Infertile Couples Research Articles

Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple.

CapsuleThis expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems.BackgroundInfertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply.ObjectiveThe aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems.MethodsProminent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called “InfertilItaly group”, used available evidence to develop this expert position.OutcomesStarting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures.ConclusionsThis expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.

Differences of Indirect MAR Test in the Unexplained Infertile and Fertile Couples

Infertility is the inability of a partner to get pregnant after regular sexual intercourse without contraception for 12 months. Based on the cause, male infertility is caused by genetic, hormonal, infectious, sexual, and unexplained infertility. However, many infertile couples are classified into unexplained infertility without an antisperm antibody (ASA) immunological examination. This study aimed to prove that couples classified as unexplained infertility can be caused by ASA wives. This was an observational study with a cross sectional study design. The sample consisted of 2 groups, in which the first group consisted of 36 fertile couples and the second group consisted of 35 unexplained infertility couples. All samples were carried out indirect MAR test to obtain the ASA value of the wife. If the wife's ASA value was >40%, the ASA results were positive. Conversely, if the ASA value was <40%, the ASA results were negative. From these 2 groups, there was a statistically significant difference (p<0.0001) that the wife's ASA value in the unexplained infertility group was significantly higher than that in the fertile group. This study concluded that the positive ASA results from the indirect MAR test were significantly found in the unexplained infertility sample.

One4Two®: An Integrated Molecular Approach to Optimize Infertile Couples' Journey.

The current diagnostic path of infertile couples is long lasting and often ineffective. Genetic tests, in particular, appear as a limiting step due to their jeopardized use on one side, and to the limited number of genes evaluated on the other. In this context, the development and diffusion, also in routine diagnostic settings, of next generation sequencing (NGS)-based methods for the analyses of several genes in multiple subjects at a time is improving the diagnostic sensitivity of molecular analyses. Thus, we developed One4Two®, a custom NGS panel to optimize the diagnostic journey of infertile couples. The panel validation was carried out in three steps analyzing a total of 83 subjects. Interestingly, all the previously identified variants were confirmed, assessing the analytic sensitivity of the method. Moreover, additional pathogenic variants have been identified underlying the diagnostic efficacy of the proposed method. One4Two® allows the simultaneous analysis of infertility-related genes, disease-genes of common inherited diseases, and of polymorphisms related to therapy outcome. Thus, One4Two® is able to improve the diagnostic journey of infertile couples by simplifying the whole process not only for patients, but also for laboratories and reproduction specialists moving toward an even more personalized medicine.

Marital Duration, and Fertility-Related Stress as Predictors of Quality of life: Gender Differences among Primary Infertile Couples.

Context:Infertility is a global public health issue, and the current data suggest that the problem is growing. Various infertility-related issues are responsible for poorer mental health and well-being in couples with primary infertility.Aim:The present study aimed to understand the gender differences of psychological factors related to infertility in couples with primary infertility. Furthermore, an attempt was also made to understand gender-specific associations that could interact with the fertility-related quality of life (FertiQoL).Settings and Design:This cross-sectional hospital-based study included 100 married couples with the diagnosis of primary infertility, irrespective of the cause of infertility. The study was conducted at Infertility centers in the Eastern region of India.Subject and Methods:One hundred men and women (n = 100 couples) with the diagnosis of primary infertility were recruited in the study. The fertility problem inventory and FertiQoL were used to measure the couples fertility-related stress and FertiQoL, respectively.Statistical Analysis Used:Descriptive statistics, independent t-statistics, Pearson correlation, linear regression, and mediation analysis were conducted.Results:A significantly higher social and sexual concern of infertility and “need for parenthood” were found in women. Men had a significantly better quality of life compared to women. Significant negative predictors of quality of life were noted for both men and women separately. Fertility stress was a significant mediating factor between marital duration and global FertiQoL in men. However, women showed a direct negative association between marital duration and FertiQoL.Conclusions:The study provides important insights into the couple's experiences with various infertility problems that may potentially be addressed during psychotherapy or during infertility counseling.

Re-examining the Role of Coping Strategies in the Associations Between Infertility-Related Stress Dimensions and State-Anxiety: Implications for Clinical Interventions With Infertile Couples

Research has shown a direct relationship between infertility-related stress and anxiety in infertile patients. The present study goes into this relationship in depth, testing the moderating role of coping strategies (Seeking Social Support, Avoidant, Positive Attitude, Problem-Solving, Turning to Religion) in the associations between specific infertility-related stress dimensions (Social Concern, Need for Parenthood, Rejection of Childfree Lifestyle, Couple’s Relationship Concern) and State-Anxiety among male and female partners of infertile couples. Gender differences were also explored. Both members of 254 infertile couples completed a questionnaire consisting of Socio-demographics, Fertility Problem Inventory–Short Form (FPI-SF), Coping Orientation to Problem Experienced–New Italian Version (COPE-NIV), and State-Trait Anxiety Inventory-Y (STAI-Y). The results revealed that Social Concern and Couple’s Relationship Concern, in both partners, and Need for Parenthood, in female partners, had positive correlations with State-Anxiety. Seeking Social Support and Avoidant coping were related to increasing levels of State-Anxiety in both partners, whereas Positive Attitude coping strategies were related to lower levels of State-Anxiety in female partners. Problem-Solving and Avoidant coping played moderating roles between specific infertility-related stress dimensions and State-Anxiety in unexpected directions. Problem-Solving exacerbated the negative effects of Social Concern, whereas Avoidant coping buffered the negative effects of several infertility-related stress dimensions in both partners. Interventions to improve stress management and psychological health in infertile couples should consider that the adequacy of coping strategies is inherently situation specific. It therefore follows that patient-centered clinical interventions should consider the potential inadequacy of promoting Problem-Solving strategies, and that even Avoidance can be an efficient strategy for dealing with specific infertility-related stress dimensions.

Effect of Educational Program about Life style behaviors for infertile Couples at infertility outpatient clinic in women’s health Hospitals.

In recent times, the modifiable lifestyle factors have been shown to affect the chance of conception in both infertile and general population. There is strong evidence that weight, smoking, alcohol consumption, caffeine intake, nutritional habits, physical activity, Stress, exposure to animals, pollution and Recreational drugs had an adverse impact on reproductive health. Aim: assess the perception of infertile couples regarding the effect of lifestyle factors on fertility; compare the lifestyle factors between fertile and infertile couples. Methods: A descriptive cross-sectional design was used to conduct this study. It was conducted at infertility outpatient clinic women’s health Hospitals, Assiut University, Egypt. Sample: included 117 infertile couples. Structured interview questionnaire was used and included two parts: Socio-demographic data and questions to assess perception of infertile couples regarding lifestyle. Simple Lifestyle Indicator Questionnaire. Results: A highly statistically difference was found between infertile husbands and wives regarding perceived the smoking habits. No significant difference was found among infertile couples regarding drinking alcohol, over or underweight, stress, exposure to animals and environmental pollution, dietary habits, and influence of caffeine, exercises and taking recreational drugs. Conclusion: perceptions of the impact of lifestyle factors on fertility vary by sex, socioeconomic factors and treatment. Lifestyle factors significantly affected couples fertility, as BMI, exercises, nutritional status and stress with a statistical difference between groups. Recommendation: In-services educational program for infertile couples for maintaining lifestyle habits to improve their chance of spontaneous conception.

Problems of Infertile Couples with respect to their gender, age and duration of married life

Problems of Infertile Couples with respect to their gender, age and duration of married life

Low Testosterone and Semen Parameters in Male Partners of Infertile Couples Undergoing IVF with a Total Sperm Count Greater than 5 Million.

Low serum testosterone is found in approximately 15% of subfertile men. Although testosterone is essential in spermatogenesis, it is unclear whether low testosterone levels may have a negative impact on the semen parameters of men belonging to infertile couples with a total sperm count greater than 5 million. Furthermore, it is debatable whether the initial evaluation of the subfertile male should include an endocrine assessment. This was a retrospective, single-center cohort study conducted at a tertiary fertility clinic. Male partners of infertile couples undergoing in vitro fertilization (IVF), with a total sperm count greater than 5 million, were included. All men provided morning blood samples, and none had been on exogenous testosterone or other relevant medications. Low total testosterone (TT) was defined as <264 ng/dL. Free T was calculated using TT and sex hormone-binding globulin (SHBG) levels (nmol/L) by a constant albumin concentration of 43 g/L. In total, 853 patients were included: 116 had low TT (<264 ng/dL) and 737 had normal TT (≥264 ng/dL). Semen volume, sperm cell count, progressive (A + B) motility and morphology (≥4% strict Kruger) were lower in the low TT group but not significantly different between low and normal TT groups (3.2 ± 1.79 vs. 3.23 ± 1.64, p = 0.87; 76.82 ± 83.18 vs. 67.55 ± 57.70, p = 0.7; 54.89 ± 19.45 vs. 56.25 ± 19.03, p = 0.6; 5.77 ± 3.23 vs. 6.89 ± 3.94, p = 0.23). The percentage of patients with below-reference sperm volume (<1.5 mL), cell count (<15 × 106/mL), motility (A + B) (<32%) and morphology (<4%) was higher in the low TT group but not statistically different compared to the normal TT group. Multivariable regression analysis revealed that low TT and free T levels had no significant effect on the aforementioned semen parameters (coefficient: 3.94, 0.88, 1.37, 0.39; p = 0.53, 0.8, 0.3, 0.2; coefficient: 0.001, 0.06, 0.007, 0.0002; p = 0.73, 0.52, 0.85, 0.98). Despite our robust methodological approach, the presence of biases related to retrospective design cannot be excluded. Our findings highlighted the lack of association between low TT levels and semen parameter alterations in male partners of infertile couples undergoing IVF, with a total sperm count greater than 5 million. However, it is important to emphasize that more patients in the low TT group had subnormal semen parameters, albeit the difference was not statistically significant. Larger, prospective studies are warranted in order to validate these findings, as well as to investigate the existence of a TT threshold below which semen parameters might be negatively affected.

Resilience as the predictor of quality of life in the infertile couples as the most neglected and silent minorities

ABSTRACT Background: It has been demonstrated that infertility can affect quality of life (QoL) in infertile couples. Resilience is considered a protective factor against the distress caused by infertility and the quality of life status. There is a new definition for Fertility Quality of Life that evaluates particularly the impact of infertility on various aspects of life. Material and methods: In this couple-based study, the main objective was investigating the quality of life based on the gender and resilience of infertile couples. Measurement tools were three questionnaires including a demographic one, a quality of life of infertile couples questionnaire and the Connor–Davidson Resilience Scale. Data analysis was done through paired t-test and linear multiple regressions test. Results: Overall the difference of mean score for QoL is statistically significant (P > 0.001) between men and women (69.48% vs 58.87%), which means that QoL status was positive in men and neutral in women. In addition, the mean score of male resilience was more than female resilience (P = 0.009). The results showed there was a significant and positive correlation between the QoL status and resilience score (P = 0.008, r = 0.13) (P < 0.1), and resilience (β = 0.04 and P = 0.04) had a significant protective effect on the quality of life. Conclusion: Low resilience status in infertile couples is better to be considered as a risk factor compromising the quality of life and infertility consolers should keep in mind this issue and provide a comprehensive and holistic approach for a better outcome of infertility treatment. Abbreviations: QoLICQ: Quality of Life in Infertile Couple Questionnaire; CD-RISC: Connor–Davidson Resilience Scale; IVF: in vitro fertilisation; ART: assisted reproductive technique; PTSD: posttraumatic stress disorder; IUI: intrauterine insemination; ICSI: intracytoplasmic sperm injection.

State-Of-The-Art Ultrasound in the Management of the Infertile Couple

Ultrasound is vital tool for imaging women and men with infertility as it is inexpensive, accessible and non-invasive, providing crucial information to allow quick diagnosis. It also helps to facilitate an interactive discussion with the patient where findings can instantly be seen and acted upon. Additionally, US is indispensable for assisting IVF and ICSI treatment especially with the introduction of 3D technology ensuring the best quality oocytes are used to strive for the best outcomes. The diagnosis and treatment of infertility can be extremely distressing for patients and we must ensure we provide the highest level of care with the use of US playing a key role in management. Furthermore, all contemporary trainees aspiring for a career in reproductive medicine should be trained and competent in advanced ultrasound.

Prevalence Rates of Chlamydia Trachomatis and Other Sexually Transmitted Organisms in Infertile Couples Attending a Tertiary Medical Centre in Malaysia

INTRODUCTION: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) infections are well recognized and prevalent sexually transmitted infections (STIs). The role of Mycoplasma spp and Ureaplasma spp are still controversial as some are commensals of genitourinary tract. OBJECTIVES: To estimate the prevalence rate of 7 organisms: Chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) in infertile married couples during infertility evaluation. MATERIALS &amp; METHODS: A total of 274 samples from all of the 137 couples who attended the reproductive center from June to December 2014 were collected. Detection of the organisms was performed using multiplex polymerase chain reaction. RESULTS: STI-associated organisms were detected in 35.4% (97/274) of subjects. The prevalence rates of CT, MG, TV, UU, MH were 7.3%,1.1%, 0.4%,5.4% and 5.1% respectively. Twenty-one (7.7%) subjects were positive for more than one organism. 24/274 (8.8%) of subjects had history of urogenital tract-related symptoms and 50% (12/24) were tested positive to one or more organisms. The presence of symptoms in both male and female subjects were found to be 10% (2/20) in CT infection, 10% (7/67) in UP, 14% (2/14) in MH and 13% (2/15) in UU infections. CONCLUSION: Sexually transmitted organisms were detected in one third of subjects planning for fertility evaluation. The absence of symptom in most subjects particularly in CT infection emphasizes the need for microbiological screening during infertility evaluation. The presence of genital ureaplasmas and mycoplasmas in infertile couples should not be neglected. There is a growing need to clarify whether their roles are simply colonizers or pathogens implicated in infertility.

Outcome of Laparoscopy in Infertile Couples attending a Teaching Hospital in Eastern Nepal: A Descriptive Cross-sectional Study.

Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the outcome of laparoscopy in infertile females attending Nobel Medical College as laparoscopy is considered as a gold standard in investigation and treatment of infertility. A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology over a period of May 2018-April 2020, where the outcomes of laparoscopy in infertile females were studied. All the patients with abnormal HSG, unexplained infertility and adnexal mass in the background of infertility were enrolled. Of the 100 infertile patients who underwent laparoscopy, 62 (62%) had evidence of tubal disease as documented by unilateral or bilateral block, 63 (63%) had peritubal adhesions and hydrosalpinx in 15 (15%). Associated pelvic pathology like endometriosis in 50 (50%) in the form of cyst, adhesions and complete and partial obliteration of Pouch of Douglas. Laparoscopy is definitely an effective diagnostic tool of tubal and pelvic pathology. Laparoscopy is recommended for all infertile females with suspected tubal factor and moreover it provides opportunity to correct the condition in possible cases.

The Impact of Maternal Age on Intracytoplasmic Sperm Injection (ICSI) Outcomes in Infertile Couples

Objective: The aim of the study is to investigate the impact of maternal age on ICSI outcomes representedby the number of retrieved oocytes, number of fertilized oocytes, embryo quality and pregnancy rate ininfertile couples undergoing ICSI.Patients and Method: The study included sixty two infertile couples who underwent ICSI cycles. Theydivided in to two groups depending on females’ age: group ? with age less than 35 years and group ??with age more than 35 years. Assessment of ICSI outcomes in form of retrieved oocytes number, fertilizedoocytes number, quality of embryo and rate of pregnancy were done and the results were compared betweenboth groups.Results: The study showed that females whom their age more than 35 years produced significantly loweroocytes number with a lower fertilized oocytes when compared with females younger than 35 years. (themean total number of retrieved oocytes 3.24±0.52 vs 10.84±0.81 and the mean total number of fertilizedoocytes 2.29±0.26 vs 7.62±0.52, p-value =0.002 and 0.02 respectively. The total number of good qualityembryos was significantly less in the females older than 35 years 1.12±0.18 vs 6.80±0.46, p-value=0.003and the total number of bad quality embryos was significantly more 1.47±0.24 vs 0.60±0.1, p-value=0.02when compared with females younger than 35 years. Pregnancy rate was significantly less in the olderfemales p-value=0.0005.Conclusion: The maternal age is one of the most important predictor of ICSI outcomes. An advancedfemales age has a negative impact on ICSI outcomes and females older than 35 years usually producedlower number of oocytes during oocytes’ retrieval with a lower fertilization rate. Embryos produces fromthose females usually of bad quality and exhibited a lower implantation potential.

Dimensions of Forgiveness and the Influential Factors in Infertile Couples

Dimensions of Forgiveness and the Influential Factors in Infertile Couples

Self-Esteem and Defense Mechanisms in Infertile Couples Based on the Cause of Infertility in Royan Infertility Treatment Center in 2017

Introduction: Infertility could decrease the self-esteem of the infertile couples. Using the defensive style is one way to deal with stressful events. Therefore, the aim of this study was to investigate the role of self-esteem and defense mechanisms based on the cause of infertility. Methods: In this cross-sectional study, 400 infertile couples referred to infertility center in Tehran, Iran. Participates classified in 4 groups for the cause of infertility: female, male, both and unknown. Data gathering tools in this study were demographic questionnaire, Rosenberg Self-Esteem Scale and Defense Styles Questionnaire (DSQ). Data were analyzed (SPSS 18 software) using paired t-test for comparison between the groups according to the cause of infertility and using regression analyses tests. Results: The results of this study showed that men in female infertility group has significantly higher self –esteem than other groups (P&lt;0.049). In couples, husbands with female and male factor showed more self-esteem than their wives (P&lt; 0.001, P&lt;0.008, respectively). In defense mechanisms, there was no difference between women, men, and couples. In this study, self-esteem showed a negative relationship with immature and neurotic defense mechanisms and a positive relationship with mature defense mechanism. Conclusion: The findings of this study showed that women had higher levels of vulnerability than their husbands did even when they were not the cause of infertility so they have a low self-esteem. Therefore, it is suggested that infertile women receive more psychological counseling than men, and in order to facilitate the treatment of infertile couples and provide better services to improve marital relationships and solve their problems, differences between men and women about psychological issues should be considered.

Comparison of Agonist and Antagonist of GnRH in Induction Ovulation in Infertile Couples with Male Factor Referred to Fatemieh Hospital of Hamadan

Comparison of Agonist and Antagonist of GnRH in Induction Ovulation in Infertile Couples with Male Factor Referred to Fatemieh Hospital of Hamadan

Selected Risk Factors and Pattern of Semen Abnormality in Male Partners of Infertile Couples in Eastern Nepal: A Descriptive Cross-sectional Study.

Semen analysis is an initial basic step in evaluating and diagnosing male infertility. Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The present study aimed to study certain risk factors and semen parameters of infertile male. It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners of infertile couple who underwent certain risk factors evaluation and semen analysis according to WHO guideline. Multiple risk factors were present like Gulf country migration, smoking, chemical exposure and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers. Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had <25% motile spermatozoa. Surprisingly 46% of our patients were Gulf country workers and abnormal semen analysis is very important factor for infertility. Large prospective studies need to be carried out involving Gulf migrant workers only.

Advances in Management of the Infertile Couple

Advances in Management of the Infertile Couple

Sexual Satisfaction Among Infertile Couples: Demographics and Psychosocial Health Factors.

The purpose of the current study was to explore sexual satisfaction among infertile couples in Jordan and its associations with psychosocial and sociodemographic factors. Using a descriptive correlational design, 248 infertile couples from outpatient clinics were recruited and filled out a questionnaire on sexual satisfaction, in addition to perceived social support, depressive symptoms, psychological stress, coping skills, optimism, life satisfaction, and sociodemographics. Sexual satisfaction was significantly and positively correlated with perceived social support, optimism, life satisfaction, and coping. Stronger association was observed between sexual satisfaction and optimism. No difference was found in sexual satisfaction in relation to participants' gender, age, working status, or education. This study highlights the importance of building mental health nurses' competence to provide education and counseling on sexuality to improve the quality of life of infertile couples and optimize their sexual wellness. The most recent guidelines for psychosocial care for infertile couples are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 58(9), 40-47.].

During the Coronavirus Pandemic and After Its Occurrence, We Need to Think of Infertile Couples More Than Ever

During the Coronavirus Pandemic and After Its Occurrence, We Need to Think of Infertile Couples More Than Ever