Resultados de las consultas municipales de atención a la pareja infértil 2017-2020 / Results of the Municipal Consultations for Infertile Couple Care 2017-2020

Introducción: La infertilidad afecta hasta un 15 por ciento de las parejas en edad reproductiva en el mundo y es uno de los factores que inciden en la baja natalidad de Cuba. Antes del 2016 no existían consultas de infertilidad en todos los municipios y era bajo el número de embarazos logrados, lo que motivó la decisión de extenderlas a todos los municipios del país. Objetivo: Describir los resultados de las consultas municipales de infertilidad en los primeros cuatro años de su implementación (2017-2020). Métodos: Estudio observacional transversal de casos, atendidos en las 82 consultas municipales de infertilidad existentes antes del 2016 y después de su generalización a todos los municipios del país. Resultados: En las consultas municipales han sido atendidas 81,3 por ciento de las parejas infértiles que lo demandan, se incrementó el número de consultas ofrecidas de 24 215 en el año 2016 a 140 183 en el 2020. En ese período se elevó en 10 por ciento los embarazos obtenidos, 63,5 por ciento de los logrados en todos los niveles de atención. Conclusiones: Las consultas municipales incrementaron sus resultados entre el año 2017 al 2020 y los nacimientos obtenidos pueden ser considerados como una contribución del sector salud a reducir la baja natalidad que experimenta el país(AU)

Introduction: Infertility affects up to 15percent of couples of reproductive age in the world and is one of the factors affecting the low birth rate in Cuba. Before 2016, infertility consultations did not exist in all municipalities and the number of pregnancies achieved was low, which motivated the decision to extend them to all municipalities in the country. Aim: To describe the results of municipal infertility consultations in the first four years of their implementation (2017-2020). Methods: Cross-sectional observational study of cases, attended in the 82 municipal infertility consultations existing before 2016 and after their generalization to all municipalities in the country. Results: 81.3percent of the infertile couples requesting treatment were attended in the municipal consultations. The number of consultations offered increased from 24 215 in 2016 to 140 183 in 2020. In that period, pregnancies obtained increased by 10 percent, 63.5 percent of those achieved at all levels of care. Conclusions: Municipal consultations increased their results from 2017 to 2020 and the births obtained can be considered as a contribution of the health sector to reduce the low birth rate experienced by the country(AU)

Reproducción asistida en Chile: una mirada global para el desafío de ofrecer un acceso oportuno / Assisted Reproduction in Chile: a global overview of the challenge of providing an opportune access

En el año 2018 se conmemoraron 40 años desde el primer resultado exitoso producto de una fertilización in vitro (FIV), el nacimiento de Louise Brown en Inglaterra. Se estima que a la fecha han nacido más de 8 millones de seres humanos gracias a las tecnologías de reproducción asistida (TRA), técnicas que están en constante avance y desarrollo. Sin embargo, a pesar de ser cada vez más relevantes como tratamiento de la infertilidad, su acceso todavía es muy limitado y poco equitativo, alcanzando menos del 15% de la población a nivel global. En esta revisión analizamos los aspectos epidemiológicos de la infertilidad y exponemos el contraste entre la necesidad teórica de TRA y los ciclos realizados a nivel mundial, reflejando el bajo acceso a los tratamientos. Se enfatiza la realidad latinoamericana y con especial detalle la chilena, explorando tanto su dimensión histórica como actual, perfilando los desafíos que como país deberemos enfrentar en los próximos años.

The 40-year anniversary of the first in vitro fertilization (IVF) newborn, Louise Brown in England, was celebrated in 2018. To date, over 8 million children have been born with assisted reproductive technologies (ART), a group of techniques in continuous development. Despite the increasing relevance of such technologies as treatments for infertility, the access to ART has been limited to less than 15% of the world population.In this review, we analyze the epidemiological aspects of infertility and present the contrast between the theoretical demand and the actual number of ART cycles performed worldwide, reflecting the low access to infertility treatments. We put emphasis on the Latin American historic and current context, then provide more details on the Chilean reality, and finally outline the challenges Chile will face in the future regarding access to ART.

Obesidad: epidemia del siglo XXI y su relación con la fertilidad / Obesity: an epidemic of the 21st century and its relation to fertility

En Chile, la obesidad y el sobrepeso han presentado un constante incremento, en las últimas décadas. Cifras del Ministerio de Salud (MINSAL) dan cuenta de un aumento de prevalencia, desde un 61% en 2003, hasta una preocupante estimación de 74% de la población adulta, en 2019 según la Organización para la Cooperación y el Desarrollo Económicos (OCDE). La Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO por sus siglas en inglés) estimó que 4 millones de adultos chilenos padecían de obesidad en 2019, situando a Chile como el país latinoamericano con el más alto índice de la condición. El porcentaje de la población adulta, en edad reproductiva, que presenta obesidad, se estima en 9 -18% para hombres y 12 -28% para mujeres. El exceso de grasa corporal tiene serias consecuencias adversas, para el potencial fértil y la capacidad reproductiva de las parejas, comprometiendo fecundidad y determinando infertilidad, trastornos de la ovulación, función sexual y peores resultados en técnicas de reproducción asistida y pronóstico obstétrico

In Chile, excess weight and obesity have shown a steady increase over the last decades. Data from the ministry of health (MINSAL) show a rise in prevalence from 61% in 2003 to an alarming 74% of the adult population by 2019 according to the Organization for Economic Cooperation and Development (OCDE). The United Nations Food and Agriculture Organization (FAO) estimates that 4 million adult Chileans suffered obesity in 2019, placing Chile as the country in Latin America with the highest incidence of the condition. The percentage of reproductive age adults that suffer obesity is estimated in 9-18% for men and 12-28% for women. The excess body fat has serious detrimental effects on fertility potential and the reproductive capacity of couples compromising fecundity and causing anovulatory infertility and sexual dysfunction as well as poorer results in assisted reproductive technologies and obstetric outcome

Características de parejas infértiles en la provincia de Santiago de Cuba / Characteristics of infertile couples in Santiago de Cuba

Introducción: La incidencia de la infertilidad ha aumentado y, de acuerdo con médicos expertos y diversos organismos especializados, existe una clara relación entre el sistema de vida actual y la disminución de la fertilidad. Objetivo: Caracterizar a las parejas infértiles según variables clínico-epidemiológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 132 parejas infértiles asistidas en la consulta de Infertilidad y Reproducción Asistida del Hospital General Docente Dr. Juan Bruno Zayas Alfonso, durante el año 2018. Resultados: Un elevado número de las féminas tenían edades superiores a los 40 años (32,2 %), 7 % de las parejas estudiadas fueron diagnosticadas con infertilidad secundaria y existió 33,3 % de prevalencia del hábito de fumar, con predominio en el sexo masculino. Conclusiones: La edad de las féminas, las infecciones de transmisión sexual y el antecedente de abortos previos pudieran ser las principales causas de infertilidad en la provincia de Santiago de Cuba.

Introduction: The incidence of infertility has increased and, according to expert doctors and diverse specialized organizations, a clear relationship exists between the system of current life and the decrease of fertility. Objective: To characterize the infertile couples according to selected clinical-epidemiological variables. Methods: An observational, descriptive and cross-sectional study of 132 infertile couples assisted in the Infertility Service and Assisted Reproduction of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital, was carried out during 2018. Results: A high number of women were older than 40 years (32.2%), as long as, seven percent of the studied couples was diagnosed with secondary infertility and thirty three point three percent presented nicotine addiction, with prevalence in the male sex. Conclusions: The age of women, sexually transmitted infections and history of previous abortions could be the main causes of infertility in Santiago de Cuba.

Caracterización clínico-epidemiológica de parejas infértiles / Clinical-Epidemiological characterization of infertile couples

Introducción: Aproximadamente, el 15 por ciento de todos los matrimonios no tienen hijos. Según estudios realizados en Cuba, la prevalencia de infertilidad oscila entre 12 y 14 por ciento, destacándose dentro de sus causas los factores pélvicos que afectan las trompas o el endometrio con 30-50 por ciento, seguido de la disfunción ovulatoria con el 10 a 25 por ciento y solo 10 por ciento son de causa desconocida. Objetivo: Caracterizar a las parejas infértiles según variables clínico epidemiológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo, transversal a 224 parejas infértiles, en la provincia Santiago de Cuba. Cuba, en el periodo 2015-2016. Resultados: El 40,3 por ciento de las parejas estudiados presentaron infecciones de transmisión sexual de diferentes etiologías y el 45,6 por ciento se diagnosticaron con infertilidad secundaria. Conclusiones: La edad de la mujer por encima de los 35 años, los antecedentes patológicos personales, la ingestión de medicamentos, la presencia previa de infección de trasmisión sexual así como el antecedente de varios episodios de enfermedad pélvica inflamatoria, están relacionadas con la etiología infecciosa de la infertilidad y pudieran constituir las principales causas de este trastorno en nuestro país(AU)

Introduction: Approximately 15 percent of all marriages do not have any children. According to studies carried out in Cuba, the prevalence of infertility ranges from 12 to 14 percent, among whose highlighted causes are pelvic factors that affect the tubes or the endometrium, accounting for 30-50 percent, followed by ovulatory dysfunction, accounting for 10-25 percent, while only 10 percent are of unknown cause. Objective: To characterize infertile couples based in the selected clinical-epidemiological variables. Methods: An observational, descriptive, cross-sectional study was carried out with 224 infertile couples in Santiago de Cuba Province, Cuba, in the period from 2015 to 2016. Results: 40.3 percent of the studied couples had sexually transmitted infections of different etiologies, while 45.6 percent were diagnosed with secondary infertility. Conclusions: The age of the woman over 35 years, personal pathological antecedents, ingestion of medications, the previous presence of sexually transmitted infections, as well as the history of several episodes of pelvic inflammatory disease, are related to the infectious etiology of infertility and could be the main causes of this disorder in our country(AU)

Perfil biopsicossocial de pacientes que procuram mutirão de infertilidade na cidade de Ribeirão Preto (SP) / Biopsychosocial profile of patients seeking tertiary care of infertility in the city of Ribeirão Preto (SP)

Objetivo: Investigar por meio de questionário os aspectos psicológicos e sociais de pacientes inférteis atendidas no 1 ◦ Mutirão de Infertilidade do Hospital Electro Bonini, em Ribeirão Preto (SP). Métodos: Foram entrevistadas 116 mulheres que procuraram atendimento para investigação e tratamento de infertilidade. Os resultados foram analisados para identificação do perfil psicossocial das pacientes. Resultados: Os principais questionamentos levaram em conta grau de tristeza por não engravidar, esperança de engravidar, se já engravidou, se já pensou em adotar filhos, desistência do tratamento. Os resultados foram condizentes com os dados encontrados na literatura. A análise do perfil biopsicossocial nos revelou o acentuado grau de tristeza e preconceito ou pressão social por não conseguir engravidar. Entretanto, essas mulheres demonstram grande esperança de gestar e a maioria não pensa em desistir do tratamento. Conclusão: Este estudo comprova o aspecto patológico que a infertilidade ocasiona na vida dos casais, principalmente nas mulheres, já que 75% relataram que se sentem infelizes ou depressivas por não conseguirem engravidar. O trabalho multidisciplinar, nesse sentido, é de fundamental importância na compreensão dos conflitos emocionais íntimos e profundos que a infertilidade provoca.(AU)

Objective: To investigate, through a questionnaire, the psychological and social aspects of infertile patients attended at the Infertility Ambulatory Clinic of Electro Bonini Hospital, in the city of Ribeirão Preto (SP). Methods: Were interviewed 116 women who sought care for investigation and treatment of infertility. The results were analyzed to identify the social and psychological profiles of the patients. Results: The main questions took into accountthe degree of sadness for not getting pregnant, their hope to get pregnant, if they had already been pregnant, if they had ever thought about adopting a child, withdrawal of treatment. The results were consistent with the data found in the literature. The biopsychosocial profile analysis revealed a strong degree of sadness and prejudice or social pressure for not getting pregnant. However, those women have great hope of getting pregnant and the vast majority doesn't think of quitting treatment. Conclusion: This study proves the pathological aspect that infertility causes in the lives of couples, especially women, since 75% reported that they feel unhappy or depressed for not being able to get pregnant. Multidisciplinary work, in that sense, plays an important role in understanding the intimate and deep emotional conflicts that infertility causes.(AU)

Aspects epidemiologiques et etiologiques des couples infertiles a Abidjan

Objectif : Ce travail avait pour objectifs d'identifier les caracteristiques sociodemographiques des couples infertiles et de preciser les principales etiologies. Methode : Nous avons mene une etude retrospective descriptive portant sur 210 couples consultant pour infertilite dans les services de gynecologie du CHU de Treichville et d'une clinique privee de la place durant la periode 1er fevrier 2013 au 30 septembre 2014 (20 mois). Resultats. La prevalence de l'infertilite etait de 14;03%. L'age moyen etait de 34;31 ans chez les femmes et de 43;2 ans chez les hommes. La majorite des patientes avait atteint au moins le niveau d'etude secondaire (77;1%). Les couples residant hors d'Abidjan etaient de 15%; et les differentes couches socio-economiques etaient touchees par l'infertilite. La duree moyenne de vie commune des couples etait de 6;9 ans avec une duree moyenne d'infertilite de 6;3 ans. L'infertilite etait en general de type secondaire; touchant aussi bien les femmes (41%) que les hommes (30%). Les etiologies chez les femmes etaient d'origine uterine (47;06%); hormonale (22;79%) et tubo peritoneale (17;65%). Chez l'homme les troubles du sperme etaient domines par l'oligoasthenospermie (69;91%) d'etiologie generalement infectieuse. Conclusion. l'infertilite etait frequente dans nos services; touchant aussi bien les femmes que les hommes

Propedêutica básica da infertilidade conjugal / Basic propedeutics of conjugal infertility

A infertilidade é um problema que afeta cerca de 10%-20% da população, com incidência variável em todo o mundo. A avaliação do casal infértil é geralmente indicada depois de um ano, tempo em que a maioria dos casais normais teria sido bem sucedida na tentativa de concepção. Algumas investigações são controversas, e, na presença de múltiplos métodos, o custo, a segurança e a conveniência deveriam ajudar a decidir o mais apropriado.

Infertility is a problem affecting approximately 10%-20% of the population with variable incidences across the world. Evaluation of a couple is generally indicated after one year, by which time most normal couples attemptiong conception would have been successful. Some of the investigations are controversial and in the presence of multiple methods of investigating one aspect, the cost, safety, convenience and evidence-base should help in deciding on the appropriate method.

Características de homens e mulheres que buscam tratamento para infertilidade em serviço público de saúde / Characteristics of men and women seeking infertility treatment in a public health service

Objetivo: caracterizar a população que busca tratamento para infertilidade em um serviço público de saúde. Método: estudo descritivo com 101 homens e 101 mulheres que se consultavam pela primeira vez em ambulatório de reprodução humana de hospital universitário. Informações socioeconômicas e sobre a infertilidade foram coletadas por meio de entrevista única, com questionário estruturado. Resultados: a maior parte das pessoas tinha entre 25 e 35 anos, no máximo nível médio de escolaridade completo, renda per capita familiar entre um e três salários mínimos, declarou ser casada havia mais de cinco anos e que apresentava o problema de infertilidade havia dois anos ou mais. Um pouco menos da metade afirmou nunca ter feito tratamento para infertilidade. Houve diferença significativa entre homens e mulheres quanto a idade, união anterior, trabalho remunerado, tratamento anterior para engravidar, quem tinha o problema para engravidar e ter filhos de uma união anterior. Conclusões: as pessoas chegam ao serviço depois de um tempo relativamente longo de infertilidade. Especificamente as mulheres já chegam com idade que, muitas vezes, inviabiliza sua admissão para tratamento em vista das normas dos serviços. É preciso desenvolver estratégias para facilitar o acesso a esses serviços, para que sejam respeitados os direitos reprodutivos.

Objective: to characterize the population seeking infertility treatment at a public health service. Method: it was carried out a descriptive study with 101 men and 101 women who wereconsulúng for the first time ín a human reproductíon outpatient clíníc at an university hospital Astructured questionnaire was used to collectin formation on subjects' socioeconomic characterístícs and infertility problem. Results: the most of the subjects were 25-35years old, have at most medium level of scholarship, familiar per capita income between one to three minimum salaries, they declared they were married for more than tive years and that they had the infertility problem fortwo years ar more. Alittle less than half said they had never had treatment for infertility. There was a significant difference between men and women regarding age, previous marriage, paid work, previous infertility treatment, who had the infertility problem, and have children from a previous union. Conclusions: people come to the clinic after a long period of infertility. Specifically women are already at an age that often precludes admission for treatment in view of the standards of servires. It is necessary to develop strategies to facilitate access to these services for reproductive rights.

Impaired fertility in Jamaica: evidence from fertility surveys / La fertilidad alterada en Jamaica: evidencias de encuestas sobre fertilidad

OBJECTIVE: It has been a long held belief that increased contraceptive use is primarily responsible for lowered fertility in Jamaica since the 1970s. However, historically, subfecundity has played a major role in suppressing fertility rates. In order to reveal the prevalence and trend in fertility impairment, a study was conducted using data from the 1989, 1993, 1997 and 2002 reproductive health surveys. METHODS: Bivariate analysis was used to highlight women's lack of childbearing in the five-year period prior to the survey, and the reasons they provide for their inability to become pregnant. Using the impairment typology of Chandra and Stephen (1998), cross-tabulations were used to present the sociodemographic background of women determined to experience fertility impairment. RESULTS: The data reveal that 28 per cent of sexually experienced women aged 15-49 years in 1989 and 31 per cent in 2002 reported some form of fecundity impairment. Impairment is largely due to sub-fecundity resulting from miscarriage or abortion, rather than failure to conceive. Women with impairment were predominantly found in married and common-law unions, were mothers, were 30 years or older, had experienced fetal loss, were working, and did not want an additional child. CONCLUSION: As childbearing and increasing age raise the prevalence of impairment, many women are unlikely to meet their family building goals. We therefore recommend that health screening for conditions related to infertility be introduced.

OBJETIVO: Por mucho tiempo se ha creído que el aumento en el uso de anticonceptivos es el principal responsable de la disminución de la fertilidad en Jamaica a partir de la década del 70. Sin embargo, históricamente, la subfecundidad ha jugado un papel fundamental en suprimir las tasas de fertilidad. Con el fin de mostrar la prevalencia y la tendencia en la alteración de la fertilidad, se realizó un estudio usando datos de encuestas sobre salud reproductiva, realizados en 1989, 1993, 1997 y 2002. MÉTODOS: El análisis bivariado se usó para resaltar la falta de embarazos en las mujeres en el periodo de cinco años previo a la encuesta, y las razones que ellas aducen con respecto a su incapacidad para salir embarazadas. Tomando por base la tipología de las alteraciones de Chandra y Stephen (1998), se usaron tabulaciones transversales para presentar el marco sociodemográfico de las mujeres que enfrentaban alteraciones de la fertilidad. RESULTADOS: Los datos revelan que el 28 por ciento de las mujeres con experiencias sexuales y edades de 5 a 49 años, en 1989, y 31 por ciento en 2002 reportaron alguna forma de alteración de la fecundidad. En gran medida, las alteraciones se deben a la subfecundidad producida como consecuencia de abortos espontáneos o provocados, más bien que a no poder concebir. Las mujeres con alteraciones de la fertilidad eran predominantemente casadas o vivían en unión consensual; eran madres; tenían 30 años de edad, o más; habían experimentado la pérdida de un feto; estaban trabajando, y no querían tener otro hijo. CONCLUSIÓN: A medida que los embarazos y la edad aumentan la prevalencia de la alteración de la fertilidad, muchas mujeres presentan una menor probabilidad de alcanzar sus metas de constituir una familia. Por lo tanto, se recomienda que se introduzcan tamizajes de las condiciones de salud en relación con la infertilidad.

Fecundidad y fertilidad: aspectos generales / Fertility: general features

En este artículo se examina la fecundidad natural con énfasis en los factores determinantes y sus moduladores las variables diferenciales. Se presenta estrategias para el estudio de la prevalencia de la infertilidad mediante estudios basados en población o su estimación y tendencias en base a datos de nuliparidad al final de la vida reproductiva aportados por censos de población de las últimas décadas. Se revisa además, el concepto de fecundabilidad y su relación con el número de ciclos necesarios para lograr el embarazo con una probabilidad razonable de acuerdo a la edad de la mujer. Se presenta una revisión de las enfermedades de transmisión sexual más prevalentes, el tabaquismo y su asociación con la fertilidad. Finalmente, se analiza la postergación de la maternidad en el ámbito público y privado, y el efecto de la edad del hombre y la mujer sobre la fertilidad.

This study analyzes the natural fertility emphasizing the proximate determinants of fertility and differencials. The strategies to establish the prevalence of infertility through population based surveys and it trends through the study of childlessness at the end of a woman’s reproductive life are presented. Furthermore, the concept of fecundability and its association with time to conception and the woman’s age are reviewed. A revision of the most prevalent STDs and cigarette smoking and their association with fertility are presented. Finally, it is analyzed the postponement of maternity within the public and private environment and male and female age effect over fertility.

¿Qué sabemos hoy sobre las relaciones entre estrés e infertilidad? / What we know today about the relationship between stress and infertility?

El objetivo de este artículo es sintetizar los resultados de la investigación acerca de la relación entre factores psicológicos, particularmente el estrés, e infertilidad. Los primeros estudios basados en casos clínicos, exploraron las características psicológicas o conflictos intrapsíquicos que pueden ser causa de infertilidad. Posteriormente la investigación puso el acento en describir las consecuencias emocionales más frecuentes de la infertilidad y sus tratamientos. Además se describieron las diferencias en la respuesta emocional de hombres y mujeres. Estos estudios aportaron a relevar la importancia de un abordaje integral de la infertilidad que integre los aspectos emocionales.En base a las teorías sobre el estrés y la incidencia de los estilos psicológicos de enfrentamiento del estrés, se caracterizó el estrés específico asociado a la infertilidad y los tratamientos (ámbito personal, de relación de pareja y social) y se desarrollaron instrumentos de evaluación. Se estudió qué tipo de enfrentamiento produce una mejor adaptación tanto en hombres como en mujeres. En los años 90 se han realizaron varias investigaciones siguiendo parejas infértiles, que demostraron que el nivel de estrés experimentado afecta significativamente la calidad de la relación de pareja, la adherenciaa los tratamientos y la respuesta a los mismos expresada en tasa de embarazo y número de ciclos de tratamiento para lograr una gestación. De la investigación surgen conclusiones que orientan la metodología y el contenido de la intervención psicosocial para que ésta sea una contribución efectiva en la salud mental de las personas, su adherencia al tratamiento y el resultado de los mismos.

The aim of this article is to summarize the results of research concerning psychological factors, particularly stress, in relation to infertility. The first studies based on clinical cases, explored the psychological characteristics or intrapsychic conflicts associated to infertility. Subsequently, studies placed emphasis on describing the most frequent emotional consequences and their treatment. The differences in the emotional response from men and women were also described. These studies contributed to highlight the importance of an integral approach to infertility which includes emotional aspects. Based on the stress theories and the incidence of psychological coping styles, it was possible to characterize stress associated specifically to infertility and its treatment (personal, for couple and social relationships), the type of approach which produces better adaptation, both in women and men, and also to develop methods of evaluation. In the 90´s various studies involving infertile couples, demonstrated that the level of stress experienced has considerable effect on the quality of couple relationships, adherence to treatment and the efficacy of the treatments themselves, expressed in terms of pregnancy rates and the number of cycles needed to achieve a pregnancy. Findings from these studies have helped to orient the methodology and content of psychosocial intervention, thus helping to contribute positively to the mental health of couples, their adherence to infertility treatment and the results, themselves.

La infertilidad en un área de salud del municipio Cerro / Infertility in a health area of Cerro municipality

OBJETIVOS: caracterizar el comportamiento de la infertilidad en 11 consultorios del Policlínico Héroes de Girón del municipio Cerro. MÉTODOS: se realizó un estudio descriptivo de corte transversal. La selección de los consultorios fue por muestreo por criterios, y los de selección fueron: que tuvieran una distribución equitativa en los Grupos Básicos de Trabajo, así como la estabilidad y conocimiento profundo del área por el personal de enfermería (quien ejecutó la investigación, previa capacitación en el tema). Se aplicaron 2 instrumentos: un formulario a nivel del consultorio y una encuesta a las parejas con problemas por infertilidad. Como medida de resumen se utilizó el porcentaje. RESULTADOS: de un total de 700 parejas en edad fértil que se encontraron, 40 tenían problemas de infertilidad, para un 5,7 por ciento, y de ellas fueron entrevistadas 35. Existió predominio de los factores femeninos, principalmente el tubárico. La mayoría de las parejas estaban en edades óptimas para procrear, con relaciones matrimoniales estables y más de 2 años intentando tener descendencia. Predominó la infertilidad primaria. Más de la mitad de las parejas no tenían seguimiento por esta causa, y las que lo tuvieron, a pesar de ser por más de 3 años, conocen poco la causa de la infertilidad. CONCLUSIONES: la infertilidad en la población estudiada alcanza una mayor magnitud por los problemas de atención, que por la proporción numérica que representa. Se encontró fundamentalmente en edades óptimas para la reproducción, en relaciones estables, con una espera prolongada y con predominio de infertilidad primaria de causa tubárica. Las dificultades diagnósticas y terapéuticas y lo largo del proceso hacen que la mayor parte de las parejas se encuentren insatisfechas con el seguimiento que reciben.

OBJECTIVE: a descriptive cross-sectional study was conducted to characterize the behavior of infertility in 11 family physician's offices of "Héroes de Girón" Polyclinic in Cerro municipality. METHODS: the family physician's offices were chosen by criterion and selection sampling. The selection was based on an equitative distribution in the Basic Working Groups, as well as on the stability and deep knowledge of the area on the part of the nursing personnel that carried out the investigation after being trained on the topic. Two instruments were applied: a questionnaire at the family physician's office level and a survey to the couples with infertility problems, Percentage was used as a summary measure. RESULTS: of a total of 700 couples at fertile age, 40 had infertility problems, accounting for 5.7 percent. 35 of them were interviewed. It was observed a predominance of the female factors, mainly the tubal factor. Most of the couples were at optimal ages to procreate with steady marriage relations and they had been trying to have children for more than 2 years. Primary infertility prevailed. More than half of the couples were not followed up for this reason, and those who were, in spite of being followed up for more than 3 years, knew little about the cause of infertility. CONCLUSIONS: infertility in the studied population reaches a greater magnitude due to the problems of attention rather than for the figure it represents. It was mainly found at optimal ages for reproduction, in stable relations with a prolonged waiting and with predominance of primary tubal infertility. The diagnostic and therapeutic difficulties, as well as the long process make that most of the couples be unsatisfied with the follow-up they recieve.

Comparative study of intracytoplasmic sperm injection and in vitro fertilization with high insemination concentration in sibling oocytes in the treatment of unexplained infertility.

INTRODUCTION: Some unexplained infertile couples may have fertilization failure; the in vitro fertilization (IVF) with high insemination concentration (HIC) and intracytoplasmic sperm injection (ICSI) were reported to give better fertilization rate when compared to standard IVF procedure. OBJECTIVE: To compare the fertilization rate, abnormal fertilization rate, total fertilization failure rate, and pregnancy rate between the IVF with HIC and ICSI for the treatment of unexplained infertility. MATERIAL AND METHOD: The prospective study in 36 unexplained infertile couples in Thammasat University Hospital between 2005-2007 was performed by equally dividing sibling oocytes in assisted reproductive technology cycles with controlled ovarian hyperstimulation protocol in each patients into two groups; group I were inseminated with 200,000 sperms (IVF with HIC) and group II underwent ICSI procedure. The embryos from the better fertilization group were selected to transfer The fertilization rate, the abnormal fertilization rate, the implantation rate, the pregnancy rate and total fertilization failure rate were compared by Chi-square test and Fisher's exact test with statistical significance if p < 0.05. RESULTS: The fertilization rate, the abnormal fertilization rate, the implantation rate, the pregnancy rate and total fertilization failure rate of group I and II were 56.97% vs. 70.29% (p = 0.15), 6.56% vs. 1.26% (p = 0.003), 12.50% vs. 15.00% (p = 0.50), 38.46% vs. 36.36% (p = 0.67) and 13.89% vs. 0.0% (p = 0.04) respectively. CONCLUSION: ICSI exhibited least total fertilization failure rate (0.0% VS. 13.89%) and gave less abnormal fertilization rate (1.26% vs. 6.56%) with statistical significance in unexplained infertility when compared to the IVF with HIC procedure. Therefore, applying of ICSI procedure may increase the success chance of embryo transfer and pregnancy outcomes.

Epidemiology of depression among infertile and fertile couples in Shiraz, southern Iran.

BACKGROUND: Depression is considered as one of the main psychological disorders associated with infertility. Depression may play a significant role in the life of infertile individuals, their infertility treatment follow-up and in their hopefulness for the future; it may also influence the intensity and continuousness of the mutual relationship of the affected couple. AIMS: This study was done to determine the depression rate and make a comparison between infertile and fertile couples with respect to the same. SETTING AND DESIGN: The depression rate was evaluated between two groups--infertile couples (case group) and fertile couples (control group). MATERIALS AND METHODS: Ninety-one infertile couples (cases) and 9l fertile ones (controls) were randomly enrolled in our study. Beck depression inventory (BDI) and demographic information were provided. STATISTICAL ANALYSIS: We used Chi-square, t-test; and one-way Analysis of Variance (ANOVA) was performed to find out significant difference between infertility duration in various couples and its effect on the score of depression. RESULTS: The BDI mean difference between infertile and fertile couples was significant (P=0.015). It was significantly more among couples with infertility from 1-3 years' duration compared to those with infertility of 1-year duration or less. CONCLUSION: Regarding the high rate of depression among infertile couples, it seems necessary to pay more attention to infertility centers that offer psychological and psychiatric services.

Tubal abnormalities in Thai infertile females.

OBJECTIVE: To determine the prevalence of tubal abnormalities among infertile patients attending the clinic at Srinagarind Hospital. DESIGN: A descriptive study SETTING: Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SUBJECT: A total of 740 female patients presented at the infertility clinic, Srinagarind Hospital between 1 January 1998 and 31 December 2002. MATERIAL AND METHOD: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted. MAIN OUTCOME MEASURE: Prevalence of tubal abnormalities in infertile females being treated in the infertility clinic during the study period. RESULTS: Among the 740 patients being recruited to the present study, 533 cases (72.03%) were diagnosed with primary infertility while the rest (207 or 27.97%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 4.68 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 556 cases (75.14%), 30 cases (4.05%) and 154 cases (20.81%), respectively. The prevalence of tubal abnormalities demonstrated in the present study was 27.30% (202 from 740 cases). Among the 202 patients with tubal abnormalities, the pathologies detected were cornual occlusion (46.04%), combined tubal abnormalities (30.20%), distal tubal occlusion (8.42%), hydrosalpinx (3.47%), peritubal adhesion (3.96%), and other abnormalities (7.91%). Other pelvic pathologies detected from laparoscopy were endometriosis (61.49%), pelvic adhesion (24.22%), leiomyoma (12.42%), and ovarian cyst (1.87%). CONCLUSION: Tubal abnormalities were detected in over one-fourth of all infertile females being treated at Srinagarind Hospital. Further study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.

The oral contraceptive pill effectively permits cycle batching for an intermittent in vitro fertilization programme in Trinidad and Tobago / Las Píldoras Anticonceptivas Orales Permiten la Agrupación Eficaz de los Ciclos para un Programa Intermitente de FIV en Trinidad y Tobago

Assisted reproductive technology (ART) in small island states like Trinidad and Tobago is usually provided in batches so as to minimize the cost of providing the service. As a result, patients 'cycles have to be synchronized in order to coincide with the arrival of a visiting embryologist. This is a retrospective study which evaluates the experience of pre-treatment with an oral contraceptive pill (OCP) as a means of batching cycles for an intermittent ART programme. Seventy-four in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles in which OCP usage was employed (Group A), were compared with 121 cycles which did not require pharmaceutical manipulation (Group B). In both groups more than 50 of women were older than 36-years. Two cycles were cancelled in Group A and seven in Group B, because of poor ovarian response. Although the pregnancy rate per treatment cycle was higher in Group A than in Group B (26.3 vs 17.3), this difference was not significant. More spontaneous miscarriages occurred in the non-OCP women and ovarian cyst formation was more common in these women. The authors experience indicates that the OCP is a simple, cheap and efficient means of batching patients for an intermittent ART programme and can be utilized in other small ART centres

La tecnología de reproducción asistida (TRA) en los pequeños estados insulares como Trinidad y Tobago, usualmente se ofrece por tandas a fin de minimizar los costos del servicio brindado. En consecuencia, los ciclos de las pacientes tienen que ser sincronizados de modo que coincidan con la visita del embriólogo. Éste es un estudio retrospectivo que evalúa la experiencia del pretratamiento con píldoras anticonceptivas orales (PAO) como medio de agrupar los ciclos con el propósito de organizar un programa intermitente de TRA. Setenta y cuatro ciclos de fertilización in vitro (FIV) e inyección intracitoplasmática de esperma (ICSI) en los que se recurrió al uso de PAO (Grupo A), fueron comparados con 121 ciclos que no requirieron manipulación farmacéutica (Grupo B). En ambos grupos, > 50% de las mujeres tenían más de 36 años de edad. Dos ciclos fueron cancelados en el grupo A y siete en el grupo B, debido a una respuesta ovárica pobre. Aunque la tasa de embarazo por ciclo de tratamiento fue más alta en el grupo A que en el grupo B (26.3% vs. 17.3%), esta diferencia no fue significativa. El número de abortos espontáneos fue mayor y la formación de quistes ováricos más común, en las mujeres que tomaron PAO. La experiencia de los autores indica que la PAO es un medio simple, económico y eficaz de agrupar a los pacientes en un programa intermitente de TRA, y puede utilizarse en otros centros pequeños de TRA.

Assisted reproductive technology. What is needed in the Kingdom of Saudi Arabia?

In 1978, the first in vitro fertilization baby was born. Since then, we have seen the introduction of several new modalities of assisted reproductive technologies ART, and the spread of ART procedures throughout the world. The number of ART units in the Kingdom of Saudi Arabia is increasing rapidly. The associated complications of ART procedures include fetal, maternal and childhood