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Abstract Background Infertility is caused by heterogeneous risks, but most of them are unexplained. The sperm DNA Fragmentation Index (DFI) was increasingly acknowledged as a parameter for the evaluation of male infertility. This study aimed to investigate the association between sperm DFI and laboratory and clinical outcomes in a population with unexplained infertility. Methods The clinical data of an infertile population was collected for the selection of reproductive patients with unexplained infertility. The authors classified the patients with normal sperm parameters in a control group (DFI < 25%) and an observation group (DFI ≥ 25%) and compared the difference in basal characteristics, laboratory, and clinical outcomes between the two groups. The authors conducted a correlation analysis to examine the relationship between DFI and the number of D3 good-quality embryos, as well as the clinical pregnancy rate and live birth rate. A total of 176 cases were enrolled in the retrospective study. Results The observation group (n = 88) showed advanced male age, lower sperm concentration, progressive motility, and morphology assessment than the control group. In addition, lower No. of D3 good-quality embryos, clinical pregnancy rate, and the live birth rate were shown in the observation group. A negative correlation between the DFI and No. of D3 good-quality embryos (rs = -0.347, p < 0.001) or live birth rate (rs = -0.185, p = 0.028) was shown. Conclusions Sperm DFI was a good indicator for the prediction of D3 good-quality embryos in unexplained infertility couples, but it did not provide sufficient information regarding clinical pregnancy outcome but live pregnancy outcome.
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Background and Objectives: It cannot be stressed enough that infertility is a problem of the couple and not an individualalone. IUI as a mode of artificial insemination is widely used in treating couples with unexplained infertility. The present studywas done with the objective of comparing the effectiveness of TI and IUI with husband’s sperm in couples with unexplainedinfertility undergoing superovulation with clomiphene.Methodology: In this cross-over study, a total of 60 couples with unexplained infertility were subjected to controlled ovarianhyperstimulation with clomiphene and prospectively randomized to receive either TI (Group A) or IUI (Group B). The groupswere interchanged when pregnancy was not achieved in either group after three cycles of each intervention.Results: A positive pregnancy test was seen in both IUI and TI after cross-over. There were seven pregnancies (four in IUI andthree in TI), out of which 6 (85.71%) were viable pregnancies, while one was non-viable (14.29%). Both IUI and TI had threeviable pregnancies each. The one non-viable pregnancy was from the IUI group.Interpretation and Conclusions: The findings of the present study showed that both TI and IUI are effective treatment modalitiesfor women with unexplained infertility. Although the addition of IUI to ovulation induction does increase the cycle fecundability,it does not improve the fecundity.
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Background: Persistent thin endometrium affects <1% of patients. Various treatments have been proposed with no satisfactory results. GCSF is one such treatment modality which improves endometrial thickness and implantation. Aim of this study was to analyse the effects of dose and the site of instilling intrauterine G-CSF in COS IUI cycles in patients with unexplained infertility and to note the pregnancy rates among them.Methods: It is a 3-year retrospective study done in obstetrics and gynecology department of AJ Institute of Medical Sciences and Research Centre, that included all unexplained infertility cycles with controlled ovulation stimulation-IUI protocols where for a thin endometrium GCSF was used. The method of ovarian stimulation, the drug and dose used, the trigger for ovulation and the ovarian and endometrial response was noted. The day of the intrauterine GCSF and the dose and the site of instillation was noted. The endometrial response to GCSF the outcome for pregnancy was noted. All the data was analyzed statistically.Results: Significant endometrial response was seen with a dose of 100 mg,150 mg and 300 mg. Pregnancy outcome was better when GCSF was instilled just above the level of the os. GCSF instilled at the level of the fundus increases the possibility of ectopic pregnancy.Conclusions: Instillation of GCSF of 100 mg dosage just above the os; is a safe and effective method for improving the endometrial thickness and increasing pregnancy rate.
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Ovulation induction has been a major breakthrough in the management of female infertility since many decades. Letrozole, an aromatase inhibitor has been used as a potential therapy for ovulation induction. A large number of clinical evidences have been emerging which cite the beneficial role of Letrozole in conditions like anovulatory infertility, polycystic ovary syndrome (PCOS), unexplained infertility and an incipient role in endometriosis- related infertility with regards to higher live-birth rates. Letrozole is a superior alternative to Clomiphene citrate (CC) which has been used conventionally as ovulation inducer. Clomiphene citrate has certain well-defined disadvantages, whereas Letrozole overcomes these limitations to a reasonable extent. The peripheral anti-estrogenic effect of CC leads to prolonged depletion of estrogens receptors, adversely affecting endometrial growth and development as well as quantity and quality of cervical mucus. Persistent blockade of estrogen receptor leads to CC resistance and is associated with reduced ovulation and pregnancy rates. Available evidences suggest Letrozole is superior to CC owing to the lack of persistent anti-estrogenic action due to its short half- life and lack of action on estrogen receptors. This typically leads to monofollicular growth and also higher live birth rates. The current evidences suggest that Letrozole can be placed as first line therapy for the management of infertility due to PCOS and unexplained infertility.
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Infertility is a condition in which successful pregnancy has not occurred, despite normal intercourse over 12 months. The cause of female infertility is multifactorial. Ayurveda assures normal pregnancy by proper maintenance of Garbha Samgraha samagris and normalcy of mind. All the causes of female infertility come under the imbalance of Garbha Samgraha Samagri and mind factors. In this case report patient suffered from primary infertility since six years, after allopathic consultation came for ayurvedic treatment. From detailed history involvement of vitiated Vatha, Agnimandhya and stressful mind was noticed. She was treated with Chiruvilwadi kashayam, Dhanwantharam gulika, Jeerakarishtam, Kumaryasavam and Manasamithravatakam for one month. Took follicular study on next cycle and revealed post ovulatory status on 16th day of cycle. Advised Phalasarpis, Dhanwantharam Gulika and Manasamithravatakam for two weeks. Patient came with positive urine pregnancy test after one week of missed period. The line of treatment followed in this case was to maintain Agni, normalize Vatha and assure proper health to mind. During the second half of the cycle Garbhasthapana medicines were administered. Patient took Dhanwantharam gulika and phalasarpis throughout the first trimester along with regular ante natal check up. Continued Dhanwantharam gulika up to 36 weeks and started Sukhaprasavagritham upto delivery from 36 weeks onwards. She delivered a female baby on 06.05.2018.
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Background: Infertility, as defined by World Health Organization (WHO), is failure to achieve pregnancy during 1 year of regular unprotected intercourse. The objective of this study was to determine the incidence of unsuspected pathology at hysterolaparoscopy in presumed unexplained infertility, the incidence of intervention done for correcting pathology and its outcome and the importance of hysterolaparoscopy in the evaluation and treatment of infertile couples.Methods: This prospective observational study was carried out at IVF and Endoscopy centre, Department of obstetrics and gynecology at the Ruby Hall clinic, Pune from 1st November 2014 to 30th July 2016, after obtaining institutional ethical clearance and who met the inclusion and exclusion criteria. A detailed clinical history and physical examination and bimanual pelvic examination were done, following which all the patients were subjected to baseline blood investigation, 3D pelvis (TVS) and semen analysis. Day care hysterolaparoscopy was performed and systematic analysis were done.Results: The mean duration of infertility was 2 to 4 years. In our study out of 75 women 62 (82.67%) showed normal hysteroscopic findings, remaining 13 women (17.67%) showed abnormal hysteroscopic findings like cornaul blockage, intrauterine adhesions and tuberculosis endometrium. Abnormal laparoscopic findings were reported in 29.33% of which the most common pathology was endomertiosis (21.33%).Conclusions: Diagnostic Hysterolaproscopy is a safe, effective, minimally invasive, cost effective, daycare comprehensive procedure in evaluation of unexplained infertility. Apart from routine diagnostic protocol missed pathologies can be detected and this tool can be used for diagnostic as well as therapeutic intervention.
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Background: Balance between endometrial cell proliferation and apoptosis is crucial for successful embryo implantation. PTEN (phosphatase and tensin homolog deleted on chromosome 10), a pro-apoptotic factor, is proposed to be one of the signaling proteins through which estrogen and progesterone act to affect cellular homeostasis. Although reports in literature have suggested role of PTEN in regulating endometrial cell proliferation and apoptosis during window of implantation, its involvement in women with unexplained infertility is not clear. In the present study, we examined expression, cellular distribution and activation status of PTEN, cell proliferation, and apoptosis in midsecretory endometrium from women with unexplained infertility as compared to fertile controls.Methods: Endometrial biopsies from infertile (n=11) and fertile women (n=22) were used for immunohistochemical evaluation of PTEN, phospho-PTEN and Ki67. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling assay was performed for detection of apoptotic cells.Results: Biopsies from infertile women as compared to fertile controls demonstrated statistically significant: i) decrease in nuclear PTEN (P < 0.001), increase in nuclear phospho-PTEN (P < 0.05), increase in nuclear and cytoplasmic phospho-PTEN/PTEN ratio (P < 0.001 and P < 0.05 respectively) in endometrial stroma, ii) increase in cytoplasmic phospho-PTEN (P < 0.001) and phospho-PTEN/PTEN ratio (P < 0.05) in glandular epithelium (GE), iii) increase in Ki67 labeling in GE (P < 0.01) and stroma (P < 0.05) and, iv) decrease in (P < 0.001) apoptosis.Conclusions: Altered PTEN expression and associated modulation in cellular homeostasis during the implantation window might contribute to mechanism underlying unexplained infertility.
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Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle. Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.
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Introduction: Celiac disease is an immune response to a gluten-based diet that affects the small intestines of people with a genetic predisposition to disease. Celiac has intra intestinal and extra instestinal manifestations., In recent years, celiac and infertility have been considered. The present study examines the effect of celiac disease and its treatment on the menstrual cycle, pregnancy and menopause. In this study, we compared the prevalence of celiac disease in fertile women with infertile women in Zahedan. Materials and Methods: In this case control study, 150 patients with unexplained infertility from Febraury 2016 to 2017 referred to Infrtility Clinic of Alis ibn-Abitaleb Hospital in Zahedan (Iran), were included in the study. Total IgA and IgA TTG were evaluated. IƒTTG is positive, for confirmation of diagnosis, biopsy is performed from the distal part of the duodenum. In control group, 150 fertile women with two or more children with the same characteristics were studied. Results: Theree patients with unexlained infertility (2%) were positive for TTG. Two of them (1/3%) were positive to celiac disease in small intestinal biopsy. None of the women in the control group had TTG positive (p=0.49) Discussion and Conclusion: It seems that some infertile patients with unexplained infertility suffer from celiac disease, but with a (p=0.49), it seems that celiac screening as a cause of infertility with unexplained cause needs more studies with larger sample size in Iran (AU)
Subject(s)
Humans , Female , Menopause , Pregnancy , Case-Control Studies , Celiac Disease/therapy , Infertility, Female/etiology , Menstrual CycleABSTRACT
Background: Being a diagnosis of exclusion the treatment options of unexplained infertility are often empiric. There is significant dilemma regarding the superiority of one over another. Despite increasing use of intrauterine insemination (IUI) in adjunct to controlled ovarian hyperstimulation (COH) there is scarcity of randomized controlled trials (RCT) from developing countries. Objective was to compare IUI and timed intercourse (TI) in super ovulated cycles among couples with unexplained infertility over one year.Methods: In this prospective randomized controlled trial total 85 patients were randomly assigned into group 1 (COH with IUI, N= 44) and group 2 (COH with TI, N=41). Patients underwent COH using sequential Clomiphene Citrate and injection human menopausal gonadotrophin followed by IUI in group 1 and timed intercourse in group 2. Either protocol was repeated for three consecutive cycles. Finally, both groups were compared for clinical pregnancy rate, adverse effects and acceptability of the treatment process and outcome. Comparison was done by Student’s unpaired t test for continuous and 2-tailed chi square test for categorical variables.Results: Clinical pregnancy rates following COH/IUI and COH/TI were 13.64% and 19.51% respectively. There was observable difference in the acceptability of the outcome (38.64% in IUI and 56.09% in TI group). All the results including complications and side effect rates were statistically insignificant.Conclusions: Present study failed to show any improvement of pregnancy rates following addition of IUI over TI and it raised the probability that the outcome of the procedure may not be well accepted.
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Resumen Objetivo: Determinar si la eliminación de espermatozoides positivos a marcadores tempranos de apoptosis en parejas con infertilidad inexplicable incrementa la tasa de nacidos vivos. Materiales y métodos: Ensayo piloto, con asignación al azar, controlado y triple ciego; y un estudio paralelo de dos grupos. Se incluyeron parejas con diagnóstico de infertilidad inexplicable que se asignaron en una proporción 1:1 al grupo A (método de capacitación espermática swim-up) o grupo B (método de capacitación espermática swim-up complementado con separación magnética de células activadas; magnetic-actived cell sorting; MACS). Posteriormente, a todas las muestras se les efectuó una inyección intracitoplasmática de espermatozoides, como técnica de fertilización. Por último, todos los embriones obtenidos se analizaron hasta la etapa de blastocisto y todas las transferencias se llevaron a cabo en la misma etapa. Resultados: Se incluyeron 40 parejas y no se encontraron diferencias en la tasa de fertilización. Con la aplicación de MACS se obtiene mayor porcentaje de embriones de buena calidad en día 3 (90.3 vs 99.5%; p = 0.03) y en día 5 (77.3 vs 90.1%; p = < 0.0001) disminuyó el porcentaje de embriones arrestados (16.3 vs 7.9%; p = 0.01). Por último, las tasas de implantación (42.1 vs 57.1%), embarazo clínico (60 vs 80%) y nacidos vivos (55 vs 80%) aumentaron, sin diferencias estadísticamente significativas. Conclusiones: La separación magnética de células activadas (MACS) en parejas con infertilidad inexplicable mejora el desarrollo embrionario. A pesar de no existir una diferencia significativa se observa una tendencia al incremento de embarazos clínicos y nacidos vivos.
Abstract Objective: To determine if the live births delivery rate with the eliminating sperm positive to early apoptotic events is higher in couples with unexplained infertility. Materials and methods: A pilot randomized controlled trialA pilot and triple-blinded; using a parallel study of two groups. We included a total of 40 couples with unexplained infertility assigned in a 1:1 proportion either to the group A (sperm training method swim-up) or to the group B (swim-up sperm training method supplemented with the use of "magnetic-actived cell sorting (MACS)"). Subsequently, all samples were submitted to intracytoplasmic sperm injection as a fertilization technique. Finally, all embryos obtained were analyzed until the blastocyst stage, and all the transfers were performed in the same stage. Results: There are no differences in the fertilization rate; however, with the use of "magnetic-actived cell sorting" there is a higher percentage of good quality embryos on day 3 (90.3% vs 99.5%, p = 0.03) and day 5 (77.3% vs 90.1%, p = <0.0001). In addition, a decrease in the percentage of arrested embryos was demonstrated (16.3% vs 7.9%, p = 0.01). Finally, implantation (42.1% vs 57.1%), clinical pregnancy (60% vs 80%) and live birth rates (55% vs 80%) increased; however, no statistically significant differences were reported. Conclusions: The use of "magnetic-actived cell sorting" in couples with unexplained infertility improves embryonic development. Although there is no significant difference, a trend is observed in relation to the increase in the number of clinical pregnancies and live births.
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Objective@#To investigate the clinical significance of sperm acrosin activity detection in selecting the method of assisted reproduction for patients with unexplained infertility (UI).@*METHODS@#This retrospective study included 49 UI couples treated by IVFET (49 cycles) after three failures in intrauterine insemination (IUI) and another 95 couples with uterine tube obstruction (UTO) treated by IVF (131 cycles). We analyzed the laboratory data, clinical outcomes and sperm acrosin activity in the two groups of patients. According to the level of sperm acrosin activity of the males, we further divided the UI patients into two subgroups, a 0.05). The sperm acrosin activity was remarkably lower in the UI than in the UTO patients (36.03 vs 61.98 IU/106, P < 0.01), and so was the fertilization rate in the < 36 IU/106 than in the ≥36 IU/106 sperm subgroup (47.7% vs 80.3%, P < 0.01).@*CONCLUSIONS@#The low fertilization rate caused by decreased sperm acrosin activity may be the main cause of infertility and the potential factor of UI. When sperm acrosin activity is < 36 IU/106 sperm, IVF plus shortterm fertilization by remedial ICSI should be preferred to IUI.
Subject(s)
Female , Humans , Male , Pregnancy , Acrosin , Metabolism , Embryo Implantation , Fallopian Tubes , Fertilization in Vitro , Methods , Infertility, Female , Infertility, Male , Pregnancy Rate , Reproduction , Retrospective Studies , Sperm Injections, Intracytoplasmic , Spermatozoa , MetabolismABSTRACT
Introducción: La infertilidad es un problema de salud mundial en aumento. Sus factores causales relacionados con el sexo femenino son mayoritarios. Recientemente se ha planteado una fuerte asociación entre los trastornos de la fertilidad y las alteraciones funcionales del sistema inmune, que contribuyen al origen y mantenimiento de la infertilidad.Objetivo: identificar en la literatura científica actualizada la contribución de los mecanismos inmunológicos en el desarrollo de la infertilidad femenina.Desarrollo: los mismos componentes inmunitarios que garantizan el éxito de la reproducción, pueden generar un entorno inflamatorio perpetuado, ante un estímulo antigénico, que produce lesión tisular. La inflamación desregulada repercute en reacciones autoinmunes contra las estructuras del aparato reproductor, y afectan su funcionalidad. La presencia de autoanticuerpos y citocinas proinflamatorias, como marcadores biológicos de estos fenómenos, ha sido reportada en entidades como la endometriosis y el síndrome de ovario poliquístico.Conclusiones: aunque se ha señalado que el sistema inmune desempeña un importante rol en el desarrollo de la reproducción femenina normal y patológica, el conocimiento obtenido en esta área sigue siendo exiguo. La subestimación de los factores inmunitarios en el escenario clínico muchas veces omite posibles alternativas diagnósticas y terapéuticas, que pudieran contribuir a incrementar la calidad del enfoque asistencial a las mujeres infértiles. La complejidad de los sistemas inmune y endocrino, y el corto alcance de las herramientas diagnósticas disponibles, son factores que contribuyen a esta insuficiência(AU)
Introduction: Infertility is a growing worldwide health problem whose causal factors are mostly associated to the female sex. A close relationship has recently been suggested between fertility disorders and functional alterations of the immune system contributing to and maintaining infertility.Objective: review updated scientific literature about the subject to identify the role of immune mechanisms in the development of female infertility.Development: the very immune components ensuring the success of reproduction may create a perpetuated inflammatory environment in the presence of an antigenic stimulus, resulting in the development of a tissular lesion. Dysregulated inflammation triggers autoimmune reactions against reproductive structures, affecting their operation. The presence of autoantibodies and proinflammatory cytokines as biological markers of these phenomena has been reported for conditions such as endometriosis and polycystic ovary syndrome.Conclusions: the immune system is known to play an important role in both normal and pathological female reproduction. However, information about the subject continues to be scant. Underestimation of the immune factors present in the clinical environment often blocks the way for diagnostic and therapeutic alternatives which could otherwise improve the quality of the care of infertile women. The complexity of the immune and endocrine systems, as well as the limited reach of the available diagnostic tools, are factors contributing to such insufficiency(AU)
Subject(s)
Humans , Female , Immune System/metabolism , Infertility, Female/etiology , Endometriosis/metabolismABSTRACT
Unexplained infertility diagnosis is made in the presence of a normal semen analysis when tubal patency and normal ovulatory function are established. Among several potential causes, unexplained infertility could be attributed to vaginal pH and cervical mucus abnormalities. Although the vaginal canal and the cervix generally function as effective barriers to sperm, and although the production of mucus is essential to transport them from the vagina to the uterine cavity, these factors receive little attention in the investigation of couples with unexplained infertility. A substantial reduction in sperm number occurs as they transverse the cervix. From an average of 200 to 300 million sperm deposited in the vagina, only a few hundred achieve proximity to the oocyte. Given this expected high spermatozoa loss, a slight modification in cervical mucus may rapidly transform the cervix into a "hostile" environment, which, together with changes in vaginal environment and cervix structure, may prevent natural conception and be a cause of infertility. In this review, we discuss the physiological role of the vaginal pH and cervical mucus in fertility, and describe several conditions that can render the cervical mucus hostile to sperm and therefore be implicated in the pathophysiology of unexplained infertility.
RESUMO O diagnóstico de infertilidade inexplicada baseia-se na presença de espermograma normal, constatadas também permeabilidade tubária e função ovulatória normais. Entre as várias causas potenciais de infertilidade inexplicada, a presença de muco cervical e pH vaginal anormais devem ser consideradas. Embora a produção adequada de muco cervical seja essencial para o transporte dos espermatozóides da vagina para a cavidade uterina, e tanto o canal vaginal quanto o colo do útero desempenham função importante como barreira à passagem dos espermatozóides, estes fatores recebem pouca atenção na investigação de casais com infertilidade inexplicada. Uma redução substancial do número de espermatozoides ocorre à medida que estes percorrem o trato reprodutivo feminino. Partindo de cerca de 200 a 300 milhões de espermatozoides depositados na vagina, apenas algumas centenas alcançam a proximidade do oócito. Alteracões do muco cervical podem rapidamente transformar o colo do útero num ambiente hostil, que em conjunto com alterações no ambiente vaginal e da estrutura de colo do útero, podem apresentar-se condicões impedientes para a concepção natural; desse modo, convertem-se em causa de infertilidade. Nesta revisão, discutimos o papel fisiológico do pH vaginal e do muco cervical na fertilidade, descrever várias condicões que podem tornar o muco cervical hostil aos espermatozoides e, por fim analisamos como estes fatores interferem na fisiopatologia da infertilidade inexplicada.
Subject(s)
Humans , Female , Sperm Agglutination , Sperm Transport , Vaginal Diseases/diagnosis , Uterine Cervical Diseases/diagnosis , Cervix Mucus/diagnostic imaging , Infertility , Hydrogen-Ion ConcentrationABSTRACT
Aims: To compare the treatment outcome of the 37.5 Units/day follitropin-alpha (Study Group) with 75 Units/day (Control Group) as the initial dose for chronic low-dose step-up ovulation induction for unexplained infertile, non-PCOS (polycystic ovarian syndrome) women. Methodology: Retrospective study and comparison of the patient characteristics and treatment outcome of 2 patient groups of 100 patient-cycles (Study and Control groups: Low-dose step-up cycles with initial doses of 37.5 Units/day and 75 Units/day, respectively). 95 (Study group) and 98 (Control group) ovulatory cycles were included in the final analysis. Results: Cycle cancellations were less common in the Study Group (6.3% vs 15.3%; P=0.02); those in the control group being mostly due to excessive response. The conception rates were similar: 11.5% and 11.2% in the study and the control groups, respectively. Total and mean daily gonadotropin used were lower in the study group (P=0.02 and P=0.04). 1 mild OHSS (Ovarian hyperstimulation syndrome) was observed in each group. There were no multiple pregnancies in either group. Conclusion: The initial daily dose of 37.5 Unit/day is more effective in achieving a unifollicular cycle while being as safe and effective as 75 Units/day; requiring a lower amount of gonadotropin for the conventional treatment of unexplained infertility in non-PCOS women.
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OBJECTIVE: Several publications have established a relationship between sperm DNA damage and male factor infertility, based on data from America, Europe, and Asia. This study aimed to compare the extent of sperm DNA damage in sperm samples from Nigerian men with unexplained infertility and in sperm samples from a fertile group composed of sperm donors who had successfully impregnated a female partner naturally or through assisted conception. METHODS: A total of 404 men underwent male fertility evaluation at Androcare Laboratories and Cryobank participated in this study. Semen analysis and a sperm chromatin structure assay (SCSA) were performed on all subjects. RESULTS: The men in the unexplained infertility group were slightly older than the men in the fertile sperm group (36+/-10 years vs. 32+/-6 years, p=0.051). No significant difference was observed between the two groups in semen analysis parameters (p> or =0.05). Men in the unexplained infertility group with normal semen parameters had a significantly higher DNA fragmentation index (DFI) than men in the fertile sperm group (27.5%+/-7.0% vs. 14.1%+/-5.3%, p<0.05). In the unexplained infertility group, 63% of the men had a DFI greater than 20%, compared to 4% in the fertile sperm group. In the unexplained infertility group, 15.2% of the subjects had a DFI greater than 30%, compared to 1% in the fertile sperm group. CONCLUSION: Our study showed that the SCSA may be a more reliable predictor of fertility potential than traditional semen analysis in cases of unexplained infertility.
Subject(s)
Female , Humans , Male , Americas , Asia , Chromatin , DNA Damage , DNA Fragmentation , Europe , Fertility , Fertilization , Infertility , Semen , Semen Analysis , Spermatozoa , Tissue DonorsABSTRACT
Aims: To examine the effect of single endometrial curettage (EC), performed during the menstrual period in primary clinical care setting, on pregnancy rate (PR) in women with unexplained infertility and subgroup analysis based on age and primary and secondary infertility. Study Design: Randomized controlled clinical study. Place and Duration of Study: Private practice setting, Baghdad, between February 2009 and January 2012. Methodology: A total of 197 couples aged 20-40 years with unexplained infertility were randomly allocated into two groups: group A comprised 110 women who underwent EC during the menstrual period; and group B included 87 women, who represent the control group, with no EC done. Both groups received no further fertility treatment. The main outcome measured was cumulative clinical (PR) during 6 months after the endometrial curettage. Results: PR was higher in control group compared to EC group (48.3% vs. 45.5%), and in secondary infertility in women aged 31-40 years (75% vs. 58.8%), and in primary infertility in women aged 20-30 years (35% vs. 5.4%) and 31-40 years (25% vs. 5.5%). Conclusion: EC may improve PR in couples with primary unexplained infertility independent of the age group, and in secondary infertility age group 31-40 years. Adequately powered studies are suggested to confirm or refute the findings.
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Antecedentes: Existe una tendencia global creciente de no realizar laparoscopia diagnóstica en el estudio de pacientes con infertilidad inexplicada e histerosalpingografía normal. Este tipo de manejo podría tener ciertos inconvenientes dado que existen lesiones, especialmente tuboperitoneales, que no son diagnosticadas y pudiesen influir en los resultados. Nuestro grupo maneja estas pacientes con laparoscopia diagnóstica/terapéutica y posteriormente tres ciclos de inseminación intrauterina. Objetivos: Validar nuestro manejo de la infertilidad inexplicada, estimar la frecuencia de patología pélvica en pacientes con infertilidad inexplicada con histerosalpingografía normal, evaluar la tasa de embarazo posterior a la resolución laparoscópica de su patología y revisar la literatura existente. Resultados: Se revisaron todas las cirugías laparoscópicas realizadas en pacientes con infertilidad inexplicada del Hospital Clínico de la Universidad Católica, entre los años 2007-2011. De estas, 57 pacientes cumplían los criterios de inclusión y 39 recibieron al menos 1 ciclo de inseminación intrauterina posterior al procedimiento. El 82,4 por ciento de las pacientes presentaron hallazgos a la laparoscopia, siendo los más prevalentes la endometriosis grado I y II (57,8 por ciento), y las adherencias pelvianas (43,8 por ciento). De las 57 pacientes que fueron sometidas a laparoscopia diagnóstica/terapéutica, sólo 25 completaron 3 ciclos de inseminación intrauterina posterior, 8 lograron concepción (32 por ciento). Conclusión: Nuestros resultados son similares a los expuestos en otros trabajos en términos de hallazgos patológicos y tasa de fertilidad post laparoscopia. Dado el escaso acceso a técnicas de fertilización in vitro en nuestro medio, nuestro manejo plantea una excelente alternativa para este grupo de pacientes.
Background: There is an increased global tendency for avoiding a diagnostic laparoscopic surgery, among patients with unexplained infertility and a normal histerosalpingography. This decision may have certain consequences, as there may be undiagnosed lesions, such as tuboperitoneal ones, which could have an impact in the management of these patients. Our group treats them with diagnostic therapeutic laparoscopy, followed by three cycles of intrauterine insemination. Objectives: Validate our management of unexplained infertility, estimate the frequency of pelvic pathology in patients with unexplained infertility with a normal histerosalpingography, evaluate the pregnancy rate after the laparoscopic resolution of their pathology, and review the existent literature. Results: We reviewed all laparoscopic surgeries performed in patients with unexplained infertility in Hospital Clínico de la Pontificia Universidad Católica, between 2007-2011. From these, 57 patients met the inclusion criteria, and 39 of them received at least one intrauterine insemination cycle after the procedure. Laparoscopic alterations were present in 82.4 percent of the patients, being the most prevalent ones endometriosis grade I and II (57.8 percent) and pelvic adhesions (43.8 percent). Of the 57 patients who underwent laparoscopy, only 25 completed three cycles of intrauterine insemination, 8 of which conceived (32 percent). Conclusion: Our results are similar to those exposed in other series, regarding pathologic findings and fertility rate after laparoscopy. As there is limited access to advanced reproductive techniques in our country, our management represents an excellent choice for this group of patients.
Subject(s)
Humans , Female , Pregnancy , Adult , Infertility, Female/surgery , Infertility, Female/diagnosis , Laparoscopy , Hysterosalpingography , Tissue Adhesions/complications , Endometriosis/complications , Fallopian Tube Diseases/complications , Ovulation Induction , Infertility, Female/etiology , InseminationABSTRACT
OBJECTIVE: The aim of this study is to assess the IVF/ICSI outcomes of infertile women with minimal to mild endometriosis associated and unexplained infertility. METHOD: We performed a retrospective analysis of 513 (IVF/ICSI) cycles with minimal to mild endometriosis associated infertility, 338 cycles with unexplained infertility, 351 cycles with tubal factor infertility as controls between Jan. 1997 and Apr. 2004. Exclusion criteria for study were: age>36 yrs old, the number of oocytes retrieved 20 mIU/ml, patients with nonobstructive azoospermia, polycystic ovarian syndrome. RESULTS: The incidence of primary infertility was significantly higher in minimal to mild endometriosis (72.3%) and unexplained (68.5%) than tubal factor (31.2%) (p<0.0001). There was no difference in fertilization rate between minimal to mild endometriosis associated infertility and unexplained infertility. But minimal to mild endometriosis associated infertility showed significantly lower fertilization rate and the number of total embryos than tubal factor infertility (62.3+/-21.2% vs. 68.8+/-17.6% (p<0.0001), 8.38+/-5.0 vs. 9.81+/-5.2 (p<0.0001)). But the number of good quality embryos was similar. Clinical pregnancy rates of minimal to mild endometriosis associated, unexplained, and tubal factor infertility was 32%, 35.8%, 39.9% and implantation rates was 13.5+/-23.3, 14.3+/-23.6, 16.1+/-23.5, respectively. CONCLUSION: The IVF/ICSI outcomes of minimal to mild endometriosis associated infertility is comparable to those of unexplained infertility with respect to clinical pregnancy rates, implantation rates, and live birth rates. And we suggest that IVF should be considered earlier in patients with minimal to mild endometriosis associated and unexplained infertility because of significantly decreased fertilization rates and longer duration of infertility.
Subject(s)
Female , Humans , Azoospermia , Embryonic Structures , Endometriosis , Fertilization , Fertilization in Vitro , Incidence , Infertility , Live Birth , Oocytes , Polycystic Ovary Syndrome , Pregnancy Rate , Retrospective StudiesABSTRACT
OBJECTIVE: This study was aimed to evaluate the obstetric and perinatal outcomes of women with unexplained infertility following assisted reproductive technology (ART). METHODS: From January 1999 to February 2002, a total of seventy-nine singleton pregnancies which progressed beyond 20 weeks gestation following embryo transfer in women finally diagnosed as unexplained infertility by diagnostic laparoscopy were enrolled in this study. The matched control was spontaneously conceived 172 singleton pregnancies. Retrospectively, we analyzed the obstetric outcome and compared gestational age at delivery, birth weight, Apgar score, and the incidence of perinatal mortality, preterm labor, preeclampsia, gestational diabetes mellitus, and oligohydramnios between two groups. RESULTS: The mean gestational duration of study group was shorter than control group (38.2 +/- 0.5 vs. 39.4 +/- 0.1 weeks, p=0.001). The incidence of gestational diabetes mellitus was significantly higher in the study group (7.6% vs. 1.2%, p=0.01). There was no significant difference in the mean birth weight (3088.1 +/- 86.1 g vs. 3243.8 +/- 37.2 g), the incidence of small for gestational age (10.1% vs. 11.6%), preeclampsia (3.8% vs. 2.3%), oligohydramnios (3.8% vs. 5.8%), preterm labor (7.6% vs. 5.2%), cesarean delivery (45.6% vs. 41.3%), and perinatal mortality (1.3% vs. 0.6%) between the two groups. CONCLUSION: The gestational duration of women with unexplained infertility after IVF-ET was shorter, but the incidence of preterm birth was not increased. And the incidence of gestational diabetes mellitus of study group was higher than that of spontaneously conceived pregnancies.