Risk Of Infertility In Women Research Articles

Relationship between Chlamydia Trachomatis infection, infertility, and serum 25-hydroxyvitamin D: a cross-sectional study from NHANES 2013-2016.

Chlamydia trachomatis is a common sexually transmitted disease that is associated with considerable morbidity and harmful sequelae, including pelvic inflammatory disease and infertility. Strategies for prevention and treatment of infertility in women with C. trachomatis infection require further investigation. There is evidence suggesting that vitamin D could be a potential treatment. This study aimed to investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels, chlamydia seropositivity, and the risk of infertility in women. We conducted this cross-sectional study using 2013-2016 National Health and Nutrition Examination Survey data. Women aged 18-39 years with complete serum 25(OH)D and chlamydia Pgp3Ab multiplex bead/enzyme-linked immunosorbent assay data available were included. The correlation between 25(OH)D level, chlamydia seropositivity, and infertility was evaluated using the weighted chi-squared test and the t-test with multivariate logistic regression and moderation effect models. Among the 1424 women who met our eligibility criteria, the weighted chlamydia seropositivity rate was 36.8%. The 25(OH)D level was significantly lower in the seropositive group compared with seronegative control. (P = 0.009). After adjusting for ethnicity, the effect of 25(OH)D was no longer significant (P = 0.693). Further analysis in the chlamydia-seropositive subset revealed that the vitamin D level was lower in the infertile group (P = 0.024). In an interaction model, 25(OH)D was found to antagonizes the positive relationship between chlamydia and infertility (OR = 0.985, 95% CI: 0.971-0.999, P = 0.040). The serum vitamin D level may be more related to the prognosis in terms of infertility than to the risk of chlamydia infection. This finding may reveal a possible treatment strategy for chlamydia infection.

Chaos and feasibility analysis of a healthy lifestyle’s sustainability using fractional-order polycystic ovarian syndrome’s effect on infertility

In this study, we developed a fractional-order model for polycystic ovarian syndrome issue transmission in women through four compartments with the Mittag-Leffler kernel. For biological feasibility, we discussed the positivity and boundedness of solutions with fixed point mappings in Banach spaces. Sensitivity analysis is performed using different variables as response functions each time, employing Latin Hyper-cube Sampling (LHS) and Partial Rank Correlation Coefficient (PRCC) with 200 iterations. Further, the reproductive number is determined for the model’s biological feasibility with an analysis of parameter impact through Matlab software. The solutions are examined for global stability using the Lyapunov function with a first derivative. Chaos Control will use the regulate for linear responses approach to bring the system to stabilize according to its points of equilibrium. Numerical solutions are derived by using a Newton polynomial in the generalized form of the Mittag-Leffler kernel, which illustrates the effect of the fractional operator and parameters involved in the system. Results are also analyzed with different assumptions of parameter values and initial conditions to observe the different impacts of treatment to overcome the risk of infertility in women. Such type of investigation will be useful to investigate the spread of disease as well as helpful in developing control strategies to overcome the risk of problems and best management care pre-detection of the issue and for treatment.

Impaired glucose tolerance and cardiovascular risk factors in relation to infertility: a Mendelian randomization analysis in the Norwegian Mother, Father, and Child Cohort Study.

Are impaired glucose tolerance (as measured by fasting glucose, glycated hemoglobin, and fasting insulin) and cardiovascular disease risk (as measured by low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and diastolic blood pressure) causally related to infertility? Genetic instruments suggest that higher fasting insulin may increase infertility in women. Observational evidence suggests a shared etiology between impaired glucose tolerance, cardiovascular risk, and fertility problems. This study included two-sample Mendelian randomization (MR) analyses, in which we used genome-wide association summary data that were publicly available for the biomarkers of impaired glucose tolerance and cardiovascular disease, and sex-specific genome-wide association studies (GWASs) of infertility conducted in the Norwegian Mother, Father, and Child Cohort Study. There were 68 882 women (average age 30, involved in 81 682 pregnancies) and 47 474 of their male partners (average age 33, 55 744 pregnancies) who had available genotype data and who provided self-reported information on time-to-pregnancy and use of ARTs. Of couples, 12% were infertile (having tried to conceive for ≥12 months or used ARTs to conceive). We applied the inverse variance weighted method with random effects to pool data across variants and a series of sensitivity analyses to explore genetic instrument validity. (We checked the robustness of genetic instruments and the lack of unbalanced horizontal pleiotropy, and we used methods that are robust to population stratification.) Findings were corrected for multiple comparisons by the Bonferroni method (eight exposures: P-value < 0.00625). In women, increases in genetically determined fasting insulin levels were associated with greater odds of infertility (+1 log(pmol/l): odds ratio 1.60, 95% CI 1.17 to 2.18, P-value = 0.003). The results were robust in the sensitivity analyses exploring the validity of MR assumptions and the role of pleiotropy of other cardiometabolic risk factors. There was also evidence of higher glucose and glycated hemoglobin causing infertility in women, but the findings were imprecise and did not pass our P-value threshold for multiple testing. The results for lipids and blood pressure were close to the null, suggesting that these did not cause infertility. We did not know if underlying causes of infertility were in the woman, man, or both. Our analyses only involved couples who had conceived. We did not have data on circulating levels of cardiometabolic risk factors, and we opted to conduct an MR analysis using GWAS summary statistics. No sex-specific genetic instruments on cardiometabolic risk factors were available. Our results may be affected by selection and misclassification bias. Finally, the characteristics of our study sample limit the generalizability of our results to populations of non-European ancestry. Treatments for lower fasting insulin levels may reduce the risk of infertility in women. The MoBa Cohort Study is supported by the Norwegian Ministry of Health and Care Services and the Norwegian Ministry of Education and Research. This work was supported by the European Research Council [grant numbers 947684, 101071773, 293574, 101021566], the Research Council of Norway [grant numbers 262700, 320656, 274611], the South-Eastern Norway Regional Health Authority [grant numbers 2020022, 2021045], and the British Heart Foundation [grant numbers CH/F/20/90003, AA/18/1/34219]. Open Access funding was provided by the Norwegian Institute of Public Health. The funders had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the article for publication. D.A.L. has received research support from National and International government and charitable bodies, Roche Diagnostics and Medtronic for research unrelated to the current work. O.A.A. has been a consultant to HealthLytix. The rest of the authors declare that no competing interests exist. N/A.

Glycemic index, glycemic load, dietary inflammatory index, and risk of infertility in women.

The dietary glycemic load (GL) indicates the quantity and quality of carbohydrates, which can affect ovulation and fertility by controlling insulin sensitivity. Also, past studies confirm the role of the dietary inflammatory index (DII) in many diseases, including metabolic syndrome and cardiovascular disorders, so it may be related to reproductive health. This case-control study aims to study the association between glycemic index (GI), GL, and DII with infertility in women. This study was conducted on 300 infertile women in the case group and 300 fertile women in the control group in Kermanshah, Iran. Food intake was evaluated using FFQ, and using NUTRITIONIST IV software programs, GI and GL values were determined. DII was computed as well using FFQ data. Physical activity was assessed using IPAQ-SF. The association between GI, GL, and DII with infertility was evaluated using a logistic regression test, using STATA version 14 software. The results showed that the DII, GI, and GL were higher in the case group compared to the control group ([p = .009], [p = .0001], and [p = .0007], respectively). The increase in GI, GL, and DII caused an increase in infertility factors, and consequently enhanced chance of infertility ((adjusted odd ratio [OR] 2; 95% confidence interval [CI], 1.16, 3.45), (OR 3.68; 95% CI, 1.99, 6.82), and (OR 1.7; 95% CI, 0.97, 2.95), respectively). The present study indicated that the chance of infertility is higher in women who follow a diet with high GI, GL, and DII. Therefore, a positive association may be present between GI, GL, and DII with infertility.

Association between antibiotic exposure and the risk of infertility in women of childbearing age: A case-control study

BackgroundBased on self-report questionnaires, two previous epidemiological studies investigated the association between the exposure of women to antibiotics and their fertility. However, biomonitoring studies on low-dose antibiotic exposure, mainly from food and water, and its relation to the risk of infertility are missing. MethodsBased on a case-control study design, 302 women with infertility (144 primary infertility, 158 secondary infertility) and 302 women with normal fertility, all aged 20–49 years, were recruited from Anhui Province, China, in 2020 and 2021. A total of 41 common antibiotics and two antibiotic metabolites in urine samples were determined by liquid chromatography–triple quadrupole tandem mass spectrometry (LC-QqQ-MS/MS). ResultsTwenty-eight antibiotics with detection rates from 10% to 100% in both cases (median concentration: ∼2.294 ng/mL) and controls (∼1.596 ng/mL) were included in the analysis. Logistic regression analysis revealed that after controlling for confounding factors, high concentrations of eight individual antibiotics (sulfamethoxazole, sulfaclozine, sulfamonomethoxine, penicillin G, chlorotetracycline, ofloxacin, norfloxacin, and cyadox) and four antibiotic classes (sulfonamides, tetracyclines, quinoxalines, and veterinary antibiotics) were related to a high risk of female infertility, with odds ratios (ORs) ranging from 1.30 to 2.86, except for chlorotetracycline (OR = 6.34), while another nine individual antibiotics (sulfamethazine, azithromycin, cefaclor, amoxicillin, oxytetracycline, pefloxacin, sarafloxacin, enrofloxacin, and florfenicol) and classes of chloramphenicol analogs and human antibiotics were related to a reduced risk of infertility, with ORs ranging from 0.70 to 0.20. Based on restricted cubic spline models after controlling for confounding factors, we observed that the relationship between all of the above protective antibiotics and infertility was nonlinear: A certain concentration could reduce the risk of female infertility while exceeding a safe dose could increase the risk of infertility. ConclusionThese results provide preliminary evidence that the effects of antibiotics on female fertility vary based on the active ingredient and usage and imply the importance of exposure dose. Future studies are needed to verify these results by controlling for multiple confounding factors.

The impact of the ileoanal pouch on female fertility in ulcerative colitis: A systematic review and meta-analysis.

Ileal pouch-anal anastomosis is a restorative option for patients with ulcerative colitis (UC) requiring surgery. The primary outcome of this study was the relative risk of infertility in women with UC undergoing restorative proctocolectomy (RPC) compared to the same patients before undergoing RPC. Infertility was defined as the inability to conceive after 1year of regular sexual intercourse without contraception. A systematic review and meta-analysis were performed to include all relevant articles from 1946 from MEDLINE, Embase and Cochrane Central Register of Controlled Trials. Studies included reported on the fertility rate of a cohort with UC and also reported the rate after RPC in those within the cohort who underwent surgery. This study was registered on PROSPERO (CRD42021259745). Thirteen studies met the inclusion criteria and accounted for 793 patients pre-pouch and 802 post-pouch. The mean and median age of the patients at analysis was 36.8 and 32.7 years respectively; and the median duration of follow-up following ileal pouch-anal anastomosis was 110.4 (68-139) months. Our results highlight that following RPC the relative risk of infertility is 4.17 (95% CI 1.99, 8.74) compared with patients before RPC who had UC. The findings of this meta-analysis provide an update on a previous meta-analysis published over a decade ago and results remain congruent. This suggests that despite advancements in surgical techniques the risk to fertility remains similar to a decade ago. However, further high quality studies are needed to try and decipher independent risk factors associated with a decrease in infertility.

Bioactive NIR-II Light-Responsive Shape Memory Composite Based on Cuprorivaite Nanosheets for Endometrial Regeneration.

Intrauterine adhesions (IUAs) caused by mechanical damage or infection increase the risk of infertility in women. Although numerous physical barriers such as balloon or hydrogel are developed for the prevention of IUAs, the therapeutic efficacy is barely satisfactory due to limited endometrial healing, which may lead to recurrence. Herein, a second near‐infrared (NIR‐II) light‐responsive shape memory composite based on the combination of cuprorivaite (CaCuSi4O10) nanosheets (CUP NSs) as photothermal conversion agents and polymer poly(d,l‐lactide‐co‐trimethylene carbonate) (PT) as shape memory building blocks is developed. The as‐prepared CUP/PT composite possesses excellent shape memory performance under NIR‐II light, and the improved operational feasibility as an antiadhesion barrier for the treatment of IUAs. Moreover, the released ions (Cu, Si) can stimulate the endometrial regeneration due to the angiogenic bioactivity. This study provides a new strategy to prevent IUA and restore the injured endometrium relied on shape memory composite with enhanced tissues reconstruction ability.

Evidence for Ovarian and Testicular Toxicities of Cadmium and Detoxification by Natural Substances

Cadmium (Cd) is an environmental toxicant, capable of reducing mitochondrial ATP production and promoting the formation of reactive oxygen species (ROS) with resultant oxidative stress conditions. The ovary and testis are the primary gonads in which female gametes (oocytes) and male gametes (spermatozoa), estrogen and testosterone are produced. These organs are particularly susceptible to Cd cytotoxicity due to their high metabolic activities and high energy demands. In this review, epidemiological and experimental studies examining Cd toxicities in gonads are highlighted together with studies using zinc (Zn), selenium (Se), and natural substances to reduce the effects of Cd on follicular genesis and spermatogenesis. Higher blood concentrations of Cd ([Cd]b) were associated with longer time-to-pregnancy in a prospective cohort study. Cd excretion rate (ECd) as low as 0.8 μg/g creatinine was associated with reduced spermatozoa vitality, while Zn and Se may protect against spermatozoa quality decline accompanying Cd exposure. ECd &gt; 0.68 µg/g creatinine were associated with an increased risk of premature ovarian failure by 2.5-fold, while [Cd]b ≥ 0.34 µg/L were associated with a 2.5-fold increase in the risk of infertility in women. Of concern, urinary excretion of Cd at 0.68 and 0.8 μg/g creatinine found to be associated with fecundity are respectively 13% and 15% of the conventional threshold limit for Cd-induced kidney tubular effects of 5.24 μg/g creatinine. These findings suggest that toxicity of Cd in primary reproductive organs occurs at relatively low body burden, thereby arguing for minimization of exposure and environmental pollution by Cd and its transfer to the food web.

Causal Associations Between Educational Attainment and 14 Urological and Reproductive Health Outcomes: A Mendelian Randomization Study.

Background: The impact of educational attainment (EA) on multiple urological and reproductive health outcomes has been explored in observational studies. Here we used Mendelian randomization (MR) to investigate whether EA has causal effects on 14 urological and reproductive health outcomes.Methods: We obtained summary statistics for EA and 14 urological and reproductive health outcomes from genome-wide association studies (GWAS). MR analyses were applied to explore the potential causal association between EA and them. Inverse variance weighted was the primary analytical method.Results: Genetically predicted one standard deviation (SD) increase in EA was causally associated with a higher risk of prostate cancer [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.05–1.25, P = 0.003] and a reduced risk of kidney stone (OR 0.73, 95% CI 0.62–0.87, P < 0.001) and cystitis (OR 0.76, 95% CI 0.67–0.86, P < 0.001) after Bonferroni correction. EA was also suggestively correlated with a lower risk of prostatitis (OR 0.76, 95% CI 0.59–0.98, P = 0.037) and incontinence (OR 0.64, 95% CI 0.47–0.87, P = 0.004). For the bioavailable testosterone levels and infertility, sex-specific associations were observed, with genetically determined increased EA being related to higher levels of testosterone in men (β 0.07, 95% CI 0.04–0.10, P < 0.001), lower levels of testosterone in women (β −0.13, 95% CI−0.16 to−0.11, P < 0.001), and a lower risk of infertility in women (OR 0.74, 95% CI 0.64–0.86, P < 0.001) but was not related to male infertility (OR 0.79, 95% CI 0.52–1.20, P = 0.269) after Bonferroni correction. For bladder cancer, kidney cancer, testicular cancer, benign prostatic hyperplasia, and erectile dysfunction, no causal effects were observed.Conclusions: EA plays a vital role in urological diseases, especially in non-oncological outcomes and reproductive health. These findings should be verified in further studies when GWAS data are sufficient.

Identification and Validation of the Signatures of Infiltrating Immune Cells in the Eutopic Endometrium Endometria of Women With Endometriosis.

Endometriosis is an oestrogen-dependent chronic inflammatory process with primary symptoms including dysmenorrhea, chronic pelvic pain, and infertility. The immune environment of the endometrium is essential for successful embryo implantation and ongoing pregnancy. In this study, we assessed the composition, density, and distribution of infiltrating immune cells in the endometria of women with endometriosis. Gene expression profiles of endometrial samples were downloaded from the Gene Expression Omnibus (GEO) database. We found that the TNF signalling pathway, the IL-17 signalling pathway, and the MAPK signalling pathway were significantly enriched in the eutopic endometria of women with endometriosis. The fractions and proportion of infiltrating immune cells were estimated by the CIBERSORT, MCP-counter, and ImmuCellAI methods. We found that the proportions of CD8+ T cells, activated NK cells, and follicular helper T cells were significantly higher in the endometria of women with endometriosis than in the endometria of normal controls, while the proportions of M2 macrophages and resting mast cells were significantly lower in the eutopic endometria. In GSE120103 (n = 36), we found that elevated CD8+ T cells in endometriosis increased the risk of infertility (P = 0.0019). The area under the receiver operating characteristic (ROC) curve (AUC) of CD8+ T cells to distinguish fertile and infertile endometriosis was 0.914. In clinical samples (n = 40), we found that the proportions of CD8+ T cells and CD56+ NK cells were significantly higher in the eutopic endometria of women with endometriosis than in the endometria of normal controls, while the proportion of CD163+ macrophages were lower in the eutopic endometria. The AUCs of CD8+ T cells and CD163+ macrophages were 0.727 and 0.833, respectively, which indicated that CD8 and CD163 were potential diagnostic markers for endometriosis. In conclusion, our results demonstrated that increased CD8+ T cells and CD56+ NK cells and decreased CD163+ macrophages within the eutopic endometria of women with endometriosis reveal a proinflammatory feature in the endometrial immune environment and that elevated CD8+ T cells increase the risk of infertility in women with the disease.

Factors influencing vitamin D levels in women attending the fertility clinic and the effect on assisted fertility outcomes.

Several factors affect vitamin D levels, such as sunshine, region, diet, obesity and so on. The primary objective of this study is to determine the prevalence of vitamin D deficiency (VDD) among infertile women in China and the contribution of VDD to the risk of infertility in women. This single-center, retrospective case-control study included 2,456 infertile women. We investigated the vitamin D levels in all patients in the different seasons and across different ages. The clinical data of 411 patients who were in the assisted fertilization programs [in vitro fertilization (IVF) and ICSI] were also analyzed, as well as the correlation between vitamin D status and IVF clinical outcome. There were significant differences in 25-hydroxyvitamin D (25(OH)D) concentrations in different seasons (P<0.01). The proportions of severe VDD in spring, winter, summer, and autumn were 18.5%, 18.6%, 7.8%, and 8.8%, respectively. The normal levels of 25(OH)D concentration (50-74.9 nmol/L) in summer, autumn, spring, and winter were 28.5%, 26.4%, 13.5%, and 18.3%, respectively. The 25(OH)D concentrations in 3 months (July, August, and September) had the highest levels, with levels over 40 nmol/L in these months. Compared with winter, the risk of severe VDD was lower in summer and autumn (P<0.01). Serum 25(OH)D concentration significantly correlated with female infertility. Inference from these results shows that vitamin D may minimize the risk of female infertility and may be related to the seasons and age.

Association by Polymorphism of the IL22 Gene in Situations, rs867810424 (A/G) and rs1390124543 (A/G) with a Risk of Infertility in Women

Infertility is a growing and effective social disease in family relationships. The importance of controlling and measuring patient risk is determined by the individual's predisposing factors to infertility, genetic and acquired background. Inflammatory disorders are seen in many diseases, and cytokines, including IL22, play a role. IL22 is a precursor cytokine and has a dual role in are associated with increased egg fertility and the expansion of fatal growth. The aim of this study was to investigate the effect of two variants rs86781042 and rs1390124543 in IL22 on female infertility in southern Iran and compare it with healthy individuals. In this case study, evidence was used to study the polymorphism of the IL22 gene in the blood of 200 infertile and healthy patients in Shiraz hospitals, for DNA extraction and purification, using Salting Out and Proteinase K methods, followed by electrophoresis and PCR ARM was used. The results were analysed using SPSS software and Hardy Weinberg equilibrium. According to the results, it seems that the expression of two polymorphisms of IL22 gene is directly related to infertility in women in southern Iran and by using this relationship; it can be used as a biomarker for screening infertile women and diagnosing the disease.

Dioxin exposure associated with fecundability and infertility in mothers and daughters of Seveso, Italy.

Is there an association between 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure and fecundability and infertility among Seveso women and their daughters? TCDD exposure is associated with a decrease in fecundability and increased risk of infertility in women, as well as their daughters. In animal studies, maternal exposure to TCDD is associated with decreased fertility in offspring. Effects of TCDD are mediated by activation of the aryl hydrocarbon receptor (AHR) pathway. The Seveso Women's Health Study (SWHS) has followed 981 women exposed to TCDD in a 1976 accident since 1996. In 2014, we initiated the Seveso Second Generation Study to follow-up their children. We obtained information on pregnancy history including time of trying to conceive from SWHS women and their daughters who were 18 years or older. We considered TCDD exposure as initial 1976 serum TCDD concentration and estimated TCDD at pregnancy. We examined relationships of TCDD exposure with time to pregnancy (TTP, the monthly probability of conception within the first 12 months of trying) and infertility (≥12 months of trying to conceive). We also assessed contributions of polymorphisms in the AHR pathway via genetic risk score. Among SWHS women (n = 446), median TTP was 3 months and 18% reported taking ≥12 months to conceive. Initial 1976 TCDD (log10) was associated with longer TTP (adjusted fecundability odds ratio = 0.82; 95% CI 0.68-0.98) and increased risk of infertility (adjusted relative risk = 1.35; 95% CI 1.01-1.79). TCDD at pregnancy yielded similar associations. Among SWHS daughters (n = 66), median TTP was 2 months and 11% reported taking ≥12 months to conceive. Daughters showed similar, but non-significant, associations with maternal TCDD exposure. A limitation of this study is time to pregnancy was reported retrospectively, although previous studies have found women are able to recall time to conception with a high degree of accuracy many years after the fact. The number of SWHS daughters who had a live birth was small and we were unable to examine fecundability of SWHS sons. Consistent with previous findings in animal studies, our study found that TCDD exposure may be associated with decreased fertility in Seveso mothers and potentially in their daughters exposed in utero. There may be susceptible genetic subgroups. The literature has largely considered the genetics of the AHR pathway in the context of male fertility but not female fertility, despite strong biological plausibility. These findings should be replicated in larger populations and of different ancestry. Future studies in Seveso should examine the sons and the grandchildren of exposed mothers given the animal literature suggesting potential heritable epigenetic effects. This study was supported by grant numbers F06 TW02075-01 from the National Institutes of Health, R01 ES07171 and 2P30-ESO01896-17 from the National Institute of Environmental Health Sciences, R82471 from the U.S. Environmental Protection Agency and #2896 from Regione Lombardia and Fondazione Lombardia Ambiente, Milan, Italy. J.A. was supported by F31ES026488 from the National Institutes of Health. The authors declare they have no actual or potential competing financial interests. N/A.

Research Article Endothelial nitric oxide synthase G894T polymorphism increases the risk of infertility in women with endometriosis

Research Article Endothelial nitric oxide synthase G894T polymorphism increases the risk of infertility in women with endometriosis

THE RISK OF INFERTILITY IN THE CHLAMYDIAL VAGINAL INFECTION

Across-section study carried on 100 women attended the Maternity and Child Teaching Hospital and certain public clinics in Diwanyia city from the first of march 2005 to the end of August 2005 ,and complete medical history was taken from each one ,then a serological test was done by using Chlamydial Kit (Biorapid Chlamydia antigen)to identify the rate of infection with Chlamydia and its correlation with risk of infertility in women .The study was revealed that the prevalence rate of chlamydial infection was 26% among women ,and there is an risk factor or Odds ratio (OR) =6 to produce infertility among women.

High-Throughput Analysis of Ovarian Cycle Disruption by Mixtures of Aromatase Inhibitors.

Background:Combining computational toxicology with ExpoCast exposure estimates and ToxCast™ assay data gives us access to predictions of human health risks stemming from exposures to chemical mixtures.Objectives:We explored, through mathematical modeling and simulations, the size of potential effects of random mixtures of aromatase inhibitors on the dynamics of women's menstrual cycles.Methods:We simulated random exposures to millions of potential mixtures of 86 aromatase inhibitors. A pharmacokinetic model of intake and disposition of the chemicals predicted their internal concentration as a function of time (up to 2 y). A ToxCast™ aromatase assay provided concentration–inhibition relationships for each chemical. The resulting total aromatase inhibition was input to a mathematical model of the hormonal hypothalamus–pituitary–ovarian control of ovulation in women.Results:Above 10% inhibition of estradiol synthesis by aromatase inhibitors, noticeable (eventually reversible) effects on ovulation were predicted. Exposures to individual chemicals never led to such effects. In our best estimate, of the combined exposures simulated had mild to catastrophic impacts on ovulation. A lower bound on that figure, obtained using an optimistic exposure scenario, was 0.3%.Conclusions:These results demonstrate the possibility to predict large-scale mixture effects for endocrine disrupters with a predictive toxicology approach that is suitable for high-throughput ranking and risk assessment. The size of the effects predicted is consistent with an increased risk of infertility in women from everyday exposures to our chemical environment. https://doi.org/10.1289/EHP742

CLINICAL AND EPIDEMIOLOGICAL FACTORS DETERMINING PROPAGATION AND CLINIC OF UROGENITAL TRICHOMONIASIS IN WOMEN

The problem of urogenital trichomoniasis (UGT) is relevant not only due to its high prevalence and multiple organ lesions, but also to the ability to have a negative impact on reproductive health. In Kazakhstan, UGT is one of the leading infections in the structure of sexually transmitted infections: in 2011 51.5%; 2012 — 43.5%; 2013 — 42.0% with the prevalence of co-infection with other STIs, in which the rate of complications is increased by 2 times and are more profound with the involvement of inflammation in the upper urogenital tract. The recorded incidence of trichomoniasis in the RK is characterized by annual rate decrease (since 2011 a 1.5 times decrease) due to small fluctuations of syphilis, gonorrhea, chlamydia morbidity which indicates a large reservoir of latent infection, and low level of diagnostics. Most clearly demonstrates this situation an incidence of UGT in 2 cities: so in Astana in 2013, the recorded incidence decreased by 2.8 times compared to 2011; in Almaty — 6 times in 2012 and 4.3 times in 2013. Conducted clinical and epidemiological analysis of UGT morbidity in women allowed to identify the following: in recent years the tendency of UGT to growth with a significant proportion of latent asymptomatic forms (for more than one quarter of patients with UGT, UGT is most common in young adults, average age 30.5±2.5 years); in half of the cases recorded, mixed trichomonas infection, mostly in combination with Chlamydia, which causes a high incidence of complications of the upper urogenital tract; there is a high frequency of trichomonas infection combination with infections caused by Candida, mycoplasma, which determines the prospects of the combination therapy UGT in combination with drugs, correcting immunodeficiency. There is quite a high incidence of gynecological pathology, the severity of which depends on the frequency of the spectrum of pathogens that are associated with T. vaginalis. The data obtained allows to select women with trichomonas infection of the urogenital tract with the complication risk that affect the reproductive function; UGT develops together with urogenital tract disbacteriosis with a predominance of Staphylococcus species, having adhesive, lizotsimogenic, hemolytic activity that must be considered when conducting a combined therapy with drugs, correcting microflora. The frequency of various complications was significantly higher in patients with mixed infection. Particular attention is drawn to the attention of the high frequency of adnexitis, uterine fibroids, their rate was equivalent to and higher than the corresponding figures of 1.9 times and 5 times, respectively (38.0% versus 20.0% and 7.8%, p 0,05) at monoinfection. In this group of ovarian cyst recorded in 10.1% of cases. Basically, the above-mentioned diseases were observed in patients with trichomonas, chlamydial infection. Adnexitis and uterine fibroids in all 30 cases were recorded in patients co-infected with this that has made 75,0±6,8%. Our findings are consistent with studies of high risk of pelvic inflammatory disease in women with trichomoniasis. Other studies have reported increases of 1.9 times the risk of tubal infertility in women with trichomoniasis. Trichomoniasis can also play a role in cervical neoplasia and postoperative infections.

Effect of increased protein intake on the risk of female infertility.

Introduction An unbalanced diet and consumption of nutritionally inadequate food may contribute to disease and health disorders. 1 The lit erature also suggests that the nutritional quality of food, including the amount and type of proteins consumed, may impact female fertility. 2,3 It is possible because the cells present in the ovaries contain insulin-like growth factor-1 (IGF-1) receptors. The IGF-1 level is correlated, among others, with the protein intake. 3-5 Based on these premises, we used epidemiological and clinical data to determine the effect of protein intake on the po tential risk of infertility in women. Patients and methods The study was conducted on a group of 100 women aged 20 to 40 years, who were patients at the Gynaecology and Obstetrics Clinical Hospital of the Poznan University of Medical Sciences, Poznan, Poland. We used simple random sampling (dependant) to ensure research integrity. Participants were divided into 2 groups: group A, including women with infertility disorders (diagnosed by a gynecologist), receiving no pharmacological infertility treatment, and wishing to become pregnant; and group B, including women with no infertility disorders, with no natural or induced miscarriages in history, with successful pregnancies in the past, and wishing to become pregnant.

The role of knowledge and perceived susceptibility in intentions to optimize fertility: findings from the International Fertility Decision-Making Study (IFDMS)

What is the role of knowledge, perceived vulnerability and level of risk of infertility in women's intentions to take action to improve their chance of becoming pregnant (i.e. by seeking medical and/or non-medical help and making lifestyle changes)? Women younger than age 35 were more likely to intend to take measures to improve their chance of conceiving when they were knowledgeable about fertility and felt susceptible to infertility; however, there was no such association in older women. The majority of young adults wish to become parents but many are jeopardizing their chances by engaging in behaviours that decrease fertility (e.g. smoking, not seeking timely medical advice when faced with problems conceiving). Research is needed to establish what motivates people to take steps to optimize their chances of pregnancy. The Health Belief Model (HBM) postulates that knowledge and beliefs about susceptibility to infertility are critical in whether people will engage in fertility-optimizing behaviours. This cross-sectional survey included 1345 childless women (trying to conceive and having never engaged in fertility medical treatment) from the International Fertility Decision-Making Study (IFDMS). Infertility risk factors were determined using the FertiSTAT. The Cardiff Fertility Knowledge Scale (CFKS) assessed fertility knowledge. Perceived susceptibility was defined as whether a fertility problem was suspected. The outcome measure was intentions to optimize one's fertility by making lifestyle changes and/or seeking help. In this study, 75.5% of women had an infertility risk factor and 60.3% suspected a fertility problem. The average correct score on the CFKS was 51.9%. Intentions to optimize fertility were lower among women who were heavy smokers (P < 0.05) and who had been trying to conceive for a year or over (P < 0.01), while intentions to optimize fertility were greater among those with a higher body mass index or greater knowledge and those who suspected a fertility problem (all P < 0.001). These overall effects were qualified in some subgroups. Heavy smokers were more likely to intend to seek medical help when they had greater knowledge (P < 0.001) and women having difficulty conceiving were more likely to intend to seek medical help if they felt susceptible to infertility (P < 0.001). Heavy smokers who were knowledgeable intended to change their lifestyle only when they felt they had a fertility problem (P < 0.01). Intentions to change were not dependent on knowledge and perceived susceptibility in older women. The data were cross-sectional and thus we cannot infer causality. The results may have been affected by the sample profile, which was biased towards high levels of perceived susceptibility and low levels of knowledge. To maximize impact, educational campaigns should take into account the presence and type of infertility risk factors in the target audience. Merck-Serono S. A. Geneva-Switzerland (an affiliate of Merck KGaA Darmstadt, Germany) and the Economic and Social Research Council (ESRC, UK) funded this project (RES-355-25-0038, 'Fertility Pathways Network'). L.B. is funded by a postdoctoral fellowship from the Medical Research Council (MRC) and the ESRC (PTA-037-27-0192). B.F. is funded by an interdisciplinary PhD studentship from the ESRC/MRC (ES/1031790/1). I.T. is an employee of Merck-Serono S.A. Geneva-Switzerland (an affiliate of Merck KGaA Darmstadt, Germany).

Effect of ovarian stimulation and oocyte retrieval on reproductive outcome in oocyte donors

To assess whether there is an increased risk of infertility in women that have previously undergone ovarian stimulation and oocyte retrieval for oocyte donation. Cross-sectional survey. Tertiary referral center. A total of 194 past oocyte donors. Telephone questionnaire. Incidence of infertility after oocyte donation. Of the women who indicated having pursued conception after oocyte donation, 95% (57/60) became pregnant unassisted. Before oocyte donation, 41 women in this cohort had already been trying to conceive, of which 38 had delivered a child and 3 (7.3%) had needed infertility treatment. The data suggest that oocyte donation does not affect short-term reproductive health.