RESUMO
Objective:To explore the causes of male and female sub fertility in the couples undergoing 'In Vitro Fertilization' at LIFE clinic
Materials and Methods:In this retrospective, cross-sectional, observational study from Lahore, Pakistan all couples coming for evaluation and treatment for sub-fertility from 1st January to 30th April 2015 at Lahore institute of fertility and endocrinology LIFE with n=344 patients were included Fertility and Endocrinology [LIFE]. Sampling method was non probability consecutive.The data collection instrument was an especially designed Performa. Causes of Sub fertility male and female were studied and data was extracted from the files of LIFE
Results:Out of 344 patients 138[40.1%] had female factors, 122[35.5%] had male factor, 38[11.0%] had combined factors whereas 46[13.4%] had unexplained infertility. Out of 138, 55[39.85%] females had tubal factor, 2[1.45%] had endometriosis, 21[15.22%] had PCO and 60[43.47%] had unexplained causes of sub-fertility. Out of 122 males, 90 [74.4%] had oligospermia/asthenospermia and 32[25.6%] had azoospermia
Conclusion:Tubal factor was a major cause of sub-fertility in females whereas in 2/3 of the females, cause of sub-fertility was not explained.Among the males,oligospermia was the most common cause and was found in 74.4%. Health education about menstrual hygiene should be imparted early in life to prevent Sub-fertility due to infection. Premarital counseling and testing should be made easily available. Andrology should be made part of the Gynecology courses and curricula. Community based Sub-fertility research should be encouraged to assess the disease burden and frequency of preventable causes
RESUMO
Objective: To find out the impact of woman's age on the number of retrieved oocytes, embryos obtained, embryo`s transferred,pregnancy, abortion and cancellation per cycle
Materials and Methods: In this study in-vitro fertilization [IVF] or intracytoplasmic sperm injection [ICSI] cycles were completed. Number of oocytes retrieved, embryos obtained and transferred were observed along with rates of cancellation,pregnancy and abortion per cycle
Results: The study was performed on 75 women undergoing ART cycles. Patients age was divided into five categories 40 years [n=45] 60.0%, 41[n=4] 5.30%, 42 [n= 9] 12.0%, 43 [n=6] 8.0% and =44years [n=11] 14.7%. The mean age of these women was 41.17 +/- 1.67. The mean number of retrieved oocytes per cycle was 5.69 + /- 4.78; embryos obtained per cycle were 2.71 +/- 3.96; No of transferred embryos was 1.16 +/- 1.01. The overall pregnancy rate was 6.0% [7/75] per cycle. The abortion rate was found in 5.86% [7/75] and the overall cancelation rate was 9.6% per oocytes retrieval
Conclusion: Aged women yield lesser number of oocytes as well as embryos. Pregnancy rates and delivery rates are also decreased. So the women of age more than 40 years must be counseled thoroughly before enrolling them in the ART programs
RESUMO
Background: Semen analysis is the basic step when investigating sub fertility disorders related to male genital tract. Valuable clinical information can be obtained from Semen analysis report about the spermatogenesis and functional capabilities of spermatozoa
Objective: To determine the fertilization rate and pregnancy outcomes among intracytoplasmic sperm injection patients and its association with sperm parameters
Methodology: This retrospective analytical study was carried out at Lahore Institute of Fertility and Endocrinology, Lahore. Male partners of 272 couples were included in the study as they came for evaluation for assisted reproduction in between 1st July and 31st December 2014. Before samples were collected these males were asked to remain abstinent for 3 days. Specimens were collected by masturbation, and in cases of azoospermia it was retrieved by Percutaneous Epididymal Sperm Aspiration [PESA] or Testicular Sperm Apiration [TESA]. Semen analysis was performed according to the methods and standards outlined by the World Health Organization [WHO]. Oocytes were aspirated after 35-36 hours approximately, by ultrasound-guided transvaginal retrieval. About 4-5 hours after the aspiration of oocyte, in the IVF cycles, they were inseminated. After 18 to 20 hours all oocytes were examined for pronuclei followed by cleavage assessment within 24 hours. Embryos were examined and best embryos two or three were transferred into the uterine cavity on the 3rd day
Results: Fertilization did occurred in 182 [95.8%] patients with normal sperm count, in 30 [90.9%] with subnormal sperm count and in 43 [87.8%] with Azoospermia. Fertilization did occur in 209 [95.4%] patients with normal sperm morphology, in 12 [92.3%] with subnormal sperm morphology and in 34 [85.0%] with Azoospermia. Fertilization did occur in 160 [98.2%] patients with normal sperm motility, in 59 [88.1%] with subnormal sperm motility and in 36 [85.7%] in the Azoospermia group
Conclusion: Sperm motility and morphology abnormality affected fertilization in intracytoplasimic sperm injection. Though value of semen analysis is limited but gives direction to the investigation. Mere semen examination is not at all sufficient to make definitive diagnosis. It is not at all predictive about the functional abilities of the sperms. There is a need for adding an andrology component to the training of the gynecologists
RESUMO
Background: Infertility has social, psychological and physical effect on couples
Objective: To describe the characteristics of women attending a private clinic for assisted reproductive technology
Subjects and Methods: The infertile couples who came to Lahore Institute of Fertility and Endocrinology [LIFE] from 1[st] January to 31[st] December, 2013 for infertility work up, were included in the study. The sampling technique used in this study was non probability, convenient, and time based, as the study design was cross sectional. Sample size was 534 patients of assisted reproductive technology.[ART]. A questionnaire was used for the data collection. This questionnaire included information on woman's demographics, obstetric and infertility history, radiology and hormone investigation. SPSS version 20 was used for the data analysis
Results: Patients with age less than 35 years were 398 [74%], between 36-39 were 103 [19%] and more than 40 years were 33[6%]. Follicle stimulating hormone [FSH] was less than 9 l U/ ml in 418 [78%] between 9-11 l U/ ml in 83[15%] and greater than 11 l U/ ml in 33[6%]. Patients having regular menstrual cycle were 498 [93%]. Patients having parity were 118 [22%] who had delivered a child. Body mass index [BMI] was less than 25 in 163[30%], between 25-30 in 219[41%], greater than 30 in 152 [28%].As with the female factors, no causes were found in 254 [47%], tubal cause in 120 [22%], PCO in 68 [12%], endometriosis in 13[2%], un-explained causes were found in 79[5%]. Count of antral follicles was 6-8 per ovary in 369 [69%], 3-5 per ovary was 129 [24%], 0-2 per ovary was 36[7%]. Primary infertility was seen in 350 [65%] patients, secondary infertility in 178 [33%], unexplained infertility in 6[1%]. Regarding duration of infertility, in 113[21%] patients it was 2 or less than 2 years, 118 [22%] was 4 years, in 49 [9%] was 5 years, in 87 [16%] was 7 years, in 82 [15%] was 10 years, in 85 [16%] was greater than 10 years
Conclusion: Importance of recognition of infertility as a health issue will not only remove treatment barriers but also improve the health seeking behaviors of the infertile couple. Health education about fertility will ease the social taboos and improve the delivery of health services to infertile couples. Age, FSH, menstrual regularity, parity, BMI, female factor, antral follicles, type of infertility, duration of infertility may have a predictive value forecasting the success of the outcome of IVF. Further research is needed on these lines