Female Factor Infertility Research Articles

The Comparison of Coping Strategies With Stress and Marital Satisfaction in Women on the Basis of Infertility Factor

Background: Nowadays infertility issue has become a social concern and is associated with numerous social and psychological problems. Infertility can influence interpersonal, marital and social relationships. Objectives: The aim of this study was to determine the type of coping regarding stress and the level of marital satisfaction in infertile women associated with their infertility factors and to obtain the relationship between these two variables. Materials and Methods: The sample group included 50 women with female infertility factor and 50 women with male infertility factor. The participants contacted upon their treatment course with Assisted Reproductive Technology (ART) in Mehr infertility clinic, Tehran, Iran. Enrich marital satisfaction questionnaire and standard scale for measuring coping were used during this study. Results: Data analysis showed that coping and marital satisfaction were different in the two groups of participants based on their infertility factors. The women with female infertility factor used more emotion- focused and less useful coping strategies than the women with male infertility factor (P < 0.001). The women with male infertility factor had significantly more marital satisfaction than their infertile counterparts (P = 0.019). Conclusions: The results provided useful evidence about the types of coping in infertile women. Also considering infertility factor, a significant relationship was found between the type of coping and marital satisfaction in infertile couples.

Ingredients identification and quality control evaluation of phalakalyan ghrita: an ayurvedic formulation

Infertility is defined as failure to conceive within one year or more than one year of regular and unprotected coitus. It is the most sensitive and cumbersome problem which haunts every couple. Total 10-15% of world population affected due to this problem. Among them Female is directly responsible about 40%. The sub factors of female infertility are Ovarian, Endometrial, Tubal and Uterine etc. In Ayurved so many formulation are given for Infertility. Phalakalyana Ghrita (PKG) is a commonly used and prescribed Ayurvedic poly herbal formulation in all types of Infertility. However, till date no published data is available on its analytical profile. The main aims and objectives of this study are to develop the pharmacognostical and phytochemical profile of PKG. The pharmacognostical study reveals the presence of Lignified fibres, Prismatic crystals, Borderpitted vessels, Rhomboidal crystal, Scleroids, Stone cells etc. Pharmaceutical analysis showed that the loss on drying value was 0.47% w/w, Specific gravity was 0.9133, Refractive index was 1.46, Iodine value was 48.56, Saponification value was 227.05, and Acid value was 1.29. HPTLC fingerprinting profile of PKG revealed 10 spots at 254 nm and 5 spots at 366nm.

Relationship between donor sperm parameters and pregnancy outcome after intrauterine insemination: analysis of 2821 cycles in 1355 couples.

The aim of this study was to investigate whether sperm parameters can affect the pregnancy outcome of artificial intrauterine insemination with cryopreserved donor spermatozoon (AID). A total of 1355 couples received 2821 AID treatment cycles in the Reproductive Medicine Center of the Tongji Medical College between January 2010 and December 2013, and the data were collected and retrospectively analysed. The relationship between pre-freezing, post-thawing as well as optimised sperm parameters and AID pregnancy outcome was investigated. Clinical pregnancy rate and cumulated pregnancy rate were also calculated. A total of 728 cycles from 2821 treatment cycles achieved pregnancies, and cumulated pregnancy rate was 25.81%. Pre-freezing progressive sperm motility in pregnant cycles was higher than that in nonpregnant cycles (P = 0.001); logistic regression analysis also indicated that pre-freezing progressive sperm motility was the only parameter affecting pregnancy outcome (P = 0.0001). Our study also showed that the cumulated pregnancy rate increased progressively and reached a plateau after the fifth cycle. In conclusion, pre-freezing progressive sperm motility should be a valuable predictor for AID pregnancy outcome. Female fertility factors should be considered, or IVF/ICSI should be recommended when couples received more than 5 AID cycles without pregnancy.

Two Spontaneous Pregnancies after Treatment with Ovocyplus&amp;lt;sup&amp;gt;TM&amp;lt;/sup&amp;gt; among an Infertile Patient with Two Failed IVF: A Case Report

The role of oxidative stress in female reproduction is becoming increasingly important, as recent evidence suggests that it has been implicated in the pathology of infertility of both known and idiopathic origin. Although its efficacy has yet to be well established, supplementation with antioxidants is a new tool being developed in the therapeutic armamentarium for female-factor infertility. We present a case of a spontaneous viable pregnancy in a 37-year-old patient with a history of two consequent In Vitro Fertilization (IVF) failures, occurring after a 5-month antioxidant treatment. This report suggests that oral antioxidants supplementation in female patients may provide an alternative or adjunct to conventional fertility therapies and improve their chances of becoming pregnant.

Diagnostic Ambiguity and Psychosocial Distress among Chinese Women with Idiopathic and Non-Idiopathic Infertility

The aim of this study is to investigate how women with different diagnoses on their cause of infertility—non-idiopathic (female, male, mixed), or idiopathic (unknown causes)—display different levels of psychosocial well-being prior to their IVF treatment. Women who attended an assisted reproduction clinic were recruited to fill out a set of questionnaire about 3 months before the start of their first IVF treatment cycle (valid N = 330). Measures included anxiety, somatic, emotional, and spiritual distress, as well as marital satisfaction. Somatic distress was found to be highest among women without a known cause of infertility. Women with mixed-factor diagnosis reported significantly lower emotional distress. Spiritual distress was found to be the highest in female-factor infertility group. Results remained significant after controlling for marital satisfaction. The current findings suggest that facing infertility whose cause is unexplained, women may express their distress through somatic complaints. Whe...

Hysteroscopy findings and its correlation with latent endometrial tuberculosis in infertility

In India, 5 to 18 % of females attending infertility clinics are diagnosed to be suffering from genital tuberculosis. The present study was conducted to find out the prevalence of endometrial tuberculosis in infertility and its correlation with hysteroscopic changes. Patients attending infertility clinic with history of more than 2 years of unexplained infertility, failure to conceive in spite of successful ovulation induction in anovulatory infertility, and secondary infertility with a history of unexplained abortion or ectopic pregnancy were included in the study. In all the 105 cases, hysteroscopy was done, and the endometrium was subjected to DNA-PCR (polymerase chain reaction) testing for detection of Mycobacterium tuberculosis infection. Hysteroscopy features were compared in tuberculosis positive (39 %) and negative (61 %) cases for correlation. Tuberculosis was detected in 43.75 % of ostial and periostial fibrosis, 48.48 % of intrauterine fibrosis, and 66.67 % of the irregular cavity surface. A complete 6-month course of antitubercular treatment was given to the tuberculosis positive cases among which 39 % conceived without any additional treatment. The pregnancy rate of 64.7 % in secondary infertility and 20.8 % in primary infertility was very much promising. Tuberculosis is one of the major etiological factors in female infertility in developing countries. Preliminary assessment by hysteroscopy followed by PCR testing for Mycobacterium tuberculosis will detect it early. Subsequent antitubercular treatment may reverse the reproductive capability and prevent permanent damage to the female reproductive organs.

Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination

To determine whether there is a difference in ongoing pregnancy rates (PRs) between patients undergoing IUI with strict sperm morphology ≤4% compared with >4% on initial semen analysis. Retrospective chart review with multivariate analysis. Academic outpatient reproductive center. A total of 408 couples with male and/or female factor infertility and known strict sperm morphology (SSM). A total of 856 IUIs with partner's sperm (IUI-P). Ongoing PRs based on ultrasound documentation of intrauterine pregnancy with fetal heart tones. There is no statistically significant difference in per cycle PRs when comparing patients with a strict sperm morphology of ≤4% versus >4% who undergo IUI-P (17.3% vs. 16.7%; odds ratio 0.954, 95% confidence interval 0.66-1.37). Multiple potential confounding factors were assessed using multivariate analysis. Strict sperm morphology ≤4% is not associated with lower PRs in couples undergoing IUI-P, and thus should not be the sole reason for advancing to IVF.

Clinical management and therapeutic outcome of infertile couples in southeast Nigeria.

BackgroundInfertility is highly prevalent in Nigeria and most infertile couples in southeast Nigeria are offered conventional forms of treatment, which consist mainly of ovulation induction and tubal surgery, due to limited availability and high cost of endoscopic and assisted reproductive technologies like laparoscopy and in vitro fertilization. The aim of this study was to determine the prevalence of infertility, outcome of infertility investigation, and the treatment outcome of infertile couples following therapeutic interventions in southeast Nigeria over a 12-month period.MethodsThis was a prospective cross-sectional study of 218 consecutive infertile couples presenting for infertility management at the infertility clinics of two tertiary health institutions in Enugu, southeast Nigeria. Infertility investigations were carried out on these couples using the available conventional diagnostic facilities. Following the results of the investigations/diagnosis, conventional treatment was offered to the couples as appropriate. Data analysis was both descriptive and inferential at 95% confidence level.ResultsThe mean age of the women was 33.5±4.62 (range: 15–49) years. Most (58.3% [n=127]) were nulliparous. The prevalence of infertility was 12.1%. Infertility was primary in 28.4% (n=62) and secondary in 71.6% (n=156). Female etiologic factors were responsible in 32.1% (n=70), male factors in 26.1% (n=57), and a combination of male/female factors in 29.4% (n=64). The etiology was unknown in 12.4% (n=27). Tubal factors 23.8 % (n=52) and ovulation failures 26.1% (n=57) are common female factors implicated. Pregnancy rate following treatment was 16.7% (n=28). Multivariate regression analysis indicates that younger age of ≤30 years, duration of infertility ≤5 years, and female factor infertility were associated with higher pregnancy outcome following treatment.ConclusionThe prevalence of infertility is high and pregnancy rate following conventional treatment is poor. There is a need to improve facilities for managing infertility as well as making artificial reproductive techniques readily available, accessible, and affordable.

The psychological impact of infertility and fertility treatment on the male partner

Objectives: This paper reports the findings of two studies that examined factors predicting infertility distress in male partners within couples with an infertility diagnosis and where the couple was receiving fertility treatment. Design: A cross-sectional design was implemented using a questionnaire battery (The questionnaire battery comprised an inventory of four different standardised questionnaires compiled together into one booklet) compiled from earlier theory-building qualitative research conducted by the authors. Methods: Infertility related distress was examined in relation to a number of psychosocial variables including relationship dynamics, self-esteem, current mental health and attitudes towards idealised masculinity. The questionnaire battery was completed by 167 men undergoing or consulting for fertility treatment. Participants were recruited through Irish fertility clinics (Study 1, n = 111) and through an online survey (Study 2, n = 55). Results: Regression analyses identified four variables that predicted variance in infertility distress in both studies: ‘Attitude towards idealised masculinity’, ‘Mental health’, ‘Relationship satisfaction’ and ‘Self-esteem’. This finding was found to be robust having controlled for age, time since diagnosis, number of attempts at treatment and diagnostic category (male factor, female factor or mixed factor infertility). Conclusion: Recommendations for fertility clinics and mental health professionals should be made in relation to managing infertility distress and supporting couples during fertility treatment.

Impact of Age on Ovarian Response and IVF Outcome during Controlled Ovarian Hyperstimulation in Women from Gaza Strip

Background: Although age is an important factor in female fertility, not much date were focused on the relationship between age and ovarian response and in vitro fertilization (IVF) outcome. However, the female reproductive capacity varies with age.Objective: To assess the impact of age on ovarian response and IVF outcome during controlled ovarian hyperstimulation in women from Gaza Strip. Methods: This prospective cohort study consisted of 75 women attending IVF at Al-Basma Fertility Center in Gaza City. The number of oocytes and embryos were recorded for each female and the occurrence of pregnancy was followed for three months. The obtained data were computer analyzed using SPSS statistical package version 18.Results: The mean age of the study population was 29.2±5.9 years. The total number of oocytes was significantly decreased with increasing age (F=3.932 and P=0.024).In this context Pearson correlation test exhibited negative significant correlation between women age and the number of mature oocyte (r=-0.276, P=0.017). There was an inverse relationship between age and ovarian response (F=6.773 and P=0.001), showing good response (9-16 oocytes) at mean age of 26.7±5.0 years. When related to women age, IVF outcome showed that the chance of getting pregnant increased with decreased age (F=4.278 and p= 0.018). Conclusion: The ovarian response and the chance of getting pregnancy were diminishing with ageing, implying that maternal age should by consider during IVF program.DOI: http://dx.doi.org/10.3329/jom.v15i1.19858 J Medicine 2014; 15: 36-40

Comparative analysis of three sperm DNA damage assays and sperm nuclear protein content in couples undergoing assisted reproduction treatment

Is there an association between sperm DNA damage, measured by three different assays, sperm nuclear protein content and clinical outcomes in assisted reproduction treatment (ART)? Sperm DNA damage measured by terminal deoxynucleotidyltransferase-mediated dUTP nick-end labelling (TUNEL) and the Comet assay were significantly associated with ART outcomes in our single institution study. Abnormal protamine expression is known to be associated with sperm DNA damage and male infertility. A number of studies have shown a significant relationship between sperm DNA damage and ART outcomes. To date, there are no large studies providing direct comparisons of DNA damage tests within the same study population. Thus, the prognostic value for each method remains unknown. Cross-sectional study of 238 men from infertile couples undergoing ART at the University Center for Reproductive Medicine, Utah, USA, between April 2011 and March 2013. Sperm from men undergoing ART were tested for DNA damage using the alkaline Comet assay, TUNEL and flow cytometric chromatin evaluation (FCCE) assays. Histone retention was analysed using the aniline blue staining method, whereas protamine content (proteins P1 and P2) and ratio were analysed using acid urea gel electrophoresis. The prognostic value of each sperm DNA test to predict clinical pregnancy was calculated. Histone retention was associated with sperm DNA damage (P < 0.001), reduced embryo quality (P = 0.005) and clinical pregnancies (P < 0.001). The mean percentage of sperm with DNA damage was significantly higher in sperm from non-pregnant couples compared with that from pregnant couples, as measured by TUNEL assay (15.04 ± 1.16% versus 8.79 ± 0.56%; P < 0.001) and alkaline Comet assay (72.79 ± 2.49% versus 55.86 ± 2.29%; P < 0.001). There was no association between clinical pregnancies and DNA fragmentation index measured by FCCE (12.97 ± 1.46 versus 14.93 ± 1.65; P = 0.379). Of the protamine parameters analysed, only the P1/P2 ratio was associated with sperm count (P = 0.013), men's age (P = 0.037), maturity (P = 0.049) and blastocyst quality (P = 0.012). Histone retention and sperm DNA damage measured by Comet and TUNEL assays were associated with fertilization rate (P < 0.05), embryo quality (P < 0.05) and implantation rate (P < 0.05). A potential drawback of this study is that it is cross-sectional. Generally in such studies there is more than one variable that could cause the effect. Analysing sperm is one part of the equation; there are also a number of female factors that have the potential to influence ART outcomes. Therefore, given the large and well-established role of female factors in infertility, normal sperm DNA integrity and protamination do not necessarily ensure clinical pregnancy in ART. Thus, female factors can reduce the prognostic value of sperm DNA tests. Further, our use of native semen instead of prepared sperm may have iatrogenically increased the DNA damage. Alteration in sperm nuclear protein affects sperm DNA integrity. Further, with the current dataset, TUNEL and Comet assays appeared more predictive of ART success than FCCE. No personal or direct financial support has been received for any of this work. The authors declare no competing interests. N/A.

Birth characteristics in a clinical sample of women seeking infertility treatment: a case–control study

ObjectiveTo determine the distribution of low birth weight (LBW), preterm birth, small for gestational age (SGA) and large for gestational age (LGA) by main cause of infertility (female, combined, male,...

Diagnostic Laparoscopy in the Evaluation of Female Factors in Infertility in Kashmir Valley

Objectives: To evaluate the female factors in infertility using laparoscopy in Kashmiri women. Materials and Methods: One hundred cases of infertility [primary and secondary] were included in this prospective study. Before the procedure, apart from complete history and detailed examination, baseline investigations (complete blood count, blood sugar, kidney and liver function tests, ECG, chest X-ray) were performed as per our institutional protocol for pre-anaesthesia check up. Laparoscopy was done in proliferative phase of menstrual cycle. To test the patency of tubes, chromotubation was done in all cases under laparoscopic vision by using 10-15 ml of autoclaved methylene blue dye. All the data was collected on pre-designed proforma and the results were tabulated and raw percentages calculated to describe the results. Results: In primary infertility group [n=82], most common laparoscopic finding was tubal occlusion in 15 (18.3%), followed by endometriotic deposits in 14 (17.1%) patients. Other findings were polycystic ovaries in 10 patients (12.2%), peritubal and periovarian adhesions in 6 patients (7.3%), fibroids in 6 patients (7.3%), genital tract tuberculosis in 5 patients (6.1%), ovarian cysts in 4 patients (4.8%), hypoplastic uterus in 2 patients (2.4%) and pelvic inflammatory diseases in 2 patients (2.4%), in this group. The commonest finding by laparoscopy in patients with secondary infertility [n=18] was tubal occlusion in 5 (27.7%), followed by peritubal and periovarian adhesions in 4 (22.2%) patients. Conclusion: laparoscopy is very effective and cheap method in evaluating infertile women and should be considered earlier in infertility workup for effective and early treatment decisions. 1Senior Resident department of obstetrics and gynecology, Sheri Kashmir Institute of Medical Sciences Medical College, Srinagar, J&K, India. 2Associate Professor department of obstetrics and gynecology, Sheri Kashmir Institute of Medical Sciences Medical College, Srinagar, J&K,India. 3Senior Resident department Of General and Minimal Access Surgery, Sheri Kashmir Institute of Medical Sciences Srinagar, J&K, India. 4Assistant Professor department of obstetrics and gynaecology, Sheri Kashmir Institute of Medical Sciences Medical College, Srinagar, J&K, India. Article History: Received 10 October 2013 Accepted 7 January 2014 Revised 25 December 2013 Available online 7 January 2014

Epidemiology of Female Infertility; A Review of Literature

The prevalence of infertility is varies worldwide ranging from 3% to 7%. The consequences of infertility are societal repercussions, personal suffering, psychological effects, clinical depression and sexual dysfunction. Therefore, the aim of the present study was a systematic review of the literature to determine the main risk factors of female infertility. MEDLINE, EMBASE and Cochrane Database were searched from 1980–2013. Information about study objectives, participants and type of study were searched systematically with extensive key words to optimize the sensitivity of data collection. Eighty-two published articles were included in the overall review. Ovarian factors, tubal and peritoneal factors, anomalies, advanced ages (over 35 years), hormonal disorders, habits, genetic factors, medical conditions and life style are the main causes of infertility in women. Changes of lifestyle, identifying and controlling chronic diseases, rapid and suitable treatments for sexually transmitted diseases can increase the chance of women fertility process.

Semen analysis: Indispensable, yet non-ideal

Women’sHealthHospital,Dept. ofObstetricsG accepted 3 November 20131. IntroductionAbout 15% of sexually active, non contracepting couples donot achieve pregnancy within 1 year of marriage and aretherefore described as infertile (1). No cause of infertility canbe found using routine diagnostic work-up in 10–15% of thecouples. A male contribution to infertility is encountered in45–50% of the remaining cases (2). Male and female infertilityfactors often coexist. In 30–45%, the cause of abnormal semenparameters remains enigmatic (idiopathic male infertility)(3,4).Semen analysis is of great value in the initial investigationof the male and its results are often taken as a surrogatemeasure of male fecundity and chances of pregnancy. It alsoprovides information on the functional integrity of thegerminal epithelium, epididymis and accessory sex glands.Additionally, reference ranges for semen parameters from afertile population may provide important data from whichthe diagnosis of infertility or prognosis of fertility can beextrapolated. Routine semen analysis should provide adequateinformation about the physical characteristics of semen(liquefaction, viscosity, pH, color, odor and volume), spermcount, sperm motility and progression, sperm morphology,leukocyte quantification and fructose detection in cases ofazoospermia or oligospermia.From an evidence-based perspective, are the measuredsemen parameters truly and wholly reflective of a man’s repro-ductive capacity? Are those parameters carefully chosen toencompass the multifaceted and complex nature of suchprocess? Are the currently acceptable values for a normalsemen analysis considered accurate ‘pass marks’ for parenthood?Will a normal semen analysis guarantee a successful culminationof a man’s endeavor to father a child? Does an abnormal semenanalysis necessarily designate abnormality?Regrettably, negation is the answer to most, if not all, theaforementioned questions. That said, two fundamental issuesfollow, why and how. Why is the currently applied semenanalysis short of providing an adequate evidence-basedsubstantiation of a man’s fertile capacity? How could we addvalue to such an important and non-invasive investigatory tool?2. Why is the currently adopted semen analysis inadequate?The prognostic value of semen components such as spermcount, motility and morphology, as surrogate markers of malefertility, is confounded by several variables. The fertility poten-tial of a man is influenced by sexual activity, function of acces-sory sex glands and other confounders. Routine semen analysisitself has its own limitations, and does not assess for spermdysfunction such as immature chromatin or fragmentedDNA. Results from at least two, preferably three, properlyspaced separate seminal analyses must be obtained before adefinitive conclusion can be drawn as wide biological variabil-ity exists within the same individual. The numerous character-istics assayed by semen analysis are only few of the many facetsreflecting semen quality. Almost one third of men with anormal semen analysis actually have abnormal sperm function.In contradistinction, men with poor semen analysis results maygo onto father children. Semen analysis should follow theWHO guidelines, laboratory manual for the examination andprocessing of human semen (5). Semen analysis may show adecreased number of sperm (oligozoospermia), decreasedmotility (asthenozoospermia), and many abnormal forms onmorphologic examination (teratozoospermia). These

Medical factors associated with early IVF discontinuation

Even when IVF is reimbursed by the social insurance system, as in France, high discontinuation rates have been reported and some patients drop out as soon as the first failed IVF cycle. This study aims to investigate medical factors associated with treatment discontinuation in an IVF centre after the first unsuccessful cycle. The study included 5135 couples recruited in eight French IVF centres and who had had an unsuccessful first IVF cycle in these centres in 2000–2002 (i.e. no live birth). Of these couples with a first failed IVF, 1337 did not have a second IVF in the centre (26%, ‘early discontinuation group’) and 3798 continued treatment with a second IVF in the centre. The characteristics of couples who discontinued IVF treatment were compared with those who continued using logistic regressions. Older women, women with duration of infertility >5years, with female factor or unexplained infertility, with 0 or 1 oocyte retrieved and no embryo transfer during the first IVF were more likely to discontinue treatment early. Risk of early discontinuation was associated with medical factors that are also well known to be associated with impaired chance of successful IVF.Even when IVF is reimbursed by the social insurance system, as in France, high discontinuation rates have been reported and some patients drop out as soon as the first failed IVF cycle. This study aims to investigate medical factors associated with treatment discontinuation in an IVF centre after the first unsuccessful cycle. The study included 5135 couples recruited in eight French IVF centres who had had an unsuccessful first IVF cycle in these centres in 2000–2002 (i.e. who remained childless after a first cycle). Of these couples with a first failed IVF, 1337 did not have a second IVF in the centre and 3798 continued treatment with a second IVF in the centre. The characteristics of couples who discontinued IVF treatment were compared with those who continued. After a first failed IVF cycle, more than one-quarter (26%) of couples discontinued IVF treatment. Older women, women with duration of infertility >5years, with female factor or unexplained infertility, with 0 or 1 oocyte retrieved and with no embryo transfer during the first IVF were more likely to discontinue treatment early. The risk of early discontinuation was associated with medical factors that are also well known to be associated with impaired chance of success during IVF treatment. A next step would be to examine whether the early discontinuation results from a decision of the couple themselves, from medical, psychological and/or social staff counselling or from some combination of all of these factors.

Intracytoplasmic Sperm Injection and Birth Defects

Abstract: Louise Brown, who in 1978 was the first person born via ART (assisted reproductive technology), gave birth herself by natural pregnancy. Although it has been the subject of many ethical and scientific arguments, various kinds of ART have been developed and advanced. ART does not affect a child's health but can cause a slightly higher occurrence of congenital anomalies because of male and/or female infertility factors including chromosomal abnormalities. However, there is no difference in offspring resulting from ICSI (intracytoplasmic sperm injection) or IVF (In vitro fertilization).

Tumor necrosis factor-308 polymorphism increases the embryo implantation rate in women undergoing in vitro fertilization

Do TNF-308 and -238 polymorphisms impact the embryo implantation rate after in vitro fertilization (IVF) in women without female infertility factor? The presence of the TNF-308A allele is associated with high implantation and multiple pregnancy rates in women without known infertility factors after ovarian hyperstimulation with exogenous FSH. Multiple pregnancies are frequent after the use of Assisted Reproductive Technologies. Single embryo transfer (SET) has been proposed as a simple way to prevent these risks. However, the extension of SET indications to patients not selected based on specific criteria is controversial because of reduced pregnancy rates. To date, the predictive value of the parameters used for SET (age, gynecological history of the patient and uterine characteristics) allows a pregnancy rate of ~30%. The potential predictive value of TNF polymorphisms (-308, rs1800629 and -238, rs361525) on implantation rate was evaluated in 424 women requiring IVF due to male fertility factors. This cohort retrospective study was conducted over 4 years in University-affiliated hospitals. The entire patient group included 424 women undergoing intracytoplasmic sperm injection (ICSI) due to male fertility factors without the contribution of any female factor. From among this group, a selected patient group included 120 women with a normal karyotype, age under 38 years, serum follicle-stimulating hormone (Day-3 FSH) levels below 10 IU/l, a long agonist desensitization protocol associated with recombinant FSH treatment and a Caucasian background. The TNF-238 polymorphism was not associated with implantation rate. In contrast, the presence of the TNF-308A allele was associated with increased Day 3-E2 levels as well as higher implantation and multiple pregnancy rates after fresh embryo transfer in women from the entire and selected patient groups. Moreover, in the selected patient group, the presence of the TNF-308A allele was also associated with a decrease in the miscarriage rate. The benefit of the TNF-308A allele in predicting implantation rates was not observed after the use of frozen embryos. Future studies are needed to evaluate whether the TNF-308A allele might also be a biomarker in women with infertility factors. The TNF-308A allele may represent a good candidate for a potential predictive, non-invasive biomarker in the SET strategy. However, its impact should be evaluated in prospective studies. This study was conducted with financial support from the French Institute for Health and Medical Research (INSERM), Organon France for a FARO (Fond d'Aide à la Recherche Organon) fellowship (to V.T.) and CHU Nice PHRC (PHRC 09-279).There are no competing interests.

English

Infertility, though not a physically debilitating disease, severely affects the couples' psychological, harmony, sexual life and social functions. With all the modern needs of contraception rising on one side, infertility is still a major challenge to the gynecology practitioners on the other hand. Male & Female contribute to the fertility of a couple and factors affecting any of reproductive organs can alter the fertile potential. Of all the factors contributing to female infertility due to ovarian disturbances, Polycystic Ovarian disease is the leading one. PCOS is the commonest endocrine disease in women of reproductive age. It affects 5-10 % of women of reproductive age.1 It is associated with increased androgen secretion, hirsutism , menstrual irregularities and infertility. It has impact not only on physical but also on mental health of women. PCOS now proves to be a significant factor in female infertility with prevalence of 0.6 to 3.4 % in infertile couples. It is noted in 30-50% of women with RPL (recurrent pregnancy loss).2 With improving laboratory facilities, sonography and with routine laparoscopic evaluation of infertility. PCOD has shown a remarkable increase of incidence in recent years. The aims of this study are 1. To know the patho-physiology of PCOS & its clinical correlation 2. To evaluate investigations 3. To compare recent modality of management options & their outcome.

Study of 100 cases of Infertility in Polycystic ovarian syndrome and its management outcome

Background: With all the modern needs of contraception rising on one side, infertility is still a major challenge to the gynaecological practitioners on other hand. Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility, being found in ∼75% of cases. PCOS now proves to be a significant factor in female infertility with prevalence of 0.6 to 3.4% in infertile couples. With improving laboratory facilities, sonography and with routine laparoscopic evaluation of infertility, PCOS has shown a remarkable increase of incidence in recent years. Aims & Objective: The diagnosis of PCOS by ultrasonography & investigations like LH, FSH, Prolactin and or Laparoscopy. The evaluation of treatment options like clomiphene citrate, metformin and laparoscopic ovarian drilling. Material and Methods: This is a study of 100 cases of infertility with polycystic ovarian syndrome and its pregnancy outcome. In this study from May 2011 to April 2013,100 cases of Infertility with PCOS were studied at the tertiary care center. Hormonal assay, Ultrasound and laparoscopy were used for diagnosis. Clomiphene citrate, metformin and laparoscopic ovarian drilling were used as treatment modalities. Results: In our study 58% patients were in the age group of 21-25 years and 100% patients complained of infertility among which 60% were of primary type. LH:FSH ratio was more than 1.6 in nearly 82% patients. Among all treatment modalities conception rate with Clomiphene citrate was 40%, with metformin it was 20% and with laparoscopic ovarian drilling followed by C/C it was 65%. Conclusion: PCOS is emerging disease of the new generation found more in young adults being the leading cause of infertility. Apart from diet and exercise changes in lifestyle modification treatment is required in most patients with good conception rate with C/C and laparoscopic ovarian drilling.