Female Infertility Patients Research Articles

Current recommendations for vaccines for female infertility patients: a committee opinion

Encounters for infertility care are opportunities to assess and update immunization status. Women of reproductive age are often unaware of their need for immunization, their own immunization status, and the potentially serious consequences of preventable disease on pregnancy outcome. The purpose of this ASRM Practice Committee document is to summarize current recommendations regarding vaccinations for women of reproductive age. This document replaces the ASRM Practice Committee document titled, "Vaccination guidelines for female infertility patients," last published in 2013 (Fertil Steril 2013;99:337-9).

Basal Temperature, Cervical Mucous, and Both Combination as Diagnostic Tools to Detect Ovulation


 
 Objective: To make basal body temperature examination andcervical mucus as an alternative examination in detectingovulation, especially in health facilities that do not have ultrasound.
 
 Methods: This cross-sectional study was conducted at the outpatientclinic of RSUPN Dr. Cipto Mangunkusumo in the year2016-2017. A total of 49 infertile female patients who had normalmenstrual cycles were asked to participate and performedbasal body temperature measurements, cervical mucussampling and transvaginal ultrasound examination, the dataare subsequently grouped into 3 Days Estimated Ovulation(DEO); DEO-2 days, DEO and DEO+ 2 days. Diagnostic testswere performed and accurate comparison between basal bodytemperature, cervical mucus and a combination of both werelater assessed.
 
 Results: The best accuracy was found on cervical mucus andcombination of both with 65% in detecting ovulation, whilstthe lowest was basal body temperature (59%) with sensitivity46.7%, and specificity 78.9%. Cervical mucus in diagnosingovulation has a sensitivity of 70% and specificity 57.8%. Thecombination of temperature-cervical mucus in diagnosing ovulationhas sensitivity of 46.67% and specificity of 94.73%.
 
 Conclusion: Cervical mucus examination has better accuracy comparedwith basal body temperature examination in detecting ovulation.Further research for validating these diagnostic tools to thewider community and not only in patients with infertility is needed.
 
 Keywords: basal body temperature, cervical mucus, infertility, ovulationdetection, ultrasound

Evaluation of endoscopic procedures in terms of achieving pregnancy in female infertile patients: An experience at a single tertiary care center

ObjectivesTo evaluate the success rate of endoscopic procedures in terms of achieving pregnancy at an interval of three months for 12 months or till achievement of fetal cardiac activity whichever is earlier. MethodsWe prospectively evaluated 157 female patients (age range 19–35 years; mean age 27.75 years), who were diagnosed as infertile. During their diagnostic work, all underwent hysterolaparoscopy. The detected anatomical abnormalities on the hysterolaparoscopy were tackled at the same time during diagnostic work-up if possible. After hysterolaparoscopy, Patients were advised for regular sexual activity. The follow-up of all recruited patients was done at an interval of three months for 12 months or till achievement of fetal cardiac activity. ResultsOf the 157 infertile female patients, 93 (59.2%) were of primary infertility and remaining 64 (41.74%) were secondary infertility patients. Hysterolaparoscopy revealed abnormalities in 125/157 patients. The detected hysterolaparoscopic anatomical abnormalities were distributed in 77/93 (82.8%) primary and 48/64 (75%) secondary infertility patients. Of the 125 patients with abnormal hysterolaproscopic findings, 121 underwent active therapeutic interventions. All of the secondary infertility patients with hysterolaparoscopic abnormalities experienced active hysterolaparoscopic interventions. Of 77 patients with hysterolaparoscopic abnormality in primary infertility group, 73 patients experienced active intervention. Out of the 125 abnormal hysterolaparoscopic patients, 121 underwent active intervention and 43 patients conceived during next 12 months. Among 32 patients with normal hysterolaparoscopic findings, 7 conceived within 12 months. Significantly higher conception was observed in hysterolaparoscopic intervention patients as compared to normal hysterolaparoscopy patients (p∼0.001). Independently in primary infertility patients, the conception rate in the patient with hysterolaparoscopic intervention was significantly higher than nonintervention group (p<0.0001). Similarly, conception rate was significantly higher in secondary infertility patients (p∼0.004). ConclusionWe concluded that the conception rate was significantly high in infertility patients, who underwent hysterolaproscopic intervention. In short hysterolaparoscopy should be considered as a potential gold standard approach in the evaluation of female infertility.

An exploration on the influence of positive simple thyroid peroxidase antibody on female infertility.

The aim of the present study was to explore the influence of positive simple thyroid peroxidase antibody (TPO-Ab) on female infertility. Venous blood was collected on an empty stomach from infertile female patients (all of whom were in line with the World Health Organization's diagnostic criteria for infertility) receiving treatments at The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University from 2014 to 2017 to detect thyroid function and thyroid antibodies [thyroglobulin antibody (TG-Ab), TPO-Ab and thyroid microsome antibody (TM-Ab)]. A total of 529 patients with normal thyroid function, TG-Ab and TM-Ab were included in the present study; they were divided into the positive group (121 cases with positive TPO-Ab) and the negative group (408 cases with negative TPO-Ab). Comparisons of age, body mass index (BMI), basal hormone levels, irregular menstruation, tubal obstruction, premature ovarian failure (POF), endometriosis (EMT) and polycystic ovary syndrome (PCOS) between the two groups of patients were conducted in order to determine whether the differences were statistically significant. The incidence rate of EMT was 39.6% in the positive group and 17.1% in the negative group (P<0.05). The incidence rate of PCOS in the observation group was 43.9%, which was significantly higher than that of the control group (21.3%; P<0.01). The results revealed that the differences in age, BMI, basal hormone levels, irregular menstruation and POF between the two groups were not statistically significant (P>0.05). Finally, the factors that had statistical significance (EMT and PCOS) were stratified by different age groups to compare the incidence rate of positive results among the different age groups, thus concluding which age group was influenced to a greater extent by TPO-Ab. The results indicated that positive TPO-Ab may be associated with PCOS and EMT, though particularly with PCOS. Infertile PCOS patients aged 28–35 years old were influenced more by TPO-Ab than those in other age groups. Thus, it is recommended that thyroid autoantibodies are detected in infertile PCOS females aged 28–35 years old, and treatment should be administered as soon thereafter.

Can hysterolaparoscopic mediated chromopertubation obviate the need for hysterosalpingography for proximal tubal blockage?: An experience at a single tertiary care center

ObjectivesTo compare the diagnostic performance for tubal patency by chromopertubation and hysterosalpingography in the female infertile patients. MethodsWe prospectively evaluated 103 female patients (age range 19–35 years; mean age 27.60 years) diagnosed as infertile, underwent hysterosalpingography (HSG) for tubal patency and uterine pathology during initial diagnostic work-up. All the enlisted patients fulfilled the criteria of infertility and these also underwent hysterolaparoscopic chromopertubation (CPT). The results of HSG were compared with the reference standard using CPT. ResultsOut of 103 female infertile patients, 60 (58.2%) were of primary and rest of them 43 (41.8%) secondary infertile patients. HSG showed abnormalities in tubal patency in 69/103 (∼67%) patients. The detected abnormalities were distributed in 40/60 (66.6%) primary and 29/43 (67.4%) secondary infertile patients. On comparison to HSG with CPT (reference standard) for tubal blockage detection, it was found that HSG was true positive (TP) in 38 patients, true negative in 34 patients, false positive in 31 patients and FN in 0 patients. We found that for detection of tubal blockage, the sensitivity, specificity, PPV, NPV and accuracy of HSG was 100.00%, 52.31%, 36.89%, 57.07% and 67% respectively. Tubal occlusion detected on HSG and CPT showed a moderate agreement (weighted kappa – 0.447; 95% CI −0.312 to 0.583). In present study, no patient shows tubal blockage in CPT while HSG was normal. ConclusionWe concluded that hysterolaparoscopic mediated chromopertubation not only diagnostic but also therapeutic, so it can obviate the need of hysterosalpingography.

Influence Factors on Contrast Agent Venous Intravasation During Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography.

To explore the risk factors on contrast agent venous intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy). The TVS 4D-HyCoSy imaging data were collected from 276 female infertile patients. The correlation between endometrial thickness, days after menstruation, intrauterine intervention history, fallopian tubal patency degree, and contrast agent venous intravasation, respectively, was analyzed. In our study, the incidence of contrast agent venous intravasation was 13.04%. Endometrial thickness and days after menstruation were significantly associated with venous intravasation (P < .05). However, there was no significance for intrauterine intervention history and fallopian tube patency degree. Contrast agent intravasation during TVS 4D-HyCoSy is not infrequent. Performing TVS 4D-HyCoSy according to endometrial thickness and menstrual period could reduce intravasation incidence to some extent.

FSHB -211 G>T is a major genetic modulator of reproductive physiology and health in childbearing age women.

FSHB -211 G>T is a major genetic modulator of reproductive physiology and health in childbearing age women.

Embryonal mitochondrial DNA: relationship to embryo quality and transfer outcomes.

The aim was to study the association between embryonal mitochondrial DNA (mtDNA) content and embryo quality and implantation outcomes. A retrospective chart review was performed with data collected from a private IVF center database. The study population included female infertility patients with ages ranging from 31 to 38years old, and the main outcome measures were embryo quality and transfer outcomes. From a total of 1510 blastocyst biopsies, the majority of embryos consisted of grade 1 (High), followed by grade 2 (mid), and grade 3 (poor). Embryos with higher mtDNA content were found to be of poorer quality (grade 3) relative to grades 1 and 2 (P = 0.003). Using a logistic model, mtDNA best predicted lowest and highest grades, but not mid-grade embryos. There was no correlation between mtDNA content and the subjects' age (R2 = 0.0018). In an analysis of only euploid embryos (N = 717), there was no longer an association between mtDNA content and embryo quality (P = 0.834). There was no difference in mtDNA content between groups of embryos that did and did not implant (P = 0.53). There was also no association noted between mtDNA content and ongoing pregnancy. Compared to day 6, day 5 blastocysts contain significantly higher amounts of mtDNA (P = 0.0005), lower rates of aneuploidy (P < 0.001), and were more likely to be high-quality blastocysts (grade 1) (P < 0.001). Although the mtDNA content shows some association to the morphologic grade of an embryo, this association does not persist in an analysis of only euploid embryos. Mitochondrial DNA content also does not appear to be associated with implantation or ongoing pregnancy. Day 5 blastocysts have significantly higher mtDNA content compared to day 6 blastocysts.

Efficacy and safety of Ding-Kun-Dan for female infertility patients with predicted poor ovarian response undergoing in vitro fertilization/intracytoplasmic sperm injection: study protocol for a randomized controlled trial

BackgroundWomen undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) who have a predicted poor ovarian response (POR) present a challenge for reproductive medicine specialists. Traditional Chinese medicine (TCM) is commonly used in China for such patients, in the belief that it will improve the ovarian response and ultimately increase pregnancy rates. However, there is a lack of high-quality evidence about the effect of TCM on improving ovarian response in such patients. The purpose of this study is to evaluate ongoing viable pregnancy rate at 12 weeks’ gestation and related indicators of ovarian response in fertile women who have a predicted poor ovarian response having immediate versus delayed IVF/ICSI after 3 months of Ding-Kun-Dan (DKD) pre-treatment.Methods/designThis study is a multicenter, randomized controlled, parallel-group, phase III, superiority clinical trial. Two hundred and seventy-eight eligible female infertility patients with POR will be included in the study and randomly allocated into an immediate treatment group and a DKD group in a 1:1 ratio. Both groups will receive IVF or ICSI as a standard treatment while in the DKD group, a commercially available Chinese medicine, DKD, will be administrated for 3 months before the IVF/ICSI cycle starts.The primary outcome of the study is the ongoing pregnancy rate at 12 weeks’ gestation. The secondary outcomes include total gonadotropin dosage, duration of stimulation, estradiol (E2) and progesterone (P) levels on human chorionic gonadotropin (hCG) trigger day, cycle cancellation rate, number of oocytes retrieved, high-quality embryo rate, biochemical pregnancy rate, the change of serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and E2 levels and all side effects, safety outcomes, and any adverse events.The protocol was approved by the Ethics Committee of the First Teaching Hospital of Tianjin university of TCM (approval no. TYLL2017[K] 004).DiscussionIVF/ICSI is increasingly used to treat couples desiring a baby. Many of these women will have poor ovarian function. In China, DKD is commonly used for these patients prior to undergoing IVF/ICSI. There is no effective treatment for poor ovarian response in Western medicine currently. It is important, therefore, to undertake this randomized control trial to determine whether DKD is effective or not.Trial registrationChinese Clinical Trial Registry, ID: ChiCTR-IOR-17011697. Registered on 19 June 2017.

Comparison of Serum Progesterone levels and Incidence of Pregnancy with Urinary and Recombinant HCG in Women Undergoing ICSI

Objective: Luteinizing hormone (LH) surge is important in the final maturation of the oocyte and in oocyte retrieval. The structural similarity of human chorionic gonadotropin (HCG) and LH allow its binding to HCG/LH receptor. So, we aimed to compare the efficacy of urinary HCG (uHCG) and recombinant HCG (rHCG) for induction of oocyte maturation, triggering ovulation and incidence of pregnancy through assessing the serum levels of estrogen, progesterone, and βHCG in infertile women undergoing intracytoplasmic sperm injection (ICSI) cycles. Subjects and Methods: Eighty-one Egyptian females were recruited in this study including 71 infertile females undergoing ICSI and 10 apparently healthy females as a control group. The infertile female patients were classified based on the treatment used for triggering of mature follicles into 35 infertile females received 1000 IU uHCG and 36 infertile females received 500 µg rHCG. Serum levels of basal follicle stimulating hormone (FSH) and LH, estrogen (E2), progesterone (P) and βHCG were measured at different times of menstrual cycle by ELISA methods. Results: serum FSH and LH were similar in all the studied groups. Serum P level at day 5 embryo transfer and number of retrieved and mature oocytes were comparable in the rHCG and uHCG groups. While Serum P level at day oocyte pick up was significantly higher in rHCG group than in uHCG group. The successful pregnancy was higher in uHCG group than in rHCG group. Conclusion: the uHCG more effective biochemical pregnancy rate more than rHCG. However, rHCG showed equivalent efficacy to uHCG in terms of serum P level at day 5 embryo transfer, the number of retrieved oocytes and mature oocytes in female patients undergoing ICSI. While rHCG increases the serum P level at day oocyte pick up to abnormal high level which may reduce the incidence of pregnancy in females received rHCG.

Evaluation of thyroid function in infertile female patients in port harcourt, Nigeria

Context: An optimally functional reproductive system and fecundity is fundamental for the sustenance of life. Undiagnosed and untreated thyroid disease may cause infertility. Aim: To evaluate and compare thyroid function tests of infertile women with those of fertile women. Settings and Design: There were 216 infertile women and 200 fertile women in this study. Materials and Methods: Serum thyrotropin (TSH), free thyroxine (FT4), free triiodothyronine (FT3), antibodies to thyroid peroxidase (TPOAb), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, progesterone, and estrogen were analysed using ELISA techniques. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc. Chicago, Illinois, U.S.A.). Results: Overall prevalence of thyroid disorders in infertile women was 4.6%. They had higher prevalence of thyroid autoimmunity (TAI) (2.8%) compared to controls (1.0%). They also had overt hypothyroidism (0.9%) and overt hyperthyroidism (0.9%) whereas controls had only subclinical hypothyroidism (1.0%). Infertile patients had significantly higher FSH, LH, prolactin, and estrogen, but lower progesterone values than controls. There was no significant difference in the mean FT3, FT4, TSH, and TPOAb between patients and controls. However, after further stratification, women with TSH >2.5 mIU/L were observed to have higher mean TSH and prolactin, and lower FT4 and FT3 levels than women with TSH ≤2.5 mIU/L. Conclusions: Significant findings were observed only in infertile, and also fertile, women with TSH >2.5 mIU/L, who had lower levels of FT4 and FT3 and higher levels of TSH and prolactin compared to women with TSH ≤2.5 mIU/L, respectively.

Gender heterogeneity study on the depression of thyroid hormone and homocysteine levels in infertile patients

Objective To explore the gender heterogeneity of depression and thyroid hormone and homocysteine levels in infertile patients. Methods Totally 250 patients with infertility were selected in Tangshan Maternal and Child Health Care Hospital affiliated to North China University of Science and Technology from December 2015 to April 2017.The Self-Rating Depression Scale(SDS) was used to evaluated the patients’s depression.The patients with infertility and depression were divided into infertility and depression group, and the patients with infertility but without depression were infertile and non-depressed group, patients with infertility and depression were divided into male infertility and depression group and female infertility group with depression, and the levels of thyroid hormone and homocysteine were measured respectively. Results ①The thyroid stimulating hormone and homocysteine levels in infertility patients with depression were significantly higher than those without depression ((2.045±1.253)uIU/ml, (2.412±1.236)uIU/ml, t=-2.287, P=0.023; (15.411±9.143)mmol/L, (19.129±13.087)mmol/L, t=-2.467, P=0.014). ②There was no statistically significant difference in the degree of depression between male and female infertility patients(χ2=0.483, P=0.785). ③ The levels of triodothyronine, thyroxine and homocysteine in male infertility patients with depression were significantly higher than those in female patients((1.926±0.648)nmol/L, (1.712±0.416)nmol/L, t=2.457, P=0.015; (117.86±19.311)nmol/L, (110.185±18.999)nmol/L, t=2.434, P=0.016; (15.575±4.139)mmol/L, (12.277±3.921)mmol/L, t=4.982, P<0.01), and the TSH was lower than that in the female group((2.496±1.329)uIU/ml, (3.057±1.583)uIU/ml, t=-2.303, P=0.023). ④The TSH and Hcy levels of male and female infertility patients were significantly positively correlated with SDS indexes, and had a significant positive predictive power to SDS score. Conclusion The levels of thyroid hormone and homocysteine are different in gender in infertile patients with depression, and the thyroid hormone and homocysteine are related to the depression.so we should pay attention to the depression symptoms of infertility patients and the changes of their biological levels, especially the gender heterogeneity. Key words: Infertility; Depression; Thyroid hormones; Homocysteine; Gender

A qualitative research on sexual experience in infertile patients

Objective To explore the sex experience of infertile women and provide feasible basis for clinical nursing measures. Methods Thirteen subjects from April to October 2016 were recruited and investigated by a qualitative research design. The data were analyzed, sorted and induced the theme. Results There were 5 categories: normal sexual needs and sexual repression, sexual behavior changes and reduced satisfaction; inferiority, self blame and guilt; uncertainty in marital relationship; desire for information and emotional support. Conclusions Nurses should focus on female infertility patients attitude to sex, to strengthen health education, to develop personalized nursing intervention measures, corrective psychological deviation, promote the improvement of patients' spouses sexual health education knowledge, providing effective family, social, emotional support, to promote patients to improve the quality of life of both partners. Key words: Infertility; Sexuality; Qualitative research

Reaction of Sera from Infertile Female Patients with Fractionated Phylogenetically Conserved Ovarian Antigens Measured by Elisa: A Pilot Study

Summary The reaction of anti-sperm antibody-positive sera from infertile women with fractionated mouse ovarian antigens was measured by enzyme-linked immunosorbent assay (ELISA). Antigens were obtained by extraction for nuclear matrix and intermediate filaments (NM-IF) producing three protein fractions – soluble, cytoskeletal and NM-IF. The results showed that sera from some infertile patients, but not control sera, react with either the soluble fraction or the NM-IF fraction. The reaction with soluble proteins was most likely directed against surface antigens, possibly aggravating the fertility problems, while the anti-NM-IF antibodies could indicate release of insoluble intracellular components by tissue damage of unknown origin.

The clinical significance of reproductive hormones concentration in follicular maturation in patient with Luteal phase defect

Forty infertile female patients were involved in this study. Twenty infertile female were with luteal phase defect and the rest twenty female were with out luteal phase defect they represent control group .All patient were stimulated with clomiphene citrate (clomid) and human menopausal gonadotropin (Humegon). hormones in follicular fluid of mature, intermediet and immature oocytes. 2-To compare the in vitro fertilization rate of the three groups of the oocytes.&#x0D; The luteal phase is characterized by the production of progesterone from the corpus luteum with in the ovary .The corpus luteum is derived both from the granulosa cells that remain after ovulation, and from some of the theca cells which differentiate to become theca lute in cells. Progesterone produced by the corpus luteum is the dominant hormone of the luteal phase. Serum progesterone level less than 10 ng/ml in cycle day twenty-one indicate the presence of luteal phase defect. Follicular fluid sample following aspiration of oocytes were classified into three group (mature, intermediate and immature oocytes) depending on the morphological structure of the oocytes and the surrounding cells. The concentrations of follicular fluid hormones were measured by enzymes immuno assay method using the minividas. Patients with luteal phase defect have significant higher levels of follicle stimulating hormone, Luteinizing hormone and prolactine hormone than patients with out luteal phase defect (control group). The control group has significant higher level of progesterone and estrogen hormones than luteal phase defect patients. The luteal phase defect patients have the lowest maturation rate and the lowest fertilization rate than control groups. The mature oocytes gave significant higher concentration of progesterone and estrogen hormones than intermediate or immature oocytes with better in vitro fertilization rate and cleavage rate than the immature oocytes. The results of the present study indicate that increased levels of gonadotropin in patients suffering from luteal phase defect have a significant clinical importance in the maturation it could lead to inhiption of the growth of oocytes and result in decrement of the maturation rate and this support the threshold theory of gonadotropin. Those hormones could be considered as potential markers of human oocytes quality and in vitro fertilization.

Assessment of tubal fimbria patency by combination of transvaginal four-dimensional hysterosalpingo-contrast sonography with uterine tubal liquid poking

Objective To investigate the clinical value of combination of transvaginal four-dimensional hysterosalpingo-contrast sonography(TVS 4D-HyCoSy) with uterine tubal liquid poking in assessment tubal fimbria patency. Methods Sixty-two female infertile patients with obstruction at tubal fimbria, or partial obstruction with pelvic adhesion were included.All of them were underwent 4D-HyCoSy as well as uterine tubal liquid poking, and were followed with laparoscopic chromopertubation (LPC) using Methylene blue in three months. Results Comparing with laparoscopy, the total coincidence rate of 4D-HyCoSy to assess the tubal fimbria patency was 94.3%, with the sensitivity of 90.1% and specificity of 94.1%. Imaging results showed that the obstruction at tubal fimbria, uncircle-like wrapping contrast medium can be seen around ovary accounted for 80%. The patent fallopian tube fimbria, circle-like wrapping of contrast medium can be observed around ovary accounted for 85.5%. Conclusions The combination of TVS 4D-HyCoSy with uterine tubal liquid poking is highly in accordance with LPC by providing real-time dynamic visualization on overflowing of contrast medium from tubal fimbria, as well as the pelvic adhesion surrounding ovaries. The 4D-HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesion surrounding ovaries with its advantages of accuracy, non-invasion and a good safety profile. Key words: Ultrasonography, three-dimensional; Hysterosalpingography; Fallopian tubal patency tests

OPPORTUNISTIC INFECTIONS AND IMMUNE DEFICIENCY IN WOMEN WITH POOR IVF RESPONSE

The aim of the study is the improvement of the efficiency of IVF on the basis of the determination of immunological and infectious risk factors for miscarriage. The materials and methods. The object of research were 21 female infertility patients included in the program of ancillary reproductive technologies (ART) for the period of 2014-2016, who had in a history from one to four ineffective IVF response. The average age of studied women was 33.5±0.9 years, the number of years with infertility amounted to 7,3±1,0. In the preparation for IVF women received a complete course of general clinical examination to identify the causes of infertility. The study of the immune status was carried out with the use of one - and two-parameter phenotyping, the results included data obtained with the flow-through cytofluorometer BECKMAN COULTER EPICS XL-II (USA), treated according to standard protocols. The control group consisted of 30 fertile women. The results of the study. Infertility women planning IVF, were found to be characterized by presenting a combination of persistent opportunistic infections of herpes group: HSV and CMV. In the 90,5% of women there were identified various immunodeficiency states from both cellular and humoral immunity: the characteristic increase in the content of HLA-DR, a reduction in CD19+ cells. In primary infertility states changes in cellular immunity were more pronounced, additionally there was the decline in immunoregulatory index (IRI), the increase in the content of CD8+, CD25+, IgM. An imbalance of the immune system in women with persistence of several opportunistic infections was both more pronounced, than in cases with monoinfection and manifested by such abnormalities of cellular immunity as the gain in the content of CD8+, NK cells CD16+, CD56+, CD25+, a decline in IRI. The conclusion. In the course of the preparation for IVF in an examination mode of women with the primary infertility and the presence of markers of several opportunistic infections, it is advisable to include an evaluation of the immune status. The identification of secondary immune deficiency is an indication for inclusion of immunocorrective therapy in the comprehensive treatment.

Dosage effects of ZP2 and ZP3 heterozygous mutations cause human infertility.

The zona pellucida (ZP) is an extracellular matrix universally surrounding mammalian eggs, which is essential for oogenesis, fertilization, and pre-implantation embryo development. Here, we identified two novel heritable mutations of ZP2 and ZP3, both occurring in an infertile female patient with ZP-abnormal eggs. Mouse models with the same mutations were generated by CRISPR/Cas9 gene editing system, and oocytes obtained from female mice with either single heterozygous mutation showed approximately half of the normal ZP thickness compared to wild-type oocytes. Importantly, oocytes with both heterozygous mutations showed a much thinner or even missing ZP that could not avoid polyspermy fertilization, following the patient's pedigree. Further analysis confirmed that precursor proteins produced from either mutated ZP2 or ZP3 could not anchor to oocyte membranes. From these, we conclude that ZP mutations have dosage effects which can cause female infertility in humans. Finally, this patient was treated by intracytoplasmic sperm injection (ICSI) with an improved culture system and successfully delivered a healthy baby.

Assessment of Fallopian Tube Fimbria Patency With 4-Dimensional Hysterosalpingo-Contrast Sonography in Infertile Women.

The purpose of this study was to evaluate the performance of 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy) for assessing fallopian tube fimbria patency in infertile women. Seventy-seven infertile female patients with obstruction at the tubal fimbria or partial obstruction with pelvic adhesions were included. All of the patients underwent 4D HyCoSy enhanced by dynamic observation after a flush of normal saline and were followed with laparoscopic chromopertubation using methylene blue within 6 months. The overall accordance between 4D HyCoSy and laparoscopic chromopertubation was 92.9%. The sensitivity and specificity of 4D HyCoSy with laparoscopic chromopertubation as a reference standard were 93.8% and 92.2%, respectively. Four-dimensional HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesions surrounding the ovaries, with its advantages of accuracy, noninvasiveness, and a good safety profile.

Three-Dimensional HyCoSy With Perfluoropropane-Albumin Microspheres as Contrast Agents and Normal Saline Injections Into the Pelvic Cavity for Morphological Assessment of the Fallopian Tube in Infertile Women.

To apply the three-dimensional (3D) hysterosalpingo-contrast sonography (HyCoSy) with perfluoropropane-albumin microspheres as contrast agents and normal saline injections into the pelvic cavity for assessment of the tubal patency and adhesions of fimbrial parts. Fifty-five infertile female patients were recruited to undergo 3D HyCoSy with normal saline injected into the pelvic cavity, in which the tubal patency was observed by visualizing the spillage of contrast agents from the fimbriae, and the fimbrial adhesion was confirmed by the finger-like projections of the fimbriae and their floating and moving status. Of the 55 patients, bilateral tubal patency was observed in 44 (80.0%), unilateral tubal patency and the other partial occlusion in 7 (12.7%), unilateral partial occlusion and the other complete occlusion in 3 (5.4%), and bilateral complete occlusion in 1 (1.8%). The fimbrial parts were observed in 105 fallopian tubes, among which 101 were seen with the finger-like fimbriae floated and moved in the pelvic cavity, whereas 4 tubes were not because of adhesion to the pelvic cavity (n = 3) or the ovary and intestine (n = 1). More than three visible, quite long, and distributed evenly finger-like projections were present for the patent fimbrial parts; however, fewer, flat, and not evenly distributed finger-like projections were present for the adhesive tubes. No serious complications occurred during or after this procedure. Combination of 3D HyCoSy with normal saline injected into the pelvic cavity may be a feasible and safe procedure to assess tubal patency and adhesions of the fimbrial parts.