Infertility Of Unknown Origin Research Articles

Immunomodulation of the Vaginal Ecosystem by Ligilactobacillus salivarius CECT 30632 Improves Pregnancy Rates among Women with Infertility of Unknown Origin or Habitual Abortions

In this study, the probiotic potential of Ligilactobacillus salivarius CECT 30632 was assessed, including properties specifically related with gynecological targets. This strain displayed co-aggregative and antimicrobial activity against a wide spectrum of vaginal pathogens while being respectful with the growth of vaginal lactobacilli. The strain produced a high concentration of lactic acid and displayed α-amylase activity when assayed in vitro. It showed a noticeable survival rate after exposition to conditions similar to those present in the human digestive tract and was adhesive to both vaginal and intestinal cells. Subsequently, their capacity to increase pregnancy rates among women with habitual abortion or infertility of unknown origin was studied. Administration of L. salivarius CECT 30632 (~9 log10 CFU) daily for a maximum of six months to these women was safe and led to a successful pregnancy rate of 67.5% (80% and 55% for women with repetitive abortion and infertile women, respectively). Significant differences in Nugent score, vaginal pH, and vaginal concentrations of lactobacilli, TGF-β, and VEFG were observed when the samples collected before the intervention were compared with those collected after the treatment among those women who got pregnant. Therefore, this strain can modulate the vaginal ecosystem and lead to better fertility outcomes.

The informativeness of the Johns-matrix image of laser autofluorescence in blood plasma films for early diagnosis of endometriosis associated with infertility

We used Jones-matrix images of protein networks of blood plasma films obtained from laser autofluorescence and determined the sensitivity, specificity, accuracy, and prognostication of positive and negative results. Our study aimed (1) to develop and substantiate new approaches for the diagnosis of endometriosis by improving the methods of Jones-matrix mapping of laser-induced auto-fluorescence and (2) to develop statistical approaches for analyzing the distribution of values of the true component of Jones-matrix images of blood plasma. Biological preparations were performed for two groups: 35 samples from control group 1 (women with infertility of unknown origin) and 85 samples from group 2 with endometriosis (women with infertility and endometriosis). The strength of the Jones-matrix method of autofluorescence mapping of plasma proteins taken from both groups was maximal for the decisions determined based on the calculation of the statistical moment of the 4th order, for statistical moment Z4, characterizing the sharpness of the peak distribution of the polycrystalline component of the plasma film. Comparison with the similar informative data of the Jones-matrix laser autofluorescence method of histological sections of the endometrial biopsy under conditions of blind endometriosis diagnosis revealed this method of analysis highly informative. Therefore, this technique can be used in screening studies to form a risk group.

Relationship between spermogram parameters, erectile dysfunction and risk of type 2 diabetes mellitus, assessed by FINDRISK questionnaire, in infertile men: the pilot study

Jūratė Pečeliūnienė¹,², Laura Asadauskaitė³, Marius Anglickis4, Irena Žukauskaitė5, Antanas Norkus6, Birutė Žilaitienė6 ¹Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Department of Internal Medicine, Family Medicine and Oncology; ²Vilnius University, Faculty of Medicine, Institute of Biomedical Sciences, Pharmacy Center; ³Šeškinė polyclinic; 4Vilnius City Clinical Hospital; 5Vilnius University Faculty of Philosophy, Institute of Psychology; 6Institute of Endocrinology, Lithuanian University of Health Sciences Abstract Background: As obesity becomes a global pandemic, the growing numbers of male infertility suggest that chronic non-infectious diseases due to metabolic disorders and lifestyle may have an effect on men’s reproductive health, unexplained infertility. Aim: to evaluate the relationship between the risk of type 2 diabetes mellitus (DM) in infertile men, assessed by FINDRISK, spermogram parameters and erectile dysfunction. Methods. The study included 18 men diagnosed with infertility of unknown origin. Patients were required to complete a FINDRISK questionnaire, sociodemographic data questionnaire. The results of their spermogram (motility, normality of form) were evaluated. Results. The FINDRISK results showed that 4 patients (22.2%) were not at risk for DM. Low risk (FINDRISK < 7) was found in 5 patients (27.8%), slightly increased (FINDRISK 7 – 11 points) – 3 patients (16.7%), moderate (FINDRISK 12 – 14) in 4 patients, high (FINDRISK 15 – 20) in 2 patients (11.1%). Calculated FINDRISK correlations with spermogram parameters showed that the higher the FINDRISK results, the lower the Mobility A. Assessing the correlations of different FINDRISK parameters with spermogram results – the average percentage of sperm in normal form in patients who exercise/otherwise move – 17%, the percentage of those who do not exercise – 5%. Eaters of vegetables, fruits – the average percentage of sperm in normal form was 17%, the average percentage of non-eaters was 5%. Those without a family history of DM had higher Mobility A, higher Mobility B, higher Mobility C and higher sperm counts were normal. Those with erectile dysfunction had higher FINDRISK scores and lower Mobility A scores. Conclusions. According to the FINDRISK questionnaire, men at higher risk for type 2 diabetes also have more pronounced changes in spermogram parameters and erectile dysfunction. More detailed research is needed to assess whether FINDRISK could be a suitable diagnostic tool for early diagnosis of infertility risk. Keywords: infertility, men, FINDRISK, spremogram, erectile dysfunction.

Is There a Relevant Clinical Impact in Differentiating Idiopathic versus Unexplained Male Infertility?

Overall, male factor infertility (MFI) accounts for up to 50% of etiologies of couple's infertility, with almost 30% of MFI cases being idiopathic in nature. Idiopathic MFI does not support a tailored treatment work-up in clinical practice. To investigate rates of and characteristics of men presenting for idiopathic versus unexplained primary infertility as compared with same-ethnicity, age-comparable fertile men. Demographic, clinical and laboratory data from 3,098 primary infertile men consecutively evaluated were analyzed and compared with those of 103 fertile controls. Idiopathic male infertility (IMI) was defined for abnormality at semen analysis with no previous history of diseases affecting fertility and normal findings on physical examination and genetic and laboratory testing. Unexplained male infertility (UMI) was defined as infertility of unknown origin with completely normal findings at semen analysis. Descriptive statistics and logistic regression models tested the association between clinical variables and idiopathic infertility status. Overall, 570 (18.5%) and 154 (5.0%) patients depicted criteria suggestive for either IMI or UMI, respectively. Groups were similar in terms of age, BMI, CCI, recreational habits, hormonal milieu, and sperm DNA fragmentation indexes. Conversely, testicular volume was lower in IMI (p<0.001). Vitamin D3 levels were lower in IMI vs. UMI vs. fertile controls (p=0.01). At multivariable logistic regression analysis only vitamin D3 deficiency (OR, 9.67; p=0.03) was associated with IMI. Characteristics suggestive for IMI versus UMI were observed in almost 20% and 5% of men, respectively. Overall, clinical differences between groups were slightly significant and certainly not supportive of a tailored management work-up. Current findings further support the urgent need of a more detailed and comprehensive assessment of infertile men to better tailoring their management work-up in the everyday clinical setting.

Comparative characteristics of patients with infertility when applying melatonin in complex preparation for assisted reproductive technologies

Оbjective of the study was to conduct a retrospective comparative characterization of patients with infertility who took or did not take melatonin with assisted reproductive technologies (ART).Materials and methods. In our study, we examined 89 women. The first (control) group included 13 healthy women oocyte donors who got pregnant on their own and gave birth to their own healthy children, the second group - 33 patients with infertility, who took 3 mg of the preparation "Vita-melatonin" produced by "Kyiv Vitamin Plant" at the same time before bedtime, two weeks before and during ovulation stimulation, the third group - 43 patients with infertility who did not take melatonin preparation before and during ovulation stimulation. There were no women who worked night shifts among the patients. Medical documentation of women of the control group and those with infertility, data of gynecological, ultrasound examination, hormones blood were analyzed. Ultrasound examination of the pelvic organs was performed on all patients with the device "Mindray DC-80 X-Insight", and measurements were performed using a transvaginal sensor. The thickness and structure of the endometrium were evaluated, and the number of antral follicles (NAF) ranging in size from 2 to 10 mm was counted in each ovary. All patients were tested for serum levels of the anti-mullerian hormone (AMG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), progesterone (P), thyroid-stimulating hormone (TSH), triiodothyronine (T4).Results. The average age of women in the first (control) group was 27.08 ± 12.38 years, the second (taking melatonin) - 33.12 ± 8.18 years, the third (not taking melatonin) - 30.95 ± 7.07 years &gt; 0.05), i. e. the age of the patients of the examined groups was equal. It should be noted that in the studied patients of both groups, the occurrence of primary infertility exceeded secondary infertility 2.7 times in the second group (p &lt; 0.05) and 1.7 times in the third (p &lt; 0.05). Infertility factors such as reduced ovarian reserve, habitual miscarriage and infertility of unknown origin were more common in patients of the second group, and endometriosis, tubal factor and male factor in the third, although the difference was not significant. The available extragenital pathology did not differ in the patients of the examined groups. The number of antral follicles was significantly higher in both ovaries of women in the control group compared with patients of the second and third groups. While the thickness of the endometrium did not differ significantly in groups, although in women of the control group it was slightly less. Regarding the study of hormonal status, it should be noted that we did not find a significant difference in the levels of hormones in the blood of women we examined. Exceptionally, there was a significant difference (p &lt; 0.001) in progesterone content between the second (0.62 ± 0.052 nmol/l) and third (181.63 ± 13.87 nmol/l) groups. Also, the patients of the third group had significantly (p &lt; 0.05) higher levels of FSH in blood (8.25 ± 0.63 mUn/ml) compared with the control group (4.93 ± 0.69 mUn/ml).Conclusions. The examined women in the control group, as well as infertility patients who received melatonin two weeks before the expected menstruation and during ovulation stimulation, and infertility patients who did not receive this preparation in similar programs, did not differ in age, occurrence of primary and secondary infertility, the factor that led to infertility, concomitant extragenital pathology, ovarian reserve and hormone levels of the reproductive panel. That is, they were equal in our study.

P–726 Analysis of the results of conjugal artificial insemination in a third-level public health hospital

Abstract Study question Our objective was to compare the results and costs between conjugal intrauterine insemination (IAC) and in vitro fertilization (IVF) in a third-level public health hospital. Summary answer The direct estimated cost for achieving a clinical pregnancy was € 3808.24 for IAC and € 14,195.88 for IVF. What is known already There is a belief among patients, professionals, and media in favor of the results offered by IVF. Studies on the results, risks, complications and costs are difficult to understand, thus making IVF the most widespread and in demand reproduction technique among fertility clinics. In 2013 the National Institute of Health and Care Excellence conducted a study comparing artificial insemination using 25 mg of clomiphene citrate vs. expectant management of sterility, without finding significant differences. After this, in their guide they recommended the elimination of insemination from the couples’ treatment protocols, proposing to replace it with three cycles of IVF. Study design, size, duration This is a retrospective observational study of a total of 1384 conjugal insemination cycles carried out in our center between 2007–2019 and 646 cycles of in vitro fertilization, intracytoplasmic injection (ICSI) or mixed. Participants/materials, setting, methods All IAC were included. IVF cycles analyzed were those made under the diagnose of tubal factor, to homogenize the samples. The calculation of the direct costs of each technique has been carried out by the collection of the costs of these procedures from the registry of public costs of the Andalusian public health system. The pharmacy spending in an average cycle has been obtained from the public prices of prescriptions made in our service. Main results and the role of chance The direct estimated cost for achieving a clinical pregnancy with the cumulative clinical pregnancy rate found in our sample was € 3808.24 for IAC and € 14,195.88 for IVF. The additional cost of a pregnancy achieved by IVF compared to one achieved by IAC was € 10,387.64. The mean age of the patients was higher in the group undergoing in vitro fertilization treatment (34.41 years) compared to those undergoing artificial insemination treatment (32.18 years), the differences between both being statistically significant ( p &amp;lt; 0.005). We also found statistically significant differences between the clinical pregnancy rate (12.2% in the group that underwent an AI and the 25.8% in which an IVF was performed) and the live newborn rate between both groups (8.7% in the group that underwent AI and 16% in which IVF was performed), both being higher for the group subjected to in vitro fertilization. In the twin pregnancy rate, we also found significant differences (p 0.005) between both groups, being 6.8% in the patients undergoing IVF compared to 0.8% in the inseminations. Limitations, reasons for caution Regarding the costs per cycle, indirect costs of these have not been taken into account, such as values in the cost of pregnancy and delivery of single or multiple pregnancies, or costs of complications derived from the techniques (ovarian hyperstimulation syndrome, fetal reductions, terminations for other reasons, etc.) Wider implications of the findings: The recommendations made by the NICE promote IVF treatment to couples with infertility of unknown origin. In our opinion, this recommendation should be subjected to a more extensive cost-effectiveness analysis of both techniques, given that IVF requires a considerably higher investment of resources, finding results not so different as expected. Trial registration number Not applicable

O-151 Detailed characterization of infertile men with idiopathic versus unexplained infertility: a single-center experience

Abstract Study question We aimed to investigate the rate of and the clinical characteristics of men with idiopathic versus unexplained infertility from a cohort of white-European men. Summary answer Approximately 20% and 5% of men evaluated for primary couple’s infertility depicted characteristics suggestive for idiopathic and unexplained infertility, respectively. What is known already Male factor infertility (MFI) can be associated with clinical, hormonal and genetic diseases, but MFI is idiopathic in almost 30% of cases. Study design, size, duration Data from 3098 infertile men (according to WHO definition) consecutively evaluated between 2003-2020 at a single academic centre were analysed and compared with those of 103 fertile controls. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Idiopathic infertility was defined for pathological semen analysis but normal physical examination and endocrine, genetic and biochemical laboratory testing. Unexplained infertility is defined as infertility of unknown origin with normal sperm parameters. Participants/materials, setting, methods Testicular volume (TV) was assessed with a Prader’s orchidometer. Serum hormones and sperm DNA fragmentation index (SDF) were measured in every patient. Vitamin D3 (VitD) deficiency was considered for vitD levels &amp;lt;20 ng/mL. Semen analyses were based on the 2010 WHO reference criteria. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Main results and the role of chance Overall, 570 (18.5%) and 154 (5.0%) patients depicted criteria suggestive for either idiopathic or unexplained primary infertility, respectively. Groups were similar in terms of age, BMI, CCI, recreational habits, circulating serum hormones and SDF. Testicular volume was lower in men with idiopathic vs. unexplained infertility [median (IQR) 20 (15-25) vs. 20 (17-25); p &amp;lt; 0.001]; more idiopathic than unexplained infertile men depicted TV &amp;lt; 15ml (23.4% vs. 12%; p &amp;lt; 0.01). Similarly, vitD levels were lower [22 (17-28) vs. 27 (21-42) ng/mL; p &amp;lt; 0.001] in idiopathic vs. unexplained infertile men, with a higher rate of pathologic VitD levels in the same group (42.1% vs. 10%; p = 0.04). When compared to fertile controls, groups were similar in terms of age, BMI, CCI and serum hormones values. TV was larger in fertile controls than idiopathic and unexplained infertile men (all p &amp;lt; 0.01). At multivariable logistic regression analysis only vitD deficiency (OR 8.1, p = 0.03) was found to be associated with idiopathic infertility after accounting for age, BMI, testosterone values and TV. Limitations, reasons for caution The small number of fertile controls may raise the possibility of biases. Wider implications of the findings Idiopathic and unexplained infertility were identified in approximately 20% and 5% of men evaluated, respectively. Idiopathic infertile men showed lower TV and lower vitD values compared to men with unexplained infertility. Future studies are needed to develop a more tailored management to these difficult MFI cases. Trial registration number .

РОЛЬ УРОГЕНИТАЛЬНЫХ ИНФЕКЦИЙ В ПАТОГЕНЕЗЕ РАЗВИТИЯ МУЖСКОГО БЕСПЛОДИЯ

Вопрос бесплодия на сегодняшний день остается актуальным как в Казахстане, так и во всем мире. На основании данных Всемирной Организации Здравоохранения, ежегодно число бесплодных пар составляет 4-5% от всеобщей популяции. Причин бесплодия - множество. Но одним из острых и первоочередных причин данной патологии является мужское бесплодие, частота возникновения которого составляет 48,8% от общего количества случаев. [1] По данным мировых исследований, в процентном соотношении причины мужского бесплодия составляют: бесплодие неясного генеза - 31,2%, варикоцеле - 14,7%, эндокринные нарушения - 8,45%, инфекции урогенитального тракта - 8,3%, иммунологические факторы - 4,8%, опухоли яичек - 1,17%. [2] The issue of infertility today remains relevant both in Kazakhstan and around the world. The World Health Organization accounts for 4-5% of the general population annually. There are many reasons for infertility. One of the acute and primary causes of this pathology is male infertility, the incidence of which is 48.8% of the total number of cases. According to world studies, the percentage of the causes of male infertility are: infertility of unknown origin - 31.2%, varicocele - 14.7%, endocrine disorders - 8.45%, infections of the urogenital tract - 8.3%, immunological factors - 4 , 8%, testicular tumors - 1.17%. Goal. Establishing the role of individual infections and their association of the urogenital tract in the development of male infertility. Materials and methods. The study was carried out on the basis of the GKP on the REM "City polyclinic No. 26" in Almaty. A retrospective analysis of individual cards of 538 men from 21 to 45 years old who consulted urologists with complaints of urination, pain and discomfort in the anogenital region and above the bosom from January to December 2020 was carried out. The patients were divided into two groups: the first group - 258 men suffering from infertility, and who have other causes of infertility, the second - 280 men with normal fertility. Diagnostic methods were selected: bacterial culture of urine and scraping from the urethra, PCR of urogenital infections. Result: The total dissemination of the urethra in patients of the first group is 3 times higher than in men of the second group. However, we were interested not only in the general dissemination and types of pathogens, as according to the literature [1,2] the most aggressive chlamydia trachomatis and ureoplasm. In our frequency of occurrence of chlamydial infection in both groups was 153 (59.3%) and 23 (8%); mycoplasma - 148 (57.3%) and 45 (16%); ureaplasma - 137 (53.1%) and 63 (22.5%); Candida - 98 (37.9%) and 35 (12.5%); Trichomonas - 87 (33.7%) and 48 (17.1%); gardnerella - 94 (36.4%) and 56 (20%) people, respectively. Conclusions. Urogenital tract infections are the main reason people see a doctor. Infections are one of the factors in the development of infertility in men. For infection of the urogenital tract, PCR is the most sensitive and accurate compared to urine culture and urethral scrapings. The total dissemination of urogenital infection in the group of men with infertility is 46.3%, in comparison with the group of men with a normal norm in whom the percentage of STIs is 16%, indicates a direct effect of urogenital infection on the development of the male population. Along with the revealed, as the main factor of influence of the reproductive system, chlamydia trachomatis 59.3%, mycoplasma 57.3%, ureoplasm 53.1%, which moved to the second and third place in the development of infertility in the studied men. This factor and methods of treatment will be studied in studies.

Application of Ligilactobacillus salivarius CECT5713 to Achieve Term Pregnancies in Women with Repetitive Abortion or Infertility of Unknown Origin by Microbiological and Immunological Modulation of the Vaginal Ecosystem.

In this study, the cervicovaginal environment of women with reproductive failure (repetitive abortion, infertility of unknown origin) was assessed and compared to that of healthy fertile women. Subsequently, the ability of Ligilactobacillus salivarius CECT5713 to increase pregnancy rates in women with reproductive failure was evaluated. Vaginal pH and Nugent score were higher in women with reproductive failure than in fertile women. The opposite was observed regarding the immune factors TGF-β 1, TFG-β 2, and VEFG. Lactobacilli were detected at a higher frequency and concentration in fertile women than in women with repetitive abortion or infertility. The metataxonomic study revealed that vaginal samples from fertile women were characterized by the high abundance of Lactobacillus sequences, while DNA from this genus was practically absent in one third of samples from women with reproductive failure. Daily oral administration of L. salivarius CECT5713 (~9 log10 CFU/day) to women with reproductive failure for a maximum of 6 months resulted in an overall successful pregnancy rate of 56%. The probiotic intervention modified key microbiological, biochemical, and immunological parameters in women who got pregnant. In conclusion, L. salivarius CECT5713 has proved to be a good candidate to improve reproductive success in women with reproductive failure.

A clinical case of sulodexide usage in infertility of unknown origin

The article shows the possible use of sulodexidi in a patient with primary infertility of unknown origin associated with an excess of the plasminogen activator type 1 inhibitor. This method illustrates the possibility of pregnancy when taking sulodexidi at the stage of pregravidar preparation in a woman with hypofibrinolysis.

Assessment of Insulin Resistance and Serum Levels of Irisin in Patients with Idiopathic Infertility

According to the World Health Organization (WHO), the definition of infertility is ‘the inability of a sexually active, non-contracepting couple to achieve spontaneous pregnancy in one year. The category ‘unexplained male infertility’ (UMI) is reserved for infertile men with infertility of unknown origin with normal semen and in which female infertility factors have been ruled out. Some cases of unexplained male infertility could be due to IR, leading to hypogonadism and other metabolic features. To evaluate serum level of irisin in patients with idiopathic infertility. Serum irisin concentrations were measured in 30 male patients with idiopathic infertility, between the ages of 25 and 50 years and 20 healthy controls using enzyme-linked immunosorbent assay (ELISA). Serum levels of irisin in male patients with idiopathic infertility were found to be lower than in healthy controls (p=0.001). Decreased serum irisin probably reflect the role of irisin in the diagnosis of idiopathic infertility.

Empiric medical therapy with hormonal agents for idiopathic male infertility.

Introduction:Infertility affects approximately 15% of all couples, and male factor contribute to up to 50% of cases. Unfortunately, the cause of male infertility is unknown in about 30% of these cases. Infertility of unknown origin is classified as idiopathic male infertility when abnormal semen parameters are present. Despite not having a definable cause, these men may respond to treatment. This review focuses on the use of empiric hormonal therapies for idiopathic male infertility.Methods:A detailed PubMed/MEDLINE search was conducted to identify all publications pertaining to empiric use of hormonal therapies in the treatment of idiopathic male infertility using the keywords “idiopathic,” “male infertility,” “empiric treatment,” “clomiphene,” “SERM,” “gonadotropin,” “aromatase inhibitor,” and “androgen.” These manuscripts were reviewed to identify treatment modalities and results.Results:Gonadotropins, androgens, aromatase inhibitors, and selective estrogen receptor modulators (SERMs) have all been used with varying results. The studies on these treatments are of variable quality. The most well-studied agents are the SERMs which show a modest increase in semen parameters and pregnancy rates. Aromatase inhibitors are most effective in non-idiopathic patients. Gonadotropin treatment is limited by their inconvenience and relative ineffectiveness in this population. Testosterone suppresses spermatogenesis and should not be used to treat infertility.Conclusion:Gonadotropins, SERMs, and aromatase inhibitors may improve semen parameters and hormone levels in men with idiopathic infertility with the best results from SERMs. Testosterone should never be used to treat infertility. Large multicenter randomized controlled studies are needed to better determine the success of empiric use of hormonal therapy on pregnancy rates.

Uterine junctional zone thickness in infertile women evaluated by MRI.

To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in infertile and healthy nulliparous women at different locations in the uterine wall during the menstrual cycle by magnetic resonance imaging (MRI). We performed pelvic 1.5T MRI (T2 -weighted turbo spin echo sequences) on 28 infertile women: 5 with infertility of unknown origin, 12 anovulating, and 11 on ovarian stimulation therapy (mean age 28.5, 30.8, and 29.3 years, respectively); and a control group consisting of 18 healthy nulliparous volunteers (mean age 26.4 years). The women with unknown infertility origin and the control group underwent MRI investigations during their follicular, ovulatory, and luteal phase. The JZ and outer myometrial thicknesses were measured at six locations in the uterine wall: anterior and posterior wall of the isthmus, midcorpus, and fundus. The JZ in the anovulating women at the posterior wall of the isthmus (4.2 mm) was significantly thicker compared to the control group (3.2, 3.0, and 2.9 mm, in respectively the three menstrual phases) (P = 0.027). The outer myometrium in the anovulating women was significantly thicker at all measured locations (average 11.5 mm) in comparison to the control group (8.1, 8.0, and 8.5 mm, in respectively the three menstrual phases) (P < 0.050). The infertile women on ovarian stimulation therapy showed a significantly thicker outer myometrium at the anterior wall (isthmus, midcorpus, and fundus) (P < 0.050). The results indicate that a thickened JZ, and especially a thickened outer myometrium, might be associated with infertility. 1 J. Magn. Reson. Imaging 2017;45:926-936.

Unexplained male infertility

ObjectiveTo highlight the concept of unexplained male infertility and discuss the potential causes and its proper management.DesignReview of literature.ResultsMale infertility of unknown origin is a condition in which fertility impairment occurs spontaneously or due to an obscure or unknown cause. I

Major Depression in Unexplained Infertility

Although a potential relationship between depression and infertility has been described throughout history, only recently has this topic been subjected to systematic investigation, and the literature is often confusing. The present study uses well-established structured psychiatric interviews - Structured Clinical Interview for DSM-III-R (KID), Beck and Family History-Research Diagnostic Criteria (Fh-RDC) - to investigate the prevalence of major depression in a small group of women with infertility of unknown origin, and a community control sample. There were significantly more women with current depression or a history of depression in the infertile group, and of these women the majority experienced their first depressive episode prior to their diagnosis of infertility.

Spermatozoal antibodies in cervical mucus

The indirect immunofluorescent technique performed on spermatozoa provides a suitable method for detecting spermatozoal antibodies in cervical mucus. Blood sera and preovulatory cervical mucus samples from 13 women with infertility of unknown origin were tested extensively with this technique. Spermatozoal antibodies in cervical mucus were detected in 3 out of 13 patients. The specificity of these antibodies was shown to be IgA in two cases and IgG in the third case. One IgA antibody was also present in the blood serum of this particular patient, however in a low titer (1:4). Blood serum from the patient with an IgG antibody in cervical mucus contained the same antibody in a high titer (1:64). The results werecompared to the concentration of immunoglobulins in cervical mucus. In view of present knowledge our data are consistent with the following theories about circulating spermatozoal antibodies. IgA antibodies result from local immunization in the female genital tract and may leak to the general circulation. IgG and IgM antibodies result mainly from general immunization. IgG antibodies may diffuse to female genital tract secretions when present in a sufficiently high concentration. IgM antibodies are rarely found in the female reproductive tract.

A comparison of screening tests for anti-sperm activity in the serum of infertile women.

2 tests of humoral antisperm activity the sperm microagglutination (SMA) and sperm immobilization (SI) tests were used to study females of 196 infertile couples 43 of whom had known organic infertility with the remaining 153 having infertility of unknown origin; 50 pregnant women served as controls. The SMA test revealed only small differences in incidence of positive SMA among all 3 groups but the SI test showed clear differences when patients with unexplained infertility were compared with patients with major organic infertility or with controls. There was no significant correlation between the 2 tests. Comparison of the present results with those of other workers suggests that the SI test is the most reliable single method for the detection of humoral antisperm activity with possible clinical significance.(AUTHORS MODIFIED)