Infertility In Relation Research Articles

O-161 #Infertility: a systematic review of information available on social media platforms

Abstract Study question How accurate, credible, reliable and readable is online information obtained from social media content in relation to the diagnosis and management of fertility problems? Summary answer Information available on social media regarding infertility often uses language that is inappropriate for a lay audience and lacks sufficient accuracy, credibility and reliability. What is known already Social media has become a popular source of information for people seeking guidance, advice and educational resources related to their own fertility journey. Social media can provide free and easily accessible information and can act as a space for community support to share real-world experiences. Many of the platforms delivering this information have not been verified and there is a growing concern regarding the accuracy of the content on these posts. A variation in expertise among content creators and the rapid spread of anecdotal experiences may contribute to the unreliability of information. Study design, size, duration Using real-time analytics software, the #infertility was tracked prospectively during National Infertility Awareness Week, an annual campaign organised by the National Infertility Association (USA) to raise awareness around infertility, on Twitter and Instagram platforms. During this one-week period, a total of 28,612 posts containing the #infertility was posted on Twitter and Instagram. Posts containing non-English language, commercial advertising and content related solely to the lived experience of infertility, for example, a patient’s blog, were excluded. Participants/materials, setting, methods Once screening was completed, 673 posts (310 on Twitter and 363 on Instagram) were identified as containing information pertaining to the diagnosis and management of fertility problems. Two independent researchers screened the included posts. Posts were evaluated using validated instruments across four domains, including assessments of 1) credibility (White Paper instrument) 2) quality (adapted DISCERN instrument) 3) accuracy (assessed by prioritized criteria developed in consultation with healthcare professionals and researchers) and 4) Readability (Flesch-Kincaid instrument). Main results and the role of chance A total of 28,612 posts, with a reach of 285,826,087 people were identified. Once screening had been completed, there were 310 posts on Twitter containing information pertaining to infertility, with 20,136 engagements and an overall reach of 75,184,476. For Instagram, 363 posts were identified as containing information pertaining to infertility, with 46,443 engagements. The most discussed topics included: 1) lifestyle interventions including nutrition and supplements, 2) polycystic ovarian syndrome, 3) endometriosis and 4) infertility in relation to COVID and the COVID vaccination programme. Only 87 Twitter posts (28%) had clear demonstration of credibility and of those posts the information contained within them was accurate 92% of the time. Of the remaining 72% of Twitter posts, no clear credentials were displayed, and the accuracy of those posts dropped to 34%. 139 Twitter posts (45%) appeared to have an undeclared Trial registration number Not applicable

Epidemiology of female infertility in Sonepat district of Haryana: a community based cross-sectional study

Background: Infertility is a global reproductive health problem and the prevalence rate increased by 0.37% per year for females. There are many such risk factors which are avoidable. Thus the purpose of the study is to identify and quantify the burden of infertility and associated risk factors for infertility. Methods: This observational community based cross-sectional study was conducted among 444 reproductive age group (18-49 years) women residing in district Sonepat, from August 2021 to May 2022. Simple random sampling technique was used to select the study subjects. The categorical data were analyzed statistically using Chi-Square test and Odds ratio with 95% confidence interval. Continuous variables were analyzed using independent t-test. Results: Out of 444 study population majority of women were fertile (88.7%), while 6.3% of women were secondary infertile and 5% women were primary infertile. Most women were aged between 30-39 years. The difference of occurrence of infertility in relation to time since marriage, male age at marriage, number of family members, thyroid, PCOD, tuberculosis and height were statistically significant. Conclusions: Almost all the factors came out to be responsible for infertility were modifiable. Awareness generation and provision of infertility care services at primary health care facilities will be of use in addressing infertility in Haryana.

Identification of novel homozygous missense and deletion mutations manifesting oligospermia infertility in Kashmiri population.

Human male infertility has a lot of known molecular components that have an accurate diagnosis, such as Y chromosome deletion and monogenic causes. Only 4% of all infertile males are diagnosed with genetic causes, while 60-70% of infertile men remain without an accurate diagnosis and are classified as unexplained. Oligospermia is a major cause of human male infertility. Its etiology and pathogenesis are linked to genetic abnormalities. The majority of genetic causes related to human male infertility remain unclear. Generally, we found a significant association between the specific type of disease and gender (p= 0.003), and the regression value (R2 ) for this association was 0.75. Association of the type of disease with body mass index was not significant (p= 0.34). There was no statistically significant difference (p= 0.40) among disease types with patients occupations. All explored mutations are listed for primary and secondary infertility in relation to the oligospermia condition. p.Arg286X is the outcome of a mismatch mutation in which the nucleotide change resulted in the substitution of Arg (arginine) amino acid with X (any amino acid) at position 286 in the Hyal3 gene of primary infertile patients having oligospermia. In primary infertile patients with the p.Arg286X mutation, a frameshift deletion mutation was also found just after the 25 nucleotide sequences of the Hyal3 genes of the second mutated exon. This deletion mutation was only detected in patients with primary infertility and was not found in people with secondary infertility or healthy controls. The other mutations in secondary infertile patients with oligospermia were: p.Lys168Ser, replacement of lysine (Lys) with serine (Ser) at position 168; p.Lys168The, replacement of lysine (Lys) with threonine (The) at position 168; p.His113X, substitution of histidine (His) with an unknown amino acid (X) at position 113; p.Pro162X, substitution of proline (Pro) with an unknown amino acid (X) at position 162; and p.Phe157X, phenylalanine (Phe) substitution with an unknown amino acid (X) at position 157. This study clarifies the site of novel mismatch and frameshift deletion mutations in the Hyal3 gene in primary infertile oligospermia patients.

Genetic predisposition to female infertility in relation to epithelial ovarian and endometrial cancers.

The associations between female infertility and epithelial ovarian cancer (EOC) or endometrial cancer (EC) have been reported in observational studies, but its causal relationship remains unknown. We intended to assess the causal effect of female infertility on EOCs and ECs using a two-sample Mendelian Randomization (MR) approach. Large pooled genome-wide association study (GWAS) datasets for female infertility (6481 cases and 68 969 controls), EOC (25 509 cases and 40 941 controls), and EC (12 906 cases and 108 979 controls) were derived from public GWAS databases and published studies. The Inverse Variance Weighted method, Weighted Median method, MR-Egger regression, and MR-Pleiotropy Residual Sum and Outlier test were adopted for MR analyses. Our results suggested that genetically predicted infertility was positively associated with the risk of EOC (OR = 1.117, 95% CI = 1.003-1.245, P = .045), but did not find a causal relationship between infertility and EC (OR = 1.081, 95% CI = 0.954-1.224, P = .223). As to the reverse direction, our study did not obtain evidence from genetics that EOCs (OR = 0.974, 95% CI = 0.825-1.150, P = .755) and ECs (OR = 1.039, 95% CI = 0.917-1.177, P = .548) were associated with an increased risk of infertility. This large MR analysis supported a causal association between female infertility and increased risk of EOCs, but did not find a causal relationship between infertility and ECs.

Reproductive Risk Factors Associated with Female Infertility in Sonepat District of Haryana: A Community Based Cross-Sectional Study.

Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. The aim of this study was to estimate the prevalence of infertility and its association with reproductive risk factors amongst women of reproductive age group (18-49 years) in district Sonepat, Haryana. This observational community-based cross-sectional study was conducted amongst 444 reproductive age group (18-49 years) women residing in district Sonepat, from August 2021 to May 2022. A simple random sampling technique was used to select the study subjects. After taking written informed consent, all the participants were interviewed using a pre-designed, pre-tested semi-structured questionnaire for desired information. Mean and standard deviation (SD) were calculated for quantitative data. Percentages and proportions were calculated for qualitative data. Out of 444 study population, majority of women were fertile (88.7%), while 6.3% of women were secondary infertile and 5% of women were primary infertile. Most women were aged between 30 and 39 years. The difference of occurrence of infertility in relation to genital discharge (P = 0.049), genital ulcer/sores (P ≤ 0.001), groin swelling (P ≤ 0.001), warts (P = 0.015), menstrual cycle duration (P ≤ 0.001) and menstrual flow amount (P = 0.048) was statistically significant. The mean age of menarche for the female with infertility was 14.34 years (standard deviation = 1.40). Almost all of the symptoms of sexually transmitted infection/reproductive tract infection were high amongst infertile females. Awareness generation about the preventable risk factors and provision of infertility care services at primary healthcare facilities will be of use in addressing infertility in Sonepat.

Polycystic Ovary Syndrome-Related Infertility Based on the Theory of “Liver and Kidney Homology”

Polycystic ovary syndrome (PCOS) is an endocrine disorder caused by hypothalamic-pituitary-ovarian (HPO) axis dysfunction. In the field of gynecology and reproduction, PCOS has emerged as both a research hot spot and a challenging area of study. According to Chinese medicine, this disease is related to kidney deficiency, phlegm and dampness obstruction, blood stasis and interconnection, Chong pulse impassability, the lack of Ren pulse, and the loss of uterine nourishment, all of which affect the normal development and maturation of eggs as well as the duration at which menstrual blood stores. In this paper, based on the theoretical basis of “liver collects blood, regulates the flow of qi, and is the master of drainage,” we explore the rationality of the treatment of this disease from the perspective of “liver and kidney have the same origin” and the development of PCOS-related infertility in relation to dysfunctional internal organs. We also explore the feasibility of treatment from the perspective of “liver and kidney homology,” expand the ideas for treatment, as well as develop and innovate the application of organ identification in PCOS in relation to infertility.

Is living in a region with high groundwater arsenic contamination associated with adverse reproductive health outcomes? An analysis using nationally representative data from India.

Exposure to groundwater arsenic via drinking water is common in certain geographies, such as parts of India, and causes a range of negative health effects, potentially including adverse reproductive health outcomes. We conducted an ecological analysis of self-reported rates of stillbirth, recurrent pregnancy loss, and infertility in relation to groundwater arsenic levels in India. We used a gridded, modeled dataset of the probability of groundwater arsenic exceeding 10μg/L (World Health Organization drinking water limit) to calculate mean probabilities at the district level (n=599 districts). A spatial integration approach was used to merge these estimates with the third India District-Level Health Survey (DLHS-3) conducted in 2007-08 (n=643,944 women of reproductive age). Maps of district level arsenic levels and rates of each of the three outcomes were created to visualize the patterns across India. To adjust for significant spatial autocorrelation, spatial error models were fit. District-level analysis showed that the average level of stillbirth was 4.3%, recurrent pregnancy loss was 3.3%, and infertility was 8.1%. The average district-level probability of groundwater arsenic levels exceeding 10μg/L was 42%. After adjustment for sociodemographic factors, and accounting for spatial dependence, at the district level, for each percentage point increase in predicted arsenic levels exceeding 10μg/L increased, the rates of stillbirths was 4.5% higher (95% confidence interval (CI) 2.4-6.6, p<0.0001), the rates of RPL are 4.2% higher (95% CI 2.5-5.9, p<0.0001), and the rates of infertility are 4.4% higher (95% CI 1.2-7.7, p=<0.0001).). While arsenic exposure has been implicated with a range of adverse health outcomes, this is one of the first population-level studies to document an association between arsenic and three adverse reproductive pregnancy outcomes. The high levels of spatial correlation suggest that further and targeted efforts to mitigate arsenic in groundwater are needed.

Infertility as inevitable: chronic lifestyles, temporal inevitability and the making of abnormal bodies in India

In seeking to explore the meaning of chronic and chronicity, the association with infertility is neither immediate nor evident. However, this paper explores this relationship by analyzing the idea of infertility in relation to chronicity. In the linkages that come forth the idea of chronic lifestyle emerging from certain ways of being and living, as well the imaginings associated with the chronic body become important nodes of exploring the relationship between infertility and chronicity. Most importantly, the role that time plays in marking the chronic state is seen to be especially potent in the practice of infertility treatment, and the narratives that emerge around its temporal inevitability. The rhetoric that marks the diagnosis and prescription of treatment is often based on the identification of the body as susceptible to reproductive decline and failure, due to the contingencies of modern living. This often translates into a more sustained involvement with ARTs, which may or may not fulfil the required desire for a child. In this paper I seek to analyse the ways in which practitioners of infertility medicine create an image of an affliction that borders on chronicity. In the process, I question the idea of both chronic diseases and chronicity by looking at how illness is imagined in narratives that IVF specialists create in public, and through the idea of a cure for infertility. By analysing data collected through ethnographic fieldwork, this paper aims to build on the idea of the chronic as inevitable within clinical discourse and practice.

Association between male infertility and male-specific malignancies: systematic review and meta-analysis of population-based retrospective cohort studies

To investigate the current evidence that correlates impaired male fertility with the risk of developing male-related malignancies. Systematic review and meta-analysis of population-based retrospective cohort studies. Not applicable. Men diagnosed with impaired fertility status and subsequently observed to determine incidence risk in developing testicular cancer (TCa) or prostate cancer (PCa). Not applicable. Pooled risk ratio (RR) differences among male factor infertility subjects compared with a fertile control population, and meta-regression analysis according to age at baseline, mean follow-up, range of study time, and year of publication. Six studies met the inclusion criteria and were critically examined. Four studies examined male infertility and TCa (n = 161,634; 174 TCa cases), and four examined infertility in relation to PCa (n = 183,950 men; 377 PCa cases) from 1963 to 2014. The pooled RR was 2.033 (95% confidence interval [CI], 1.66-2.48); heterogeneity: Q = 3.04 (degree of freedom [df] = 3); I2 = 1.55% for TCa and 1.68 (95% CI, 1.17-2.4); Q = 23.3(df = 3); I2 = 87.1% for PCa. Male infertility was associated with a subsequent risk of both TCa and PCa. Although the clinical significance of these findings remains uncertain, future studies should evaluate the underlying mechanisms to determine whether testis and prostate screening practices should be altered in men with male infertility. PROSPERO 167277.

Role of Rasayana in Female Infertility in Relation with PCOS

Role of Rasayana in Female Infertility in Relation with PCOS

In/Fertile Monsters: The Emancipatory Significance of Representations of Women on Infertility Reality TV

Reality TV is immensely popular, and various shows in this media genre involve a storyline of infertility and infertility treatment. Feminists argue that normative and constructed realities about infertility and infertility treatment, like those in reality TV, are central to the emancipation of women. Such realities are able to steer viewers' perceptions of the world. This article examines the emancipatory significance of representations of women on 'infertility reality TV shows'. While the women in these shows all have 'abnormal' qualities, we consider their portrayal as figurations of monstrosity. In the literature, monstrosity is understood as a way to challenge nonemancipatory norms by offering an alternative identity. Through a content analysis of seven reality TV shows, we identified four types of in/fertile monsters: the cyborg, the freak, the abject, and the childless. We show that these monsters are predominantly non-emancipatory as they all involve mechanisms of altering, excluding, or condemning infertility in relation to what is considered normal and acceptable womanhood. Therefore, at the end of this article, we make a plea for more diverse and emancipatory representations of infertile women in popular culture.

STRUCTURE OF UTERINE AND CERVICAL FACTOR OF INFERTILITY IN WOMEN OF EARLY AND ACTIVE REPRODUCTIVE AGE

Aim of research. The aim of this research is determining the structure and clinical peculiarities of uterine and cervical factor of female infertility in early and active reproductive age. Material and methods of research. A prospective outpatient and inpatient study of 222 patients was conducted in the Department of Gynecological Endocrinology of PI «SRI OG and P» in the period from 01.03.2015 to 01.03.2018. Conclusion. High frequency of combined forms uterine and cervical factor of infertility in relation to isolated forms (73,6 % versus 27,3 %, p &lt; 0,01) was revealed in infertile women at early and active reproductive age. High frequency of uterine myoma (34 %), endometrial polyps (26,4 %), endometrial pathology (22,6 %) and congenital anomalies of the uterus (11,3 %) was determined in the structure of uterine factor. Diseases with following frequency of occurrence were diagnosed in the combined form of uterine and cervical factor of infertility: chronic metroendometritis (77,6 %), hypoplasia of the uterus (46,7 %), cervical erosion (50,5 %), congenital abnormalities of the uterus and cervix (32,7 %), endometrial polyp (31,8 %) and pathology of the endometrium (22,4 %) which contributes to the increase of infertility rates.

Cumulative live birth rates after one ART cycle including all subsequent frozen-thaw cycles in 1050 women: secondary outcome of an RCT comparing GnRH-antagonist and GnRH-agonist protocols.

Are cumulative live birth rates (CLBRs) similar in GnRH-antagonist and GnRH-agonist protocols for the first ART cycle including all subsequent frozen-thaw cycles from the same oocyte retrieval? The chances of at least one live birth following utilization of all fresh and frozen embryos after the first ART cycle are similar in GnRH-antagonist and GnRH-agonist protocols. Reproductive outcomes of ART treatment are traditionally reported as pregnancies per cycle or per embryo transfer. However, the primary concern is the overall chance of a live birth. After the first ART cycle with fresh embryo transfer, we found live birth rates (LBRs) of 22.8% and 23.8% (P = 0.70) for the GnRH-antagonist and GnRH-agonist protocols, respectively. But with CLBRs including both fresh and frozen embryos from the first oocyte retrieval, chances of at least one live birth increases. There are no previous randomized controlled trials (RCTs) comparing CLBRs in GnRH-antagonist versus GnRH-agonist protocols. Previous studies on CLBR are either retrospective cohort studies including multiple fresh cycles or RCTs comparing single embryo transfer (SET) with double embryo transfer (DET). CLBR was a secondary outcome in a Phase IV, dual-center, open-label, RCT including 1050 women allocated to a short GnRH-antagonist or a long GnRH-agonist protocol in a 1:1 ratio over a 5-year period using a web-based concealed randomization code. The minimum follow-up time from the first IVF cycle was 2 years. The aim was to compare CLBR between the two groups following utilization of all fresh and frozen embryos from the first ART cycle. All women referred for their first ART cycle at two public fertility clinics, <40 years of age were approached. A total of 1050 subjects were allocated to treatment and 1023 women started standardized ART protocols with recombinant human follitropin-β (rFSH) stimulation. Day-2 SET was planned and additional embryos were frozen and used in subsequent frozen-thawed cycles. All pregnancies generated from oocyte retrieval during the first IVF cycle including fresh and frozen-thaw cycles were registered. Ongoing pregnancy was determined by ultrasonography at gestational week 7-9 and live birth was irrespective of the duration of gestation. CLBR was defined as at least one live birth per allocated woman after fresh and frozen cycles. Subjects were censored out after the first live birth. Cox proportional hazard model was used to evaluate the relative prognostic significance of female age, BMI, the number of retrieved oocytes and the diagnosis of infertility in relation to the CLBR. Baseline characteristics were similar and equal proportions of patients continued with frozen-thaw (frozen embryo transfer, FET) cycles after their fresh ART cycle in the GnRH-antagonist and GnRH-agonist arms. When combining all fresh and frozen-thaw embryo transfers from first oocyte retrieval with a minimum of 2-year follow-up, the CLBR was 34.1% (182/534) in the GnRH-antagonist group versus 31.2% (161/516) in the GnRH-agonist group (odds ratio (OR):1.14; 95% CI: 0.88-1.48, P = 0.32). Mean time to the first live birth was 11.0 months in the GnRH-antagonist group compared to 11.5 months in the GnRH-agonist group (P < 0.01). The total number of deliveries from all FET cycles where embryos were thawed were higher in the antagonist group 64/330 (19.4%) compared to the agonist group 43/355 (12.1%) ((OR): 1.74; 95% CI: 1.14-2.66, P = 0.01). The evaluation of prognostic factors showed that more retrieved oocytes were associated with a significantly higher CLBR in both treatment groups. For the subgroup of obese women (BMI >30 kg/m2), the CLBR was significantly higher in the GnRH-antagonist group (P = 0.02). The duration of the trial is a possible limitation with introduction of new methods as 'Freeze all' and 'GnRH-agonist triggering', but as these treatments were used in only few women, a systematic bias is not likely. Blastocyst culture of surplus embryos for freezing was introduced to both groups simultaneously, thereby minimizing the risk of bias. Furthermore, with a minimum of 2-year follow-up, a minority (<1%) still had cryopreserved embryos and no live birth at the end of the trial. The post hoc prognostic covariate analyses with multiple strata should be interpreted with caution. Finally, the physicians were not blinded to GnRH treatment group after randomization. With the improvement of embryo culture, freezing and thawing methods as well as a strategy of elective SET, CLBR until first live birth provides an all-inclusive success rate for ART. When comparing GnRH-antagonist and GnRH-agonist protocols, we find similar CLBRs, despite more oocytes being retrieved in the GnRH-agonist protocol. An unrestricted research grant is funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (MSD). The funders had no influence on the data collection, analyses or conclusions of the study. No conflict of interests to declare. EudraCT #: 2008-005452-24. ClinicalTrial.gov: NCT00756028. 18 September 2008. 14 January 2009.

Couple's infertility in relation to male smoking in a Chinese rural area.

Smoking is a well-known risk factor of reproductive health. However, the effect of paternal smoking on fertility has been less extensively examined. We conducted a cross-sectional study in a mountainous area of South-West China to assess the effect of male smoking on couples’ fertility. A total of 8200 couples aged 18–49 years in the study area were invited to participate in the study. An in-person interview was performed to collect demographic characteristics of the couples, and husbands’ life style factors including smoking and drinking habits. Information on time to pregnancy (TTP) was collected retrospectively. Infertility was defined as failure to achieve clinical pregnancy after regular unprotected intercourse for ≥12 months. Logistic regression model was used to estimate the association between male smoking and infertility. A total of 7025 couples were included in the final analysis. After adjusting for potential confounders, the couples were more likely to suffer from infertility if the husbands smoked (adjusted odds ratio [aOR] =1.28, 95% CI: 1.08–1.52) before the first pregnancy. After the analyses were performed according to husbands’ smoking duration, an increased risk started at a relatively longer smoking duration of 5–10 years (aOR = 1.58, 95% CI: 1.26–1.99) and a stronger association (aOR = 3.34, 95% CI: 2.45–4.56) was observed in the group of ≥10 years. Similar patterns were found for the number of cigarettes smoked per day and the total amount of cigarettes smoked. From our findings, we conclude that male smoking may have an adverse impact on couples’ infertility.

An Observational Study of Erectile Dysfunction, Infertility, and Prostate Cancer in Regular Cyclists: Cycling for Health UK Study

Background: Cycling is a popular sport among men. Despite its health benefits, fears have been raised regarding its effects on erectile dysfunction (ED), fertility, and on serum prostate-specific antigen levels. This study aimed to examine associations between regular cycling and urogenital abnormalities in men. Methods: A cross-sectional population study of 5,282 male cyclists was conducted in 2012–2013 as part of the Cycling for Health UK study. The data were analyzed for risk of self-reported ED, physician-diagnosed infertility, and prostate cancer in relation to weekly cycling time, categorized as <3.75, 3.75–5.75, 5.76–8.5, and >8.5 hours/week. Results: There was no association between cycling time and ED or infertility, disputing the existence of a simple causal relationship. However, a graded increase (p-trend=0.025) in the risk of prostate cancer in men aged over 50 years (odds ratios: 2.94, 2.89, and 6.14) was found in relation to cycling 3.75–5.75, 5.76–8.5, and >8.5 hours/week, respectively, compared to cycling <3.75 hours/week. Conclusions: These null associations refute the existence of a simple causal relationship between cycling volume, ED, and infertility. The positive association between prostate cancer and increasing cycling time provides a novel perspective on the etiology of prostate cancer and warrants further investigation.

Folic acid supplementation and IVF pregnancy outcome in women with unexplained infertility

Folic acid supplements are commonly used by infertile women which leads to a positive folate status. However, the effect of folic acid supplements on pregnancy outcome in women with unexplained infertility has not been well investigated. This study evaluated folic acid supplement use and folate status in women with unexplained infertility in relation to IVF pregnancy outcome. In addition, use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile, nonpregnant control women. Women with unexplained infertility used significantly more folic acid supplements and had higher median total folic acid intake from supplements compared with fertile control women (both P<0.001). Women with unexplained infertility also had significantly higher median plasma folate and lower median plasma homocysteine concentrations than fertile women (both P<0.001), but folic acid supplementation or folate status were not related to pregnancy outcome in women with unexplained infertility. In conclusion, folic acid supplementation or good folate status did not have a positive effect on pregnancy outcome following infertility treatment in women with unexplained infertility.Folate is one of the B vitamins which has been suggested to be related to infertility. Folic acid is an artificial form of folate which is commonly used in dietary supplements. Folic acid supplementation has been shown to increase folate concentrations and decrease concentrations of the amino acid homocysteine in the blood. Folic acid supplementation is commonly used by infertile women, but the effect on pregnancy outcome in women with a diagnosis of unexplained infertility has not been thoroughly investigated. In the present study, folic acid supplement use and folate status (concentrations of folate and homocysteine) in women with unexplained infertility were evaluated in relation to pregnancy outcome. In addition, the use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile control women. Our results showed that women with unexplained infertility used considerably more folic acid supplements and had higher total folic acid intake from supplements compared with fertile control women. Women with unexplained infertility had better blood folate and homocysteine concentrations than fertile women, but folic acid supplementation or folate status were not related to pregnancy outcome following the infertility treatment. In conclusion, high folic acid intake or good folate status did not increase the possibility of a birth of a healthy baby after infertility treatment in women with unexplained infertility.

P1.027 Risks Associated with Bacterial Vaginosis in Infertility Patients: A Systematic Review and Meta-Analysis

BackgroundSeveral studies have shown that bacterial vaginosis (BV) is particularly prevalent in patients with infertility, though it has not been firmly established which risks infertility patients with BV incur for...

Infertility, Pregnancy Loss and Adverse Birth Outcomes in Relation to Maternal Secondhand Tobacco Smoke Exposure

A substantial proportion of the etiology involved in female infertility and adverse pregnancy outcomes remains idiopathic. Recent scientific research has suggested a role for environmental factors in these conditions. Secondhand tobacco smoke (STS) contains a number of known or suspected reproductive toxins, and human exposure to STS is prevalent worldwide. Robust evidence exists for the toxic effects of active smoking on fertility and pregnancy, but studies of passive exposure are much more limited in number. While the association between maternal STS exposure and declined birth weight has been fairly well-documented, only recently have epidemiologic studies begun to provide suggestive evidence for delayed conception, altered menstrual cycling, early pregnancy loss (e.g. spontaneous abortion), preterm delivery, and congenital malformations in relation to STS exposure. There is also new evidence that developmental exposures to tobacco smoke may be associated with reproductive effects in adulthood. To date, most studies have estimated maternal STS exposure through self-report even though exposure biomarkers are less prone to error and recall bias. In addition to utilizing biomarkers of STS exposure, future studies should aim to identify vital windows of STS exposure, important environmental co-exposures, individual susceptibility factors, and specific STS constituents associated with female infertility and adverse pregnancy outcomes. The role of paternal exposures/factors should also be investigated.

Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis

Is bacterial vaginosis (BV) associated with the cause of infertility and does BV impinge on conception rates and early pregnancy loss following IVF? The incidence of BV is significantly higher among patients with tubal infertility when compared with patients with non-tubal infertility. BV does not impinge on conception rates but is significantly associated with preclinical pregnancy loss, though not with first trimester abortion. BV is prevalent in patients with infertility, as evident from studies across the world. This study is a meta-analysis of data on the prevalence of BV in women with infertility, the association between BV and the cause of infertility, and the associations between BV and conception rates and early pregnancy loss following IVF. The meta-analyses of the various topics involved different numbers of studies: prevalence of BV with infertility--12 studies, association with tubal infertility--3 studies and associations with conception rates--6 studies, with early preclinical pregnancy loss--2 studies and with clinical pregnancy loss--4 studies. Systematic literature searches of the electronic databases, PubMed, EMBASE, CINAHL, the Cochrane Library and ISI Web of Knowledge were performed up to September 2012. Studies were included if they reported on, at least, one of the following: prevalence of BV in infertility patients, association between BV and the cause of infertility, association between BV and conception rates with IVF or association between BV and early pregnancy loss. Studies were considered eligible if BV was diagnosed through standardized criteria like Nugent's criteria or Hay-Ison's criteria. In none of the studies, infertility as such was defined, but patients were described as unselected patients undergoing IVF. The estimated prevalence of BV (Nugent score >6) in infertile women is 19% [95% confidence interval (CI): 14-25%]. Abnormal microflora including BV and intermediate microflora (Nugent scores 4-10) occurs in 39% of the infertile patients (95% CI: 26-52%). BV is significantly more prevalent in women with infertility compared with antenatal women in the same population [OR (odds ratio) 3.32, 95% CI 1.53-7.20]. BV is significantly more prevalent in women with tubal infertility compared with women with other causes of infertility (OR 2.77, 95% CI 1.62-4.75). BV is not associated with decreased conception rates (OR 1.03, 95% CI 0.79-1.33). Similarly, none of the studies found an association between abnormal vaginal flora and conception rates following IVF treatment. BV is associated with a significantly elevated risk of preclinical pregnancy loss (OR 2.36, 95% CI: 1.24-4.51). BV is not associated with an increased risk of first trimester miscarriage (OR 1.20, 95%CI: 0.53-2.75). All included studies were centre based. In addition, publication bias cannot be ruled out. Furthermore, all estimates are obtained using an absolute minimum of studies. The standard error on the estimates is so large that it does not allow for any formal statistical conclusions regarding heterogeneity between the effects reported in different studies. It needs to be recognized that most inferences drawn in our study rely on a limited number of studies, potentially, endangering the generalizability of our findings. Moreover, all studies on cause of infertility in relation to BV included had a cross-sectional design and, therefore, do not allow for causal inferences. Still, there is strong circumstantial evidence that supports a causal link between BV and tubal infertility. Studies with a longitudinal design, on the other hand, strongly support a relation between BV and early pregnancy loss. Unfortunately, no study looked beyond first trimester fetal loss, although it is plausible that the high preterm birth rates with IVF are, at least, in part attributable to BV.

South African plants and male reproductive healthcare: Conception and contraception

Ethnopharmacological relevanceTraditional remedies from plants have been use to treat male reproductive related disorders for ages in South Africa. AimThis study reviewed the current status of medicinal plants used in male reproductive healthcare as well as their effectiveness as a mode of treatment. MethodologyA detailed literature search was done by consulting books, peer-reviewed papers, scientific databases such as Scopus, Science direct and PubMed, and Google scholars. Keywords such as aphrodisiacs, conception, erectile dysfunction, fertility, infertility and sterility in relation to medicinal plants were used during the search. Plant species were selected based on their traditional use in different aspects of male reproductive healthcare. ResultsA total of 61 plants species were found to be used in treating male impotency or as aphrodisiacs. However, only six species have been evaluated scientifically and these plants showed significant activities either in promoting conception by improving fertility and promoting erection or in contraception by decreasing sperm motility, virility and membrane integrity. ConclusionThe importance of herbal products in the treatment of male infertility and related sexual disorders is undeniable. Scientific evaluations of the six species have proved the empirical use of these plants in the improvement of male sexual disorders as well as validating their traditional uses.