Клиническая характеристика беременности после ЭКО у пациенток с бесплодием различной этиологии

Utility of screening for other causes of infertility in women with “known” polycystic ovary syndrome

Clinical outcomes for various causes of infertility with natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes

Is female infertility among women seeking medically assisted reproduction (MAR) associated with prevalent as well as incident multiple sclerosis (MS)? Women with a record of female infertility did not have an increased risk of developing MS compared with apparent fertile women; however, the prevalence of MS was slightly higher among women undergoing MAR compared with women who had a child without MAR, but this was not related to origin of infertility (i.e. male versus female factor infertility). Women with MS have fewer children compared with women without MS. Persons with MS more often have other coexisting autoimmune disorders including hypothyroidism compared with the general population. Thyroid dysfunction is associated with ovarian cause of infertility, miscarriage and ovarian failure. Conversely, women with endometriosis, that is highly associated with infertility, also more often have other coexisting autoimmune diseases including MS and hypothyroidism compared with the general population. However, whether the low fertility rate among women with MS is due to a genetically predisposition to other autoimmune and endocrine disorders that leads to reduced fertility, or an active choice of the woman, disease-related pathology or treatment-specific effect on endocrine and/or ovarian function, is not completely understood. A register-based cohort study of a total of 310 357 women from 1996 to 2018. A cross-sectional design was used for analysing prevalence of MS, whereas a cohort design with up to 24 years of follow-up was used for analysing incidence of MS. Three cohorts were included in the study (i) 55 404 women with a female infertility diagnosis registered in the Danish IVF register; (ii) 25 096 women with only male factor infertility recorded in the IVF register and thus no female infertility diagnosis and (iii) 229 857 age- and calendar-matched women with a record of first child birth in the Danish Medical Birth Register (DMBR) and no record ever in the IVF register. The prevalence and incidence of MS in the female infertility cohort were compared with the two control cohorts of apparent fertile women using log-binomial regression and Cox proportional hazard regression, respectively. The crude prevalence of having MS per 1000 persons was 3.2 for women who had undergone MAR treatment regardless of origin of infertility (i.e. male versus female factor infertility) and 2.3 for fertile DMBR controls. The age, calendar and educational level adjusted prevalence ratio of having a diagnosis of MS at the first MAR treatment was 1.27 (95% CI 1.07-1.52) for infertile women compared with fertile DMBR controls, and 1.00 (95% CI 0.77-1.31) for comparison to women with a male partner with infertility who had also undergone MAR treatment. We found no association between incident MS and female infertility compared with either of the control groups of fertile women. The cohort of infertile women is highly selected on the basis of their choice of having fertility treatment and thus does not include women with unestablished infertility or women who, for some reason, have chosen not to have MAR treatment. Additionally, due to the nature of the observational study design, we cannot exclude the possibility of unmeasured and/or residual confounding. Our results suggest that women with MS may undergo MAR treatment more often than women without MS due to more awareness about the possibility of MAR treatments, sexual dysfunction related to MS disease, but also need for timing of the pregnancy to avoid an unnecessary long time period without disease modifying therapy-especially of high efficacy-and hence a wish to conceive quickly. These findings are important for clinicians dealing with women with MS of childbearing age. The authors received no financial support for the study. T.I.K. has served on a scientific advisory board for Novartis and has received support for congress participation from Biogen. M.M. has served on scientific advisory boards for Biogen, Sanofi, Roche, Novartis, Merck, Abbvie and Alexion. She has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi and Genzyme and has received research support and support for congress participation from Biogen, Genzyme, Roche, Merck and Novartis. The remaining authors declare no conflict of interest. N/A.

Objective: Infertility has a serious impact on the psychosocial well-being of women in the developing world. The objective of the study was to evaluate the causes and treatment pattern of infertility patients in a tertiary care hospital.Methods: The prospective observational study focused on the sociodemographic properties of infertile patients, causes of infertility, and various treatments carried out in a tertiary care hospital, Erode, Tamil Nadu.Results: Of 200 cases, the majority was due to female factor (45.5%), followed by male factors (26%), both gender factors (25.5%), and unexplained etiology (6%). It was observed that major causes of male infertility (MI) were oligoasthenoteratozoospermia (OATS - 48.42%), followed by asthenozoospermia (17.89%), azoospermia (11.57%), erectile dysfunction (7.36%), oligoasthenozoospermia (5.26%), varicocele (3.15%), oligospermia (2.10%), necrozoospermia (2.10%), asthenoteratozoospermia (1.05%), and asthenozoospermia+erectile dysfunction (1.05%). In cases of female infertility (FI), the pattern of causes was polycystic ovarian disease (PCOD) (29.6%), followed by tubular block (13.23%), cyst (6.66%), hypothyroidism (4.44%), endometriosis (4.44%), hormonal problems (4.44%), fibroid (3.7%), fibroid+cyst (3.7%), premature ovarian failure (2.96%), thin endometrium (2.96%), multifollicularovary (2.96%), PCOD+hormonalproblems (2.96%), and hypothyroidism+hormonal problems (2.22%). Intrauterine insemination was the most commonly assisted reproductive technology employed, followed by in vitro fertilization and intracytoplasmic sperm injection. Of 200 infertile couples, 57 (28.5%) were unable to conceive within 6 months and 72 (36%) after 6 months following first consultation, 44 (22%) defaulted/lost follow-up/were still under consultation, 13 (6.5%) conceived with the help of assisted reproductive treatment, 10 (5%) conceived with the help of drug treatment, anddd 4 (2%) had spontaneous pregnancy.Conclusion: The major cause of infertility was found to be PCOD in females and OATS in males. The most commonly prescribed drugs were antioxidants for males and progesterone for females.

Restoration of women's reproductive health in modern conditions is a multifactorial problem for specialists (obstetricians, gynecologists, endocrinologists, hematologists, therapists), often requiring the use of assisted reproductive technologies (ART) [1,3]. According to available data, 46.7% of women who need ART have primary infertility, 53.3% have secondary infertility, and the average age is less than 35 years [2,4]. Despite the fact that only 10-20% of married couples have a verified cause of infertility, in most cases the etiopathogenesis of impaired fertility cannot be corrected [5,6]. One of the factors of a woman's infertility is the uterine factor, caused by various pathologies of the uterine cavity. The variety of pathologies (endometrial polyps, submucosal leiomyomas, intrauterine synechiae, chronic endometritis, congenital anomalies of the uterus) explains the variety of approaches to the diagnosis and treatment of uterine infertility [7]. The uterine form of infertility is the dominant cause of female infertility, exceeding the frequency of tubal-peritoneal and endocrine factors. Today, the connection between the occurrence of infertility and the age aspect has been proven. Materials. A sample and analysis of medical records of women who required the use of ART due to uterine infertility (n = 100) for 2017-2020. Results. The majority of women are residents of Ivano-Frankivsk region. The average age of women is 32.98 ± 0.4 years. When comparing the age of women, depending on the causes of the uterine form of infertility, differences were found. In adenomyosis, the age was the highest (34.44 ± 0.8 years) and can be compared with age in uterine fibroids (MM), but significantly higher than in hyperplastic processes of the endometrium (GPE), chronic endometritis (CE) or congenital anomalies of uterine development. (VARM) (p <0.001). Thus, VARM, DPE and CE can lead to infertility in women over the age of 23, which requires timely prevention and early diagnosis in this age cohort of women. Uterine factor remains one of the main factors in a woman's infertility. The probable cause of infertility in 33.4% of cases was uterine fibroids (MM), in 24.3% - adenomyosis, in 25.6% - endometrial hyperplastic processes (GPE), in 7.8% - saddle-shaped uterus as a manifestation of congenital anomaly development of the uterus (VARM), in 9.9% of women - chronic endometritis (CE). Infertility was primary in 13 (40.63%) women with MM, in 10 (43.48%) women with adenomyosis, in 21 (80.77%) women with GPE, in 2 (25%) women with VARM and in 2 women (18.18%) women with CE. The variety of pathologies (endometrial polyps, submucosal leiomyomas, intrauterine adhesions, chronic endometritis, congenital anomalies of the uterus) explains the variety of approaches to the diagnosis and treatment of uterine infertility. Conclusions. It was found that women, depending on the cause of the uterine form of infertility, had a correlation between different studied parameters. Differentiated differences in the clinical and social, anamnestic portrait of women depending on the cause of uterine infertility, which require further detailed study and analysis, which allows to differentiate approaches to timely diagnosis and targeted prevention of uterine infertility.

Background: In our society, females are blamed for infertility. Females especially in rural places face many problems socially and emotionally. Infertility is an obstacle in the development of couple when it does not take place normally. Infertility is a curse for women, the cause of which should be diagnosed accurately and early. Taking the abovemaintained silent plight of infertile females, this study was conducted based on uterine infertility as a step to increase understanding of pathological causes of primary infertility and serve community on the whole. Aim: This study aims to study histomorphological features of endometrium in primary infertility to know the etiological factors in a rural setup. Objectives: (1) To find various histomorphological patterns of endometrium in primary infertility. (2) To categorize the various etiologic causes under the following heads: (i) Hormonal cause. (ii) Infectious cause. (3) To find the principle cause for primary infertility in the ruler setup. (4) To know the importance of endometrial biopsy/dilatation and curettage (D and C) in primary infertility. Materials and Methods: A total of 99 endometrial sample of primary infertility were received from Department of Obstetrics and Gynecology of confirmed case of primary infertility. The endometrial biopsy or D and C were send in 10% formalin to department of pathology. The samples were processed, stained with hematoxylin and eosin and were studied and categorized into normal proliferative phase, inadequate proliferative phase, anovulatory phase, normal secretory phase, inadequate secretory phase/luteal phase defect (LPD), glandulostromal disparity (GSD), acute endometritis, chronic nonspecific endometritis, and tubercular endometritis. Observation and Results: It was observed that 42.42% patients had normal secretory phase or normal proliferative phase, i.e., it correlates with day of menses. The most common etiological cause for primary infertility was anovulation which was 28.28%. The second most common was LPD/inadequate secretory phase which was 15.15%. Inadequate proliferative phase was 8.08%. GSD was 3.03%. Endometrial hyperplasia was 4.04% among which 3.03% patients had simple hyperplasia without atypia and 1.01% patient had atypical complex hyperplasia. In infections, tubercular endometritis was 2.02% and chronic nonspecific endometritis was 1.01%. In the present study, anovulation was the principle cause of female primary infertility. There were 51.51% patients of primary infertility with hormonal cause and 3.03% patient with infective cause. Conclusion: Anovulation was the principle cause of female primary infertility and LPD was the second common cause of female primary infertility. In infections, tubercular endometritis was common whereas chronic nonspecific endometritis was less. Endometrial biopsy/D and C is a standard tool to know causes of primary infertility, which gives information at cellular level and detects hormonal causes, infective causes for infertility. Thus, by endometrial biopsy/D and C, we come to know the probable cause of female primary infertility, and accordingly, the treatment can be given to patient.

Harnessing the full potential of reproductive genetics and epigenetics for male infertility in the era of “big data”

Best practice policies for male infertility

Background: Infertility is defined as the failure in pregnancy after one year of unprotected intercourse. Several centers have reported different causes of infertility. The most common causes of infertility include: Female factors such as ovulation dysfunction and tubal factor; male factors like sperm disturbance as well as ; both male and female factors and unexplained infertility. The aim of this study was to find out the etiologic factors of infertility in BSMMU (Bangabandhu Sheik Mujib Medical University, Dhaka, Bangladesh)Methods: This cross sectional study was done at the Out Patient Department (OPD) of infertility in BSMMU during the period of December 2004 to March 2005. One hundred infertile couples with necessary investigations were reviewed for the study. Results: In this study the frequency of primary and secondary infertility was 56% and 44% respectively. Among 100 couples 57% had female factor, 25% had both male and female factors and in 3% had male factor and in 15% of couple, the causes of infertility were unknown. Among women, different infertility factors included: Tubal factor 33%, Ovarian factor 12% and endometriosis 11%. In this study tubal blockage were detected in 50% cases of female secondary subfertility following Menstruation Regulation (M/R). Result showed 82% of men had normal spermogram 28%, had sperm disturbance including Oligospermia, Asthenospermia, Oligoasthenospermia and teratospermia. Conclusion: Although female factor was the most common cause of infertility in BSMMU, we can not conclude that this factor is the most common causes of infertility in Bangladesh. Since this centre is considered as referral centre especially for female infertility. We suggest performance of similar researches with big sample size in different institution to evaluate most common causes of infertility in Bangladesh.DOI: http://dx.doi.org/10.3329/jom.v14i2.18460 J Medicine 2013, 14(2): 110-113

Male factor infertility may be associated with a low risk for tubal abnormalities

BackgroundInfertility is a big health problem worldwide. Few data exist on infertility in Sudan.MethodsA descriptive study was conducted to assess the pattern and the causes of infertility among couples (800) attending the University of Khartoum Fertility Centre, Saad Abualila Teaching Hospital in Khartoum, Sudan. The data on the socio-demographic characteristics of the patients, the type of infertility whether primary or secondary and the causes of infertility were extracted from the medical files retrospectively.ResultsThe mean (SD) age of the females was 32.4 (7.4) years while that of the males was 37.5 (7.2) years. The mean (SD) duration of infertility was 4.9(3.9) years. Five hundred and fifty one (68.9%) couples had primary infertility, while the remainder 249(31.1%) had secondary infertility. Two hundred and eighty four (35.5%) couples had male infertility, 342(42.8%) couples had female infertility. One hundred and forty seven (18.4%) couples had combined male and female infertility and in 27 (3.4%) couples the cause of infertility was not identified. Factors identified in the female infertility (342) were; anovulation (178, 52.05%), tubal factor (142, 41.52%), uterine factor (7, 2.05%) and other/combined (7, 2.05%). Azoospermia (75, 26.41%), oligozoospermia (45, 15.85%), asthenozoospermia (51, 17.96%), teratospermia (15, 5.28%) and mixed pathology (101, 35.56%) were the causes of the male infertility (n = 284). Female factors of infertility were observed more frequently among couples with secondary infertility compared with primary infertility (143/551(57.4) vs. 199/249(36.1), P < 0.001.ConclusionThe current study showed a high rate of primary infertility and female factor predominates compared with male factors. Future research direction should focus on the reasons why majority of clients seek this service very late.

To compare the effectiveness of double IUI with single IUI in male factor and idiopathic infertility patients undergoing controlled ovarian hyperstimulation (COH). A prospective randomized study of 1257 COH-IUI cycles was performed. Total 1270 patients with mild or moderate male factor infertility (n = 776) and idiopathic infertility (n = 494) were enrolled in this study, and 767 with male factor infertility and 490 with idiopathic infertility completed clomiphene citrate (CC)/human menopausal gonadotrophin (hMG) COH cycles and IUI. Categorized on the basis of the causes of infertility (male factor, M; idiopathic infertility, I), patients were randomized into one of the following groups: Single IUI group (M(1)/I(1)) received single insemination 34 h post hCG administration, and double IUI group (M(2)/I(2)) received two inseminations 18-24 and 36-48 h post hCG injection, respectively. The overall pregnancy rates were 15.43%. Pregnancy rate for single and double IUI group was 11.06 and 19.87% (p < 0.05), respectively. There was a significant statistical difference in cycle fecundity between M(1) and M(2) group (11.34% vs. 24.93%, p < 0.05), and between I(2) and M(2) group (11.93% vs. 24.93%, p < 0.05), but there was no significant difference between I(1) and I(2) (10.53% vs. 11.93%, p > 0.05). Double IUI increases the pregnancy rate significantly in patients with male factor infertility, and single IUI acts as efficient as double IUI in patients with idiopathic infertility.

Female infertility in the modern world remains an urgent problem that requires new algorithms for diagnosis and control of treatment. According to various authors, the first place among the causes of infertility in women is ovarian and menstrual disorders and chronic endometritis (CE). The purpose of the study is to analyze the causes of infertility in women according to the medical documentation of the “Prime-test” laboratory for the period 2014–2021, with confirmation of the diagnosis of CE by the immunohistochemistry (IHC) method. Materials and methods. Data from the medical records of patients who applied to the “Prime-test” laboratory after various gynecological interventions were studied. Female infertility was found in 521 cases. A complex histological and immunohistochemical study was conducted in 100 cases of CH. Invitrogen and eBioscience primary monoclonal antibodies were used. The results. The median age of patients with infertility was 35.7 years, with a median age of 30.45 years for patients diagnosed with CE. Ovarian-menstrual disorders (52.78%) are in the first place in the structure of the causes of infertility, in the second place (27.83%) are CE, and in the third place are infertility with an unknown cause (8.64%). The rest of the reasons accounted for a small number of cases. CE was confirmed histologically and by the IHC method in 100 cases, while the most informative marker in doubtful cases was CD138. Conclusions. Chronic endometritis is an understudied disease that requires optimization of the diagnostic and prognostic panel with the selection of the most informative markers and markers that will allow the most complete study of the state of the endometrium before and after treatment.

STUDY QUESTIONWhat are the primary causes of severe male factor infertility?SUMMARY ANSWERAlthough 40% of all patients showed primary causes of infertility, which could be subdivided into three groups based on the severity of their effect, ~75% of oligozoospermia cases remained idiopathic.WHAT IS KNOWN ALREADYThere are few large-scale epidemiological studies analyzing the causes of male factor infertility.STUDY DESIGN, SIZE, DURATIONA prospective clinical-epidemiological study was conducted at the Andrology Centre, Tartu University Hospital between 2005 and 2013, recruiting male partners of couples failing to conceive a child for over ≥12 months. Among 8518 patients, 1737 (20.4%) were diagnosed with severe male factor infertility. A reference group of fertile controls was comprised of 325 partners of pregnant women.PARTICIPANTS/MATERIALS, SETTING, METHODSThe mean age of infertility patients and fertile controls was 33.2 ± 7.3 and 31.7 ± 6.3 years, respectively. All participants were examined using a standardized andrology workup, accompanied by a structured medical interview. Hormonal analysis included serum FSH, LH and testosterone. Semen quality was determined in accordance to the World Health Organization recommendations. Cases with spermatozoa concentrations of ≤5 million/ml were screened for chromosomal aberrations and Y-chromosomal microdeletions.MAIN RESULTS AND THE ROLE OF CHANCEThe primary cause of infertility was defined for 695 of 1737 patients (~40%). The analyzed causal factors could be divided into absolute (secondary hypogonadism, genetic causes, seminal tract obstruction), severe (oncological diseases, severe sexual dysfunction) and plausible causal factors (congenital anomalies in uro-genital tract, acquired or secondary testicular damage). The latter were also detected for 11 (3.4%) men with proven fertility (diagnoses: unilateral cryptorchidism, testis cancer, orchitis, mumps orchitis). The causal factors behind the most severe forms of impaired spermatogenesis were relatively well understood; causes were assigned: for aspermia in 46/46 cases (100%), for azoospermia in 321/388 cases (82.7%), and for cryptozoospermia in 54/130 cases (41.5%). In contrast, 75% of oligozoospermia cases remained unexplained. The main cause of aspermia was severe sexual dysfunction (71.7% of aspermia patients). Azoospermia patients accounted for 86.4% of all cases diagnosed with secondary hypogonadism and 97.1% of patients with seminal tract obstruction. Of patients with a known genetic factor, 87.4% had extreme infertility (azoo-, crypto- or aspermia). The prevalence of congenital anomalies in the uro-genital tract was not clearly correlated with the severity of impaired sperm production. Previously defined ‘potential contributing factors’ varicocele and leukocytospermia were excluded as the primary causes of male infertility. However, their incidence was >2-fold higher (31.0 vs 13.5% and 16.1 vs 7.4%; P < 0.001) in the idiopathic infertility group compared to controls. In addition, the proportions of overweight (or obese) patients and patients suffering from a chronic disease were significantly increased in almost all of the patient subgroups.LIMITATIONS REASONS FOR CAUTIONThe study included only subjects with reduced total spermatozoa counts. Thus, these findings cannot be automatically applied to all male factor infertility cases.WIDER IMPLICATIONS OF THE FINDINGSThe novel insights and improved clarity achieved in the comprehensive analysis regarding the absolute, causative and plausible factors behind male infertility, as well as the ‘potential contributing factors’, will be valuable tools in updating the current clinical guidelines. The study highlights knowledge gaps and reiterates an urgent need to uncover the causes and mechanisms behind, and potential treatments of, oligozoospermic cases, representing the majority of idiopathic infertility patients (86.3%).STUDY FUNDING/COMPETING INTEREST(S)The project was financed by the EU through the ERDF, project HAPPY PREGNANCY, no. 3.2.0701.12-004 (M.P., M.L.) and the Estonian Research Council: grants PUT181 (M.P.) and IUT34-12 (M.L.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We have no competing interests to declare.TRAIL REGISTRATION NUMBERNot applicable

Endometrial infertility is the cause of inadequate implantation and serves as an obstacle to the onset and progression of spontaneous pregnancy and the implementation of assisted reproductive technology (ART) programs. One of the most common mechanisms for the development of infertility is endometrial thinning. Despite the abundance of publications, today there are no generally accepted diagnostic criteria and treatment and rehabilitation approaches for this pathology, which encourages continued scientific research in this direction. Aim was to highlight the problem of decreased fertility caused by “thin endometrium”. To create the review, the bibliographic method was applied and domestic and foreign literary sources from the Pubmed, MedLine, RSCI, e-library and Cyberleninka search engine databases were used. The search depth was 10 years. The following search phrases were used: “uterine factor of infertility”, “endometrial factor of infertility”, “thin endometrium”. Seventy five sources that were included in this review were studied and analyzed. Data presented in the literature indicate that endometrial causes of infertility are associated with incompetence of the uterine cavity mucosa, which may manifest itself as a phenomenon of ”thin endometrium”, the development mechanisms of which have not yet been fully studied. Determining the functional status of the endometrium is very important for predicting the onset of pregnancy in the natural cycle or in ART programs, since even in the presence of a good quality embryo, endometrial deficiency can prevent adequate implantation. Thus, before planning a subsequent pregnancy, it is necessary to diagnose and, if possible, neutralize or correct endometrial causes of infertility. One of the main markers of readiness for implantation at the moment is the thickness of the endometrium.