Management Of Infertile Patients Research Articles

The effect untreated right subclinical varicocele on the outcomes of contralateral left clinical varicocelectomy in infertile patients.

The management of infertile patients with unilateral subclinical varicocele (SCV) and contralateral clinical varicocele (CV) remains controversial. We aimed to evaluate the effect of untreating SCV on the outcome of contralateral clinical varicocelectomy in infertile patients with oligoasthenozoospermia (OA). Infertile patients with the diagnosis of OA who underwent left varicocelectomy were retrospectively evaluated. While all patients in the study had left clinical varicocele (LCV), some patients had concomitant right SCV. Patients were divided into two groups according to the presence or absence of a right SCV accompanying LCV as group 1; (LCV n = 104) or group 2; (LCV with right SCV, n = 74). Patients were evaluated with spermiogram parameters, pregnancy rates and serum levels of follicle stimulating hormone, luteinizing hormone, total testosterone at the first year of the follow-up. The mean sperm concentration increased significantly in both groups. However, group 1 showed significantly greater improvement than group 2. The ratio of progressive motile sperm in group 1 was increased significantly whereas no significant change was shown in group 2. Both the spontaneous pregnancy rate and the pregnancy rate with ART were statistically lower in the group of patients with right SCV. No statistically significant difference was detected in serum hormone levels in both groups after varicocelectomy operations. Untreated right SCV may have adverse impact on the outcomes of left clinical varicocelectomy. In this context, the right testis can be considered in terms of treatment in patients with right SCV accompanying left CV.

Impact of adenomyosis on IVF outcomes in women undergoing donor oocyte transfers: a prospective observational study

To prospectively examine the association between adenomyosis type, location, and severity with reproductive outcomes in patients undergoing single embryo transfer (SET) with embryos derived from donor oocytes. A prospective observational cohort study. University-affiliated in-vitro fertilization center. Infertile patients with (n=114) and without (n=114) adenomyosis who received their first donor oocyte transfer between January 2019 and January 2023 were included in the study. Adenomyosis was confirmed with the presence of at least one direct feature visualized by 2D/3D transvaginal ultrasound, and classified according to type (diffuse, focal), localization (inner/outer myometrium and/or the junctional zone) and uterine extension (mild, moderate, severe). Following an artificial or natural endometrial preparation cycle, patients underwent SET in the blastocyst stage. The primary outcome was the implantation rate. The secondary outcomes were clinical pregnancy, live birth, and miscarriage rate following SET. (s): The presence of adenomyosis did not significantly affect the implantation, clinical pregnancy, or live birth rates. However, women with adenomyosis had a significantly higher miscarriage rate compared to those without adenomyosis (20.2% vs. 9.6 %, respectively; p=0.04). The multivariate analysis assessed possible risk factors for each clinical outcome considered in the study and showed that adenomyosis affected the risk of miscarriage. Specifically, TVS-detection of adenomyosis in the junctional zone was associated with over three-fold higher odds of miscarriage (RR 3.28, 95% CI 1.38-7.78; p=0.004). Conversely, adenomyosis features detected exclusively in the outer myometrium were associated with a higher ongoing pregnancy (RR 0.30, 95% CI 0.13-0.72; p=0.004). Diffuse adenomyosis in the JZ and severe adenomyosis raised the odds of miscarriage four-fold (RR 2.29, 95% CI 1.22-4.30; p=0.015; and RR 2.20, 95% CI 1.19-4.04; p=0.005). (s): This study demonstrated that while adenomyosis did not significantly reduce the odds of implantation, the direct signs of adenomyosis in the junctional zone and disease severity are significant risk factors for miscarriage in patients receiving donor oocyte transfers. This study highlights the importance of thorough ultrasound examination and detailed adenomyosis classification in the assessment and management of infertile patients.

Genetics of infertility: a paradigm shift for medically assisted reproduction.

The field of reproductive genetics has undergone significant advancements with the completion of the Human Genome Project and the development of high-throughput sequencing techniques. This has led to the identification of numerous genes involved in both male and female infertility, revolutionizing the diagnosis and management of infertility patients. Genetic investigations, including karyotyping, specific genetic tests, and high-throughput sequencing, have become essential in determining the genetic causes of infertility. Moreover, the integration of genetics into reproductive medicine has expanded the scope of care to include not only affected individuals or couples but also their family members. Genetic consultations and counselling play a crucial role in identifying potentially affected relatives and offering tailored therapy and the possibility of fertility preservation. Despite the current limited therapeutic options, an increasing understanding of genotype-phenotype correlations in infertility genes holds promise for improved treatment outcomes. The availability of genetic diagnostic tools has reduced the number of idiopathic infertility cases by providing accurate aetiological diagnoses. The transition from research to clinical practice in reproductive genetics requires the establishment of genetic consultations and data warehousing systems to provide up-to-date information on gene-disease relationships. Overall, the integration of genetics into reproductive medicine has brought about a paradigm shift, emphasizing the familial dimension of infertility and offering new possibilities for personalized care and family planning.

Management of infertile patients with chronic endometritis

Introduction. Chronic endometritis complicates infertility management that sets the task of searching new approaches of treatment. Special attention is paid to the use of enzymatic drugs that improve repair processes. Аim. Тo evaluate the effect of the bovgialuronidasa azoxymer on the restoration of the morphofunctional state of the endometrium and receptor apparatus in infertile women with chronic endometritis. Materials and methods. Forty-seven reproductive age women who applied for infertility with chronic endometritis were examined. The general, somatic, and gynecological history assessment has been carried out. Complaints included the pain syndrome (100 %), discharge from the genital tract (100 %), and the pain during palpation and uterine traction (89.4 %). Paipel-biopsy was carried out with subsequent morphological and cultural study of the endometrium. The immunohistochemical analysis was carried out, and endometrial receptivity was studied. The middle M-echo was detected. Statistical processing was carried out using the Microsoft Exel application package (2010), STATISTICA 13.3 (USA, Tibco). Results. Diagnostic measures including cultural and morphological examination of the endometrium allows to verify chronic endometritis. The use of this protocol allows half of infertile women with chronic endometritis to achieve pregnancy. The use of bovgialuronidasa azoxymer increases rate of pregnancy on 23.9 %. Conclusion. Treatment under this protocol allows half of the patients with infertility due to chronic endometritis, including autoimmune one, to achieve pregnancy.

Imaging methods for seminal tract obstruction

Differential diagnosis between obstructive and non-obstructive azoospermia is an important task in clinical management of infertile patients. Chances of extracting sperm in obstructive azoospermia are high enough to inform the couple about favorable outcome of assisted reproductive technologies without resorting to donor sperm. Some forms of seminal tract obstruction can be corrected by microsurgical interventions or endoscopic resection of the ejaculatory ducts. Therefore, one of the objectives standing before imaging methods in reproductive andrology is the detection of these cases. In this literature review we present a detailed analysis of how to suspect and diagnose this form of azoospermia using imaging.

Latent ovarian stimulation in the management of infertile patients with hypogonadotropic hypogonadism

Latent ovarian stimulation in the management of infertile patients with hypogonadotropic hypogonadism

Tubo-ovarian Abscess and Uterine Leiomyoma in a 35-year-old woman with 8 years of infertility: A Case Report

Infertility can be influenced by several factors, including the presence of leiomyomas and tubal abnormalitieslike a tubal abscess or tubo-ovarian abscess which can cause adhesions of the tubes and surrounding tissuesor obstruction of the tubes. A 35-year-old woman is diagnosed with primary infertility of 8 years withintramural uterine leiomyoma, right tubo-ovarian abscess, and left tubal abscess with tubal obstruction.Laparotomy myomectomy and salpingostomy surgery were carried out. There were no complications duringor after the surgery. The management of infertile patients with leiomyoma and tubo-ovarian abscess whowish to preserve reproductive function requires special attention.

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice.

Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra-testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management.

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility.

PurposeThe use of antioxidants is common practice in the management of infertile patients. However, there are no established guidelines by professional societies on antioxidant use for male infertility.Materials and MethodsUsing an online survey, this study aimed to evaluate the practice pattern of reproductive specialists to determine the clinical utility of oxidative stress (OS) testing and antioxidant prescriptions to treat male infertility.ResultsResponses from 1,327 participants representing 6 continents, showed the largest participant representation being from Asia (46.8%). The majority of participants were attending physicians (59.6%), with 61.3% having more than 10 years of experience in the field of male infertility. Approximately two-thirds of clinicians (65.7%) participated in this survey did not order any diagnostic tests for OS. Sperm DNA fragmentation was the most common infertility test beyond a semen analysis that was prescribed to study oxidative stress-related dysfunctions (53.4%). OS was mainly tested in the presence of lifestyle risk factors (24.6%) or sperm abnormalities (16.3%). Interestingly, antioxidants were prescribed by 85.6% of clinicians, for a duration of 3 (43.7%) or 3–6 months (38.6%). A large variety of antioxidants and dietary supplements were prescribed, and scientific evidence were mostly considered to be modest to support their clinical use. Results were not influenced by the physician's age, geographic origin, experience or training in male infertility.ConclusionsThis study is the largest online survey performed to date on this topic and demonstrates 1) a worldwide understanding of the importance of this therapeutic option, and 2) a widely prevalent use of antioxidants to treat male infertility. Finally, the necessity of evidence-based clinical practice guidelines from professional societies is highlighted.

Clinical use of progesterone in infertility and assisted reproduction

Progesterone is essential in establishing and maintaining early pregnancy. This article discusses the clinical applications of progesterone in reproductive medicine and in the management of infertile patients, focusing on the different available formulations of this drug. The literature of the last 20 years was reviewed and the most rilevant studies were critically analyzed. Intramuscular or vaginal progesterone administration is critical to support the luteal phase following in-vitro fertilization and is widely employed in intrauterine insemination cycles as well. Furthermore, this hormone is usually administered in many disorders of the first trimester of pregnancy, including threatened abortion and recurrent miscarriage, but the evidence supporting its clinical efficiency is inconsistent.

Investigation Correlates of Chlamydia Anti-Body Testing and Hysterosalpingography among Women with Tubal Infertility

Background: Chlamydia trachomatis infection is an important preventable cause of infertility. In women, up to 70% of genital infection with Chlamydia trachomatis are asymptomatic. In the management of infertility patients, a lot of clinicians or centres do not routinely screen for Chlamydia trachomatis infection. Hence all patients being investigated for infertility may potentially be at risk of tubal blockage in addition to non-tubal factor aetiology. Those with primary tubal blockage also are at risk of worsening of the blockage. Objective: To determine if there is a relationship between IgG and IgM Chlamydia antibody testing (CAT) and tubal factor infertility. Design: It was a cross sectional descriptive study. Method: The sera of 400 consecutive consenting infertile patients presenting to the gynaecological clinic of the Ahmadu Bello University Teaching Hospital, Zaria, Northern Nigeria were tested for Chlamydia antibodies using ELISA IgG and IgM kits produced by Diagnostic Automation, Inc., 23961 Craftsman Road, Suite D/E/F, Calabasas, CA 91302, USA. Results: Up to 264 (66%) of the patients had tubal factor, 64 (16%) had uterine, 56 (14%) had ovarian, 50 (12.5%) had male while 40 (10%) had others. The causative factors were not mutually exclusive. The sero-prevalence of IgG and IgMChlamydia trachomatis amongst patients with tubal infertility were 35.6% and 35.6% respectively. There was a stronger significant relation (P = 0.008) between IgM sero-positivity which suggests recent infection and tubal infertility. The relation between IgG sero-positivity which suggest chronic infection and tubal infertility was also significant (P = 0.036) but relatively lower. Conclusion: The sero-prevalence of Chlamydia trachomatis infection, IgG and IgM was significantly higher among the sub-population with tubal infertility. Chlamydia antibody testing (CAT) has predictive value for tubal infertility.

Can the transfer of euploid blastocysts in a frozen embryo transfer overcome repeated IVF failure?

Successful implantation depends on the synchronization between a viable embryo and a receptive endometrium. Management of infertility patients with repeated IVF failure (RIF) without implantation remains a major challenge in ART. This study explored the outcome for RIF patients after transfer of euploid blastocysts in a frozen embryo transfer (FET).

Laparoscopic management of infertility patients using 5-mm optic. The Humanitas Clinical Institute experience with 1406 consecutive cases

Laparoscopic management of infertility patients using 5-mm optic. The Humanitas Clinical Institute experience with 1406 consecutive cases

INFERTILITY

Objective: To measure the success rate of combined clomiphene citrate and gonadotrophin therapy in infertile patients. Study Design: Observational analytical study. Period: June 2009 to June 2010. Methods: In this observational analytical study, total of 100 infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotrophin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in our study, 74% (2/3 rd) patients were less than 30 years of age and 26% (1/3rd ) were between 30 – 40 yrs of age. Primary infertility was seen also in 2/3rd of patients (73% ) and secondary infertility in remaining 1/3rd (27%) of patients. Polycystic ovary (PCO) was the commonest cause of an ovulation seen in 62% of patients, obesity in 24% of patients and in 14% of patients cause was unknown (unexplained infertility). on average only 4.1 Inj of gonadotrophin were required to get a mature follicle on an average 12th day (12.41 day) of the cycle. As concerned the treatment outcome, 82% of patient reported back after first course of treatment. Urine pregnancy test was positive in 18%. Remaining 64% patent were offered second course of treatment, out of which only 35% agreed for further treatment. After second course of treatment positive urine pregnancy test was seen in only 5% of patients. Remaining 30% of patients were advised third course of treatment. Out of these 30%, 8 patients took gonadotrophin regime, 10 patients agreed on follicle tracking only, 8 % of patients refused further treatment and 4 % did not report back. Conclusions: Our study shows the success rate of 23% with CC-HMG combined treatment which is double the CC alone and equal to HMG alone, thereby reducing the cost of treatment without sacrificing efficacy. In other words combined CC-HMG regime is cost effective technique in the management of infertile patients.

Successful Management of Infertile Patient with a Rare Transfundal Uterine Membrane

Abstract Background: This case report describes an infertile patient with a rare endometrial cavity pathology diagnosed on hysteroscopy. Case: The patient was a 39-year-old female with primary infertility of 9 years' duration. A diagnosis of a possible T-shaped uterus on a previous hysterosalpingogram was not confirmed on diagnostic hysteroscopy 5 years earlier at a different infertility center, where she had undergone a cycle of in-vitro fertilization with embryo transfer (IVF-ET) but was unable to conceive. At the time of diagnostic hysteroscopy at the current, unit the patient was found to have a T-shaped cavity and a trans-fundal uterine membrane obscuring an arcuate fundus. Hysteroscopic division of this thin membrane was performed successfully, followed by hysteroscopic division of the uterine septum and hysteroscopic metroplasty of her T-shaped uterus. Results: Subsequently, the patient conceived with IVF-ET but had an early miscarriage. A second IVF-ET cycle resulted in resulted in delivery of a h...

Assessment and Optimization of Oocyte Quality during Assisted Reproductive Technology Treatment

The health of fetuses, neonates, and adults depends on normal development of the oocytes and embryos from which they arise. In addition, the ability of an embryo to implant, sustain a pregnancy, and give rise to a viable offspring is unquestionably rooted in oogenesis. Therefore, defining markers that can reliably predict the best quality oocytes will prove invaluable in the care and management of infertility patients. Furthermore, identification of the best quality oocyte will also permit the transfer of a single embryo, thereby increasing overall pregnancy rates and reducing multiple rates. Although a few potentially important predictors of oocyte quality have been identified, their application for routine use in the assisted reproductive technology (ART) laboratory remains to be established. With the critical need for markers to be noninvasive, reliable, and assayable with a rapid turnaround, key areas that will take advantage of recent technological advances are identified in this article. Oocyte quality also needs to be improved in the management of human infertility by ART programs. Given that mechanisms determining oocyte quality are multifactorial and complex, several possible areas that continue to necessitate optimization are discussed.

The role of hysteroscopy in management of infertile patients

The role of hysteroscopy in management of infertile patients

Endoscopic surgery and diagnosis in infertility management and assisted reproductive techniques

Objective To describe the role of diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, and diagnostic and surgical hysteroscopy in infertile patients, with special attention to techniques of assisted reproduction. Design A personal review. Setting The Regional Center for Ambulatory Surgery and Infertility, Florence, Italy. Subjects Infertile patients undergoing assisted reproduction procedures. Interventions Diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, diagnostic and surgical hysteroscopy. Main outcome measures and results Diagnostic laparoscopy was considered mandatory in infertile patients when there was suspected tubal, ovarian or peritoneal disease interfering with the capacity to reproduce. The value of other methods as alternatives to laparoscopy and dye insufflation in the management of infertile patients was also evaluated. Salpingoscopy was also reviewed, with the conclusion that this technique is very important in the infertility work up because it allows a prognosis concerning the possibility of conception according to the status of the mucosal folds. Diagnostic hysteroscopy was evaluated. This technique is an extremely reliable outpatient procedure in infertility diagnosis and it allows savings in health costs, even though, unfortunately, it is not yet widely used. The indications for and results of hysteroscopic surgery were also reviewed. Hysteroscopic operations, compared with traditional surgery, involve reduced risk, shortened hospitalization, reduced costs and better results. Considering endoscopic techniques in relation to assisted reproduction, the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients was evaluated. However, the direct involvement of endoscopic techniques in gamete retrieval and transfer was considered to give inconsistent results. Conclusion There are clear advantages in using endoscopic surgical techniques, and many traditional surgical approaches can be replaced by operative laparoscopy and hysteroscopy. Considering assisted reproduction and endoscopic techniques, we should emphasize the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients.

Endometrial pathology and infertility

Objective: To call attention to endometrial pathologies, which in addition to causing menstrual problems, are a cause of infertility. Design: Controlled clinical study. Setting: Specialized unit in the management of infertile patients. Patient(s): Fifteen infertile women between the ages of 26 and 39 years and suffering infertility from endometrial problems for a period of 4 to 18 years were included in the study. Six patients had primary infertility and nine others had secondary infertility. Intervention(s): Once the endometrial pathology was diagnosed, treatment was initiated according to the type of problem: hysteroscopy, curettage, and hormonal replacement with or without corticoids or antiphymic drugs. Main Outcome Measure(s): Clinical studies, laboratory tests, hormonal serum levels, and endoscopy. Result(s): After initiating specific treatment for each of the pathologies, menstruation was re-established in 14 of 15 patients. Nine patients became pregnant (8 of 10 cases with bone, squamous cell, or muscular metaplasia). Conclusion(s): Pathological changes of the endometrium are causes of infertility. These problems are not as rare as thought. They must be searched for carefully and diagnosed promptly. The majority carry a good prognosis when adequately treated.

Hysterosalpingography

During the past decade, there has been a dramatic increase in the number of women seeking infertility evaluation. Hysterosalpingography (HSG) is an invaluable procedure for evaluating internal architecture of the female reproductive tract. Utilizing HSG, it may be possible to minimize the use of invasive procedures, such as hysteroscopy and laparoscopy, in defining such problems as peritubal adhesions, leiomyomas, and congenital anomalies. This review re-emphasizes the wide range of available information and advantages of HSG which can be extremely useful in the diagnosis and management of infertile patients.