Treatment Of Infertile Women Research Articles

Expression of the mRNA of the inflammatory component of the immune response in the period of the expected window of implantation in women with recurrent pregnancy loss in the programs of assisted reproductive technologies

The aim of study. To reveal the peculiarities of mRNA expression of the inflammatory component genes of the immune response in the expected window of the implantation in women with RPL in ART programs.Material and methods. 240 patients with RPL in ART programs and 100 conditionally healthy fertile women in the control group with the presence in history of at least one childbirth in time and the absence of episodes of miscarriage were examined. The average age of the examined women of the main group was 29.80 ± 0.30 years, the control group – 30.09 ± 0.32 (p >0.05). The average number of cases of involuntary termination of pregnancy after conduction of ART in main group was 3.24 ± 0.11, the average term of termination of pregnancy was 8.15 ± 0.65 weeks.All women had a paipel-biopsy of the endometrium during the expected implantation window. Samples were frozen at t = -70 °C. until the study. Reverse transcription -polymerase chain reaction was used to study mRNA expression of IL-1β, IL-2, IL-10, Foxp3, TLR9, IL-2Rα cytokine genes in endometrial biopsy obtained on the day of the implantation window.Results. It was found that the relative level of mRNA expression of IL-1β, IL-2, Foxp3, TLR9, IL-2Rα genes did not differ significantly in patients with RPL in the cycles of VRT and control group. A statistically significant decrease in mRNA expression of the IL-10 gene was noted.Conclusion. RPL in the treatment of infertile women in ART programs is associated with changes in the transcription profile of the endometrium during the intended implantation window and with a decrease in the expression level of the IL-10 gene mRNA.

Treatment of infertility in women with polycystic ovary syndrome using assisted reproductive technology

The article recent data concerning the pathogenesis, diagnostic criteria and hormonal disorders in the polycystic ovary syndrome are presented. A sequential step-by-step treatment of this disease is also described. Pаrticulаr аttention is pаid to the treаtment of infertility in women with PCOS using аssisted reproductive technology.

Aromatase inhibitors: A new approach for controlling ovarian function in cattle

Numerous treatments and protocols have been used to control the reproductive cycle in cattle, with varying effectiveness and many involving the administration of steroid hormones. Steroid hormones, such as estradiol, are perceived as having a negative impact on consumer health. This internationally shared opinion has led to a ban on the use of steroid hormones in food producing animals in many countries (i.e., European Union, New Zealand, and Australia). Letrozole, a non-steroidal aromatase inhibitor, inactivates the aromatase enzyme responsible for the synthesis of estrogens by reversibly binding to the “heme” group of the P450 subunit. Letrozole is approved as an adjuvant or first-line treatment for hormone-dependent breast cancer in post-menopausal women, but has been used increasingly for ovulation induction in the treatment of infertility in women. Using the bovine model to determine the effects on ovarian function, letrozole treatment was found to extend the lifespan of the dominant follicle and thereby delay emergence of the next follicle wave and/or ovulation. Letrozole treatment also had a luteotrophic effect; that is, larger CL and/or higher circulating concentrations of progesterone were detected in letrozole-treated heifers. Results of the initial studies in cattle provided the impetus for the development of aromatase inhibitor-based synchronization and fertility treatment in cattle. Biologically active concentrations of letrozole were achieved via intravenous, intramuscular or intravaginal administration, but the intravaginal route of administration is of particular interest because it permits extended and defined treatment periods, is minimally invasive, and reduces animal handling. Recent results revealed that irrespective of the stage of the cycle, a 4-day letrozole-based protocol induced ovulation in a significantly greater proportion of animals and with significantly greater synchrony than the control treatment. Evidence and reasons for the increasing use of programmed breeding and fixed-time artificial insemination are discussed in this review as a background to current development of an innovative aromatase inhibitor-based protocol as a safe and effective method of controlling the estrous cycle and ovulation in cattle.

Communication About Sexual Matters With Women Attending a Danish Fertility Clinic: A Descriptive Study.

IntroductionSeveral studies have shown that sexuality is an important aspect of life. Nevertheless, sexual matters are only rarely discussed between patients and doctors. Other studies have suggested that women undergoing fertility treatment compose a group of patients with low satisfaction in their sexual life.AimTo investigate how women at a fertility clinic desire and experience communication about sexual matters with doctors and to investigate the sexual function of these women.MethodsA cross-sectional self-administered questionnaire survey of women attending a Danish fertility clinic over 4 months was performed. Descriptive statistics were calculated and presented as frequencies.Main Outcome MeasureCommunication about sexual matters with doctors included the women’s comfort, preferred and actual frequency of discussion, and initiation of the conversation. Sexual function included participants’ sexuality during the past year including certain sexual difficulties.ResultsOf the 201 participating women in the survey, most felt comfortable discussing sexual matters with doctors and preferred gynecologists for such discussions. There was a greater desire for communication than what was actually experienced by the women, and most wanted to initiate the conversation themselves. The women were less satisfied with their sexual life compared with a national control group, and they experienced sexual difficulties more often.ConclusionThere is an unmet desire of women in fertility treatment for discussing sexual matters, and greater communication on this subject needs to be clinically implemented.Eldridge KE, Giraldi A. Communication About Sexual Matters With Women Attending a Danish Fertility Clinic. A Descriptive Study. Sex Med 2017;5:e196–e202.

Understanding the Blogging Practices of Women Undergoing In Vitro Fertilization (IVF): A Discourse Analysis of Women’s IVF Blogs

Infertility and its associated treatments, including in vitro fertilization (IVF), can have a profound impact on the emotional health and well-being of women desiring to become mothers. Researchers have measured the impact of infertility and described the experience of infertility and its treatment, leaving the rich descriptions of the IVF experience as captured in women’s blogs to be explored. This discourse analysis describes the blogging practices of women undergoing IVF, exploring both the content and function of the IVF blog discourse. Data were collected from the text of seven women’s blogs (n=1,149 blog posts) and resulted in four main functions of the discourse: creation of and connection to a community, emotional support, blogging as therapy, and creation of an IVF resource. Findings suggest that blogging can have a positive impact on the psychosocial consequences experienced by women in fertility treatment.

Fresh versus Frozen Embryo Transfer in PCOS: Arguments for and Against.

AbstractIn vitro fertilization (IVF) is a common infertility treatment for women with polycystic ovarian syndrome (PCOS) who have failed to conceive in ovulation induction and who have other concomitant infertility factors. Women with PCOS tend to have an excess response to ovarian stimulation during IVF. Freeze-all strategy with deferred frozen embryo transfer was initially used to prevent ovarian hyperstimulation syndrome (OHSS) in patients with a high risk. New evidence from randomized trials showed elective frozen embryo transfer in PCOS women with a low risk of OHSS could also lower the incidence of OHSS, improve live birth rate mainly by decreasing pregnancy loss, and increase birth weight of singleton infants compared with fresh embryo transfer. However, the risk of preeclampsia was higher after frozen than fresh embryo transfer. Observational studies and limited randomized trials showed the risks of other obstetric outcomes and long-term safety profile after frozen embryo transfers were at least as good as that after fresh embryo transfer. Summarily, current evidence showed elective freeze-all and frozen embryo transfer is generally superior to fresh embryo transfer to achieve live birth in women with PCOS; however, its effect on obstetric outcome and long-term outcome warrants further studies.

Clinical outcomes of infertility treatment for women with adenomyosis in Japan.

AimA multicenter, retrospective survey was conducted in order to investigate the current clinical status of adenomyosis in Japan.MethodsThe questionnaires covered the management of infertile women with adenomyosis and the outcomes of infertility treatment in women with adenomyosis. The questionnaires were sent to 1149 facilities in Japan.ResultsThe data were obtained on 535 infertile women with adenomyosis from 190 facilities. Regarding management, infertility treatment was performed without pretreatment for adenomyosis in 37 facilities, after medication in eight facilities, and after an operation in four facilities. Management policies were not established in 106 facilities. Regarding outcomes, the pregnancy rate was 41.7% and the abortion rate was 29.8%. Eighty‐five patients received medication and 89 patients underwent surgery as a pretreatment before infertility treatment, while 361 patients had no pretreatment. In relation to the type of adenomyosis, 162 patients had the focal type and 336 patients had the diffuse type. The pregnancy rate and abortion rate were not affected by pretreatment or the type of adenomyosis.ConclusionThe management policy for infertile women with adenomyosis has not been established. The pregnancy rate of infertility treatment is about 40%. There were no data to suggest that medication or surgery as a pretreatment for adenomyosis increased the pregnancy rate in infertile women.

Womens Imaging, Us Imaging for Infertility Workup

: Infertility can be defined as the inability to conceive a pregnancy after 1 year of unprotected intercourse or after 6 months in a woman over 35 years old. The use of sonography, in particular transvaginal sonography (TVS), has become an integral component of the evaluation and treatment of infertility. The TVS allows high-resolution assessment of the uterus, ovaries, and fallopian tubes. TVS plays a critical role in the diagnosis and treatment of infertile women. Initial baseline ultrasound examination is used primarily to identify structural abnormalities that might affect fertility such as uterine anomalies, endometrial polyps or submucosal leiomyomas, endometrial adhesions/synechiae, or hydrosalpinges. Sonography is also used to assess for possible underlying pathologic processes associated with infertility such as adenomyosis, endometriosis, polycystic ovary syndrome (PCOS), and low antral follicular count. If the baseline pelvic sonogram is inconclusive or noncontributory, further anatomic evaluation can be obtained by means of pelvic magnetic resonance imaging (MRI), hysterography, sonohysterography, or even hysteroscopy and laparoscopy, as indicated. CT and MRI play essential roles in evaluating gynecological disease .with the advent of multidetector CT faster scanning during optimal vascular opacification is now available which may improve accuracy in the detection and staging of gynecologic disease. However due to multiplanar capability and excellent tissue contrast, MRI is the preferred imaging modality of the female pelvis in many instances. Hysterosalpingography (HSG) is a valuable technique in evaluating the uterus and fallopian tubes. Contrast material introduced into the uterus through the cervical canal outlines the inner cavity of the uterus and tubes. A spill of contrast material into the peritoneal cavity reveals the patency of the fallopian tubes.

Uterine fibroids and effiency of in vitro fertilization programs

The aim of this review is to estimate etiologic role of uterine fibroids in female infertility; it based on the results of current studies of infertility in various cases of fibroids (submucous, intramural and subserous). In article was analyzed the efficiency of the treatment of infertility in women with uterine myoma in IVF programs.Conclusion: a detailed study of endometrial receptivity in women with uterine fibroids is necessary to for personalized strategy in patients with uterine fibroids (myoma) and infertility.

Effects of Infertility Stress, Psychological Symptoms, and Quality of Life on Predicting Success Rate of IVF/ICSI Treatment in Infertile Women

Effects of Infertility Stress, Psychological Symptoms, and Quality of Life on Predicting Success Rate of IVF/ICSI Treatment in Infertile Women

Thermosensitive bioadhesive gels for the vaginal delivery of sildenafil citrate: in vitro characterization and clinical evaluation in women using clomiphene citrate for induction of ovulation

Objective: The objective of this study is to develop and characterize in situ thermosensitive gels for the vaginal administration of sildenafil as a potential treatment of endometrial thinning occurring as a result of using clomiphene citrate for ovulation induction in women with type II eugonadotrophic anovulation. While sildenafil has shown promising results in the treatment of infertility in women, the lack of vaginal pharmaceutical preparation and the side effects associated with oral sildenafil limit its clinical effectiveness.Methods: Sildenafil citrate in situ forming gels were prepared using different grades of Pluronic® (PF-68 and PF-127). Mucoadhesive polymers as sodium alginate and hydroxyethyl cellulose were added to the gels in different concentrations and the effect on gel properties was studied. The formulations were evaluated in terms of viscosity, gelation temperature (Tsol-gel), mucoadhesion properties, and in vitro drug release characteristics. Selected formulations were evaluated in women with clomiphene citrate failure due to thin endometrium (Clinicaltrial.gov identifier NCT02766725).Results: The Tsol-gel decreased with increasing PF-127 concentration and it was modulated by addition of PF-68 to be within the acceptable range of 28–37 °C. Increasing Pluronic® concentration increased gel viscosity and mucoadhesive force but decreased drug release rate. Clinical results showed that the in situ sildenafil vaginal gel significantly increased endometrial thickness and uterine blood flow with no reported side effects. Further, these results were achieved at lower frequency and duration of drug administration.Conclusion: Sildenafil thermosensitive vaginal gels might result in improved potential of pregnancy in anovulatory patients with clomiphene citrate failure due to thin endometrium.

Problems and Complications During the Treatment of Infertility in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder existing in women in their reproductive years and it is one of the most evaluated and discussed subjects of reproductive medicine with regard to its diagnosis and treatment.Patients with PCOS constitute the most difficult population in the management of infertility. The factors that increase the success rates in the treatment of PCOS infertility are: pretreatment changes in life style, dietetic and psychological support, a detailed evaluation of the couple and the appropriate selection of the treatment protocol, a wide-spectrum approach to maintaining ovarian and endometrial synchronization in the management of the cycle, and well-developed laboratory conditions to support embryonic quality. However, even if these conditions are provided, OHSS, cancellations of the cycle, poor oocyte, and embryo qualities, unsuccessful fertilization and implantation, chromosomal abnormalities and early losses may still be experienced.

Acupuncture for polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is characterised by the clinical signs of oligo-amenorrhoea, infertility and hirsutism. Conventional treatment of PCOS includes a range of oral pharmacological agents, lifestyle changes and surgical modalities. Beta-endorphin presents in the follicular fluid of both normal and polycystic ovaries. It was demonstrated that the beta-endorphin levels in ovarian follicular fluid of otherwise healthy women who were undergoing ovulation were much higher than the levels measured in plasma.Given that acupuncture has an impact on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion, it is postulated that acupuncture may have a role in ovulation induction and fertility. To assess the effectiveness and safety of acupuncture treatment of oligo/anovulatory women with polycystic ovarian syndrome (PCOS). We identified relevant studies from databases including the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, PsycINFO, CNKI and trial registries. The data are current to 19 October 2015. We included randomised controlled trials (RCTs) that studied the efficacy of acupuncture treatment for oligo/anovulatory women with PCOS. We excluded quasi- or pseudo-RCTs. Primary outcomes were live birth and ovulation (primary outcomes), and secondary outcomes were clinical pregnancy, restoration of menstruation, multiple pregnancy, miscarriage and adverse events. We assessed the quality of the evidence using GRADE methods. Two review authors independently selected the studies, extracted data and assessed risk of bias. We calculated Mantel-Haenszel odds ratios (ORs) and mean difference (MD) and 95% confidence intervals (CIs). We included five RCTs with 413 women. They compared true acupuncture versus sham acupuncture (two RCTs), true acupuncture versus relaxation (one RCT), true acupuncture versus clomiphene (one RCT) and electroacupuncture versus physical exercise (one RCT). Four of the studies were at high risk of bias in at least one domain.No study reported live birth rate. Two studies reported clinical pregnancy and found no evidence of a difference between true acupuncture and sham acupuncture (OR 2.72, 95% CI 0.69 to 10.77, two RCTs, 191 women, very low quality evidence).Three studies reported ovulation. One RCT reported number of women who had three ovulations during three months of treatment but not ovulation rate. One RCT found no evidence of a difference in mean ovulation rate between true and sham acupuncture (MD -0.03, 95% CI -0.14 to 0.08, one RCT, 84 women, very low quality evidence). However, one other RCT reported very low quality evidence to suggest that true acupuncture might be associated with higher ovulation frequency than relaxation (MD 0.35, 95% CI 0.14 to 0.56, one RCT, 28 women).Two studies reported menstrual frequency. One RCT reported true acupuncture reduced days between menstruation more than sham acupuncture (MD 220.35, 95% CI 252.85 to 187.85, 146 women). One RCT reported electroacupuncture increased menstrual frequency more than no intervention (0.37, 95% CI 0.21 to 0.53, 31 women).There was no evidence of a difference between the groups in adverse events. Evidence was very low quality with very wide CIs and very low event rates.Overall evidence was low or very low quality. The main limitations were failure to report important clinical outcomes and very serious imprecision. Thus far, only a limited number of RCTs have been reported. At present, there is insufficient evidence to support the use of acupuncture for treatment of ovulation disorders in women with PCOS.

Adipose-Derived Stromal Vascular Fraction Cell Effects on a Rodent Model of Thin Endometrium.

Endometrial dysfunction affects approximately 1% of infertile women, and there is currently no standard therapy for improving fertility treatment outcomes in these patients. In our study, we utilized a rodent model of thin endometrium to test whether intrauterine application of adipose-derived stromal vascular fraction cells (SVF) could improve morphological and physiological markers of endometrial receptivity. Using anhydrous ethanol, endometrial area and gland density were significantly reduced in our model of thin endometrium. Application of SVF was associated with a 29% reduction in endometrial vascular endothelial growth factor (VEGF) expression and significant increases in uterine artery systolic/diastolic velocity ratios and resistance index values, suggesting reduced diastolic microvascular tone. However, no significant improvements in endometrial area or gland density were observed following SVF treatment. 3D confocal imaging demonstrated poor engraftment of SVF cells into recipient tissue, which likely contributed to the negative results of this study. We suspect modified treatment protocols utilizing adjuvant estrogen and/or tail vein cell delivery may improve SVF retention and therapeutic response in subsequent studies. SVF is an easily-obtainable cell product with regenerative capability that may have a future role in the treatment of infertile women with endometrial dysfunction.

Use of Clomiphene for Infertility in the Polycystic Ovary Syndrome

Background : The polycystic ovary syndrome is a common cause of infertility. Clomiphene is the current first-line infertility treatment in women with the polycystic ovary syndrome.Objective : To observed effect of clomiphene therapy in infertile women with polycystic ovary syndrome.Methodology : In this cross-sectional study we enrolled 210 infertile women aged 25 – 35 years diagnosed as polycystic ovary syndrome. Participants who had normal urine cavity and sperm concentration of at least 20 million/ml of her husband were prescribed clomiphene for 6 months. Medication was discontinued when pregnancy was confirmed and participants were followed until delivery.Results : After 6 months treatment 85(40.5%) patient was conceived. Live birth was 44(20.9%) of 210 subjects. Among pregnancies multiple (twin) birth was 12(5.7%). First trimester pregnancy loss was 41(19.5%). After having 6 months of therapy there was no pregnancy in125 (59.5%) patients.Conclusions : Clomiphene is safe and cost effective medicine in achieving live birth in infertile women with polycystic ovary syndrome.Northern International Medical College Journal Vol.7(1) Jul 2015: 94-96

Cost-effective analysis of infertility treatment in women with polycystic ovarian syndrome (PCOS) who failed traditional clomiphene citrate therapy

Cost-effective analysis of infertility treatment in women with polycystic ovarian syndrome (PCOS) who failed traditional clomiphene citrate therapy

A Clomiphene Citrate and Letrozol Varsus Tamoxifen and Letrozole as an Infertility Treatment in Women with Polycystic Ovary Syndrome

A Clomiphene Citrate and Letrozol Varsus Tamoxifen and Letrozole as an Infertility Treatment in Women with Polycystic Ovary Syndrome

Normosmic hypogonadotropic failure

Currently, mutations have been described in a number of genes encoding proteins that control the release of LH-RH by hypothalamus. One such protein is itself LH-RH (gene GNRH1), its receptor (GNRH1-R), the controller allocation hypothalamus LH-RH protein Kisspeptin (KISS1), receptor Kisspeptin (KISS1-R), another regulator of release of LH-RH neurokinin B gene (TAC3) and its receptor neurokinin B (TAC3-R). In infertility clinic were admitted two patients with isolated hypogonadotropic hypogonadism form. Both patients were observed during the lifetime of low-levels of FSH and LH and primary amenorrhea. At the same time indicators of ovarian reserve, as measured by the AMH were sufficient for ovarian stimulation Patients are at lifelong hormone replacement therapy. In order to induce the growth of follicles patients received preparations containing exogenous FSH and LH. Given the presence of male factor infertility, in both patients was used intracytoplasmic sperm injection (ICSI ) as a method of fertilization. In both patients were received 5 and 8 eggs, and 4 and 6 embryos, respectively. In each patient were transferred two embryos. In both patients were achieved clinical pregnancies. In the first patient pregnancy stopped at 8th week for an unknown reason, the other patient delivered a full-term baby girl alive. These data demonstrate the high efficiency of the treatment of infertility in women with normosmic hypogonadotropic failure. In genetic analysis revealed that the first patient is a carrier of a mutation in the gene receptor LH-RH (GNRH1-R) in both alleles, whereas the second patient is a heterozygous for this gene variant.

Marital stability and repartnering: infertility-related stress trajectories of unsuccessful fertility treatment

To compare the trajectories of infertility-related stress between patients who remain in the same relationship and patients who repartner. Longitudinal cohort study using latent growth modeling. Fertility centers. Childless men and women evaluated before starting a new cycle of fertility treatment and observed for a 5-year period of unsuccessful treatments. None. Marital stability and infertility-related stress. The majority of patients (86%) remained with their initial partner, but 14% of participants separated and repartnered while pursuing fertility treatments. Marital stability significantly predicted the initial status of infertility stress and infertility stress growth levels. Specifically, patients who repartnered had higher infertility stress levels at all time points compared with those who remained in the same relationship, regardless of the partner they were with at assessment. Furthermore, results showed an increasing stress trajectory over time for those who repartnered, compared with those who remained in a stable relationship. Men and women in fertility treatment who form a second union have higher initial levels of stress in their original relationship and higher changes in stress levels over the course of treatments. These findings suggest that high infertility-related stress levels before entering fertility treatment can negatively affect the stability of marital relationships and lead to repartnering.

Smoking in infertile women with polycystic ovary syndrome: baseline validation of self-report and effects on phenotype.

Do women with polycystic ovary syndrome (PCOS) seeking fertility treatment report smoking accurately and does participation in infertility treatment alter smoking? Self-report of smoking in infertile women with PCOS is accurate (based on serum cotinine levels) and smoking is unlikely to change over time with infertility treatment. Women with PCOS have high rates of smoking and it is associated with worse insulin resistance and metabolic dysfunction. Secondary study of smoking history from a large randomized controlled trial of infertility treatments in women with PCOS (N = 626) including a nested case-control study (N = 148) of serum cotinine levels within this cohort to validate self-report of smoking. Women with PCOS, age 18-40, seeking fertility who participated in a multi-center clinical trial testing first-line ovulation induction agents conducted at academic health centers in the USA. Overall, self-report of smoking in the nested case-control study agreed well with smoking status as determined by measure of serum cotinine levels, at 90% or better for each of the groups at baseline (98% of never smokers had cotinine levels <15 ng/ml compared with 90% of past smokers and 6% of current smokers). There were minor changes in smoking status as determined by serum cotinine levels over time, with the greatest change found in the smoking groups (past or current smokers). In the larger cohort, hirsutism scores at baseline were lower in the never smokers compared with past smokers. Total testosterone levels at baseline were also lower in the never smokers compared with current smokers. At end of study follow-up insulin levels and homeostatic index of insulin resistance increased in the current smokers (P < 0.01 for both) compared with baseline and with non-smokers. The chance for ovulation was not associated with smoking status, but live birth rates were increased (non-significantly) in never or past smokers. The limitations include the selection bias involved in our nested case-control study, the possibility of misclassifying exposure to second hand smoke as smoking and our failure to capture self-reported changes in smoking status after enrollment in the trial. Because self-report of smoking is accurate, further testing of smoking status is not necessary in women with PCOS. Because smoking status is unlikely to change during infertility treatment, extra attention should be focused on smoking cessation in current or recent smokers who seek or who are receiving infertility treatment. Sponsored by the Eugene Kennedy Shriver National Institute of Child Health and Human Development of the U.S. National Institutes of Health. ClinicalTrials.gov numbers, NCT00068861 and NCT00719186.