Infertility Research Articles

P-729 Contribution of medical-administrative databases to health monitoring: example of ovarian hyperstimulation syndrome (OHSS)

Abstract Study question Can we monitor post-oocyte retrieval ovarian hyperstimulation syndrome (OHSS) in the French national health data system to complement the French ART vigilance system? Summary answer Medico-administrative databases offer a more comprehensive view of post-oocyte retrieval complications and can be used to detect abnormal increases in frequency and outlier ART centers. What is known already Assisted reproductive technology (ART), widely used in Europe, accounts for about 3% of births in France. The various studies of ART complications are reassuring, showing relatively low overall complication rates. Nonetheless, the European Union has established a vigilance system to monitor these complications. However, this system is not an exhaustive source of information and does not provide a complete overview of post-ART complications. Study design, size, duration The study population was identified from the comprehensive French National Hospital discharge database and included 53,490 women under 46 years old who underwent 65,924 oocyte retrievals in 2022. Women were classified into three population subgroups according to the indication of oocyte retrieval: infertility (IF), fertility preservation (FP), and oocyte donation (OD). Participants/materials, setting, methods Hospital stays for OHSS within two months post-retrieval were analyzed and characterized according to various characteristics (age, comorbidities, indication of oocyte retrieval, type of hospital stay, length of hospital stay...). Multivariate analysis was performed to determine the relation between the occurrence of OHSS and women’s characteristics, and results are expressed as odds ratios (ORs) and 95% CI. A funnel plot was used to compare the OHSS rate per center with the national average. Main results and the role of chance Hospitalized OHSS accounted for 1.1% of retrievals in 2022 (n = 718). The mean age of the women was 31.6 years (SD 4.5). Women with Polycystic Ovary Syndrome (PCOS) accounted for about 4% of the women with OHSS. More than half of OHSS hospital stays lasted less than two days (54%). Of these stays, 2% of women were in intensive care. Multivariate analysis showed a significantly higher OHSS risk in women under 30 and those with PCOS. Other risk factors are currently introduced into the model, such as a history of OHSS or pregnancy. Funnel plot analysis showed that one ART center has an OHSS rate significantly higher than the national average. In the centers that stand out from all the others, the objective is to return to these centers to understand the possible reasons for this observed rate and to implement corrective measures. Limitations, reasons for caution Despite all its advantages, the French national health data system presents some limitations, such as the risk of inappropriate coding. Moreover, the unavailability of personal or clinical information prevented us from considering certain risk factors. Wider implications of the findings Despite the limits of using medico-administrative databases, this approach provides a better representation of post-ART complications and is a promising way to complement the ART vigilance reporting system. This concept will also be generalized to other complications with regular feedback to professionals. Trial registration number not applicable

Contribution of medico-administrative databases to health vigilance: example of post-oocyte retrieval infections.

Can we monitor post-oocyte retrieval infections in the French national health data system to complement the French ART vigilance system? Medico-administrative databases provide a more comprehensive view of post-oocyte retrieval infections and can be used to detect abnormal increases in frequency and outlier ART centers as a complementary tool to the ART vigilance system. The various studies of ART complications are reassuring, showing relatively low overall complication rates. Nonetheless, the European Union has set up a vigilance system to monitor these complications. However, this system is not an exhaustive source of information and does not provide a complete overview of post-ART complications. The study population was identified from the comprehensive French national hospital discharge database. It included women under 46 years of age undergoing an oocyte retrieval in 2019, classified into three population subgroups according to the indication of oocyte retrieval: infertility (IF) , fertility preservation (FP), and oocyte donation (OD) . The study population included 52 098 women who had undergone 65 948 oocyte retrievals in 2019. Hospital stays and delivery of antibiotics within 31 days after oocyte retrieval were analyzed. Women and infections were characterized according to various characteristics (age, comorbidities, indication of oocyte retrieval, type of hospital stay, length of hospital stay, type of antibiotherapy, etc.). Multivariate analysis was performed to determine the relation between the occurrence of infection and women's characteristics, and results are expressed as odds ratios (ORs) and 95% CI. A funnel plot and a box plot were used to compare the infection rate per center with the national average and to detect outliers. Infections in the month following the oocyte retrieval represented 6.9% of the procedures in 2019 (n = 4522). Of these infections, 112 were hospitalized (0.2% of oocyte retrievals), and 4410 were non-hospitalized (6.7% of oocyte retrievals). The hospitalized infections were essentially gynecological infections (40.9%) and urinary tract infections (23.5%). In 87.9% of non-hospitalized infections, a single antibiotic therapy was prescribed. Mixed-effect model analysis showed that the risk of infection was significantly higher in women under 30 years of age, in the FP population, in supplementary universal health coverage (CMU-C) beneficiaries, and women with endometriosis. Funnel plot and box plot analysis showed that three ART centers have an infection rate significantly higher than the national average. In the three centers that stand out from all the others, the objective is to return to these centers to understand the possible reasons for this observed rate and to implement corrective measures. Despite all its advantages, the French national health data system presents some limitations, such as the risk of inappropriate coding. Another limitation of this study is that we cannot confirm an attributable relation between the infection and the ART procedure, even if the delay of 31 days after oocyte retrieval is consistent with the occurrence of a post-retrieval complication. In addition, antibiotics may be prescribed as a 'precautionary' measure in certain situations (women with a susceptibility to infection, complicated procedures), or as antibiotic prophylaxis for embryo transfer. Despite the limits in identifying post-ART infections in medico-administrative databases, this approach is a promising way to complement the ART vigilance reporting system. This concept developed for infections will also be generalized to other complications with regular feedback to professionals. No specific funding was sought for the study. The study was supported by the Agence de la biomédecine, France. The authors declare that they have no conflict of interest. N/A.

Identification of Candidate Salivary, Urinary and Serum Metabolic Biomarkers for High Litter Size Potential in Sows (Sus scrofa).

The selection of sows that are reproductively fit and produce large litters of piglets is imperative for success in the pork industry. Currently, low heritability of reproductive and litter-related traits and unfavourable genetic correlations are slowing the improvement of pig selection efficiency. The integration of biomarkers as a supplement or alternative to the use of genetic markers may permit the optimization and increase of selection protocol efficiency. Metabolite biomarkers are an advantageous class of biomarkers that can facilitate the identification of cellular processes implicated in reproductive condition. Metabolism and metabolic biomarkers have been previously implicated in studies of female mammalian fertility, however a systematic analysis across multiple biofluids in infertile and high reproductive potential phenotypes has not been explored. In the current study, the serum, urinary and salivary metabolomes of infertile (INF) sows and high reproductive potential (HRP) sows with a live litter size ≥ 13 piglets were examined using LC-MS/MS techniques, and a data pipeline was used to highlight possible metabolite reproductive biomarkers discriminating the reproductive groups. The metabolomes of HRP and INF sows were distinct, including significant alterations in amino acid, fatty acid, membrane lipid and steroid hormone metabolism. Carnitines and fatty acid related metabolites were most discriminatory in separating and classifying the HRP and INF sows based on their biofluid metabolome. It appears that urine is a superior biofluid than saliva and serum for potentially predicting the reproductive potential level of a given female pig based on the performance of the resultant biomarker models. This study lays the groundwork for improving gilt and sow selection protocols using metabolomics as a tool for the prediction of reproductive potential.

Hematospermia and Its Sexual Ramifications: A Systematic Review

ABSTRACT Introduction Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare, usually benign condition associated with various etiologies and treatments. Though a source of great anxiety for patients, no comprehensive review exists on the sexual ramifications of HS. Objective To determine HS effects on sexual wellbeing, with emphasis on original research. Methods A systematic review of HS was performed via PubMed (Figure 1). The following search terminology was used: “(hemospermia OR hematospermia) AND (sexual OR libido OR anxiety OR infertility OR cryopreservation OR erectile dysfunction).” Articles were assessed for sexual health-related implications, such as emotional disturbances, changes in sexual activity, hindered sexual response cycles, pain associated with intercourse, altered fertility, and sexual infections. Results Thirty-eight articles met our inclusion criteria while 111 were excluded. The effect of HS on sexual health proved multifaceted. Anxiety is known to compromise sexual health. Two articles reported that anxiety following transrectal ultrasound (TRUS)-guided prostate biopsy had a positive correlation with duration of HS. Additionally, in both studies, 50% of patients reported decreased sexual activity due to HS. A similar study showed that patients with substantial prostatic calculi had greater HS after biopsy as well as significantly increased anxiety compared to those with no prostatic calcifications. Patients with underlying comorbidities experienced sexual complications from HS. One study described a man who developed HS due to hypertensive emergency. In response to his HS, sexual partners ostracized him and family members believed he was divinely cursed. Another article described 3 patients with congenital bleeding disorders (e.g., hemophilia A, prothrombin deficiency, von Willebrand disease) who required episodes of sexual abstinence due to HS. HS was associated with blood during parts of the sexual response cycle. Two studies showed urethrorrhagia occurred after sexual excitation in those with HS and urethral hemangiomas. Likewise, four articles revealed HS and post-coital hematuria, sometimes with severe bleeding after ejaculation, in patients with urethral hemangiomas, previous coital trauma, or seminal vesicle cysts (SVC.) Of note, another study demonstrated patients with SVC experienced HS and post-ejaculatory pain. In certain populations, HS indicated increased risk of sexual pathologies. One study illustrated patients with HS and chronic prostatitis had 4-fold increased risk of erectile dysfunction (ED) compared to those without HS. Sixteen articles showed that HS was associated with infertility (IF) in various circumstances, including anatomic genitourinary pathologies (e.g., SVC, prostatic cysts, Mullerian duct cysts, ejaculatory duct stones, vas deferens injuries, varicoceles), herpes simplex virus (HSV) infection with low seminal volume, hydroxyurea treatment of essential thrombocythemia, leukospermia, Zinner syndrome, and isolated follicle-stimulating hormone deficiency. Furthermore, two studies revealed HS was related to temporarily altered semen quality after shockwave lithotripsy. In 7 articles, patients with HS had infections that could be sexually transmitted, including HSV, Chlamydia, enterococcus, Ureaplasma, Schistosoma, and Zika virus. Conclusions Sexual effects of HS included increased anxiety, exacerbated comorbidities, bleeding during sexual response cycle, ED, IF, and increased risk of sexual infections. Further research is needed to better understand causality in addition to associations of HS on sexual wellbeing. Disclosure No

Deleterious impact of short duration UV-A exposure on the human sperm cell –An in vitro study

BackgroundEnvironmental stressors like radiation are a cause for male infertility. The quantum of UV-A in solar ultraviolet (UV) radiation surpasses the amount of UVB by 10 to 100 times, penetrates deeper than UV-B into tissue and mediates possible molecular damage, which warrants evaluation of the impact of UV-A on human spermatozoa. AimTo determine the differences in effects and responses of UV-A exposure on sperm cells from fertile volunteers and infertile men. Materials and MethodsThe study subjects were divided into Group I (Control) and Group II (Infertile). The impact of UV-A on sperm viability, nuclear integrity, chromatin maturity and DNA fragmentation (pre-and post-exposure) was evaluated using standard techniques. Antioxidant enzyme activity assays viz. Lipid Peroxidation (LPO), Superoxide Dismutase (SOD) and Catalase were also analysed. Statistical significance was considered at p < 0.05. ResultsThis study revealed significant decline in%viability in Group II after UV-A exposure when compared with pre-exposed Group I. The percent sperm with disrupted nuclear toroidal assembly significantly increased in infertile group after exposure, leaving the DNA vulnerable to damage. A significant elevation was observed in the percent immature forms correlated with the significant reduction in% halo formation (impaired nuclear chromatin decondensation) in both post-treated groups as compared to pre-treated groups, suggesting that disruption of sperm toroid triggers DNA damage. UV-A exposure resulted in increased LPO with decrease in antioxidant enzymes in these groups. The percent decline in viability, chromatin decondensation (halo) and antioxidant enzymes were higher in Group II than in Group I. In addition, the percent increase in disrupted toroids and immature chromatin in Group II suggested that the deleterious impact of UV-A on spermatozoa from the infertile group is significantly greater than that of fertile individuals. ConclusionThis study thus revealed that short term UV-A exposure adversely impacts spermatozoa of infertile males to a greater extent than that of the fertile group. Thus, specific awareness and precautions are imperative for occupationally exposed individuals.

Overview of hospitalizations in women undergoing oocyte retrieval for ART in the French national health data system.

What is the incidence rate of complications in women undergoing ART procedures compared to the period prior to their first oocyte retrieval? The study shows a significant increase in the post-ART incidence rate of some complications but a low overall rate of occurrence relative to the total number of oocyte retrievals. ART, widely used in Europe, accounts for 3.3% of births in France. The various studies of ART complications are fairly reassuring, showing relatively low overall complication rates but only few studies have used exhaustive national registers. The cohort for this study was identified from the comprehensive French national hospital-discharge database and includes women under 50 years with a first oocyte retrieval (T0) in 2012-2017, classified in three population subgroups according to the indication for oocyte retrieval: infertility (IF), oocyte donation (OD), and fertility preservation (FP). This study includes 156 916 women whose first oocyte retrieval occurred in 2012-2017 and 542 775 hospitalizations in 2010-2019 (excluding first retrieval). Hospitalizations for complications or others events (oocyte retrieval, delivery, pregnancy loss, and death in the hospital) during the 2 years before (control period) and after their first oocyte retrieval (post-oocyte retrieval period) were compared and expressed per 10 000 person-months (pm). In the IF subgroup, incidence rates were significantly higher after (vs before) retrieval for hospitalized ovarian hyperstimulation syndrome (OHSS) (162 vs 6/10 000 pm), adnexal torsion (14 vs 3), venous thrombosis (8 vs 1), arterial thrombosis (3 vs 1), trauma (2 vs 1), and significantly lower for infections (61 vs 87). The higher incidences of OHSS, adnexal torsion and venous thrombosis could only partially be explained by the occurrence of pregnancy.In the FP subgroup, incidence increased significantly after (vs before) retrieval for hospitalized OHSS (55 vs 0), venous thrombosis (59 vs 4), and infections (176 vs 56). For the OD subgroup, hospitalized OHSS (116 vs 0) and bleeding (24 vs 0) were significantly higher after (vs before) retrieval. The French national health data system, despite all its advantages, present some limitations such as the risk of coding errors. The unavailability of some personal information and the absence of consideration of risk factors prevented us from adjusting the risk. Finally, only complications resulting in hospitalization were analyzed which probably leads to their underestimation. The use of medico-administrative bases will be a valuable tool in public health and will furnish a better overview of the complications. Further studies are needed to complete this analysis. Adding information on drugs would help to better define T0 and less severe complications. N/A. N/A.

Poster Exhibit 8: Sexual Dysfunction & Infertility.

Poster Exhibit 8: Sexual Dysfunction & Infertility.

Infertility as a Burden- Women as Victim

Infertility as a Burden- Women as Victim

Progress in the genetic studies of spermatogenesis abnormalities.

About 15% couples suffer from infertility, half of which are caused by male factors. Male infertility usually manifests as teratozoospermia, oligospermia and/or asthenospermia, of which the most severe form is azoospermia. In this review, we summarize the recent progress in the study of genetic factors involved in nonobstructive azoospermia and teratozoospermia, Recently, with the rapid development of high-throughput chips and sequencing technologies, many genetic factors of spermatogenesis have been discovered and analyzed. For the nonobstructive azoospermia, genome-wide association studies (GWAS) and high-throughput sequencing revealed many risk loci of nonobstructive azoospermia. For the teratozoospermia, the application of whole-exome sequencing (WES) revealed a series of disease-causing genes, greatly enriching our knowledge of teratozoospermia including multiple morphological abnormalities of the flagella (MMAF). The discovery of lots of disease genes helped the characterization of the pathological mechanisms of male infertility. Therefore, a comprehensive and in-depth understanding of genetic factors in spermatogenesis abnormalities will play important roles in the clinical diagnosis, treatment and genetic counseling of male infertility.

Zakaz tworzenia chimer i hybryd a ksenotransplantacja? Uwagi de lege lata i de lege ferenda

The article describes the process of farming interspecies chimeras, specifically animals that host human organs. Such procedure is based on injection of human pluripotent cells derived from adult somatic tissue into an animal embryo and is aimed to grow functional, mature organs that can be used for xenotransplantation. Thus, this might be a promising solution to the currently experienced drastic shortage of transplantable human organs. The author addresses legal issues behind development of human organs in animal-human chimeras. The main purpose of this paper is to asses, whether the prohibition on the formation of chimeras provided for in the Infertility Treatment Act applies to the formation of chimeras for xenotransplantation (cross-species transplantation) in Polish law. The author analyzes the nature of the prohibition on creating chimeras introduced in Polish law to propose a thesis that such restriction does not apply to farming chimeric animals bearing human organs solely for transplantation purposes. The article also proposes de lege ferenda solutions to be introduced by the legislator, which would apply to xenotransplantation of organs created from patient?s stem cells.

Infertility: still a largely uncovered and undertreated disease.

Infertility: still a largely uncovered and undertreated disease.

Coping with infertility, miscarriage, and unsuccessful adoption

Coping with infertility, miscarriage, and unsuccessful adoption

Experience of the "Prof. Dr. Panait Sarbu" Hospital in Oncofertility among Breast Cancer Patients.

Introduction: Oncofertility represents a new field, dedicated to patients at childbearing age who are diagnosed with a neoplasic disease and who want to have a biologic child after they complete the oncological and surgical treatment. Because of new screening and treatment methods, most patients survive the disease, but the main long-term complication remains infertility. Young women with breast cancer are candidates for preserving their fertility mostly because of the risk of chemotherapy-related infertility due to the alkylating agent, causing dose-dependent destruction of oocytes and follicular depletion and thus bringing cortical fibrosis and ovarian blood-vessel damage (1). "Prof. Dr. Panait S #226;rbu" hospital is the first medical facility in Romania which performs oncofertility procedures among breast cancer patients within the program "Newborn Oncofertility". Material and Methods: Within the program run by our hospital 21 patients (13 men and 8 women) came for fertility preservation, including 5 patients diagnosed with breast cancer. Our specialists in reproductive medicine performed ovarian stimulation and oocyte pick-up, after which the genetic material was cryopreserved. The procedure could be performed only if the patients were under 35 years old, and provided the case had been previously discussed within the tumor board and the patient had received the oncological agreement. Disscution: There was a slight predominance of breast cancer patients who addressed the clinic with a view for preserving their fertility and those who met the conditions could start the procedure immediately, without any delay when it comes to oncological or surgical treatments. There were no side effects during ovarian stimulation treatment. Oocytes or embryos were cryopreserved using the method of vitrification.

Rare Surgical Complication of In Vitro Fertilisation Treatment: Bladder Injury During Oocyte Retrieval

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively. J Med Cases. 2021;12(3):102-106 doi: https://doi.org/10.14740/jmc3632

Status of Estrogen Receptor Beta Gene Polymorphisms rs1256049 and rs4986938 in a cohort of South Indian women with Primary ovarian insufficiency

The current study is aimed to investigate the role of estrogen receptor beta gene polymorphisms for causation of Primary Ovarian insufficiency (POI) in south Indian women. Primary Ovarian insufficiency (POI) is a menstrual disorder presenting with Primary and secondary amenorrhea, decreased estradiol levels and increased gonadotrophin levels. Most cases of POI remain unresolved even after exhaustive investigations and is a significant cause of infertility in women in the reproductive age. In this study a total of 276 subjects, of which 138 POI patients and 138 controls were analysed for biochemical profiles of FSH, LH and Estradiol. Genotypic frequencies were calculated for different models of the SNP rs1256049 and rs4986938 in the Estrogen receptor Beta gene by PCR-RFLP (Restriction length polymorphism) analysis. Statistically, significant relation is found for FSH, LH and Estradiol profiles of a different group of Premature ovarian insufficiency and controls (p A (rs1256049) polymorphisms and 1730 G>A (rs4986938) were not significantly different in both patient and control group (P=0.21 and P=0.4). The presence of 1082 G>A (rs1256049) polymorphisms and 1730 G>A (rs4986938) is not associated with causation of Premature ovarian insufficiency in south Indian women.

Recent advances and controversies in diagnosing and treating male infertility.

Interest in male infertility has increased, as it plays an important role in up to 50% of couples struggling with infertility, which is an estimated 48.5 million couples globally. Despite recent advances, diagnosing and treating male infertility remain a significant clinical challenge owing to complex multifactorial pathways and the diversity of treatment options. This review will assess current controversial topics on male infertility such as the use of home-based semen testing, management of subclinical varicocele, and recent advances in the field of sperm proteomics.

Showing NAFLD, as a key connector disease between Alzheimer’s disease and Diabetes, via systems biology analysis

Aim: Network analysis of Alzheimer and Diabetes and find their correlation with each other and other disease/pathways. Background: Alzheimer’s disease (AD) as a neurodegenerative disease and Diabetes as metabolic disease are two major health problems in recent years. Recent studies reported their correlation and same spreading pathways of these two disease together, but details of this relation at molecular level not well known. Methods: In TPP technique after treatment of extracted proteins by heat and drug concentration, the resulted proteins analyzed by mass spectrometry. Enrichment analysis of these proteins lead to Alzheimer`s and Diabetes. First, the corresponding genes for each disease were extracted from DisGeNET, then, the protein-protein interaction network for each of them were constructed using STRING. After analyzing these networks, the hub-bottleneck nodes of networks were evaluated. Also, common nodes between two networks were extracted and used for further analysis. Results: High correlation between Alzheimer disease and Diabetes by the existence of 40 genes in common. Analyzes, revealed 14 genes in AD and 12 genes in Diabetes as hub-bottleneck which seven of them were common including: CASP3, IGF1, CAT, TNF LEP, VEGFA and IL6. Conclusion: This study, revealed a direct correlation between AD and Diabetes also the correlation between these two diseases and NAFLD, suggesting small change in each three diseases can develop any other disease in patients. Also the enrichments exhibited existence of common pathways between AD, Diabetes, NAFLD and mail fertility. Key words: NAFLD, Alzheimer's Disease, Diabetes Mellitus, Type II, Male Infertility, Bioinformatics

Chlamydial infections in women

Chlamydia trachomatis (Ct) is a Gram-negative bacterium with an obligatory intracellular life cycle. Tropism manifests through columnar epithelia in the uterine cervix, rectum, lungs, and eyes. The literature review of the Medline database identified 3,458 papers. The WHO estimates that over 100 million new cases of infection by Ct occur worldwide annually, with an increase of 4.1% since the last global evaluation conducted in 2006. Chlamydia trachomatis is the most frequent sexually transmissible bacterium in the United States with a yearly incidence of more than one million reported cases. Approximately 50 to 75% of infected women show no symptoms of the infection or appear to be mucopurulent cervicitis. Pain caused by cervical motion or evaluation of the accessories in response to a bimanual exam suggests the infection has moved on to the upper genital tract leading to endometritis, salpingitis and peritonitis and its consequences: pelvic pain, infertility, ectopic pregnancy. Chlamydia trachomatis may also be the etiologic agent of bacterial urethritis, in which case, despite the patient’s report of dysuria, the urine culture is negative for the usual urinary pathogens. Since bacteria favor columnar epithelia, the Skene and the Bartholin vestibular glands may also be a site of infection and attendant symptoms. The nucleic acid amplification test is the most recommended for its higher sensitivity and specificity and is currently the gold standard for diagnosis. The antibiotics for the treatment should be chosen for their intracellular penetration ability and should have a half-life of 36 to 48 hours to cover the bacterium’s life cycle. Azithromycin is excellent at intracellular penetration, has a half-life of 5 to 7 days, and can be administered in a single dose; it may also be given to pregnant women. A recent meta-analysis showed a small increase (3%) of better outcome in the use of doxycycline against azithromycin in the treatment of urogenital infection.

A Review of the Prevalence of Endometriosis in African Women

Endometriosis is a chronic condition where growth of endometrial tissue is located outside the uterine cavity. Endometriosis has been shown to impact negatively on all aspects of the patient’s life. The aim of this paper is to show the prevalence of endometriosis in African women to encourage more research and clinical innovations to increase access and awareness to African indigenous women with endometriosis. Existing research have focused on the prevalence of endometriosis in developed countries. There is a dearth of research focused on developing countries, especially in Africa. This is likely due to underreporting or underestimation of rates due to inadequate facilities or specialised skills. Results showed that there is a significant prevalence of endometriosis in African indigenous women. This was common among women aged 31-40 years and the prevalence is higher among infertile women with moderate or severe endometriosis with majority in low socioeconomic status. There is a need to understand the prevalence of endometriosis in African women to help provide more support and management of the disease. Further research is necessary to increase awareness about the condition as these women tend to suffer in silence. This paper shows the importance of support and awareness of the disease especially to disadvantaged women in Africa who have no access to advanced medical amenities or insurance.

Endometriose: causas, implicações e tratamento da infertilidade feminina através das técnicas de reprodução assistida

A endometriose é um distúrbio inflamatório estrogênio-dependente, caracterizada pelo crescimento exacerbado de tecido endometrial e células do estroma fora da cavidade uterina. A qualidade de vida é diminuída em mulheres com endometriose, principalmente com o agravamento dos sintomas. Tendo em vista a importância da endometriose para saúde pública, o presente artigo teve por objetivo explanar a fisiopatologia da endometriose, as formas de diagnóstico e tratamento, bem como as implicações da doença na fertilidade feminina e formas de tratamento através da reprodução assistida. Para tanto, foram selecionadas 50 referências de língua portuguesa e inglesa datadas entre os anos de 2014 a 2020, prioritariamente. A etiologia da endometriose é complexa, cercada por diversas teorias, e o diagnóstico precoce é crucial para a minimização dos danos à fertilidade, visto que 30 a 50% das mulheres com endometriose exibem quadro de infertilidade. São observadas diversas complicações em pacientes acometidas pela patologia que levam à infertilidade. A fim de manter a fertilidade feminina, técnicas de reprodução assistida têm sido utilizadas com sucesso. Diante do exposto, conclui-se que para a manutenção da qualidade de vida e fertilidade feminina, o diagnóstico precoce da endometriose é imprescindível. Além disso, as técnicas de reprodução assistida surgem como a linha de tratamento com maior sucesso terapêutico para mulheres acometidas por endometriose que desejam engravidar.