Regular Sexual Activity Research Articles

Assessment of the frequency of types and causes of infertility in infertile couples referring to the Bojnurd infertility treatment center during the years 2018 to 2023

Introduction: Infertility is defined as failure to conceive a pregnancy despite a year or more of regular sexual activity without contraception55. Infertility is divided into primary and secondary, and its etiologies include male, female, male and female causes, as well as unexplained. Therefore, the present study aimed to determine the types and causes of infertility in couples referring to an infertility treatment center in Bojnurd during 2018-2023. Method: This cross-sectional study was conducted using a checklist made by the researcher on all couples who were referred to the infertility clinic in the Bent-Alhoda Hospital, Bojnurd, in North Khorasan, from 2018 to 2023. The information was extracted from the files or contact with the patients in cases of non-registration. Thereafter, data were entered into the SPSS statistical software (version 25). Following that, analysis was performed using descriptive indicators, frequency distribution, and analytical statistical tests, namely Chi-Square, independent t-test, and one-way analysis of variance, at a confidence level of 95%. Results: The mean age scores of women and men were 30.04±6.65 and 34.28±7.14 years, respectively. The mean body mass index of women was 26.10±4.87 Kg/m2. Moreover, 87.3% of women were unemployed, and most men were freelancers. The majority of women (76%) had no underlying disease. The most common types and etiology of infertility were related to primary infertility (55.9%) and unexplained causes (38.5%), retrospectively. Conclusion: Training classes to inform couples about the controllable risk factors of infertility is an essential step towards reducing the incidence of these factors.

Медико-социальные особенности акушерско-гинекологического профиля женщин, преодолевших бесплодие с помощью ВРТ.

To increase the birth rate, in addition to increasing the availability of ART, their high effectiveness is necessary. The effectiveness of providing this type of medical care is influenced by a significant number of medical, social and organizational factors. Achieving a positive result during IVF largely depends on the obstetric history of the expectant mother. Purpose. To determine the medical and social characteristics of the obstetric and gynecological profile of patients at the Center for Reproduction and Family Planning who had a positive result in the treatment of infertility using IVF. Materials and methods. Using a specially developed statistical form “Questionnaire for medical and social examination of women suffering from infertility,” an anonymous survey was conducted of 398 women whose pregnancy resulted from the IVF procedure. The significance of differences in indicators was assessed using Student’s t-test. Differences were considered significant at p<0,05. Statistical data processing was carried out using the MS Office‑2016 and StatSoft-Statistica 10.0 software packages. Results. With an average age of onset of sexual activity of 18,82± years, sexual debut before 18 years of age was observed in 32,7% of patients. Most often, for the first time, women sought medical help for infertility within 2–5 years after the start of regular sexual activity (65,4%) (m=3,38±0,17 years) to obstetrician-gynecologists at antenatal clinics and planning centers families (83,0%). Despite the fact that the average age of initial diagnosis of infertility was 28,86±0,34 years, 38,2% of women were diagnosed with infertility after 30 years of age, and 55.3% of all requests for medical help for problems with conception came from private medical organizations. In most cases, before being referred for IVF, women underwent treatment at antenatal clinics and family planning centers (91,3%). The obstetric and gynecological profile of women who have overcome infertility with the help of ART is characterized by: a history of negative IVF results (50.4%), absence of children before this pregnancy (87,0%), low detection of gynecological diseases in childhood (13,1%) and the presence of abortions (27,1%). 38,9% of patients who had a history of pregnancy terminations had two or more abortions (m=1,61±0,03 abortions). In the study group, a high frequency of abortions for medical reasons and spontaneous terminations of pregnancy was revealed (31,5% and 24,1%, respectively). Conclusion. The established obstetric and gynecological profile of women who have overcome infertility with the help of ART has revealed a significant number of medical and social risk factors, which makes it possible to develop organizational measures aimed at improving the provision of medical care to this group of women.

Safety and efficacy of a class II medical device based on highly purified and standardized plant extracts in the management of post-menopausal patients with vulvar and vaginal atrophy: a single-center prospective observational study.

Despite the gold standard treatment for genitourinary syndrome of menopause (GSM) is based on the use of local or systemic estrogen-containing products, the typical long-term side effects of hormonal treatments and, most importantly, the contraindications in patients with history of breast and endometrial neoplasms do limit in some extent its use. As hyaluronic acid and some highly purified botanicals have clearly demonstrated their anti-inflammatory and mucosa-protecting properties, we have tested, in women with GSM, a class II vaginal medical device containing hyaluronate gel and a mucoadhesive active enriched with purified alkylamides from Zanthoxylum bungeanum, triterpenes from Centella asiatica and high molecular weight polysaccharides from Tamarindus indica. Our single-center, open-label, prospective and observational study was conducted on 50 menopausal women enrolled at the Department of Maternal-Fetal Medicine at Umberto I Polyclinic Hospital in Rome, Italy. Gel administration lasted 150 days and was performed daily for the first 12 days and every 48 hours for the remaining 138 days. Clinical evaluations were performed at baseline and after 12, 57 and 150 days. Besides product safety, main outcomes of our study were: 1) vaginal health (by Vaginal Health Index score [VHI]); 2) sexual quality of life (by Female Sexual Distress Scale [FSDS]); and 3) percentage of women declaring regular sexual activity. The product was safe with no specific adverse events reported. It significantly improved VHI (about 5% after 57 days and 8% after 150 days), FSDS (about 7% after 57 days and 10% after 150 days), and sexual activity (about 20% after 150 days). It also reduced dryness, dyspareunia, burning, itching, and dysuria incidence, respectively by about 18%, 14%, 14%, 27% and 11% after 150 days. In women with GSM, the intravaginal administration of a hyaluronate-based gel enriched with purified botanical actives endowed with anti-inflammatory and mucosal-protecting properties, reduced painful sensation during sexual acts and increased regular sexual activity.

Urologic perspective of genitourinary syndrome of menopause

AbstractBackgroundExperts define the Genitourinary Syndrome of Menopause (GSM) as a collection of signs and symptoms associated with decreased oestrogen levels. Its prevalence ranges between 13% and 87% in postmenopausal women.ObjectiveWe aimed to describe the main pathophysiology mechanisms of GSM affecting the lower urinary tract and the manifestations and treatment options for lower urinary tract dysfunction in GSM.ResultsSeveral treatments and recommendations have been proposed to enhance patients' ability to manage their symptoms, such as regular sexual activity or masturbation, to increase this physiological response and reduce the severity of GSM.ConclusionGSM is a multifactorial and complex syndrome that affects postmenopausal women. Impairment of urogenital structures implies diverse manifestations of genital atrophy and lower urinary tract symptoms.

ВОЗРАСТНЫЕ ОСОБЕННОСТИ АКУШЕРСКО-ГИНЕКОЛОГИЧЕСКОГО ПРОФИЛЯ ЖЕНЩИН, ПРЕОДОЛЕВШИХ БЕСПЛОДИЕ ПРИ ПОМОЩИ ВСПОМОГАТЕЛЬНЫХ РЕПРОДУКТИВНЫХ ТЕХНОЛОГИЙ

Significance. In the context of unfavorable demographic situation, the problem of infertility in Russia is ever crucial. One of the most effective methods to treat infertility, that is globally recognized and widely used in our country, is assisted reproductive technologies. The purpose of the study was to identify age-specific characteristics of obstetric-gynecological profile of women who overcame infertility with the help of assisted reproductive technologies. Material and methods. An anonymous survey of 398 women who got pregnant through in vitro fertilization at the Center for Reproduction and Family Planning in St. Petersburg was conducted. Significance of differences was assessed using Student's t-test and Pearson's chi-square test (χ2). The relationship between indicators was assessed using the Spearman correlation coefficient (rxy). Differences were considered significant at p<0.05. Statistical data processing was carried out using the MS Office-2016 and StatSoft-Statistica 10.0 software packages. Results. The study has identified an evident effect of the age of women impregnated through in vitro fertilization on the patient distribution by the number of IVF attempts (χ2 =156.95; p =0.000), age of sexual debut (χ2 =20.55; p =0.000), and interval between the “infertility” diagnosis and regular sexual activity without fertility restrictions (χ2=92.76; p=0.000), history of abortions (χ2=14.24; p=0.001) and their number (χ2=15.28; p=0.004). The study failed to identify any evident effect of age on patient distribution by presence of children (χ2=3.56; p=0.12), reason for abortion (χ2=2.12; p=0.71) and type of infertility (χ2=2,86; p=0.52). In patients who overcame infertility with the help of assisted reproductive technologies, there is a direct strong correlation between the number of in vitro fertilization attempts to achieve pregnancy and age (rxy=0.93), age at diagnosis of infertility (rxy=0.95), and number of abortions (rxy=0.86). Conclusion. The patient's age is a factor that statistically significantly affects the number IVF attempts, age of sexual debut, interval between the diagnosis of infertility and regular sexual activity, as well as presence and number of abortions in history. In vitro fertilization effectiveness with a minimum number of in vitro fertilization attempts decreases with the increase in the age of the woman, the age at which the diagnosis of infertility is established and the number of abortions in history.

Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up

IntroductionDespite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment.ObjectivesA single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment.Subjects and methodsThe total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ).ResultsThe evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn’s disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI.ConclusionCO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.

Association between Regular Vaginal Dilation and/or Sexual Activity and Long-Term Vaginal Morbidity in Cervical Cancer Survivors

To evaluate the association between regular vaginal dilation and/or sexual activity and vaginal morbidity in locally advanced cervical cancer patients after definitive radiochemotherapy and image-guided adaptive brachytherapy from the EMBRACE I study. Physician-assessed vaginal morbidity (CTCAE v.3), vaginal dilation and patient-reported sexual activity (EORTC QLQ CX24) were assessed at baseline, every 3 months in the 1st year, every 6 months in the 2nd and 3rd year and yearly thereafter. For this longitudinal analysis, a subgroup of patients was selected with at least 3 follow-ups with information on vaginal dilation and/or sexual activity. Vaginal penetration summarized either the use of vaginal dilators or sexual activity or both. Regular vaginal penetration was defined if reported in ≥50%, infrequent if reported in <50% and absent if reported in 0% of follow-ups. Actuarial estimates of vaginal morbidity were calculated with Kaplan-Meier method and included the individual symptoms: vaginal dryness, stenosis, mucositis and bleeding. Group comparisons were evaluated with the log-rank test. The EMBRACE I study included 1416 patients overall (2008-2015); the subgroup of patients for this longitudinal evaluation consists of 882 patients, with a median follow-up of 60 months (IQR 47-77). Of those, 565 (64%) reported regular, 205 (23%) infrequent and 112 (13%) no penetration. Reporting regular penetration was associated with a significantly lower risk of vaginal stenosis G≥2 of 23% at 5 years, compared to reporting of infrequent (37%) and no penetration (36%, p≤0.001). However, reporting regular penetration was associated with a significantly higher risk for vaginal dryness G≥1 (72% vs. 69% vs. 62%, respectively, p = 0.038) and bleeding G≥1 (61% vs. 40% vs. 25%, respectively, p≤0.001). No associations were seen for G≥1 vaginal stenosis, G≥2 dryness, G≥2 bleeding and G≥1/G≥2 mucositis. Regular penetration (defined as vaginal dilation and/or sexual activity) was associated with lower risk for vaginal stenosis G≥2, but higher risk for vaginal dryness G≥1 and bleeding G≥1. Mild vaginal dryness seems to become apparent in particular for patients experiencing vaginal penetration. Minor vaginal blood loss during dilation and/or sexual activity is commonly reported by patients, resulting from atrophy of the vaginal mucosa and/or telangiectasia. While both of these G≥1 symptoms can be managed with lubricants, moisturizer and/or hormonal replacement therapy, G≥2 vaginal stenosis represents an irreversible fibrotic adverse event that can cause dyspareunia in many cancer patients. These long-term data support clinical recommendations for dilation and/or sexual activity after radiotherapy.

Influence of Letrozole and Co Q10 on Sex Hormones and Spermiogram in Infertile Men; sample of Iraqi patients

Background: The definition of World Health Organization (WHO) to the infertile couple is the failure of female get pregnancy in spite of having regular sexual activity for at least 1 year without using any contraceptive methods, worldwide it is estimated that 15 % of reproductive-age couples are struggling with infertility.&#x0D; In many cases, infertility cannot be treated, new treatment options with promising value were involved in the recent clinical trials.&#x0D; Aim: This study was designed to evaluate the effects of letrozole plus coenzyme Q10 combination on spermiogram and sex hormones in men with idiopathic oligoasthenoteratozoospermia (iOAT) syndrome.&#x0D; Patient and methods: fifty-five patients are enrolled in this study, but only 40 patients complete the study, they are treated with a combination of Letrozole 2.5 mg tablet orally twice a week plus Co-enzyme Q10 400mg per day for three months. Seminal fluid sample, follicle-stimulating hormone, estradiol, and testosterone were analyzed before starting the treatment and at the end of month 1, 2 and 3.Results: sperm concentration, sperm morphology, total sperm count and motility, serum testosterone and follicle stimulation hormone levels, in addition to testosterone/estradiol ratio were significantly improved, while estradiol levels significantly decreased after 3 months of treatment. However, seminal fluid volume showed no significant change. Finally, as a notable outcome, one spontaneous conception occurred after treatment as well as three azoospermia cases responded well after completing the course of treatment.&#x0D; Conclusions: a combination of Letrozole and CO Q10 can effectively improve sperm parameters in Iraqi men with iOAT.

ПРОБЛЕМА НЕВЫНАШИВАНИЯ БЕРЕМЕННОСТИ ПРИ АДЕНОМИОЗЕ: ПУТИ РЕШЕНИЯ

The purpose of this study is to substantiate the possibility of successful therapy of miscarriage with adenomyosis based on the study of a clinical case (the patient has a history of 7 unsuccessful IVF attempts). The analysis of this clinical case revealed that despite the presence of clinical signs of endometriosis, in particular, adenomyosis, such as copious, prolonged, painful menstruation with menarche, the absence of pregnancy for 12 months, provided regular sexual activity without the use of contraception by a married couple, unsuccessful IVF attempts in the anamnesis, the diagnosis of adenomyosis was made untimely. Although one of the signs of this disease may be the absence of spontaneous spontaneous pregnancy, despite regular ovulation, patency of the fallopian tubes and a normal spermogram in the partner, as was the case in this case. It is necessary to pay attention to the possibility of this pathology as a cause of infertility in infertile women. At the same time, each unsuccessful IVF attempt can also increase the likelihood of miscarriage, according to research. The adenomyosis revealed in this case apparently caused infertility . The treatment prescribed according to the current clinical recommendations, using progestogens in a continuous mode, in particular, dienogest at a dosage of 2 mg, showed a good result. It is important to take into account that the timing of drug administration and the time of its withdrawal are strictly individual, based on clinical criteria. In this case, as a criterion for drug withdrawal, the achievement of uniformity of the endometrium during ultrasound of the pelvic organs was used, which served as confirmation of the effective suppression of foci of endometriosis in the myometrium. To achieve this result, it took 15 months of hormone therapy with dienogest. The subsequent course of pregnancy was favorable and ended with the birth of a healthy full-term baby. This could also indicate the readiness of both the myometrium and the endometrium for fetal gestation and the normal course of pregnancy. This clinical case demonstrates the effectiveness of using dienogest at a dosage of 2 mg, prescribed with an individual selection of the duration of the course of therapy, in patients with adenomyosis in order to restore reproductive function.

P-013 Evaluation of the efficacy of a short course of multidose menotropins in the treatment of male infertility in real clinical practice

Abstract Study question Is it possible to establish prognostic criteria for response to short course of multidose menotropin therapy in men with sperm pathology. Summary answer We found the increase of the effectiveness of menotropins with an increase in the duration of their use and an increase in dosage. What is known already Currently, menotropins are widely used to treat male infertility, both to stimulate spermatogenesis and to compensate for hormonal imbalance. But the actual practice of using menotropins may differ from the recommendations given by the manufacturer. Therefore, observational programs are particularly important, which allow assessing the effectiveness of a drug in routine practice. In real-world practice, hormonal treatment of the infertility is often carried out during the preparation of a couple for IVF and lasts no more than 4-6 weeks. At the same time, there is almost no scientific data in the literature of the effectiveness of such short treatment regimens. Study design, size, duration The study was designed as a multicentre, prospective, observational cohort study. The study included 1117 men with infertility enrolled between January 2020 and April 2021. Participants/materials, setting, methods The study included men with the absence of pregnancy during 12 months of regular unprotected sexual activity. The average duration of infertility was 20.6 months. As a treatment, men received multidose menotropin at a dosage of 75 IU, 112.5 IU or 150 IU every other day with hCG 2000 IU 2-3 times a week. Sperm parameters and hormones (total testosterone, SHBG, LH, FSH, Inhibin B, estradiol) were evaluated before treatment and 4 weeks after. Main results and the role of chance The age of the patients was 18 to 65 years (33.6 ± 7.0 years). The sperm concentration after 1 month of treatment increased by 23.8% from 17.6±18.1 to 23.1 million/ml, the total sperm count increased by 32.1% from 40.2±41.7 to 53.1± 49.1 million, progressive motility increased on average from 26.5±16.2 to 32.0±16.5%, the proportion of morphologically normal spermatozoa increased from 2.3±2.5 to 3.0±2.7 %. The level of total testosterone increased by 33.3% from 11.1±4.6 to 14.8±6.3 nmol/l. The levels of Inhibin B and estradiol did not change significantly. In a comparative analysis of the effect of dosage on the parameters of the ejaculate, the dose of 112.5 IU showed the greatest effect. Limitations, reasons for caution The main limitation of this study is the large heterogeneity of enrolled patients. There will be a very large variability in the age of men, as well as the severity of deviations from the norm in the analysis of ejaculate. Wider implications of the findings Thus, multidose menotropin, already when used for 4 weeks, can significantly improve the quality of the ejaculate (concentration, total count, progressive motility, morphology). In case of insufficient effectiveness of a short course (1 month), it is advisable to continue treatment for at least 3 months or increase the dosage. Trial registration number not applicable

(479) Diabetic ED Treatment by Treating Psychosocial Factors

Abstract Introduction ED is either predominantly psychogenic or predominantly organic. Psychosocial factor prevalence in diabetic ED varies in different cultures and societies. Psychosocial factor is quite prevalent in Pakistan for e.g in Pakistani national language (Urdu) ED is named ‘NAMARDI’ meaning that ‘he is not a man’, so ED has a lot of psychosocial effect on a patient and treatment of this factor is significant in restoring normal sexual functions Objective The aim of this study is to find the outcome by treating psychosocial factors in diabetic ED patients by sex therapy, counselling and psychotropic drugs supported by good glycemic control and methyl cobalamin. Methods 74 patients of diabetic ED were treated at Nasim Fertility Centre during Sep 2020 - Jan 2021 Aging from 42 years to 62 years. Duration of diabetes was from 3 to 24 years. Diagnostic work up included detailed medical and sexual history. HbA1c, testosterone and prolactin level were documented. These patients were treated on weekly basis for 10 weeks by sex therapy and counselling. Minimum effective doses of SSRI’s, benzodiazepines, yohimbine and I/M Testosterone were also prescribed. PDE-5 Inh were also prescribed as per requirement. Patients were also advised a healthy change in lifestyle, good glycemic control and regular sexual activity. Results Patients were divided in three groups depending upon the presenting complaints A- 36 out of 74 patients had presenting complaint of less erection and less time. By treatment mentioned above, normal sexual functions were restored in 30 patients (83%) and 6 patients (17%) needed PDE- 5 inh. B- 16 out of 74 patients had presenting complaint of using PDE-5 inh which was becoming less effective. By treatment mentioned above in 11 patients (69%) natural sexual functions were restored and 5 patients (31%) they had to use PDE-5 inh in less dose with better effects C- 22 out of 74 patients had presenting complaint that PDE-5 inh has become non effective. In 6 patients (27%) normal sexual functions were restored, in 12 patients (55%) PDE -5 inh became effective and in 4 patients (18%) PDE-5 inh was still non effective so they were advised I/D inj or vacuum constriction device. Conclusions Psychosocial factors in diabetic ED is quite prevalent in Pakistani society and treating this psychosocial factor helps to restore natural normal sexual response or improve the efficacy of PDE-5 inh in less dose. Disclosure No

(459) Healthy Effects of Sex

Abstract Introduction Traditionally, sex has been thought of as a function predominantly exercised for reproductive purposes. Likely, religion and culture have both failed to promote a healthy appreciation for the pleasure that sex can provide. Due to the heavy focus on the reproductive utility of sex, society has perpetuated the misconception that increased age reduces libido. As such, the health benefits of sex, particularly in older adults, has been largely ignored as an integral part of preventative medicine. Furthermore, recent studies in the field of neuroendocrinology have demonstrated an increase in the number of receptors for estrogen, progesterone, and testosterone in different tissues of our body, especially in vital organs as brain, heart, bone, and muscle. Objective To spread awareness on the importance of maintaining a healthy amount of sexual activity in order to decrease adverse health outcomes. Methods In this study, we review the literature extensively and use the sexual histories of patients in our office to assess the beneficial health outcomes. Results We present evidence associating increased sexual activity with decreased risk of many disease states. Populations with higher frequency of arousal and orgasms showed reduced rates of breast cancer, prostate cancer, obesity, vaginal atrophy, dyspareunia, dysmenorrhea, dysfunctional uterine bleeding, recurrent urinary tract infections, urinary stress incontinence, fecal incontinence, genitourinary symptoms of menopause, abnormal false pap smears, vulvar, labial, and vaginal obliteration, and cardiovascular disease. Conclusions Our findings suggest that increased sexual activity is an important factor for the maintenance of general good health. These findings indicate decline in sexual activity, desire or function, particularly in older patients, as potential risk factors for adverse health outcomes. Promotion of healthy sexual behaviors have been strongly linked to sexual ability at advanced ages, with studies since 1948 showing that over 80% of women with orgasmic dysfunction do not masturbate, while over 80% of women who regularly achieve orgasm do not have trouble masturbating. Sexual literacy and comfort are key factors that may promote healthy sexual activity during adulthood. As such, masturbation should be promoted in adolescent and young adults as part of routine sexual education. Furthermore, standard medical practice should encourage regular sexual activity, with or without a partner. Disclosure No

A SYSTEMATIC REVIEW ON DROPOUT OF INFERTILITY TREATMENTS AND RELATED FACTORS

Infertility occurs when a couple has been unable to produce a child for a period of at least one year while engaging in regular sexual activity and not using any kind of birth control. In addition, the pair must not have used any form of contraception during that time period. Fecundity is defined as a woman's ability to carry a pregnancy to full term without experiencing complications. Studies conducted on populations indicate that the probability of a woman becoming pregnant at any given month ranges between 20 and 25 percent overall. It is difficult to compare dropout rates across different facilities and nations due to factors such as the expense of infertility treatments, the regulations that control payment, and the accessibility of these therapies. The overwhelming majority of fertility specialists are obsessed with the outcomes of therapy and the success rates of their patients, but they frequently ignore or forget about the "invisible" individuals who withdraw from treatment. There is a lack of clarity regarding the causes and factors that lead individuals to quit focusing on their relationships. Many married couples find that they are better off financially if they choose to forego having any more children. During the period of mourning that is linked with an inability to produce children, undergoing at least one cycle of in vitro fertilization (IVF) may be performed as a "ritual." Several studies have found a correlation between dropout and a number of factors, some of which are as follows: emotional factors, communication issues, delaying treatment, physical and psychological burden, personal problems, refusal to accept treatment, problems related to the infertility organization and clinics, marital issues, age of women, number of previous births, previous unsuccessful treatments, poor treatment prognosis, child adoption, spontaneous pregnancy, and lack of insurance coverage are among the factors that have been found.

Результаты мультицентровой наблюдательной программы по изучению эффективности и безопасности многодозового менотропина у пациентов с мужским бесплодием.

Introduction. Currently, menotropins are widely used to treat male infertility, both to stimulate spermatogenesis and to compensate for hormonal imbalance. But the actual practice of using menotropins may differ from the recommendations given by the manufacturer. Therefore, observational programs are particularly important, which allow assessing the effectiveness of a drug in routine practice. Purpose. To establish prognostic criteria for response to short and stadard course of multidose menotropin therapy in men with pathospermia. Materials and methods. The study was designed as a multicentre, prospective, observational cohort study. The study included 1120 men with infertility enrolled between January 2020 and April 2021. The study included men with the absence of pregnancy during 12 months of regular unprotected sexual activity. The average duration of infertility was 20.6 months. As a treatment, men received multidose menotropin at a dosage of 75 IU, 112.5 IU or 150 IU every other day with hCG 2000 IU 2-3 times a week. Sperm parameters and hormones (total testosterone, Sex hormone-binding globulin - SHBG, luteinizing hormone - LH, follicle stimulating 12 months - FSH, Inhibin B, estradiol) were evaluated before treatment and for 12 months. Results. When comparing the parameters of the spermogram, it was noted that without differentiation according to the prescribed dose, after 3 months of administration, the concentration of spermatozoa increased by 32.6%, the total number of spermatozoa in the ejaculate increased by 32.3%, progressive mobility increased by 20.7%, the proportion of morphologically normal forms increased increased by 34.8%. The level of total testosterone after 3 months of use of multidose menotropin increased by 33.6%. The levels of inhibin B and estradiol did not change significantly. When using multi-dose menotropin for 12 months, sperm concentration increased by 88.5%, the total number of spermatozoa in the ejaculate increased by 55.3%, progressive mobility increased by 42%, the proportion of morphologically normal forms increased by 64.3%. Conclusions. We found the increase of the effectiveness of menotropins with an increase in the duration of their use and an increase in dosage.

The acceptability and perceived use of HIV self-testing among technical vocational education and training students in Limpopo province.

Human immunodeficiency virus self-testing (HIVST) is a most recent testing modality to reach young people to test for HIV, due to their increased vulnerability of contracting HIV. Limited literature is available describing sexual behaviours and the acceptability of HIVST and its perceived use among students. The aim of this study was to assess the acceptability and perceived use of HIV self-testing among students in Limpopo province, South Africa. The study was conducted in Limpopo province, at a technical and vocational education and training (TVET) college. A cross-sectional study was conducted with a sample of 396 students recruited from a TVET college. The mean age of the students was 22.9 years, with the majority of the students being female (77.2%). The majority (81.4%) of the students sampled reported regular sexual activity. Sixty per cent of the students had used condoms during their last sexual encounter. The acceptability of HIVST was high, with more women showing the willingness to take up HIVST (82.5%). Being sexually active (odds ratio [OR] 1.23; (confidence interval [CI]: 2.14 -6.94; p = 0.000), a number of sexual partners (OR 1.045; CI: 1.98 -10.02; p = 0.000) and condom use during the last sexual encounter (OR 0.62; CI: 3.81 -9.59; p = 0.000) were factors associated with HIVST. The high acceptability of HIV shows a need for innovative demand creation in sexual and reproductive health (SRH) programming. The study contributes to the body of literature about the acceptability and perceived use of HIV self-testing among students. Findings can be used for improving HIVST interventions using innovative approaches.

Circumferential acquired macropenis: proposal of a geometrically-based reduction corporoplasty

Circumferential acquired macropenis is a rare syndrome of symmetric corpora cavernosa girth increase, that encompasses two distinct etiologies: post-priapistic cases, with penile girth increase both in flaccidity and erection, and idiopathic cases, with girth increase in erection only, and a thinned albuginea in the affected area (paper accepted for publication - Sexual Medicine). We propose an “ad hoc” geometrically-based reduction corporoplasty. Case: man that developed over two years a critical girth penile increase up to 21 cm, causing partner dyspareunia. DICC ruled out vascular problems; its cavernosographic phase showed a symmetric, sharp dilatation of the two corpora at the shaft middle 2/3 (see Figure). Surgical technique: following neurovascular bundle elevation, proximal and distal normal, “target” circumferences, according to perception of normal thickness albuginea, are measured. Bilateral paraurethral defined reference intervals are marked along the dilated aspect of the albuginea; circumferential measurements at such reference sections are performed. The differences between the measured circumferences and the target circumferences are then calculated. Each resulting difference is divided by two, to identify the final measurements to bilaterally define the ellipses of albuginea to be excised. Following their removal, albugineal margins are closed with a continuous water-tight suture. In all the affected aneurysmal area the thinned albuginea is reinforced by a patch of bovine pericardium (Synovis Supple Peri-Guard®), fashioned according to the target erect shaft dimensions, and anchored with cardinal stitches at the paraurethral albuginea, and in the dorsal midline.Bucks’ fascia is re-approximated, and standard circumcision performed. At 20 months follow-up the patient is maintaining a normalized penile shape, he has a regular sexual activity, with dyspareunia resolution and full patient-partner satisfaction. Circumferential acquired macropenis prevents affected men from effective sexual penetration. We present its correction by a geometrically-based reduction corporoplasty, with satisfactory results at 20 months follow-up. Authors do not have any conflict of interest.

Association between ICSI cycle outcome and response in women with infertility

Background: Infertility is the inability to achieve a clinical pregnancy after 12 months of regular and unprotected sexual activity. Increases in child-bearing delay and maternal age at first pregnancy significantly impact the rise of age-related infertility and the demand for treatment using assisted reproduction techniques (ART). As a result, many women with a low ovarian reserve and a poor ovarian response (POR) to conventional stimulation seek medical assistance at infertility clinics. Aim: The study aimed to evaluate the quality of oocytes and embryos, as well as the rates of conception, in infertile women who were candidates for fresh intracytoplasmic sperm injection between good and poor-responder women (ICSI). Patients and methods: The study was conducted on 45 infertile women undergoing ICSI at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/ Al-Nahrain University/ Baghdad/ Iraq from October 2021 to April 2022, regardless of whether they had previously undergone ICSI. The morphology of the oocytes and the quality of the resulting embryos were assessed. The patients' ages ranged from 20 to 42 years old. There was primary and secondary infertility ranging from one to 20 years. Every couple had a basic reproductive assessment. The antagonist protocol was used for all infertile females. All females had their serum levels of AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and oestradiol (E2) measured on the second or third day of their cycle. The serum oestradiol (E2) level was re-measured on the day of the hCG injection. Results: The participants in the study were 32.6 ± 5.3 years old. The findings showed that 57.8% of the patients had a well response, and 24.4% of the women were pregnant. In those who became pregnant, anti-müllerian hormone (AMH) levels were significantly higher, and follicle-stimulating hormone (FSH) levels were noticeably lower (p&gt; 0.05). The E2, LH, prolactin, and progesterone levels were not statistically different (P&gt; 0.05). Conclusion: In conclusion, the findings revealed a positive relationship between response and ICSI outcomes in infertile women.

Comparison of modified McIndoe and Davydov vaginoplasty in patients with MRKH syndrome in terms of anatomical results, sexual performance and satisfaction.

To compare the modified McIndoe versus Davydov vaginoplasty techniques in terms of anatomical results, sexual performance, and satisfaction. From September 2019 to June 2021, a comparative study was conducted on 20 patients with MRKH syndrome who underwent either McIndoe vaginoplasty (McIndoe group, 10 cases) or Davydov vaginoplasty (Davydov group, 10 cases) in a university-based tertiary care hospital (Imam Khomeini Hospital) in terms of anatomical results, sexual performance, and satisfaction. Functional results were assessed using the Female Sexual Function Index (FSFI). All surgical procedures (n = 20) were performed successfully. Patients in the modified McIndoe group were similar to those in the Davydov group in terms of hospital stay and intraoperative complications. However, postoperative complications were higher in the McIndoe group. There were no significant differences in the neovaginal length and width of the two groups at the 6-month follow-up (P > 0.05). Other parameters (duration of mold use and blood transfusion) were similar for all patients in the two groups. At 12 months after surgery, all patients had regular sexual activity. No significant differences were found in either group. In terms of anatomical results, sexual performance, and satisfaction, the two techniques were similar.

Результаты применения комплекса БЕСТФертил у пациентов после микрохирургической подпаховой варикоцелэктомии (операции Мармара)

Up to 15% of couples around the world face the problem of infertility, while male factor in infertile marriages occurs in up to 50% of cases. Varicocele occurs in 15% of the male population and in 35% of men with infertility. For now, the only effective method of treating varicocele is operative. After surgical treatment, there is an improvement in spermogram parameters, however, it is not always possible to achieve normal value of each parameter.To assess the efficiency of BESTFertil in patients after varicocelectomy.The single-center, prospective, randomized study at the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov was conducted comparing the postoperative parameters of patients who underwent varicocelectomy, followed by the course of BESTFertil (main group) and without it (control group). A total of 63 patients were included in the study: the main group - 33 patients and the control group - 30 patients. The inclusion criteria for the study were: the presence of varicocele as the cause of pathospermia and / or the absence of pregnancy in marriage for 12 months or more of regular sexual activity without contraception, in the absence of other organic pathology as a possible cause of infertility, age from 18 to 45 years. Patients from both groups underwent surgical treatment of varicocele - microsurgical subinguinal varicocelectomy according to the standard Marmar technique using an operative microscope. Patients from the main group received BESTFertil for 3 months according to the recommended scheme.In the main group an average increase in the volume of ejaculate in 6 months was 0.48 ml (11.2% of the initial), the increase in concentration was 24.4 mln / ml (59.1%), the increase in motility was 25.2% (69.2%), morphologically normal forms - 3.4% (106.3%). A relapse of the disease was revealed in one patient, according to ultrasound and angiography, however, there was also a positive dynamic of spermogram parameters: an increase in ejaculate volume - 0.8 ml; increase in sperm concentration - 22 mln/ml; A + B motility-32%; morphologically normal forms - 1%. Four patients (16.7% of the total number of patients with infertile marriage in the main group) reported pregnancy. In the control group, an average increase in the volume of ejaculate in 6 months was 0.07 ml (1.7% of the initial), the increase in concentration was 11.7 mln / ml (27%), the increase in motility was 10.6% (32.7%), morphologically normal forms - 0.6% (9.8%). Two patients (9.1% of the total number of patients with infertile marriage in the control group) report pregnancy after treatment. One patient had a relapse of the disease, confirmed by angiography, despite his spermogram parameters correspond to normospermia.These results allow us to conclude that the course of BESTFertil in patients after treatment of varicocele allows to achieve a clinically and statistically significant increase in spermogram indicators such as ejaculate volume, its concentration, sperm motility and the number of morphologically normal forms, which can help patients achieve natural pregnancy or resort to assisted reproductive technologies.

Sexual behavior and increasing vulnerability of elderly population to sexually transmitted infections: Need for active interventions

Objective: The objective of the study was to study the pattern of sexual behavior and sexually transmitted infections (STIs) among the patients attending the STIs clinic in a tertiary care hospital in Western Uttar Pradesh. Materials and Methods: A cross-sectional study was carried out among all confirmed STI cases attending the STI clinic during the period of 1 year. Data were collected by means of personal interview using pretested pro forma with questions related to their sexual behavior and STIs. Relevant investigations were carried out for all cases. Data were entered in Excel sheet and analyzed by means of Epi Info version 7. Results: A total of 373 patients were reported with anogenital lesions. Out of these, 310 were confirmed cases of STI. Surprisingly, in the clinic, the attendance of elderly was 41 (13% of total cases). The attendance of older adults (>40 years of age) was more (178, 57.41%) in comparison to the younger population (132, 42.58%). Among the older population, males outnumbered female patients. Out of the total lesions, the most common genital lesion was herpes genitalis followed by balanoposthitis. Conclusion: We generally assume that, with increasing age, the chances of acquiring STIs are less, but in our study, most of them admitted to having regular sexual activity and this clearly indicated the vulnerability of the elderly population to STIs. We definitely need to focus on their sexual needs and sex education to prevent the increased rate of infections among them.