Female Infertility Patients Research Articles

Infertile women who screen positive for depression are less likely to initiate fertility treatments.

Are infertile women who screen positive for depression less likely to initiate infertility treatments? Infertile women who screen positive for depression are less likely to initiate treatment for infertility. Infertility imposes a psychological burden on many couples. Depression and anxiety have been demonstrated in ~40% of infertile women, which is twice that of fertile women. Further, the psychological burden associated with infertility treatment has been cited as a major factor for discontinuation of infertility care. Prospective, observational study in a clinical-based cohort of 416 women who completed a questionnaire after the new patient visit, from January 2013 until December 2014 inclusive. All new female infertility patients (n = 959) seen between January 2013 and December 2014 at University of North Carolina Fertility received an electronic questionnaire to screen for mental health disorders and to evaluate their perception of mental health disorders on infertility. Of 959 surveys sent, 416 women completed the questionnaire (43%). The prevalence screening positive for depression, using the NIH PROMIS screening tool, was 41%. Sixty-two percent of all women initiated infertility treatment, and of these, 81% did so within 4 months. In multivariate analysis, women who screened positive for depression had 0.55 times the odds of initiating treatment for infertility (95% CI: 0.31-0.95). Similarly, women who screened positive for depression had 0.58 times the odds of initiating infertility treatment within 4 months (95% CI: 0.35-0.97), which was the time of censoring from the most recent patient evaluated. Women who screened positive for depression were less likely to pursue treatment with oral medications or IVF (P = 0.01 and P = 0.03, respectively), as compared to women who did not screen positive for depression. Questionnaire-based evaluations may result in a lower prevalence of psychological disorder as some participants feign emotional well-being. Although we did not identify differences in women who responded to our survey and those who did not, responder bias may still be present. In addition, infertility is a couple's disease. However, this study only included psychological evaluation of the female partner. We have no information about the women's previous treatment. Screening for depression is important in the infertility patient population, as further evaluation and psychological interventions may improve compliance with fertility treatments, quality of life, and potentially, the overall chance of pregnancy. None.

Возможности и перспективы расширенного алгоритма диагностики генитального туберкулеза у пациенток с бесплодием

Возможности и перспективы расширенного алгоритма диагностики генитального туберкулеза у пациенток с бесплодием

Отдаленные результаты лечения пациенток с бесплодием и эндометриоидными кистами яичников

Отдаленные результаты лечения пациенток с бесплодием и эндометриоидными кистами яичников

Analysis of the current situation and influencing factors of depression among female outpatients with infertility in reproductive medicine center

Objective To investigate the status of depression in female infertility patients and its influencing factors in reproductive medicine center. Methods Totally 147 cases of female infertility patients from the reproductive medicine center of a tertiary hospital in Beijing were collected as the research object by convenient sampling method from July to September 2015. The questionnaire survey was used to investigate the patients′ general information, disease related data and depression mood. Results In the study, the average depression score of 147 participants was (0.45±0.12). Among them, there were 32 cases (21.8%) of mild depression, 15 cases (10.2%) of moderate depression and 4 cases (2.7%) of severe depression. Multiple regression analysis showed that patients with depression were affected by academic qualifications, age and whether there was a history of transplantation. Conclusions The outpatients of the reproductive medicine center have a more severe depression mood and will be affected by the patient′s education background, age, and whether there is a history of transplantation. It is recommended to consider the patient′s education background, age, and whether there is a history of transplantation in patients′ health education. Key words: Health education; Infertility; Depression; Influencing factors

A study of sociocultural factors on depression in Chinese infertile women from Hunan Province

Objective: To explore the sociocultural factors influencing depression in Chinese infertile women in Hunan Province.Methods: A cross-sectional study was carried out. A total of 211 Chinese infertile women completed demographic details, a disease-related information questionnaire, a self-rating depression scale (SDS) and a social support rating scale (SSRS).Results: One hundred and seven (50.71%) of the participants were classified as depressed according to the self-rating depression scale. The average SDS index score was 50.06 ± 10.59. Using analysis of variance (ANOVA), Pearson correlation and a multivariable regression analysis, the results showed family type, feelings of discrimination, social support, feelings of shame and reproductive pressures were influential factors in depression among Chinese infertile women.Conclusion: Sociocultural factors influence depression levels in Chinese female infertile patients. The unique aspects of Chinese culture may have a negative mental impact on the patients, and cultural factors should be taken into consideration in the development of coping strategies for Chinese infertile women.

The Role of Advanced Age and Duration of Infertility on Oocyte Number Retrieved during In Vitro Fertilization

Introduction: The number of oocytes retrieved during in vitro fertilization related to the success of pregnancy. Today in vitro fertilization has been considered as definitive therapy for infertility problem. Age and duration of infertility is an important factor in infertility that should be evaluated in detail. The purpose of this study was to clarify the role of age and duration of infertility on the number of oocytes retrieved during in vitro fertilization.Method: This was an analytic observational study, including infertile female patients who followed the in vitro fertilization program at Fertility Clinic Graha Amarta Dr Soetomo Hospital Surabaya. Total sampling was conducted during January 1st-June 30th 2014 and found 66 study subjects. Evaluation was performed on age, duration of infertility and the number of oocytes retrieved following ovarian stimulation using FSH and GnRH antagonist injection. All data were analyzed by ANOVA test with level significance of ≤ 0.05.Result: In the group of age <35 years the average number of oocytes retrieved was 9.43 ± 6.29 oocytes, and in the group of age ≥ 35 years averaged number was 6.03 ± 4.67 oocytes. There was significant differences of oocytes number retrieved between the two groups (p = 0.017). The number of oocytes retrieved in group of duration of infertility 1-2 years, 3-4 years and ≥ 5 years were 13.40 ± 3.28 ; 8.64 ± 6.80 and 6.82 ± 5.45, respectively. There was significant differences of oocytes number retrieved between the three groups of duration of infertility (p = 0.017).Discussion: The advanced of age and the longer duration of infertility may contribute to the incidence of the less number of oocytes retrieved in infertile women who follow in vitro fertilization.

The Role of Advanced Age and Duration of Infertility on Oocyte Number Retrieved during In Vitro Fertilization

Introduction: The number of oocytes retrieved during in vitro fertilization related to the success of pregnancy. Today in vitro fertilization has been considered as definitive therapy for infertility problem. Age and duration of infertility is an important factor in infertility that should be evaluated in detail. The purpose of this study was to clarify the role of age and duration of infertility on the number of oocytes retrieved during in vitro fertilization. Method: This was an analytic observational study, including infertile female patients who followed the in vitro fertilization program at Fertility Clinic Graha Amarta Dr Soetomo Hospital Surabaya. Total sampling was conducted during January 1st-June 30th 2014 and found 66 study subjects. Evaluation was performed on age, duration of infertility and the number of oocytes retrieved following ovarian stimulation using FSH and GnRH antagonist injection. All data were analyzed by ANOVA test with level significance of ≤ 0.05. Result: In the group of age <35 years the average number of oocytes retrieved was 9.43 ± 6.29 oocytes, and in the group of age ≥ 35 years averaged number was 6.03 ± 4.67 oocytes. There was significant differences of oocytes number retrieved between the two groups (p = 0.017). The number of oocytes retrieved in group of duration of infertility 1-2 years, 3-4 years and ≥ 5 years were 13.40 ± 3.28 ; 8.64 ± 6.80 and 6.82 ± 5.45, respectively. There was significant differences of oocytes number retrieved between the three groups of duration of infertility (p = 0.017). Discussion:. The advanced of age and the longer duration of infertility may contribute to the incidence of the less number of oocytes retrieved in infertile women who follow in vitro fertilization.Keywords: age, duration of infertility, oocyte, in vitro fertilization

Prevalence of macroprolactin (MPRL) in infertile female patients: frequent misdiagnosis and mismanagement of hyperprolactinemia

The biological actions of prolactin (PRL), a polypeptide hormone, are mostly related to lactation and reproduction. Hyperprolactinemia is associated with suppression of hypothalamic-pituitary-gonadal axis through the inhibition of the pulsatile secretion of gonadotropin releasing hormone (GnRH). Is one of the most common endocrine disorders causing female infertility and occurs in 30-40 % of infertile women (1,4). A monomer of 23 kDa is the bioactive fraction. However, there are others isoforms whith low or absent bioactivity, as dimer or big-PRL (50 kDa) and macroprolactin (MPRL,150-170 kDa)(5). Several clinical studies have demonstrated that macroprolactinemia occurring in 10-42 % of all cases of hyperprolactinemia (1). Usually, treated with dopamine agonists without discriminating whether the presence of MPRL, producing a sharp decrease of PRL levels. But it is unknown if a hypoprolactinemia could affect ovarian stimulation and embryo implantation (6,7). The objective of this work was to evaluate the prevalence of MPRL in infertility female patients. prospective observational study. 195 infertile women were screened for hyperprolactinemia and only serum PRL levels greater than 26 ng/ml were further studied for the presence of MPRL. The free PRL (f-PRL) was analyzed by a precipitation with polyethylene glycol (PEG) precipitation assay(8,9). We calculated the percentage of recovered prolactin (PRL-r%). The determination of PRL was performed by ECLIA ROCHE-(EGII) . Patients with risk factor of hyperprolactinemia were excluded. The results were expressed in percentage. the age media was 35 (20-45). 18% of evaluated patients shown hyperprolactinemia. After precipitation of MPRL, 46% of diagnosed by hyperprolactinemia shown f-PRL <26 ng/ml. The median percentage of prolactin recovered was 71%. The prevalence of MPRL in infertile women was 8%. MPRL presence is a significant cause of misdiagnosis, unnecessary investigation, and inappropriate treatment in patients with suspected hyperprolactinemia. PEG precipitation is useful to screen all patients with high PRL levels. As the bioactivity of MPRL is low or absent, the evaluation of f-PRL will be recommended. Further studies with larger groups of patients are needed to confirm these findings.

Anti-mullerian hormone levels decline with the presence of antiphospholipid antibodies.

Autoimmunity is thought to be an important cause of premature ovarian senescence, characterized by abnormal ovarian reserve markers. Anti-Mullerian hormone (AMH) has emerged as the most reliable marker for ovarian reserve. We here investigated whether non-specific immune markers are associated with a low age-specific AMH. To test the hypothesis that autoimmunity may predispose to low AMH, we investigated in 351 female infertile patients whether panels positive for non-specific immune tests (antinuclear antibody, antiphospholipid antibodies [APAs], lupus anticoagulant, antithyroid antibodies, and total immunoglobulin levels) are associated with low AMH levels. Analysis of covariance was performed to determine statistical significance of associations. Age of infertile women was 38.6±5.3years. A total of 50 women (14.2%) had abnormally elevated levels of one or more APA. Even after age adjustments, the presence of at least one APA was significantly associated with a low AMH (P<.0066). No one specific APA or other immune marker demonstrated an association with AMH. APAs but no other immune markers appear associated with decreased levels of AMH, supporting the hypothesis that non-specific autoimmunity may adversely affect ovarian reserve.

Chinese medicine as complementary therapy for female infertility.

Chinese medicine (CM) has been used in clinical treatment for thousands of years in China, Japan, Korea, and other countries. CM is at present attracting many attentions around the world for reproductive health care and disease prevention, including treatment of female infertility. This review focuses on the CM treatment for female infertility patients, and supplies a summary on the efficacy, safety, and mechanism of some Chinese herbal medicines, herbal medicine-derived active compounds, and acupuncture. A large number of researches have reported that CM could alleviate or even cure female infertility by regulating hormone, improving reproductive outcome of in vivo fertilization, affecting embryonic implantation, curing polycystic ovarian syndrome, endometriosis, pelvic inflammatory disease, relieving mental stress, and regulating immune system. Meanwhile, a few studies claimed that there was little adverse reaction of CM in randomized controlled trials. However, up to present there is a lack of adequate evidences with molecular mechanistic researches and randomized controlled trials to prove the CM as an effective and safe treatment for infertility. Thus, utility of CM as a complementary medicine will be a feasible method to improve the outcome of female infertility treatment.

Utility of 128-multislice CT virtual HSG in assessment of female infertility

ObjectiveThe aim of this study to assess the utility of 128-MDCT VHSG in evaluation of different female infertility causes. Patients and methodsForty eight infertile female patients were included in the study, which was conducted in Radiodiagnosis Department, Zagazig University Hospitals from November 2014 to May 2015. MDCT Hysterosalpingography was performed between days 6 and 12 of the menstrual cycle at least 48hours after menses. Resultswe compared findings of MDCT-VHSG with hysteroscopy or/ and laparoscopy results. We found that MSCT-VHSG more accurate in diagnosis of uterine and ovarian infertility causes, while less accurate in the diagnosis of tubal causes. The sensitivity for detecting uterine and fallopian tubes pathology by MDCT-VHSG was 100% and 100% respectively, while the specificity was 100%, 85.71% respectively. MDCT-VHSG had reported 100% and 92.85% PPV in detecting uterine and fallopian tubes pathology respectively, while the NPV was 100% and 100% respectively. ConclusionThe MDCT-VHSG is a diagnostic modality which permits the evaluation of the different causes of the female infertility, but still limited value in assessment of peritubal adhesions.

Somatic symptoms, sleep disturbance and psychological distress among women undergoing oocyte pick-up and invitro fertilisation-embryo transfer.

This study investigated the relationship between somatic symptoms, sleep disturbance and psychological distress in women who underwent oocyte pick-up and invitro fertilisation-embryo transfer. According to worldwide research, women receiving assisted reproductive technologies may suffer from somatic and psychological symptoms and even experience sleep disturbance. Apparently, the guilt of infecundity forces Asian women to conceal this scenario and delay the time at which they accept medical assistance and mental support. A longitudinal study. The subjects in this study were infertile female patients who received oocyte pick-up and invitro fertilisation-embryo transfer therapies in a hospital in northern Taiwan. Data were collected via a structured questionnaire, including somatic symptoms, Pittsburgh Sleep Quality Index and a five-item brief symptom rating scale. Data were analysed using the McNemar's test, Wilcoxon Sign Rank and fully entered multiple regression with spss version 20.0 software. The mean age of 100 participants was 34·54 (SD=3·94) years old. They experienced abdominal distention, breast engorgement, nausea, faintness, diarrhoea, sleep disturbance and psychological distress when they received invitro fertilisation-embryo transfer; these results were apparently higher than those receiving oocyte pick-up. In addition, sleep disturbance was the most significant factor involved in psychological distress during oocyte pick-up and invitro fertilisation-embryo transfer therapies. The most serious indicator of the women's psychological distress during oocyte pick-up and invitro fertilisation-embryo transfer treatment is anxiety. Sleep disturbance was the most significant factor involved in the psychological distress of women having problems with conception. Assisted reproductive technologies nurses can assess women's psychological distress by caring for their sleep disturbance without directly exploring their mood state. Moreover, these medical personnel should understand infertile female patients' psychological distress is mainly associated with their sleep disturbance. Developing various strategies to improve both sleep quality and psychological distress for infertile female patients should be recognised in future studies.

Chinese Herbal Products for Female Infertility in Taiwan: A Population-Based Cohort Study.

Female infertility and low birth rate are significant public health issues with profound social, psychological, and economic consequences. Some infertile women resort to conventional, complementary, or alternative therapies to conceive. The aim of this study was to identify the Chinese herbal products (CHPs) most commonly used for female infertility in Taiwan.The usage of traditional Chinese medicine (TCM) and the frequency of CHP prescriptions to infertile women were determined based on a nationwide 1-million randomly sampled cohort of National Health Insurance Research Database beneficiaries. Descriptive statistics and multiple logistic regression analysis were employed to estimate the adjusted odds ratio (aOR) for TCM usage and potential risk factors.In total, 8766 women with newly diagnosed infertility were included in this study. Of those, 8430 (96.17%) had sought TCM treatment in addition to visiting the gynecologist. We noted that female infertility patients with risk factors (e.g., endometriosis, uterine fibroids, or irregular menstrual cycle) were more likely to use TCM than those without TCM medication (aOR = 1.83, 1.87, and 1.79, respectively). The most commonly used formula and single CHP were Dang-Gui-Sha-Yao-San (17.25%) and Semen Cuscutae (27.40%), respectively. CHP formula combinations (e.g., Dang-Gui-Sha-Yao-San plus Wen-Jing-Tang 3.10%) or single Chinese herbal combinations (e.g., Semen Cuscutae plus Leonurus japonicus 6.31%) were also commonly used to treat female infertility. Further well-conducted, double-blind, randomized, placebo-controlled studies will be needed to evaluate the efficacy and safety of these CHP combinations for female infertility.

Association of thyroid disorders in females with primary infertility attending a tertiary-care hospital in northeast India

Background: A close interconnection is present between hypothyroidism and hyperprolactinemia. Failure to ovulate regularly in women of the reproductive age group may occur owing to hypothyroidism. Objective: To look for thyroid disorders among the primary infertile group of female patients and to see the association of serum prolactin level and thyroid-stimulating hormone (TSH) level, if any. Materials and Methods: In this study, we investigated 53 diagnosed female subjects of primary infertility who were sent to the Department of Biochemistry for hormonal investigation. Fifty-three fertile age-matched females were enrolled for the study as control subjects. Serum prolactin and the TSH levels were measured by using chemiluminiscence method (Access 2, Beckman Coulter). Result: Significantly higher prolactin and TSH levels were found among cases when compared with control subjects. A positive association was found between TSH and prolactin levels among the primary infertile female subjects. Conclusion: This study showed significantly higher prolactin and TSH levels among the primary infertile female patients. Therefore, for proper management of infertile cases, it may be necessary to look for thyroid dysfunction and treat it accordingly.

Role of obesity in female infertility and assisted reproductive technology (ART) outcomes

Introduction: Obesity is a preventable catastrophic pandemic in developed countries, and its occurrence is increasing in Saudi Arabia. One of the consequences of obesity is infertility, which is prevalent in 9–15% of the population. Objective: To evaluate the impact of obesity on female infertility. Materials and Methods: A retrospective study was performed in 196 infertile female patients of the reproductive age group seeking help in the reproductive unit of King Fahad Medical City, Riyadh. Data regarding age, duration of infertility, cause of infertility, body mass index (BMI), and their fertility outcomes were collected and evaluated using the Statistical Package for the Social Sciences version 20 (IBM Corp., NY). Results: In this study, primary and secondary infertilities were not statistically associated with female BMI, although maximum number of patients was reported in the overweight and obese classification. Out of 65 patients in the overweight group, 28 (43.1%) patients with primary infertility and 37 (56.9%) with secondary infertility had BMI between 25 and 29.9; similarly, in the obese group, out of 94 patients, 46 (48.9%) patients with primary infertility and 48 (51.1%) with secondary infertility had BMI between 25 and 29.9. There was overall, statistically significant difference (P = 0.029) between response to assisted reproductive technology and female BMI. Out of the 65 overweight patients, 28 (43.1%) of them and, out of 94 obese patients, 25 (26.6%) of them were pregnant by in vitro fertilization; 29.2% of the overweight and 20.2% of the obese women had successful pregnancy. Conclusion: The likelihood of successful pregnancy among obese women is less compared to normal weight women.

Investigation of the impact of antinuclear antibody on the outcome of in vitro fertilization/intracytoplasmic sperm injection treatment

ObjectiveThe aim of this study is to investigate the influence of antinuclear antibodies (ANAs) on the pregnancy and early miscarriage rates, thereby evaluating the outcome of in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) treatment. Materials and methodsA total of 517 infertile female patients undergoing IVF/ICSI treatment (experimental group) were chosen for this study, and 186 women with normal reproductive history (control group) were designated as the control. Serum ANAs from the participants were tested using indirect immunofluorescence assay, while antiextractable nuclear antigens were tested by immune blot assay. ResultsThe ANA expression in the infertile patients (39.45%) was higher than that in the control group (16.13%). A high ANA titer (≥1:320) was found only in infertile patients. ANA positivity significantly decreased the pregnancy rate and increased the early miscarriage rate after IVF/ICSI treatment. The rate of early miscarriage was higher in the high-ANA-titer individuals after IVF/ICSI treatment. Clinical pregnancy rate in anti-scl-70- and anti-PM-scl-positive individuals after IVF/ICSI treatment was lower than that in the ANA-negative individuals. Anti-Rib-p, anti-Jo-1, and anti-dsDNA were found to cause high risk of early miscarriage in pregnant women. ConclusionANA positivity may not only be the cause of bad outcome during IVF/ICSI treatment, but also pose as a risk factor for IVF/ICSI treatment.

Ultrasonography and Doppler Study to Predict Uterine Receptivity in Infertile Patients Undergoing Embryo Transfer

To detect whether ultrasonographic parameters and Doppler analysis of uterine blood flow can be of value in the prediction of endometrial receptivity in infertile female patients undergoing embryo transfer. In this study, a total of 200 women with primary infertility undergoing embryo transfer were analyzed. Transvaginal ultrasonography was done on the 10th day of the menstrual cycle. To assess the uterine receptivity, we analyzed all the ultrasonographic and Doppler parameters. The slightly modified version of Applebaum Uterine Scoring System was used. This uterine scoring system included all the following parameters: endometrial thickness, endometrial morphology, endometrial blood flow within zone 3, myometrial echogenecity, uterine artery pulsatility index (PI), end diastolic blood flow, and myometrial blood flow internal to the arcuate vessels seen on gray-scale examination. The pregnancy rates were higher in women with thick, distinct five-line endometrium and multifocal endometrial vascularity within zone 3. Absent endometrial flow, despite highest values for the other parameters, was associated with no conception. In our study, no pregnancy occurred with uterine PI values of more than 2.8. Absence or reversal of end diastolic blood flow was associated with no conception. A maximum score of 20 was associated with the pregnancy rate of 97.4%, whereas scores of 13 or less resulted in no pregnancies. Uterine scoring system will help to perform embryo transfers in only favorable uteri and postpone or cancel those cycles in which poor uterine score is demonstrated.

Adolescents conceived through donor insemination: an in-depth qualitative study of the experiences of contacting and meeting donor offspring

analyses were used to identify factors independently associated with increased impact. RESULTS: A total of 809 women met the inclusion criteria, of which 396 (49%) completed the questionnaire. Most participants (75.5%) reported having no prior children. The majority (58.8%) attributed infertility to only female factors, 30.4% to a combination of male and female factors, 7.3% to only male factor, and 3.5% reported that the etiology had not been determined. The actual cause of infertility from the medical records was statistically different from the perceived cause of infertility, p<0.01. In the multivariate analysis, women with female factor only infertility reported the highest level of sexual dysfunction (p<0.01) and personal distress (p¼0.01). Women <40 years old were at higher risk for sexual dysfunction, personal distress and social distress when compared to those older than 40 (p<0.01 for all). Respondents with prior biological children reported lower levels of social and personal distress but higher levels of marital distress (p<0.05). Relative to those with <6 months of infertility, respondents with 6-48 months of infertility reported lower rates of sexual dysfunction (p¼0.05) but higher rates of marital distress (p¼0.04). These results are similar to those previously published for male respondents from the same cohort (1). CONCLUSIONS: Women seeking care for infertility are at high risk of sexualdysfunction,andsocial,marital,andpersonaldistress.Thesedatasupport the practice of screening female infertility patients for psychosocial distress and offering appropriate treatment or referrals to help address these concerns. Providers should consider the roles that younger age and perceived causes of infertility play in a women’s overall wellbeing. Reference:

Subclinical hypothyroidism in the infertile female population: a guideline

There is controversy regarding whether to treat subtle abnormalities of thyroid dysfunction in the infertile female patient. This guideline document reviews the risks and benefits of treating subclinical hypothyroidism in female patients with a history of infertility and miscarriage, as well as obstetrical and neonatal outcomes in this population.

Hysterosalpingography versus hysterscopy in intrauterine pathology research of infertile patients

Background: The objective of the present paper is to confirm the validity and reliability of hysterosalpingography (HSG) in intrauterine pathology research of infertile female patients by comparing the hysteroscopy (HC) findings to a “gold standard’’ test. Aim: To analyze HSG and HC findings in infertility patients. Materials and Methods: The research was conducted as a prospective study at the Gynecological and Obstetrics Clinic “Narodni front’’ in Belgrade. Results: HSG indicated pathological findings in 72.5% of patients whereas HC revealed abnormalities of uterine cavity in 77.5%. In 12.5% of patients, HSG demonstrated a normal uterine cavity, and HC confirmed pathological findings, while in 7.5% of patients with filling defects and irregular shapes on HSG images, HC reported normal findings. In 22.5% of patients normal finding as well as endometrial polyps were reported; congenital malformations (anomalies)were found in 32.5%, submucosal myomas in 12.5% and Asherman’s syndrome in 10%. Conclusion: HC finding was crucial in final diagnosing.