Known Cause Of Infertility Research Articles

Breast Cancer and Fertility Preservation in Young Female Patients: A Systematic Review of the Literature.

Breast cancer affects almost 1.5 million women worldwide below the age of 45 years each year. Many of these women will be advised to undergo adjuvant chemotherapy to minimize the risk of death or recurrence of the tumor. For these patients, chemotherapy is a known cause of infertility, as it can damage primordial follicles, which can lead to early menopause or premature ovarian insufficiency. This systematic review aims to synthesize the current evidence of the most suitable treatments for fertility preservation. This review was performed following the PRISMA guidelines. The authors conducted an extensive search from the last 15 years. Relevant studies were pursued in PubMed, Embase, and the Cochrane Library up until 31 July 2023. A total of seven eligible studies were identified. From the reviewed literature, ovarian suppression with gonadotropin-releasing hormone agonists showed promising results in preserving fertility for breast cancer patients undergoing chemotherapy. Additionally, oocyte and embryo cryopreservation demonstrated successful outcomes, with embryo cryopreservation being the most effective option. Notably, the slow-freezing and vitrification methods were both effective in preserving embryos, with vitrification showing superior results in clinical-assisted reproductive technologies. Ovarian tissue cryopreservation emerged as a viable option for prepubertal girls and those unable to undergo conventional ovarian stimulation. The potential of in vitro maturation (IVM) as an alternative method presents a promising avenue for future fertility preservation research. The most suitable treatments for fertility preservation in young patients is the temporary suppression with luteinizing hormone-releasing analogs, while the patient undergoes chemotherapy and cryopreservation. For cryopreservation, the physicians might deem it necessary to either cryopreserve ovarian tissue taken from the patient before any treatment or cryopreserve embryos/oocytes. Cryopreservation of oocytes and/or embryos is the most effective solution for fertility preservation in women of reproductive age, who have a sufficient ovarian reserve and are diagnosed with breast cancer, regardless of the histological type of the tumor. Because approximately 50% of young breast cancer patients are interested in becoming pregnant right after completion of therapy, the evolution and development of fertility preservation techniques promise to be very exciting.

Effect of Letrozole and Clomiphene Citrate versus Letrozole Alone for Ovulation Induction in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy characterized by oligo-ovulation or anovulation signs of androgen excess and multiple small ovarian cysts. It is thought to be one of the leading causes of female sub-fertility. It has been estimated that PCOS affects 5-10% of females in reproductive age. In this study, we used combination of letrozole and clomiphene vs letrozole alone in ovulation induction in infertile PCOS women. Objective: The objective of the study was to compare the effectiveness of the combination of letrozole and clomiphene citrate and letrozole alone in ovulation induction in infertile women with PCOS. Methods: Randomized controlled trial conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2021. A total of 50 women 18-40 years of age with a diagnosis of infertility and PCOS as defined by the Rotterdam criteria and no other known cause of infertility were included in this study. Participants were randomly assigned into two groups by using a computer-generated random table to either 5 mg letrozole alone or the combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3-7 for two treatment cycle. Statistical analysis was performed by the SPSS program for Windows, version 22.0. Main outcome measured by number & size of mature follicles, endometrial thickness, day 21 serum progesterone & ovulation rate in both groups. The secondary outcome includes pregnancy rate and complication of both treatment arms. Results: Regarding demographic criteria, there was no significant difference between two groups. In the current study, clinical characteristics, laboratory parameters and cycle characteristics were also comparable to both groups and showed no significant difference. Dominant follicles were found 24(52.2%) in group A (CC+Letrozole) and 29(63.0%) in group B (Letrozole Alone) without any significant difference. Mono follicular development was found 18(75.0%) in group A and 24(82.8%) in group B which was not statistically significant. Endometrial thickness and serum progesterone level at 1st and 2nd cycle were not statistically significant between two groups (p>0.05). Ovulation rate was higher in group B than group A (76.0% vs 72.0%) with absolute difference 4.0 and relative ratio 0.95. Pregnancy rate was also higher in group B than group A (24.0% vs 16.0%) with absolute difference 8.0 and relative ratio 0.67. Ovulation and pregnancy rate were not statistically significant between two groups. Regarding side effects, no significant difference was found between two groups. Conclusion: Although it was not statistically significant, ovulation and pregnancy rate was a little higher in alone letrozole group than combined group. The results of this preliminary study suggested that letrozole may have a better role as a first-line treatment for anovulatory patients with PCOS.

Total fertilization failure after ICSI: insights into pathophysiology, diagnosis, and management through artificial oocyte activation.

Total fertilization failure (TFF) is the failure of all metaphase II oocytes to fertilize in ART cycles. The phenomenon represents a known cause of infertility, affecting 1-3% of ICSI cycles. Oocyte activation deficiency (OAD) is the leading cause of fertilization failure, attributed to sperm- or oocyte-related issues, although until recently little attention has been given to oocyte-related deficiencies. Different strategies for overcoming TFF have been proposed in clinical settings, mainly using artificial oocyte activation (AOA) by calcium ionophores. Typically, AOA has been blindly applied with no previous diagnosis testing and, therefore, not considering the origin of the deficiency. The scarcity of data available and the heterogeneous population subjected to AOA make it challenging to draw firm conclusions about the efficacy and safety of AOA treatments. TFF leads to an unexpected, premature termination of ART, which inflicts a substantial psychological and financial burden on patients. This review aims to provide a substantial update on: the pathophysiology of fertilization failure, focusing both on sperm- and oocyte-related factors; the relevance of diagnostic testing to determine the cause of OAD; and the effectiveness and safety of AOA treatments to overcome fertilization failure. Relevant studies were identified in the English-language literature using PubMed search terms, including fertilization failure, AOA, phospholipase C zeta (PLCζ), PLCZ1 mutations, oocyte-related factors, wee1-like protein kinase 2 (WEE2) mutations, PAT1 homolog 2 (PATL2) mutations, tubulin beta-8 chain (TUBB8) mutations, and transducin-like enhancer protein 6 (TLE6) mutations. All relevant publications until November 2022 were critically evaluated and discussed. Fertilization failure after ART has been predominantly associated with PLCζ deficiencies in sperm. The reason relates to the well-established inability of defective PLCζ to trigger the characteristic pattern of intracellular Ca2+ oscillations responsible for activating specific molecular pathways in the oocyte that lead to meiosis resumption and completion. However, oocyte deficiencies have recently emerged to play critical roles in fertilization failure. Specifically, mutations have been identified in genes such as WEE2, PATL2, TUBB8, and TLE6. Such mutations translate into altered protein synthesis that results in defective transduction of the physiological Ca2+ signal needed for maturation-promoting factor (MPF) inactivation, which is indispensable for oocyte activation. The effectiveness of AOA treatments is closely related to identifying the causal factor of fertilization failure. Various diagnostic tests have been developed to determine the cause of OAD, including heterologous and homologous tests, particle image velocimetry, immunostaining, and genetic tests. On this basis, it has been shown that conventional AOA strategies, based on inducing the calcium oscillations, are highly effective in overcoming fertilization failure caused by PLCζ-sperm deficiencies. In contrast, oocyte-related deficiencies might be successfully managed using alternative AOA promoters that induce MPF inactivation and meiosis resumption. Such agents include cycloheximide, N,N,N',N'-tetrakis(2-pyridylmethyl)ethane-1,2-diamine (TPEN), roscovitine, and WEE2 complementary RNA. In addition, when OAD is caused by oocyte dysmaturity, applying a modified ovarian stimulation protocol and trigger could improve fertilization. AOA treatments represent a promising therapy to overcome fertilization failure caused by sperm- and oocyte-related factors. Diagnosing the cause of fertilization failure will be essential to improve the effectiveness and safe utilization of AOA treatments. Even though most data have not shown adverse effects of AOA on pre- and post-implantation embryo development, the literature is scarce on the matter concerned and recent studies, mainly using mice, suggest that AOA might cause epigenetic alterations in the resulting embryos and offspring. Until more robust data are available, and despite the encouraging results obtained, AOA should be applied clinically judiciously and only after appropriate patient counseling. Currently, AOA should be considered an innovative treatment, not an established one.

Association of Anti-Mullerian Hormone with Some Physiological and immunological Parameters of Infertile Males.

The measurement of anti-Müllerian hormone (AMH), which is released in the serum and seminal fluid is a specific indicator of Sertoli cell function. This study aimed to evaluate AMH as a potential clinical indicator of infertility in maleswith normal and low sperm concentrations, as well as those with primary and secondary infertility. It was a retrospective analysis of 140 males chosen from sole infertility and IVF center in Erbil. without a known cause of infertility, 40 men with normal sperm counts, 100 men with primary, and 40 men with secondary infertility were assessed. An in-house ELISA was used to assess the serum AMH. Semen parameters, Semen and sera cytokines, and certain sex hormone mean levels were compared and correlated with AMH as the primary outcome measures. Seminal and serum AMH levels in infertile males were significantly lower. While an insignificant correlation was detected between AMH and LH, prolactin, or testosterone in azoospermic men, there was a significant adverse association between seminal AMH and FSH. A substantial positive association between seminal AMH and testosterone was found in oligospermia men, although no significant correlations were observed with FSH, LH, or prolactin. In conclusion, AMH in seminal plasma is a reliable marker of male infertility with a role in sperm production.

Evaluation of IL-1β and TNF-α level in endometrial flush in patients with recurrent implantation failure

Infertility is defined as the inability to conceive within a year of regular unprotected intercourse affecting one in six couples. The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease [1]. Unexplained Infertility (UI) and Recurrent Implantation Failure (RIF) are diagnoses based on failed pregnancy attempts with current infertility treatment options. UI is diagnosed when testing is inconclusive and RIF is diagnosed after three failed In Vitro Fertilization (IVF) cycles. UI is the absence of conception despite 12 months of unprotected intercourse, not explained by anovulation, poor sperm quality, tubal pathology or other known cause of infertility. RIF is defined by three failed IVF cycles in which one or two high-quality embryos are transferred in each cycle or by two failures in oocyte donor recipients after the transfer of good quality embryos [1]. UI is a common cause of infertility affecting 10-30% of infertile couples [2], while RIF is present in around 10% of in vitro fertilization (IVF) cycles [3].

Prioritizing IVF treatment in the post-COVID 19 era: a predictive modelling study based on UK national data.

STUDY QUESTIONCan we use prediction modelling to estimate the impact of coronavirus disease 2019 (COVID 19) related delay in starting IVF or ICSI in different groups of women?SUMMARY ANSWERYes, using a combination of three different models we can predict the impact of delaying access to treatment by 6 and 12 months on the probability of conception leading to live birth in women of different age groups with different categories of infertility.WHAT IS KNOWN ALREADYIncreased age and duration of infertility can prejudice the chances of success following IVF, but couples with unexplained infertility have a chance of conceiving naturally without treatment whilst waiting for IVF. The worldwide suspension of IVF could lead to worse outcomes in couples awaiting treatment, but it is unclear to what extent this could affect individual couples based on age and cause of infertility.STUDY DESIGN, SIZE, DURATIONA population based cohort study based on national data from all licensed clinics in the UK obtained from the Human Fertilisation and Embryology Authority Register. Linked data from 9589 women who underwent their first IVF or ICSI treatment in 2017 and consented to the use of their data for research were used to predict livebirth numbers.PARTICIPANTS/MATERIALS, SETTING, METHODSThree prediction models were used to estimate the chances of livebirth associated with immediate treatment versus a delay of 6 and 12 months in couples about to embark on IVF or ICSI.MAIN RESULTS AND THE ROLE OF CHANCEWe estimated that a 6-month delay would reduce livebirths by 0.4%, 2.4%, 5.7%, 9.5% and 11.8% in women aged <30, 30-35, 36-37, 38-39 and 40-42 years, respectively, while corresponding values associated with a delay of 12 months were 0.9%, 4.9%, 11.9%, 18.8% and 22.4%, respectively. In women with known causes of infertility, worst case (best case) predicted chances of livebirth after a delay of 6 months in women aged <30, 30-35, 36-37, 38-39 and 40-42 years varied between 31.6% (35.0%), 29.0% (31.6%), 23.1% (25.2%), 17.2% (19.4%) and 10.3% (12.3%) for tubal infertility and 34.3% (39.2%), 31.6% (35.3%) 25.2%(28.5%) 18.3% (21.3%), and 11.3% (14.1%) for male factor infertility. The corresponding values in those treated immediately were 31.7%, 29.8%, 24.5%, 19.0% and 11.7% for tubal factor and 34.4%, 32.4%, 26.7%, 20.2% and 12.8% in male factor infertility. In women with unexplained infertility the predicted chances of livebirth after a delay of 6 months followed by one complete IVF cycle were 41.0%, 36.6%, 29.4%, 22.4% and 15.1% in women aged <30, 30-35, 36-37, 38-39 and 40-42 years, respectively, compared to 34.9%, 32.5%, 26.9%, 20.7% and 13.2% in similar groups of women treated without any delay. The additional waiting period, which provided more time for spontaneous conception, was predicted to increase the relative number of babies born by 17.5%, 12.6%, 9.1%, 8.4% and 13.8%, in women aged <30, 30-35, 36-37, 38-39 and 40-42 years, respectively. A 12-month delay showed a similar pattern in all subgroups.LIMITATIONS, REASONS FOR CAUTIONMajor sources of uncertainty include the use of prediction models generated in different populations and the need for a number of assumptions. Although the models are validated and the bases for the assumptions are robust, it is impossible to eliminate the possibility of imprecision in our predictions. Therefore, our predicted live birth rates need to be validated in prospective studies to confirm their accuracy.WIDER IMPLICATIONS OF THE FINDINGSA delay in starting IVF reduces success rates in all couples. For the first time, we have shown that while this results in fewer babies in older women and those with a known cause of infertility, it has a less detrimental effect on couples with unexplained infertility, some of whom conceive naturally whilst waiting for treatment. Post COVID 19, clinics planning a phased return to normal clinical services should prioritise older women and those with a known cause of infertility.STUDY FUNDING/COMPETING INTEREST(S)No external funding was received for this study. B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548) and reports consultancy work for ObsEva, Merck, Merck KGaA, Guerbet and iGenomics. SB is Editor-in-Chief of Human Reproduction Open. None of the other authors declare any conflicts of interest.

Maternal age at delivery and fertility of the next generation.

While most known causes of infertility relate to the health of the woman and/or her partner, questions have been raised regarding the possible contributions of transgenerational or epigenetic factors. The goal of this hypothesis-generating work was to examine whether Generation 1's (G1's) age at the delivery of G2 (Generation 2) was associated with G2's fertility in later life. We conducted a retrospective cohort study of women (G2s) recruited online in 2016. A questionnaire queried G2s regarding demographics and fertility. The primary exposure was G1's age at G2's birth. Outcome measures included the following: 12-month infertility, time to pregnancy, and childlessness. The adjusted relative risk (RR) of G2 infertility and childlessness by G1 age at G2's birth was estimated through a modified Poisson regression approach. The fecundity odds ratio (FOR) for the association between G1's age at G2 birth and time to pregnancy for G2 was estimated by discrete-time survival models, with complementary log-log link. A total of 2,854 women enrolled. We found no association between G1 age at G2's birth and G2 infertility. Being born to a G1 aged 15-19years was associated with a longer time to pregnancy for G2 (FOR 0.84, 95% confidence interval 0.72, 0.99), relative to being born to a G1 aged 20-24years. We observed the suggestion of a possible increased risk of childlessness among G2s born to older G1s, but the estimate was imprecise. While being born to a G1 who was 15-19years old was associated with an increase in G2 time to pregnancy, we found no association between G1 age at G2's birth and infertility and only the suggestion of a modest association with childlessness. These data suggest a possible subtle effect of G1 age at G2's birth on G2 fertility, which warrants further study.

A randomized controlled trial of combination letrozole and clomiphene citrate or letrozole alone for ovulation induction in women with polycystic ovary syndrome

To evaluate whether a combination of letrozole and clomiphene citrate (CC) results in higher ovulation rates than letrozole alone in infertile women with polycystic ovary syndrome (PCOS). Open-label randomized controlled trial. Academic medical center using two clinic sites. Women 18-40years of age with a diagnosis of infertility and PCOS as defined by the Rotterdam criteria and no other known cause of infertility. Participants were randomized in a 1:1 ratio, stratified by age and body mass index, to either 2.5mg letrozole alone or the combination of 2.5mg letrozole and 50mg CC daily on cycle days 3-7 for one treatment cycle. Ovulation defined as mid-luteal serum progesterone concentration ≥3ng/mL. Seventy patients were randomized: 35 to letrozole alone and 35 to letrozole and CC. Results were analyzed according to the intention-to-treat principle. Women who received the combination of letrozole and CC had a statistically higher ovulation rate compared with those who received letrozole alone (27 of 35 women [77%] vs. 15 of 35 women [43%]). There were no serious adverse events or multiple-gestation pregnancies in either group. The side-effects profile was similar in the two treatment groups. The combination of letrozole and CC was associated with a higher ovulation rate compared with letrozole alone in women with infertility and PCOS. Further studies are needed to evaluate the effect on live birth rate. NCT02802865.

Suppressive regulatory T cells and latent transforming growth factor-\u03b2-expressing macrophages are altered in the peritoneal fluid of patients with endometriosis

BackgroundEndometriosis is a known cause of infertility. Differences in immune tolerance caused by regulatory T cells (Tregs) and transforming growth factor-β (TGF-β) are thought to be involved in the pathology of endometriosis. Evidence has indicated that Tregs can be separated into three functionally and phenotypically distinct subpopulations and that activated TGF-β is released from latency-associated peptide (LAP) on the surfaces of specific cells. The aim of this study was to examine differences in Treg subpopulations and LAP in the peripheral blood (PB) and peritoneal fluid (PF) of patients with and without endometriosis.MethodsPB and PF were collected from 28 women with laparoscopically and histopathologically diagnosed endometriosis and 20 disease-free women who were subjected to laparoscopic surgery. Three subpopulations of CD4+ T lymphocytes (CD45RA+FoxP3low resting Tregs, CD45RA−FoxP3high effector Tregs, and CD45RA−FoxP3low non-Tregs) and CD11b+ mononuclear cells expressing LAP were analyzed by flow cytometry using specific monoclonal antibodies.ResultsProportions of suppressive Tregs (resting and effector Tregs) were significantly higher in the PF samples of patients with endometriosis than in those of control women (P = 0.02 and P < 0.01, respectively) but did not differ between the PB samples of patients and controls. The percentage of CD11b+LAP+ macrophages was significantly lower in PF samples of patients with endometriosis than in those of controls (P < 0.01) but was not altered in the PB samples.ConclusionProportions of suppressive Tregs and LAP+ macrophages are altered locally in the PF of endometriosis patients.

Successful pregnancy after 21-nodule removal by abdominal myometrectomy

Background. Leiomyomas are a known cause of infertility and recurrent pregnancy loss, with a global incidence of 25-30% and 2.7-10.7% during pregnancy. They can have an unpredictable evolution and determine numerous complications during pregnancy, such as preterm delivery and severe postpartum hemorrhage. Case presentation. This case report presents a successful pregnancy obtained after the removal of 21 leiomyomas by abdominal myometrectomy. A 28-year-old patient, gravida 2, abortus 1, with uterine fibroids, was subjected to multiple abdominal myometrectomy. Four months after surgery, the patient reported amenorrhea for 7 weeks, and intrauterine evolutive pregnancy was confirmed. She had an uncomplicated pregnancy and delivered by caesarean section a healthy female fetus, weighing 2900 g. Conclusion. The management of leiomyomas before obtaining a pregnancy should be highly recommended. To the best of our knowledge, this is the first case reporting a successful pregnancy after the removal of 21 fibroid nodules by abdominal myometrectomy.

Alternativa terapéutica en gestantes con el diagnóstico de insuficiencia lútea.

La insuficiencia lútea es una causa conocida de infertilidad (abortos tempranos). El objetivo del presente trabajo es ofrecer una alternativa terapéutica a pacientes gestantes portadoras de insuficiencia lútea. El tratamiento ideal debería de ser a base de progesterona químicamente pura, de la cual carecemos en nuestro medio. Los progestágenos, que constituirían la alternativa terapéutica, son conocidos actualmente de tener efectos luteolíticos. La función del cuerpo lúteo en el humano puede ser definida en términos de cantidad y duración de la síntesis esteroidogénica de progesterona y estrógenos. Estas dos hormonas reflejan la actividad de diferentes tipos celulares a nivel del cuerpo lúteo y se ha observado que ellos pueden variar independientemente durante la fase lútea.

An association study of four candidate loci for human male fertility traits with male infertility.

Are the four candidate loci (rs7867029, rs7174015, rs12870438 and rs724078) for human male fertility traits, identified in a genome-wide association study (GWAS) of a Hutterite population in the USA, associated with male infertility in a Japanese population? rs7867029, rs7174015 and rs12870438 are significantly associated with the risk of male infertility in a Japanese population. Recently, a GWAS of a Hutterite population in the USA revealed that 41 single-nucleotide polymorphisms (SNPs) were significantly correlated with family size or birth rate. Of these, four SNPs (rs7867029, rs7174015, rs12870438 and rs724078) were found to be associated with semen parameters in ethnically diverse men from Chicago. This is a case-control association study in a total of 917 Japanese subjects, including 791 fertile men, 76 patients with azoospermia and 50 patients with oligozoospermia. Azoospermia was diagnosed on the basis of semen analysis (the absence of sperm in ejaculate), serum hormone levels and physical examinations. Oligozoospermia was defined as a sperm concentration of <20 × 10(6)/ml. We excluded patients with any known cause of infertility (i.e. obstructive azoospermia, varicocele, cryptorchidism, hypogonadotropic hypogonadism, karyotype abnormalities or complete deletion of AZF a, b or c). The SNPs rs7867029, rs7174015, rs12870438 and rs724078 were genotyped using DNA from peripheral blood samples and either restriction fragment length polymorphism PCR or TaqMan probes. Genetic associations between the four SNPs and male infertility were assessed using a logistic regression analysis under three different comparative models (additive, recessive or dominant). The genotypes of all four SNPs were in Hardy-Weinberg equilibrium in the fertile controls. The SNPs rs7867029 and rs7174015 are associated with oligozoospermia [rs7867029: odds ratio (OR) = 1.70, 95% confidence interval (CI) = 1.07-2.68, P = 0.024 (log-additive); rs7174015: OR = 6.52, 95% CI = 1.57-27.10, P = 0.0099 (dominant)] and rs12870438 is associated with azoospermia (OR = 10.90, 95% CI = 2.67-44.60, P = 0.00087 (recessive)] and oligozoospermia [OR = 8.54, 95% CI = 1.52-47.90, P = 0.015 (recessive)]. The association between rs7174015 and oligozoospermia under a dominant model and between rs12870438 and azoospermia under additive and recessive models remained after correction for multiple testing. There were no associations between rs724078 and azoospermia or oligozoospermia. Even though the sample size of case subjects was not very large, we found that three SNPs were associated with the risk of male infertility in a Japanese population. The three infertility-associated SNPs may be contributing to a quantitative reduction in spermatogenesis. This study was supported in part by the Ministry of Health and Welfare of Japan (1013201) (to T.I.), Grant-in-Aids for Scientific Research (C) (23510242) (to A.Ta.) from the Japan Society for the Promotion of Science, the European Union (BMH4-CT96-0314) (to T. I.) and the Takeda Science Foundation (to A.Ta.). None of the authors has any competing interests to declare.

Diagnostic Ambiguity and Psychosocial Distress among Chinese Women with Idiopathic and Non-Idiopathic Infertility

The aim of this study is to investigate how women with different diagnoses on their cause of infertility—non-idiopathic (female, male, mixed), or idiopathic (unknown causes)—display different levels of psychosocial well-being prior to their IVF treatment. Women who attended an assisted reproduction clinic were recruited to fill out a set of questionnaire about 3 months before the start of their first IVF treatment cycle (valid N = 330). Measures included anxiety, somatic, emotional, and spiritual distress, as well as marital satisfaction. Somatic distress was found to be highest among women without a known cause of infertility. Women with mixed-factor diagnosis reported significantly lower emotional distress. Spiritual distress was found to be the highest in female-factor infertility group. Results remained significant after controlling for marital satisfaction. The current findings suggest that facing infertility whose cause is unexplained, women may express their distress through somatic complaints. Whe...

State-mandated insurance coverage is associated with the approach to hydrosalpinges before IVF

The aim of this study was to determine whether practice in states with infertility insurance mandates is associated with physician-reported practice patterns regarding hydrosalpinx management in assisted reproduction clinics. A cross-sectional, internet-based survey of 442 members of Society for Reproductive Endocrinology and Infertility or Society of Reproductive Surgeons was performed. Physicians practising in states without infertility insurance mandates were more likely to report performing diagnostic surgery after an inconclusive hysterosalpingogram than physicians practising in states with mandates (RR 1.2, 95% CI 1.1–1.3, P<0.01). Additionally, respondents in states without mandates were more likely to report that, due to lack of infertility insurance coverage, they did not perform salpingectomy (SPX) or proximal tubal occlusion (PTO) before assisted reproduction treatment (RR 1.4, 95% CI 1.1–1.8, P=0.01). Finally, respondents in states without mandates were less likely to report that the presence of assisted reproduction treatment coverage determined the urgency with which they pursued SPX or PTO before treatment (RR 0.7, 95% CI 0.5–1.0, NS). These results persisted after controlling for physician years in practice, age and clinic volume. In conclusion, self-reported physician practice interventions for hydrosalpinges before assisted reproduction treatment may be associated with state-mandated infertility insurance.Fallopian tube dysfunction is a known cause of infertility and severe dysfunction is manifested by dilation and occlusion, known as hydrosalpinx. Outcomes with assisted reproductive techniques (ART) are lower when hydrosalpinges are present and while there are several theories for this, reproductive specialist recommend “neutralizing” the tube either by occlusion or removal in order to enhance pregnancy rates. In the United States, coverage for infertility services is not uniform with only 15 states having some legislation requiring infertility benefits. Some states where ART is covered liberally, physicians might have different practice patterns related to the neutralization of hydrosalpinges compared to those who are in non –mandated states. We utilized a survey of over 400 providers in the United States to examine their practice patterns as it relates to hydrosalpinges based on which state they practice in and whether or not that state has mandated coverage of not.

Ectopie testiculaire et cryptorchidie ; de quoi parle-t-on ? Indications opératoires

Cryptorchidism is one of the commonest congenital anomalies in the male genitalia, affecting 3 to 5% of male full-term neonates. It is a known cause of infertility associated with a greater risk of development of germ cell tumor. The benefits of early orchidopexy include psychological affects, prevention of testicular degeneration and decrease in the risk of testicular cancer. Laparoscopy is the best way to diagnose and manage intra-abdominal testes.

Seven ways to preserve female fertility in patients with endometriosis

Endometriosis is a known cause of infertility in reproductive-aged women. Most treatment plans target pain caused by the disease, and may overlook the possibility that the patient may want to conceive. This review assesses current studies on fertility preservation in endometriosis patients and outlines the seven best methods to preserve fertility. We propose the following seven ways to preserve fertility in patients with endometriosis: choosing the best surgical techniques; avoiding unnecessary surgery; measuring ovarian reserve before surgery; emergency IVF before laparoscopic surgery; using a gonadotropin-releasing hormone agonist; maintaining a healthy lifestyle; and cryopreservation. Each endometriotic patient should be assessed on an individual basis, using these seven methods as guidelines, in order to maximize fertility preservation.

Anti-Müllerian hormone in men with normal and reduced sperm concentration and men with maldescended testes

To evaluate serum anti-Müllerian hormone (AMH) in well-characterized men with normal and reduced sperm concentration and in men with a history of or persistent maldescended testes as a possible clinical marker of male factor infertility and/or maldescended testes. Retrospective analysis of 199 men selected from our database (Androbase). The university-based Institute of Reproductive Medicine. One hundred eight men with normal and 60 men with reduced sperm concentration without known cause of infertility and additionally 31 infertile men with current or former maldescended testes were evaluated. Serum AMH was analyzed by an in-house ELISA. Hormone and semen parameters were compared and correlated with AMH. No significant differences were found in AMH levels. Only in men with maldescended testes did AMH correlate negatively with FSH and positively with testicular volume and sperm concentration. No correlations between AMH and LH or testosterone (T) were found. Anti-Müllerian hormone serum levels are not significantly affected by impaired spermatogenesis in general but are correlated with spermatogenic parameters in men with current or former maldescended testes. Therefore, AMH measurement does not improve clinical routine diagnostics but should be evaluated further in patients with maldescended testes. Anti-Müllerian hormone might serve as a marker of Sertoli cell number, function, and/or maturation in these men.

Endometrial tuberculosis in the Nigerian middle belt: an eight-year review

Endometrial tuberculosis (TB) is a known cause of infertility in women which, because of the global increase in the spread of TB, should always be considered when investigating the cause of infertility. We undertook this review in order to determine its incidence among infertile women in the Nigerian middle belt. This is a retrospective study of all histopathological slides of infertile women seen at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between 1997 and 2004 who were evaluated for infertility by endometrial biopsy. The slides were reviewed and, where necessary, new sections were cut from tissue blocks and stained with haematoxylin and eosin. Ziehl-Neelsen stain used to demonstrate acid-fast bacilli. Clinical reports were extracted from histopathological request form. A total of 661 patients were included in the study. Primary infertility constituted 30%, secondary 69% and unspecified cases 1%. TB endometritis was seen in 0.45%. Endometrial TB is not a frequent cause of infertility in our set-up. However, with the worldwide resurgence of TB, its possible presence should always be taken into consideration.

No Difference in Cycle Pregnancy Rate and in Cumulative Live-Birth Rate Between Women With Surgically Treated Minimal to Mild Endometriosis and Women With Unexplained Infertility After Controlled Ovarian Hyperstimulation and Intrauterine Insemination

Whether and how minimal to mild endometriosis is related to subfertility remains a controversial issue. Retrospective studies have pointed to reduced fecundity in these women compared to those with unexplained infertility. Studies of the effect of removing endometriosis surgically have given conflicting results. This study was planned to test the hypothesis that, compared to women with no known cause of infertility, those having surgical removal of nonadvanced endometriosis have similar or higher rates of clinical pregnancies (live births) per cycle and cumulative live births following controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI). The study population included 58 women with endometriosis who were treated during 137 cycles with COH and IUI, and 49 with unexplained infertility who were similarly treated during 122 cycles. Endometriosis was minimal in 41 instances and mild in 17. It had been removed laparoscopically within 7 months before the onset of treatment. COH employed gonadotropin far more often than clomiphene citrate. The groups with minimal and mild endometriosis and unexplained infertility were similar except for a significantly shorter duration of infertility in the latter group. The pregnancy rate per cycle averaged 20% and was closely similar in women with minimal endometriosis (21%), mild endometriosis (19%), and unexplained infertility (20.5%). The respective cumulative live birth rates within four cycles were 70%, 68%, and 66.5%. Six couples, half of them in the group with minimal endometriosis, had a spontaneous pregnancy during the interval between two treatment cycles. These pregnancies were excluded from life table analysis. These findings suggest that, when COH and IUI are carried out shortly after laparoscopic removal of minimal or mild endometriosis, pregnancy outcomes are as good as in patients with unexplained subfertility. The investigators believe that COH with IUI is a reasonable first-line treatment for women who have not become pregnant within 6–12 months of having endometriosis excised and who have no other identifiable condition that might compromise fertility.

Direct effect of cortisol on steroid production by granulosa cells from PMSG-induced follicles of prepubertal gilts

Stress-induced elevation of glucocorticoids is a known cause of infertility in domestic animals. For this reason a possible direct effect of cortisol (C) on steroidogenesis in granulosa cells (GC) from a range of developing follicles was examined in vitro. In this study, 38 Yorkshire-Landrace gilts (60–70 kg) were given a single dose of pregnant mares' serum gonadotrophin (PMSG, 700 i.u. i.m.) to induce follicular growth. Ovaries were recovered from groups of 2–12 gilts at 48, 72, 96, 108, 120, 144, 170 and 196 h post-PMSG treatment. Follicular fluids were aspirated and dispersed GC prepared from the follicles (48–120 h only). Granulosa cells were incubated in medium TC-199 (1 × 10 6 cells per 3 ml per 3 h) with (1.0 μg C; 0.1 μg testosterone (T)) or without hormone treatment; and the progesterone (P4), androstenedione (A4) and oestradiol (E2) contents of the medium were determined by radioimmunoassay. Stimulation by PMSG resulted in apparently normal follicular development. Oestradiol synthesis by GC from all follicles was low in the absence of substrate T, but increased ( P<0.001) when T was added. Exposure to cortisol in vitro depressed P4 synthesis in GC from ovulatory follicles (120 h) recovered from a single gilt; it also enhanced A4 formation in GC from follicles at all stages of development ( P<0.05) and increased E2 synthesis ( P<0.05) in GC from 72- and 108-h follicles. The study has demonstrated a direct effect of cortisol in vitro on steroid secretion by granulosa cells from developing follicles of the porcine ovary. Similar direct effects on steroid formation in vivo have yet to be demonstrated but might predispose developing follicles to cystic/atretic degeneration.