Patients Undergoing Infertility Treatment Research Articles

Effectiveness of a Spousal Support Program in Improving the Quality of Life of Male Patients Undergoing Infertility Treatment: A Pilot Study.

ABSTRACTBackground: There are various causes of male infertility. Infertile men usually have a low quality of life (QoL) and a high level of stress compared with men without infertility problems. The present study aimed to examine the effects of a spousal support program to enhance the QoL of male patients undergoing infertility treatmentMethods: The present quasi-experimental study (pretest-posttest) was conducted among 38 infertile couples in Tokyo (Japan) during April-August 2018. The levels of QoL, distress, and spousal support were measured using self-administered valid and reliable questionnaires. The paired t test was used to analyze pre- and post-intervention data with SPSS software (version 23.0). P<0.05 was considered statistically significantResults: There were significant differences between the pre-test and post-test scores for the relational and emotional sub-scales of QoL. The paired t test results showed that the post-test emotional sub-scale (66.9±16.9) was significantly higher than the pre-test emotional sub-scale (58.5±13.5; t (30)=2.2, P=0.04). Similarly, the post-test relational sub-scale (71.2±21.6) was significantly higher than its pre-test score (60.8±13.7; t (30)=2.3, P=0.03). The majority of the participants 23 (74.2%) expressed satisfaction with the program.Conclusion: The spousal support program was well-received and significantly improved part of the QoL of men who were infertile due to various causes

Uterine artery embolization for postpartum and postabortion hemorrhage: a retrospective analysis of complications, subsequent fertility and pregnancy outcomes.

To evaluate the impact of UAE for postpartum and postabortion hemorrhage on future infertility, especially in patients undergoing infertility treatment, along with angiographic endpoints. Sixty-two sessions performed emergent or prophylactic UAE for postpartum or postabortion hemorrhage between 2008 and 2017 were selected. Subsequent pregnancy outcomes and complications were investigated as primary outcomes. The cases were divided into two groups based on the presence of massive hemorrhage. The relationships between angiographic endpoints and complications were also evaluated as secondary outcomes. The mean patient age was 34.1 ± 6.5years. Fourteen of the 23 patients (60.9%) with desired fertility achieved pregnancy and 10 patients achieved live births (43.5%). In the patients during infertility treatment, three of the four patients had complications of severe adhesion after caesarean section or placenta accreta. In the group of patients with massive hemorrhage, the occurrence of uterine infection was significantly high (p = 0.014), but the angiographic endpoints were not significant, regardless of the occurrence of uterine infection. It was unnecessary to modify embolic endpoint according to seriousness of the hemorrhage. The pregnancy and live birth rates were acceptable, although patients undergoing infertility treatment had a higher rate of delivery complications.

Circular RNA sequencing reveals the molecular mechanism of the effects of acupuncture and moxibustion on endometrial receptivity in patients undergoing infertility treatment.

The present study aimed to determine the profile of differentially expressed circular RNAs (circRNAs) in infertile patients treated with acupuncture and moxibustion and verify the role of acupuncture and moxibustion in altering endometrial receptivity (ER). High‑throughput RNA sequencing and bioinformatics analysis of samples from six pairs of patients treated with or without acupuncture and moxibustion were conducted. The reliability of high‑throughput RNA sequencing was validated using reverse transcription‑quantitative PCR. The most significant circRNA functions and pathways were selected by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. A circRNA‑miR‑mRNA interaction network was constructed to determine the connection between circRNAs, microRNAs (miRs), and mRNAs. High‑throughput RNA sequencing identified 2,653 circRNAs. A total of 86 circRNAs was differentially expressed, of which 57 were upregulated and 29 were downregulated, between the acupuncture and moxibustion group and the control group. In the GO analysis, the identified BP terms were chromatin modification, positive regulation of transcription from RNA polymerase II promoter involved in unfolded protein response, oxidative DNA demethylation, regulation of transcription from RNA polymerase II promoter in response to hypoxia, and regulation of smooth muscle cell differentiation. The identified CC terms were nucleoplasm, nucleolus, nucleus, histone acetyltransferase complex, and annulate lamellae. The identified MF terms were methylcytosine dioxygenase activity, chromatin binding, zinc ion binding, histone binding, and protein binding. In the KEGG pathway analysis, the identified pathways were protein processing in endoplasmic reticulum, degradation of aromatic compounds, shigellosis, mTOR signaling pathway, bacterial invasion of epithelial cells, and prostate cancer. Circ‑SFMBT2, circ‑BACH1, and circ‑LPAR1 were significantly upregulated (P<0.05) and associated with numerous miRs and mRNAs. Acupuncture and moxibustion could impact ER by regulating the expression of circRNAs.

Mdm2-p53-SF1 pathway in ovarian granulosa cells directs ovulation and fertilization by conditioning oocyte quality.

Functions of tumor suppressor p53 and its negative regulator mouse double minute 2 homolog (Mdm2) in ovarian granulosa cells remain to be elucidated, and the current study aims at clarifying this issue. Mice with Mdm2 deficiency in ovarian granulosa cells [ Mdm2-loxP/ progesterone receptor ( Pgr)-Cre mice] were infertile as a result of impairment of oocyte maturation, ovulation, and fertilization, and those with Mdm2/p53 double deletion in granulosa cells ( Mdm2-loxP/ p53-loxP/ Pgr-Cre mice) showed normal fertility, suggesting that p53 induction in the ovarian granulosa cells is detrimental to ovarian function by disturbing oocyte quality. Another model of Mdm2 deletion in ovarian granulosa cells ( Mdm2-loxP/ anti-Mullerian hormone type 2 receptor-Cre mice) also showed subfertility as a result of the failure of ovulation and fertilization, indicating critical roles of ovarian Mdm2 in ovulation and fertilization. Mdm2-p53 pathway in cumulus granulosa cells transcriptionally controlled an orphan nuclear receptor steroidogenic factor 1 (SF1), a key regulator of ovarian function. Importantly, MDM2 and SF1 levels in human cumulus granulosa cells were positively associated with the outcome of oocyte maturation and fertilization in patients undergoing infertility treatment. These findings suggest that the Mdm2-p53-SF1 axis in ovarian cumulus granulosa cells directs ovarian function by affecting their neighboring oocyte quality.-Haraguchi, H., Hirota, Y., Saito-Fujita, T., Tanaka, T., Shimizu-Hirota, R., Harada, M., Akaeda, S., Hiraoka, T., Matsuo, M., Matsumoto, L., Hirata, T., Koga, K., Wada-Hiraike, O., Fujii, T., Osuga, Y. Mdm2-p53-SF1 pathway in ovarian granulosa cells directs ovulation and fertilization by conditioning oocyte quality.

Validity and Reliability of the Japanese Version of the Fertility Quality of Life (FertiQoL) Tool for Couples Undergoing Fertility Treatment

Background: FertiQoL, which measures the Quality of Life (QOL) of reproductive partners, has been translated and used in 45 languages in the world. The reliability and validity of the original English version of FertiQoL have been confirmed. However, there is still no report on the reliability and validity of the Japanese version by a large-scale survey. This study aimed to examine the reliability and validity of the Japanese version of the FertiQoL scale for measuring the QOL of patients with reproductive problems. Methods: An unsigned self-filled questionnaire survey was conducted in patients undergoing infertility treatment at seven facilities in the Kanto area in Japan using the 34 items of the Japanese version of the FertiQoL scale. The study design was quantitative cross-sectional descriptive research. The investigation period was from April 2013 to April 2018. The contents of the investigation were attributes, FertiQoL scale, and distress scale. To determine the construct validity, principal component analysis, confirmatory factor analysis, and correlation analysis for each subscale were performed using SPSS Statistics Ver. 23.0 and AMOS Ver. 23.0. The study was performed after obtaining approval from the Research Ethics Review Committee of the responsible institutions to which the researchers belong as an ethical consideration. Results: The participants included 1201 patients undergoing infertility treatment and who provided valid responses. The Cronbach’s α was 0.92, and confirmatory factor analysis identified six domains with 34 items that showed the following values: goodness of fit index = 0.877, adjusted goodness of fit index = 0.855, comparative fit index = 0.893, and root mean square error of approximation = 0.059. The correlation coefficient was 0.669 (p < 0.001) with the distress scale. Conclusions: The Japanese version of FertiQoL showed adequate reliability and validity for assessing the QOL of patients with reproductive problems in Japan.

Supportive Care Needs and Medical Care Requests of Male Patients during Infertility Treatment

Background: This study aimed to clarify the supportive care needs and medical care requests of male patients during their infertility treatment to be able to provide them with optimal nursing care. Methods: A self-filled questionnaire survey was conducted in 411 male patients who were undergoing infertility treatment at 4 human reproductive clinics. The investigation period was from April to August 2016. This research used across-sectional study design. The submission of the filled questionnaire was taken as an indication of agreement and consent to the research. The main contents of the questionnaire were attributions, care needs, and medical care requests of male patients. The care needs were evaluated by descriptive statistics, and the free descriptions of the medical care requests were analyzed for their contents qualitatively and recursively. The study was performed after the approval of the Research Ethics Review Committee. Results: The number of valid responses was 331 (80.5%). The care needs of the male patients were warm care from their wives, provision of information on their treatment, daily life information for conceiving, and evaluation data. The 6 categories of the open-ended responses were as follows: warm support, improvement of examination environment, adjustment of medical examination schedule, information provision, support from wife, and subsidy for treatment costs. These were extracted from the medical care requests by qualitative inductive analysis. Conclusions: The care needs and medical care requests of male patients undergoing infertility treatment were mainly on being provided information and supporting their wives. As supporting nursing care for these male patients, provision of sufficient information regarding the examination results and infertility treatment is recommended, and environmental considerations peculiar to male patients are necessary. Consideration from female patients is also an indispensable factor similarly to the provision of care for male patients.

Relative Morphokinetics Assessed by Time-Lapse Imaging Are Altered in Embryos From Patients With Endometriosis.

Time-lapse technology allows almost continuous noninvasive assessment of embryonic development. It was shown previously that relative kinetics defining cleavage synchronicity are better predictors of blastocyst quality than absolute time points. This study aims to compare relative kinetics in embryos from patients with and without endometriosis. Time-lapse data were collected retrospectively from 596 patients undergoing infertility treatment for in vitro fertilization from January 2011 to July 2016. Four hundred twenty-eight patients with confounding comorbidities (ie, polycystic ovary syndrome, pathological spermiogram in the included cycle, numerical/structural genetic abnormalities, preimplantation genetic screening performed) or incomplete data sets were excluded. Of the 168 included patients, 72 (42.9%) had endometriosis. Indications for in vitro fertilization of controls were tubal factor, unexplained infertility, or prolonged infertility. Relative kinetics were calculated as defined previously: cleavage synchronicity (CS)2-8=((t3-t2) + (t5-t4))/(t8-t2), CS4-8=(t8-t5)/(t8-t4), CS2-4=(t4-t3)/(t4-t2), DNA replication time ratio (DR)=(t3-t2)/(t5-t3). In women with more than one embryo, the median time was analyzed. Median age, body mass index, smoking status, and AMH levels were similar in both groups. Embryos from patients with endometriosis showed poorer relative kinetics. The relative time CS2-8 was decreased in embryos from patients with endometriosis (0.7 [0.0-0.93] vs 0.8 [0.0-0.94], P < .05) and CS4-8 was increased (0.4 [0.0-1.0] vs 0.3 [0.0-1.0], P < .05). The less powerful diagnostic relative kinetic parameters (CS2-4 and DR) were not significantly different. Embryos from patients with endometriosis presented with altered relative kinetics suggesting poorer embryo quality. These findings support recently published data demonstrating reduced oocyte quality in patients with endometriosis which is one possible explanation for their poor response to fertility treatment.

A predictive fertility treatment model based on oocyte quality and reactive oxygen species

While there no general consensus, our work has shown treatment of oocytes with various oxidants, such as reactive oxygen species and those generated through the myeloperoxidase (MPO)/H2O2 system, caused dramatic alterations in spindle shape in which morphologic parameters are not measurable and are uninformative in terms of oocyte quality. Prospective translational research study We sought to combine all of our work and generate a global model that can predict the impact of these various oxidants on the oocyte configuration and therefore be utilized to predict fertility outcomes. Oocyte integrity is maintained through a balance of many forces encompassed by the microtubule organizing center (MTOC) with the pericentrin location, spindle (MT) and chromosomal (CH) configurations serving as a reflection of oocyte quality. Ideally, the spindle has a symmetrical pointed barrel shape, assembled around the tightly aligned chromosomal plate at the equator. Both in animal and human models we treated oocytes with varying oxidants such as ONOO-, purified or endogenously generated MPO through macrophages, and HOCl. Oocytes treated with these various oxidants showed either loss of pericentrin that causes a loosening /shrinking of the spindle apparatus and ballooning effect, pericentrin movement within the pole to pole axes either inward creating a shorter wider spindle or outward leading to a progressive elongation and thinner spindle based on concentration, or pivoting around the pole to pole axis creating a “C” shape which is noted in many inflammatory disorders such as diabetes. In all cases, progressive increase in time and concentration caused disappearance of the MTOC proteins, spindle breakage or complete degradation. A global model created using the type of ROS and MPO and its alterations on oocyte quality was created and may serve as a diagnostic tool for patients undergoing infertility treatment to predict the success of treatment and the source of the insult, Table 1. Creating a global model, will serve not only as a diagnostic tool to potentially help identify the root cause of infertility but may be utilized as a means for prediction of fertility treatment. This can help guide patient expectations by providing realistic treatment goals.Tabled 1Model ImageDescriptionAssociated Treatments/DisordersAControl spindle with symmetrical microtubules, compact linear chromosomal arrangement and pericentrin clustered at both poles—BInward movement of pericentrin (green arrows), creatingshorter wider spindle, chromosomal alignment largely maintainedLow concentration of ROS exposureCOutward movement of pericentrin (green arrows), resulting in a longer thinner spindle, chromosomal alignment largely maintainedHigh concentration of ROS exposureDMovement of pericentrin outside the polar axis (green arrows) and resultant pivoting of the microtubule spindle around the chromosomal attachment, chromosomes are disorderedInflammatory diseasesESpindle breakage (red arrows) and complete loss of pericentrin, chromosomes are disorderedHigh oxygen exposure, postovulatory stagingFMicrotubule spindleand pericentrin are completely degraded with only disordered chromosomes remainingExtremely high ROS exposure Open table in a new tab

The presence of human papillomavirus in semen does not affect the integrity of sperm DNA.

It remains unknown whether human papillomaviruses (HPVs) in semen affect sperm DNA integrity. We investigated whether the presence of these viruses in semen was associated with an elevated sperm DNA fragmentation index. Semen samples of 22 normozoospermic patients undergoing infertility treatment, nine fertile donors and seven fertile men with a risk of HPV infection (genital warts or condylomas) were included in the study. The samples were examined by an INNO-LiPA test PCR-based reverse hybridisation array that identifies 28 types of HPVs as simple or multiple infections. Sperm DNA integrity was determined by sperm chromatin dispersion assay (SCD). Our preliminary findings demonstrate an increase in HPV infection in infertile men with respect to fertile men. However, the sperm DNA fragmentation index was not increased in semen containing these viruses.

Cryopreservation of very low numbers of spermatozoa from male patients undergoing infertility treatment using agarose capsules

This study tried to cryopreserve low numbers of spermatozoa from men undergoing infertility treatments by inserting into agarose capsules. The capsules were transferred into a drop of cryoprotectant solution and injected 3-4 motile spermatozoa that were selected by the swim-up method by conventional intracytoplasmic sperm injection. These capsules were put on a Cryotop® and frozen in liquid nitrogen vapor, and then submerged into liquid nitrogen and subsequently thawed and recovered. The motile spermatozoa in the capsules were counted. Eventually, we cryopreserved 2142 motile spermatozoa in 702 agarose capsules from 26 male patients and 1356 (63%) spermatozoa maintained their motility after thawing. The spermatozoa motility rates after thawing (MRAT) ranged from 20.0% (5/25) to 95.1% (58/61) among patients. The median MRAT was 68.3% (interquartile range 46.1-75.7). The total number of motile spermatozoa collected by swim-up method strongly correlated with MRAT (r=0.746). It was possible to cryopreserve spermatozoa from male patients undergoing infertility treatment using agarose capsules. However, there were wide differences in MRAT among patients. It seems the spermatozoa from semen where there were many motile spermatozoa may have higher freezing resistance. Further studies using this method in cryptozoospermic semen, testicular and epididymal spermatozoa are required.

The Frequency of Staphylococcus aureus Isolated from Endocervix of Infertile Women in Northwest Iran.

Infertility is one of the major social issues. Due to the asymptomatic cervical infection associated with Staphylococcus aureus (S. aureus), the majority of patients remain undiagnosed. The present study intended to assess the frequency of S. aureus isolated from infertile women's endocervix in northwest Iran. In a descriptive cross sectional study, specimens were randomly collected during vagina examination using a sterile speculum and swabbing. After performance of antibiotic susceptibility testing, polymerase chain reaction (PCR) was used to identify methicillin-resistance S. aureus (MRSA) and toxic shock syndrome toxin-1 (TSST-1). About 26 (26%) and 9 (9%) women's urogenital tracts were colonized by S. aureus and Candida spp., respectively, of which three (11.5%) patients were infected with fungi and S. aureus, simultaneously. Antibiotic susceptibility results showed high activity of vancomycin and co-trimoxazole on isolates. Regarding PCR results, mecA sequences were detected in 7 (26.9%) strains, whilst the tst gene encoding TSST-1 was not detected in any of clinical strains. The prevalence of S. aureus was very high in infertile women. Therefore, it demands all patients undergoing infertility treatment to be investigated thoroughly for this type of infection.

Aneuploidy screening and genome profiling in infertile couples

Current assessment of the infertile male utilizes semen analyses, chromatin fragmentation, and fluorescent in situ hybridization (FISH) on spermatozoa. At least 15% of infertility cases are related to genetic disorders, such as chromosomal and single-gene alterations. To investigate whether all genome sequencing by estimating the involvement of specific genes can supplement standard tests used for patients undergoing infertility treatment and help profile the male genome.

Sac Size and Fetal Heart Rate as Predictor of Miscarriage in Patients Undergoing Infertility Treatment [18G

INTRODUCTION: Pregnancies achieved by assisted reproductive technology (ART) are associated with a spontaneous miscarriage (SAB) rate as high as a 10–25% even after documentation of fetal cardiac activity. Our objective was to determine which ultrasound parameters are relevant in predicting miscarriage after documentation of fetal viability following ART. METHODS: A retrospective chart review was performed at Wayne State University and its affiliated infertility clinic to assess factors such as such fetal heart rate (FHR), sac size (SAC), and crown rump length (CRL). All 104 ART cycles between 2008 and 2011 resulting in singleton clinical pregnancy were analyzed. The four visits following a positive pregnancy test were analyzed for FHR, SAC and CRL. RESULTS: The relationship between the minimum (min) values of FHR, SAC, and CRL recorded at each visit between 6 and 9 weeks gestation and SAB were examined using Pearson/Spearman correlations, logistic regressions, and receiver-operating characteristic (ROC) curves. FHR_min, SAC_min, and CRL_min were positively correlated with each other (P<.05) and each was negatively correlated with SAB (P<.05). Regression analyses revealed that maternal age and CRL_min were not significant predictors for SAB unlike FHR_min and SAC_min. With one unit increase in FHR_min and SAC_min, the odds of SAB were reduced by 4% and 22%, respectively. CONCLUSION: FHR and SAC can be useful in predicting miscarriage after ART. There is a decrease in miscarriage rates as minimum FHR and minimum sac size increase. Further studies need to be conducted to determine which other parameters can predict a decrease risk of SAB.

Experiences of Spanish women undergoing hysterosalpingography as part of the infertility process: a phenomenological study.

To describe and understand the experiences and perceptions of women who undergo hysterosalpingography as part of the infertility process. Nurses and midwives should conduct research into the emotional aspects of caring for patients undergoing infertility treatment. The hysterosalpingography is considered to be the most feared test in the infertility process and the one about which very little is known. A phenomenological qualitative study. Ten Spanish women who had undergone hysterosalpingography participated in this study. In-depth interviews were carried out between October 2012-May 2013. Data analysis was performed with the help of atlas.ti software to identify emerging themes. The experience of the participants who underwent hysterosalpingography during the infertility process is represented by the following three themes: (1) becoming a mother to feel complete as a person and as a woman, with the subthemes 'maternity as a life objective' and 'maternity in terms of gender identity'; (2) infertility--an intimate experience which provokes negative feelings, with the subthemes 'negative feelings regarding own infertility' and 'infertility as an experience that is little shared with others'; (3) Undergoing hysterosalpingography, with the subthemes 'feelings regarding hysterosalpingography', 'treatment by medical providers' and 'areas for improvement regarding the service given by the providers'. For women who undergo hysterosalpingography, maternity may be seen as a life objective that could identify them as women. Results suggest that although infertility is experienced with negative feelings such as anxiety, frustration and sadness, hysterosalpingography seems to be related with both hope and fear when facing the test. Knowing the experiences of these women could help nurses, midwives and physicians to provide better patient-centred care.

Sperm midpiece apoptotic markers: impact on fertilizing potential in in vitro fertilization and intracytoplasmic sperm injection.

The aim of this study was to investigate the relationship between apoptotic markers present in human spermatozoa, namely phosphatidylserine translocation (PST) from the inner to the outer layer of the cytomembrane and the active form of caspase-3 (c3) versus the fertilizing potential of male gametes in conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) models. A total of 116 male patients treated with their partners for infertility underwent basic semen analysis and an assessment of the presence of PST and the active c3 in sperm using flow cytometry. Forty patients underwent IVF, group A, while 76 patients underwent ICSI, group B. The fertilizing potential of the gametes was measured as the percentage of oocytes with pronuclei present after either procedure. PST and active c3 were identified in vital gametes, mainly in the midpiece area. Concentration, motility, morphology, and viability of spermatozoa strongly negatively correlated with both markers. In group A, a negative correlation between both markers and the success rate of conventional IVF was observed (r = −0.4, p = 0.04 for PST; r = −0.4, p = 0.02 for active c3, respectively). In group B, the success rate of ICSI did not correlate with either marker (r = −0.2, p = 0.85 for PST and r = 0.1, p = 0.51 for active c3). The two apoptotic markers localized in the sperm midpiece area may affect their function not only by decreasing basic andrologic parameters but also by reducing the probability of conception. Therefore, analysis of PST and active c3 in the sperm of patients undergoing infertility treatment should be recommended.

Pharmaceutical and clinical development of a novel progesterone formulation.

Progesterone plays an essential role in reproductive events. Its use for luteal support in patients undergoing infertility treatment is an established practice. The different routes used to administer progesterone impact on its efficacy in luteal support: oral administration has been shown to be ineffective due to an extensive first-pass metabolism in the liver; vaginal application has a good efficacy but has drawbacks such as vaginal leakage, irritation, discomfort and uncertainty about the real dose adsorbed; finally, intramuscular administration ensures a precise dosage but can be extremely painful with, in some cases, formation of sterile abscesses. A new progesterone preparation is now available in several European and extra-European countries that combines the precise dosage of the injectable formulation with the comfort of a well-tolerated subcutaneous self-administration. The pharmacokinetic and pharmacodynamic properties of this new product are reviewed here, together with the clinical evidence obtained in two multicenter randomized clinical trials.

The oocyte-to-baby rate of day 2, day 3 versus day 5 embryo transfer: a retrospective study

Objectives: To investigate whether the time of embryo transfer (ET) affect the oocyte-to-baby rate. Materials and Methods: The database was retrospectively analyzed including total number of oocytes collected and corresponding oocyte-to-live baby born (LBB) rate. Then the relationship between different time of embryo transfer and oocyte-to-baby rate was compared. In a year period all patients undergoing infertility treatment were included in the study. The outcome parameters were total number of oocytes collected and corresponding oocyte-to-LBB. Results: For patients under the age of 35 years, there was no increase in oocyte-to-LBB regardless of the time of ET. For patients older than 35 years, the oocyte use rate increased significantly when embryo was transferred on day 2. Oocyte-tobaby rates were also analyzed after grouping patients on the number of oocytes retrieved per cycle. For patients 35 years, the oocyte-to-baby rate was best on day 2 when about 15 oocytes were retrieved. Conclusions: This retrospective analysis demonstrated the relationship between the time of ET and ooctye-to-baby rate that is indicative of a more biologically efficient reproductive system.

Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment.

The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540) at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%). The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6). The K6 scores of the following participants were significantly (p < 0.05) and independently high: those with more frequent miscarriage/stillbirth/abortions, those with repeated miscarriages as the cause of infertility, those with infertility of unknown causes, those living with no child, those having a low joint income with their partner, those with the opinion that “women should devote themselves to their household duties” those who had considered stopping treatment, those without the opinion that “married life without children is favorable” and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment.

Localisation and quantification of alkali-labile sites in human spermatozoa by DNA breakage detection-fluorescencein situhybridisation

The localisation and quantification of constitutive alkali-labile sites (ALSs) were investigated using a protocol of DNA breakage detection plus fluorescence in situ hybridisation (DBD-FISH) and alkaline single-cell gel electrophoresis (SCGE or comet assay), in spermatozoa of infertile and fertile men. Semen samples from 10 normozoospermic patients undergoing infertility treatment and 10 fertile men were included in this study. ALSs were localised and quantified by DBD-FISH. The region most sensitive to alkali treatment in human spermatozoa was located in the basal region of the head. ALSs were more frequent in spermatozoa of infertile men than in those of fertile men. These results were confirmed by SCGE comet assays. In conclusion, the most intense localisation of hybridisation signals in human spermatozoa, representing the highest density of constitutive ALSs, was not randomly distributed and was predominantly located in the base of the head. Moreover, infertile men presented with an increase in ALS frequency. Further studies are necessary to determine the association between ALS, sperm chromatin organisation and infertility.

Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies

ObjectiveTo compare maternal and perinatal outcomes in twin pregnancies conceived via assisted reproductive techniques (ART) compared with spontaneous twin pregnancies. Study designThis retrospective study examined 345 dichorionic, di-amniotic twin pregnancies (207 conceived spontaneously and 138 conceived via ART), delivered between January 2007 and June 2011 at the San Pietro Fatebenefratelli Hospital, Rome, a tertiary medical centre. Maternal and perinatal outcomes were compared. A multiple logistic regression analysis was performed to calculate risk estimates as odds ratios (OR) adjusted for maternal age, parity and systemic diseases. Patient data were obtained from a computerized database and analyzed using Statistical Package for the Social Sciences Version 17. ResultsGestational age and birth weight were lower in the ART group, and preterm delivery, gestational diabetes and placental abruption were higher in the ART group compared with the spontaneous conception group. The incidence rates of respiratory complications, patent ductus arteriosus and admission to the neonatal intensive care unit were higher among ART newborns. Length of hospital stay for mothers and newborns was longer in the ART group. No differences in mode of delivery, Apgar score at 5min, congenital anomalies, perinatal mortality, and other considered pregnancy and neonatal complications were found between the two groups. Multivariate analysis adjusted for maternal age, parity and systemic diseases revealed that only the rates of placental abruption [OR 7.45, 95% confidence interval (CI) 2.05–26.98] and patent ductus arteriosus (OR 3.39, 95% CI 1.01–11.46) were significantly higher for the ART group. ConclusionsTwin pregnancies conceived via ART are at greater risk of poorer outcomes than spontaneous twin pregnancies. This may be related to the type of conception and specific negative features of subfertile patients undergoing infertility treatment.