Infertility Rates Research Articles

O-117 Advances in PGT diagnostics - technologies beyond copy number

Abstract Genetic abnormalities are well recognised as the main factor contributing to the high rate of infertility, pregnancy loss and congenital abnormalities in humans. A prime example of this can be seen from recent studies showing that embryos identified as uniformly aneuploid following PGT-A have little to no reproductive potential. However, embryos shown to have no gross chromosomal abnormalities after PGT are not a guarantee of healthy pregnancy and many other undetected genetic issues are likely to influence embryo competence. Developments in both sample preparation and methods for DNA analysis are driving ever-increasing data yield from PGT platforms, permitting not only DNA quantitation, but also allowing qualitative evaluation of genotyping data in parallel. This opens the door to the possibility of overcoming some of the previous limitations of PGT, leading to a more comprehensive assessment of the genetic health and reproductive potential of embryos. How to use this increasing amount of information, and if it can tangibly improve test accuracy and clinical outcomes, remains open to debate. There is, for instance, no consensus on how to interrogate genotyping data for better distinction of clinically relevant aneuploidy as well as genome wide (ploidy) abnormalities and exogenous DNA contamination, which could impact the correct reporting of PGT results. There is also no consensus on the potential benefit of genotyping data to be used for the accurate distinction of meiotic recombination by linkage analysis, nor for fingerprinting of embryos to identify rare, but catastrophic, lab error events as a routine part of treatment. Finally, there is no clear path on how to utilise these improvements in embryo genotyping, to detect sub-chromosomal de novo genetic abnormalities that could impact embryo viability beyond the scope of current testing for chromosomal abnormalities alone. The aim of this presentation is therefore to focus on the current state of the ART and address the current and potential future uses of genotyping in PGT. Topics covered will include identification of biopsy sample contamination to determine the truth from the noise, through to how we can rescue embryos by utilising PGT as a molecular fertilisation check and how fingerprinting of embryo can be an invaluable tool in the clinic. The origin of aneuploidy will be explored and how genotyping is reshaping our understanding of aneuploidy landscape of the preimplantation embryo. From a more basic science perspective, the potential of genotyping to identify meiotic recombination will be discussed and how this fundamental element of human reproduction could be an important biomarker for reproductive competence. Lastly future perspectives on how the evolution of PGT technologies can bring us closer to the accurate detection of de novo genomic changes will be explored and how this is taking PGT-A beyond just aneuploidy detection. It is no secret that PGT for embryo selection continues to be a controversial area of reproductive medicine, and the field of PGT-A especially continues to show disquieting inconsistency in data analysis and reporting. This new era of genotyping brings with it information that can be used as a standardization tool helping to focus and facilitate improvements in the field of PGT for better and more consistent clinical reporting and outcomes.

P-334 Hysterosalpingo-Contrast-Sonography: a key step in the female infertility workup?

Abstract Study question The main objective of this study is to estimate the possibility of offering Hystero-Salpingo-Contrast-Sonography (HyCoSy) as a first-line diagnosis test in the female infertility exploration Summary answer HyCoSy represents a key step in decision-making regarding subsequent steps in infertility diagnosis and treatment What is known already In this age of rising rates of infertility; the evaluation of the fallopian tubes and the endometrial cavity in an essential part of the infertility investigation. Traditionally hysterosalpingography has been used to evaluate tubal patency; but it has many disadvantages; laparoscopy and hysteroscopy are at present considered as the gold standard techniques for tubal and endometrial cavity assessment, respectively. Hysterosalpingo- Contrast –Sonography or HyCoSy was introduced over 20 years ago since 1981; it allows to gynecologist to evaluate the fallopian tubes the uterus and the ovaries with only one ultrasound in the office. Study design, size, duration During two years, one hundred and sixty-seven patients with a context of female infertility with normal spermogram were included in our prospective and descriptive study, Participants/materials, setting, methods Our patients underwent: a Hysterosalpingography (HSG), a Hysteroscopy, a Laparoscopy and as part of our study: a Hystero-Salpingo-Contrast-Sonography (HyCoSy), a comparison was made between the tubal and uterine parameters found by the HyCoSy with those of the HSG after comparison with the data shown by the Gold Standard techniques: Laparoscopy and Hysteroscopy, also we evaluated the failure rate, its duration, its tolerability, its cost, its complications, its limitations and the rate of post-HyCoSy pregnancies. Main results and the role of chance The technique was impossible in 4 patients, so a failure rate of 2.4%, the average duration of the procedure was 17+/-1 min (10-30 min), generally well tolerated, pain assessment found an average of 3 on the VAS (2-4), the rate of all minor complications was 8.85% at 5 min and 3.06% at 15 min, no case of allergy to the contrast product was noted. Following the 4 cases of failures the comparison was only possible in 163 patients, after comparing the data with the GOLD STANDARDS For the tubal permeability we noted almost perfect concordances between the three techniques HyCoSy, HSG and laparoscopy, with a concordance of 0.87 between HyCoSy versus laparoscopy (p value at 0.34) and 0.85 between HSG versus laparoscopy (p value at 0.18), For the uterine cavity evaluation the comparison of hydrosonography(step one of our technique) to hysteroscopy finds an almost perfect agreement at 0.88 (p value at 0.71) in contrast to a low agreement at 0.27 between the HSG and the gold standard (p value <0.02). Our technique also allows us to carry out a morphological and functional assessment of the ovaries as well as a study of the peritoneal cavity. Limitations, reasons for caution A disadvantage of this technique is the rate of false results, regardless of the contrast product used. However, it is important to note that these errors also occur when using an HSG, or during a Laparoscopy.A review of the literature allows us to identify the causes and identify solutions. Wider implications of the findings It is important to work more on improving exploration techniques by working to ensure that they are as precise, tolerable, of certain safety and as economical as possible and why not with a therapeutic effect. Trial registration number not applicable

Effect of Body Mass Index (BMI) on In Vitro Fertilization (IVF) Outcomes in Women with Polycystic Ovary Syndrome (PCOS)

Objective: Obesity is known to have negative impaction on reproductive health and ovarian functions. It may alter endocrine axis and quality of oocytes, and indirectly effect the success of in vitro fertilization (IVF). Methods: Medical records of patients with polycystic ovary syndrome (PCOS) who were applied for IVF between 2018 and 2024 were reviewed. Demographics, indications for reproductive treatment, IVF outcome parameters and the factors contributing to morbidity of treatment were recorded. Student’s test with one-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used to compare the variables. P<0.05 was considered statistically significant. Results: 186 patients with PCOS were divided as lean (BMI<25 kg/m2, control), overweight (BMI 25-30 kg/m2) and obese (BMI>30 kg/m2). Mean ages and primary infertility rates were similar (both, p>0.05), but duration of infertility was longer in overweight and obese patients (p<0.05). Although patients with higher BMI required more induction dose for the cycle, number of retrieved oocytes did not change significantly, with achieved chemical and clinical pregnancy (each, p>0.05). Moreover, fertilization rates of transferred oocytes and rates of adverse outcomes during pregnancies were similar in the groups (each, p>0.05). Although overweight and obese patients with PCOS required more gonadotropin induction for IVF cycle (2311 vs 1920 vs 1752 IU, respectively, p<0.05), the numbers of metaphase II and fertilized oocytes were seen to be similar with increasing BMI (each, p>0.05). Conclusion: There is longer infertility duration and a higher requirement for gonadotropins in overweight and obese patients with no effect of BMI on most of IVF parameters such as retrieved oocyte, clinical pregnancy, obstetric complication and delivery rate.

Oocyte biology: Perhaps chromosomal glue can be reapplied

Meiotic cohesion loss underlies elevated rates of infertility and chromosome abnormalities in children of older women. A new study shows that cohesins are turned over throughout meiotic prophase, suggesting that cohesion loss is likely not solely due to early establishment of cohesion.

Reproductive functions and pregnancy outcome in female patients with celiac disease.

Abnormalities in the reproductive functions are often ignored while evaluating a patient with celiac disease (CeD). We evaluated the entire reproductive functions in female patients with CeD. In a case control study between 2020 and 2021 using detailed questionnaire, we evaluated reproductive functions (age at menarche, menstrual pattern, fertility, pregnancy outcome and menopause) in biopsy-proven female patients with CeD of age >10years. The questionnaire was administered either in person or telephonically. Age-matched healthy female controls (twice the number) were also recruited. Of 1086 CeD patients, 470 were females and 288 were included. As compared with controls (n=586), females with CeD had higher age at menarche (14.6±2.0 vs 13.6±1.5years; P=0.001), delayed menarche (30.8% vs 11.4%; P=0.001), abnormal menstrual pattern (39.7% vs 25.8%; P<0.001), involuntary delay in conception at >1year (33.8% vs 11.8%; P=0.01), current infertility rate (10.5% vs 5.2%;P=0.028), and poorer overall pregnancy outcomes (abortion [23.5% vs 12.8%; P=0.001], pre-term birth [16.3% vs 3.7%; P=0.001]). Either one or more aspect of reproductive functions and pregnancy outcome is affected adversely in three-fourth female patients with CeD.

Female Infertility and Obesity Across the United States: A Geographic Cross-Sectional Analysis

Introduction: The CDC’s “Adult Obesity Maps in 2022” suggests that the southern parts of the United States (US) have the highest prevalence rates of obesity. Similarly, the Health Resources and Services Administration identifies the Southern states as having the highest numbers of medically underserved areas. The health implications of obesity are numerous, with some affecting reproductive ability in both genders. With infertility on the rise, studies have examined the numerous modalities that implicate obesity in female infertility. One such route associates the increased adipose tissue with reduced oocyte maturation by promoting functional hyperandrogenism and hypoestrogenism, which triggers anovulation. This study was devised to investigate the landscape across the different regions in the US and detect correlations between female infertility and obesity. The hypothesis was that the southern region would have the highest correlation between female infertility and obesity compared to other regions across the US. Methods: This cross-sectional study used the NIH’s ‘All of Us’ Researcher Workbench to devise two cohorts of all ages, ethnicities, and races. The first group, the control cohort, included “female infertility” participants and excluded “sex assigned at birth – male” participants. The second group, the variable cohort, consisted of participants with both “obesity” and “female infertility” while excluding “sex assigned at birth – male” participants. The US was divided into four regions based on zip code. The first three digits of each participant’s zip code were logged and localized to the Midwest, Northeast, South, or West. The participant’s data was coded into the Python analysis software. Various data points were also recorded and analyzed. The number of participants with both female infertility and obesity was then compared to the number of females with infertility only and compared against each region to establish a correlation percentage. Statistical analysis used Chi-Square and focused on identifying degrees of freedom. Results: In the control group, the number of participants who qualified for infertile females was 2,754, with 1,182 participants from the Midwest, 1,062 from the Northeast, 279 from the South, and 231 from the West. For the variable cohort, 1,198 participants were concurrently infertile and obese females. This data was also sub-grouped based on region: the Midwest with 481 participants, the Northeast with 491 participants, the South had 133 participants, and the West had 93 participants. Each variable group number was subsequently divided by its respective control group’s number of infertile female participants. The percentages for each region were: Midwest (28.9%), Northeast (31.6%), South (32.3%), and West (28.7%). The results suggest that the Southern US region has the highest percentage of concurrently infertile and obese females compared to the rest of the country, while the lowest is the West. These findings were statistically significant (two-tailed P value &lt; 0.0001). Conclusion: Our study utilized the NIH ‘All of Us’ Researcher Workbench to demonstrate the variation among the different United States regions and their correlations between females who are both obese and infertile. Knowing that the southern region of the United States has (A) the highest rates of obesity, (B) the highest rates of medically unserved communities, in addition to (C) the highest rate of concurrent female infertility and obesity, this study serves as a platform to stress the need for increased awareness of the implications of obesity. Increasing access to health education and medical care across the country, especially in the southern states, focusing on managing obesity may help improve infertility.

Assessing the impact of medically assisted reproduction on autism spectrum disorder risk.

Techniques of medically assisted reproduction interact with the embryo at crucial developmental stages, yet their impact on the fetus and subsequent child's health remains unclear. Given rising infertility rates and more frequent use of fertility treatments, we aimed to investigate if these methods heighten the risk of autism spectrum disorder (ASD) in children. A population-based cohort study was conducted at Soroka University Medical Center, a tertiary referral hospital, encompassing singleton births. The incidence of ASD in offspring, incorporating either hospital or community-based diagnoses, was compared in relation to the conception method. To examine the cumulative incidence of ASD, a Kaplan-Meier survival curve was utilized. Cox proportional hazards model was employed to adjust for confounders. Among 115,081 pregnancies, 0.5% involved ovulation induction (OI) and 1.7% in vitro fertilization (IVF), with the rest conceived naturally. Fertility treatments were more common in older patients and linked to more diabetes, hypertensive disorders, preterm, and cesarean deliveries. Out of 767 ASD diagnoses, offspring from OI and IVF had higher initial ASD rates (2.1% and 1.3%) than natural conceptions (0.6%). In a Cox model accounting for maternal age, ethnicity, and gender, neither OI nor IVF was significantly associated with ASD. The adjusted hazard ratios were 0.83 (95% CI 0.48-1.43) for OI and 1.34 (95% CI 0.91-1.99) for IVF. When considering fertility treatments combined, the association with ASD remained non-significant (aHR 1.11, 95% CI 0.80-1.54, p = 0.52). Fertility treatments, including OI and IVF, do not exhibit a significant association with heightened ASD risk in offspring.

The impact of assisted reproductive technologies on ADHD: A systematic review and meta-analysis

BackgroundThe escalating utilization of assisted reproductive technology (ART) in response to global infertility rates has spurred research into its complications. Short-term and long-term outcomes have been extensively studied, particularly the neurological concerns surrounding attention-deficit/hyperactivity disorder (ADHD) among ART-conceived children. This study aims investigate the association between ART and ADHD. MethodsMedline, Embase, Scopus, and Web of Science databases were searched through April 4, 2023. Cohort, case-control, and cross-sectional studies were eligible for inclusion. primary summary measures included the unadjusted relative risk (RR) and adjusted hazard ratio (HR) with 95 % confidence intervals. Both fixed-effects and random-effects models were utilized for meta-analysis data pooling to determine the overall effect size. The onset of ADHD in children conceived through ART compared to those conceived naturally. ResultsThe systematic search yielded 8 studies with 10,176,148 individuals included in the meta-analysis. The meta-analysis revealed a pooled RR of 0.93 (0.68–1.26) for cohort studies and a pooled RR of 0.97 (0.41–2.29) for cross-sectional studies, along with a pooled HR of 1.08 (1.03–1.13) for ADHD in the ART group compared to the non-ART group. ConclusionWhile this study identifies some potential association between ART and ADHD, the limited effect size and inherent heterogeneity underscore the need for cautious interpretation.

THE ROLE OF EPILEPSY IN WOMEN'S REPRODUCTIVE FUNCTION

According to the World Health Organization, epilepsy is one of the most common neurological diseases in the world, affecting about 50 million people. The overall prevalence of epilepsy in the Russian Federation in 2020 was 2.49 patients per 1,000 people, and the total number of registered epilepsy patients in Russia was 366,134 people. About 40% of epilepsy patients are women of reproductive age. The course of epilepsy in women of reproductive age has its own characteristics, which are associated with daily and monthly cyclic rhythms. Epilepsy has a wide range of physiological consequences due to antiepileptic pharmaceutical therapy. The purpose of the review is to summarize up-to-date information on the impact of epilepsy on women's reproductive health. The authors conducted a search for publications in the electronic databases PubMed, eLibrary and Google Scholar. The search strategy included the presence of the following keywords and their combinations: "epilepsy", "reproductive health", "sex hormones", "pregnancy", "menstrual cycle", "fetal", "neonatal", "epilepsy", "reproductive health", "sex hormones", "pregnancy", "menstrual cycle", "fetal", "neonatal". The search was conducted among studies published before December 2023. Women are particularly concerned about epilepsy throughout their reproductive years. Infertility rates increase as a result of the psychological stress faced by people with epilepsy and impaired physiological processes that support reproductive health. Finally, the doctor should examine the physiological effects of antiepileptic and anticonvulsant drugs. The main goal of therapy is to provide women with epilepsy with a seizure-free life, excellent overall well-being and improved health. The current plan is achievable if the practitioner is familiar with the sexual differences in the course of epilepsy at the molecular level. The limitation is that modern treatment methods cannot be available to every woman in conditions of limited resources.

Reduced human fecundity attributable to ambient fine particles in low- and middle-income countries

BackgroundExposure to ambient fine particulate matter (PM2.5) has been associated with reduced human fecundity. However, the attributable burden has not been estimated for low- and middle-income countries (LMICs), where the exposure–response function between PM2.5 and the infertility rate has been insufficiently studied. ObjectiveThis study examined the associations between long-term exposure to PM2.5 and human fecundity indicators, namely the expected time to pregnancy (TTP) and 12-month infertility rate (IR), and then estimated PM2.5-attributable burden of infertility in LMICs. MethodsWe analyzed 164,593 eligible women from 100 Demographic and Health Surveys conducted in 49 LMICs between 1999 and 2021. We assessed PM2.5 exposures during the 12 months before a pregnancy attempt using the global satellite-derived PM2.5 estimates produced by Atmospheric Composition Analysis Group (ACAG). First, we created a series of pseudo-populations with balanced covariates, given different levels of PM2.5 exposure, using a matching approach based on the generalized propensity score. For each pseudo-population, we used 2-stage generalized Gamma models to derive TTP or IR from the probability distribution of the questionnaire-based duration time for the pregnancy attempt before the interview. Second, we used spline regressions to generate nonlinear PM2.5 exposure–response functions for each of the two fecundity indicators. Finally, we applied the exposure–response functions to estimate number of infertile couples attributable to PM2.5 exposure in 118 LMICs. ResultsBased on the Gamma models, each 10 µg/m3 increment in PM2.5 exposure was associated with a TTP increase by 1.7 % (95 % confidence interval [CI]: -2.3 %–6.0 %) and an IR increase by 2.3 % (95 %CI: 0.6 %–3.9 %). The nonlinear exposure–response function suggested a robust effect of an increased IR for high-concentration PM2.5 exposure (>75 µg/m3). Based on the PM2.5-IR function, across the 118 LMICs, the number of infertile couples attributable to PM2.5 exposure exceeding 35 µg/m3 (the first-stage interim target recommended by the World Health Organization global air quality guidelines) was 0.66 million (95 %CI: 0.061–1.43), accounting for 2.25 % (95 %CI: 0.20 %–4.84 %) of all couples affected by infertility. Among the 0.66 million, 66.5 % were within the top 10 % high-exposure infertile couples, mainly from South Asia, East Asia, and West Africa. ConclusionPM2.5 contributes significantly to human infertility in places with high levels of air pollution. PM2.5-pollution control is imperative to protect human fecundity in LMICs.

Infertility rates among the pemphigus population.

Infertility rates among the pemphigus population.

Preconception depression reduces fertility: a couple-based prospective preconception cohort.

Is preconception depression associated with time to pregnancy (TTP) and infertility? Couples with preconception depression needed a longer time to become pregnant and exhibited an increased risk of infertility. Preconception depression in women contributes to impaired fertility in clinical populations. However, evidence from the general population-especially based on couples-is relatively scant. A couple-based prospective preconception cohort study was performed in 16 premarital examination centers between April 2019 and June 2021. The final analysis included 16521 couples who tried to conceive for ≤6 months at enrollment. Patients with infertility were defined as those with a TTP ≥12 months and those who conceived through ART. Couples' depression was assessed using the Patient Health Questionnaire-9 at baseline. Reproductive outcomes were obtained via telephone at 6 and 12 months after enrollment. Fertility odds ratios (FORs) and infertility risk ratios (RRs) in different preconception depression groups were analyzed using the Cox proportional-hazard models and logistic regression, respectively. Of the 16 521 couples analyzed, 10834 (65.6%) and 746 (4.5%) couples achieved pregnancy within the first 6 months and between the 6th and 12th months, respectively. The median (P25, P75) TTP was 3.0 (2.0, 6.0) months. The infertility rate was 13.01%. After adjusting for potential confounders, in the individual-specific analyses, we found that preconception depression in women was significantly related to reduced odds of fertility (FOR = 0.947, 95% CI: 0.908-0.988), and preconception depression in either men or women was associated with an increased risk of infertility (women: RR = 1.212, 95% CI: 1.076-1.366; men: RR = 1.214, 95% CI: 1.068-1.381); in the couple-based analyses, we found that-compared to couples where neither partner had depression-the couples where both partners had depression exhibited reduced fertility (adjusted FOR = 0.904, 95% CI: 0.838-0.975). The risk of infertility in the group where only the woman had depression and both partners had depression increased by 17.8% (RR = 1.178, 95% CI: 1.026-1.353) and 46.9% (RR = 1.469, 95% CI: 1.203-1.793), respectively. Reporting and recall bias were unavoidable in this large epidemiological study. Some residual confounding factors-such as the use of anti-depressants and other medications, sexual habits, and prior depressive and anxiety symptoms-remain unaddressed. We used a cut-off score of 5 to define depression, which is lower than prior studies. Finally, we assessed depression only at baseline, therefore we could not detect effects of temporal changes in depression on fertility. This couple-based study indicated that preconception depression in individuals and couples negatively impacts couples' fertility. Early detection and intervention of depression to improve fertility should focus on both sexes. This work was supported by grants from the National Natural Science Foundation of China (No. 82273638) and the National Key Research and Development Program of China (No. 2018YFC1004201). All authors declare no conflicts of interest. N/A.

Impact of an educational intervention on fertility awareness of healthcare professionals

Introduction: With couples' increasing postponement of pregnancy to later in life and the associated rising infertility rates, healthcare professionals need to be proactive in counselling on the risk factors affecting reproduction. To do so, they need specific counselling skills and evidence-based information. The aim of this study was to assess and compare participants' knowledge of fertility issues before and after an educational intervention on preconception health care.Methods: A cross-sectional observational study was conducted, using the same questionnaire to assess the pre- and post-intervention status. The questionnaire was developed on the basis of a literature review on infertility risk factors. The survey was conducted in a conference setting. Participation in the survey was voluntary and confidentiality was assured to all participants (midwives, nurses and healthcare students). The differences in participants' pre- and post-intervention knowledge were calculated using the Wilcoxon signed rank test.Results: The results of our study show an improvement in participants' overall knowledge on infertility risk factors. These improvements were statistically significant in the sections of 'Age and Fertility' and 'Environmental Hazards', while in the sections 'Pre-existing Medical Conditions' and 'Lifestyle Factors Affecting Fertility', participants already possessed comprehensive knowledge prior to the educational intervention.Discussion and conclusion: Health professionals can improve their knowledge on preconception health through continuous education. Further studies need to test the long-term effects of different educational approaches.

Pregnancy-related complications in patients with endometriosis in different stages

BackgroundEndometriosis is one of the most common and costly diseases among women. This study was carried out to investigate pregnancy outcomes in women with endometriosis because of the high prevalence of endometriosis in reproductive ages and its effect on pregnancy-related complications outcomes.MethodsThis was a cross-sectional study performed on 379 pregnant women with endometriosis who were referred to the endometriosis clinic of the Avicenna Infertility Treatment Center from 2014 to 2020. Maternal and neonatal outcomes were assessed for the endometriosis group and healthy mothers. The group with endometriosis was further divided into two groups: those who underwent surgery and those who either received medication alone or were left untreated before becoming pregnant. The analysis of the data was done using SPSS 18.ResultsThe mean age of the patients was 33.65 ± 7.9 years. The frequency of endometriosis stage (P = 0.622) and surgery (P = 0.400) in different age groups were not statistically significant. The highest rates of RIF and infertility were in stages 3 (N = 46, 17.2%) (P = 0.067), and 4 (N = 129, 48.3%) (P = 0.073), respectively, but these differences were not statistically different, and the highest rate of pregnancy with ART/spontaneous pregnancy was observed in stage 4 without significant differences (P = 0.259). Besides, the frequency of clinical/ectopic pregnancy and cesarean section was not statistically different across stages (P > 0.05). There is no significant relationship between endometriosis surgery and infertility (P = 0.089) and RIF (P = 0.232). Most of the people who had endometriosis surgery with assisted reproductive methods got pregnant, and this relationship was statistically significant (P = 0.002) in which 77.1% (N = 138) of ART and 63% (N = 264) of spontaneous pregnancies were reported in patients with endometriosis surgery. The rate of live births (59.4%) was not statistically significant for different endometriosis stages (P = 0.638). There was no stillbirth or neonatal death in this study. All cases with preeclampsia (N = 5) were reported in stage 4. 66.7% (N = 8) of the preterm labor was in stage 4 and 33.3% (N = 4) was in stage 3 (P = 0.005). Antepartum bleeding, antepartum hospital admission, preterm labor, gestational diabetes, gestational hypertension, abortion, placental complications and NICU admission were higher in stage 4, but this difference had no statistical difference.ConclusionEndometriosis is significantly correlated with infertility. The highest rates of RIF and infertility are observed in stages 3 and 4 of endometriosis. The rate of pregnancy with ART/spontaneous pregnancy, preterm labor, preeclampsia and pregnancy-related complications is higher in stage 4. Most of the people who had endometriosis surgery with assisted reproductive methods got significantly pregnant. Clinical/ectopic pregnancy, cesarean sections, and live birth were not affected by the endometriosis stages.

Testis–Gut-Reproduction Axis: The Key to Reproductive Health

Reproductive health is an important issue for humanity. In the context of the increasing incidence rate of male infertility, it is essential to find the factors that affect male reproductive health. Gastrointestinal health is closely related to reproductive health. Gastrointestinal hormones (GIH) and gut microbiota (GM), as important material foundations for gastrointestinal function, can promote or inhibit testicular reproductive function, including spermatogenesis, sperm maturation, androgen synthesis, and even broader male diseases such as sexual function, prostate cancer, etc. On the contrary, the functional health of the testes is also of great significance for the stability of gastrointestinal function. This review mainly discusses the important regulatory effects of GIH and GM on male reproductive function.

Gonadotropin elevation is ootoxic to ovulatory oocytes and inhibits oocyte maturation, and activin decoy receptor ActRIIB:Fc therapeutically restores maturation

BackgroundElevated FSH often occurs in women of advanced maternal age (AMA, age ≥ 35) and in infertility patients undergoing controlled ovarian stimulation (COS). There is controversy on whether high endogenous FSH contributes to infertility and whether high exogenous FSH adversely impacts patient pregnancy rates.MethodsThe senescence-accelerated mouse-prone-8 (SAMP8) model of female reproductive aging was employed to assess the separate impacts of age and high FSH activity on the percentages (%) of viable and mature ovulated oocytes recovered after gonadotropin treatment. Young and midlife mice were treated with the FSH analog equine chorionic gonadotropin (eCG) to model both endogenous FSH elevation and exogenous FSH elevation. Previously we showed the activin inhibitor ActRIIB:Fc increases oocyte quality by preventing chromosome and spindle misalignments. Therefore, ActRIIB:Fc treatment was performed in an effort to increase % oocyte viability and % oocyte maturation.ResultsThe high FSH activity of eCG is ootoxic to ovulatory oocytes, with greater decreases in % viable oocytes in midlife than young mice. High FSH activity of eCG potently inhibits oocyte maturation, decreasing the % of mature oocytes to similar degrees in young and midlife mice. ActRIIB:Fc treatment does not prevent eCG ootoxicity, but it restores most oocyte maturation impeded by eCG.ConclusionsFSH ootoxicity to ovulatory oocytes and FSH maturation inhibition pose a paradox given the well-known pro-growth and pro-maturation activities of FSH in the earlier stages of oocyte growth. We propose the FOOT Hypothesis (“FSH OoToxicity Hypothesis), that FSH ootoxicity to ovulatory oocytes comprises a new driver of infertility and low pregnancy success rates in DOR women attempting spontaneous pregnancy and in COS/IUI patients, especially AMA women. We speculate that endogenous FSH elevation also contributes to reduced fecundity in these DOR and COS/IUI patients.Restoration of oocyte maturation by ActRIB:Fc suggests that activin suppresses oocyte maturation in vivo. This contrasts with prior studies showing activin A promotes oocyte maturation in vitro. Improved oocyte maturation with agents that decrease endogenous activin activity with high specificity may have therapeutic benefit for COS/IVF patients, COS/IUI patients, and DOR patients attempting spontaneous pregnancies.

The effects of conservative and surgical approaches in tubal ectopic pregnancy on fertility.

Medical treatment, expectant approaches, and surgical treatment options are available in the treatment of ectopic pregnancy. Regardless of the treatment, in addition to its effectiveness, the main concern is to limit the risk of relapse and preserve fertility. Determine the impact of medical or surgical treatment for ectopic pregnancy on future fertility. Retrospective. Department of obstrtrics and gynecolgy at Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey. Patients who were treated for ectopic pregnancy between June 2016 and November 2019 were allocated into two groups. Expectant approach or medical treatment by methotrexate constituted the conservative treatment group while salpingectomy by laparoscopy indicated the surgical treatment group. Fertility rates within two years following treatment were evaluated according to treatment options. 202 patients. Of the 202 patients, 128 had medical treatment and 74 patients had surgical treatment for ectopic pregnancy. Of 272 diagnosed with ectopic pregnancy, 70 were excluded for various reasons. Parity and unemployment rate was significantly higher in the surgical treatment (P=.006 and P=.12, respectively). Moreover, ectopic mass size and serum β-hCG levels were significantly higher in the surgical treatment group (P<.001 and P<.001, respectively). There were no significant differences between the conservative and surgical treatment groups in time to pregnancy (17.0 months vs 19.0 months, P=.255). Similarly, there was no significant difference between the conservative and surgical treatment groups with respect to history of infertility (P=.12). There were no significant differences between the conservative and surgical treatment groups in terms of live birth (51.6% vs 44.6%) and ectopic pregnancy (2.3% vs 1.4%) (P=.72 for both). There was no significant difference between the conservative and surgical treatment groups with respect to infertility rate (35.9% vs 41.9%, P=.72) and admittance to the IVF program (3.9% vs 6.8%, P=.39) following ectopic pregnancy treatment. Reproductive outcomes did not differ significantly in women undergoing expectant management, medical treatment, and surgery for ectopic pregnancy. This finding suggests that clinicians should not hesitate to act in favor of surgical treatment for ectopic pregnancy even if there were concerns for future fertility. Retrospective study.

Infertile women of Ethiopia: Psychological challenges and coping strategies.

Worldwide, an estimated 48 million couples and 186 million individuals are infertile, according to estimates from the World Health Organization. Ethiopia has a higher rate of infertility than the World Health Organization estimated for the entire world. Though research on the issue of infertility is growing both globally and in Ethiopia, not much has been studied. Therefore, the main objective of this study was to explore the psychological and coping strategies of infertile women in Bichena town, Ethiopia. The study followed a qualitative research approach and a descriptive phenomenological design. Data were collected through in-depth interviews with 15 infertile women using a purpose-sampling technique. Thematic analysis was the method of data analysis. The findings of this study indicated that stress, anxiety, depression, low self-esteem, and sexual dissatisfaction were the main psychological challenges that infertile women experience. Infertile women also used a variety of coping strategies, such as religious strategies, traditional strategies, medical strategies, and other strategies (marital separation and acceptance). The study concluded that infertile women in the study area were challenged by psychological factors and used different coping strategies to manage their ongoing problems. This study also has theoretical implications for the current literature and practical implications for infertile women, non-governmental organizations, community and health professionals.

Prevalence of infertility and barriers to family building among male physicians.

Fertility declines with increasing age and physicians often delay childbearing beyond prime reproductive years for the sake of medical training. However, the risks of infertility in male physicians compared to the general population remain poorly studied. To characterize rates of infertility among male physicians and identify barriers in access to fertility care and family building. Between June 2022 and December 2022, male physicians were invited to complete a questionnaire regarding fertility and family building. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). Two hundred thirty-five responses were included in the final analysis. The mean age of respondents was 36.3±7.4 years. Of 151 respondents with children or currently attempting to have children, 66 (43.7%) delayed family building due to their medical training or career. The most influential factors affecting timing of children were lack of flexibility in schedule, lack of time, stress, and financial strain. Forty-three (18.3.%) respondents had seen a doctor for fertility evaluation; an additional 12 (5.1%) said they considered doing so but did not, mostly due to being too busy. Sixty (25.5%) had undergone semen testing in the past. Thirty-one (13.2%) reported a diagnosis of fertility issues in either themselves or their partner. Twenty-seven (11.5%) endorsed either them or their partner having undergone assistive reproductive technologies or other procedures for infertility. A significant proportion of male physicians delayed building their family or seeking fertility evaluation due to their medical career. Around 23.4% of male physicians have either seen or considered seeing a physician for fertility evaluation, suggesting a high prevalence of infertility in this cohort. Our results indicate a need for interventions to support family building and fertility evaluation and treatment among male physicians.

Occupational hazards and pregnancy in orthopaedics: female surgeons are at increased risk of infertility and pregnancy complications.

Female surgeons have increased rates of infertility and pregnancy complications compared to the general population. Reported infertility rates in surgeons are 32% compared to 10.9% in the general population. Reported pregnancy complication rates in surgeons range from 25% to 35%. In the orthopaedic operating theatre occupational hazards that have an effect on pregnancy outcomes include radiation, exposure to methyl methacrylate in bone cement, surgical smoke, sharps injuries, exposure to anaesthetic waste gases and the effects of the physical demands of surgery including prolonged work hours and night shift work. Outside the operating theatre exposure to nitrous oxide, formaldehyde, surgical scrub also have evidence of negative pregnancy outcomes. This review summarizes the available evidence as it relates to specific occupational hazards that face health workers in an orthopaedic operating theatre. This information, while targeted at orthopaedic health workers, is also relevant to anaesthetists, radiographers, nursing staff, medical device company representatives and female surgeons in other specialties.