Medical Treatment For Infertility Research Articles

Acceptability and feasibility of the mindfulness based program for infertility (PBMI)

IntroductionInfertility is described as a low-control stressor that may induce psychopathological symptoms. The Mindfulness Based Program for Infertility (MBPI) is a structured intervention targeting infertile women that aims to cultivate mindfulness and acceptance skills. The MBPI efficacy was tested in 55 infertile women who completed the program and 37 women in a control group. By the end of the MBPI, women who attended the program revealed a significant decrease in depressive symptoms, internal and external shame, entrapment and defeat. Inversely, they showed significant improvement in mindfulness skills and self-efficacy to deal with infertility.AimsDetermine the MBPI feasibility and acceptability.MethodsThe MBPI includes 10 weekly sessions, in a group format, with the duration of about 2 hours each. Participants’ recruitment was supported by the Portuguese Fertility Association. Fifty-five female participants with an infertility diagnosis who were pursuing medical treatment for infertility completed a questionnaire specifically developed to address the acceptability and satisfaction with the MBPI at the end of the 10th session.ResultsParticipants scored as “very useful” most of the MBPI components (mindfulness practice, acceptance skills, values clarification, psychoeducation on stress and fertility-related lifestyle factors), except for the yoga component. The same pattern was found for the utility information, group support, small group exercises, contact with the therapist, progress notes and MBPI materials. The mean score for satisfaction with the therapist knowledge/competence was 9.55 (maximum: 10), the MBPI quality 8.91 and the MBPI global utility 8.95.ConclusionsThe MBPI showed to be feasible and well accepted by participants.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Successful fertility treatment with gonadotrophin therapy for male hypogonadotrophic hypogonadism

SummaryGonadotrophin therapy with human chorionic gonadotrophin and recombinant FSH is indicated for use in men with reduced spermatogenesis due to hypogonadotrophic hypogonadism (HH). Patients require regular monitoring for side effects and desired response to treatment. We present a man with HH, azoospermia and a history of previous anabolic steroid usage who had undergone gonadotrophin therapy, had subsequently achieved conception and has now fathered a child.Learning points In total, 15% of couples do not achieve pregnancy within 1 year and seek medical treatment for infertility: male factors contribute to 50% of these.The evaluation of male infertility should include a full history and examination, an endocrine profile and a quality-controlled semen analysis.HH with defective spermatogenesis is an important cause of male infertility in a small percentage of cases.Gonadotrophin therapy requires regular monitoring for side effects and desired response to treatment.Any sustained rise in prostate specific antigen levels should prompt urological assessment for possible prostate biopsy.A multidisciplinary approach is required for gonadotrophin therapy, especially if assisted fertilisation techniques are required once, spermatogenesis is achieved.

자궁근종 및 자궁선근증을 동반한 불임환자 증례보고

ABSTRACT A Case Report of One Patient with Infertility Accompanied by Adenomyosis and Uterine MyomaJeong-Im Lee 1 , Eun-Young Nam 2 , Hyung-Jun Kim 2 , Dong-Nyung Lee 11 Dept. of Internal Medicine, Oriental Medical Hospital, Se-Myung University, Chungju 2 Dept. of Obstetrics and Gynecology, Oriental Medical Hospital, Se-Myung University, JecheonObjectives: Adenomyosis is the disease caused by ingrowth of lining tissue into the uterine muscle. Final treatment of the disease is hysterectomy. But if a patient want to get pregnant, there is a tendency to avoid surg ical treatment. This paper introduces the potential of oriental medical treatme nt for infertility caused by adenomyosis through a case study. Methods: A 34-year-old female patient, who wants to get pregnant, was di agnosed with adenomyosis. She wants to take oriental medical treatment in the ◯◯ Oriental Hospital. We applied herb-medication, acupuncture and moxibustion. Results: Overall condition including the symptoms was relieved and succeeded in pregnancy after oriental medical treatment Conclusions: Oriental medical treatment has an effect infertility caused by adenomyosis Key Words: Adenomyosis, Uterine Myoma, Infertility, Dysmenorrhea

한방 난임 치료의 특성과 결과에 대한 분석 -2011년 주요 한의과대학 부속한방병원 및 연구 참여 한의원을 중심으로-

Objectives: We analyzed retrospective clinical data of Korean medical institutes for infertility care and investigated current status and outcome of the Korean medical treatment of infertility as a part of foundational research for verifying validity of constructing national support system and developing appropriate policy on Korean medical treatment of infertility. Methods: We investigated data uploaded on the homepage of The Society of Korean Medicine for Subfertility (http://www.okinfertility.org) by Korean medical institutes for infertility care to get informations such as patients' age, body height, weight, methods of Korean medical treatment, cost and duration of treatment, success or failure of pregnancy and result of treatment. Results: The average age of patients was <TEX>$33.1{\pm}3.8$</TEX> and the average body height was <TEX>$161.2{\pm}5.3cm$</TEX> and the average body weight was <TEX>$55.2{\pm}8.5kg$</TEX>. The method of Korean medical treatment was Herbal medicine (97.5%), acupuncture (80.4%), moxibustion (57.7%), cupping (32.7%). The average cost of treatment was <TEX>$1,160,625{\pm}882,499$</TEX> won, and the average medical cost per visit was <TEX>$357,845{\pm}241,602$</TEX> won. The average duration of treatment was <TEX>$11.26{\pm}10.58$</TEX> weeks, and the average number of visits per patient was <TEX>$4.78{\pm}6.10$</TEX> times. The average duration of treatment was the longest in the group of infertile patients with the highest average medical cost per visit. The average pregnancy success rate was 30.9% overall, and that of the group of infertile patients was 25.8%. Conclusions: When we develop the standard project model with expectation for about 25% success rate of pregnancy and delivery in the group of patients who have idiopathic and ovulatory factors, it is desirable to perform acupuncture and moxibustion treatment 1-2 times a week with herbal medicine. The treatment period is set to at least 12 weeks. Average treatment fee maybe calculated by converting the averaged treatment cost of clinic's one month worth of daily treatment fee and medical hospital's ten day treatment fee into weekly treatment cost.

Food and drug supplements to improve fertility outcomes.

Food and drug supplements (FDS) are extensively used by infertile couples either to supplement medical infertility treatment and assisted conception or as a means to independently improve conception rates. The majority of FDS are composed of antioxidants that are used for male and female infertility. Their use, despite being biologically plausible, lacks scientific support due to limitations stemming from poorly designed small studies. FDS and for that matter complementary and alternative medicine (CAM) is plagued by fallacies that confuse or mislead the public and thus may prevent many patients from making the right therapeutic decisions regarding their infertility problem. We do concur that the absence of evidence is not the evidence of absence; however, one should be wary of the apparent benign effects of FDS and CAM. The current literature seems to suggest a beneficial effect of antioxidants on male infertility. There is, however, no FDS that has been proven beyond doubt to increase conception rates in female infertility. The additive value of CAM and FDS on the success of assisted conception is also not known. Well-designed randomized studies are urgently needed given the popularity and ever increasing consumption of these supplements by the infertile couples.

Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort

Previous studies have shown decreased pregnancy rates and early menopause in female cancer survivors; however, infertility rates and reproductive interventions have not been studied. We investigated infertility and time to pregnancy in female childhood cancer survivors, and analysed treatment characteristics associated with infertility and subsequent pregnancy. The Childhood Cancer Survivor Study (CCSS) is a cohort study including 5 year cancer survivors from 26 Canadian and US institutions who were younger than 21 years at the time of diagnosis between Jan 1, 1970, and Dec 31, 1986, and a sibling control group. We included women aged 18-39 years who had ever been sexually active. We gathered demographic, medical, and reproductive data via a baseline questionnaire, and quantified exposure to alkylating agents and radiation therapy. Self-reported infertility, medical treatment for infertility, time to first pregnancy in survivors and siblings, and the risk of infertility in survivors by demographic, disease, and treatment variables were analysed. 3531 survivors and 1366 female sibling controls who enrolled between Nov 3, 1992, and April 4, 2004, were included. Compared with their siblings, survivors had an increased risk (relative risk [RR] 1·48 [95% CI 1·23-1·78]; p<0·0001) of clinical infertility (ie, >1 year of attempts at conception without success), which was most pronounced at early reproductive ages (RR 2·92 [95% CI 1·18-7·20], p=0·020, in participants ≤24 years; 1·61 [1·05-2·48], p=0·029, in those aged 25-29 years; and 1·37 [1·11-1·69], p=0·0035, in those aged 30-40 years). Despite being equally likely to seek treatment for infertility, survivors were less likely than were their siblings to be prescribed drugs for treatment of infertility (0·57 [95% CI 0·46-0·70], p<0·0001). Increasing doses of uterine radiation and alkylating agent chemotherapy were strongly associated with infertility. Although survivors had an increased time to pregnancy compared with their siblings (p=0·032), 292 (64%) of 455 participants with self-reported clinical infertility achieved a pregnancy. A more comprehensive understanding of infertility after cancer is crucial for counselling and decision making about future conception attempts and fertility preservation. National Cancer Institute, American Lebanese Syrian Associated Charities, Swim Across America.

난임부부의 한방의료기관 이용 실태 및 한방난임치료 지원사업 수요에 관한 설문조사연구

Objectives: The purpose of this study is to investigate use condition of Korean medical institution and demand of Korean Medical Treatment Project of Infertility in infertile couple. Methods: Questionnaires were distributed to all members of the incorporated association AGAYA(http://www.agaya.org/) via e-mail and to infertile women who visited to Korean medicine OB & GY outpatient clinic of university Korean medicine hospitals of the country and an infertility specialized Korean medicine hospital. One hundred twenty four of completed questionnaires were analyzed. Results: 1. Korean medical institution utilization rate of infertile couple was 89.6% and was similar with western medical institution utilization rate of 87.1%. 2. 96.8% of infertile couple answered that Korean Medical Treatment Project of Infertility is necessary. And 90.3% of infertile couple answered that herbal medicines should be supported first of all. 3. 90.3% of infertile couple answered that they will participate if Korean Medical Treatment Project of Infertility go ahead. Conclusions: It was confirmed that most of the infertile couple have been received Korean medical treatment for infertility, and think that Korean Medical Treatment Project of Infertility is necessary.

Estimation of Seminal MDA Levels in Infertility patients

Background- Defective sperm function is the most common cause of infertility. There is growing evidence that damage to spermatozoa by Reactive Oxygen Species(ROS) play a key role in male infertility. Oxidative stress is a common pathology seen in approximately half of all infertile men. Mammalian spermatozoa are rich in poly unsaturated fatty acids (PUFA) and are very susceptible to attack by ROS, leading to a chain of chemical reactions called lipid peroxidation (LPO). Malondialdehyde (MDA), an end product of lipid peroxidation represents level of lipid peroxidation. Objectives- The objective of this study was to estimate the levels of seminal Malondialdehyde(MDA) in patients of infertility and to compare these values in normozoospermic and oligozoospermic patients and to correlate these values with the seminal parameters. Methods- The study was carried out in the Department of Physiology, Govt. Medical College, Aurangabad. n=60 men (30 normozoospermic and 30 oligozoospermic) between the age group of 20-45 years referred for semen analysis in the Department of Physiology from the infertility clinic were studied. The semen analysis was preformed according to WHO criteria. Seminal MDA levels were measured by using thiobarbituric acid assay (TBARS). The MDA levels were compared between the normozoospermic and oligozoospermic patients and correlated with various sperm parameters. Results- The MDA levels were increased in oligozoospermic patients and were inversely related to the sperm count and motility. Conclusion- We conclude that the MDA levels may be correlated for the pathophysiology of male infertility and its assessment may guide in the medical treatment of infertility.

Maternal fecundity and asthma among offspring—is the risk programmed preconceptionally? Retrospective observational study

To evaluate the association between maternal fecundity factors and time to pregnancy and risk of asthma in offspring. Retrospective observational hospital-based birth cohort study. A university-based obstetrics and gynecology department. A total of 40,914 women, who delivered between 1989 and 2007, were linked with the register for asthma reimbursement (n = 2,577) for their offspring. Fecundity factors were recorded during pregnancy. Logistic regression analyses were used. None. Asthma among offspring. The risk of asthma was significantly increased if the mother had any infertility problems (adjusted odds ratio [adjusted OR] 1.39, 95% confidence interval [CI] 1.19-1.63), medical infertility treatment (aOR 1.43, 95% CI 1.13-1.80), or any infertility treatment (aOR 1.50, 95% CI 1.26-1.79). The risk of asthma among offspring was also higher among mothers who had more than two miscarriages (aOR 1.25, 95% CI 1.04-1.51) and time to pregnancy over 3 months (aOR 1.25, 95% CI 1.07-1.45). These findings suggest that maternal subfertility exposes offspring to an increased risk of asthma. The study is registered in Kuopio University Hospital register (TUTKI): ID5302448.

Hormones of Life: Endocrinology, the Pharmaceutical Industry, and the Dream of a Remedy for Sterility 1930–1970 (review)

Reviewed by: Hormones of Life: Endocrinology, the Pharmaceutical Industry, and the Dream of a Remedy for Sterility 1930–1970 Elizabeth Siegel Watkins Christer Nordlund. Hormones of Life: Endocrinology, the Pharmaceutical Industry, and the Dream of a Remedy for Sterility 1930–1970. Sagamore Beach, Mass.: Science History Publications, 2011. x + 297 pp. $34.95 (978-0-88135-475-1). Although its title may suggest a more expansive topic, Hormones of Life is actually the biography of a single, rather unsuccessful drug called Gonadex (chorionic gonadotropin) that was produced and marketed by the Swedish company Aktiebolaget Leo from 1948 to 1986 as a remedy for female sterility, as well as for menstrual problems and menopausal discomforts. The author, Christer Nordlund, locates the trajectory of this drug’s birth, life, and death in a rich context of scientific knowledge about hormones and reproduction, medical treatment of infertility, the culture of academic–medical–industrial collaborations, international competition [End Page 141] in the pharmaceutical industry, the global politics of World War II and its aftermath, and the history of eugenics and population policies from the 1930s to the 1970s. Hormones of Life takes its place on the bookshelf alongside other drug biographies, such as Nelly Oudshoorn’s Beyond the Natural Body, Toine Pieters’s Interferon, and Jordan Goodman and Vivien Walsh’s The Story of Taxol, that use the lifecycle of a particular pharmaceutical product as a lens to investigate the relationships among industry, medicine, academia, the state, and the media in modern health care.1 The book begins with an introduction that lays out the author’s theoretical and methodological orientations and then proceeds in three sections of three chapters each. The first section, “Tradition,” provides narrative background for the science, the industry, and one key individual involved in shaping the genesis of Gonadex. The first chapter gives the history of endocrinology and endocrine therapy from the late 1800s to the 1930s; the second introduces the clinician and researcher Axel Westman and his interest in infertility; and the third presents Aktiebolaget Leo and its foray into hormone production. The next section, “Innovation,” takes a close look at Gonadex in the late 1940s. Chapter 4 traces the development and testing of the preparation that would become Gonadex; chapter 5 details the company’s release of the product in 1948, its coordinated public relations campaign, and subsequent sensational reporting by the media; chapter 6 explores the reception of Gonadex by the medical profession and prospective users. The final section, “Development,” presents the decades-long denouement of the Gonadex story. Chapter 7 explains how Leo refashioned Gonadex in the early 1950s, after the drug was denied full licensing because of problems with its standardization. Chapters 8 discusses developments in research on the pituitary gland and the impact of this research on Gonadex, and chapter 9 describes Leo’s development of a new gonadotropin product to complement Gonadex in the treatment of infertility. The conclusion explains how the technology of in vitro fertilization displaced hormones from the center of the therapeutic conversation about assisted reproduction. Nordlund’s consideration of the fate of Gonadex as an infertility treatment in light of changing values of population size is especially interesting. Gonadex was developed in the immediate postwar years, when Sweden was concerned about falling birth rates and the quality of its population, and Nordlund sees the positive efforts to promote fertility with pharmaceutical assistance as the counterpart to Sweden’s negative efforts to control reproduction with its infamous sterilization policy. By the 1960s, however, concerns about overpopulation meant that the Swedish welfare state demonstrated less interest in helping involuntarily childless couples to conceive; rather, its attention was focused on techniques for [End Page 142] preventing pregnancy. Nordlund demonstrates how this shift in policy influenced industrial strategies for hormone production and forced Leo to seek markets for its gonadotropin products outside Sweden’s borders. Hormones of Life was originally published in Swedish in 2008. The book is meticulously researched; Nordlund succeeded in gaining access to Leo’s corporate archives, and he mines these records along with other archival collections to paint a detailed portrait of pharmaceutical production, regulation, marketing, and use in the mid-twentieth century. The book suffers in places...

The impact of infertility on sexuality: A literature review.

Most studies address medical treatment of infertility and psychosocial outcomes caused by infertility-related stress, but few studies examine the infertility's impact on sexuality. A literature review was conducted to answer the questions: 1) How is sexual self concept impacted in infertile individuals and their partners? 2) Does infertility have a negative impact on sexual relationships? 3) Is sexual function affected by infertility? In answering these questions, we may develop a better understanding of sexuality in the context of infertility, and thus better inform infertility management. Ultimately the aim is to improve the quality of life for infertile couples. A literature search was conducted for publications from 1990 to 2011 via the electronic databases PubMed, PsycInfo and Scopus, which focused on sexuality in infertile subjects or couples. In this review, all studies were descriptive quantitative studies which mapped the different aspects of sexuality in the context of infertility. The results suggested that infertility and its treatment approaches for fertilisation could lead to changes in sexual self-esteem, sexual relationship and sexual function. The literature substantiated that many infertile subjects experienced trouble in various aspects of sexuality. However, further research should examine the reciprocal relations between sexual self concept, sexual relationship and sexual function in the context of infertility. How these changes affect the partners of infertile subjects should also be addressed.

Reproductive Technologies and Parent–Child Relationships: Japan's Past and Present Examined through the Lens of Donor Insemination

AbstractThis manuscript addresses the principles that underlie the creation of parent–child relationships in Japan. I argue here that the use of reproductive technologies reinforces social norms that dictate the importance of blood relationships within modern families, and these norms, in turn, drive the development of reproductive technologies to the point that their use becomes standard. Here, I will use the social positioning of donor insemination (DI) as the point from which to examine the emergence of parent–child relationships.1 The ethical implications of “third‐party reproductive technologies” like donor insemination, the use of donated eggs, fertilized embryos, and practices of surrogate birth, have come to be questioned in recent years. However, the process of questioning the very concept of an unrelated third‐party donor makes clear the tacit norms behind parent–child relationships, which drive the development and use of reproductive technologies. Here, I will discuss (1) the historical background and contemporary social positioning of DI; and (2) examine the concept of third‐party donors. In cases of male infertility, DI provides a unique opportunity for couples to produce a child who is genetically related to one of them (the woman), and with the institutionalization of DI as a medical infertility treatment, it has become possible for couples to secretly undergo treatment and thus simulate a normative, blood‐related modern family. However, there is a significant level of social resistance to the notion of DI, and with the development of treatment options that make use of the man's own sperm, DI has become only rarely utilized. This fact makes DI an excellent case study to examine the ways that blood and genetic relationships are prioritized in contemporary Japanese society.

Traditional practices used by infertile women in Turkey

Numerous traditional methods are used in the treatment of infertility around the world. To identify the traditional practices of infertile women using one clinic in Ankara, Turkey. The population comprised all women (5700) who attended one infertility outpatient clinic in 2007. The sample was calculated using sample calculation formula and 410 women were included in the study. The survey method was used for data collection. Of the responding women, 27.3% had tried a traditional practice, and 67.8% who tried traditional practices used an herbal mixture. The reason for the women's use of a traditional practice was 'hope' (66.9%), and 15.2% of them had experienced an adverse effect related with traditional practice. Maternal education level, perceived economic status, duration of marriage all significantly affected the use of traditional practices (P<0.05). The women who had received unsuccessful medical treatment for infertility and who had experienced side effects after medical treatment had a higher rate of use of traditional practice (P<0.05). Almost one in three of the women who responded to the questionnaire had tried traditional methods, and some experienced adverse effects related to the practice. For couples with infertility problems, educational programmes and consultation services should be organized with respect to their traditional culture. Women should be informed about the hazards of traditional practices and avoidance of harmful practices, and continuous emotional support must be provided for infertile couples. In the future, nursing staff should play a much larger role in these supportive services.

Chapter 6 - Medical Treatment of Infertility Related to Endometriosis

Chapter 6 - Medical Treatment of Infertility Related to Endometriosis

How is Distress from Infertility Associated with Depression?

!Purpose: Infertility is a widespread disease that often has a negative effect on the mental health of infertile patients. A common reaction of infertile patients is depression, but there is still inconclusiveness regarding the level of depression in infertile patients. The aim of this study was to examine the level of depression in infertile patients, and to assess existing preventive health services. Material and Methods: Thirty-nine infertile women and 24 infertile men of a Swiss fertility centre completed self-report questionnaires on depression, physical health, and the degree of suffering from unfulfilled child wish. Results: A high proportion of the infertile patients reported depressive symptoms. More than 40% scored above the threshold of mild depression and 26% showed clinically relevant depressive symptoms. The depression score of one partner related to the depression score and the suffering caused by infertility of the other partner. The cause of infertility was not linked to the levels of depression of infertile patients. Conclusions: A great proportion of Swiss infertile patients experience depressive symptoms reaching sometimes clinically relevant levels of depression. Offering psychological or pharmacological support for patients during the medical treatment of infertility seems advisable in order to

Enhancement Technologies and the Person: An Islamic View

The availability of newer choices in contemporary bioethics, especially enhancement technologies, poses a challenge for Muslim patients and their care providers in making appropriate decisions. How should they reconcile personal autonomy with ethical guidelines of Islamic Shariah (jurisprudence)? This article discusses such concerns.

Artificial gametes

In vitro fertilization (IVF) has been an efficient medical treatment for infertility in the past decades. However, conventional IVF approaches may be insufficient when gametes are lacking or non-viable thus precluding a significant number of patients from treatment. Ultimately, creation of artificial gametes may provide an universal solution for all indications. Somatic cell nuclear transfer (SCNT) has provided successful cloning in different animal species indicating that a derived technology may be applicable in infertility treatment procedures. Attempts to produce functional male or female gamete through nuclear transfer have been described through the process called haploidization. Initial successes have been observed, however, significant alterations at spindle construction and chromosomal segregation were also described. Stem cell technology may provide an alternative route to obtain fully functional gametes. Both sperm cells and oocytes were obtained using specific culture conditions for embryo originated stem cell. These two mainstream approaches are presented in the current review. Both of these techniques are involving sophisticated methods and consequently both of them demonstrate technical and ethical challenges. Related questions on (mitotic/meiotic) cell division, genetic/epigenetic alterations and cell renewal are needed to be addressed before clinical application.

Development and validation of the Infertility Self-Efficacy scale

To develop and validate a scale of perceived self-efficacy for people coping with infertility treatment. Self-efficacy scale development involved: [1] item generation with medical experts in reproductive health; [2] a principal components analysis with varimax rotation to identify underlying item components; [3] test-retest reliability and construct (convergent and discriminant) validity with infertility patients, who were administered the Infertility Self-Efficacy (ISE) scale with other measures; and [4] expert acceptability, as determined by reproductive health professionals. Recruitment at a fertility center, a national infertility organization, and medical trials web pages. A total of 213 participants (159 women; 54 men) with a diagnosis of infertility in the past 2 years were recruited for the various study phases. None. Participants' infertility self-efficacy was assessed with an online assessment battery using the ISE scale; comparison mental health measures assessed current levels of fertility problem distress, perceived stress, and coping style. Reliability, validity, and component structure of the ISE was assessed. Measurement development yielded a brief 16-item ISE scale that taps an infertility patient's perception about his or her ability to engage in a set of cognitive, emotional, and behavioral skills related to the medical treatment of infertility. The single component of "cognitive/affect regulation" suggests this core set of skills is relevant to successfully managing the experience of infertility. The ISE correlations with comparison mental health measures were as expected, suggesting good convergent and discriminant validity. The ISE scale appears to be a reliable and valid measure of an individual's self confidence in areas related to health promotion during infertility treatment. Assessing an infertility patients' self-efficacy with the ISE may be useful in clinical research and as a counseling tool to help guide patients in actively managing their fertility treatment.

Plasma adiponectin levels and risk of myocardial infarction in men

Previous studies have shown decreased pregnancy rates and early menopause in female cancer survivors; however, infertility rates and reproductive interventions have not been studied. We investigated infertility and time to pregnancy in female childhood cancer survivors, and analysed treatment characteristics associated with infertility and subsequent pregnancy.The Childhood Cancer Survivor Study (CCSS) is a cohort study including 5 year cancer survivors from 26 Canadian and US institutions who were younger than 21 years at the time of diagnosis between Jan 1, 1970, and Dec 31, 1986, and a sibling control group. We included women aged 18–39 years who had ever been sexually active. We gathered demographic, medical, and reproductive data via a baseline questionnaire, and quantified exposure to alkylating agents and radiation therapy. Self-reported infertility, medical treatment for infertility, time to first pregnancy in survivors and siblings, and the risk of infertility in survivors by demographic, disease, and treatment variables were analysed.3531 survivors and 1366 female sibling controls who enrolled between Nov 3, 1992, and April 4, 2004, were included. Compared with their siblings, survivors had an increased risk (relative risk [RR] 1·48 [95% CI 1·23–1·78]; p<0·0001) of clinical infertility (ie, >1 year of attempts at conception without success), which was most pronounced at early reproductive ages (RR 2·92 [95% CI 1·18–7·20], p=0·020, in participants ≤24 years; 1·61 [1·05–2·48], p=0·029, in those aged 25–29 years; and 1·37 [1·11–1·69], p=0·0035, in those aged 30–40 years). Despite being equally likely to seek treatment for infertility, survivors were less likely than were their siblings to be prescribed drugs for treatment of infertility (0·57 [95% CI 0·46–0·70], p<0·0001). Increasing doses of uterine radiation and alkylating agent chemotherapy were strongly associated with infertility. Although survivors had an increased time to pregnancy compared with their siblings (p=0·032), 292 (64%) of 455 participants with self-reported clinical infertility achieved a pregnancy.A more comprehensive understanding of infertility after cancer is crucial for counselling and decision making about future conception attempts and fertility preservation.National Cancer Institute, American Lebanese Syrian Associated Charities, Swim Across America.

Immunological and endocrinological studies on lymphocyte subpopulation and medical treatment for infertility in patients with endometriosis

We investigated the relationship between interleukin-6 (IL-6) levels and subset profiles of T lymphocyte (T-cell) and macrophage in peritoneal fluid (PF) with or without endometriosis (EM). IL-6 levels in PF with EM were significantly higher than those without EM. IL-6 producing cells with EM were analyzed in each activated mature T-cell (CD3+CD69+) and macrophage (CD14+) were 0.5 and 3.5%, respectively, whereas it was mostly negative in those without EM. Cytotoxic T-cell (CD8+CD11b−) profiles in PF with EM were also quiet different from those without EM. Cellular immunity in the peripheral blood did not change during the course of IVF-ET cycles, although plasma levels of ovarian steroid hormones significantly increased comparing with that in normal ovarian cycles. Cytotoxic T-cell type 1 (Tc1) profiles might be useful predictive values in the pregnancy outcome for infertile patients with EM.