Antichlamydia Antibodies and Sperm Quality among Male Partners of Infertile Couples in Nigeria

: The impact of Chlamydia trachomatis on semen quality has been studied with varied results. Aim: To determine the prevalence of antichlamydial antibodies and their relationship with sperm quality among male partners of infertile couples in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional study of infertile male partners of couples attending infertility clinics at the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Nigeria. Their sera were assayed for antichlamydial antibodies, and semen analysis and culture were done for each participant. Results: Two hundred and eighty-two (282) male partners of infertile couples were studied. Infertility was commoner among participants aged 40 years or more (45.1%) and was mainly of the "primary type" (62.1%). Antichlamydia antibody was detected in 156 (55.3%) participants and was significantly associated with sperm quality (P = 002; OR = 2.294; 95% CI = 1.36­3.88). Overall, 81 (28.7%) had abnormal sperm quality. The sperm count, progressive motility, and vitality were significantly lower in participants with abnormal sperm quality than those with normal sperm quality (P < 0.001) while morphology, volume, and liquefaction time did not differ significantly (P > 0.05). Staphylococcus aureus was the predominant organism isolated from culture (122/282, 43.3%) while Streptococcus species were the least (4/262, 1.4%). There was significantly more Staphylococcus aureus isolated from the semen of participants that were seropositive to antichlamydial antibodies than those that were seronegative (80/156, 51.3% vs. 42/126, 33.3%; OR = 2.105; 95% CI = 1.30­3.42; P = 0.003). Conclusion: The prevalence of antichlamydial antibodies among male partners of infertile couples in Enugu, Nigeria is high and there is a significant association with sperm quality, sperm count, and bacterial isolates in seminal culture. Male partners of infertile couples in Enugu should be screened for antichlamydial antibodies and appropriate treatment offered wherever indicated. There is a need for increased public awareness and advocacy campaigns on the impact of Chlamydia infection on male factor infertility. This primary preventive measure may help in reducing the burden of Chlamydia infection and male factor infertility.

A construção da infertilidade como doença: ciência, regulamentação e mercado / Infertility as disease: science, regulation and market

Introdução A forma como a nossa sociedade lida com a noção de saúde e como constrói a ideia da doença é discricionária e, ao mesmo tempo em que impacta, ela é impactada pela disponibilidade de tratamentos de um complexo industrial biomédico. O caso específico a ser analisado nessa dissertação é o da infertilidade. De que forma essa condição é definida como doença? Por quais atores? Quais tratamentos são disponibilizados para essa doença? Quais conflitos de interesse estão presentes nessa definição? Como se dá a regulamentação dessas questões, no âmbito internacional, e no âmbito nacional? Objetivo O objetivo dessa dissertação é analisar de que forma, e por meio de quais atores, se constrói a dupla condição da infertilidade atualmente: a sua definição como doença, e a noção de que a fertilidade é uma condição natural a ser preservada, uma potencialidade dos corpos femininos. Considera-se, para tanto, que tais construções são permeadas pelo mercado das tecnologias de reprodução assistida (TRAs) e são objeto de regulamentação nacional e internacionalmente. Métodos Foi realizado um estudo baseado em metodologia de caráter qualitativo, incluindo análise documental. Foram analisadas informações de fontes primárias. Foi feita análise documental da Classificação Internacional de Doenças (CID) e da Organização Mundial de Saúde - e seus parceiros -, tendo em vista serem essas as fontes reconhecidas mundialmente para a definição de condições patológicas. Ademais, foi analisado o papel regulamentador dessas entidades internacionais, assim como, dos atores, em âmbito nacional, responsáveis pela regulamentação da prática médica no campo da infertilidade e do mercado das Tecnologias de Reprodução Assistida (TRAs). A fim de propiciar um panorama de análise mais completo, foram estudados os websites das dez principais clínicas privadas da Cidade de São Paulo em busca de quatro conceitos-chave: a definição de "infertilidade" apresentada pelas clínicas, a indicação clínica para o procedimento de fertilização in vitro, o termo usado para se referir ao procedimento de congelamento de gametas femininos e as taxas de efetividade apresentadas nos websites para os tratamentos de infertilidade. Foram estudados os relatórios financeiros e balanços das principais empresas do complexo tecno-científico da biomedicina que atuam na cidade de São Paulo, a fim de identificar as tecnologias/equipamentos sendo desenvolvidos pelas empresas, quais mercados são alvo delas e a relação desse movimento com a proliferação de condições patológicas relacionadas à infertilidade. Resultados A definição da infertilidade como patologia é feita pela OMS por meio da Classificação Internacional de Doenças e, conforme observado, é adotada mundialmente, inclusive pelas clínicas de Reprodução Assistida paulistanas. Essa definição é feita pela OMS e por seus parceiros, os quais se apresentam como instituições neutras e de caráter técnico, apesar de serem patrocinadas direta ou indiretamente pelas indústrias responsáveis por ofertarem tecnologias reprodutivas. Os outros atores partícipes nessa definição consistem em associações de clínicas de reprodução assistida e médicos dessa área, as quais além do próprio interesse em expandirem seus negócios possuem, muitas vezes, financiamento direto das mesmas indústrias. Conclusão A partir dessas análises foi possível identificar o caráter não-neutro da definição da infertilidade como doença, a nova perspectiva da fertilidade como potencial reprodutivo, a influência de atores do mercado na construção desses conceitos, assim como os impactos desses conceitos no mercado das tecnologias para reprodução assistida. Ademais, observou-se a frágil regulamentação existente nesse campo, tanto no cenário internacional como no cenário nacional e a atuação limitada do setor público nessa seara. O poder público está ausente das decisões sobre a adoção das TRAs e sobre a sua aplicação nos corpos das mulheres, da mesma forma que não intervém nas discussões conceituais acerca da condição patológica atribuída à infertilidade pelo campo biomédico. A regulamentação estatal se limita a questões sanitárias, por meio da atuação da ANVISA, o que permite a autoregulamentação da classe médica e do mercado, os quais são permeados por contradições e conflitos de interesse.

Introduction The way in which our society deals with the notion of health and how the idea of disease is built is discretionary and at the same time that it impacts it is impacted by the availability of treatments of the industrial biomedical complex. The specific case to be analyzed in this dissertation is infertility. In what way is this condition defined as a disease? By whom? What treatments are made available for this disease? What conflicting economic interests are present in this definition? How are these processes regulated in both the international and domestic field? Objectives This dissertation aims to analyze how and by means of which participants the dual notion of infertility is conceived currently: its definition as a disease and the idea that fertility is a natural condition to be preserved, a potential of the female body. To do so, it is deemed that such constructions are pervaded by the market of Assisted Reproductive Technologies (ARTs) and are subject to both domestic and international regulations. Methods In order to achieve this aim, a study was performed based upon methodology of a qualitative nature, including documentary analysis. A documentary analysis was made of the International Classification of Diseases (ICD) and of the World Health Organization (WHO) - and its partners -, bearing in mind that it is acknowledged throughout the world for defining pathological conditions. Furthermore, the regulating role of these international entities was analyzed, as was that of those taking part in the Domestic scope, responsible for regulating medical practice in the field of infertility and the market of Assisted Reproductive Technologies (ARTs). In order to provide a more complete overview, the websites of the ten main private clinics in São Paulo were studied seeking four key concepts: the definition of "infertility" presented by the clinics, the clinical indication for the procedure of fertilization in vitro, the term used to refer to the procedure of freezing female gametes and the effectiveness rates displayed on the websites for treating infertility. The main participants of the industrial biomedical complex, focusing on the pharmaceutical industry and medical equipment were identified, as was any relationship thereof with the main fertility clinics of São Paulo city. To do so, the financial reports and balance sheets of the main companies of the technical-scientific complex of biomedicine performing in São Paulo city were studied, in order to identify the technology/equipment being developed by companies, their target markets and the relationship of this movement with the proliferation of pathological conditions related to infertility. Results The definition of infertility as a pathology in the ICD elaborated by the World Health Organization - WHO - is adopted worldwide including by clinics in São Paulo. This definition is elaborated by the WHO and its partners which are funded by the Industry of ART even though they portray an image of neutrality and technical-scientific character. The other players involved in these definitions are fertility clinics' associations and doctors that provide fertility treatments, which have their own business interests and sometimes are even funded directly by this Industry. Conclusion These analyses allowed the identification of the non-neutral nature of the definition of infertility as a disease, the new perspective of fertility as reproductive potential, the influence of entities in the market in building these concepts, as well as the impact of these concepts on the assisted reproductive technology market. Furthermore, the lack of string regulations in this field was noted, in both the international and domestic scenarios and the limited performance of the public sector in this area, which allows the self-regulation of the medical class and the market, pervaded with contradictions and self- interest.

Prevalence and intensity of pain during diagnostic hysteroscopy in women attending an infertility clinic: analysis of 489 cases / Prevalência e intensidade da dor na histeroscopia diagnóstica em mulheres atendidas em uma clínica de infertilidade: análise de 489 casos

ABSTRACT Objective To investigate the prevalence and intensity of pain perception during diagnostic hysteroscopy in women and potential related factors. Methods A total of 489 women were investigated at an infertility clinic. Fluid diagnostic hysteroscopy was performed without analgesia or anesthesia by gynecologists with different levels of experience in operative hysteroscopy, using a 2.9mm rigid scope. The Visual Analog Scale was used to score pain intensity after vaginal speculum insertion and after hysteroscopy. Data collected included age, ethnicity, body mass index, history of infertility and endometrial surgery (curettage and/or hysteroscopy), smoking habits, and hysteroscopy diagnosis. Only the state of anxiety was assessed by the State-Trait Anxiety Inventory given to each patient before the procedure. Results Hysteroscopy median (25th to 75th) Visual Analog Scale scored 3.3 (3 to 5), and 41.7% of the women referred Visual Analog Scale score ≥4. Median (25th to 75th) State-Trait Anxiety Inventory score was 42 (38 to 45), and 58.3% of the women referred State-Trait Anxiety Inventory score >40. Hysteroscopy Visual Analog Scale score was significantly correlated to surgeon experience and to vaginal speculum insertion but not to State-Trait Anxiety Inventory score, ethnicity or abnormal hysteroscopic findings. Conclusion Diagnostic hysteroscopy was mostly perceived as a mild discomfort procedure by most women. Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings.

RESUMO Objetivo Investigar a prevalência e a intensidade da percepção da dor durante a histeroscopia diagnóstica, bem como os possíveis fatores relacionados. Métodos Foram incluídas 489 mulheres submetidas à propedêutica de infertilidade. A histeroscopia diagnóstica foi realizada sem analgesia ou anestesia, por ginecologistas com níveis de experiência diferentes em histeroscopia, usando histeroscópio rígido de 2,9mm. A Escala Visual Analógica foi utilizada para avaliar a intensidade da dor após a inserção do espéculo vaginal e após a histeroscopia. Os dados coletados incluíram idade, etnia, índice de massa corporal, história de infertilidade e cirurgia endometrial (curetagem e/ou histeroscopia), tabagismo e histeroscopia diagnóstica. Avaliou-se apenas o estado de ansiedade pelo Inventário de Ansiedade Traço-Estado de cada paciente antes do procedimento. Resultados A mediana (25ºa 75º) de histeroscopia pela Escala Visual Analógica foi 3,3 (3 a 5), e 41,7% das mulheres obtiveram pontuação ≥4. A mediana (25ºa 75º) do Inventário de Ansiedade Traço-Estado foi 42 (38 a 45), e 58,3% das mulheres referiram pontuação >40. A pontuação da Escala Visual Analógica da histeroscopia apresentou correlação estatisticamente significante com a experiência do cirurgião e a inserção do espéculo vaginal, mas não a pontuação do Inventário de Ansiedade Traço-Estado, etnia ou achados histeroscópicos anormais. Conclusão A histeroscopia diagnóstica foi percebida pela maioria das mulheres como desconforto leve, mas um número considerável de pacientes classificou o procedimento como doloroso. A percepção da dor esteve ligada ao limiar individual e à experiência do cirurgião, mas não aos níveis de ansiedade pré-procedimento, à etnia e nem aos achados histeroscópicos anormais.

Reasons for non-compliance with quality standards at primary healthcare clinics in Ekurhuleni, South Africa

Background: The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa's current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni. Aim: This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards. Setting: The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province. Methods: A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted. Results: The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards. Conclusion: Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance