Female Infertility Patients Research Articles

Fear of fertility side effects is a major cause for COVID-19 vaccine hesitance in infertile patients.

This study aims to investigate the acceptance, hesitance and attitudes of infertile female patients toward the COVID-19 vaccination. An anonymous cross-sectional online survey was conducted between 28th of January to 10th of August 2022. The questionnaire consisted of 35 questions on demographics, COVID-19 vaccination status, prior concerns of the vaccinated participants and reasons for not vaccinating among unvaccinated participants, and factors influencing the decision not to vaccinate. Of 406 participants who answered all questions, 92.1% reported having received at least one dose of COVID-19 vaccine, 7.9% were unvaccinated. Factors associated with the decision for vaccination were full time or part time employment (p = 0.05), high trust in the principle of vaccination (p < 0.001), high willingness for other vaccination during fertility treatment (p < 0.001) and risk factors for severe COVID-19 (p = 0.007). Concerns about directly occurring adverse effects after vaccination (42.0%), about impact on own fertility (21.9%) or on the fertility treatment (27.5%) were the main concerns beforehand of vaccinated participants. Correlations between fertility concerns and mistrust in the general principle of vaccination were found. Beside general health concerns, unvaccinated participants reported fears about fertility impairment as the most important arguments against a COVID-19 vaccination (median of 5.0 on a five-point-Likert scale). Both vaccinated and unvaccinated participants stated having concerns and fears about side effects of the COVID-19 vaccination on their fertility. To increase patients' trust in medical recommendations, such as vaccination, to avoid mistrust in the medical system and to maintain patient's compliance, there should be additional educational services that address infertile patients and their needs.

The diagnostic value of hysterosalpingo-contrast sonography in female infertility of the fallopian tube.

To explore the clinical diagnostic value of hysterosalpingo-contrast sonograghy (HyCoSy) in female infertility of the fallopian tube. One hundred nineteen female infertility patients who underwent laparoscopy in Shenzhen Hospital of Beijing University of Chinese medicine (Longgang) and Longgang District People's Hospital of Shenzhen City from June 2019 to December 2021. Patients diagnosed with fallopian tube obstruction; 119 patients included 233 fallopian tubes (five patients had the affected fallopian tubes removed due to ectopic pregnancy) were selected for HyCoSy, and then the results of laparoscopic examination were taken as the gold standard for diagnosis. The authenticity of the diagnostic test was evaluated using four grid table data, and the consistency of the two diagnostic methods of hysterosalpingography and laparoscopy was compared by Kappa test. Of the 233 fallopian tubes assessed, 139 were unobstructed, 50 were blocked at the proximal end and 44 were blocked at the distal end by laparoscopy. The results of HyCoSy showed that 115 were unobstructed, seventy three was considered proximal obstruction and 45 were distal obstruction. When compared to laparoscopy, the accuracy of HyCoSy in the diagnosis of tubal patency, proximal obstruction and distal obstruction was 74.2%, 78.1% and 80.7%, respectively. Two methods had good consistency in the diagnosis of tubal patency (Kappa=0.486) and proximal tubal obstruction (Kappa=0.444), and poor consistency in the diagnosis of distal tubal obstruction (Kappa=0.375). Laparoscopy and HyCoSy are both useful in the diagnosis and etiological analysis of female infertility. HyCoSy can be the first choice, those who have doubts about the screening results can actively carry out laparoscopy to further improve the accuracy of diagnosis and etiological analysis of this disease.

Predictors and incidence of depression and anxiety in women undergoing infertility treatment: A cross-sectional study.

The global incidence of infertility is increasing year by year, and the association between infertility and mental illness has been widely concerned. The aim of this study was to investigate the incidence of anxiety and depression in infertile women in China and explore the risk factors which might lead to anxiety and depression. From January 2020 to December 2020, female infertile patients who received assisted reproduction technology (ART) treatment at West China Second Hospital were recruited and a total of 1712 eligible female patients were finally enrolled in this study. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionaire-9 (PHQ-9) were used to evaluate the patients' psychological status. The reliability of all scales was evaluated by Cronbach's α and Spearman-Brown half coefficient, and Kaiser-Meyer-Olkin (KMO) value was calculated by factor analysis to evaluate validity. Univariate and multivariate logistic regression analysis were applied for assessing independent risk factors of anxiety and depression, respectively. The incidence of anxiety and depression in infertile women were 25.2% and 31.3%, respectively. Cronbach's α coefficients and Spearman-Brown half-fold coefficients of GAD-7 and PHQ-9 were 0.870, 0.825, 0.852 and 0.793, respectively. Univariate and multivariate logistic regression analysis showed that education level (junior college degree or above, OR:1. 6, 95% CI: 1.2-2.1, P = 0.003), somatic symptoms (severe somatic symptoms, OR:15.2, 95%CI: 5.6-41.3, P<0.001), sleep quality (poor sleep quality, OR:9.3, 95% CI:4.7-18.4, P<0.001) were independent risk factors for anxiety. And age>35 years old, moderate and severe somatic symptoms and poor sleep quality were independent risk factors for depression. Somatic symptoms and poor sleep quality are both the risk factors of anxiety and depression symptoms of infertile woman. And high educated (junior college degree or above) patients are more likely to be complicated with anxiety symptoms, while elderly patients (age>35) are prone to be complicated with depression symptoms.

Causes of Infertility among the Couples Who are Attending the Infertility OPD of BSMMU

Introduction: Infertility may be defined as inability to conceive within one year of unprotected regular coitus. Approximately 85 – 90% of healthy young couples conceive within 1 year, most within 6 months1. Infertility therefore affects approximately 10 – 15% of couples and represents an important part of clinical practice2. A general classification of causes of infertility are male 35 – 40%, female 40 – 50% (tubal 25%, ovulatory 20% and cervical 1 – 2%), sexual 10% and unknown 10%3. More than one factor per couple accounts for the total percentage appearing to exceed 100%. Objective: To assess the determinants of infertility among the infertile couples both male and female attending the outpatient department of infertility unit of the department of obstetrics and gynaecology of Bangabandhu Sheikh Mujib Medical University , Shahbagh, Dhaka. Materials &amp; Methods: This prospective observational study was conducted in the Infertility unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period from 01.07.2018 to 31.12.2021. Five hundred infertile couples were recruited from the out-patient department of infertility unit who came to take treatment for their infertility problem. Data were collected from the couples by data collection sheet and the data were plotted in the tables. The data were analyzed by SPSS program, version 28. Results: The socio-demographic characteristics of the study subjects (n = 500).Husbands age group was 22 -55in years, Mean ± SD (34.0 ± 5.9). Age of the female partners was 18 – 44 years, mean ± SD (27.1 ± 5.2). Majority of the female study subjects had secondary level of education (49.4%), where as in male study subjects secondary level of education was 30.4%, followed by graduates (29.6%). Occupation of female partners was mostly housewife = 395 (79.0%), occupation of male partners was mostly service = 356 (71.2%). Regarding religion, Muslims were 476 (95.2%), others were 24 (4.8%). Majority of them hailed from rural area (62%). According to BMI, majority of female were overweight (56%). Among the respondents, majority of them had primary infertility (59.8%) and the rest (40.2%) had secondary infertility. Regarding hormonal status of infertile women, most of them (94%) had serum FSH below normal (&lt; 3U/L), serum LH below normal (&lt; 2U/L) in 96% patients, Serum TSH above normal (&gt;4.5 mU/L) in 49.0% patients, serum FT4 above normal (&gt;21 pml/L) in (60.8%) patients, serum Prolactin level above normal (&gt;630 mU/L) in 27.8) patients. Diabetes: In male = 28 (5.6%).Mumps: In male = 7 (1.4%). Chicken pox: In male = 18 (3.6%). Hypertension: In male = 10 (2.0%). Orchitis: In male = 6 (1.2%). Personal history of husband: Smoking = 129 (25.8%). In male patients, Testosterone level normal (10 – 30 nmol/L) in 133 (26.6%) patients and above normal (&gt;30 nmol/L) in 367 (73.4%) patients. The semen analyses of the husbands of the infertile female patients shows, quality of semen poor (&lt;4%) in 305 (61%) patients. Regarding semen quality, oligospermia (&lt;15 million/ml) was in 480 (96%) patients and azospermia (0% count) in 20 (4%) patients. In case of motility of sperms, rapid linear below normal (&lt;50%) was in 90 (18%). In case of slow linear (SL), below normal (&lt;15%) in 324 (64.8%) patients. In case of morphology of sperms, below normal (&lt;14million/ml) in 25 (5%) patients. Regarding structural abnormalities of female organs bicornuate uterus was found in 15.2% patients, abnormal uterine cavity in 11.4% patients. In 13.0% patients’ abnormal right ostium were found and in 12.6% patients’ abnormal left ostium were found. Intrauterine adhesion was found in 35.2% patients and submucus fibroid in 17.6% patients. Abnormal right fallopian tube was found in 33.2% patients and abnormal left fallopian tube was found in 34.2% patients. Dye test in 42.4% patients were negative that means the tubes were blocked. Conclusion: This study shows that a significant percentage of both male and female are suffering from infertility. The major causes of male infertility are partly hormonal, structural abnormalities of male genitalia, infection of genital tract, and partly psychological.Causes of female infertility are mostly hormonal, structural abnormalities of the uterus, fallopian tubes, infection of the genital tract and partly psychological. Medicine Today 2023 Vol.35(1): 20-26

An Explorative Study to Assess the Suicidal Risk Amongst Infertile Patients

IntroductionThis given study was designed to qualitatively and quantitatively examine the Psychosocial – emotional consequences of infertility on female infertile patients . Suicidal risk amongst infertile patients was a incidental yet significant finding with 25 percent of the study population reporting a positive result by the MINI scale. There are very few studies conducted in the Indian context that analyses the psychosocial aspects of infertility and the impact of ART treatment on the quality of life.The finding in our study indicates that both infertility and stress associated with ART treatment contributes to psychological turmoil namely depression , anxiety, psychopathology and quality of life impairment in addition to suicidal ideation and suicidal risk.ObjectivesAimsTo assess the psychosocial impact of infertility amongst female infertile patients including suicidal risk/ suicidal ideation in the given study population.MethodsA total of 300 women attending the Obstetrics and Gynecology out patients department of a tertiary hospital in Kolkata, India were selected by simple random sampling. 100 fertile women attending the routine ante natal clinic were selected as cases and 100 infertile women seeking fertility treatment were selected as controls. 100 women didn’t follow up with the study. The following questionnaires were administered to both case and control group- BAI, BDI, SCL-90-R, SF-36, MINI and socio demographic proforma ; by trained clinic psychologist . The raw scores &amp; adjusted scores were analysed statistically by SPSS using the following tests, independent t test, chi square test and Z test.ResultsThe results of the MINI scale indicate that up to 25% of the infertile cohort suffer from suicidal risk/ suicidal ideation which is statistically significant in comparison to the control group.The other psychosocial parameters are also statistically significant in the case in comparison to the control population.Conclusions Although the psychosocial impact of infertility has been well researched and documented. Few studies have been conducted globally which assess suicidal risk amongst infertile patients. Our results corroborate earlier studies such as the Danish administrative population-based registry study by Trille Kristina Kjaer et al which found a causative link between infertility and suicidal risk.Further research is needed in this directionDisclosure of InterestNone Declared

The Mechanism of Acentrosomal Spindle Assembly in Human Oocytes

ABSTRACT During somatic cell mitosis and meiosis, spindle assembly is an essential step for ensuring accurate chromosome transmission and is mediated via duplicated centrosomes. In nonsomatic cells, canonical centrosomes are absent in the oocytes of many species, suggesting the mechanism of female meiotic spindle assembly is not conserved between species. Human oocytes lack detectable acentriolar microtubule organizing centers at the meiotic spindle poles and the exact mechanism of acentrosomal spindle assembly in human oocyte remains unclear. This study aimed to utilize 3-dimensional (3D) high-resolution imaging of more than 2000 human oocytes to identify and characterize key structures in the spindle assembly process. First, human oocytes were stained to visualize chromosomes, kinetochores, and microtubules before maturation. Approximately 2 to 4 hours following nuclear envelope breakdown (NEBD), the nucleation of spindle microtubules was initiated from kinetochores. To identify factors driving this spindle microtubule nucleation from kinetochores in human oocytes, 86 human centrosome and microtubule-related proteins were localized by immunofluorescence in more than 1000 fixed human oocytes. Of these, 43 proteins localized in the meiotic spindle, among which 4 proteins (centriolar coiled-coil protein 110 [CCP110], cytoskeleton-associated protein 5 [CKAP5], disrupted in schizophrenia 1 [DISC1], and transforming acidic coiled-coil-containing protein 3 [TACC3]) showed kinetochore and spindle microtubule localization. It was observed that these 4 proteins belong to the same structure (human oocyte microtubule organizing center [huoMTOC]), and a dense microtubule cluster was observed around this structure, which caused asymmetrical microtubule distribution around the nuclear envelope before NEBD. Next, it was observed that TACC3 had over 29-fold greater expression than CCP110, CKAP5, and DISC1, and after being depleted using siRNA, there was complete disruption of the huoMTOC, and the distribution of microtubules was drastically diminished. The other 3 proteins showed similar but less severe diminishment of the huoMTOC when depleted. Next, to visualize the dynamic process of huoMTOC-regulated spindle assembly, 3D time-lapse imaging was used following NEBD. This showed the huoMTOC fragments and relocates on the kinetochores to initiate microtubule nucleation and spindle assembly. Again, each huoMTOC component was down-regulated in human oocytes and brought through this stage, showing that with each component there was significant impairment of spindle microtubule nucleation and spindle assembly compared with the control group (P &lt; 0.001), and spindle microtubules were greatly decreased. It was hypothesized that given the key role of the huoMTOC in human spindle assembly, a disrupted huoMTOC resulting from mutations in CCP110m CKAP5, DISC1, or TACC3 may cause abnormal oocyte maturation in patients. A cohort of 1394 infertile female patients characterized by oocyte maturation arrest was screened for mutations through whole-exome sequencing data sets. Two patients with loss-of-function mutations in TACC3 were identified, and analysis of their retrieved oocytes found a missing huoMTOC, suggesting the disruption of the huoMTOC impaired the nucleation of microtubules in the oocytes of patients. This study identified and characterized a structure, which was named the huoMTOC, which serves as a major site of microtubule nucleation and is required for spindle assembly in human oocytes.

Intrauterine instillation of autologous platelet-rich plasma in infertile females with thin endometrium undergoing intrauterine insemination: an open-label randomized controlled trial

Thin endometrium in infertile female patients has always been a clinical challenge for the treating reproductive physicians. This study aimed to evaluate the effect of intrauterine instillation of autologous platelet-rich plasma on endometrial thickness and vascularity in infertile female patients with thin endometrium undergoing ovarian stimulation with intrauterine insemination. This prospective randomized control study included 120 women undergoing ovarian stimulation with intrauterine insemination, aged between 21 and 37 years, with persistent thin endometrium (<7 mm) on ≥1 cycle in previous ovarian stimulation cycles, even after conventional treatment with estradiol valerate. The women were randomly assigned to study group A and control group B. Baseline endometrial thickness and endometrial vascularity were noted. Intrauterine instillation of autologous platelet-rich plasma was done on the day of trigger in group A, whereas estradiol valerate was given in group B. Another evaluation of endometrial parameters was done on the day of intrauterine insemination. The cycle was repeated for 3 cycles or until the pregnancy was achieved, whichever occurred earlier. Parameters were noted for both groups. Primary outcomes were the change in endometrial thickness and endometrial vascularity. Secondary outcomes were positive pregnancy rate and clinical pregnancy rate. In group A, mean pre-platelet-rich plasma endometrial thickness was 4.66±0.79 mm, which significantly increased to 7.47±0.85 mm after platelet-rich plasma instillation (P<.05) after 3 cycles. This increase was significantly greater than that observed in group B. There was significant increase in endometrial vascularity in group A compared with group B (P<.05). The positive pregnancy rate and clinical pregnancy rate in group A were 23.73% and 18.64%, respectively, and significantly higher than those in group B. Autologous platelet-rich plasma is a promising, easily procurable, and novel option for management of infertile females with thin endometrium not responding to conventional treatment. Using it in intrauterine insemination cycles can reduce costs and psychological burden of this subgroup of women by reducing the need for resorting to advanced options such as in vitro fertilization and surrogacy.

The impact of stigma on mental health and quality of life of infertile women: A systematic review.

The stigma of not giving birth to children affects approximately 53. 08~64% of female infertility patients worldwide. This stigma not only causes harm to the mental health of these infertility patients, but also affects their quality of life, making them bear the adverse social consequences such as domestic violence, marriage breakdown, or even delay in receiving the treatment. Therefore, it is crucial to have a deep understanding of the patients' stigma and effective intervention in alleviating it. This study aims to discuss and summarize the stigma in infertile women and its impact on patients, and to provide a theoretical basis for the clinical treatment and nursing intervention of disease stigma in infertile female patients. The literature search used four English databases (Cochrane Library, EMBASE, Web of Science, and PubMed) and two Chinese databases (CNKI and Wanfang). The search time of the literature ranges from the establishment of the library to 2022, with no language restriction. The review included 28 studies, with 20 cross-sectional studies and 8 qualitative studies. This study found that social support, living environment, education level, occupation, and fertility awareness were the major influencing factors of infertility stigma. Infertility stigma can bring heavy mental pressure and psychological burden to female infertility patients and affect their quality of life. Therefore, effective and targeted psychological interventions should be developed to reduce the patients' stigma and improve their quality of life. Healthcare workers must develop targeted nursing interventions, provide professional counseling services to reduce the level of stigma in female infertility patients, alleviate fertility stress, and improve their quality of life.

Potential therapeutic drug targets and pathways prediction for premature ovarian insufficiency —Based on network pharmacologic method

Ethnopharmacological relevanceThe incidence of premature ovarian insufficiency (POI) is gradually increasing, the proportion is rising especially in female infertility patients. The risk of death of POI patients with cardiovascular disease also increases significantly. The cause of POI is complex and unclear, and clinical treatment is still in the exploratory stage, are two major constraints of treating POI. Traditional Chinese medicine (TCM) is widely used in the treatment of POI, and it is a good way to combine the development of modern new drugs with the help of TCM to predict the therapeutic targets. Aim of the studyIn this study, four herbs commonly used in clinical treatment of POI, namely Radix Paeoniae, Polygonatum sibiricum, Rehmannia glutinosa and Eucommia ulmoides were selected to predict their mechanism in the treatment of POI, using network pharmacology methods. Then verify the predicted targets by animal test. Aim to find more effective POI potential core treatment targets and main pathways. Materials and methodsWe screened the active ingredients of drugs from the TCM System Pharmacology Analysis Platform (TCMSP), Performed target prediction of active ingredients from databases such as SwissTargetPrediction and compare and analyze the POI-related targets retrieved from them to obtain potential targets for drug treatment of POI. Used STRING database to construct a protein interaction network, Cytoscape 3.7.2 software to construct an active ingredient-target-pathway network, and DAVID database to conduct the Kyoto Encyclopedia of Genes and Genomes (KEGG) on the intersection targets and gene ontology (GO) enrichment analysis. ResultsThe result is: there were 25 key targets for the treatment of POI with Radix Paeoniae Alba, 31 for the treatment of POI by Eucommia ulmoides, 28 for the treatment of POI by Polygonatum sibiricum, and 8 key targets for the treatment of Rehmannia glutinosa. The intersection targets of four herbs were defined as the core targets, which are CYP19A1, EGF, ESR1, ESR2, MDM2, AR, PCYP17A1, PPARG. Four Chinese herbs treat POI mainly through HIF-1 signaling pathway, PI3K-Akt signaling pathway, FoxO signaling pathway, Estrogen signaling pathway etc. A mouse model of POI was constructed based on the results of network pharmacology to verify the predicted targets. The results showed that the protein expression of the core target changed, and the estrogen level was increased by reducing the expression of peroxisome proliferator-activated receptor gamma (PPARG). ConclusionsThis study predicts the mechanism of multiple herbs in the treatment of POI, screens out more potential therapeutic drug targets and main pathways of POI treatment and provides new ideas for the subsequent development of POI therapeutic drugs.

Common Autoimmune Antibodies in Unexplained Infertile Female Patients in Saudi Arabia.

Unexplained female infertility is a devastating health problem that has become increasingly prevalent worldwide with no specific explanation despite comprehensive evaluations. Recent data suggestthat serum autoimmune antibodies are frequently found in patients with unexplained female infertility. This study aims to identify the prevalence of common autoantibody abnormalities in females with unexplained infertility in Saudi Arabia. A cross-sectional study was conducted on female patients with unexplained infertility sequentially referred to the allergy and immunology clinic at King Abdulaziz University Hospital (KAUH). Demographics, clinical characteristics, and 12 common autoantibody immunological tests were described as frequency and percentage. The chi-square test was applied to evaluate any associations. A total of 119 females with unexplained infertility were studied; of those, 97 (81.5%) had secondary infertility. Their average age was 33.9 ± 5.6 years ranging from 23 to 49 years. The overall prevalence of a high level of at least one autoantibody (above the normal range) was 84%. The predominant high autoantibodies were antithyroglobulin in 42 (35.3%), antithyroid microsomal in 41 (34.5%), beta 2 glycoprotein IgM in 40 (33.6%), antigliadin IgA in 32 (26.9%), antinuclear in 22 (18.5%), and anticardiolipin IgM in 18 (15.1%) of the participants. The following significant associations were found in our study: secondary infertility with beta 2 glycoprotein (p = 0.022), age with antithyroglobulin (p = 0.027), and the number of pregnancies with anti-tissue transglutaminase IgG and antigliadin IgA(p = 0.015 and p = 0.043, respectively). A high level of at least one autoantibody was detected in the majority of females with unexplained infertility. Antithyroid, antiphospholipid, antigliadin, and antinuclear autoantibodies were the most commonautoantibodies.These findings may encourage autoantibody screening in infertile females to discover any potential immunopathology in further clinical studies.

Study on autoimmune antibody of infertile women based on ultrasound images

Objective: to study the clinical value of reproductive immune autoantibody based on ultrasound image in the diagnosis of infertility. Methods: Eighty infertile women who were admitted to our hospital from June 2019 to May 2020 were included in the study. ELISA was used to detect the serum reproductive immunity antibodies of the patients, including anti-sperm antibody (AsAb), anti-endometrial antibody (EMAb), anti-ovarian antibody (AOAb) and anti-cardiolipin antibody (ACA). Results: the results of reproductive immune antibody test indexes of female infertility patients with different types were compared, and the difference was statistically significant (p &lt; o. 05). conclusion: the detection of reproductive immune autoantibody in clinic can be used for the diagnosis of female infertility, and has important clinical value.

Study on autoimmune antibody of infertile women based on ultrasound images

Objective: to study the clinical value of reproductive immune autoantibody based on ultrasound image in the diagnosis of infertility. Methods: Eighty infertile women who were admitted to our hospital from June 2019 to May 2020 were included in the study. ELISA was used to detect the serum reproductive immunity antibodies of the patients, including anti-sperm antibody (AsAb), anti-endometrial antibody (EMAb), anti-ovarian antibody (AOAb) and anti-cardiolipin antibody (ACA). Results: the results of reproductive immune antibody test indexes of female infertility patients with different types were compared, and the difference was statistically significant (p &lt; o. 05). conclusion: the detection of reproductive immune autoantibody in clinic can be used for the diagnosis of female infertility, and has important clinical value.

Reproductive endocrine characteristics and in vitro fertilization treatment of female patients with partial 17α-hydroxylase deficiency: Two pedigree investigations and a literature review

Background17α-hydroxylase/17, 20-lyase deficiency (17-OHD) is caused by the mutations of the CYP17A1 gene. The classical phenotype of 17-OHD includes hypertension, hypokalemia, and abnormal sexual development, with partial 17-OHD typically less severe than the complete deficiency. Infertility is always one of the main clinical manifestations of partial 17-OHD. However, to date, the pregnancy potentials of partial 17-OHD female patients have rarely been investigated, and few live-birth cases have been reported among them. Moreover, the reproductive endocrine characteristics of partial 17-OHD female patients have not been completely clarified and the treatment skills of in vitro fertilization and embryo transfer (IVF-ET) have not been well summarized yet.MethodsTwo Chinese infertile female patients clinically diagnosed as partial 17-OHD were enrolled and their pedigree investigations were performed. Hormones were determined to depict the endocrine conditions of partial 17-OHD female patients. The adrenocorticotropic hormone (ACTH) stimulation test was performed to evaluate the functions of the adrenal cortex. Genotype analysis was conducted by next-generation sequencing (NGS) and Sanger sequencing was used to verify the results. IVF-ET was performed for the treatment of their infertility. Specifically, the progestin-primed ovarian stimulation (PPOS) protocol was chosen for the controlled ovarian hyperstimulation (COH) cycles, and the hormone replacement treatment (HRT) protocol was adopted for the endometrial preparation in frozen–thawed embryo transfer (FET) cycles.ResultsHormone assays revealed a reduced estradiol (E2) and testosterone (T) level, and an elevated progesterone (P4) level. The classic ACTH stimulating test evidenced a suboptimal response of cortisol to ACTH. Genotype analysis demonstrated that the proband1 carried two variants: c.1459_1467del (p.Asp487_Phe489del)het and c.995T>C (p.lle332Thr)het. The proband2 was found to be a homozygote with the mutation of c.1358T>A (p.Phe453Ser)hom. The two female patients both succeeded in pregnancy and delivery of healthy babies through IVF-ET, with the usage of PPOS, HRT, and low-dose glucocorticoids.ConclusionsPartial 17-OHD female patients manifested menstrual cycle disorders and infertility clinically; displayed high P4 and low E2 and T; showed sparse pubic hair in physical examinations; and revealed multiple ovarian cysts in ultrasonic visualization. Moreover, the pregnancy potentials of infertile partial 17-OHD women seemed to increase with the adoption of IVF-ET. Considering the sustained elevated P4 level, PPOS is a feasible protocol for them in COH.

Impact of administration route on serum progesterone levels in women undergoing artificial endometrial preparation

ObjectiveAre there differences in serum progesterone levels between different routes of exogenous progesterone administration for artificial endometrial preparation? Material and methodsThis prospective, observational, single-centre study included 9 infertile female patients who underwent cycles of artificial endometrial preparation between January and June 2019 with different progesterone formulations (3 cycles in 2 patients; 2 cycles in 2 patients; and 1 cycle in 5 patients). Oestrogen stimulation was followed by vaginal progesterone 400 mg every 12 h (first cycle), subcutaneous progesterone 25 mg every 12 h (second cycle), and intramuscular progesterone 50 mg every 24 h (third cycle). Progesterone therapy was continued for 5 days and daily serum progesterone was recorded. The primary outcome was day 5 serum progesterone. ResultsDay 5 mean ± standard deviation serum progesterone levels after vaginal, subcutaneous, and intramuscular administration were 14.6 ± 5.5, 47.9 ± 22.3, and 60.3 ± 65.5 ng/mL, respectively (p = 0.032 across routes). From day 1 to day 5, the coefficients of variation for serum progesterone were 66% and 75% with the vaginal and subcutaneous routes, respectively, indicating low variability, and 146% with the intramuscular route, indicating high variability. Two linear regression models were conducted: a normal linear regression model, which found no significant effect of administration route on serum progesterone, and a mixed-effects linear regression model, which also showed no statistically significant differences between routes. ConclusionAll routes of progesterone administration showed satisfactory day 5 mean serum progesterone levels, regardless of administration route.

A Survey on Korean Medicine Doctors’ Recognition and Treatment for Developing Korean Medicine Clinical Practice Guideline of Female Infertility

Objectives: This study was conducted to develop a Korean Medicine(KM) Clinical Practice Guidelines(CPG) of female infertility. We conducted this questionnaire survey to reflect the experiences of Korean Medicine doctors(KMD) and clinical field in Korea.Method: We sent a questionnaire survey to KMD belonging to the Association of Korean Medicine by e-mail. We received 665 responds, and analyzed the answers.Results: 51.2% of respondents knew the previously developed CPG of female infertility, and 18.3% actually used. 83.3% agreed about the necessity of CPG of female infertility, and 80.3% had practical use plan. 90.2% of respondents treated less than 5 infertility woman for a month. 22.7% of respondents treated 50% of patients with collaborative treatment of KM and Western medical treatments. The main age group of patients was ‘35~40 years’(54.7%), and the most common cause was unexplained infertility(61.7%). The most common pattern identification of female infertility patients was Kidney deficiency(55.4%). KMD used 'a combination of decoction of herbal medicine, acupuncture and moxibustion treatment' the most(43%), and 'a decoction of herbal medicine treatment alone' was next(35%). 84.2% conducted lifestyle modification education about diet, stress, exercise etc.Conclusion: We figured out Korean Medicine doctors' recognition about CPG of female infertility, preference of treatments, and also characteristics of patients visiting Korean Medical clinics to make a practical CPG reflecting clinical situation.

P-503 The role of the duration of infertility on the of quality of life and psychological health in infertile couples

Abstract Study question Is the quality of life (QoL) and psychological health affected by the duration of infertility in infertile women? Summary answer The duration of infertility negatively impacts infertile women's QoL and psychological health. What is known already Infertility is a deeply distressing experience. The process, from suspicion to received diagnosis and treatments often endures over a long period of time and usually involves repeated oscillations between hope and delusion, perception of loss of control, loss of self-esteem, inability to plan future, changes in identity and worldviews and difficulties in social interactions. Therefore, being infertile and undergoing fertility treatments is a condition which affects all infertile couple’s QoL. Whether QoL of these individuals is affected by the duration of infertility should be the focus of further investigation, to define psychological care interventions with patients dealing with infertility. Study design, size, duration This transversal study enrolled 442 female infertile patients that completed a modified non-validated Fertility Quality of Life Questionnaire (FertiQoL) between August and November 2021, containing multiple choice questions, which were evaluated in an ordinal manner (from one to five, being five the reference category associated with best QoL parameter). Participants/materials, setting, methods The FertiQoL questionnaire was conducted through an online-platform and consisted of 24 items derived from four subscales (mind-body, emotional, social, and relational), 10 treatment-related items, and two overall life and physical wellness items. Additionally demographic infertility-related characteristics were answered by the participants. Generalized Linear Models were performed to assess the association between FertiQoL scores and duration of infertility. Results are described by B coefficient and the p value. Main results and the role of chance A negative association between duration of infertility and FertiQoL scores were observed. With one unit increase in duration of infertility, the log of odds of having a positive perception about: (i) one’s own health decreases by -2.07 to -5.49, p &amp;lt; 0.001, (ii) one’s satisfaction with the quality of life decreases by -0.981 to -3.90, p &amp;lt; 0.001, (iii) ability to handle other life plans and goals while dealing with infertility decreases by -0.59 to -2.77, (iv) ability to deal with one's fertility issues decreases by-1.38 to -4.00, p &amp;lt; 0.001, (v) experience of envy feelings increases by 0.10 to 2.71, p &amp;lt; 0.001, (vi) experience oscillations of hope and hopelessness feelings increases by 0.25 to 0.97, p &amp;lt; 0.001, (vii) experience of social isolation due to infertility increases by 0.92 to 3.12, p &amp;lt; 0.001, (viii) loving to one's partner despite fertility problems decreased by -0.54 to -5.99 p &amp;lt; 0.001, (ix) feeling discomfort in social situations increases by 0.80 to 2.73, p &amp;lt; 0.001, (x) feeling of inferiority in relation to people who have children increases from 0.48 to 1.29, p &amp;lt; 0.001, (xi) feeling of anger due to infertility increases from -0.20 to -1.56, p &amp;lt; 0.001, and (xii) unpleasant effects of infertility treatment increases from 0.217 to 1.97, p &amp;lt; 0.001. Limitations, reasons for caution Lack of adequate opportunities to conduct face to face interview and lack of knowledge of the real state of the participants, concerning infertility or when involved in an assisted reproduction treatment (ART), knowledge of which treatment. Wider implications of the findings Long infertility duration is a significant risk factor affecting women's QoL and psychological health. It can be hypothesized that, besides the duration of infertility itself, repeated ART treatments related to longer infertility may compromise QoL, highlighting the importance of the psychological counseling for infertile patients, especially those with longer infertility. Trial registration number Not applicable

An explorative study to assess the psychosocial impact of infertility on female Infertile Patients

IntroductionThe primary aim of our study was to assess the psychoscial impact of infertility amongst female infertile patients. We selected infertile women visiting the gynaecological OPD of R.G.Kar Medical College and Hospital - one of the busiest and most reputed government hospitals in eastern India. Most of the research on psychological aspects on infertility has been done in the developed rich nations of the world, our study is one of the very few to have been conducted in a developing nation like India.ObjectivesIncidence of depression , psychopathology and anxiety in female infertile patients in comparison to control fertile group. Impairment in quality of life Impact of other variable factorsMethodsSource of data : RGK Medical College, Kolkata, IndiaSampling technique : Consecutive Random SamplingTools for data collection: Beck’s Depression Inventory, Beck’s Anxiety Inventory, SF36, SCL 90, Mini International Neuropsychiatric Interview, Self Reporting Questionnaire, Socio Demographic Proforma.Data Analysis: The data was collected and analyzed by means of descriptive and inferential statistics. Inferential statistics- Data analyzed by using SPSS. The relationship between continuous and binary explanatory variables with SF36, SCL 90, BDI and BAI scores were assessed using unpaired t test.ResultsStatistical analysis by independent t test shows significant increased levels of depression, anxiety, significant difference in psychopathology and quality of life in the 2 study groups.ConclusionsInfertility has a significant impact on psychosocial well being of infertile patients, Greater collaboration is required between psychiatrists, psychologists and infertility specialists to assist infertile couples.DisclosureNo significant relationships.

A study on the current state of Korean medicine treatment in infertile women: an observational multi-center study protocol

Objectives: The purpose of this study is to investigate the characteristics of female infertility patients who come to Korean medicine clinics and analyze the trends of Korean medicine treatment methods and the effects of female infertility by registry data.Methods: We are recruiting study participants from Korean medicine hospitals and clinics. If female infertility patients come, we will ask them to register for this study. After enrollment, we will collect demographic information, treatment methods, pregnancy results, adverse events, and treatment costs.Result: First, we will analyze the characteristics of patients, the status of the use of Korean medicine treatment interventions, the cost status of Korean medicine infertility treatment, and the delivery characteristics of pregnant women after Korean medicine treatment. Second, we will analyze the effectiveness of Korean medicine treatment. The primary outcome is clinical pregnancy rate, and secondary outcomes are 12-week pregnancy maintenance rate, degree of dysmenorrhea and premenstrual syndrome, stress level, and health-related quality of life score.Discussion: This study is the first observational multi-center study in Korea for female infertility. By establishing the registry, we are creating a resource that contains patient-reported outcome measures for female infertility. The registry is expected to provide valuable data for developing Korean medicine Clinical practice guidelines for female infertility.

An Explorative Study to Assess the Suicidal Risk Amongst Infertile Patients

AimsTo assess the psychosocial impact of infertility amongst female infertile patients including suicidal risk/ suicidal ideation in the given study population.MethodsA total of 300 women attending the Obstetrics and Gynecology out patients department of a tertiary hospital in Kolkata, India were selected by simple random sampling. 100 fertile women attending the routine ante natal clinic were selected as cases and 100 infertile women seeking fertility treatment were selected as controls. 100 women didn't follow up with the study. The following questionnaires were administered to both case and control group- BAI, BDI, SCL-90-R, SF-36, MINI and socio demographic proforma ; by trained clinic psychologist .The raw scores &amp; adjusted scores were analysed statistically by SPSS using the following tests, independent t test, chi square test and Z test.ResultsThe results of the MINI scale indicate that up to 25% of the infertile cohort suffer from suicidal risk/ suicidal ideation which is statistically significant in comparison to the control group.The other psychosocial parameters are also statistically significant in the case in comparison to the control population.ConclusionAlthough the psychosocial impact of infertility has been well researched and documented. Few studies have been conducted globally which assess suicidal risk amongst infertile patients.Our results corroborate earlier studies such as the Danish administrative population-based registry study by Trille Kristina Kjaer et al which found a causative link between infertility and suicidal risk.Further research is needed in this direction.

Whole-organ decellularization of the human uterus and in vivo application of the bio-scaffolds in animal models.

The aim of this investigation was to design a perfusion-based decellularization protocol to provide whole human uterine bio-scaffolds with preserved structural and componential characteristics and to investigate the in vivo properties of the decellularized tissues. Eight human uteri, donated by brain-dead patients, were decellularized by perfusion of sodium dodecyl sulfate (SDS) through the uterine arteries using a peristaltic pump. The bio-scaffolds were evaluated and compared with native human uterus regarding histological, immunohistochemical, structural, and bio-mechanical properties, in addition to CT angiographies to examine the preservation of the vascular networks. Subsequently, we obtained acellular patches and implanted them on uterine defects of female Wistar rats to investigate the bio-compatibility and regenerative potential of the bio-scaffolds. Finally, we performed immunostaining to investigate the potential role of circulating stem cells in recellularization of the implanted bio-scaffolds. The outcomes of this investigation confirmed the efficacy of the proposed protocol to provide whole human uterine scaffolds with characteristics and extra-cellular matrix components similar to the native human uterus. Subsequent in vivo studies demonstrated the bio-compatibility and the regenerative potential of the scaffolds and suggested a signaling pathway as an underlying mechanism for the regenerative process. To the best of our knowledge, this investigation provides the first efficient perfusion-based decellularization protocol for the human uterus to obtain whole-organ scaffolds. The outcomes of this investigation could be employed in future human uterus tissue engineering studies which could ultimately result in the development of novel treatments for female infertile patients.