History Of Infertility Research Articles

“An incomplete Kartagener syndrome presenting with recurrent exacerbation of bronchiectasis: a case report”

Background: Kartagener syndrome (KS), a rare subgroup of Primary Ciliary Dyskinesia (PCD) with an autosomal recessive pattern of inheritance is characterised by the clinical findings affecting the ciliary movement. It typically presents with a triad of sinusitis, bronchiectasis, and situs inversus, while cases lacking situs inversus are termed as incomplete KS posing diagnostic challenges. Case Presentation: A 42-year-old; non-smoker, non-alcoholic Nepalese male with a history of recurrent cough, nasal discharge and infertility was diagnosed with incomplete KS. His clinical examination revealed coarse crackles bilaterally and rhonchi while spirometry showed mixed obstruction & restrictive patterns. His imaging findings clearly indicated infective bronchiectasis. Symptomatic management and multidisciplinary care were initiated for him. Discussion: This case reveals the complexity of diagnosing incomplete KS, a subgroup of PCD. The presence of post-infective bronchiectasis, recurrent sinusitis strongly supported the diagnosis. Successful medical intervention and ongoing multidisciplinary management are crucial for addressing the patient’s diverse clinical manifestations. Conclusion: This case highlights the importance of recognizing the varied presentations of KS and/or PCD and the need for a multidisciplinary approach to its management. Increased clinical awareness and timely diagnosis are essential for improving patient outcomes and effectively managing potential complications.

Testicular Germ Cell Tumors: A Review.

Testicular cancer is the most common solid malignancy among males aged 15 to 40 years in the US, with approximately 10 000 new cases diagnosed each year. Between 90% and 95% of testicular cancers are germ cell tumors (GCTs). The mean age at diagnosis for testicular cancer is 33 years. GCTs are categorized as seminomas and nonseminomatous GCTs (NSGCTs) based on their embryonic origins and path of differentiation. Risk factors include cryptorchidism, family history of testicular cancer, gonadal dysgenesis, infertility, cannabis use, and genetic conditions such as Klinefelter syndrome. The most common presenting symptom of testicular cancer is a painless testicular mass. History, physical examination, scrotal ultrasound, laboratory assessment of GCT-associated serum tumor markers (α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase), and prompt referral to a urologist are indicated when testicular cancer is suspected. Early diagnosis and treatment, starting with a radical inguinal orchiectomy, are important to optimize outcomes. At diagnosis, GCT is stage I (localized to the testicle) in 70% to 75% of patients, stage II (metastatic only to the retroperitoneal lymph nodes) in 20%, and stage III (widely metastatic) in 10%. Treatment of GCTs is guided by histology, clinical staging, and risk classification, with 5-year survival rates of 99%, 92%, and 85% for those diagnosed at stages I, II, and III, respectively. Optimal treatment often involves a multidisciplinary team at high-volume, experienced medical centers and may include surveillance (serum tumor markers [α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase] and imaging of the chest, abdomen, and pelvis), surgery (retroperitoneal lymph node dissection), chemotherapy, and/or radiation. Treatment decisions should consider long-term survivorship concerns, including body image, fertility, hypogonadism, mental health, financial cost, adherence to follow-up, and late adverse effects of therapy such as cardiovascular disease, secondary malignancies, and potential psychosocial effects such as anxiety, depression, and social isolation. Testicular cancer is the most common solid malignancy in young men in the US, and 90% to 95% are GCTs. Patients with testicular GCT have a 5-year survival rate of 99%, 92%, and 85% for stages I, II, and III, respectively. Prompt diagnosis and treatment are important to optimize outcomes, and treatment decisions should balance oncologic control with survivorship concerns to minimize long-term adverse effects of treatment.

A STUDY OF EFFICACY AND SAFETY OF DRUGS USED FOR INFERTILITY AT A TERTIARY CARE CENTER-A PROSPECTIVE OBSERVATIONAL STUDY

Objective: To assess the efficacy and safety of drugs used for infertility with respect to ovulation induction and conception. Methods: A prospective observational study was conducted in gynaecology Out Patient Department (OPD) of a tertiary care hospital from June 2019 to November 2019. 45 women who presented with history of infertility were included. Details of socio-demographic factors, treatment, investigations, efficacy and safety parameters were collected. Efficacy parameters considered were mature follicle ≥18 mm, endometrial thickness of ≥7 mm, occurrence of ovulation and pregnancy. Safety parameters included any adverse effects encountered during drug therapy. Results: Out of 45 patients, 24 were treated with Clomiphene citrate and 21 with Letrozole. The two groups had similar baseline characteristics. Mature follicular size was attained in 83.3% of Clomiphene citrate group and 61.9% of letrozole group. Mean endometrial thickness was 7.6 mm in Clomiphene citrate while 8.3 mm in letrozole group. Ovulation occurred in 45.8% of patients in Clomiphene citrate group and 47.6% of letrozole group. 41.7% of patients in Clomiphene citrate group and 28.6% of letrozole group conceived. However, there was no significant difference between the two groups in the above parameters. No serious adverse effects were observed. Conclusion: Both letrozole and clomiphene citrate were equally efficacious in ovulation induction and did not cause any serious adverse effects.

Being underweight or obese in adolescence may increase the risk of female infertility later in life: The Japan Nurses' Health Study.

Underweight or obesity is associated with infertility in women, but large cohort studies with a life course perspective are rare. We explored the association between body mass index (BMI) at age 18 and subsequent infertility among Japanese women. In total, 15,907 married women aged 30-44years who participated in a prospective cohort baseline survey during 2001-2007 were cross-sectionally analyzed. Those with a history of cancer, and those with a partner with infertility or missing data were excluded. All data were obtained from self-reported questionnaires. The main outcome measure was infertility, defined as a self-reported history of infertility for at least 2years. Age and cause of infertility were also recorded. Overall, 2825 participants (17.8%) reported being infertile. The proportions of women who were underweight (BMI <18.5kg/m2), overweight (BMI ≥25 and<30kg/m2), and obese (BMI≥30kg/m2) at age 18 were 12.8%, 4.5%, and 0.4%, respectively. Multiple logistic regression analysis revealed a 1.31-fold and a 1.82-fold increase in the rate of infertility in those women who were underweight or obese during adolescence, respectively, compared with those of normal weight. Further analysis by cause of infertility revealed no significant associations with overweight or obesity at age 18, but being underweight was positively associated with infertility of unknown cause. Being underweight or obese at adolescence is a potential risk factor for subsequent infertility among Japanese women. In particular, being underweight during adolescence may be a contributing factor to unexplained infertility later in life.

Infertility and Risk of Ovarian Cancer in the Women's Health Initiative.

There is a consistent relationship with greater ovulation frequency and increased risk of ovarian cancer. However, prior research on infertility, which may be associated with ovulation frequency through multiple mechanisms, and ovarian cancer has yielded conflicting results, possibly due to prior research conflating fertility treatment with infertility and restricting follow-up to premenopausal cases. Our objective was to determine the association between infertility and risk of postmenopausal ovarian cancer, overall and by histotype, in a population that had not received treatment with IVF. We utilized data from the Women's Health Initiative (n = 112,925 postmenopausal participants) with over 25years of follow-up. At baseline, participants were asked whether they had ever tried to become pregnant for more than one year without becoming pregnant and whether a reason was found. Cox proportional hazards models were used to calculate hazard ratios (HRs) of incident adjudicated ovarian cancer comparing participants with a history of infertility to fertile participants overall and by histotype. 17% of participants reported a history of infertility at baseline and 1,109 ovarian cancer cases were diagnosed during follow-up. No statistically significant association was observed between infertility and risk of any ovarian cancer (HR: 1.09, 95% CI 0.92-1.29), but those reporting infertility had a 90% higher risk of endometrioid and clear cell ovarian cancers (HR: 1.90 95% CI 1.09-3.34) compared to fertile participants. The reported reason(s) for infertility had no discernable impact on these associations. Infertility may be associated with clear cell and endometrioid ovarian cancer but not other ovarian tumor histotypes.

Factors influencing endometrial receptivity in women with recurrent implantation failure

BackgroundEmbryo implantation involves two key elements: a good quality embryo and receptive endometrium. Endometrial receptivity abnormalities are known as one of the possible causes of recurrent implantation failure (RIF), especially when the embryo is euploid. This study was aimed to evaluate the impact of age and other clinical factors on endometrial receptivity in women with RIF.Methods68 women with RIF (defined as at least three unsuccessful transfers of good quality embryo of at least 1BB category of blastocysts) and 49 controls (women undergoing IVF treatment because of idiopathic infertility or male factor) were included to the study. After preparation of the endometrium by the hormone replacement therapy endometrial biopsies were taken from each patient and sequenced with beREADY test TAC targeting 67 biomarker genes for endometrial receptivity. Depending on the test result patients were classified into one of four different groups: pre-receptive (n = 16), early-receptive (n = 54), receptive (n = 44) and late-receptive (n = 3).ResultsIn women with RIF pre-receptive endometrium has been detected substantially more often than in controls − 13 (19,1%) vs. 3 (6,1%) patients (p = 0,043). Early-receptive endometrium was diagnosed in the majority of patients with idiopathic infertility − 12 (66.7%) vs. 6 (33.3%) women (p = 0.042) and with polycystic ovary syndrome (PCOS) − 12 (70,6%) vs. 3 (17.7%) women (p = 0,0447). We found significant association between abnormal endometrial receptivity and patient’s age and duration of infertility. Young women were diagnosed significantly more often as normal or late-receptive, whereas older women with longer history of infertility as early-receptive and pre-receptive.ConclusionsIn patients with RIF in comparison to other women undergoing IVF procedures, patient’s age and infertility duration are the most important factors related to endometrial receptivity abnormalities, indicating that older women with a longer history of infertility may benefit the most from endometrial receptivity testing.Trial registrationNot applicable.

Serum ferritin levels in women with polycystic ovary syndrome.

To study ferritin levels, and potential factors influencing them, in women with polycystic ovary syndrome (PCOS) and investigate potential associations between ferritin levels and other parameters in these women. Longitudinal general population-based cohort study, including data from both questionnaires and clinical measurements. The study was conducted with data from the participants of the Women's Health Study, including a total of 1,918 Finnish women aged approximately 35 years. Polycystic ovary syndrome was defined according to the Rotterdam criteria by the presence of at least 2 of the following findings: oligomenorrhea/amenorrhea, hyperandrogenism (clinical or biochemical), and polycystic ovarian morphology. Serum ferritin levels and other parameters were determined from the cohort data, and the associations between ferritin levels and other investigated parameters were investigated with linear regression models. Women with PCOS had significantly higher median ferritin levels than those without PCOS (51.43 μg/L vs. 44.85 μg/L). Low ferritin levels were less common among women with PCOS who had oligomenorrhea or amenorrhea compared with those among women who did not (1.5% vs. 11.8%). The median ferritin levels were also found to be lower in hyperandrogenic women with PCOS than in those with normoandrogenemia (49.96 μg/L vs. 73.50 μg/L). Women with PCOS had higher fasting insulin levels than those without PCOS (8.85 mU/L vs. 7.60 mU/L), and a positive association between fasting insulin and ferritin levels was found in the whole population (effect size, 0.0619; 95% confidence interval, 0.005-0.119). Finally, associations between ferritin levels and history of infertility were investigated in both the total population and women with PCOS; however, no significant associations were found. Our results suggest that women with PCOS have higher ferritin levels than those without PCOS and that both the decreased blood loss from irregular menstruation and increased androgen levels can influence ferritin levels in women with PCOS. A metabolic connection was also found because the serum insulin levels were associated positively with the serum ferritin levels in the total population, whereas the history of infertility did not seem to be associated with the serum ferritin levels in any of the study groups.

Infertility and risk of ovarian cancer: A systematic review and meta analysis

ABSTRACT Post-modernization has increased infertility globally. Infertility can cause ovarian, breast, and endometrial cancers. Recent studies have shown that a substantial proportion of couples undergoing infertility treatment develop cancer. However, existing studies yielded inconsistent results. Therefore, we conducted a meta-analysis to determine whether infertility increases the risk of ovarian cancer. Our systematic review and meta-analysis intended to identify the association between ovarian cancer and infertility based on the existing research. In accordance with PRISMA guidelines, this review contains studies on infertility and ovarian cancer as an outcome measure among ovarian cancer groups and those not having cancer. Two authors independently retrieved the articles through electronic databases such as PubMed and Scopus. This review includes 25 studies published worldwide between 2001 and 2022. This systematic review has been registered with the International Prospective Registry of Systematic Reviews (PROSPERO) (CRD CRD42021288860). The systematic review included 25 articles, while the meta-analysis included four. In total, data from 84,49,557 participants in 25 studies were extracted (21 cohort studies and 4 case-control studies). The global prevalence of ovarian cancer among women with a history of infertility was 0.5%. The calculated OR of developing ovarian cancer as a result of infertility was 1.35 (95% CI: 0.92–1.97). The pooled odds ratio of developing ovarian cancer as a result of infertility drug use was 0.93 (95% CI: 0.94–2.46). Pooled effect was shown to be stable and reliable by cumulative meta-analysis. The current meta-analysis showed that women who used infertility drugs had a higher risk of developing OC than those having a history of infertility.

Ultrasound-guided hysteroscopic uterine evacuation in cases of missed abortion.

To describe the hysteroscopic, ultrasound-guided removal of missed abortion products of conception, emphasizing identification and resection of the different layers, visualization of the embryo and yolk sac, and maternal contamination-free direct sampling of the embryo and trophoblast. Illustration of a step-by-step innovative ultrasound-guided surgical technique for uterine evacuation during optically directed embryo and trophoblast biopsy. Private university-affiliated infertility center. Women with missed abortion, with or without a history of infertility or recurrent pregnancy loss. The 7 patients included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, and scientific literature websites. Missed abortion was diagnosed by transvaginal ultrasound confirming loss of fetal heartbeat. After informed consent, the patient was brought to the operating room. Under deep sedation, a 5-mm hysteroscope was inserted transcervically, and the uterine cavity was distended with normal saline (80-100 mm Hg). The implantation site was identified by direct visualization and transabdominal ultrasound. The gestational sac was opened with hysteroscopic scissors, and the extracoelomic cavity was entered. The yolk sac and embryo were visualized and evaluated. Embryo and chorionic villi sampling were performed with hysteroscopic forceps. After removal of the embryo, resection of the gestational sac was accomplished with hysteroscopic forceps and scissors. Step-by-step educational video. Optically identified embryonic and trophoblastic tissue and the corresponding cytogenetic result were obtained in all cases, without maternal cell contamination. There were no intraoperative complications. Patients' follow-up revealed no cases of retained products of conception or intrauterine adhesions. All patients who attempted pregnancy were successful, without complications. Ultrasound-guided hysteroscopic removal of a missed abortion is noninvasive and potentially safer than conventional surgical techniques. It allows comparison of trophoblastic vs. embryo biopsy and resolution of, for example, mosaicism in placental pole preimplantation embryo biopsies. A potential disadvantage is the relative complexity of the procedure compared with routine dilation and curettage (1-5).

Investigating predictive factors in treatment response with metformin in patients with gestational diabetes mellitus: a cross-sectional analytical-descriptive study.

As the utilization of metformin for gestational diabetes mellitus (GDM) treatment continues to rise, a substantial segment of these patients will ultimately necessitate insulin during their therapeutic journey. Hence, assessing patients' clinical and laboratory attributes becomes invaluable in determining their likelihood of responding favorably to metformin medication. This discernment aids in selecting an optimal management approach, wherein the patients most likely to benefit significantly from metformin are identified, while alternative therapies like insulin are considered for individuals with a lower probability of treatment response. This was a cross-sectional analytical-descriptive study of individuals with GDM. Initially, the subject's laboratory results and demographic information were submitted. Following that, metformin was administered to all subjects along with counseling on maintaining a healthy diet and lifestyle. Following a 4-week interval, the patients were reassessed and divided into two groups based on their response to metformin medication and then analyzed. 807 people participated in this study, of which 329 people (40.8%) responded to treatment and the failure rate of metformin treatment was 59.2%. This research revealed that the predictive factors of response to metformin medication were, respectively, the amount of 1-hour oral glucose tolerance test (OGTT) (OR = 62.66), 2-hour postprandial plasma glucose (OR = 54.04), 2-hour OGTT (OR = 17.37), followed by the history of abortion (OR = 14.88), the number of pregnancies (gravida 3 and more) (OR = 5.06) and history of infertility (OR = 2.6). The current study's findings indicated that to enhance GDM care, metformin prescriptions should be prescribed to patients depending on their clinical characteristics and laboratory results.

The Role of GnRH Agonist Therapy and Hysterosalpingography (HSG) in Diagnosing and Treating Tubal Factor Infertility

ABSTRACT The paper describes the treatment of a 27-year-old woman with a history of infertility, heavy menstrual periods, and severe endometriosis with bilateral hydrosalpinx. The patient received hormonal treatment with triptorelin acetate, a GnRH agonist, to treat her endometriosis and regulate her menstruation. Hysterosalpingography confirmed the presence of bilateral hydrosalpinx, thus suggesting IVF as the most suitable method to conceive. The patient went through a long protocol using GnRH agonist and 14 oocytes were retrieved from her with 10 being fertilized. To avoid ovarian hyperstimulation syndrome (OHSS), all the embryos were frozen and thawed after six months of hormone replacement therapy for the preparation of the endometrium, and a single blastocyst was transferred. The patient conceived, and a subsequent β-hCG level of 256 mIU/mL proved good pregnancy status 14 days after the embryo transfer. This case demonstrates how a personalized and holistic treatment approach to the management of infertility, especially in patients with such conditions as endometriosis and hydrosalpinx, can be very fruitful.

Inflammation and Ovarian Function in Reproductive-Aged Women.

Inflammation is a marker of immune activation. Inflammation may have an effect on both ovarian function and luteal function, both essential to pregnancy. High inflammation may also signal dysregulated processes within the ovary, which could be in part measured through Anti-Müllerian hormone, follicle-stimulating hormone, and inhibin B levels. To determine the relationship between inflammation, measured by C-reactive protein, and three biomarkers of ovarian function during the early follicular phase: Anti-Müllerian hormone, follicle-stimulating hormone, and inhibin B. Secondary cross-sectional analysis of data and serum obtained in Time to Conceive, a prospective cohort study sample of 843 women attempting pregnancy in central North Carolina from 2008 to 2016. Participants were aged 30 and 44 years, had no history of infertility, endometriosis, or polycystic ovarian syndrome, and were not currently breastfeeding. Serum samples were obtained on days 2, 3, or 4 of the menstrual cycle. C-reactive protein (natural-log transformed), Anti-Müllerian hormone (natural-log transformed), follicle-stimulating hormone (natural-log transformed), and inhibin B (untransformed) were measured in serum. Diminished ovarian reserve was examined dichotomously and defined as an Anti-Müllerian hormone level below 0.7 ng/mL. The analysis included 703 participants with C-reactive protein measured. In an adjusted linear regression model, a 20% increase in C-reactive protein was associated with a 0.57 pg/mL decrease in inhibin B (95% CI: -0.84 to -0.29 pg/mL) and a 0.535% decrease in follicle-stimulating hormone (95% CI: -1.01 to -0.06). Although there was not a significant relationship between Anti-Müllerian hormone and C-reactive protein, a 20% increase in C-reactive protein was associated with a 0.87% increase in Anti-Müllerian hormone (95% CI: -0.27 to 2.01). C-reactive protein was not associated with the odds of diminished ovarian reserve in an adjusted logistic regression model (OR: 0.97, 95% CI: 0.77-1.20). Inflammation, as measured by C-reactive protein, is associated with early follicular phase follicle-stimulating hormone and inhibin B, although this is not true of AMH. Inflammation may exert an effect on ovarian function.

Impact of caesarean scar defects on the success of assisted human reproduction: the NICHE-ART prospective French cohort study protocol

BackgroundThe global increase in caesarean sections (CS), currently at 21.1% of all deliveries, has led to a rise in uterine scar defects, or ‘niches’, at the hysterotomy site. These niches,...

Tips and Tricks for Robotic Management of Diffuse Adenomyosis

To demonstrate a step-by-step approach in two cases of diffuse adenomyosis using different surgical techniques depending on the disease's extent. The video also highlights surgical tips to minimize blood loss and maximize the excision of the adenomyotic disease. Description of technique and narrated surgical video footage. An endometriosis and adenomyosis referral center. The patients included in this video gave consent for the publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites. A 38-year-old nulligravid patient with a history of chronic pelvic pain, dysmenorrhea, and infertility for 2 years had previously undergone two unsuccessful invitro fertilization (IVF) cycles. During her first IVF cycle, five embryos were produced; one embryo was transferred, and the remaining embryos were frozen. In the second attempt, one frozen embryo was transferred after endometrial preparation as per protocol. However, both cycles were unsuccessful, resulting in implantation failure. Preoperative magnetic resonance imaging revealed diffuse adenomyosis in the posterior wall of the uterus, measuring 8.7 × 6.0 cm, with a thickened junctional zone (>12 mm). A 36-year-old G2P1 patient with a history of cesarean section and secondary infertility had two IVF cycles: the first resulted in early pregnancy loss at 6 weeks, and in the second cycle, she was premedicated with gonadotropin-releasing hormone for 3 months; however, it was unsuccessful. Preoperative magnetic resonance imaging identified diffuse adenomyosis involving both the anterior and posterior uterine walls, with a thickened junctional zone (>12 mm). In the first case, a classic excisional technique was performed to remove the adenomyosis from the posterior uterine wall. In the second case, a double flap approach was used to excise adenomyosis from both the anterior and posterior uterine walls. Intracavitary diluted indocyanine green dye was used to maximize the precise excision of adenomyosis tissue while maintaining an adequate myometrial residual around the cavity. Robotic-assisted excision of adenomyosis tissue while sparing adequate myometrium and reconstructing uterine walls. Both procedures were completed without complications, and patients were discharged on the same day of surgery. Patients were seen at 6 weeks for postoperative follow-up with no complaints. The plan is to obtain imaging before resuming IVF treatment. Patients were advised to wait 6 months after surgery before attempting conception to allow for recovery. Uterus-sparing surgical techniques for diffuse adenomyosis are advisable in selected cases where medical management and/or repeated IVF cycles fail. Preoperative imaging is crucial for precisely mapping the disease and applying the appropriate surgical technique. Different techniques have been proposed using an open or a minimally invasive approach. The use of a robotic platform, in conjunction with indocyanine green dye, can facilitate these surgical techniques and potentially improve outcomes.

Successful Live Birth Outcome in A Patient with Empty Follicle Syndrome: A Case Report and Literature Review.

Here, we report on a rare case of a successful live birth in a patient with empty follicle syndrome. A 35-year-old woman with ovulatory disorder and a 4-year history of primary infertility conducted in vitro fertilization-embryo transfer (IVF-ET) treatment in our hospital. The patient experienced six controlled ovarian stimulation cycles. In the first two cycles, despite adequate ovarian response, normal development of multiple follicles, and normal serum estradiol (E2) levels, no oocytes were retrieved from these mature follicles during the aspiration procedure. The patient was diagnosed with "empty follicle syndrome". Whole exome sequencing (WES) identified a missense mutation in the luteinizing hormone/chorionic gonadotropin receptor (LHCGR). In subsequent cycles, we try to increase the trigger dosage, combine gonadotropin-releasing hormone agonists (GnRH agonist) with human chorionic gonadotropin (HCG) for a dual trigger, supplement with luteinizing hormone (LH)-like active substances during the stimulation process, and extend the time between triggering and oocyte retrieval. In the end, successful oocyte retrieval and pregnancy were achieved.

An observational study of diagnostic hysterolaparoscopy for evaluation of infertility at a tertiary care hospital

Infertility is an illness recognised by the World Health Organisation (WHO) that refers to the inability to achieve a clinical pregnancy after engaging in regular, unprotected sexual intercourse for a period of 12 months or more. The incidence of primary infertility in India ranges from 3.9% to 16.8%. Hysteroscopy has emerged as a crucial technique for diagnosing infertility, providing a direct view of the uterine chamber to detect any possible abnormalities. The objective of this research is to analyse the use of diagnostic hysterolaparoscopy (DHL) in the evaluation of infertility. This research was a retrospective observational study that included 150 female patients who had a previous history of infertility. The study was done from May 2022 to September 2023. Information on the social and demographic characteristics of individuals and their medical history pertaining to infertility were collected by conducting interviews using a pre-tested, semi-structured questionnaire. Every participant took Dual-Hemisphere Language testing, and the gathered data were organised in Microsoft Excel. The significance threshold was established at 5% with a significance level of α = 0.05.: Out of the 150 patients that received DHL, 89 (59.33%) had primary infertility, whereas 61 (40.67%) had secondary infertility. Laparoscopy detected abnormalities in 35 (39.3%) of the individuals with primary infertility and 26 (42.6%) of the cases with secondary infertility. Abnormalities identified during hysteroscopy were 12 (13.4%) of the individuals with primary infertility and in 6 (9.83%) of the cases with secondary infertility. The prevalent abnormalities detected during hysteroscopy were uterine synechiae, fibroids, and uterine septa. The incidence of tubal obstructions was higher in the primary infertility group compared to the secondary infertility group.Diagnostic hysterolaparoscopy (DHL) is a very useful method for assessing infertility, namely in identifying adnexal adhesions, endometriosis, and uterine septa. In addition, DHL has the ability to detect several structural abnormalities in the uterus, fallopian tubes, and pelvis, which may assist in formulating suitable treatment strategies. So, both diagnostic and therapeutic intervention can be done at same sitting.

Successful pregnancy after preimplantation genetic testing for structural rearrangements in a couple with complex chromosome rearrangement and recurrent in vitro fertilization failures: a case report

To present a case of a couple with 20 years of infertility and 10 recurrent invitro fertilization (IVF) failures, identifying a paternal complex chromosome rearrangement using high-resolution karyotype together with preimplantation genetic testing for structural rearrangements (PGT-SR) and utilizing IVF-intracytoplasmic sperm injection to achieve a successful pregnancy. Case report. Al Ain Fertility Center, Abu Dhabi, United Arab Emirates. A 40-year-old male patient and a 37-year-old female patient with a history of infertility and recurrent IVF failures. Invitro fertilization-intracytoplasmic sperm injection with high-resolution karyotype and PGT-SR. Identification of chromosomal abnormalities, successful embryo development, pregnancy outcome, and newborn karyotyping. Karyotyping revealed a paternal complex chromosome rearrangement, t(3;4;12) (q21;q33;q21), and a chromosomal polymorphism in the female (1qh+). Invitro fertilization-intracytoplasmic sperm injection with PGT-SR produced one euploid/balanced female embryo from 20 embryos across 8 cycles. The patient conceived after hormone replacement therapy and frozen embryo transfer, resulting in an uneventful, full-term pregnancy and delivery of a healthy baby via C-section. Newborn karyotyping was normal (46,XX). High-resolution karyotype and PGT-SR should be offered to patients undergoing IVF, especially those with severe male factors, recurrent IVF failures, implantation failures, or recurrent pregnancy losses, to enhance the chances of a successful pregnancy.

Expression of mRNA-TLR-5 Gene in Patients with Endometriosis using Real-time PCR in Tehran, Iran.

Endometriosis is one of the common diseases of women, especially in reproductive age, and it is one of the most important causes of infertility in women. The aim of this study was to investigate the level of mRNA-TLR-5 expression in women with endometriosis. The present study was performed in Nikan Hospital, Tehran, Iran, in 2021. The samples of endometrial mucosa for the eutopic group and an ovarian endometriotic cyst for the ectopic group were obtained from the patients who underwent laparoscopic surgery at the Fetal Infertility Center and were diagnosed with endometriosis. Normal endometrial samples were also obtained from patients who had no history of infertility and underwent laparoscopic TL surgery for reasons other than endometriosis such as ovarian cysts (control group). After RNA extraction and cDNA synthesis, TLR-5 gene expression was evaluated by the Real-Time PCR method. Based on the results of the comparison of TLR-5 gene expression in all three ectopic, eutopic endometrium, and control groups by Real-Time PCR, it was found that the TLR-5 gene expression is significantly higher in ectopic samples than in the other two groups, but there is a significant difference between two utopic and control groups. The increase in TLR-5 expression in the ectopic group can probably be a reason for reducing the apoptosis of cells entered into the peritoneal cavity and creating an environment for the survival and proliferation of these cells.

Chronic endometritis and infertility. Clinical and morphological aspects

Target. Optimize the diagnosis of chronic endometritis. To evaluate the influence of various factors on the formation of chronic endometritis in patients with infertility, to study the effectiveness of office hysteroscopy and endometrial biopsy in its diagnosis.Materials and methods of research. A retrospective analysis of the medical histories of patients with chronic endometrioma and a history of infertility was conducted for the period from 2020 to 2022 at the Stavropol Regional Clinical Multidisciplinary Center in Stavropol.Results. Hysteroscopy with endometrial scratching, as well as routine endometrial curettage, were among the leading risk factors for the development of chronic endometritis. More gentle office hysteroscopy with endometrial biopsy showed high sensitivity but average specificity in the diagnosis of chronic endometritis.

LITHOPEDION: A CASE REPORT

This article presents a case of lithopedion, a rare condition characterized by the calcification of a deceased fetus within the mothers abdomen. The objective is to highlight the clinical features, diagnostic challenges, and management strategies associated with this phenomenon. We describe the case of a 34-year-old patient, gravida 2 para 1 (G2P1), in whom lithopedion was incidentally discovered during a cesarean section.A lithopedion, also known as a stone baby, refers to the calcification of a fetus following intra-abdominal fetal demise. This occurs when the non-viable fetus is encased in a calcified shell, a process termed fetal mummification. It is an exceptionally rare outcome of a failed intrauterine or ectopic pregnancy [1].Our case is unusual, as the lithopedion was discovered incidentally during a cesarean section in a woman with a history of infertility. The newborn presented in a breech position, likely due to the reduced intrauterine space caused by an adnexal mass.