Infertility Medications Research Articles

Why couple infertility is historically a female-driven problem?

The history of studies in the field of infertility represents a chapter of great interest in gender issues. This paper aims to delve deep into the historical roots of the aspect of gender inequality related to couple infertility, with a journey back in time, from classical antiquity to the contemporary age, reporting junctions and metaphors linked to particular historical moments as well as to cultural and religious constructs. This is a narrative review based on an extensive literature search of publications regarding the role of women in couple infertility over the centuries. Rarely in the ancient world, male infertility was taken into consideration, and the sources deal with it mainly indirectly. This attitude of "blaming" the woman for the lack of children had, in fact, strong social implications, which only the scientific research of recent years has managed to bring back into the context of a more egalitarian approach. In the "journey" narrated in this article, the reader starts from the responsibility of couple infertility attributed exclusively to women in some ancient societies, whose central role was determined by their ability to procreate, going up to the medicalization of infertility in the contemporary age, which contributed to sharing with men this participation in the impossibility of having children.

Management of encounters related to subfertility and infertility in Australian general practice: a focus on Aboriginal and Torres Strait Islander females

ObjectiveTo investigate the management of subfertility and infertility among Aboriginal and Torres Strait Islander females attending Australian general practice.MethodsCross-sectional study of 1,258,581 women (18–49 years) attending general practice between January 2011 and June 2019, utilising data from NPS MedicineWise MedicineInsight, a national general practice database in Australia.ResultsThe prevalence of subfertility/infertility encounters was lower for Aboriginal and Torres Strait Islander females (12.37 per 1,000) than for non-Indigenous females (16.62 per 1,000). Aboriginal and Torres Strait Islander females with a subfertility/infertility encounter were younger and more likely to live outside Major cities and in areas of socioeconomic disadvantage than non-Indigenous females. Rates of prescribed infertility medications were not different between groups, however Aboriginal and Torres Strait Islander females were more likely to receive a pelvic ultrasound (24.30% vs. 19.90%); tests for luteinizing hormone (31.89% vs. 25.65%); testosterone (14.93% vs. 9.96%) and; glycated haemoglobin (HbA1c) (6.32% vs. 3.41%),but less likely to receive an anti-müllerian hormone test (2.78% vs. 7.04%).ConclusionsLower encounter rates for infertility/subfertility among Aboriginal and Torres Strait Islander peoples may indicate access issues, preferred use of Aboriginal community-controlled health centres or younger average age at first birth and thus less age-related infertility.Implications for public healthFuture efforts should focus on maximising the inclusiveness of infertility surveillance. There is also a need for further research into the experiences of and preferences for infertility care and associated barriers among Aboriginal and Torres Strait Islander people.

The Rate of Spontaneous Preterm Birth and Associated Neonatal Adverse Outcomes in Low-Risk Pregnancies Conceived Spontaneously Versus Intrauterine Insemination or Infertility Medications

The objective of this work is to compare the rate of spontaneous preterm birth and associated neonatal morbidity among low-risk pregnancies conceived spontaneously versus pregnancies conceived using infertility medications/intrauterine insemination (IFM/IUI). This population-based retrospective cohort study utilized the US Vital Statistics data set from 2015 to 2019. Low-risk pregnancies, resulting in a live birth, of individuals who conceived either spontaneously or with the assistance of IFM/IUI were examined. The primary measured outcome was the rate of spontaneous preterm delivery, defined as delivery before 37 weeks’ gestation without induction of labor. Of the 19,382,574 deliveries during the study period, 7,876,515 (40.6%) met the inclusion criteria. While 7,843,328 (99.6%) conceived spontaneously, 33,187 (0.4%) conceived using IFM/IUI. The rate of spontaneous preterm delivery was significantly higher for patients who conceived using IFM/IUI (71.0 per 1,000 live births) compared to patients who conceived spontaneously (60.3 per 1,000 live births; adjusted relative risk, 1.40; 95% confidence interval, 1.35–1.46). While the rate of spontaneous preterm births and associated composite of neonatal adverse outcomes are significantly higher in pregnancies conceived using IFM/IUI than spontaneous conception, the mortality is similar.

More Than a Physical Condition: The Stigmatized Experience of Infertility

Despite its high prevalence, infertility is a very stigmatized experience. This paper explores how infertility can be seen not only in physical health terms, but also as a distressing event with significant mental health implications that result from living in a pronatalist society. Women are especially impacted by the consequences of infertility due to gendered expectations of parenthood and the medicalization of infertility. Moving forward, to destigmatize infertility and reduce adverse mental health effects, society as a whole must start normalizing childfree people and valuing women for more than their reproductive capabilities.

A Study to Assess the Effectiveness of Planned Teaching Programme on Knowledge regarding No-Scalpel Vasectomy (NSV) among Married men and women in a selected rural area, Coimbatore

The present study is aimed to assess the knowledge of married men and women regarding No-Scalpel Vasectomy in a selected rural area, Coimbatore. The objectives of the study is to assess the knowledge among married men and women about No Scalpel Vasectomy by using a structured questionnaire, to assess the effectiveness of planned teaching programme, and to find the association between the findings and selected demographic variables such as age, gender, religion, educational status, occupation, monthly income, type of family, age at marriage, duration of married life, number of children, history of infertility medication if any, adoption of temporary family planning method, relatives with permanent family planning methods, awareness about No-Scalpel Vasectomy. The conceptual frame work for this study was based on Modified Open System Model by J.W. Kenny. Pre-experimental one group pretest posttest design was used for this study. The study was conducted among 60 married men and women who have not undergone permanent sterilization residing in Semmanichetti Palayam, Coimbatore. The village is 18 kilometre away from PPG College of Nursing. Purposive sampling technique was used in this study. Data collection was done from 16 September 2019 to 12 October 2019. Formal written permission was obtained from the medical officer in SMC Palayam, Primary Health Centre. Data was collected by administering the structured questionnaire before and after the planned teaching programme. The post- test was conducted after the sixth day of planned teaching programme. Data was analysed by using descriptive and inferential statistics. Paired ‘t’ test was used to find the effectiveness of planned teaching programme and ‘Chi-Square’ was used to find the association. The result of the study reveals that married men and women have lack of knowledge about No-Scalpel Vasectomy. The mean knowledge of married men and women in the pre-test was 14.93 in the pre-test with the standard deviation of 1.7. There was a marked gain in the mean knowledge score of married men and women after the administration of planned teaching programme (24.32) with the standard deviation of 1.8. The study concluded that the Planned Teaching Programme is effective in increasing the knowledge regarding No-Scalpel Vasectomy.

Psychological Impacts of Infertility and Other Reproductive Technologies

Individuals and couples all over the world find incapacity to conceive children to be a distressing circumstance. Infertility has a wide range of implications, including societal pressure as well as personal distress. Advances in assisted reproductive technologies, like as IVF, can give many couples hope where treatment is accessible, yet there are still challenges to overcome in terms of medical coverage and expense. The medicalization of infertility has unknowingly resulted in a dismissal of couples' emotional responses, which include distress, loss of control, stigmatization, and a disruption in their adult developmental trajectory. Evidence is accumulating that there is a link between fertility treatment stress and patient drop-out and pregnancy rates. Fortunately, psychological therapies for infertility patients, particularly those emphasizing stress management and coping-skills training, have been demonstrated to be useful.

The association of adverse outcomes with pregnancy conception methods among low-risk term pregnancies

To compare composite neonatal and maternal adverse outcomes among low-risk singleton pregnancies at 37-41 weeks among conception methods: spontaneously-conceived (SC) pregnancy; infertility medications and/or intrauterine insemination (IFM/IUI); and assisted reproductive technology (ART). Population-based retrospective cohort study. US Vital Statistics datasets 2013-2017. Low-risk pregnancies (without hypertensive disorders, pregestational or gestational diabetes, or history of preterm birth) of women ≥20 years with nonanomalous singletons, who labored, delivered at 37-41 weeks, and had data on pregnancy conception method. None. The primary outcome was the composite neonatal adverse outcome (CNAO). The secondary outcome was the composite maternal adverse outcome (CMAO). Of the 19.7 million deliveries during the study period, 54.0% (N = 10,676,184) met the inclusion criteria, with 99.0% (N = 10,573,741) being conceived spontaneously, 0.4% (N = 47,227) by IFM/IUI, and 0.5% (N = 55,216) by ART. The overall rate of CNAO was 6.68 per 1,000 live births. Compared with SC, the risk of CNAO was significantly higher among IFM/IUI (adjusted relative risk [aRR], 1.29; 95% CI, 1.18-1.41) and ART (aRR, 1.29; 95% CI, 1.18-1.39). The overall rate of CMAO was 2.50 per 1,000 live births. Compared with SC, the risk of CMAO was significantly increased among IFM/IUI (aRR, 1.72; 95% CI, 1.50-1.97) and ART (aRR, 2.40; 95% CI, 2.17-2.65). Among low-risk term singleton pregnancies, IFM/IUI and ART have modestly higher rates of adverse outcomes to maternal-neonatal dyad than SC.

Lesbians achieving pregnancy: The intersections of social location and the heteronormative medicalization of infertility

AbstractFew sociological studies address the relationship between social location and other intersecting influences on lesbian's experiences achieving pregnancy. Other disciplines examine the experiences of lesbians seeking infertility interventions, whether low‐tech (self‐insemination at home) or high‐tech (paying for medical interventions within a medical institution). Recently, as lesbians seek to achieve pregnancy, many are increasingly coming into contact with the heteronormative medical world. In this review, we discuss the intersecting factors of race/ethnicity, social class and sexuality, and how these factors influence and shape lesbian experiences regarding the heteronormative medicalization of infertility.

Flavin-Containing Monooxygenase 3 Polymorphic Variants Significantly Affect Clearance of Tamoxifen and Clomiphene.

Human flavin-containing monooxygenase 3 (hFMO3) is a drug-metabolising enzyme that oxygenates many drugs and xenobiotics in the liver. This enzyme is also known to exhibit single nucleotide polymorphisms (SNPs) that can alter the rates of monooxygenation of therapeutic agents. The purpose of this study was to investigate the effect of the three common polymorphic variants of hFMO3 (V257M, E158K and E308G) on the metabolism and clearance of three structurally similar compounds: tamoxifen (breast cancer medication), clomiphene (infertility medication) and GSK5182 (antidiabetic lead molecule). For GSK5182, none of the three variants showed any significant differences in its metabolism when compared to the wild-type enzyme. In the case of clomiphene, two of the variants, V257M and E308G, exhibited a significant increase in all the kinetic parameters measured with nearly two times faster clearance. Finally, for tamoxifen, a mixed behaviour was observed; E158K variant showed a significantly higher clearance compared to the wild type, whereas V257M mutation had the opposite effect. Overall, the data obtained demonstrate that there is no direct correlation between the SNPs and the metabolism of these three hFMO3 substrates. The metabolic capacity is both variant-dependent and substrate-dependent and therefore when testing new drugs or administering already approved therapies, these differences should be taken into consideration.

The medicalization of infertility and new reproductive technologies: the case of infertile couples in Oran (Algeria)

The medicalization of infertility and new reproductive technologies: the case of infertile couples in Oran (Algeria)

Clomiphene citrate-induced visual hallucinations: a case report

BackgroundPolycystic ovary syndrome is a common cause of chronic anovulation and infertility in otherwise healthy fertile couples. Clomiphene citrate is used as a first-line ovulation induction therapy in patients with polycystic ovary syndrome. Clomiphene citrate can cause both systemic and ocular side effects. We report a rare side effect of illusory palinopsias in a patient with polycystic ovary syndrome treated with ovulation induction therapy with clomiphene citrate, and emphasize the need for gynecologists and their patients to be aware of this rare ocular side effect.Case presentationA 30-year-old Asian woman complained of persistent visual afterimages following treatment with 100 mg clomiphene citrate for anovulation. Her symptoms started on the fourth day after commencing the treatment and would last for 5 to 10 minutes. Similar visual symptoms were noted during her second cycle of treatment with clomiphene citrate. The severity of her symptoms reduced following the stoppage of the medication; however, the symptoms have persisted for more than 1 year since she stopped taking the drug.ConclusionsClomiphene citrate can cause disturbing illusory palinopsias. These afterimages persist even after stopping the infertility medication. It is a side effect not frequently seen by gynecologists or ophthalmologists. Gynecologists should make their patients aware of this rare ocular side effect when their patients start treatment with clomiphene citrate for infertility.

African‐American Midwifery, a History and a Lament

AbstractThe medicalization of fertility and infertility, pregnancy, abortion, contraception, childbirth, and postpartum care has not always worked in the interests of women. It has had particularly devastating effects on African‐American women. Their fertility has been managed for hundreds of years, first as slaves forced to have children for owners, then as objects to be experimented on without anesthetics, and finally as mothers sterilized without their consent. The relatively high rates of infant and maternal mortality, along with limited access to safe and high‐quality reproductive services, are continuing signs of such devastation. This article discusses the history and consequences of the medicalization of pregnancy, contraception, and abortion in America. Attention is drawn to the ways in which the profession of medicine took control away from midwives, the traditional birth attendants and pregnancy caregivers, and the particular consequences for African‐American women. Ultimately, we posit that greater access to midwifery care could lower infant and maternal mortality rates and improve reproductive services. The reintroduction of spirituality through midwifery would also restore the important role of “wise women” in supporting women, babies, and communities.

Study of the impact of the use of certain infertility medications on the functions of Kidney

The present study work investigates the effect of infertility drugs, clomiphene citrate (CC) and humegon, on the function of vital body organs. This study has been accomplished using 60 albino rats (30 male, 30 female), which have been divided into three groups 20 animal (10 male, 10 female) for each group. The first group fed daily with 50mg of clomiphene citrate by intragastric gavage for 30 days. The second group fed daily with 50mg of clomiphene citrate for 30 days, and then injected with 75 IU of humegon for 10 days. The animals were killed after the scheduled time and the required tests have been conducted in the laboratories of college of science and Al-Ramady teaching Hospital. Many biochemical and histological changes were induced in these animals when treated with CC or CC with humegon. The biochemical tests included, Uric acid, Creatinine and Electrolytes. The treated animals showed a significant decrease in Uric acid, Creatinine and Electrolytes. The light microscopic examination of Kidney showed glomerular hypertrophy, tubular necrosis, inflammatory infiltration and dilated blood vessels.

Improving Upon Nature: The Rhetorical Ecology of Chemical Language, Reproductive Endocrinology, and the Medicalization of Infertility

Chemical theories of human fertility and reproduction first became prevalent in both technical and mainstream media outlets beginning in the 1930s and 1940s, and they have remained prevalent to this day. In this essay, I analyze a selection of primary sources from this era that defined human fertility as a chemically induced process, rather than, for instance, a characteristic related to the conservation of nervous energy or to moral physiology. The resulting rhetorical history demonstrates the ways in which this chemical rhetoric was appropriated to re-envision sex, gender, and reproductive health in light of appeals to biochemical variability, artificiality, and technical expertise. Tracing these appeals sheds light on the rhetorical ecology that supported the widespread medicalization of (in)fertility and demonstrates how public vocabularies of science and medicine are constituted as they move across and interact with broader social discourses.

Geç Osmanlı öğüt kitaplarında kısırlık

Bu makalede geç Osmanlı tıp ve öğüt kitaplarının kısırlık ya da istendiği halde çocuk sahibi olamama sorununa yaklaşımı incelenmektedir. Kısırlık ve tedavisi üzerine yapılan tartışmalar on dokuzuncu yüzyıl boyunca yürütülen nüfus artışını sağlamaya yönelik politikaların bir uzantısı olarak düşünülmelidir. Bu dönemde Osmanlı matbuat kültürünün önemli bir türü olan öğüt kitaplarında üretilen söylemler ve fikirler aracılığıyla özelde kısırlık genel olarak da nüfus politikalarının toplumsallaşmasını ve daha geniş kitlelerin gözünde görünürlük hale gelmesini sağlamıştır. Bu çalışmada, Osmanlı tıp doktorları ve aydınlarının doğum ve doğurmayı neredeyse insanî ve millî bir vazife gibi tanımladığı ve kısırlık ve tedavisini de böylesi bir çerçeveye oturttuğu gösterilmeye çalışılacaktır. Bu doğrultuda bu çalışmada kısırlığın sadece bedensel ya da tıbbî bir sorun olmayıp aynı zamanda toplumsal ve politik bir mesele olarak kavranabileceği ileri sürülmektedir. Yukarıda da belirtildiği gibi nüfus ve doğum politikaları aslında daha makro düzeydeki politik görüşlerin dile getirildiği, kendilerini ifşa ettiği bir alandır. Osmanlı tıp doktorları ve aydınları, nüfus artışını önlerine bir politik hedef olarak koyarken nüfusu geniş anlamıyla ele almış ve nüfusu salt sayılardan ibaret değil, toplum ve gelecek tahayyülleriyle ilişkili bir mesele olarak kavramışlardır. Bu çalışma, popüler tıp kitaplarında ve öğüt kitaplarını incelemek suretiyle geç Osmanlı matbuat kültüründe kısırlığın, tıbbî, ahlakî ve sosyal boyutlarını incelemektedir

The relationship between infertility treatment and cancer including gynaecological cancers

Key content Increasing availability and expanding usage of infertility treatment is a concern with regard to a possible increase in the risk of future malignancy development for women and their offspring. Infertile women are at significantly increased risk of developing ovarian and uterine cancers, especially nulliparous women. Earlier studies pointed to a possible increase in the risk of ovarian cancer following large doses and multiple cycles of clomiphene citrate. Recent studies did not observe any increase in malignancy risk due to infertility medications. Other confounding factors, such as infertility itself, may well be the reason for the increased percentage of cancer cases noted in earlier studies. Uterine cancer risk is possibly increased following multiple cycles and high doses of clomiphene citrate. There is no strong evidence linking infertility treatment with non‐gynaecological or childhood cancers, with the possible exception of melanoma. Learning objectives To highlight the available evidence linking infertility treatment with gynaecological, non‐gynaecological and childhood cancers. How to counsel women about any possible risk of future neoplasia after infertility treatment. Ethical issues Is it ethical to persevere with multiple fertility treatment cycles if it might be associated with increased risk of neoplasia in the future?

Quality of life and predictive factors in patients undergoing assisted reproduction techniques

To evaluate the quality of life (QOL) of a cohort of women undergoing assisted reproduction techniques (ART), to compare two QOL questionnaires [Short Form 36 (SF36) and FertiQoL], and to identify the predictive factors related to QOL. Women who received infertility medication from a hospital pharmacist during a one-year period were included in this study. Two standardized validated questionnaires - FertiQoL and SF36 - were used. Multivariate analyses were used to assess predictive factors for QOL. Sixty-one women participated in this study. Median QOL scores ranged from 58 to 100. Comparisons between the two questionnaires revealed lower QOL scores when using FertiQoL. Most correlations between the questionnaires were positive, and significant for the majority of SF36 mental dimensions. The major predictors of QOL were: accompanied to the pharmacist's visit by partner, nationality, ART (in vitro fertilization or artificial insemination), employment status (employed or unemployed), tobacco consumption, age, number of cycles, infertility factor and treatment results (pregnancy, no pregnancy or treatment cancellation). FertiQoL examines dimensions such as partner and social relationships. As such, it is recommended that FertiQoL should be used together with a short version of SF36 to investigate QOL among patients undergoing ART.

Racial disparities in access and cost for commonly prescribed infertility medications may contribute to disparities in pregnancy outcomes

To determine if disparities in cost and access to commonly prescribed infertility medications exist in predominately minority neighborhoods. A prospective phone survey of pharmacies in Bronx and Westchester counties of New York State was done to assess the availability and cost of commonly used infertility medications. Demographic data for each county was defined by U.S. Census Data. Pharmacies were categorized by ZIP code and the availability and cost for medication determined and compared to the racial composition of that ZIP code. 121 pharmacies were surveyed. Availability and cost of 15 medications commonly used to treat infertility were obtained. Data were stratified by racial demographics and analyzed with Fishers exact test, ANOVA, or Chi-square test for trend. Reduced availability of Clomiphene citrate (CC) was observed in the Bronx pharmacies (79 vs. 89%, P<0.01), an area populated by >80% blacks and Hispanics. Choriogonadotropin alpha (CGa) was not available in the Bronx (0 vs. 15%, P<0.01). There was also a significant decrease in the trend for the availability of both CC and CGa when the percentage of blacks increased from 10 to >40% (53 vs. 33%, P<0.01) compared to no change for increasing percentage of whites. In contrast the availability of CGa was highest in areas with > 80% white compared to areas with >40% black or Hispanic (15 vs. 0%, P<0.01). Interestingly as the percentage of the black population increased the cost of CGa significantly decreased ($133 ± 14 vs. $99 ± 10, P<0.01) and there was also a trend for reduced CC costs. Racial disparities in infertility outcomes are linked to delayed treatment and referral patterns or inadequate access or utilization of subspecialty care. These data suggest disparities in the availability of commonly used medications but not increased cost may adversely affect compliance and contribute to suboptimal treatment and delayed referral to subspecialist.

Religion and conscientious objection: A survey of pharmacists’ willingness to dispense medications

Some US states allow pharmacists to refuse to dispense medications to which they have moral objections, and federal rules for all health care providers are in development. This study examines whether demographics such as age, religion, gender influence 668 Nevada pharmacists' willingness to dispense or transfer five potentially controversial medications to patients 18 years and older: emergency contraception, medical abortifacients, erectile dysfunction medications, oral contraceptives, and infertility medications. Almost 6% of pharmacists indicated that they would refuse to dispense and refuse to transfer at least one of these medications. Religious affiliation significantly predicted pharmacists' willingness to dispense emergency contraception and medical abortifacients, while age significantly predicted pharmacists' willingness to distribute infertility medications. Evangelical Protestants, Catholics and other-religious pharmacists were significantly more likely to refuse to dispense at least one medication in comparison to non-religious pharmacists in multinomial logistic regression analyses. Awareness of the influence of religion in the provision of pharmacy services should inform health care policies that appropriately balance the rights of patients, physicians, and pharmacists alike. The results from Nevada pharmacists may suggest similar tendencies among other health care workers, who may be given latitude to consider morality and value systems when making clinical decisions about care.

Review of available infertility treatments

Treatments for infertility vary in their intensity, invasiveness and associated risks. Treatment can range from medication to induce ovulation to invasive manipulation of eggs and sperm outside of the body. The type of treatment utilized is dependent upon the cause, degree and duration of infertility; the patient's age; the tolerance of side effects; the history of responsiveness and side effects in previous treatments; and the specific treatment preferences of the associated physician and facility. Infertility medications are specifically used for ovulation induction or for controlled ovarian hyperstimulation. In ovulation induction, the goal is to stimulate growth, maturation and ovulation of a single follicle. The single follicle is then fertilized secondary to timed intercourse or artificial insemination, where semen is injected directly into the uterus. Artificial insemination or intrauterine insemination can also be used with either natural or drug-induced ovulation. In controlled ovarian hyperstimulation (COH), multiple follicles are stimulated to grow and mature with medications. COH is necessary for assisted reproductive techniques (ART). The most commonly utilized type of ART is in vitro fertilization. ART are much more complex and invasive than ovulation induction in that they involve techniques to manipulate and fertilize the egg outside of the body. The goal of ART is to cause recruitment and maturation of multiple follicles. After a sufficient number of follicles have grown and matured, they are retrieved and transferred to an incubator for fertilization. The resulting embryos are returned to the uterus for implantation or cryopreserved. Both ovulation induction and ART require medications for the recruitment, development and maturation of eggs. Both techniques utilize similar medications; however, the doses of medication and the specific protocols for their use are varied. This review will discuss the range of available infertility treatments from medications alone to medications in combination with invasive medical procedures. The mechanism of action, side effects, use and effectiveness of the different classes of medications will be discussed. Because there are multiple medications in specific classes, comparisons of their protocols for use, effectiveness and side effect profiles will be detailed. Lastly, new variations of traditional assisted reproductive techniques will be presented.