Cause Of Infertility In Patients Research Articles

Determinants of Infertile of Infertile Women Requesting Assisted Reproduction Techniques in a Low Resource Setting in Western Nigeria

Background: Infertility is an important gynaecological condition with psycho-social, cultural, economic, religious, demographic, and clinical consequences. Although the prevalence of couples having problems with conception has remained relatively stable worldwide, there has been an increase in the proportion of couples seeking fertility services. This substantial increase might reflect the improvement in the advancements in fertility care, improved success rates, increased availability of specialists and or involvement of insurance firms in infertility treatment. Paradoxically, countries in Africa with high infertility burden still lags in fertility care. This study was therefore aims to investigate the types and causes of infertility in patients attending fertility care in an assisted conception Centre in a public tertiary hospital in southwest Nigeria. Methods: This was a retrospective study of patient records who attended Assisted fertility centre (AFC) of Lagos University Teaching Hospital (LUTH), from January 1st, 2015, to December 31st, 2023. Categorical variables were analysed using percentages while continuous variables were analysed using mean and standard deviation and the association between categorical variables was analysed using chi-square test. The statistical significance level was set at p-value < 0.05. Results: The mean age and mean duration of infertility of the participants in the study was 40.89±6.8, and 8.14±3.5 respectively. About 72.9% had more than secondary education while almost two thirds of the participants had secondary infertility, 36.1% had previous pelvic surgeries, 11.4% had chronic pelvic pain and menstrual abnormality. Secondary infertility was more prevalent in women who has chronic pelvic pain, or those who has had previous pelvic surgery, previous infertility or previous abortion. Conclusion: In conclusion our analysis suggests that Secondary infertility is the commonest cause of inability to conceive in our facility. It also revealed that most of our women present late for fertility care at an advanced maternal age.

The identification and functional analysis of CircRNAs in endometrial receptivity of mice with polycystic ovary.

The disorders of endometrial receptivity and ovulatory dysfunction are both significant causes of infertility in patients with polycystic ovary syndrome (PCOS). In this study, we investigated the expression profile and functional implications of circular RNAs (circRNAs) in the endometrial receptivity of PCOS-affected mice. Twenty-four female C57BL/6 mice were divided into PCOS and normal control groups. The PCOS group received subcutaneous DHEA treatment, while the control group remained untreated. Gene chip technology was utilized to analyze circRNA expression in endometrial tissues on the fourth day of gestation with subsequent bioinformatics analyses into circRNA functions. Furthermore, endometrial epithelial cells were used to determine represented circRNA functions. Results showed that the PCOS group exhibited 205 differentially expressed circRNAs, with 147 upregulated and 58 downregulated ones. qRT-PCR confirmed differential expression of circRNAs, including circRNA_38548, circRNA_001686, circRNA_38550, and circRNA_27938. Predicted target genes and a circRNA-miRNA-mRNA regulatory network were constructed. Additionally, four circRNAs (circRNA_38548, circRNA_38550, and circRNA_001686) were identified to contribute to abnormal endometrial receptivity by regulating genes such as Lifr, FOXK1, FOXO1, HOXA10, through interactions with miRNAs. Further research is warranted to elucidate the underlying mechanisms involving these circRNAs.

Myomectomy: surgical tactics, reproductive outcomes

The article highlights modern approaches to the surgical treatment of uterine fibroids in patients of reproductive age, depending on the size and type of localization of the node in the uterus in accordance with the FIGO classification. It has been established that submucosal uterine fibroids of types 0, 1, 2 are subject to hysteroscopic removal, since their effect on the onset, prolongation of pregnancy and reproductive outcomes has been proven. Intramural uterine leiomyomas are subject to removal if the node size is more than 5 cm or other unidentified causes of infertility in patients with reproductive plans. Subserous uterine leiomyomas do not affect fertility and do not require removal.

Role of Mitochondria Transfer in Infertility: A Commentary.

Mitochondria transfer techniques were first designed to prevent the transmission of diseases due to mutations in mtDNA, as these organelles are exclusively transmitted to the offspring by the oocyte. Despite this, given the crucial role of mitochondria in oocyte maturation, fertilization and subsequent embryo development, these approaches have been proposed as new potential strategies to overcome poor oocyte quality in infertile patients. This condition is a very common cause of infertility in patients of advanced maternal age, and patients with previous in vitro fertilization (IVF) attempt failures of oocyte origin. In this context, the enrichment or the replacement of the whole set of the oocyte mitochondria may improve its quality and increase these patients’ chances of success after an IVF treatment. In this short review, we will provide a brief overview of the main human studies using heterologous and autologous mitochondria transfer techniques in the reproductive field, focusing on the etiology of the treated patients and the final outcome. Although there is no current clearly superior mitochondria transfer technique, efforts must be made in order to optimize them and bring them into regular clinical practice, giving these patients a chance to achieve a pregnancy with their own oocytes.

Identification of Potential Molecular Mechanism Related to Infertile Endometriosis.

ObjectivesIn this research, we aim to explore the bioinformatic mechanism of infertile endometriosis in order to identify new treatment targets and molecular mechanism.MethodsThe Gene Expression Omnibus (GEO) database was used to download MRNA sequencing data from infertile endometriosis patients. The “limma” package in R software was used to find differentially expressed genes (DEGs). Weighted gene co-expression network analysis (WGCNA) was used to classify genes into modules, further obtained the correlation coefficient between the modules and infertility endometriosis. The intersection genes of the most disease-related modular genes and DEGs are called gene set 1. To clarify the molecular mechanisms and potential therapeutic targets for infertile endometriosis, we used Gene Ontology (GO), Kyoto Gene and Genome Encyclopedia (KEGG) enrichment, Protein-Protein Interaction (PPI) networks, and Gene Set Enrichment Analysis (GSEA) on these intersecting genes. We identified lncRNAs and miRNAs linked with infertility and created competing endogenous RNAs (ceRNA) regulation networks using the Human MicroRNA Disease Database (HMDD), mirTarBase database, and LncRNA Disease database.ResultsFirstly, WGCNA enrichment analysis was used to examine the infertile endometriosis dataset GSE120103, and we discovered that the Meorangered1 module was the most significantly related with infertile endometriosis. The intersection genes were mostly enriched in the metabolism of different amino acids, the cGMP-PKG signaling pathway, and the cAMP signaling pathway according to KEGG enrichment analysis. The Meorangered1 module genes and DEGs were then subjected to bioinformatic analysis. The hub genes in the PPI network were performed KEGG enrichment analysis, and the results were consistent with the intersection gene analysis. Finally, we used the database to identify 13 miRNAs and two lncRNAs linked to infertility in order to create the ceRNA regulatory network linked to infertile endometriosis.ConclusionIn this study, we used a bioinformatics approach for the first time to identify amino acid metabolism as a possible major cause of infertility in patients with endometriosis and to provide potential targets for the diagnosis and treatment of these patients.

108 Infertility from retained fetal bone after termination: Case report and literature review

Primary Objective: To review the literature addressing symptoms of retained fetal content after termination. Secondary objective: To discuss a case of hysteroscopic management in a patient with retained fetal bone content after remote termination procedure. Case report and literature review in an Urban based healthcare system of a patient who underwent hysteroscopic removal of retained fetal bone after remote history of surgical termination. This report describes the case of a 37-year-old woman presenting for infertility who had a termination of pregnancy at 20 weeks 17 years prior. Upon ultrasound echogenic structures were seen in the cervix and further confirmed with MRI. Hysteroscopy revealed mature fetal bone which was then removed. Literature Review: In the literature, similar cases have an original presentation of secondary infertility. Studies of the underlying pathophysiology have shown that these patients have prostaglandin levels similar to those with intrauterine devices (IUD) (6). Thus, retained fetal bone in the uterus may cause an environment in the uterus similar to an IUD resulting in secondary infertility. Other instances of retained bone have been attributed to osseous metaplasia secondary to chronic inflammation of the uterus (7). This in addition to other causes of calcification must remain in the differential until ruled out. Retained products are not uncommon in patients with termination at an advanced gestational age. The presented case portrays an unusual finding in an infertility patient remote from her termination episode. Review of the images in this case may help providers consider retained bone as an alternative to causes of infertility in patients with a history of termination.

Male Infertility Diagnosis: Improvement of Genetic Analysis Performance by the Introduction of Pre-Diagnostic Genes in a Next-Generation Sequencing Custom-Made Panel.

BackgroundInfertility affects about 7% of the general male population. The underlying cause of male infertility is undefined in about 50% of cases (idiopathic infertility). The number of genes involved in human spermatogenesis is over two thousand. Therefore, it is essential to analyze a large number of genes that may be involved in male infertility. This study aimed to test idiopathic male infertile patients negative for a validated panel of “diagnostic” genes, for a wide panel of genes that we have defined as “pre-diagnostic.”MethodsWe developed a next-generation sequencing (NGS) gene panel including 65 pre-diagnostic genes that were used in 12 patients who were negative to a diagnostic genetic test for male infertility disorders, including primary spermatogenic failure and central hypogonadism, consisting of 110 genes.ResultsAfter NGS sequencing, variants in pre-diagnostic genes were identified in 10/12 patients who were negative to a diagnostic test for primary spermatogenic failure (n = 9) or central hypogonadism (n = 1) due to mutations of single genes. Two pathogenic variants of DNAH5 and CFTR genes and three uncertain significance variants of DNAI1, DNAH11, and CCDC40 genes were found. Moreover, three variants with high impact were found in AMELY, CATSPER 2, and ADCY10 genes.ConclusionThis study suggests that searching for pre-diagnostic genes may be of relevance to find the cause of infertility in patients with apparently idiopathic primary spermatogenic failure due to mutations of single genes and central hypogonadism.

The cytokine profile of follicular fluid changes during ovarian ageing

ObjectiveOvarian ageing is one of the commonest causes of infertility in patients consulting for assisted reproductive technology. The composition of the follicular fluid (FF), which reflects the exchanges between the oocyte and its microenvironment, has been extensively investigated to determine the metabolic pathways involved in various ovarian disorders. Considering the importance of cytokines in folliculogenesis, we focused on the cytokine profile of the FF during ovarian ageing. Material and methodsOur cross-sectional study assesses the levels of 27 cytokines and growth factors in the FF of two groups of women undergoing in vitro fertilization. One group included 28 patients with ovarian ageing clinically characterized by a diminished ovarian reserve (DOR), and the other group included 29 patients with a normal ovarian reserve (NOR), serving as controls. ResultsWith univariate analysis, the cytokine profile was found to differ significantly between the two groups. After adjustment of the p-values, platelet-derived growth factor-BB (PDGF-BB) was the only cytokine with a significantly lower concentration in the DOR group (7.34 ± 16.11 pg/mL) than in the NOR group (24.39 ± 41.38 pg/mL) (p = 0.005), independently of chronological age. ConclusionThus, PDGF-BB would seem to be implicated in the physiopathology of DOR, potentially in relation to its role in folliculogenesis or in the protection against oxidative stress.

Study on Causes of Female Infertility at National Ayurveda Teaching Hospital, Borella, Sri Lanka: A Survey Based Study

Background: Infertility is defined as the inability to conceive after at least one year of unprotected intercourse. It is a complex disorder with significant medical, psychosocial, and economic problems. In about one third of couples are infertile. Approximately 167 million married women aged 15-49 years in developing countries were infertility. The present study aimed to determine the most common causes of female infertility in patients who visiting the National Ayuvedic Teaching Hospital, Borella, Sri Lanka. Methods: In this study 635 infertile (primary and secondary) women were selected to determine the causes of infertility. The subjects were selected from the gynecology clinic, between the periods of February 2015 to March 2016. The data were gathered using a questionnaire; and after that proper statistical method was applied to analyze the data. Results: From the results age between 28-37 years (37.16%) are more prevalent to infertility and the causes of infertility are mainly due to anovulatory cycle (31.18%) and menstrual irregularities (19.21%). BMI also one of the significant cause for infertility. Conclusion: Therefore, identifying the risk factors and proper treatment on time along with policy makers providing facilities to resolve the infertility could possible diverse this alarming increasing trend of infertility.

Subfertility in women with familial Mediterranean fever

The aim of this study was to examine the causes and different modalities used for management of subfertile patients with familial Mediterranean fever (FMF). The study comprised of 74 infertile women with FMF. All patients were diagnosed as having FMF. All patients underwent a full infertility work-up. They were scheduled to expectant treatment, ovulation induction and timed intercourse, intrauterine insemination or intracytoplasmic sperm injection. Anovulation was reported in 18 patients (24.32%). Anovulation was due to polycystic ovary syndrome in 12 (16.22%) cases and due to other causes in six patients (8.11%). Excessive clear peritoneal fluid was present in 56 (57.67%) and male-factor infertility was present in 14 couples (18.91%). Ovulation induction and timed intercourse was adopted for a maximum of six cycles and intrauterine insemination for three cycles. In vitro fertilization/intracytoplasmic sperm injection was needed in six cases using standard long agonist protocol. Twenty-six women became pregnant. The causes of infertility in patients with FMF are not different from those expected in the general population. Treatment of the problem should be causal, adopting the conventional lines of treatment up to in vitro fertilization/intracytoplasmic sperm injection when appropriate. Colchicine is the treatment of choice and it is important to use it in its proper doses to control the disease.

The Effect of Comprehensive Care and Degree of Iron Overload on Maternal and Fetal Outcomes in Pregnancies of Transfusion-Dependent Beta-Thalassemia Patients

Abstract 5297 Introduction:Iron overload resulting in hypogonadotrophic hypogonadism is the major cause of infertility in patients with beta-Thalassemia Major (bTM). However, in patients who are able to achieve pregnancy, the effects of iron overload and comprehensive care by hematologists specialized in Hemoglobinopathies on maternal-fetal outcomes have not been well-documented. We hypothesize that in patients with transfusion-dependent bTM, lack of comprehensive care prior to conception or elevated ferritin is associated with poor maternal-fetal outcomes and increased rates of antepartum complications. Methods:A retrospective review was conducted on transfusion-dependent bTM patients who delivered at the Mount Sinai Hospital (MSH), a quaternary referral, high risk obstetrics care institution in Central Ontario, Canada, between 2000 and 2010 based on the Antenatal Database, Delivery Database, electronic and paper-based medical records. Patients were jointly managed by a maternal-fetal medicine specialist and hematologist specialized in hemoglobinopathies. All forms of chelation were discontinued during pregnancy. We analyzed the maternal-fetal outcomes and antepartum complications based on the presence or absence of comprehensive care prior to pregnancy by the Red Blood Cell Disorders (RBCD) Clinic at the University Health Network, a hemoglobinopathy comprehensive care centre from the same catchment area as MSH. Components of comprehensive care include regular monitoring of iron burden, screening and treatment of target organ damage from iron overload, genetic counseling from physicians, and psychosocial counseling from a social worker. We also analyzed the relationship between the pre-pregnancy ferritin levels and birth weight, gestational age, and any antepartum complications. Results:We identified 40 singleton deliveries and 3 twin deliveries by 42 patients (40 bTM, 1 Thalassemia Intermedia, 1 Hemoglobin E/beta-Thalassemia). There were no maternal or fetal deaths. The 3 twin pregnancies were excluded from analysis due to being a potential confounder in maternal and fetal outcomes. Mean maternal age at delivery was 33.11 years (95% CI 31.77, 34.45 years). Mean gestational age at delivery was 38.29 weeks (95% CI 37.41, 39.17 weeks) with six (15%) pre-term births (<37 weeks). Fourteen deliveries (35%) were by Caesarian section and 26 were vaginal deliveries. Six (15%) were low birth weight (<2500 g) and 2 (5%) were small for gestational age. Ten of the 39 patients analyzed (11 deliveries) received comprehensive care at RBCD clinic prior to their pregnancies. There was no significant difference in maternal-fetal outcomes or antepartum complications between patients who received comprehensive care prior to conception and those who did not. However, patients who received comprehensive care were significantly younger and had lower parity (P = 0.0072 and 0.0276 respectively). In the 19 deliveries where pre-pregnancy ferritin was available, there was no association between pre-pregnancy ferritin and fetal birth weight, gestational age, or any antepartum complications. Discussion:There was no association between pre-pregnancy ferritin level and maternal-fetal outcomes. Presence of comprehensive care prior to conception did not appear to significantly change the maternal-fetal outcomes in transfusion-dependent beta-Thalassemia patients. We speculate that the lack of difference may be due to a higher proportion of primigravida in the comprehensive care group acting as a potential confounder, given that primigravida in general have higher rates of adverse pregnancy outcome. In addition, patients with higher parity may have less severe complications from iron overload, and consequently are less likely to be referred to a comprehensive care center. Limitations include small sample size and single center study. Further prospective observational studies with larger sample size are required to evaluate whether a) introduction of uniform comprehensive care to all women with bTM in child-bearing age will improve pregnancy outcomes; b) ferritin or liver iron concentration is useful in predicting antepartum complications in bTM patients. Disclosures:Kuo:Novartis Canada: Research Funding.

HOXA-10 expression in the mid-secretory endometrium of infertile patients with either endometriosis, uterine fibromas or unexplained infertility

The aim of this study was to investigate HOXA-10 expression in endometrium from infertile patients with different forms of endometriosis; with uterine fibromas, or with unexplained infertility and from normal fertile women. Expression levels of HOXA-10 mRNA and protein in endometrium were measured during the mid-secretory phase. This study utilized laser capture microdissection, real-time RT-PCR and immunohistochemistry. HOXA-10 mRNA and protein expression levels in endometrial stromal cells were significantly lower in infertile patients with different types of endometriosis (deep infiltrating endometriosis, ovarian endometriosis and superficial peritoneal endometriosis), with uterine myoma, and unexplained infertility patients as compared with healthy fertile controls. HOXA-10 mRNA expression levels of microdissected glandular epithelial cells were significantly lower than those of microdissected stromal cells, without significant differences among the different groups. No protein expression was detected in glandular epithelial cells. The percentage of patients with altered protein expression of HOXA-10 in stromal cells were significantly higher in patients with only superficial peritoneal endometriosis (100%, 20/20, P < 0.05) compared with the other infertile groups (deep infiltrating endometriosis: 72.7%, 16/22; ovarian endometriosis: 70.0%, 14/20; uterine myoma: 68.8%, 11/16; unexplained infertility: 55.6%, 5/9). The present findings suggested that altered expression of HOXA-10 in endometrial stromal cells during the window of implantation may be one of the potential molecular mechanisms of infertility in infertile patients, particularly in patients with only superficial peritoneal endometriosis. One of the underlying causes of infertility in patients with only superficial endometriosis may be altered expression of HOXA-10 in endometrial stromal cells.

Influence of polymorphism of glutathione S-transferase T1 on Chinese infertile patients with varicocele

To investigate the influence of glutathione S-transferase T1 (GSTT1) gene polymorphism on Chinese infertile patients with varicocele, 63 infertile patients with varicocele and 54 healthy fertile controls were recruited in this case-control study. Our results show that oxidative damage may be the cause of infertility in patients with varicocele, and GSTT1 null genotype predisposes to over oxidative damage to spermatocytes of infertile patients with varicocele.

Evaluation of Serum ProlactinLevels in Patients with Endometriosisand Infertility

The aim of this study was to clarify the significance of serum prolactin concentrations in patients with infertility and endometriosis. Forty patients with infertility and laparoscopically proven endometriosis were recruited into the study. Basal serum prolactin levels and prolactin levels after TRH administration were measured. The mean basal serum prolactin concentrations were 12.5, 16.5, 19.5, and 26.5 ng/ml and those after thyrotropin-releasing hormone (TRH) administration were 88.3, 114.2, 125.3 and 138.8 ng/ml in patients with stages I, II, III and IV endometriosis, respectively. A statistically significant relationship was found between the basal serum prolactin levels as well as those after TRH injection and the stage of the endometriosis. The patients were divided in two groups. Group I consisted of 20 patients who did not receive any treatment, while group II consisted of 20 patients who were initially treated with GnRH analogues for 24 week and subsequently with several therapeutic schemes in order to improve their fecundity. The pregnancy rate was not different between the two groups. The patients, however, who did not become pregnant had higher serum prolactin concentrations after TRH administration as compared to those who conceived. We conclude that occult hyperprolactinemia may be a cause of infertility in patients with endometriosis.

Diagnosing testicular function using 31P magnetic resonance spectroscopy: a current review.

Patients with low sperm counts combined with normal concentrations of gonadotrophins, and in whom physical examination and post-ejaculatory urine analysis are normal, present a diagnostic dilemma. This situation can be caused by testicular failure or by ductal obstruction, which have very different clinical prognoses. Ductal obstruction might be correctable by microsurgical vasovaso/vasoepididymostomy, whereas this approach is of no use in primary testicular failure. A possible diagnostic step for these patients is a testicular biopsy to differentiate between hypospermatogenesis and a normal gonad. However, to date testicular biopsy is seldom performed because of its invasive character. An alternative accurate, non-invasive method to assess testicular function could be very helpful in the evaluation of idiopathic azoospermia or idiopathic oligozoospermia. During the past decade, magnetic resonance (MR) spectroscopy has been developed from a scientific tool into a non-invasive clinical diagnostic tool and has also been used to study testicular function. Recent studies have shown that 31P-MR spectroscopy, based upon differences in the ratio of peaks of phosphomonoester to beta-adenosinetriphosphate, is a non-invasive technique able to differentiate between groups of patients with testicular failure and ductal obstruction, and it correlates reasonably well with the averaged mean Johnsen score of testicular biopsy. The role for a non-invasive technique in the diagnosis of male infertility, such as 31P-MR spectroscopy, can be manifold. It serves not only as an alternative for biopsy but can also be used to assess obstruction as the cause of infertility in patients with subnormal sperm counts, and to predict the chances of pregnancy in patients planned for vasovasostomy to correct a prior vasectomy. However, the main limitation to MR spectroscopy becoming a universal clinical diagnostic technique is the limited availability of 1.5 Tesla MR scanners.

The Incidence of Antisperm Antibodies in Infertility Patients with a History of Cryptorchidism

Infertility in patients with a history of cryptorchidism is usually the result of oligo-asthenospermia. In this study we analyzed the incidence of antisperm antibodies in infertility patients with a history of cryptorchidism, general infertility patients and donors of known fertility. Of the cryptorchid patients 66% tested positive for antisperm antibodies compared to 2.6% of the control group of infertile patients and 2.8% of the donors of known fertility. Sperm progressive motility was significantly (p <0.05) decreased in the cryptorchid patients testing positive for antisperm antibodies compared to those testing negative for antisperm antibodies, and compared to both control groups. Of the patients treated for cryptorchidism by orchiopexy 52% were positive for antisperm antibodies, and the mean patient age at orchiopexy was significantly (p <0.01) higher in the positive antibody group (14.2 ± 1.2 years old) than the negative antibody group (8.6 ± 0.8 years old). While decreased sperm concentration, motility and morphology are usually the primary causes of infertility in patients with a history of cryptorchidism, it appears that the presence of antisperm antibodies is also increased in these patients, which may contribute to reduced fertility.

Prolactin hyperstimulation in response to thyrotropin-releasing hormone in patients with endometriosis

In order to clarify the role of hyperprolactinemia as a possible cause of infertility in patients with endometriosis, baseline serum prolactin (PRL) concentrations and the PRL response to thyrotropin-releasing hormone (TRH) stimulation were measured in 14 infertile women with endometriosis and in 13 normal, fertile women. Baseline PRL concentrations were 2-fold greater in the endometriosis group than in normal subjects, but the mean values did not differ significantly. Following TRH administration, a significant increase in peak PRL concentrations was observed in patients with endometriosis (211.5 +/- 34.9 ng/ml) when compared with corresponding values in control subjects (117.1 +/- 14.9 ng/ml, P less than 0.05). This hypersecretory state was selective for PRL because no significant differences between the baseline and TRH-stimulated thyroid-stimulating hormone (TSH) concentrations or total serum thyroxine concentrations were observed. In summary, some infertile women with endometriosis exhibit a greater capacity for PRL secretion than normal women. These results suggest that relative hyperprolactinemia may be responsible for the infertility associated with endometriosis, and that PRL suppression may be indicated in these patients.