psychosocial problems. Nurses should be aware of these problems during diagnostic procedures for infertility treatment, which should also include psychiatric counseling.
... [5][6][7][8] This may lead couples to consider infertility as a major catastrophe. [9,10] Studies show that diagnosis of infertility may lead to severe emotional distress, [11] marital instability, [12,13] and increased mental health issues, including depression, anxiety, low self-esteem, and aggression. [11] It is also found that men and women are similarly affected by infertility, and the same is true for the negative impact on their psychological health. ...
... The commonest causes of female infertility were pelvic inflammatory diseases, tubal factors, abortion, and ovulatory dysfunction. Similarly, a meta-analysis by Direkvand-Moghadam et al. reported these factors as causes of female infertility [40]. This indicates that the management of infections affecting the reproductive organs and abortion requires attention. ...
... The commonest causes of female infertility were pelvic inflammatory diseases, tubal factors, abortion, and ovulatory dysfunction. Similarly, a meta-analysis by Direkvand-Moghadam et al. reported these factors as causes of female infertility [40]. This indicates that the management of infections affecting the reproductive organs and abortion requires attention. ...
Article
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BACKGROUND Infertility is a practical concern of Africans due to social disgrace and exclusion. This meta-analysis aims to analyze the proportion of primary and secondary infertility and identify the etiologic factors based on the studies conducted in Africa. METHODS An internet-based search was conducted on the following databases; PubMed/Medline, EMBASE, Cochrane library, and google scholar. Both population and institution-based studies conducted among African couples, males, and females were included. Data extraction and critical appraisal of the articles were done by two independent investigators. Meta-analysis using a random effect model was conducted by Stata version 14. Forest plot, heterogeneity test, and funnel plot for publication bias were performed. RESULTS The pooled proportion of primary and secondary infertility in Africa was 49.91% (I² = 98.7, chi-square = 1509.01, degree of freedom = 19 and p < 0.001) and 49.79% (I² = 98.7, chi-square = 1472.69, degree of freedom = 19 and p < 0.001) respectively. The pooled prevalence of the causes of infertility indicated that 54.01% and 22.26% of the infertility cases were respectively due to female and male-related problems. In 21.36% of infertility cases, both sexes were affected, while 10.4% of the causes of infertility were unexplained. The pooled prevalence of mostly reported causes of male infertility was 31% (oligospermia), 19.39% (asthenozoospermia), and 19.2% (varicocele). The most commonly identified causes of female infertility were pelvic inflammatory disease, tubal factors, and abortion with a pooled prevalence of 39.38%, 39.17%, and 36.41% respectively. Conclusions In Africa, the proportion of primary and secondary infertility is approximately equal. Infertility is mostly due to female-related causes like; pelvic inflammatory diseases, uterine tube related problems, and abortion. Oligospermia, asthenozoospermia, and varicocele were the commonest causes of male-related infertility. It is suggested that interpretation and utilization of these findings should consider the presence of substantial heterogeneity between the included studies.
... 1396.113). All participants underwent clinical and laboratory examinations, a physical examination, and a sperm analysis, which assessed number, motility, viability, and morphology in accordance with the World Health Organization guidelines [16]. From every individual in both groups, 2 mL of blood was collected in sterile tubes containing EDTA (EDTA K3E 15%, 0.12 mL; BD Vacutainer, BD Vacutainer Systems, Plymouth, UK), and the blood samples were stored at −20°C before DNA extraction. ...
Article
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Objective: Spermatogenesis is a complex process that is regulated by a number of genes, some of which are involved in folate-dependent 1-carbon metabolism. Methionine synthase (encoded by MTR) is a key enzyme participating in this pathway. This study aimed to investigate the relationship of the MTR 2756A > G polymorphism with idiopathic male fertility in the Iranian population. Methods: The participants of this study included 100 men with idiopathic infertility and 100 healthy men as the control group. Genotyping of MTR 2756A > G was performed using the polymerase chain reaction and restriction fragment length polymorphism technique. The obtained data were analyzed using SPSS ver. 20.0 with a level of confidence of p< 0.05. Results: The frequencies of the A and G alleles at this locus were 77% and 23% in infertile patients and 84% and 16% in the control group, respectively. The frequencies of the GG, GA, and AA genotypes were 5%, 36%, and 59% in the infertile patients versus 3%, 27%, and 70% in the control group, respectively. No significant difference was observed in any genetic models. Conclusion: In general, the findings of this study suggest that the MTR 2756A > G single-nucleotide polymorphism is not a predisposing factor for idiopathic infertility in men.
... İnfertilite nedenleri; %40'ı kadına ait nedenler; %40'ı erkeğe ait nedenler, %10 hem kadın hem erkeğe ait nedenler ve %10'u açıklanamayan (nedeni belirlenemeyen) nedenler olarak karşımıza çıkmaktadır (1)(2)(3). İnfertilite temel olarak fiziksel bir problem olarak görülse de aslında biyolojik, sosyal, kültürel, psikolojik ve ekonomik yönleri mevcuttur (4-7). Özellikle infertilite nedenindeki belirsizlik, tedavi süresinin bilinmemesi, tedavilerin olumsuz sonuçlanması, tedavinin ekonomik yükü, toplum baskısı gibi nedenlerle psikolojik problemlerin infertil popülasyonda daha sık olduğu görülmektedir (4)(5)(6)(7)(8). ...
... The incidence of infertility in reproductive-aged women has been rising along with the changes of the modern life style and the constant deterioration of the global environment [1]. Fortunately, assisted reproductive technology (ART) brings hope to infertile couples who desire babies. ...
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Purpose: To examine available data from randomized controlled trials to assess if the freeze-all embryo and subsequent frozen-thawed embryo transfer (FET) results in better clinical outcomes than fresh embryo transfer (ET). Methods: Meta-analysis. Results: We conducted an electronic literature search on PubMed and Embase databases and manually supplemented another 2 articles from relevant citations. Seven studies were finally included in the meta-analysis,including 1141 women who underwent fresh embryo transfer and 1079 who underwent frozen embryo transfer. The results of the meta-analysis suggested that the live birth rate [RR (95% CI) 1.18 (1.08-1.30), P = 0.0003] and clinical pregnancy rate [RR (95% CI) 1.10 (1.02-1.19), P = 0.02] were significantly higher in FET group. Miscarriage rate [RR (95% CI) 0.62 (0.48-0.80), P = 0.0002], and moderate to severe OHSS occurrence rate [RR (95% CI) 0.22 (0.12 to 0.39), P < 0.00001] were significantly lower in FET group. Differences of biochemical pregnancy rate, ongoing pregnancy rate and implantation rate between the two groups did not reach the statistical significance. Conclusions: Our results suggest that the IVF/ICSI with FET is more efficient and less risky for OHSS compared with ET. However, we should comprehensively inform patients with advantages, disadvantages and potential risks related to embryo cryopreservation, and carefully assess their fertility conditions to make the most beneficial clinical decision.
... Female infertility is defined as the inability to conceive naturally or to carry a pregnancy to full term (Gaware et al., 2009). The incidence of female infertility is rising and varies from 10 to 20% (Moghadam et al., 2013). Female infertility is caused by genetic, hormonal, or environmental factors. ...
... This problem can have some consequences for the couples involved, particularly for the women (Sami & Ali, 2006). It must be mentioned that these disorders could influence directly the life style of the involved families, especially in developing countries (Shea, Rutstein, & Iqbal, 2004;Direkvand Moghadam, Delpisheh, & Khosravi, 2013). ...
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Male and female infertility is one of the medical, physiological, and emotional factorsamong couples willing to have a child. It is defined unable to achieve pregnancy after regularintercourse for 12 months without using any protection (contraceptive pills or condoms). Thereare many factors that work as a barrier to the couple for a successful conception. These factorscould be environmental, lifestyle, past medical history, and emotional. About 15 to 20% ofa couple of their reproductive age are currently suffering from this trauma in India only. Nothaving a child, consider an isolated or cut-off person in society which ultimately affects notonly the mental status of the couple as well as sociological effects. This is an observationalstudy in which we counter many demographic and reproductive factors, those work as anobstacle to a successful pregnancy in couples. That couple who are of their reproductive age,visiting an IVF center has a bundle of emotions and stress with them along with new hope tobe pregnant. Infertility has been also related to some other factors like physical conditions,environmental conditions, psychological issues, and also acquired risk factors. In females,Menstrual disorders, past medical history, hormonal disorders, overweight/obesity, and manydemographic factors, and habits, play a significant role in causing infertility. The average lengthof the marriage of infertile couples, their duration of infertility, and sterility at the first visit tothe infertility clinic has been also considered. The couples who had experienced at least oneof the assisted reproductive techniques such as microinjection, intrauterine infusion (IUI), andin-vitro fertilization (IVF) are included in this study. During this study period, All the infertilewomen who had diagnostic laparoscopy for primary infertility were included and the femalewho had less than 12 months of marriage or who had pregnancy at least once were excluded.Different environmental, physiological, and psychological conditions emphasized the need tostudy the different causes of female and male infertility in each area.
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Male and female infertility is one of the medical, physiological, and emotional factors among couples willing to have a child. It is defined unable to achieve pregnancy after regular intercourse for 12 months without using any protection (contraceptive pills or condoms). There are many factors that work as a barrier to the couple for a successful conception. These factors could be environmental, lifestyle, past medical history, and emotional. About 15 to 20% of a couple of their reproductive age are currently suffering from this trauma in India only. Not having a child, consider an isolated or cutoff person in society which ultimately affects not only the mental status of the couple as well as sociological effects. This is an observational study in which we counter many demographic and reproductive factors, those work as an obstacle to a successful pregnancy in couples. That couple who are of their reproductive age, visiting an IVF center has a bundle of emotions and stress with them along with new hope to be pregnant. Infertility has been also related to some other factors like physical conditions, environmental conditions, psychological issues, and also acquired risk factors. In females, Menstrual disorders, past medical history, hormonal disorders, overweight/obesity, and many demographic factors, and habits, play a significant role in causing infertility. The average length of the marriage of infertile couples, their duration of infertility, and sterility at the first visit to the infertility clinic has been also considered. The couples who had experienced at least one of the assisted reproductive techniques such as microinjection, intrauterine infusion (IUI), and in-vitro fertilization (IVF) are included in this study. During this study period, All the infertile women who had diagnostic laparoscopy for primary infertility were included and the female who had less than 12 months of marriage or who had pregnancy at least once were excluded. Different environmental, physiological, and psychological conditions emphasized the need to study the different causes of female and male infertility in each area.
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Assisted reproductive techniques used in the treatment of infertility have been promising methods for infertile individuals. Embryo selection and embryo transfer are an important part of assisting reproductive techniques. The selection of the embryo to be transferred is important for the implantation and clinical pregnancy success. In addition, whether to use a fresh embryo or frozen embryo for embryo transfer is a controversial issue. While the fresh embryo transfer technique is widely used, the frozen embryo transfer technique has become widespread. The main factor in choosing the method of freezing the embryos is to avoid the negative effects of controlled ovarian hyperstimulation on endometrial receptivity. Therefore, it is thought that the use of frozen embryos can improve pregnancy outcomes and reduce the risk of developing obstetric and perinatal problems. However, in the embryo freezing technique, there are problems such as the risk of developing degeneration in the embryo during freezing or thawing process and postponing the transfer. In addition, adverse conditions have been reported such as an increased risk of developing hypertensive disorders in the mother and macrosomia in the baby.
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Human infertilities are disorders that afflict many people all over the world. Both male and female reproductive systems must work together in a precise and coordinated manner and infertility has a wide range of problems for this system. Recent advances in nanomedicine immensely helped design the diagnostic and therapeutic approaches to alleviate human infertility in both sexes. Nanoscience has recently been used by researchers to increase the detection limit of infertility-related biomarkers via fabricating sensitive nanobiosensors for detecting Follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-müllerian hormone (AMH), pregnancy-associated plasma protein-A (PAPP-A), progesterone, and testosterone. At the same time, a variety of nanostructures, including magnetic nanoparticles (i.e., zinc nanoparticles, cerium nanoparticles, gold nanoparticles, silver nanoparticles), nano-vitamins, extracellular vesicles, and spermbots, have shown promising outcomes in the treatment of human infertilities. Despite recent advancements, some nanostructures might have toxic effects on cells, especially germ cells, and must be optimized with the right ingredients, such as antioxidants, nutrients, and vitamins, to obtain the right strategy to treat and detect human infertilities. This review presents recent developments in nanotechnology regarding impairments still faced by human infertility. New perspectives for further use of nanotechnology in reproductive medicine studies are also discussed. In conclusion, nanotechnology, as a tool for reproductive medicine, has been considered to help overcome current impairments.
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Infertility has recently become a growing social and economic world problem. Genital mycoplasmas, such as Mycoplasma hominis and M. genitalium, are most frequently associated with several adverse effects on men’s fertility. The present study aimed to determine the prevalence of M. hominis and M. genitalium in the semen samples in thenortheast of Iran. During thiscross-sectional study from February to May, 2018, 100 semen samples were collected from 100 infertile men in Mashhad, Khorasan Razavi province, northeast of Iran. The presence of M. hominis and M. genitalium was detected by cultivation, polymerase chain reaction (PCR), and Multiplex PCR assays. The colony of mycoplasma was confirmed by Diene’s stain; moreover, arginine hydrolysis, glucose, and urea utilization were evaluated. The following semen indices were analyzed according to World Health Organization guidelines for semen analysis: color, volume, appearance, liquefaction, viscosity, concentration, pH, leukocyte concentration, progressive motility, morphological normality, motile sperm concentration, functional sperm concentration, sperm motility index, and functional sperm. The gene of 16SrRNA (GPO1& MGSO primers) was used as the target gene of the Mycoplasma genus in PCR assay. Multiplex-PCR was performed with a specific primer for conserved regions in the 16SrRNA gene for M. hominis (RNAH1& RNAH2 primers) and the 140-kDa Adhesion Protein Gene for M. genitalium (MG1 & MG2 primers).According to the results,9 (9%) samples were PCR-positive for Mycoplasma spp , while there were 7 (7%) cases isolated by cultivation. M. hominis was detected in 8 (8%) samples by Multiplex PCR, while there was no evidence for M. genitalium. The mean age scores of all infertile and infected men were obtained at 31 and 30 years, respectively. The study could not show any statistical correlation between mycoplasma infection and abnormal semen parameters. The heterogeneity of mycoplasma prevalence in the reports can be ascribed to differences in geographic areas, the sensitivity of the identification method, condition of the group (fertile/infertile), sample size, and operator proficiency. Various results have been reported in numerous studies conducted on the relationship between mycoplasma infection and abnormal semen parameters.
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Background & Objective:Ischemia and Reperfusion (I/R) lead to the production of excessive reactive oxygen species (ROS). In the present study, the protective effects of the cell culture conditioned medium (CM) on sperm quality disorder induced by torsion-detorsion (T-D) in adult rat’s testis was evaluated. Materials & Methods:In this study, 42 adult rats were divided into seven groups. 1-Normal control group treated without surgery. 2-Laparotomy group, surgery operated without T-D. 3-T-D group, surgery operated along with T-D. 4-T-D+DMEM group, after T-D Dulbecco's Modified Eagle's Medium (DMEM) has been injected. 5-7 groups included T-D+F, T-D+M, and T-D+FM, along with T-D injected conditioned medium of fibroblast, macrophage, and fibroblast-macrophage co-culture respectively. All injections were made at a rate of 10μL once after T-D in the rete testis. After 35 days, sperm quality parameters were evaluated and obtained data were compared between groups by one-way ANOVA statistic method and Tukey test post hoc at P<0.05 level.Results:The experimental groups that received CM of the fibroblast and macrophage compared to groups T-D and T-D+DMEM showed ameliorative effects in comparison with T-D and T-D+DMEM groups. No ameliorative effects were observed in the T-D+FM group. Conclusion: The results of this study showed the high ability of supernatant of the separate fibroblast and macrophage culture in improving sperm parameters after testicular T-D. Keywords:Testicular torsion-detorsion, Fibroblast, Macrophage, Sperm quality, Rat
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World Health Organisation (1991) defines infertility as failure to conceive despite one year of cohabitation and exposure to pregnancy. If the couple has never conceives despite cohabitation and exposure to pregnancy (i.e. sexually active, non- contracepting, and non- lactating) for a period of one year, it is called primary infertility (Saoji, A. V., 2014). It is estimated that million couples suffer from infertility every year of which probably between 15-20 millions (25%) are in India alone (Sharath KC et. al 2013, Chander PP et. al 2000). As per study published at the end of 2012 by WHO, one in every four couples in developing countries had been found to be affected by Infertility (Mascarenhas MN, et. al 2012). There are many reasons for infertility both in male and female where this study examines the causes of female infertility such reasons that may cause infertility condition in female are genetic abnormalities, infectious or environmental agents and behavior. Age is also one of the most important factor that determines infertility among females. Thus, infertility is mainly classified into two types; Primary Infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after a minimum of one year of attempting to do so through unprotected intercourse. Secondary Infertility is the term used to describe couples who have previously been pregnant at least once, but had not been able to achieve another pregnancy. (Patel Mital., et. al 2012)
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The review-philosophical work is devoted to the problem of subfertility. The low fecundity of a part of individuals who are within the fertile population is one of the most urgent social and medical problems of modern society. Usually there are no obvious reasons for fertility decline in subfertile people. The work considers a paradigm in which the low existing fertility in a part of the population is able to find an explanation in connection with the existence of various normal variants of the development of organs and tissues of the reproductive system. Normally the time to pregnancy in subfertile individuals is increased. Timing in general is a major factor in optimizing the management of a couple with unexplained infertility which should be taken into account in the management of infertility. The work presents modern terminology used in reproductive medicine. The paper shows the methodological problems that can arise in the assessment of individual fertility potential. A “fertility scale” is presented that can help in assessing fertility and determining the algorithm for management of infertile couple. The modern understanding of the etiology of subfertility/infertility is showed. The role of evidential and causal decision theory used for understanding of the pathogenesis of fertility decline is discussed. Also the philosophical view on the problem of unexplained infertility and outlines approaches to its solution, which are based on the diagnosis of anatomical and physiological (physical) features of the reproductive system of subfertile individuals are presented. In the continuation of the article will consider the cause-effect relationships characteristic of subfertility and infertility, as well as methods that allow better understanding of such connections. The problem of heterogeneity of compared statistical series, the role of external and internal factors in the development of subfertility and infertility, a number of factors affecting fertility decline, the obligatory conditions for conception and the place of violations of these conditions in the structure of infertility causes, the role of “obvious” and “non-obvious” fertility will discussed. Main principles for optimization of conception conditions and the modern approaches to the management of couples with unexplained infertility are set out in the continuation of the article. The special role of transvaginal sonography in the study of the nature of subfertility and the diagnosis of the reproductive system development features is shown.
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Introduction: Infertility is a major problem in medical sciences. The prevalence of infertility is increasing worldwide. The prevalence of infertility has different based the studies conducted in various parts of Iran. Therefore, we carried out a systematic review to examine the prevalence of infertility in Iran. Methods: This study systematically reviewed the prevalence of infertility in Iran using keywords infertility, prevalence of infertility and Iran. In the initial search, 32 articles were available. After reviewing all full-texts, 13 articles were selected for analysis. Data were combined using meta-analysis (random effects model) and analyzed using STATA software version 11.1. Results: Of the 13 reviewed articles, 55658 people have been participated. Average of infertility was reported 13.2%. Overall prevalence of primary infertility and secondary infertility in Iran were respectively 5.2% and 3.2%. 2.2% of the participants in the studies had primary infertility at present. Conclusion: Despite the prevalence of infertility is different in various parts of Iran, the overall prevalence of infertility in Iran is close to the global statistic.
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Introduction: Identifying the dimensions of infertility experience in postmenopausal women, would help determining the woman's needs and may lead to appropriate design of intervening strategies in order to improve the quality of their lives. Therefore, this phenomenological study was aimed to evaluate the experience of infertility in postmenopausal women. Materials and Methods: in this phenomenological study, 8 postmenopausal infertile women were evaluated. The inclusion criteria at the time of study were: termination of menstruation for at least one year and have never been pregnant before. Women who were menopause with surgical or medical interventions were excluded. Data were collected using semi-structured interviews. Purposeful sampling was continued until data saturation. Data analysis was performed simultaneously with data collection. To ensure the accuracy of data interpretation, other colleagues also reviewed the data. To determine the validity of the findings, results were returned to some of the participants for further evaluation. Results: According to the codes and categories obtained in this study a main concept of experiences named the mother concept and other eight sub-concepts including the social relations, insecurity, resourcefulness, culture, spirit, cause of infertility, beliefs and barriers to treatment, were extracted. Conclusions: Infertility is a very important and crucial concept in the life of most women. Infertility affects many aspects of the women’s life. This situation is more obvious at the end of the child bearing years and beginning of menopause. Studying the dimensions and importance of infertility for postmenopausal women would lead us to the identification of the perspectives and needs of infertile women. © 2015, Semnan University of Medical Sciences. All rights reserved.
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The purpose of this matched case-control study was to investigate the social correlates of primary infertility among females aged 35 years or less. The study was conducted in the Clinics of Samarkand Medical Institute, Uzbekistan, among 120 infertile and 120 healthy women matched by age, residential area, and occupation from January to June 2009. Data were collected by face-to-face interviews using a structured questionnaire. Median duration of infertility was 10.0 months (interquartile range = 6.0-13.0). The rate of remarriage was 3.5 times higher among infertile women compared with healthy subjects. Insufficient family income, poor quality of life, life stress, and discontentment with daily routines as well as 'bad' relationships with family members (husband, mother- and father-in-law) were significant correlates of female infertility. Infertile women were more likely to underestimate the importance of sexual intimacy, and a negative attitude to sex. Female infertility is associated with various social correlates leading to higher remarriage rates and to further complicating the problem of infertility. Thus, a correction of women's basic attitudes and their relationships to their surrounding social habitat should be an essential component of any program of infertility management.
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Infertility is a significant disability, yet there are no reliable estimates of its global prevalence. Studies on infertility prevalence define the condition inconsistently, rendering the comparison of studies or quantitative summaries of the literature difficult. This study analyzed key components of infertility to develop a definition that can be consistently applied to globally available household survey data. We proposed a standard definition of infertility and used it to generate prevalence estimates using 53 Demographic and Health Surveys (DHS). The analysis was restricted to the subset of DHS that contained detailed fertility information collected through the reproductive health calendar. We performed sensitivity analyses for key components of the definition and used these to inform our recommendations for each element of the definition. Exposure type (couple status, contraceptive use, and intent), exposure time, and outcomes were key elements of the definition that we proposed. Our definition produced estimates that ranged from 0.6% to 3.4% for primary infertility and 8.7% to 32.6% for secondary infertility. Our sensitivity analyses showed that using an exposure measure of five years is less likely to misclassify fertile unions as infertile. Additionally, using a current, rather than continuous, measure of contraceptive use over five years resulted in a median relative error in secondary infertility of 20.7% (interquartile range of relative error [IQR]: 12.6%-26.9%), while not incorporating intent produced a corresponding error in secondary infertility of 58.2% (IQR: 44.3%-67.9%). In order to estimate the global burden of infertility, prevalence estimates using a consistent definition need to be generated. Our analysis provided a recommended definition that could be applied to widely available global household data. We also summarized potential biases that should be considered when making estimates of infertility prevalence using household survey data.
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Aim of this study was to describe the proportion of contributory factors of female infertility in a population that sought fertility treatment. Furthermore, the clinical findings and underlying pathologies associated with ovulatory dysfunction were also sought. A cross-sectional study was carried out at the infertility clinic of the North Colombo Teaching Hospital. New clinic attendees were recruited and both partners had a detailed clinical interview. The women underwent a baseline pelvic ultrasound scan, assessment of ovulation and a hormone profile. Tests for tubal patency were carried out when clinically indicated. Ovulatory dysfunction was noted in 53% (n=218). Clinical and investigatory findings associated with ovulatory dysfunction included irregular menstrual cycles, acanthosis nigricans, hirsutism, polycystic ovary syndrome, a LH:FSH ratio of >1, and increased TSH or testosterone levels. Unilateral tubal occlusion was seen in 9.1 % (n=18) while it was bilateral in 1% (n=2). Abnormalities in sexual function were noted in 10.8% (n=56). Abnormalities in ovulation were common. Clinical findings that could be used to recognise women at risk of ovulatory dysfunction were identified. Abnormalities in sexual function, which are often overlooked in the clinical management of infertility, were seen in over 10% of patients. Tubal factor infertility is rare.
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Infertility is defined as the inability of a couple to conceive after 12 months of regular, unprotected intercourse. However infertility is a clinical presentation and not a disease. Thus to be able to offer a new classification, it is necessary to apply a clinical presentation (philosophy) suggested by the University of Calgary in 1991. In recent years several classification algorithms have been proposed which apply key predictors of clinical, imaging, or morphological types to determine the diseases that can cause infertility. On the other hand, an algorithm is a product of an expert's mind after many years of practice and experience, which is too difficult to understand by a medical student. However there has not been any simple schematic classification based on a logical justification applying integration of etiologies with basic science to break down etiologies into categories, subcategories and disease classes of this clinical presentation. Because etiology has also become an important criterion for the characterization of causes of infertility, a classification proposal is presented here that attempts to include all relevant (basic science) features of the causative diseases of this clinical presentation.
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ADHD prevalence has risen in parallel with rising prevalence of pregnancy smoking and childhood obesity. The objective was to determine the epidemiological association of pregnancy smoking and childhood obesity with ADHD. A cross-sectional community study was conducted in 2006 using a parental questionnaire. A total of 1,074 schoolchildren aged 5-11 years were enrolled from 15 primary schools in a lower socio-economic area of Merseyside. ADHD was defined by the question "does your child have Attention Deficit Hyperactivity Disorder, (ADHD), which has been diagnosed by a doctor?" The prevalence estimates for childhood obesity, maternal smoking during pregnancy and childhood ADHD were 14.9% (116/777), 28.0% (269/955), and 3.4% (32/945), respectively. ADHD prevalence increased fivefold in children with obesity (RR, 4.80, 95% CI 2.2-10.4, P < 0.001) and more than twofold in children of mothers who smoked during pregnancy (RR, 2.44, 95% CI 1.2-4.9, P = 0.02). Regression analysis adjusting for obesity, overweight, maternal smoking during pregnancy, heavy maternal smoking, household member smoking during pregnancy, doctor-diagnosed asthma, preterm birth, and low birthweight showed significant independent associations of ADHD prevalence with obesity (AOR, 4.66, 95% CI 1.57-13.89, P = 0.006) and pregnancy smoking (AOR, 3.19, 95% CI 1.08-9.49, P = 0.04). There was a positive dose-response association of ADHD with the number of maternal cigarettes smoked during pregnancy. Measures to reduce both smoking among pregnant women and childhood obesity might reduce prevalence of childhood ADHD.
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Women with infertility experience higher rates of psychological distress compared with their fertile counterparts. In developing countries, socio-cultural factors may aggravate this distress. We aimed to determine the prevalence of psychological distress as well as its associated socio-cultural characteristics among women attending the infertility clinic of a tertiary hospital in Nigeria. Women (n=100) attending an infertility clinic were consecutively recruited over a two-month period and compared with a similar number of pregnant women attending the antenatal clinic at the same hospital. A semi-structured questionnaire was designed to record socio-demographic and clinical variables. The 30-item General Health Questionnaire was used to screen for psychological distress. The prevalence of probable psychological distress was significantly higher among the infertile group compared with their fertile counterparts (P<0.001). There were significant differences between the groups in terms of their mean age (P<0.01), employment status (P<0.02), educational status (P<0.01), and duration of marriage (P<0.001). Infertile women who had previously sought help from a traditional or faith-based healer for infertility were more likely to experience probable psychological distress (P<0.017). Infertile women are more vulnerable to psychological distress and require psychological support. There is a need to incorporate mental health screening and treatment in the routine care of infertile women in Nigeria.
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The aim of this study was to verify whether anti-thyroid antibodies are present in the follicular milieu of euthyroid infertile women with thyroid autoimmunity undergoing in vitro fertilization (IVF) and whether IVF outcome is different in affected women with respect to negative controls. A secondary endpoint was to check whether there are changes in thyroid hormone levels during the IVF cycle. Anti-thyroglobulin and anti-thyroperoxidase levels were measured in both follicular fluid and serum on the day of oocyte retrieval in women with thyroid autoimmunity. Serum TSH, FT3, and FT4 levels were measured in all patients before treatment initiation, on the day of oocyte retrieval and of pregnancy test. IVF outcome parameters were recorded in all women. Oocyte fertilization, grade A embryos, and pregnancy rates were lower in women with thyroid autoimmunity than in negative controls, while early miscarriage rate was higher. Anti-thyroid antibodies were measurable in follicular fluid in all affected women and were strongly correlated with serum levels. No significant changes in thyroid hormone levels were recorded in any women. The presence of anti-thyroid antibodies in ovarian follicles, as demonstrated for the first time in this study, may play a critical role in female infertility related to thyroid autoimmunity.
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There is now compelling evidence that long-term health and physiological function are modified by events that occur early in life and involve interactions between the genome and the developmental environment. That reproductive function may similarly be influenced by early life events has been established in selected human populations, and investigations into underlying mechanisms are the subject of current animal studies. No systematic literature search was conducted. This review highlights early life influences on reproduction with a particular focus on nutritional impacts, and provides a brief overview with reference to some key studies in both the human and animal literature. We highlight the controversies, current unanswered questions and mechanisms underlying the association between the early life environment and long-term reproductive function. Currently, the impact of early life events on reproductive health and disease risk is poorly understood. It is clear, however, that nutrition spanning the entire developmental lifespan plays an integral role. Improved insight into the underlying mechanisms is likely to have significant implications for our current understanding of reproductive disorders, and therefore for the health and reproductive potential of future generations.
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Genital infections represent one of the most important causes of infertility, affecting: fallopian tubes, endometrial mucosa, sperm parameters. The aim of this study is to evaluate the involvement of four sexually transmitted infections (STD) in the achievement of infertility and to establish the prevalence of each infectious agent in our patients. We analyzed the presence of Chlamydia trachomatis (CT) antigen, Ureaplasma urealyticum (UU), Mycoplasma hominis (MH) and Neisseria gonorrhoeae (NG) in the endocervical secretions and Chlamydia trachomatis antibodies IgA, IgG, IgM in the serum of 125 infertile women as well as in 30 pregnant women in the 3rd trimester of pregnancy, as a control group. RESULTS. In infertile women, the prevalence rate of the four bacterial markers was: CT antigen 1/125 (0.80%), CT IgG antibodies 19/125 (15.20%), MH 6/125 (4.80%), UU 51/125 (40.80%) and NG 1/125 (0.8%). From the control group, none was positive for CT antigen, but 1/30 (3.33% of patients) was positive for CT IgA while the prevalence rate for MH and UU were 16.66% and 43.33% respectively. We couldn't prove any association between genital MH/UU and infertility as the prevalence was higher in the control group than in the cases, but the correlation of the CT infection with the infertility was clearly shown. However, it is necessary to perform routine tests to screen for CT, NG, UU and MH among infertile patients. The positivity for CT IgG is a marker better correlated with fallopian tube obstruction than the CT antigen.
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Overweight and obesity are an epidemic in Western society, and have a strong impact on fertility. We studied the consequences of overweight and obesity with respect to fecundity, costs of fertility treatment and pregnancy outcome in subfertile women. We searched the literature for systematic reviews and large studies reporting on the effect of weight on both fecundity and pregnancy outcome in subfertile women. We collected data on costs of treatment with ovulation induction, intrauterine insemination and in vitro fertilization, as well as costs of pregnancy complications. We calculated, for ovulatory and anovulatory women separately, the number of expected pregnancies, complications and costs in a hypothetical cohort of 1000 normal weight, overweight and obese women each. In our hypothetical cohort of 1000 women, compared with women with normal weight, live birth was decreased by 14 and 15% (from 806 live births to 692 and 687 live births) in overweight and obese anovulatory women, respectively, for ovulatory women it was decreased by 22 and 24% (from 698 live births to 546 and 531 live births), respectively. These outcomes were associated with an increase in the number of complications and associated costs leading to cost per live birth in anovulatory overweight and obese women were 54 and 100% higher than their normal weight counterparts, for ovulatory women they were 44 and 70% higher, respectively. Overweight and obese subfertile women have a reduced probability of successful fertility treatment and their pregnancies are associated with more complications and higher costs.
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This review summarizes the epidemiology and consequences of maternal smoking in pregnancy, with emphasis on the adverse effects on birth outcomes. In developed countries, approximately 15%, and in developing countries, approximately 8% of women smoke cigarettes, and adolescents and women from lower socioeconomic groups are more likely than other women to smoke while pregnant. Maternal smoking during pregnancy is the largest modifiable risk factor for intrauterine growth restriction. A meta-analysis of recent studies showed that the pooled estimate for reduction of mean birthweight was 174 g (95% confidence limits 132-220 g). Other studies confirm a weaker association between maternal smoking and preterm birth. The population attributable risk of low birthweight due to maternal smoking in the UK is estimated to be 29-39%. Tobacco smoke toxins damage the placenta and may lead to placental abruption, abortion or placenta praevia. Infants of mothers who smoke in pregnancy are at an increased risk of respiratory complications including asthma, obesity and, possibly, behavioral disorders. These effects may be dose-related, as there is good evidence that mean birthweight decrements are greater with increased numbers of cigarettes smoked during pregnancy. Cotinine is a useful indicator of tobacco smoke exposure in pregnant women and higher levels in body fluids have been related to lower birthweights. Maternal genetic polymorphisms of the cytochrome P (CYP)450 and glutathione-S-transferase (GST) subfamilies of metabolic genes influence the magnitude of the effect of nicotine exposure on birth outcomes through their influence on nicotine metabolism. Greatly increased risk of cigarette smoke-induced diseases, including low birthweight, has been found in individuals with susceptible genotypes. Interventions to control maternal smoking are also considered.
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To identify risk factors associated with depression and anxiety in infertile women and men undergoing in vitro fertilization (IVF). Prospective study. A university hospital in Sweden during a 2-year period. 825 participants (413 women and 412 men). Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as the diagnostic tool for evaluating mood and anxiety disorders, and fertility history and outcome of IVF treatment collected from the patients' medical records. Risk factors associated with depression and anxiety disorders. A negative pregnancy test and obesity were the independent risk factors for any mood disorders in women. Among men, the only independent risk factor for depression was unexplained infertility. No IVF-related risk factors could be identified for any anxiety disorder. A negative pregnancy test is associated with an increased risk for depression in women undergoing IVF, but no risk of developing anxiety disorders is associated with the pregnancy test result after IVF. Pregnancy test results were not a risk factor for depression or anxiety among men.
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Cigarette smoking amongst pregnant adolescents is a preventable risk factor associated with low birthweight (<2,500 g), preterm birth (<37 weeks) and infant mortality. The aim of this study was to compare birth outcomes of adolescents who smoke during pregnancy with those who do not and to construct their birthweight-for-gestational-age curves. A retrospective cohort analysis of 534 adolescents (<or=19 years) and 8972 adults who delivered singleton births between 1998-2003 at the Liverpool Women's Hospital. Adolescent pregnancy occurred in 5.6% of deliveries. Mean age of adolescents was 18.1 years (SD = 1.0) and 46.2% smoked during pregnancy including 83.5% light smokers (<10 cigarettes daily). Babies born to adolescent smokers were significantly lighter by -170 g (P = 0.005). The prevalence of low birthweight was almost double in adolescents who smoked (12.1% versus 6.8%, RR = 1.7; CI = 1.0-3.0), and their mean Apgar scores at 5 min were lower (<0.05). A higher prevalence of preterm birth (P < 0.05) and maternal anaemia (P < 0.01) occurred amongst adolescent smokers. Adolescents smoking >10 cigarettes daily had babies with larger birthweight reduction (P = 0.001). Almost half of all adolescents smoked during their pregnancy. Birthweight-for-gestational-age curves of smoking adolescents showed a marked fall-off in weight from 36 weeks of gestation, and at least 10% of adolescent smokers showed fetal growth restriction from before 32 weeks of gestation.
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Obesity is strongly associated with female infertility, but the mechanisms underlying this relationship are largely unknown. We investigated the effect of increasing dietary fat percentage upon body mass, hypothalamic neuropeptide gene expression, adipose hormone secretion and fertility in females of the inbred mouse strains C57BL/6J and DBA/2J. To assess the effect of obesity independent of dietary influence, we also compared these parameters in wild-type female C57BL/6J mice to those congenic for the obesogenic mutations ob/ob and A(y)/a. After 24 weeks, rather than exhibiting an obese, leptin-resistant phenotype like their female DBA/2J counterparts, wild-type female C57BL/6J mice remained lean, fertile and manifested increased hypothalamic LEPR-B expression. Although both mutant genotypes were associated with obesity and subfertility, ob/ob mice demonstrated significantly increased hypothalamic LEPR-B expression, whereas A(y)/a mice had a significant reduction. Interestingly, wild-type female C57BL/6J mice were noted to manifest significantly higher and lower levels of adiponectin and tissue plasminogen activator inhibitor-1 (tPAI-1), respectively, than weight-matched wild-type female DBA/2J mice. We conclude that (1) resistance to the obese-infertile phenotype in female C57BL/6J mice is associated with increased hypothalamic leptin receptor expression and alterations in adipokine levels consistent with decreased adipose tissue inflammation and (2) that long-standing hyperleptinemic obesity in mice is associated with a downregulation of the hypothalamic leptin receptor.
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Chlamydia trachomatis is a well recognized sexually transmitted pathogen. Besides its potential to produce genital tract infection, C. trachomatis is increasingly being associated with long-term complications like infertility. The present study was undertaken to assess the role of C. trachomatis in female infertility as such data are lacking. Women of primary and secondary infertility (n=110) and 30 healthy term pregnant women as control group were enrolled in the study. Detailed clinical history of each patient was recorded. Hysterosalpingography was performed in all patients. Endocervical swabs were collected for culture on cycloheximide treated McCoy cell line and for antigen detection by ELISA. C. trachomatis was detected in 31 (28.1%) of the 110 infertile women while one (3.3%) in control group was positive for C. trachomatis (P<0.01). Cell culture alone identified 25 (22.72%) patients suffering from chlamydial infection while C. trachomatis antigen was detected by ELISA in 18 (16.37%) patients. The one control case was positive for Chlamydia antigen by ELISA and not by cell culture. Chlamydial positivity was seen in 20 of the 74 (27%) women with primary infertility and in 11 of the 36 (30.6%) with secondary infertility. Of the 58 asymptomatic women, 21(36.2%) had chlamydia infection while among the 52 symptomatic cases 10 (19.2%) were infected; 38 per cent women with chlamydial infection also had tubal occlusion. A significantly high rate of C. trachomatis infection was found in infertile women and more so in asymptomatic females and in secondary infertility cases. Lack of symptoms make clinical diagnosis of chlamydial infection difficult. Screening of infertile women for C. trachomatis is therefore recommended so far early therapeutic interventions.
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Although the relationship between emotional stress and infertility has been widely accepted, this knowledge is still not widely utilized in the care of the infertile couple. One of the reasons for this lies in the difficulty in assigning a clear-cut causal relationship between infertility and emotional factors. Nevertheless, the evidence is overwhelming that such a relationship exists. Emotional tensions can directly affect fertility by altering hypothalamic-pituitary pathways or by causing tubal spasm, and indirectly by contributing to vaginismus, dyspareunia, frigidity and to a decrease in male libido. Equally important to the concept that emotional stress can effect fertility is the concept that infertility can result in emotional stress, thus, initiating a vicious circle. Many couples who prior to the development of an infertility 'problem', were in a state of good emotional health, suffer a serious emotional breakdown in association with the state of infertility, a 'crisis of infertility'. This can be aggravated by the infertility tests, the treatment and by instructions of the therapist that invade the psychosexual life of the couple. It is therefore necessary that the physician dealing with the infertile couple be aware of the role that primary emotional factors may have on the infertility, the fact that emotional factors are created by the fact of infertility, the additional emotional tensions that his or her tests and treatments might add to the problem.
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With the demands of the modern western world of today, women delay the conception of their first child and this adversely impacts on their fertility. Vast attempts have been made to diagnose and counter ageing women infertility. In this literature review article, we bring forward theories which may account for the age-related decline of fertility and explained about the assessment and treatment modalities currently available. After concluding that ovarian stimulation with the use of gonadotrophins and clomiphene citrate is not useful in women of 40 year and over, it leaves us with in-vitro fertilization as the most suitable method of increasing the rate of successful pregnancies and live birth rates. It is important to campaign the effects age has on fertility since, even highly educated women, are not aware of the full impacts age has on fertility.
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Objective: The objective was to evaluate the effects of infertility and its duration on female sexual functions. Materials and methods: One-hundred and seventy-four (21.5 %) primary infertile cases, who attended the infertility outpatient clinic of our hospital, with a mean age of 31.2 ± 3.8 (range 20-45), have been determined as study group. In addition, 635 (78.5 %) cases with a mean age of 32 ± 3.2 (range 17-45) years, which attended the gynecology outpatient clinic with various complaints, were included as the control group. Infertile cases were grouped into three according to infertility duration: less than 2 years (Group I), 2-5 years (Group II), and 5 years and longer (Group III). Sexual dysfunction was evaluated via Turkish version of female sexual function index (FSFI) in the women who accepted to participate in this research. Results: All the 809 cases incorporated in our study were found to be at risk for sexual dysfunction. Upon comparison between infertile and fertile groups, no meaningful statistical difference was determined within the scores of desire, arousal, lubrication, orgasm, sexual satisfaction, pain and total FSFI parameters (p > 0.05). The assessment on infertility durations showed that only sexual satisfaction scores were similar, whereas all other parameter scores and total FSFI scores were different significantly between all three groups. The scores got meaningfully lower as infertility duration of the couples extends (p < 0.05). Conclusions: As the infertility duration extends, the scores of all parameters, except sexual satisfaction, decreases. But as many factors play a role in female sexual dysfunction, to blame prolonged infertility as a situation that negatively affects female sexual life, prospectively designed studies should be performed.
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Patients with cancer are at risk of loss of gonadal function due to the cancer treatment. Chemo- and radiation therapy are known to induce gonadal failure in both men and women and especially treatment with alkylating agents and/or abdominal or testicular radiation therapy poses a high risk. Methods exist to preserve fertility and these should be discussed with and offered to the patient if necessary and possible. For men, cryopreservation of semen is simple, non-invasive and low-cost. For women, cryopreservation of oocytes, embryos or ovarian tissue is an option in order to preserve fertility.
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Chlamydia trachomatis has for long been considered to be a major contributor to tubal infertility. However, the scientific evidence based on human clinical research is weak. C. trachomatis is associated with pelvic inflammatory disease, and pelvic inflammatory disease is associated with tubal infertility. But no interventional trial nor well-conducted study or large cohort study has assessed the risk of infertility given an undiagnosed or untreated genital chlamydial infection. We suggest that the many well established registers in Denmark serve to further elucidate the evidence.
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The aim of this study was to compare the frequency of abnormal cervical cytology in women with infertility problems with that of fertile women by using ThinPrep® liquid-based Pap Tests™. A retrospective case–control study for over 2 years was conducted. The cases included all women with infertility problems who had Pap tests during their infertility treatment period. The cases were further subdivided into primary and secondary infertility groups. The control group included all women without infertility problems who had routine Pap tests in the same period. The age and demographic features were adjusted and matched for both groups. Statistical analysis included chi-square test and Fischer exact test. The infertility group (n = 490) showed significantly (P < 0.05) more abnormal cervical squamous epithelial abnormalities (48 positive cases, 9.8%) than the controls (n = 7,150, 216 positive cases, 3%). Women with secondary infertility had more epithelial abnormalities and more high-grade lesions than women with primary infertility. Women with infertility had statistically significant higher frequency of squamous intraepithelial lesions than women without infertility problems of similar age and demographic background. The data suggest that women with infertility might benefit from more frequent cervical cytology screening. Diagn. Cytopathol. 2010;38:791–794. © 2009 Wiley-Liss, Inc.
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The functional reproductive alterations seen in women with type 1 diabetes (T1D) have changed as therapy has improved. Historically, patients with T1D and insufficient metabolic control exhibited a high prevalence of amenorrhea, hypogonadism and infertility. This paper reviews the impact of diabetes on the reproductive axis of female T1D patients treated with modern insulin therapy, with special attention to the mechanisms by which diabetes disrupts hypothalamic-pituitary-ovarian function, as documented mainly by animal model studies. A comprehensive MEDLINE search of articles published from 1966 to 2012 was performed. Animal model studies on experimental diabetes and human studies on T1D were examined and cross-referenced with terms that referred to different aspects of the gonadotropic axis, gonadotrophins and gonadal steroids. Recent studies have shown that women with T1D still display delayed puberty and menarche, menstrual irregularities (especially oligomenorrhoea), mild hyperandrogenism, polycystic ovarian syndrome, fewer live born children and possibly earlier menopause. Animal models have helped us to decipher the underlying basis of these conditions and have highlighted the variable contributions of defective leptin, insulin and kisspeptin signalling to the mechanisms of perturbed reproduction in T1D. Despite improvements in insulin therapy, T1D patients still suffer many reproductive problems that warrant specific diagnoses and therapeutic management. Similar to other states of metabolic stress, T1D represents a challenge to the correct functioning of the reproductive axis.
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To explore the distribution and factors associated with female infertility in 3 areas in Xinjiang Uygur Autonomous Region so as to provide rationales for the prevention, diagnosis and treatment of infertility. A total of 1895 women of reproductive age were enrolled with a cluster random stratified sampling method. A questionnaire survey and pelvic examinations were conducted. The collected data were statistically analyzed. The prevalence of infertility in these three areas ranged from 7.5% (76/1014) to 26.2% (144/550) with an average of 15.2% (279/1835). The prevalence of infertility was the highest in Shan shan and it was related with its unique geographical environment and life style. The lower levels of education and income, the higher prevalence of infertility. The occurrence of infertility was also correlated with their residence, premarital sex, body mass index and some concurrent diseases. It is necessary to carry out further studies on healthful life styles and those factors associated with the morbidity of infertility. The prevalence of infertility may be reduced and local reproductive health improved by avoiding or reducing the adolescent premarital sex and unmarried abortion.
Article
Female infertility occurs in about 37% of all infertile couples and ovulatory disorders account for more than half of these. The ovaries are in continuous interaction with the other endocrine organs. The interplay may account for infertility occurring at different levels and may render the diagnosis of infertility a difficult exercise for the involved physician. A hypothalamic cause of female infertility should be considered in an appropriate clinical context, with tests pointing to a hypogonadotropic hypogonadism. It can be functional, physiological or related to organic causes. Hyperprolactinemia has well characterized effects on the normal gonadal function and treatment is well established. Acromegaly and Cushing's disease may impair fertility at different levels, mechanisms involved however remain ill defined. Thyroid disorders, both hyperthyroidism and hypothyroidism, can interact with the ovaries, through a direct effect on ovarian function, but autoimmunity may be involved, as well as alterations of the sex hormone binding protein levels. Primary ovarian disorders, such as the polycystic ovary syndrome and primary ovarian insufficiency are frequent diseases, for which novel treatments are currently being developed and discussed. We will propose an algorithm for the diagnosis and approach of the female patient presenting with infertility on the basis of the available evidence in literature.
Article
Cigarette smoking is associated with lower fecundity rate, adverse reproductive outcomes and higher risk of IVF failure. Over the last decades, prevalence of smoking among women of reproductive age has increased. The aim of this work was first to focus on the knowledge of the effects of cigarette smoking on reproductive stages and particularly on implantation process and early placentation. Human clinical and experimental studies were analysed in order to find hypothesis and explanations for the effects observed. Then, our second aim was to analyse which factors could influence smoke effects. We observed that smoke compounds induce impairment of endometrial maturation, disturb angiogenesis and trophoblastic invasion. Cigarette compounds also impair uterine and endometrial vascularisation and myometrial relaxation. These effects lead to implantation failure in IVF and higher risk of miscarriage. Many factors influence the effects of cigarette smoke, as smoke behaviour, dose and duration of exposition. Sidestream is also damaging on reproductive function. Prenatal exposure leads to irreversible and deleterious effects on ovarian reserve. These observations need to be confirmed in order to improve health care in women of reproductive age. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Article
We previously have shown the efficacy of recombinant (r) chlamydial protease-like activity factor (CPAF) vaccination against hydrosalpinx development following primary genital chlamydial challenge. In this study, we evaluated further the protection induced by rCPAF vaccination against infertility. Following primary challenge, fertility levels were not significantly different between the mock- and CPAF-vaccinated and Chlamydia alone challenged mice. However, following secondary genital chlamydial challenge, mock (PBS) immunized mice displayed a significant reduction of fertility compared to age-matched naïve mice, while mice vaccinated intranasally with rCPAF+CpG displayed significant prevention of infertility. These results suggest that hydrosalpinx may be a reliable indicator of impending infertility, and that rCPAF is a promising candidate to prevent infertility resulting from repeated genital chlamydial infections.
Article
To find out different causes of female infertility with diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. A case series. Department of Obstetric and Gynaecology, Liaquat University Hospital (LUH), Hyderabad, rom January 2006 to December 2007. All infertile women underwent diagnostic laparoscopy for primary and secondary infertility during the study period were included. Couples who had not lived together for at least 12 months, and those with male factor infertility were excluded. Data were collected on a proforma, and analysed on SPSS package for windows version 10. Frequencies were calculated for laparoscopic findings regarding primary and secondary infertility. Fifty infertile women underwent laparoscopy during the study period, 32 (64%) had primary infertility while 18 (36%) secondary infertility. Eight (25.0%) patients with primary and 2 (11.1%) patients with secondary infertility had no visible abnormality. The common finding was tubal blockage in 7 (21.9%) and 6 (33.3%) cases of primary and secondary infertility respectively. Five (15.6%) cases of primary infertility were detected as polycystic ovaries (PCO) which was not found in cases of secondary infertility. Endometriosis was found in 4 (12.5%) cases with primary infertility and 2 (11.1%) cases with secondary infertility. Pelvic inflammatory disease (PID) was found in 1 (3.1%) and 2 (16.7%) cases of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 2 (6.3%) cases with primary infertility and 4 (22.2%) cases with secondary infertility. Fibriod was found in 2 (6.3%) and 1 (5.6%) cases of primary and secondary infertility respectively. Ovarian cyst detected in 2 (6.3%) cases with primary infertility while none was found in cases of secondary infertility. Most common causes responsible for infertility were tubal occlusion, endometriosis, peritubal and periovarian adhesions. Ovarian causes were seen in primary infertility only.
Article
A recent decline in the male:female (M:F) sex ratio may relate to pregnancy cigarette smoke exposure. Aim: To assess trends and cigarette exposure dose-response effects on the sex ratio. A retrospective analysis was carried out of deliveries at the Liverpool Women's Hospital between 1998 and 2003, and of deliveries reported in community surveys from the same area in 1998 and 2006. For the hospital sample, the M:F sex ratio was 1.14 if no parent smoked, and 0.77 when both parents smoked during the mother's pregnancy (p < 0.001). Heavy maternal smokers (>10 cigarettes per day) were more likely to deliver a female baby than light smokers (p < 0.001). Smoking was associated with increased likelihood of female birth controlling for birth year, socio-economic status, alcohol exposure, maternal haemoglobin and body mass index (adjusted OR: 1.41, 95% CI 1.12-1.92, p < 0.001). In the community sample controlling for socio-economic status the ratios were 1.13 (95% CI 1.03-1.24, p = 0.015) in 1998 and 1.31 (95% CI 1.16-1.48, p < 0.001) in 2006. Secular trends showed decreasing ratios in hospital and community samples for both smokers and non-smokers. Pregnancy cigarette smoking increased the proportion of female births with evidence for a dose-response association.
Article
The aim of this study was to compare the effects of bromocriptine versus cabergoline on pregnancy in hyperprolactinaemic infertile women. A total of 183 infertile women with hyperprolactinemia undergoing intrauterine insemination (IUI) were randomly divided into two groups. Group A: 94 with bromocriptine and group B:89 with cabergoline. The efficacy and safety was evaluated on the basis of normalization of prolactin levels, normalization of menstrual cycle, disappearance of galactorrhea, occurrence of pregnancy and adverse effects with each of these medications. The presence of galactorrhea and irregular menstruation were significantly lower in patients of group B than group A (P<0.001 and P=0.011, respectively) with a significant lower prevalence of side effects in cabergoline group. Pregnancy was significantly more achieved among the women with the treatment of cabergoline (82%) as compared to bromocriptine (56.4%) (P<0.001). Our results suggest that cabergoline treatment in infertile women with prolactinemia is more effective. It lowers prolactin with better tolerability and much more effective in the achievement of pregnancy.
Article
To determine the impact of infertility on female sexual function. A case-control study. Academic infertility and gynecology practices. One hundred nineteen women with infertility and 99 healthy female controls without infertility between the ages of 18 and 45 years were included in this study. Anonymous survey and Female Sexual Function Index. Female Sexual Function Index scores, frequency of sexual intercourse and masturbation, and sex-life satisfaction. Twenty-five percent of our control group had Female Sexual Function Index scores that put them at risk for sexual dysfunction (<26.55), whereas 40% of our patients with infertility met this criterion. Compared with the control group, the patients with infertility had significantly lower scores in the desire and arousal domains and lower frequency of intercourse and masturbation. The patients with infertility retrospectively reported a sex-life satisfaction score that was similar to that of the controls before their diagnosis, whereas their current sex-life satisfaction scores were significantly lower than those of the controls. Women with a diagnosis of infertility were found to be at higher risk for sexual dysfunction on the basis of their Female Sexual Function Index scores compared with women without infertility. The interaction of sexual function and infertility is complex and deserves further study.
Article
Niemann Pick C2 (NPC2) and NPC1 proteins function cooperatively to catalyze cholesterol efflux from lysosomes. NPC1 is expressed in ovarian cells and female NPC1 mice are infertile. This work addressed for the first time the localization and function of murine NPC2 protein in the ovary. Ovarian NPC2 was localized to theca and luteal cells, which use cholesterol as a substrate to produce estradiol and progesterone, respectively. NPC2 deficient (NPC2-/-) females had abnormal estrous cycles and were infertile, with normal folliculogenesis until the antral stage, but a complete absence of corpora lutea and many zonae pellucidae remnants, indicative of anovulation. Serum estradiol was reduced and ovarian cholesterol was accumulated in NPC2-/- mice, suggesting a defect in cholesterol export from intracellular stores. After superovulation, NPC2-/- mice ovulated less eggs than their wild type littermates, showed ovaries with less corpora lutea and numerous unruptured follicles, and lower serum progesterone concentration. Together, these results suggest that NPC2 participates in the traffic of ovarian cholesterol required to provide the substrate for steroid synthesis and support follicle maturation, ovulation and luteinization.
Article
Understanding the risk factors of female infertility among child-bearing aged women, in Nanchang area. A hospital-based matched case-control study was carried out in Nanchang. Matched by age (+/- 2 years old), 383 pairs of cases and controls were recruited and studied. Database was established with EpiData 3.0 software. Both cases and controls were interviewed face to face, with a uniformed questionnaire. Conditional logistic regression model was used for univariate and multivariate analysis on SPSS 11.5 to estimate odds ratios (OR) and 95% confidence intervals (CI). Data from multiple conditional logistic regression analysis showed that the risk factors of infertility would include pelvic inflammatory diseases (OR = 7.078, 95% CI: 3.462-14.467), post-abortion complications' history (OR = 3.674, 95% CI: 1.690-7.986), drug treatment history (OR= 23.576,95% CI: 12.324-45.102), dysmenorrhea (OR = 1.622, 95% CI: 1.161-2.266), pain from sexual intercourse (OR = 2.447, 95% CI: 1.201-4.986), monthly frequency of sexual intercourse (OR = 1.416, 95% CI: 1.048-1.913) and mental stress (OR = 2.146, 95% CI: 1.662-2.771). The protective factor of infertility, however, was level of education (OR = 0.522, 95% CI: 0.391-0.696). Prevention and treatment of pelvic infection, application of strictly controlled drugs, popularization of awareness on sexual and reproductive health and relief of mental stress would be important measures in decreasing the incidence of infertility.
Article
The World Health Organization defines infertility as inability to conceive despite regular sexual intercourse sustained for a period exceeding 12 months with no contraceptive methods. The aim of this study was to evaluate the effect of infertility on marital and sexual interactions among infertile couples. Two hundred six infertile couples were qualified to the study as the research group. The control group consisted of 190 fertile couples. A specific questionnaire was used as a research tool in this study. It included the sociodemographic part, infertility status, and validated scales: Polish version of Index of Marital Satisfaction and Index of Sexual Satisfaction. Statistica 6.0 (Medical University of Silesia; Katowice, Poland) was used in the statistical analysis. The statistical analysis made use of: Mann-Whitney U-test, chi-square with Yates' continuity correction, ancova log-linear analysis of covariance, and logistic regression analysis. The study showed a significantly better partner relationship in female infertile as compared with female fertile. Clinically significant disorders of partnership stability were observed in 11.65% of studied women and in 20% of controls. Marital adjustment and sexual satisfaction were comparable among male groups. The probability of marital disorders increased with: age above 30 (odds ratio [OR] = 1.6), female sex (OR = 1.5), and lower education (OR = 1.7) among the study population. Diagnosed male factor and infertility duration of 3-6 years were connected with the highest relationship instability and the lowest sexual satisfaction both in female and male infertile. The risk factors of marital dissatisfaction in infertility include: female sex, age over 30, lower education level, diagnosis of male infertility, and infertility duration of 3-6 years.
Article
Incidence of female infertility is growing worldwide and the its rate varies from 10 to 20%. It has been reported diverse risk factors associated with this medical complication. To identify the risk factors with significant association with female infertility. A case-control study was carried out. There were included 440 patients, divided into 220 women with primary or secondary female infertility (cases) and 220 women without infertility recruited at mediate postpartum (controls). Twenty sociodemographic and clinical risk factors for female infertility were analyzed. Statistical analysis was performed with percentages, arithmetic media, standard error, Student t test and chi squared. An alpha value was set at 0.05. There were 6 factors with statistical significance: advanced age (p < 0.001), elevated body mass index (p < 0.001), age of onset of sexual activity (p < 0.001), prior pelvic surgeries (p < 0.001), and presence of stress (p < 0.001). Other risk factors such as smoking, chemical and radiological treatments, pelvic inflammatory disease, exercise, contraceptive use, alcohol intake, drugs, coffee, solvents, glue and insecticides, were not significant. There are clinical and demographic risk factors associated with female infertility. Them identification in women at reproductive age could diminish the frequency of female infertility and, thus, avoid them consequences.
Article
To determine the role of maternal CYP1A1, GSTT1, and GSTM1 metabolic gene polymorphisms in modulating the association between pregnancy smoking exposure and fetal growth restriction. A case-control study was conducted to investigate if the association of pregnancy smoking and birth outcome was modulated by maternal gene polymorphisms. A total of 90 mothers with an IUGR baby (cases) and 180 mothers without IUGR (controls) were enrolled. Almost half of smokers who carried a CYP1A1 variant (51.3%), GSTT1 null (43.6%), or GSTM1 null genotypes (64.1%) delivered a baby with IUGR. Smokers with the variant CYP1A1 "aa" genotype had babies with lower mean birthweight than non-smokers with the same genotype (p=0.004). An interaction test showed increased prevalence of IUGR in smokers with the CYP1A1 (Aa/aa) variant (adjusted OR, 1.9; 95% CI, 1.4-5.5, p=0.01), or with the GSTT1 null (AOR, 1.5; 1.1-3.1, p=0.001), or GSTM1 null genotypes (AOR, 1.5; 1.2-3.7, p=0.001). Risk of fetal growth restriction in mothers who smoked during pregnancy was modulated by maternal metabolic gene polymorphisms. The genetic control of the conversion of toxic metabolites of tobacco smoke to less damaging substances is important for maternal and fetal health.
Article
The authors investigated the risks of negative reproductive outcome among female hairdressers. A cross-sectional study was conducted in 1997-1999, and 16,907 women in their forties were invited (response 71%). Information on infertility, delayed conception, spontaneous abortions, smoking, education, and occupation was collected. Infertility and spontaneous abortion were higher among female hairdressers than among women in other occupations (adjusted relative risks = 1.30; 95% confidence intervals = 1.08 to 1.55 and 1.31; 1.07 to 1.60, respectively). There was a significant interaction between work and smoking habits. Smoking increased the risk of infertility among women in other occupations, but this was not found among hairdressers. Female hairdressers have an increased risk of infertility and spontaneous abortions that might be due to their occupational chemical exposure. The risk was primarily found among never smokers.
Article
Prenatal smoking exposure causes intrauterine fetal growth restriction (IUGR), although its effects on fetal proportionality are less clearly defined. The present study assessed fetal proportionality in babies with IUGR using maternal salivary cotinine to indicate maternal smoking exposure. A case-control study at the Liverpool Women's Hospital, UK of babies with asymmetric and symmetric IUGR and non-growth restricted babies was carried out. 270 white women including 90 IUGR cases and 180 controls were enrolled. Asymmetry presented in 52.2% of IUGR cases. Geometric mean maternal cotinine concentration was higher with asymmetric (p=0.002) than symmetric IUGR (p=0.07), when compared to controls. Maternal smoking exposure was independently associated with asymmetric IUGR (OR 2.4, 95% CI, 1.5-4.4, p</=0.001). Maternal anaemia was more frequent in babies with symmetric IUGR (OR 1.9, 1.3-3.4, p=0.002), but not in asymmetric babies. Rohrer's index ranged between 1.64 and 2.25 for asymmetric infants and significantly decreased with increasing maternal cotinine concentration in IUGR babies. Increased cotinine was not associated with shortened gestational age in IUGR babies. Asymmetric IUGR occurred more frequently in heavy smokers. Stopping smoking even late in pregnancy may be beneficial for improved fetal outcomes. Symmetric IUGR was associated with maternal anaemia, highlighting the importance of prenatal nutritional status.
Article
Infertility in women has many possible causes and must be approached systematically. The most common cause of medically treatable infertility is the polycystic ovary syndrome (PCOS). This syndrome is common in young women and is the cause of anovulatory infertility in 70% of cases. It is therefore an important condition to screen and manage in primary care medical settings. In the past 10 years, insulin sensitization with weight loss or metformin has been shown to be a safe and effective treatment for PCOS infertility that eliminates the risk of multiple pregnancy and may reduce the risk of early pregnancy loss as compared with ovulation-inductor drugs. The authors believe metformin should be considered as first-line therapy because it has the advantage to allow for normal single ovulation, for reduced early pregnancy loss, and, most importantly, lifestyle modifications and weight loss before pregnancy. Losing weight not only improves fertility but also reduces adverse pregnancy outcomes associated with obesity.
Article
The authors undertake to show that the obstetric future of women who have been operated on for uterine synechiae is not as poor as would appear from previous publications. 59 p. 100 of 75 women who wanted to become pregnant did so and 46 p. 100 went on to have at least one living child. If one only takes into account those women who were able to be followed up, 71 p. 100 became pregnant and 55 p. 100 had pregnancies with a viable child. When women with only uterine synechiae and without an associated lesion were considered, 81 p. 100 of them became pregnant and 67 p. 100 had a viable child. From this it is important to screen for an associated lesion by laparoscopy. The authors also write about the value of hysteroscopy carried out to find synechiae more easily and to control the treatment.
Article
The interaction between emotional stress and infertility has been investigated for many years. Many infertile couples show marked stress during infertility evaluation and treatment. Most of the investigations that were performed during the last two decades show that in the majority of cases stress is the result and not the cause of infertility. The biological interaction between stress and infertility is the result of the action of stress hormones at the brain level, especially on the hypothalamus-pituitary and on the female reproductive organs. Stress hormones such as catecholamines (adrenalin, nonadrenaline and dopamine) and the hypothalamic-pituitary-adrenal axis interact with hormones which are responsible for normal ovulatory cycles: i.e., gonadotropin releasing hormone (GnRH), prolactin, LH and FSH. Endogenous opiates and melatonin secretion are altered by stress and interfere with ovulation. Sympathetic innervation of the female reproductive system provides routes by which stress can influence fertility at the of the sex organs level. Infertility causes stress which is aggravated as time passes and the couple remains infertile. Among the causes of stress are the couple's isolation, life with unrealized potential and unborn child, disruption of day-to-day life during infertility evaluation and treatment, and the couple's feeling that they do not have control of their own lives. The IVF program is considered by many as the final step for the evaluation of the couples fertility potential, hence, couples participating in an IVF program are highly stressed, especially after a failed IVF cycle.
Article
The incidence of intrauterine adhesions (IUA) was estabished in 120 patients who were subjected to hysterogram after abortion and D&C. The overall incidence was 15%: 31% in the group whose histological specimens showed 'missed abortion' and only 6% in those showing 'early abortion.'
Article
The purposes of the study were to compare treatment-related stresses of couples undergoing IVF or ICSI treatment (ejaculated, epididymal or testicular spermatozoa) and to identify sex differences and risk factors for depression. A one-year cohort of couples was retrospectively sent questionnaires on infertility and treatment-related distress and depression (Depression Scale, D-S). Two hundred and eighty-one women and 281 men (61% of those eligible) were included. As determined by analysis of the medical charts, successful couples were more likely to participate. Treatment-related distress was generally higher for women than for men. Treatment by ICSI carried additional burdens for the men: they reported a greater subjective responsibility for the infertility, impact of childlessness on daily life, treatment-related stresses (particularly for MESA/TESE) and time demands. Even when clinical differences between treatments (e.g. age, previous treatments) were controlled statistically, depression scores did not differ. Independent of the treatment, women were significantly more depressed than their age-matched female controls from the general population and their husbands. The men only reported marginally elevated depression scores compared to their controls. Meaningful characteristics were identified that could guide clinicians to give psychological support to those couples at risk for depression, e.g. an unsuccessful treatment outcome, repeated treatment cycles, a low socioeconomic status, foreign nationality, or, for women, a lack of partner support.
Article
Subtle menstrual disturbances that affect the largest proportion of physically active women and athletes include luteal phase defects (LPD). Disorders of the luteal phase, characterized by poor endometrial maturation as a result of inadequate progesterone (P4) production and short luteal phases, are associated with infertility and habitual spontaneous abortions. In recreational athletes, the 3-month sample prevalence and incidence rate of LPD and anovulatory menstrual cycles is 48% and 79%, respectively. A high proportion of active women present with LPD cycles in an intermittent and inconsistent manner. These LPD cycles are characterized by reduced follicle-stimulating hormone (FSH) during the luteal-follicular transition, a somewhat blunted luteinizing hormone surge, decreased early follicular phase estradiol excretion, and decreased luteal phase P4 excretion both with and without a shortened luteal phase. LPD cycles in active women are associated with a metabolic hormone profile indicative of a hypometabolic state that is similar to that observed in amenorrheic athletes but not as comprehensive or severe. These metabolic alterations include decreased serum total triiodothyronine (T3), leptin, and insulin levels. Bone mineral density in these women is apparently not reduced, provided an adequate estradiol environment is maintained despite decreased P4. The high prevalence of LPD warrants further investigation to assess health risks and preventive strategies.
Article
The course of the transfer catheter through the cervical canal is one of the most important issues for a successful embryo transfer (ET) during in vitro fertilization (IVF) cycles. Technically difficult ETs due to cervical stenosis are associated with reduced chance of pregnancy after assisted reproductive procedures. In the current case series, we report on three patients with cervical stenosis who underwent IVF-ET cycles. These three patients, in whom ET was classified as "difficult," failed to conceive with previous ET attempts. An intervention to create a cervical tract was performed with operative hysteroscopy under general anesthesia before transcervical ET. After the hysteroscopic shaving procedure, we observed quite an improvement in access to the endometrial cavity during ET procedure. These patients had significantly easier ET procedures compared with previous attempts and achieved clinical pregnancies. Hysteroscopic revision of the cervical canal results in easier ET and improves pregnancy rates in patients with cervical stenosis and histories of difficult ET.