Different Causes Of Infertility Research Articles

Assessment of ovarian reserve.

Various methods have been proposed and are currently used in the assessment of ovarian reserve in order to predict the outcome in assisted reproduction. This review focuses on the current information regarding the ovarian reserve markers and tests, an active area of research. Female age alone is a rough parameter for assessing ovarian reserve. The basal follicle stimulating hormone level is not adequately sensitive to predict poor outcome and the same is true for other basal parameters, including basal estradiol, the follicle stimulating hormone/luteinizing hormone ratio, and inhibin-B levels. The clomiphene citrate challenge test has a low sensitivity but this sensitivity is greater than that of basal follicle stimulating hormone. The value of other hormonal dynamic tests remains to be determined. Among the ultrasound markers the total antral follicle count seems to be promising. Ovarian biopsy in this assessment is controversial. History of poor response to ovarian stimulation is a strong indicator for declining ovarian function. There is currently no clinically useful predictive test sufficiently accurate and distinct in time from controlled ovarian stimulation to assess ovarian reserve accurately. Further research is warranted to validate the ovarian reserve tests in the general population and in populations with different causes of infertility.

Age-related changes in ovarian volume ,antral follicle counts and basal follicle stimulating hormone levels: comparison between fertile and infertile women

Our objective was to compare the relationship between age ,basal follicle stimulating hormone (FSH) level and ultrasound-measured mean ovarian volume (MOV) and mean antral follicle counts (MFC) in a groupof infertile and fertile women between the ages of 35 and 45 years. Menstrual cycle day 3 serum FSH ,MOV and MFC were analyzed in 62 infertile and 53 fertile women. Basal FSH and MFC did not differ betweeninfertile and fertile women ,whereas MOV was significantly smaller in infertile women (p < 0.05). In the infertile group ,there was a negative correlation between MOV and age (ρ = -0.389,p < 0.05) ,between MOV and basal FSH (ρ = 0.495 ,p < 0.01) ,and between MFC and age (ρ = -0.553 ,p < 0.01). In the fertile group ,there was a strong negative correlationbetween MOV and basal FSH (ρ = -0.631 ,p < 0.01) ,and between MFC and basal FSH (ρ = -0.710 ,p < 0.01). Mean basal FSH ,MOV and MFC did not differ between subgroups of patientswith different causes of infertility. In the infertile group ,patients with small ovaries of volume less than 1.8 cm3 (mean volume -1 SD) had higher mean basal FSH (p < 0.05) and lowerMFC (p < 0.01) levels than patients with normal ovarian volume. In conclusion ,transvaginal ultrasound (TVU) indices and indirect hormonal parameters of ovarian reserve were similar in infertileand fertile women aged between 35 and 45 years. It is suggested that ,in infertile women above 35 years of age ,TVU rather than hormonal parameters be preferred ,based on our data showing a stronger associationbetween age and TVU indices of ovarian reserve than between age and increase in basal FSH level. Thus ,TVU assessment of ovarian volume and antral follicle counts is a practical and cost-effective ,if notbetter ,technique for ovarian reserve testing.

Correlation analysis of predictive factors of successful implantation in fertilization in vitro

Endometrial receptivity as isolated predictive factor of successful implantation, with its specifity is determined with numbered factors. Purpose of this study was to evaluate significance and correlation between relevant factors using appropriate statistical analyses on term of embryo implantation. Evaluated group contained 85 women whom according different causes of infertility have been determined for assisted reproduction program. Analysed measurements were: endometrial thickness, assessed hyperechogenity in relation with absolute endometrial thickness (HEA relation) and uterine blood flow (pulsatile index-Pi). Simultaneously were analyzed serum estradiol (E2; pg/ml) and progesterone (P; nmol/l) levels. After these evaluations achieved results were processed with standard statistical pack. Beside that were applied parameter and nonparameter tests with aim to test significancy of difference and multiple regressive analyse (Stepwise). Resulted measured parameters have been presented in basic analyse as middle value (Xrs) from all measurements + SD (standard deviation) and significance of difference is tested by mentioned statistical tests (Table 1). Application of Stepwise analyse, "step by step", has used parameter by parameter based on value which has decreased variability and based on achieved correlative coefficient between dependent uneven and complex of independent uneven values. This procedure confirms best correlation between HEA relation and serum progesterone levels and HEA relation in correlation with associated values: P, E2 and endometrial thickness (Table 1). Investigation provided till now shows that embryo quality and endometrial receptivity with highest probability determine success of applied assisted reproduction, successful embryonal implantation There is assessed influence of endometrial receptivity represented trough HEA relation using many folded regressive analyse where qualitative endometrial value has been looked with dependency with other parameters gives picture for high determinancy with hormonal activity and with stimulative ovarian activity. This determinancy could be viewed mostly through serum progesterone levels on day of HCG administration. Correlative relation between qualitative endometrial characteristics on day of HCG administration has high value related to progesterone levels. Results presented with this research confirm once again complexity characteristic for factors that play final role in embryo implantation in IVF program. There is presented only one aspect related with this problem with aim to contribute quantification importance and assessment rate of mutual influence these factors known till now as relevant.

Concentrations of placental protein 14 in uterine flushings from infertile women: validation of the collection technique and method of expression of results.

Concentrations of various proteins in uterine flushings have been described as a direct method for assessment of the secretory activity of the endometrium. We investigated levels of the endometrial protein known as placental protein 14 (PP14) in flushings obtained from 271 infertile women. Under transvaginal ultrasonographic control, 2 ml of 0.154 M sodium chloride solution were injected into the uterine cavity and re-aspirated, five times. In contrast to previous studies the recovered volume of each flushing was not consistent (range: 0.05-2.1 ml); the volume varied significantly between serial samples obtained from an individual (P = 0.02, one-way ANOVA), different cycle days (P < 0.0001, one-way ANOVA) and women with bilaterally blocked versus patent Fallopian tubes (P < 0.05, Student's t-test). Concentrations of PP14 showed a better correlation with protein content (r = 0.506, P < 0.0001) than with the recovered volume (r = 0.087, P = 0.095). We therefore corrected PP14 concentrations for total protein content as an indicator of the efficiency of the flushing process. Corrected PP14 concentrations varied significantly relative to time since the onset of menstruation (P = 0.001, Kruskal Wallis ANOVA) with higher levels on days 1-8, as previously observed in plasma samples. No significant difference in PP14 levels was found with different causes of infertility. This study shows that uterine flushing is not a consistent process in women with differing physical characteristics and at varying times throughout the menstrual cycle.

Influence of gonadotrophin-releasing hormone agonist total dose in the ovarian stimulation in the long down-regulation protocol for in-vitro fertilization.

The goal of our study was to assess whether the total dose of gonadotrophin-releasing hormone agonist (GnRHa) administered affects the success of an in-vitro fertilization (IVF) programme. A retrospective analysis was performed on a total of 72 IVF cycles carried out on 70 patients with different causes of infertility included in our assisted reproduction programme. Cycles were divided into two groups according to the number of days of GnRHa administration (leuprolide acetate 1 mg/day) necessary until ovarian desensitization occurred: group I (GI) < 13 days (n = 27) and group II (GII) > or = 13 days (n = 45). The following parameters were assessed: number of gonadotrophin ampoules, number of stimulation days, endometrial thickness on the day of human chorionic gonadotrophin (HCG) administration, number of recovered oocytes, pregnancy rate. Pregnancy rate/cycle and pregnancy rate/transfer were positively correlated with the dose of GnRHa (GI: 44 and 60% respectively versus GII: 20% and 25% respectively). It is concluded that a long administration of GnRHa has no effect upon ovarian response, although the pregnancy rate is subsequently decreased.

Midluteal-phase vaginal color Doppler assessment of uterine artery impedance in a subfertile population

To compare the midluteal uterine artery impedance to blood flow as measured by the pulsatility index in women with different causes of infertility with that of women with normal fertility and to correlate this with endometrial thickness. A prospective study of normal women undergoing insemination with donor semen and subfertile women with tubal damage, endometriosis, premature ovarian failure, anovulation, or unexplained infertility. A tertiary infertility center. One-hundred sixty-one women (25 to 40 years of age) who were attending the clinic for subfertility treatment and 23 normal women who were having artificial insemination with donor sperm because their partners were azoospermic. All women were examined by transvaginal ultrasonography, with color flow imaging and blood flow analysis, on day 21 of an unstimulated ovarian cycle. The mean pulsatility index of the left and right uterine arteries and the endometrial thickness. The patients were grouped according to the causes of infertility and compared with normal women. There were 23 women in the normal group (median pulsatility index, 1.91; range, 0.84 to 2.95), 35 with unexplained infertility (median pulsatility index, 2.45; range, 1.0 to 7.0), 91 with tubal damage (median pulsatility index, 2.65; range, 1.25 to 8.0), 8 with endometriosis (median pulsatility index, 2.32; range, 2.05 to 5.7), and 22 with anovulatory infertility (median pulsatility index, 3.03; range, 1.6 to 7.0). All the infertile groups had significantly different median pulsatility indexes when compared with the normal group, and the pulsatility indexes correlated with endometrial thickness. The impedance to uterine artery blood flow is significantly different in women with different causes of infertility as compared with women of normal fertility. Increased resistance to uterine blood flow in the midluteal phase may be an important contributing factor to some causes of infertility and the cause of some previously "unexplained" infertility.

Alternatives to IVF: the outcome of 1071 first GIFT procedures.

Gamete intra-Fallopian transfer (GIFT) is the most important treatment method for infertile couples that has been developed since in-vitro fertilization and embryo transfer (IVF/ET) became available. Analysis of the data of 1071 first GIFT procedures is presented and the predominant factors affecting success are discussed. An overall pregnancy rate of 33.6% was achieved in this group of patients who were unselected in relation to age, number of oocytes transferred, quality of sperm and response to ovulation induction. The success of GIFT is dependent upon the number and quality of oocytes transferred and upon the quality of the sperm. Pregnancy occurred in 21.4% of patients receiving up to four oocytes compared with 40.3% in whom five or more were transferred. Multiple pregnancy rates however were 17.3% in the first group and 32.3% in the second group. Age is a major factor influencing the chances of success with patients less than 30 years of age achieving a 40.2% pregnancy rate reducing to 19.2% in the over 40 group. Conversely the spontaneous abortion rate increased from 23.4% in the under 30 group to 48.6% in those over 40 years of age. No pregnancies were achieved when sperm motility was less than 20% in the original specimen, whereas pregnancy rates of up to 20% resulted when sperm density was below 10 million. The overall results of this study show comparable success rates for different causes of infertility and that there is a definite association between the outcome of treatment and the number and quality of gametes transferred. A philosophy of flexibility in the treatment of infertile couples is advocated.