Outpatient Infertility Clinic Research Articles

Comparison between the levels of anti mullerian hormone after treatment with clomid versus letrozole in polycystic women: an experimental study.

To compare the effect of two ovulation induction drugs on anti-Mullerian hormone level in polycystic women. The experimental cohort study was done at the infertility outpatient clinics of Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from May 2020 to April 2021, and comprised infertile women aged 18-35 years with confirmed diagnosis of polycystic ovarian syndrome. Baseline blood level of anti-Mullerian hormone was tested in all patients. The patients were divided into two groups. Group A patients received clomid 50mg twice daily to a maximum of 200mg for 5 days starting from the third day of the menstrual cycle. Group B patients received letrozole 2.5mg twice daily for 5 days starting from the third day of the menstrual cycle. After ovulation induction on day 12- 14, a second sample of serum anti-Mullerian hormone was tested, and intergroup comparisons were done. Data were analysed by using the available statistical package of SPSS-28 (Statistical Packages for Social Sciences- version 28). Students-t-test , Paired-t-test , Pearson correlation , t-test or ANOVA test Statistical significance was considered for P value equal or less than 0.05. Of the 83 women, 41(49.4%) were in Group A with mean age 26.0±4.9 years, while Group B had 42(50.6%) subjects with mean age 27.0±5.1 years. Post-intervention, the level of anti-Mullerian hormone decreased significantly in both groups (p<0.05). The decrease in Group B was more than Group A, but the difference was not significant (p>0.05). Ovulation induction drugs clomid and leterzole decreased the level of anti-Mullerian hormone significantly.

Monogram and Heat Map on Magnetic Resonance Imaging to Evaluate the Recommendation for Myomectomy in Patients with Infertility: A Pilot Study.

Uterine myomas can cause infertility. Studies are attempting to determine the indications for myomectomy. However, the multiplicity and localization of myomas complicate this issue. We aimed to develop a visualization tool to aid patients with infertility in their decision-making for myomectomy. We included 191 women with uterine myoma attending an outpatient infertility clinic, of whom 124 patients underwent myomectomy. Of these, 65 (52.4%) patients became pregnant within 17.6 months after surgery, and 54 (83.1%) of them had a live birth. A logistic regression model predicting the pregnancy rate (area under the curve, 0.82; 95% confidence interval, 0.74-0.89; validation value, 74.6%) was generated using the leave-one-out cross-validation method. This model incorporated five factors: age, maximum level of infertility intervention following myomectomy, presence of submucosal myoma, maximum diameter of the myoma, and type of myomas (multiple or single). We successfully visualized the degree of involvement of each factor in the pregnancy rate by developing a nomogram based on this model. We expanded the data from the preoperative magnetic resonance images and applied machine learning using a convolutional neural network. The classification accuracy was 71.4% for sensitivity and 77.7% for specificity. Heatmap images, generated using gradient-weighted class activation mapping to show the classification results of this model, could distinguish between myomas that required enucleation and those that did not. Although a larger sample size is needed to further validate our findings, this innovative pilot study demonstrates the potential of machine learning to refine assessment criteria and improve patient decision-making.

Prevelance and risk factors of female sexual dysfunction in females attending infertility clinic at Kasr Alainy hospital: a cross-sectional descriptive study

Background: Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Egypt. Sexual problems are reported by approximately 40 percent of females worldwide. There is a strong relationship between FSD, quality of life and infertility. Objective: The aim of this study is to assess the prevalence of female sexual dysfunction and also to investigate possible risk factors that may cause sexual dysfunction in the Egyptian infertile women seeking fertility Patients and Methods: This cross-sectional clinic-based survey was conducted at the infertility clinic, in Kasr Al-Ainy Hospital, Cairo, Egypt from October 2023 to February 2024. During this study, 186 women were enrolled and asked to answer the validated Arabic version of the Female Sexual Function Index and World Health Organization Quality of Life Questionnaire- Brief that were provided by female investigators. Results: 186 females were included in our study. The prevalence of FSD was 56 females (30.1%) while 130 females (69.9%) had good sexual function with FSFI &gt;28.1. Also, patients with sexual dysfunction had mean value of QoL that was (38.5±8.7) while females with good sexual function had mean value of QoL that (64.2±11.2) respectively. We found that the most frequent risk factors of female sexual dysfunction were advanced maternal and paternal age, no maternal occupation, duration of marriage &lt;5 years, nulliparous women ,maternal obesity, timed intercourse and number of IVF trials. On the other hand, no relations were reported between female sexual dysfunction and family income, residence, menstrual Rhythm, associated chronic medical diseases, drug intake, contraception, vaginitis, mode of delivery, circumcision and previous episiotomy. Conclusion: FSD is a major health problem that affect 30.1% of women attending infertility outpatient clinic in Kasr Alainy Hospital and greatly affected their quality of life.

Stigma and depression among obese infertile women: a cross-sectional study

BackgroundObesity causes infertility through various pathways, including disruption of ovarian follicular development, qualitative and quantitative development of the oocyte, fertilization, embryo development, and implantation. In traditional societies such as Türkiye, having children is a determinant of social status. Stigma is defined as a negative sense of social difference from others. Depression is a common health problem in infertile women due to the stressful nature of treatment procedures, fear of treatment failure, and the patient’s inability to become pregnant. In this cross-sectional study, the sample consisted of 161 infertile women from an infertility outpatient clinic of a university hospital in Eastern Turkey.ResultsIt was determined that depression scores had a strong positive correlation with stigma scores. In the multiple regression analysis performed to evaluate the effects of five independent variables determined to have an effect on depression scores, it was seen that the independent variables explained depression levels by 80%.ConclusionThe findings of this study suggest that stigma and depression are significant factors affecting the psychosocial and emotional well-being of obese women experiencing infertility. These results underscore the potential need for more comprehensive psychosocial support and assessment for women experiencing infertility related to obesity. Obese patients should be informed about the importance of pre-pregnancy weight reduction and should be encouraged to lose weight before the treatment to reduce the poor obstetrical outcomes due to obesity. Additionally, evidence-based guidelines should be prepared for assisted reproductive techniques for fertility treatment in obese infertile women.

Regulation of Assisted Reproduction in Hungary

Following the implementation of state oversight of human reproductive procedures in 2020, several regulations have been introduced to mitigate potential issues. To enhance patient care and alleviate the workload of IVF centers, a network of specialized infertility outpatient clinics will be established alongside existing centers of assisted reproduction. These changes aim to address the challenges faced by infertility centers and improve the chances of patients having children. The policy currently allows for up to five insurance-funded treatment cycles, while cryopreserved embryo transfers are not subject to a specific limit. Furthermore, the previous threemonth waiting period between treatment cycles has been eliminated, and restrictions on the number of embryos that can be implanted have been implemented. Limiting the number of embryos transferred during IVF procedures is a common practice aimed at reducing the risks associated with multiple pregnancies. By allowing only one embryo for the first transfer up to the age of 36, especially when transferred on day five of embryonic development, this initiative prioritizes the health and safety of both the mother and potential offspring. It helps to minimize the chances of complications such as preterm birth and low birth weight, which are more common with multiple pregnancies. Additionally, it can improve the overall success rates of IVF by focusing on the quality of the transferred embryo rather than the quantity. The Hungarian government anticipates that these measures will enhance the success rates of IVF treatments, consequently leading to a rise in future childbirths and a decrease in the number of frozen embryos. This study aims to delineate the effectiveness of the introduced changes in 2023 and provide recommendations accordingly.

Effect of health education program on knowledge, stress, and satisfaction among infertile women undergoing in vitro fertilization injection

Abstract Background Stress and dissatisfaction are common issues among patients undergoing in vitro fertilization (IVF). The process of IVF can be emotionally and psychologically challenging, leading to stress, anxiety, and depression in patients. This can be exacerbated by factors such as the length of infertility, the uncertainty of the outcome, and the financial burden of treatment. Additionally, the physical demands of the treatment, the side effects of medication, and the fear of failure can contribute to dissatisfaction and emotional strain in IVF patients. This pre-post intervention study design aimed to evaluate the effect of a health education program on knowledge, stress, and satisfaction among 100 infertile women undergoing IVF attending the Woman’s Health Hospital’s infertility outpatient clinic and IVF unit at Assiut University. Knowledge and stress were measured by women’s knowledge about IVF and the perceived stress scale, respectively. The satisfaction was measured using the Scale of Patient Satisfaction about IVF. Results There is a marked improvement in the knowledge of infertile women, with a significant reduction in their stress levels after the health education program. Furthermore, the satisfaction scores of the women who participated in the program improved significantly. Conclusion The health education program demonstrated a positive impact on knowledge, stress levels, and satisfaction among infertile women undergoing IVF. These findings highlight the positive impact of the program on the participants and emphasize the importance of continuous educational programs regarding IVF to improve knowledge, decrease stress levels, and increase their overall satisfaction with the treatment.

Delayed impacts of COVID-19 infection on unexplained male infertility: 2-year follow-up of normal sperm parameters in unexplained male infertility in KSA.

The current study aimed to assess the long-term effect of COVID-19 infection on unexplained male infertility. A retrospective comparative study of 134 men attending the infertility outpatient clinic of our institution before exposing to COVID-19 infection in KSA from January 2019 to July 2022. Medical recorded data of these patients who were investigated before COVID-19 infection were retrospectively collected using the hospital's electronic database, including semen analysis, sex hormonal, and ultrasound testicular size, and their data were compared prospectively to collected data after 2-year follow-up. One hundred and thirty-four infertile males who got COVID-19 infection in KSA (median age, 33 years) were assisted retrospectively preinfection and delayed 2 years postinfection (median of 23 months). Of the 134 men, 44 (32.83%) were asymptomatic positive COVID-19 (Group A), 68 (50.74%) had mild-to-moderate symptomatic positive COVID-19 (Group B), and 22 (16.41%) had severe symptomatic positive COVID-19 (Group C). There was no significant change between pre- and postinfections in sperm parameters, sex hormonal level, and testicular size. Subgroup analyses were performed for patients regarding the severity of infections. None of the evaluated parameters differed significantly after infections up to 2 years. Results of this study demonstrate that COVID-19 infection does not have significant changes in sperm parameters, sex hormonal level, and testicular size. The long-term impact of COVID-19 infections has no significant effect on normal sperm parameters, sex hormones, and testicular size in male infertility in KSA.

Asszisztált reprodukció újragondolva

Following the implementation of state oversight of human reproductive procedures in 2020, several regulations have been introduced to mitigate potential issues. To enhance patient care and alleviate the workload of IVF centres, a network of specialized infertility outpatient clinics will be established alongside existing centres of assisted reproduction. These changes aim to address the challenges faced by infertility centres and improve the chances of patients having children. The policy currently allows for up to five insurance-funded treatment cycles, while cryopreserved embryo transfers are not subject to a specific limit. Furthermore, the previous three-month waiting period between treatment cycles has been eliminated, and restrictions on the number of embryos that can be implanted have been implemented. Limiting the number of embryos transferred during IVF procedures is a common practice aimed at reducing the risks associated with multiple pregnancies. By allowing only one embryo for the first transfer up to the age of 36, especially when transferred on day five of embryonic development, this initiative prioritizes the health and safety of both the mother and potential offspring. It helps to minimize the chances of complications such as preterm birth and low birth weight, which are more common with multiple pregnancies. Additionally, it can improve the overall success rates of IVF by focusing on the quality of the transferred embryo rather than the quantity. The Hungarian government anticipates that these measures will enhance the success rates of IVF treatments, consequently leading to a rise in future childbirths and a decrease in the number of frozen embryos. This study aims to delineate the effectiveness of the introduced changes in 2023 and provide recommendations accordingly.

The association between cervical HPV and female fertility

Objective: Genital human papillomavirus (HPV) infection is the most common sexually transmitted viral infection worldwide with a prevalence of 10-12% in the female population in the reproductive age; few studies addressed the effect of HPV infection on fertility. It is aimed to investigate the presence of HPV infection in infertile women in the present study.&#x0D; &#x0D; Materials and methods: In this retrospective cross-sectional study; the outpatient infertility clinic records between July 2020 and January 2023, were evaluated. Infertility examination and evaluation were performed following the guidelines. Infertile female individuals and control group’s HPV results were analyzed.&#x0D; &#x0D; Results: 234 infertile and 340 non-infertile females were included in the study, HPV positivity was found %11.5 for all infertile women. No significant relationship was found between and HPV (p=0.850).&#x0D; &#x0D; Conclusion: No significant association was found between female infertility and HPV. Still HPV may play a role in infertility with different genotypes. Further studies should include HPV genotypes.

“The biggest disappointment”: women’s expectations from sex are ignored, from the perspective of infertile women

ABSTRACT Objective The aim of this study is to determine the attitudes, behaviours and experiences of infertile women towards sexuality. Methods This study was carried out in the infertility outpatient clinic of a state hospital in Istanbul of Turkey. Fifteen infertile women who had been receiving primary infertility treatment for at least two years and were actively continuing infertility treatment were included in the study. Data were collected by means of an detailed information form and a semi-structured interview. Content analysis was applied to the data obtained from semi-structured interviews. Consistency percentage calculation was made between the codes and themes determined by 4 researchers who are experts in their fields. Results Results based on the interviews with the participants, 2 main themes, 6 sub-themes and 27 codes related to sub-themes were determined as ‘Factors Affecting Sexual Life’ and ‘Overview of Sexual Health and Sexuality’. ‘Disappointment’ was determined as the most commonly defined code in the determined main theme and sub-themes. Conclusion It was determined that the majority of infertile women base their sexual lives on reproductive functions, experience serious sexual health problems, feel worthless, and describe their sexual life as a great disappointment.

Association between self-reported sedentary behavior and health-related quality of life among infertile women with polycystic ovary syndrome

BackgroundHigh sedentary behavior and poor health-related quality of life (HRQoL) were common among women with polycystic ovary syndrome (PCOS). However, the association of sedentary behavior with HRQoL among infertile women with PCOS is still unknown. This study aimed to investigate the association of sedentary behavior with HRQoL among them.MethodsA cross-sectional study was conducted with 283 participants recruited from infertility outpatient clinic. A self-administered, structured questionnaire including the modified PCOS health-related QoL questionnaire (MPCOSQ), the International Physical Activity Questionnaire short form (IPAQ-SF), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) was used. Anthropometric and laboratory indictors related to PCOS were also collected. Multivariable linear regression analyses were performed to identify the associations. Bonferroni correction was utilized for multiple testing correction.ResultsSedentary behavior was associated with reduced HRQoL among this group. Specifically, over seven hours per day of sedentary behavior was strongly associated with total and several aspects of HRQoL (β ranged from − 0.378 to − 0.141, all P < 0.0063) after adjusting for physical activity, anxiety and depression. In addition, elevated BMI (β = − 0.407, P < 0.001) and anxiety (β ranged from − 0.410 to − 0.245, all P < 0.0063) were associated with poor HRQoL, while physical activity and depression were not.ConclusionSedentary behavior is an important behavior among infertile women with PCOS as it was associated with poorer HRQoL. Future interventions seeking to improve HRQoL should be considered to reduce sedentary behavior and psychological burden as primary intervention targets.

Cortisol Level Related to Depression in Women with Endometriosis

Background: Several main symptoms of endometriosis can lead to physical and psychological stress and also hormonal disturbances as the result of prolonged stress. Cortisol was associated with the onset of depression. This study aimed to determine the relationship between cortisol levels and depression in women with endometriosis at the Department of Obstetrics and Gynecology at Dr. Mohammad Hoesin General Hospital (RSMH) Palembang.&#x0D; Methods: A cross-sectional study was performed at the Reproductive Endocrinology and Infertility outpatient clinic and inpatient ward, Department of Obstetrics and Gynecology at Dr. Mohammad Hoesin General Hospital Palembang, from January to November 2020. There were 74 samples of endometriosis patients who met the inclusion criteria. The blood cortisol level was examined using the ELISA method. The determination of depression level was performed by filling out the Beck Depression Inventory questionnaire. Data were analyzed using SPSS version 22.0.&#x0D; Results: Seventy-four samples met the inclusion criteria. As many as 44 patients (59.5%) without depression, 20 patients (27%) with mild depression, 8 patients (10.8%) with moderate depression, and only 2 patients (2.7%) with severe depression. There were no differences in age, marital status, parity, menstrual cycle, and duration of treatment between endometriosis patients with and without depression (p &gt; 0.05). There was a significant difference in cortisol levels between endometriosis patients with and without depression (p = 0.017). Endometriosis patients with cortisol levels ≤ 7.4 mg/dl were three times more at risk of depression than endometriosis patients with cortisol levels &gt; 7.4 mg/dl. In addition, there was a significant relationship between cortisol level and depression status (OR = 3.023 (95% CI 1.153–7.942; p = 0.041). This study also found a significantly low negative correlation between cortisol levels and BDI scores (r = -0.249; p = 0.032).&#x0D; Conclusion: There was a significant relationship between serum cortisol levels and depression in women with endometriosis. Endometriosis patients with depression had significantly lower cortisol levels than endometriosis patients without depression.

Association of Phthalate Exposure with Endometriosis and Idiopathic Infertility in Egyptian Women

BACKGROUND: Phthalates are compounds found in medical supplies, cellophane wraps, beverage containers, metal can linings, and other products. They have the potential to be significant endocrine disruptors. In experimental animals, thereby affecting their reproductive capacity. Endometriosis is a gynecological condition defined by ectopic endometrial glands and stromal development. Exposure to phthalates has been linked to the development of endometriosis in numerous studies. The dangers of phthalates to women’s reproductive health and fertility have been widely reported. AIM: So far, the relationship between phthalates and infertility is not proven so we decided to see if there was a link between the urine phthalate metabolite levels and endometriosis or idiopathic infertility in Egyptian women. METHODS: Our research was carried out at the infertility outpatient clinic of the Faculty of Medicine of Cairo University. It included 100 female subjects aged 18−40-years-old. Group A (idiopathic infertility; n = 40), Group B (endometriosis; n = 40), and Group C (control; n = 20) were the three age-matched groups that were studied. Using high-performance liquid chromatography (HPLC), the urine levels of mono-2-ethylhexyl phthalate (MEHP) were quantified. RESULTS: The comparison between the study groups has revealed statistically significant differences regarding the urine MEHP levels between Groups A and B. An analysis of the urine MEHP levels in the study Groups A and B has also revealed that the significantly higher urinary MEHP levels are correlated with the use of dietary plastic containers, the use of cosmetics, and the patients’ estrogen levels. Moreover, the urinary MEHP levels of Group A were associated with a history of abortions. CONCLUSIONS: Higher levels of urinary MEHP are positively associated with female reproductive disorders, specifically endometriosis, idiopathic infertility, and abortion.

Infertility-related stress and quality of life among infertile women with polycystic ovary syndrome: Does body mass index matter?

ObjectiveInfertility and obesity are common among women with Polycystic ovary syndrome (PCOS) and related to poor quality of life (QoL). Obesity may confer an elevated adverse effect of infertility-related stress given its relationship with increased susceptibility to stress. This study aimed to investigate the association of infertility-related stress with QoL among infertile women with PCOS, and to evaluate whether body mass index (BMI) modifies this association. MethodsA cross-sectional study was conducted with 306 participants recruited from the infertility outpatient clinic. A self-administered, structured questionnaire including COMPI Fertility Problem Stress Scale (COMPI-FPSS) and the modified PCOS health-related QoL questionnaire (MPCOSQ) was conducted in this study. The moderation model was conducted by the PROCESS macro using SPSS. ResultsThe mean score of QoL was 142.67 (SD = 20.11), ranged from 93 to 183 (theoretical range = 30–210). QoL was negatively associated with infertility-related stress (r = −0.373, P < 0.001). Moderation analysis indicated that the interaction term between infertility-related stress and BMI significantly predicted QoL (β = −0.154, P = 0.005, f2 = 0.03) as well as emotional disturbance (β = −0.170, P = 0.002, f2 = 0.04). Specifically, higher BMI significantly exacerbated the effect of infertility-related stress on QoL and emotional disturbance. ConclusionInfertile women with PCOS experienced poor QoL. The moderation role of BMI provides a better understanding of individual difference in relationship between infertility-related stress and QoL. Interventions aiming to improve QoL among infertile women with PCOS should focus on alleviating infertility-related stress, especially among women with high BMI.

Use of uterine artery Doppler velocimetry values to predict pregnancy in clomiphene citrate-induced intrauterine insemination cycles in patients with polycystic ovary syndrome

Objective: The aim of this study is to investigate the effectiveness of uterine artery Doppler velocimetry values to predict pregnancy in clomiphene citrate-induced intrauterine insemination cycles (IUI) in patients with polycystic ovary syndrome (PCOS). Materials and methods: Patients with PCOS who applied to the infertility outpatient clinic between 01/06/2020 and 31/11/2021 were included in this prospective interventional study. For ovulation induction, patients used clomiphene citrate (CC) 50-150 mg daily between days 5 and 9 of the cycle. When at least one dominant follicle of 17 mm or larger was detected in serial transvaginal ultrasound controls, ovulation was triggered and IUI was performed 36 hours later. Uterine artery flow Resistance Index (RI), Pulsatility Index (PI) and systolic-diastolic ratio (S/D) were evaluated with Doppler ultrasound in all patients on the 3rd day of the cycle and on the trigger day. Uterine artery Doppler values of the group that achieved pregnancy and those who could not conceive were compared as the main outcome of the study. Results: The study was designed on 56 cycles in which IUI can be performed after ovulation induction. In these 56 cycles, 10 pregnancy were obtained and the clinical pregnancy rate was 17.9%. The pregnant and non-pregnant groups were similar in terms of demographic characteristics, basal hormone levels, basal period and trigger day endometrial thickness, follicle number and mean dominant follicle diameter (p&gt;0.005). There was no significant difference in mean uterine artery Doppler values (PI, RI and S/D) measured on the 3rd day of the cycle and on the trigger day between the pregnant and non-pregnant groups (p&gt;0.005). Conclusion: Considering the hormonal changes in stimulated cycles and the effect of CC itself on endometrial receptivity, we think that only uterine artery Doppler values are not effective in predicting pregnancy success in CC-induced IUI cycles in patients with PCOS.

Clomiphene Citrate versus Letrozole for Induction of Ovulation in Infertile women having Polycystic Ovarian Syndrome (Randomized Controlled Trial)

Background: Polycystic ovary syndrome is a disorder but with unclear etiology that its diagnosis depends on exclusion of other etiologies with ovulatory disorders and androgen excess as congenital adrenal hyperplasia, 21-hydroxylase deficient non classic congenital adrenal hyperplasia (NCAH), adrenal or ovarian androgen-secreting tumors, disorders of adrenocortical dysfunction as Cushing’s disease, and abuse of androgenic or anabolic drugs. Polycystic ovary syndrome affects approximately 6-15% of women in reproductive age and constitutes 50% of the causes of infertility in women. Aim of the Work: To compare the efficacy of letrozole on ovulation induction to that of clomiphene citrate in women suffering polycystic ovary syndrome and the effect on the follicular maturation, endometrial thickness and pregnancy rate. This study was carried in the outpatient infertility clinic of Ain-Shams Maternity Hospital during the period from November 2020 till April 2021. Patients and Methods: This study included 80 infertile women diagnosed as having polycystic ovary syndrome. Women were randomized into two groups. Letrozole group (1) included 40 women who were given the aromatase inhibitor (Letrozole) orally in a 5mg dose daily from day 3 to day 7 of the menstrual cycle. While Clomiphene citrate group (2) included 40 women who were given the clomiphene citrate orally in 100mg dose daily from day 3 to day 7 of the menstrual cycle. All women were counseled and informed consent was obtained before recruitment. Results: In this study, ovulation rate was significantly more frequent in the Letrozole group (82.5%, 33 women reached ovulation successfully) than in Clomiphene citrate group (60%, 24 women reached ovulation successfully) within P value=0.024. Clomiphene citrate at a dose of 100mg showed more efficacies in the number of follicle ≥18mm than Letrozole at a dose of 5mg. In Letrozole group, the number of follicles (≥18mm in diameter) ranged from 1 to 2 with a Mean±SD= 1.4±0.65 and in Clomiphene citrate group, the number of follicles (≥18mm in diameter) ranged from 1 to 3 with a Mean±SD= 1.9± 0.41 (P value=0.0001). Conclusion: Letrozole can be considered as a first line treatment of anovulation in polycystic ovary syndrome. But, moreover studies including larger number of cases will further confirm the efficacy of letrozole versus clomiphene citrate in induction of ovulation, reaching to the optimum doses for aromatases inhibitors, more observation on endometrial thickness, incidence of pregnancy outcomes, incidence of abortion and incidence of congenital fetal malformations.

Hysteroscopic evaluation of uterine cavity in women with unexplained infertility

Objective: To detect missed uterine abnormalities on primary work up in unexplained infertile women. Study design: An observational study was performed in the outpatient infertility clinic of Beni-Suef University Hospitals. It included 100 women with unexplained infertility. Diagnostic office hysteroscopy was done for all participants. Women were grouped according to the infertility type and compared as regards uterine abnormalities detected. Results: Uterine abnormalities were detected by hysteroscopy in 29% of women. No significant difference was found regarding the hysteroscopic findings between primary and secondary infertility groups. However, uterine polyp cases were detected more in women with primary infertility (55.5% /18). A significant difference in intrauterine adhesions between both groups being detected only in secondary infertility group (p value =0.006). Conclusion: Outpatient preliminary and routine diagnostic office hysteroscopy may be a beneficial part of a primary and secondary infertility workup.

Sildenafil Citrate adjuvant Ovulation Induction Therapy with Clomiphen Citrate in Polycystic Ovarian Syndrome for Successful Ovulation; Cross-Over, Randomized Controlled Trial

Abstract Background Sildenafil Citrate (Respatio® 20 mg) as an adjuvant therapy in induction of ovulation along with Clomiphen Citrate (Clomid ®), is settled to enhance the endometrial receptivity through enhancing endometrial thickness and echogenicity. Yet, the exact role of Sildenafil in ovulation itself is still under study assuming that through increasing ovarian blood flow as a part of pelvic blood flow, will enhance the ovulation measured by the number and diameter of the growing follicles. Aim of the Work The aim of this study is to evaluate the efficacy of sildenafil citrate on the ovulation in PCOS women undergoing induction of ovulation using clomiphene citrate. Patients and Methods The current study was conducted in Ain Shams University Maternity Hospital- Infertility outpatient clinic during the period between January 2018 and December 2019. It included a total number of 595 patients who either were assessed for eligibility of the study, of which, 141 were excluded due to non-matching inclusion criteria or had exclusion criteria. 22 patients did not consent to participate in the study432 patients were matched, randomized and allocated to the two groups of the study each with 216 and received induction of ovulation according to the protocol of the study with either Clomiphen Citrate and Sildenafil Citrate or Clomiphen Citrate only, then they were followed up for 3 months. Those who didn't get pregnant given 2 months with no induction to wash over the effect and croos over the groups was done and followed up for another 3 months. Results Pregnancy test was positive in 39.8% in Clomiphen/Sildenafil group compared to just 30.1% in Clomiphen group. The patients that did not have positive pregnancy test in the first three months, have a rest for 2 months and then cross over of the groups took place. 145 patients shifted to Clomiphen/ Sildenafil protocol while 126 patients shifted to Clomiphen protocol and follow up for 3 months again and positive pregnancy test was 38% and 25% in the two groups in order. Conclusion using sildenafil citrate in patients with PCO syndrome undergoing induction of ovulation increases the chemical and clinical pregnancy rates through not only increasing the endometrial thickness and improving the endometrial pattern with improving the endometrial Doppler indices but also improving the ovulation by improving the ovarian arteries Doppler indices as well.

Pulsatility and Resistance Indices of Uterine and Ovarian Arteries in Anovulatory Women With Polycystic Ovary Syndrome.

We aimed to compare the ovarian and uterine artery blood flow of anovulatory patients with polycystic ovary syndrome (PCOS) with those of ovulatory women throughout the menstrual cycle using color Doppler ultrasound. Seventy-one women with PCOS, who were admitted to the infertility outpatient clinic of a training and research hospital, were included in the study. The patients were divided into 2 groups as anovulatory (group 1, n = 23) and ovulatory (group 2, n = 37). Each patient was followed up throughout her menstrual cycle and included in either group 1 or group 2. Anovulatory cycles were determined by consecutive ultrasound examinations, and the progesterone value was measured in the luteal period. Eleven patients were excluded from the study because they did not continue their follow-up. The uterine and ovarian artery pulsatility and resistance indices of all patients in both groups were evaluated 3 times throughout a menstrual cycle: 7th to 10th day, 13th to 17th day, and 21st to 25th day. It was observed that the uterine artery resistances of the patients with anovulatory cycles remained relatively high throughout the menstrual cycle compared with ovulatory cycles. Both pulsatility and resistance indices of uterine and ovarian arteries were significantly higher in anovulatory cycles compared with ovulatory cycles at all evaluation times throughout the menstrual cycle (P < 0.05). Ovarian artery resistance in anovulatory patients did not significantly change during the menstrual cycle. Anovulatory patients with PCOS have higher uterine and ovarian artery resistance than ovulatory artery resistance, and the former shows a significant decrease throughout the cycle.

P–510 Psychological distress and quality of life in infertile women attending Infertility clinic at tertiary care center: a pilot study

Abstract Study question What are the levels of psychological distress (anxiety and depression) and quality of life faced by infertile couple presenting with or undergoing treatment for infertility? Summary answer The levels of psychological distress and quality of life seems to be affected more in women than their husbands and may require psychological intervention. What is known already Infertility is a biopsychosocial crisis which can cause psychological distress in the form of depression and anxiety, and can impair quality of life .It often has a stressful impact on relationships and can affect a couple’s sex life. Most of the time these aspects are not explored and only medical and surgical treatment is offered depending on the cause. Assessing the psychological distress and quality of life contributes to decrease the stress and helps to improve the outcome of management by improving the relationship of the individual to achieve pregnancy. These women need psychological support, in the form of counselling. Study design, size, duration Cross-sectional study .100 infertile couples attending fertility clinics. Previous data indicate that the mean infertility specific QoL in infertile couples is 54.39 for females (nd 60.63 for males .Thus, a minimum sample size of 77 samples per group is needed to be able to reject the null hypothesis with probability 80% power. With a 30% dropout rate, the sample size is 100 samples per group. The study was conducted from Jan 2018 to June 2019. Participants/materials, setting, methods Infertile couples aged between 25 to 40years attending the Infertility outpatient clinic in OBG department, JIPMER, Pondicherry, India were recruited in to the study. Presence of a pre-existing major medical illness and presence of a major psychiatric illness were excluded from the study. After written consent, the severity of depression and anxiety was measured using the Hospitol Anxiety and Depression Scale (HADS Scale) and QoL was assessed with the Fertility Quality of Life (FertiQoL) questionnaire. Main results and the role of chance The average ages (SD) of men and women were 33.6 (4.29) and 31.3(4.03) years, respectively. Women reported higher levels of depression (p &amp;lt; 0.001) and anxiety (p &amp;lt; 0.001) as compared to their husbands. Depression and anxiety was noted more in women who were more than 32year age and prolonged duration of infertility. There was a significant association between depression, gender, duration of marriage and duration of infertility among the infertile couples.78% women felt that their attention and concentration were impaired and 63% responded that they cannot move towards their life goals . Around 72% and 60% felt drained out and lost, respectively. 57% women had fluctuant thoughts like hope and despair. More women felt were socially isolated and uncomfortable with social situations than men. 45% reported social pressure and 52% were felt angry because of fertility problem. Only 24% women were satisfied with support from friends and 37% of their family can understand them. Overall only 51% of the participants gave positive response to fertiqol questions. The total FertiQoL scores were significantly higher in the husbands than the wives (p &amp;lt; 0.001). Poor Qol were significantly associated with male cause of infertility (p = 0.004), primary infertility (p = 0.022) and previous history of receiving multiple treatments (p = 0.020). Limitations, reasons for caution The main limitation of the study is the cross-section study design which cannot detect exact cause of psychological distress and small sample size from single center which did not define entire population. Self reported questionairre was more subjective 5han objective which might be counfounding. Wider implications of the findings: Couples going through infertility have a varying degree of emotional moods swinging between anxiety and depression impairing QoL.,women being affected more than men.Counselor who can empathize with the couple should form an integral part of the infertility team providing psychological intervention along with infertility treatment. Trial registration number NA