Period Of Infertility Research Articles

The role of laparoscopic drilling in the treatment of polycystic ovarian syndrome

PCOS patients diagnose by having two of the following criteria: first oligo- and/or anovulation, second hyperandrogenism (by clinical picture with or without biochemical features), and lastly ultrasound findings of polycystic disease. The underlying cause of PCOS is unknown. Theories about cause may include genetic predisposition. The role laparoscopic drilling for ovaries show advancing in treatment of PCOD in form of restore ovulation specially those patients in whom there is resistant to clomiphene citrate or incompliant for long term therapy.
 Aim of the study: in this retrospective study we discuss the role laparoscopic ovarian drilling (LOD) in the correction of ovulation failure in PCOD patients showing primary infertility.
 
 Patients and methods: This study includes 50 patients female, age between (22-35) years old. Inclusion criteria including period of infertility of 1–10 year duration, body weight increase with (BMI 29–35 Kg/m2),gynecological problems with abnormal mensturation, clinical pictures goes with high level of androgen hormone like acne vulgaris and hirsutism.
 RESULTS: 50 patients were studied here .In 40 patients (80%), they show no menstrual cycle changes. Follow up period was 12 months.30 of patient (60%) had pregnancy; the mean time for the first pregnancy was 3.5months after operation.

Prevalence of sexually transmitted diseases among men from infertile couples

Introduction. Sexually transmitted diseases (STDs) can potentially disrupt male fertility; however, the prevalence data for STDs among men from infertile couples is controversial. Aim. The aim of the study was to estimate the prevalence of STDs among men from infertile couples seeking medical assistance in an assisted reproductive technology clinic. Materials and methods. We retrospectively studied the medical records of 307 men (mean age: 35 ± 15 years) consecutively attending an outpatient reproductive clinic for infertility treatment. Duration of the infertile period varied from 4 to 228 months (mean: 38 ± 12 months). We collected urethral swab specimen to investigate the presence of Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, Mycoplasma, and Ureaplasma species in 235 (76.5%), 232 (75.6%), 270 (87.9%), 301 (98.1%), and 300 (97.7%) men, respectively. Blood tests for syphilis, hepatitis B and C, human immunodeficiency virus (HIV), human herpesvirus (HHV), and cytomegalovirus (CMV) were conducted in 229 (74.6%), 224 (73%), 227 (73.9%), 230 (74.9%), 233(75.9%), and 232 (75.6%) men, respectively, and statistical analysis of the data was performed. Results. Remarkably, all tests were negative in 94 (30.6%) men, and no patient had T. vaginalis or C. trachomatis infection. However, N. gonorrhoeae, Mycoplasma, and Ureaplasma were detected in 1 (0.4%), 6 (2.6%), and 14 (4.7%) men, respectively. Syphilis, hepatitis B and C, HIV, HSV, and CMV tests were positive in 1 (0.4%), 2 (0.9%), 6 (2.6%), 1(0.4%), 177 (76%), and 133 (57%) men, respectively. Conclusions. The prevalence of STDs is high among men from infertile couples. Further studies are warranted to investigate the relationship between STDs and male infertility. (For citation: Korneyev IA, Zasseev RD, Shevchuk IG, Pelipejchenko AA. Prevalence of sexually transmitted diseases among men from infertile couples. Urologicheskie vedomosti. 2018;8(2):30-35. doi: 10.17816/uroved8230-35).

Quality-of-life predictors for men undergoing infertility treatment in Japan.

To dentify the predictors of the quality of life (QOL) of infertile men who are undergoing infertility treatments in Japan and to create a QOL prediction model, with the main variables aimed at providing more adequate support to male patients. This cross-sectional study used the quantitative data that were collected from 321 returned self-report questionnaires that had been distributed to the men of 411 couples who were undergoing fertility treatment. The following four scales were used to measure the main outcomes: FertiQoL, psychological distress, spousal support, and workplace support. The data were analyzed by descriptive statistics, multiple regression analyses, and structural equation modeling. The number of returned questionnaires was 321 (78.1%). The QOL that was measured by FertiQoL was significantly lower in those men who were diagnosed with male factor infertility than in the other male patients. The two significant predictors of QOL were: spousal support and the infertility period. The structural equation modeling revealed that the same factors were related to QOL. Male factor infertility, less spousal support, and a longer period of infertility were associated with a poorer QOL of those men who were undergoing infertility treatment. These results suggest that focusing on infertility causes, the length of the infertility period, and the couples' partnership during treatment is needed to provide full support to men who have been diagnosed with infertility.

Post-warming degree of blastocoel re-expansion is the best prognosticator for live birth rates in vitrified-warmed single blastocyst transfer cycles

Recent studies have presented contradictory results regarding significance of Inner-cell-mass (ICM)/Trophectoderm (TE) gradation and degree of blastocoel expansion/re-expansion for increased live-birth rates. Also, few studies have reported combined results from fresh/frozen and single/double transfer cycles. This study aimed at individually assessing the relevance of grades of ICM, TE and degree of post-warm blastocoel re-expansion on live-birth rates exclusively in vitrified-warmed single-blastocyst transfer cycles. Retrospective study (n=216) vitrified-warmed elective single blastocyst transfer cycles. Oocyte donation, Embryo-donation, assisted hatching and preimplantation genetic diagnosis cycles were excluded. All blastocysts were graded as per Gardner and Schoolcraft method of classification as 1-6 for degree of expansion and grades A/B/C for ICM and TE. Natural-cycle endometrial preparation with hormone supplementation followed by luteal-phase support with micronized progesterone. Endometrial response was noted by ultrasound. Single blastocyst-transfer was done 3 hours after warming of vitrified blastocyst. Warmed blastocyst was compared with pre-vitrified blastocyst for degree of expansion, gradation of ICM/TE. β-hCG level measured on day8 of transfer indicated pregnancy. Live-birth was the primary outcome measure. Women were classified into Live-birth (LB; n=74) and non-pregnant (NP; n=142) groups. Age, BMI, infertility period, number of oocytes retrieved, rate of formation of good quality cleavage-stage and blastocyst-stage embryos and survival rates post-warming did not differ significantly between the two groups. Same brand of embryo-transfer catheter and same brand and volume of media was used for transfer. However, degree of re-expansion was significantly higher in LB group than in NP group (Mean ± SD: 3.6 ± 1.0 v 3.2 ± 0.94, P=0.0068). The Fisher-Exact test odds-ratio for achieving a live-birth with 3-4 degree of re-expansion was 2.78 (p=0.0016) whereas the odds ratio was much lower (0.36) with any other degree of re-expansion. Although ICM grade was higher/better in Live-birth group than in non-pregnant group, the difference remained statistically non-significant (Odds ratio 1.25, p=0.82). No significant difference was observed in TE grades between the two study groups (p=0.17). A notable difference was also observed in endometrial echopattern (p=0.03) although the endometrial thickness remained comparable between the groups. Thus, post-warming degree of re-expansion is the single most promising predictive factor for live birth rates in such cycles. Re-expansion of blastocoel to an expanded grade 3/4 is superior to ICM and TE cell gradation for better live-birth rates in vitrified-warmed single blastocyst transfer cycles. However, larger multicentric trials may be required to establish it as robust predictor of live-birth.

The Effects of Combined Oral Antioxidants on Male Infertility

High reactive oxygen species (ROS) levels was considered as an important factor of male infertility that can result in DNA damage, decrease motility and damage membrane integrity. The role of antioxidants is to maintain the balance between ROS production and their clearance which improve sperm parameters and enhance male fertility. Sixty six male patients with median age of 29 years with a mean period of infertility of 1.5 year that attend the infertility clinic in Al-Diwaniya Maternity and Pediatric Hospital were selected randomly in this study which extend from January 2013 to October 2014 (22 months).The patients were selected to have idiopathic oligo-astheno-teratozoospermia,they underwent a detailed history,general and genital physical examination,Two semen analyses,baseline hormone profile and scrotal Doppler ultrasound examination. All patients were given a combination of oral antioxidants including vitamin E (400 IU. once daily),coenzyme Q10 (75 mg. tablet twice a day),zinc sulphate (15 mg. tablet three time a day) and L-carnitine (1000 mg. twice a day) for three months duration of treatment. Semen analysis was repeated after three months from initiation of therapy and was evaluated for changes in volume,concentration,motility and morphology in comparison with baseline semen analyses and any pregnancy was also documented. Thirteen patients (19%) get pregnancy after a period of 2 to 3 months,other patients show variable changes in their seminal analysis after 3 months. Thirty patients (45%) show increasing in seminal volume of 0.5 to 2 ml., while the sperm concentration was increased in 28 patients (42%). Twenty two patients (33%) show increasing in motility, morphology was increased in 34 patients (51%).From all 66 patients; 6 patients (9 %) get improvement in all four parameters,while 9 patients (14 %) get improvement in only 3 parameters,20 patients (30 %) get improvement in only 2 parameters,23 patients (35 %) get improvement in only one parameter and 8 patients (12 %) had no improvement in any parameter. This study demonstrates a possible role of combined oral antioxidants in the improvement of semen parameters and pregnancy rate for selected infertile men with superiority for the use of combination of antioxidants rather than single agent treatment.

Estrous cycle-dependent modulation of in vivo microvascular dysfunction after nanomaterial inhalation

Preconceptive health encompasses male and female reproductive capability. In females, this takes into account each of the stages of the estrous cycle. Microvascular reactivity varies throughout the estrous cycle in response to hormonal changes and in preparation for pregnancy. Microvascular alterations in response to engineered nanomaterial (ENM) exposure have been described within 24-h of inhalation; however, the impact upon the uterine vasculature at differing estrous stages and at late-stage pregnancy is unclear. Female Sprague Dawley (SD) rats (virgin and late stage pregnancy [GD 19]) were exposed to nano-TiO aerosols (173.2 ± 6.4 nm, 10.2 ± 0.46 mg/m3, 5 h) 24-h prior to experimentation leading to a single calculated deposition of 42.2 ± 1.9 μg nano- TiO2 (exposed) or 0 μg (control). Animals were anesthetized, estrous status verified, and prepared for in situ assessment of leukocyte trafficking and vascular function by means of intravital microscopy, Uterine basal arteriolar reactivity was stimulated using iontophoretically applied chemicals: acetylcholine (ACh, 0.025 M; 20, 40, 100, 200 nA), sodium nitroprusside (SNP, 0.05 M; 20, 40, 100 nA), phenylephrine (PE, 0.05 M; 20, 40, 100 nA). Finally, adenosine (ADO, 10−4 M) was superfused over the tissue to identify maximum diameter. In situ vessel reactivity after exposure was significantly blunted based on estrous stage, but not at late-stage pregnancy. Local uterine venular leukocyte trafficking and systemic inflammatory markers were also significantly affected during preparatory (proestrus), fertile (estrus), and infertile (diestrus) periods after ENM inhalation. Overall, these deficits in reactivity and increased inflammatory activity may impair female fertility after ENM exposure.

Perifollicular Vascularity in Poor Ovarian Responders in In vitro Fertilization Cycles.

Context:Poor response is reported in 9%–24% of stimulated cycles. Color Doppler indices of follicular blood flow are correlated with oocyte recovery, fertilization rate, developmental potential of oocyte, and pregnancy rate in in vitro fertilization (IVF) treatment.Aim:The aim of this study is to find out the correlation between perifollicular vascularity with clinical outcomes in poor ovarian responders during IVF cycles.Settings and Design:A total of 49 poor ovarian responder women undergoing conventional IVF-embryo transfer procedure at a tertiary care hospital between September 2014 and 2015 were included in the study. It was a prospective observational study.Subjects and Methods:Patients were recruited on the day of trigger following a transvaginal ultrasound if they developed ≤4 dominant follicles of ≥16 mm diameter. After ovarian stimulation patients who had all follicles with low-grade vascularity were classified as Group A, those with follicles with high-grade vascularity were Group C, and Group B included patients with follicles of both good and poor vascularity.Statistical Analysis Used:Analysis of variance and Chi-square/Fisher's exact test and software, namely SAS 9.2 and SPSS 15, has been used.Results:A total 49 patients were recruited for the study.10 patients were allocated in Group A, 26 patients in Group B and 13 in Group C. Both groups were comparable in terms of age, period of infertility, follicle-stimulating hormone, luteinizing hormone, and gonadotrophin requirement. The number of metaphase II oocytes and good quality oocytes was significantly higher in Group C. Implantation rate, clinical pregnancy rate, multiple pregnancy rate, miscarriage rate, and live birth rate were comparable among all groups.Conclusions:Perifollicular vascularity has an important role to play in clinical outcomes in poor ovarian responders in IVF cycles.

Химический состав грудного молока у родильниц, проживающих в зоне экологического неблагополучия после периода бесплодия

Химический состав грудного молока у родильниц, проживающих в зоне экологического неблагополучия после периода бесплодия

The Effects of Combined Oral Antioxidants on Male Infertility

BackgroundHigh reactive oxygen species (ROS) levels was considered as an important factor of male infertility that can result in DNA damage, decrease motility and damage membrane integrity. The role of antioxidants is to maintain the balance between ROS production and their clearance which improve sperm parameters and enhance male fertility.Patients and methodsSixty six male patients with median age of 29 years with a mean period of infertility of 1.5 year that attend the infertility clinic in Al-Diwaniya Maternity and Pediatric Hospital were selected randomly in this study which extend from January 2013 to October 2014 (22 months).The patients were selected to have idiopathic oligo-astheno-teratozoospermia, they underwent a detailed history, general and genital physical examination, Two semen analyses, baseline hormone profile and scrotal Doppler ultrasound examination . All patients were given a combination of oral antioxidants including vitamin E (400 IU. once daily), coenzyme Q10 ( 75 mg. tablet twice a day), zinc sulphate (15 mg. tablet three time a day) and L-carnitine ( 1000 mg. twice a day) for three months duration of treatment. Semen analysis was repeated after three months from initiation of therapy and was evaluated for changes in volume, concentration, motility and morphology in comparison with baseline semen analyses and any pregnancy was also documented.ResultsThirteen patients (19%) get pregnancy after a period of 2 to 3 months, other patients show variable changes in their seminal analysis after 3 months. Thirty patients (45%) show increasing in seminal volume of 0.5 to 2 ml. , while the sperm concentration was increased in 28 patients(42%) . Twenty two patients (33%) show increasing in motility , morphology was increased in 34 patients (51%) .From all 66 patients; 6 patients (9 %) get improvement in all four parameters, while 9 patients (14 %) get improvement in only 3 parameters, 20 patients (30 %) get improvement in only 2 parameters, 23 patients (35 %) get improvement in only one parameter and 8 patients (12 %) had no improvement in any parameter.ConclusionThis study demonstrates a possible role of combined oral antioxidants in the improvement of semen parameters and pregnancy rate for selected infertile men with superiority for the use of combination of antioxidants rather than single agent treatment.

Етіопатогенетичні аспекти перебігу І триместра вагітності у жінок після застосування допоміжних репродуктивних технологій

The objective: to study etiopathogenetical aspects of pregnancy after IVF in women with a history of infertility. Patients and methods. A prospective comprehensive survey of 220 pregnant in the first trimester of pregnancy after IVF with infertility of different genesis in history and 50 naturally firstly pregnant women. Results. Etiopathogenetical factors of complications of pregnancy and reproductive losses in women after IVF in the first trimester of pregnancy were defined, including the leading role played by the age of pregnant women over 27 years, burdened obstetric and gynecological history, a long period of infertility, the imbalance of steroid hormones and the development of OHSS, consequences carried inflammatory processes and surgery on the pelvic organs. Conclusion. First trimester of pregnancy is most dangerous for developing of complications of pregnancy and reproductive losses for women after ART regardless of etiologic factors of infertility in history, and involves optimization and implementation of comprehensive diagnostic and treatment and preventive measures. Key words: infertility, pregnancy, assisted reproductive technology.

Resolved Parental Infertility and Children's Educational Achievement.

Although difficulty conceiving a child has long been a major medical and social preoccupation, it has not been considered as a predictor of long-term outcomes in children ultimately conceived. This is consistent with a broader gap in knowledge regarding the consequences of parental health for educational performance in offspring. Here we address that omission, asking how resolved parental infertility relates to children's academic achievement. In a sample of all Swedish births between 1988 and 1995, we find that involuntary childlessness prior to either a first or a second birth is associated with lower academic achievement (both test scores and GPA) in children at age 16, even if the period of infertility was prior to a sibling's birth rather than the child's own. Our results support a conceptualization of infertility as a cumulative physical and social experience with effects extending well beyond the point at which a child is born, and emphasize the need to better understand how specific parental health conditions constrain children's educational outcomes.

Качество жизни женщин с бесплодием и патологией эндометрия в поздний репродуктивный период

Research has shown that infertile women are less satisfied with their lives than fertile women, as their mental, communicative, sexual and emotional well-being is undergoing a number of changes, especially in the late reproductive period when the proportion increases anxiety and depressive disorders. The objective: сompare the quality of life parameters in infertile and fertile women of late reproductive age with endometrial pathology. Patients and methods. The study included 237 women 35–44 years with different clinical forms of endometrial pathology. A questionnaire health SF-36 is used for studying the quality of life. Results. The study of quality of life showed that patients with infertility compared with fertile women significantly higher assessed and psychological (p<0.008) and the physical component of their health (p<0.02), showed the greatest difference in emotional functioning (p<0.002). It was revealed that the longer the sterility, the worse the patients rated their physical functioning (с=-0.32, p<0.001) and mental health (с=-0.25, p<0.02), and the higher their overall health satisfaction (с=0.28, p<0.004).A subjective satisfaction with the physical and mental state is assessed. It was found that the age lowers the quality of life assessment more than a period of infertility. According to data obtained in the study of quality of life does not depend from infertility factors, but is largely determined by the presence of children. Conclusions. It is concluded that the quality of life of secondary infertile women closest to the profile of fertile women; patient late reproductive age with infertility and endometrial pathology more satisfied with their lives than fertile women with endometrial pathology similar age. Key words: endometrial pathology, late reproductive period, infertility, quality of life.

Changes in prevalence and abundance of parasitic invasions in sheep at various physiological stages

The aim of the study was to determine the degree of parasitic invasion at various physiological stages, as well as tracing the dynamics of parasitic invasions in a flock of sheep kept in the combined indoor-pasture management system. The observations were performed on 224 mother ewes of the synthetic SCP prolific meat line over the course of two years. The animals were kept in the combined indoor-pasture management system with uniform feeding and environmental conditions and were under continuous animal husbandry and veterinary supervision. The ewes participating in the experiment were not wormed in the year preceding the experiment and during the observations. The experiment involved parasitologic tests aimed at the determination of abundance and prevalence of invasions of gastrointestinal parasites in mother ewes. The study material was faeces collected from the rectum in the following stages: pregnancy (November), day 2, 28, 42 and 56 after lambing, drying off (day 100 after lambing) and rest (between dry-off and mating). In the analysis of the results of the study it can be noted that, in most cases, the highest prevalence and abundance levels are observed in the infertility period. Moreover, the period of pregnancy and lambing was a crucial one. On the other hand, the lowest abundance and prevalence levels in the majority of cases were observed on day 28 and 42 after lambing. The results of the study should be taken into consideration during the development of prevention strategies limiting parasitic invasions in sheep flocks. Adjusting chemotherapy to the most important periods of parasitic invasions will enable a more efficient fight against parasites. It should also reduce the excessive use of chemical preparations, which is crucial due to the increasing resistance of parasites. Apart from the aforementioned actions, farmers should pay attention to supporting immunity by means of feed, especially in the periods of highest vulnerability to invasions. Such actions should lead to the reduction of losses caused by parasitic invasions in sheep flocks.

Psychosocial needs of women and their partners after successful assisted reproduction treatment in Barcelona.

It is assumed that pregnancy and parenthood after a period of infertility are unproblematic and gratifying. However, a review of the literature highlights the complexity of the psychological and social consequences of pregnancy, childbirth and parenting after successful treatment with assisted reproductive technology. These experiences, including those following the creation of new forms of non-genetic and/or social parenthood, require investigation in order to understand how women and their partners integrate their journey from infertility to pregnancy and parenthood after successful assisted reproductive treatment. This paper presents results derived from qualitative interviews with 30 pregnant women and 21 couples after assisted reproductive treatment (repeated rounds of individual interviews with the study participants) conducted from July 2010 to April 2014 as part of a larger ethnographic study exploring the psychosocial needs of women and partners following assisted reproductive treatment in Barcelona’s. The transcribed text was coded into categories of either predetermined or emergent topics. Prior studies have found that couples who achieve pregnancy after infertility may experience higher levels of anxiety in relation to pregnancy. This anxiety can be linked with a higher risk of complications during pregnancy after assisted reproductive treatment compared with spontaneous conception. However, the evidence concerning adjustment to pregnancy and parenthood is inconclusive. This study highlights the necessity for participants to give meaning to these treatments, given the variability that exists in perceptions of infertility and pregnancy after successful assisted reproductive treatment.

Study on Risk Factors, Clinical Presentation & Operative Management of Ectopic Pregnancy

Introduction: Ectopic pregnancy is a major clinical problem in gynaecology because it is often difficult to diagnose as the patient present in different ways. An accurate history taking and physical examination is considered to be most important in the diagnosis of ectopic pregnancy. There are two treatment options, medical or surgical. Surgical treatment is the fastest treatment for ectopic pregnancy though surgical management decreased from approximately 90% to 65%1. Surgery may be the only treatment option if there is internal bleeding. In the medical treatment group, 15% of cases were categorized as failures and required surgery1.Objectives: This study was conducted in the department of obst and Gynae of Dhaka Medical College Hospital from January 2005 to June 2005 in an attempt to find out the risk factors of ectopic pregnancy, the way of presentation and to analyze the operative treatment of ectopic pregnancy.Materials and Methods: A total 50 consecutive patients who were clinically suspicious of ectopic pregnancy were included in this study between January 2005 to June 2005. Patients who were clinically suspicious of EP and also supported by positive urinary pregnancy tests, beta hCG and no intrauterine gestational sac in ultrasonography were included in this study. Detailed discussion about the study was done with the patient and then informed verbal consent was taken from them. Detailed history about patient profile, presenting symptoms, any risk factors and clinical examination done and the findings were recorded in the predesigned data collection sheet. Data was expressed in terms of frequencies and percentagesResults: Most of the patients were in the age group of 20-30 years and 38% of low parity (para- 1).Previous miscarriage, infertility,IUCD users and PID identified as the risk factors of ectopic pregnancy— 42% patients had history of previous abortion or MR, period of infertility 22%, pelvic infection 12%, IUCD users 16%. In this study acute abdominal pain after a short period of amenorrhoea was found to be the main symptoms in ectopic pregnancy—100% patients were presented with lower abdominal pain, 70% with period of amenorrhea and 50% patients with per vaginal bleeding. All the patients were presented with acute condition and were surgically managed fastest treatment. At the time of operation 84% of ectopic tubal pregnancy were found ruptured, 10% were tubal abortion and 4% unruptured. Sites of ectopic pregnancy were ampullary 50%, isthmic 20%, fimbrial 10%.Conclusion: Most of the patient presented in acute condition with the classical features of ruptured ectopic pregnancy. Near half of the patient were in younger age group (26 – 30 years) having risk factors like history of previous abortion/MR 42%, infertility 22% use of IUCD 16%, PID 12%. More then three forth( 84%) of cases were diagnosed as ruptured ectopic during operation. Operative management was done on the basis of site of ectopic and parity of the womanBangladesh J Obstet Gynaecol, 2013; Vol. 28(1) : 9-14

Factors Related to the Number of Antral Follicles on InVitro Fertilization (IVF)

Objective: To determine factors which are related to the number of
 antral follicles on infertile patients.
 Method: This cross sectional study was conducted in In-Vitro Fertilization
 (IVF) clinic of Graha Tunjung, Sanglah hospital, Bali. All fertile
 patients following the IVF program were calculated the number
 of antral follicles in both ovarian using transgene USG. This sample
 was recruited by random sampling from April 1st, 2001 to April 30th,
 2011. We analyzed the data using Chi square test through SPSS for
 Windows 17.0 version.
 Result: Of 102 samples, the mean of patients’ age was 32.9% (SD
 4.6) years old. From 72 patients (70.6%) experienced above 3 years
 of infertile period, the primary infertile was on 69 patients (67.7%).
 There was a relationship between patients’ age and the number of
 antral follicles significantly (prevalence ratio (PR) 1.41; 95% CI 1.11-
 1.79). Meanwhile, the number of antral follicles and type of infertile
 (PR 1.02; 95% CI 0.76-1.37) also infertile period (PR 0.95; 95% CI
 0.72-1.27) were not associated significantly.
 Conclusion: Patients’ age has an association with the number of antral
 follicles on IVF.
 [Indones J Obstet Gynecol 2016; 4-2: 75-77]
 Keywords: age, infertile, infertile period, number of antral follicles
 and type of infertile

Evaluation of ten years of intrauterine insemination results at a tertiary center

Purpose: To report on ten years of intrauterine insemination (IUI) practice at Haseki Training and Research Hospital to determine retrospectively, the impact of IUI on the management of subfertile couples. Materials and Methods: This study was a retrospective analysis of all IUI cycles completed from June 1, 2003, to July 1, 2013, at the Haseki Training and Research Hospital, Istanbul, Turkey. Baseline clinical characteristics, drugs used for ovulation induction, and triggering ovulation were reviewed. The primary outcome was clinical pregnancy. Results: The overall clinical pregnancy rate was 10.2% (26/253). Improved success was significantly associated with a shorter period of infertility (4.8 ± 3.9 years vs 3.2±2.4 years; p = 0.01). Clinical pregnancy rates were significantly higher when recombinant FSH was used for ovulation induction than clomiphene citrate (CC) (22% vs 5.6%; p = 0.002). Patients were also analysed for the drug used for triggering ovulation. The clinical pregnancy rate was 27.2% in the recombinant hCG group compared with 8.6% in the urinary hCG group (p = 0.006). Conclusions: IUI may be a safe and cost-effective option for mild male factor infertility or unexplained infertility. Better results may be obtained when recombinant FSH and recombinant hCG are used and when the duration of infertility is short.

Peculiarities of the course of benign uterine disease in women of childbearing age with metabolic syndrome

The aim of the research: to identify the peculiarities of the course of benign uterine disease in women of childbearing age with metabolic syndrome for further improvement in diagnostics, treatment and prevention of the medical condition mentioned above.Materials and methods. In the first stage a retrospective chart review was conducted for 382 patients with benign uterine disease. 130 women with benign uterine disease with metabolic syndrome and without metabolic syndrome were studied prospectively, 50 somatically healthy women with normal menstrual and reproductive function were included in the control group. Anamnesis, character of the past inflammatory diseases of the reproductive organs, abdominal surgeries, duration of the infertility period were studied, data of socioeconomic status, somatic, gynecologic, obstetric, infection history were studied thoroughly. All women underwent full clinical and laboratory check-up. Special attention was paid to past surgeries. All examined women underwent anthropometric measuring (body height, body weight, waist circumference, hip circumference), BMI (body mass index) was used to evaluate body weight, blood pressure. Metabolic syndrome (MS) was determined by the following “combined” criteria – criteria of WHO 1999 (impaired glucose tolerance) and criteria IDF (2009) taking into account the age-related levels of lipids and arterial blood pressure (AP) according to the results of the population study.Results and discussion. Analyzing the data of the clinical characteristics of the women examined it’s necessary to draw a conclusion, that the patients of the main group in whole didn’t differ from the women in the control group. Therefore, further we examined the women of both main and control groups using special laboratory and instrumental methods and taking into consideration the representativeness of these groups. The analysis of smoking habit (table 6) revealed the prevalence of the smoking women (40.3% and 39.7 % compared to 18.0 %). High figure of smoking women among those with impaired menstrual function and uterine leiomyoma can be indicative of negative influence of smoking on synthesis of hormones by ovaries. Analysis of incidence of unfavorable ecological conditions among the examined women showed that one third of the them lived in areas of environmental pollution. The collected data revealed clinical evidence of estrogen dominance prevailing in patients of the main group. Thus, for the great majority of the patients symptoms such as headache 29 (40.3%) and 43 (55.1%) compared to 3 (6.0%) in healthy women of the corresponding age, (p < 0.05), frequent mood swings (70.8%, 76.9% in the 1st and 2nd groups correspondingly compared to 4.0% in healthy women, p < 0.05), fatigue (73.6%, 70.5% and 8.0% in healthy women, p < 0.05).Conclusions. Having analyzed the anamnestic data, it was revealed that in women of the main group, inflammation of fallopian tubes and ovaries was observed more frequently, abortions in anamnesis was more prevalent, especially one abortion, the number of delivered pregnancies was far lower (3.2 times) in women of the main group compared to those of the control group, which is understandable as the main group consisted of women with infertility, for a part of whom this infertility was secondary. Despite the young age of the patients (median age 33), extragenital pathology was prevalent in more than half of the women in the control group, in 76.7% of women with metabolic syndrome and benign uterine disease. The nature of extragenital pathology did not differ significantly. The proportion of women who were satisfied with their self-realization was significantly lower in women with metabolic syndrome and benign uterine disease. Analysis of the incidence of adverse environmental conditions showed that a third of the women surveyed lived in areas of environmental pollution. Women with the metabolic syndrome and benign uterine disease the duration of menstrual cycle is longer, with normal volume of blood loss. All women with symptoms of benign uterine disease generally have relative estrogen dominance, which is commonly characterized with mammalgia and mastalgia.

Women's narratives of crisis and change: Transitioning from infertility to pregnancy.

This study explores ways women, who endured prolonged fertility difficulties, after which they eventually conceived, integrate the two phases within their life stories. A total of 12 women were interviewed during their first pregnancy after having experienced 2-6 years of infertility. Three types of narratives were identified: (1) the infertility overshadows the pregnancy and approaching motherhood, (2) the pregnancy leads to a dissociation concerning the infertile period, and (3) the two states coexist together along an integrated continuum. We suggested that the different narrative types may occur in diverse circumstances that entail integrating a crisis or prolonged illness into a constructive and meaningful life story.

The Role of Residential Early Parenting Services in Increasing Parenting Confidence in Mothers with A History of Infertility.

Mothers with a history of infertility may experience parenting difficulties and challenges. This study was conducted to investigate the role of residential early parenting services in increasing parenting confidence in mothers with a history of infertility. This was a retrospective chart review study using the quantitative data from the clients attending the Karitane Residential Units and Parenting Services (known as Karitane RUs) during 2013. Parenting confidence (using Karitane Parenting Confidence Scale-KPCS), depression, demographics, reproductive and medical history, as well as child's information were assessed from a sample of 27 mothers who had a history of infertility and who attended the Karitane RUs for support and assistance. The data were analyzed using SPSS version 19. More than half of the women (59.3%) reported a relatively low level of parenting confidence on the day of admission. The rate of low parenting confidence, however, dropped to 22.2% after receiving 4-5 days support and training in the Karitane RUs. The mean score of the KPCS increased from 36.9 ± 5.6 before the intervention to 41.1 ± 3.4 after the intervention, indicating an improvement in the parenting confidence of the mothers after attending the Karitane RUs (P<0.0001). No statistically significant association was found between maternal low parenting confidence with parental demographics (including age, country of birth, and employment status), a history of help-seeking, symptoms of depression, as well as child's information [including gender, age, siblings, diagnosis of gastroesophageal reflux disease (GORD) and use of medication]. Having a child after a period of infertility can be a stressful experience for some mothers. This can result in low parenting confidence and affect parent-child attachment. Our findings emphasized on the role of the residential early parenting services in promoting the level of parenting confidence and highlighted the need for early recognition and referral of the mothers with a history of infertility to such centers.