Chief Complaint Of Infertility Research Articles

Non-Obstructive Azoospermia with Hypergonadotropic Hypogonadism without a Significant Abnormalities in the Physical Examination

Background: Around 10 % of infertile men and 1 percent of all males have azoospermia. There are two types of azoospermia, which are obstructive and non-obstructive azoospermia. Non-obstructive azoospermia's main mechanism is because the testes fail to produce the sex hormone and induce spermatogenesis (primary testicular failure).
 Case: A patient is 28 years old and has a job as a car paint worker. He came with the chief complaint of infertility since two and a half years ago. He and his wife were having intercourse 3-4 times a week. Past medical history is unremarkable. His wife’s medical history is also unremarkable. Physical examination and ultrasound of the testes are normal. The semen analysis in this patient was azoospermia for 2 different times in the span of 2 weeks with no abnormalities in the accessory gland. Hormonal profiles results are testosterone level 2,32 ng/mL and FSH 15,03 mIU/mL, which indicatehypergonadotropic hypogonadism. The patient was suggested to evaluate further (complete hormonal profile, karyotyping analysis, and Y-Chromosome microdeletion) and educate about the possibility to conceive with assisted reproductive technology (ART).
 Discussion: Hypergonadotropic hypogonadism is a challenging case that needs a complete assessment such as complete hormonal profile, karyotyping analysis, Y-chromosome microdeletion analysis, and also, in this case, the paint thinner exposure in the workplace is needed to be considered. The chance of normal conception is very small, and the assisted reproductive procedure is necessary.
 Conclusion: Some abnormalities are usually present in the physical examination of azoospermia patients. This case convinces us of the importance of thorough history taking and other investigations. Managing this patient will be challenging, with the goal of the therapy is to achieve spermatogenesis to be able to use the spermatozoa available for ICSI.

Microsurgical varicocelectomy for intratesticular varicocele with a history of orchiopexy for undescended testis

IntroductionWe report a case series of six patients with a chief complaint of infertility who underwent microsurgical varicocelectomy for intratesticular varicocele (ITV) after undergoing orchiopexy for undescended testis in their childhood.Case presentationThe patients' median age was 34 years. The median age at which orchiopexy was performed was 4.5 years. All the cases of ITV were accompanied by extratesticular varicocele (ETV). All the patients underwent a microsurgical subinguinal varicocelectomy. At 3 months after operation, the ITV and ETV had disappeared in all the cases. Sperm density and motility increased in five and four patients, respectively.ConclusionITV occurs at a relatively high frequency after orchiopexy for undescended testis. Disorder of the valvular function of the testicular vein in peeling the testicular vessels was thought to be a primary cause and is often found on the left side. Doppler ultrasonography of the testis is considered important for diagnosis.

Abstract #1165468: Stalk Effect: Cushing’s Disease Mistaken for Prolactinoma

The diagnostic workup for hypercortisolism is not infrequent in clinical practice. Common findings of high cortisol are weight gain, facial plethora, and menstrual irregularity. Here we discuss a distinct presentation of amenorrhea and galactorrhea as an unexpected exhibition of Cushing’s disease. A 35-year-old woman with a history of obesity presented with the chief complaint of infertility. Six months prior, she began to experience amenorrhea, galactorrhea, headaches, excessive sweating, and weight gain. Serum prolactin (PRL) level was found to be mildly elevated at 35.3 ng/mL. Magnetic resonance imaging (MRI) of the brain demonstrated a 11 mm x 9.8 mm x 9.6 mm pituitary macroadenoma. She was started on oral cabergoline 0.5 milligrams twice weekly for prolactinoma treatment, with resolution of all symptoms and return to normal PRL range. Tumor size on repeat MRI was stable. Six months later, she conceived. Cabergoline was stopped. She delivered a healthy infant but developed recurrence of her symptoms, now with diplopia. PRL was elevated at 61.9 ng/mL. Cabergoline was reinitiated. Further labs demonstrated elevated plasma adrenocorticotropic hormone (ACTH) of 121 pg/ml, elevated morning salivary cortisol of 0.217 ug/dL and elevated urinary free cortisol of 142 ug/24 hour. Overnight dexamethasone test showed unsuppressed cortisol. Cushing’s disease was diagnosed. Tumor size was 13 mm x 17 mm x 17 mm prior to surgical resection. Tumor pathology showed corticotroph adenoma. PRL highlighted in just a few scattered tumor cells. Her elevated prolactin levels were ultimately suspected to be due to stalk effect. Approximately 40% of all pituitary adenomas are prolactinomas. Clinical signs and symptoms of hyperprolactinemia include infertility, amenorrhea, and galactorrhea. Mild elevations of prolactin may cause infertility and can be consistent with prolactinoma. Amenorrhea associated with galactorrhea strongly suggests hyperprolactinemia. However, clinicians must note that in the presence of sellar mass and mild hyperprolactinemia, a non-prolactin-secreting mass must first be diagnostically ruled out. Cushing’s disease may present similarly with menstrual irregularities, hyperprolactinemia, and galactorrhea due to stalk effect. This patient demonstrated initial diagnostic uncertainty due to her incomplete workup and rapid clinical response to cabergoline. Her elevations in prolactin and response to cabergoline at the time of her original presentation may substantiate the proposed off-label use of dopamine agonists in non-prolactinoma pituitary tumors.

Case Report on Hypothyroidism in Infertile Woman with IVF Conception

Introduction: Hypothyroidism affects 2–4% of women in their reproductive years. Anovulatory cycles, luteal phase defects, hyperprolactinemia, and sex hormone imbalances are all symptoms of sex hormone imbalances are all consequences of hypothyroidism on fertility.
 Main Symptoms/or Important Clinical Findings: A 33 years old female admitted in AVBRH on date 19/1/2021 with chief complaint of infertility with hypothyroidism since 8 year, pain in abdomen, irregular menses. 
 Obstetric History: Patient had obstetric history of menarche start age of 15 year and flow of bleeding in slow/light. After irregular menses, she received IVF cycle and she was conceived the pregnancy in 1st IVF cycle.
 The Main Diagnoses, Therapeutic Intervention, and Outcome: After physical examination and investigation, doctor was detected a case of primary infertility with hypothyroidism. Patient was treated with tab.thyronom50 mg drug to reduce the symptoms of hypothyroidism.
 Nursing perspective: Administered flued replacement i.e. DNS, RL, monitored fetal heart rate and vital sign per 4 hourly.
 Conclusion: Pregnancy conceived with in vitro fertilization increasing the more risk of gestational hypothyroidism as well as fetal complication. Treatment and management improves the outcome of pregnancy.

Distinct peritoneal fluid ghrelin and leptin in infertile women with endometriosis and their correlation with interleukin-6 and vascular endothelial growth factor

Objective: The objective of the present study was to evaluate the levels of leptin, ghrelin, interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in peritoneal fluid in patients with endometriosis and infertility, and study their correlation.Design and setting: This cross-sectional study included women undergoing diagnostic and/or therapeutic laparoscopy for endometriosis with chief complaint of infertility and/or pain at a tertiary care hospital. Based upon laparoscopic and histopathological findings, patients were categorized as with endometriosis and no endometriosis. Of the 50 patients with infertility (age 23–41 years), 19 had endometriosis while 31 had no endometriosis. The markers were assessed using ELISA kits.Results: The median levels of leptin in patients with endometriosis (10.20 ng/mL) were higher (p = 0.04) and median levels of ghrelin in patients with endometriosis (150.4 pg/mL) were lower (p = 0.037) versus patients with no endometriosis (5.07 ng/mL and 229.6 pg/mL, respectively). The median levels of IL-6 and VEGF in patients with endometriosis were not different between the groups. The correlation analyses showed that leptin levels and IL-6 were positively correlated (p = 0.0001).Conclusions: The results suggest that ghrelin and leptin might play a key role in pathophysiology of endometriosis, and leptin is associated with inflammation in endometriosis.

Transvaginal Hydrolaparoscopy by Flexible Fiberscope - A Study of Preliminary Cases -

Transvaginal hydrolaparoscopy (THL) has become a first-line procedure in infertile women, and THL by flexible fiberscope (THLF) is a less traumatic and a more suitable outpatient procedure than diagnostic laparoscopy. We performed THLF on infertile women based on four indications; (i) tubal obstruction and/or peritubal adhesion as suggested by hysterosalpingography (HSG); (ii) serum antibody against Chlamydia (C) positive for trachomatis; (iii) diagnosis of early stage endometriosis; and (iv) unexplained infertility. Seven women with a chief complaint of infertility were the subjects of the present study. Two of the 7 cases had a history of gynecological surgery. Six of 7 cases had a history of C. trachomatis infection. Four cases had abnormal findings of fallopian tubal patency in hysterosalpingography. Parafallopean tubal atresia and tubal obstruction were observed in 4 cases by THLF. In one case the bilateral ovaries were extremely small and atrophic. None of the cases had serious complications after THLF. After the THLF, six women were able to have a baby by assisted reproductive technology (ART) within two years. As THL was developed using a solid scope, indications for THL have been limited, and have excluded cases with retroverted uterus or peritoneal surgical history. In the present study, THL using a fiberscope was carried out in infertile women with retroverted uterus, and in women with a history of peritoneal cavity surgery to examine the feasibility of extending the indications for THL. Findings on the THLF were given precedence in deciding further treatment strategies. We believe that THLF can be useful in helping patients with these indications to successfully achieve early pregnancy. This study is the first trial of THLF.

Peritoneal fluid leptin levels are increased but adiponectin levels are not changed in infertile patients with pelvic endometriosis

Objective. Endometriosis is a leading cause of infertility, and recent studies suggest that leptin and adiponectin may have a role in its causation and progression. This study assessed levels of leptin and adiponectin in serum and peritoneal fluid (PF) in patients with endometriosis and infertility.Design and setting. This cross-sectional study included women undergoing diagnostic and/or therapeutic laparoscopy for endometriosis with chief complaint of infertility. Following laparoscopy, patients diagnosed with endometriosis served as cases while patients with no endometriosis served as controls. Patients with polycystic ovarian syndrome, diabetes, thyroiditis and patients on prior therapy with danazol or leuprolide were excluded from the study. Leptin and adiponectin levels were analysed in blood and PF using commercially available ELISA kits.Results. Of the 50 patients (aged 22–41 years), 15 had endometriosis (cases) while 35 had no endometriosis (controls). The median PF leptin level was significantly higher in cases as compared to controls (27.7 vs. 15.6 ng/ml, p = 0.019), and this remained significant even when PF leptin was BMI-normalised (p = 0.004). However, median serum leptin and adiponectin levels remained comparable between the two groups.Conclusions. This study confirmed the role of PF leptin in causation and progression of endometriosis. However, this would have been definitive if healthy fertile females were included in this study.

DNA hybridization study using Y-specific probes in an XX-male

A 30-year-old male attended the Toyama Medical and Pharmaceutical University Hospital with the chief complaint of infertility. Physical examination showed bilateral small testes and the semen contained no sperm. Hormonal studies revealed hypergonadotropic hypogonadism and cytogenetic studies showed a 46,XX karyotype. High-resolution banding showed no abnormalities in both of the X chromosomes. Histological examination of both testes showed germinal aplasia and the proliferation of Leydig cells. The diagnosis of XX-male was made from the above findings. A DNA hybridization study using 17 Y-specific probes revealed the presence of a major part of the short arm of the Y chromosome, which had presumably been translocated to the X chromosome. The translocated Y short arm had a small deletion within it.

Endométriose et ascite hémorragique massive récidivante: Cas clinique et revue de la littérature

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It generally involves the peritoneum, ovaries and rectovaginal septum. Its characteristic symptoms include dysmenorrhea, pelvic pain, deep dyspareunia and infertility. It may also involve the gastrointestinal tract, urinary tract or extra abdominal sites, giving rise to a wide variety of clinical symptoms such as bloody stools, renal haemorrhage, hemoptysis and pleural effusion during menstruation. Recurrent hemorrhagic ascites secondary to endometriosis is an unusual occurrence, 41 cases have been reported since 1954. Here we report an additional case, in order to draw attention to this condition. A 28 years-old black nulligravida woman was seen for the first time in april 2000 with a chief complaint of infertility. Her past medical history was unremarkable. She had regular menses but associated with severe dysmenorrhea. She also recalled abdominal and pelvic pain for several years. She underwent an ovulation induction with gonadotrophin, which resulted in a progressive increase of pelvic pain. A first laparoscopy was performed, revealing voluminous ascites (10 I). Two years later the ascites recurred spontaneously. Ultrasound examination revealed suspect "para uterine masses". A second exploratory laparoscopy showed a voluminous bloody ascites (71), and extensive adhesions. On histologic examination all specimens (peritoneal biopsies) were compatible with endometriosis and ruled out malignancy. Treatment with Gn RH analog was performed and full remission was obtained after 6 months. One year later the ascites recurred again spontaneously, leading to a third laparoscopy in an other medical institution. Histologic examination showed endometrial stromal tissue and fibrous proliferation. Later she became pregnant after in vitro fertilization. In the first trimester of pregnancy, the pelvic ultrasound showed only a small effusion in the pouch of Douglas. Still, the ascites did not progress during pregnancy. The patient was hospitalized from 27 to 33 weeks of gestational age for threatened labor, but she finally had a normal vaginal delivery at 36 weeks of gestational age. Four months later, she had no complaint, but the pelvic ultrasound showed the recurrence of the ascites. She will have a drainage. The future treatement will consists of GnRH analog for about six months, which will be relayed by a long term progestative therapy. A diagnosis of endometriosis should always be considered in middle-age women who presents with bloody ascites. Long follow-up is advisable for patients who undergo conservative treatment because of thehigh risk of recurrence.

Management of Male Infertility.

While 85% of couples are able to conceive after one year of protected intercourse, approximately 15% of couples are unable to initiate a pregnancy without some form of assistance or therapy. These patients are said to be primarily infertile. In approximately one-third of these couples, a male factor appears to be singularly responsible, and in an additional 20% both a male and a female factor can be identified. Therefore, a male factor is at least partly responsible for difficulties in conception in roughly 50% of these couples. It has been shown that the longer a couple remains subfertile, the worse their chance for an effective cure. In addition, many couples experience significant apprehension and anxiety after only a few months of failure to conceive. For these reasons, unduly prolonged unprotected intercourse should not be advocated before workup of the male is instituted. Although it has often been recommended that clinical evaluation be delayed until 12 months of unprotected intercourse has passed, we believe that the initial screening of the male should be considered whenever the patient presents with the chief complaint of infertility. This initial evaluation, however, should be rapid, noninvasive, and cost-effective. The most important part of the management of male infertility is the correct diagnosis. The use of standard techniques for evaluating medical problems in general, such as complete history, physical examination, and laboratory tests is essential for this purpose.

The evaluation of male infertility

Data available over the past 25 years regarding infertility reveal that, in approximately one-third of cases, significant pathology is found in the man alone, while in 20% of cases, abnormalities are found in both the man and the woman. It is often recommended that clinical evaluation of the couple be delayed until one year of unprotected intercourse has passed. Because more couples wait until their late 30s to try to conceive, however, the initial screening of the man should be considered whenever a patient presents with the chief complaint of infertility. Advances are being made rapidly in both the diagnosis and treatment of infertile men. Semen analysis is the most important test to direct the necessary evaluation. With continued work in this field and continued development of available diagnostic and treatment modalities, clinicians will be able to treat infertile couples more successfully

Cytogenetic Survey of 1,007 Infertile Males

The aim of this study was to investigate the influence of a chromosome abnormality on male infertility. The subjects consisted of 1,007 males with the chief complaint of infertility. Karyotyping was conducted mainly by G banding. Major chromosome abnormalities were observed in 62 patients (6.2%) in total and consisted of sex chromosome abnormalities were observed in 62 patients (6.2%) in total and consisted of sex chromosome abnormalities in 38 patients (3.8%) and autosomal chromosome abnormalities in 24 (2.4%). Among the patients with sex chromosome abnormalities, 28 cases were 47, XXY, 3 were 47,XYY, and 7 cases had a Y chromosome abnormality. Autosomal chromosome abnormalities comprised 10 cases of reciprocal translocation, 8 cases of Robertsonian translocation, 5 cases of inversion, and 1 case of ring chromosome. In patients with a sperm density or = 30.1 mIU/ml, a luteinizing hormone value > or = 8.9 mIU/ml, a testosterone value < or = 2.69 ng/ml, or an average testis volume < or = 8 ml, the incidence of major chromosome abnormalities was significantly higher. These findings suggest that patients who need microinsemination should undergo chromosome analysis. We should counsel patients about obtaining adequate information on each chromosome abnormality.

Cytogenetic survey of 1,007 infertile males.

The aim of this study was to investigate the influence of a chromosome abnormality on male infertility. The subjects consisted of 1,007 males with the chief complaint of infertility. Karyotyping was conducted mainly by G banding. Major chromosome abnormalities were observed in 62 patients (6.2%) in total and consisted of sex chromosome abnormalities were observed in 62 patients (6.2%) in total and consisted of sex chromosome abnormalities in 38 patients (3.8%) and autosomal chromosome abnormalities in 24 (2.4%). Among the patients with sex chromosome abnormalities, 28 cases were 47, XXY, 3 were 47,XYY, and 7 cases had a Y chromosome abnormality. Autosomal chromosome abnormalities comprised 10 cases of reciprocal translocation, 8 cases of Robertsonian translocation, 5 cases of inversion, and 1 case of ring chromosome. In patients with a sperm density < 5 x 10(6)/ml, a total motile sperm count < 1 x 10(6), a follicle-stimulating hormone value > or = 30.1 mIU/ml, a luteinizing hormone value > or = 8.9 mIU/ml, a testosterone value < or = 2.69 ng/ml, or an average testis volume < or = 8 ml, the incidence of major chromosome abnormalities was significantly higher. These findings suggest that patients who need microinsemination should undergo chromosome analysis. We should counsel patients about obtaining adequate information on each chromosome abnormality.