Secondary Subfertility Research Articles

Predictive Value of Pregnancy History in Subfertile Couples: Results From a Nationwide Cohort Study in The Netherlands

Prior pregnancy is considered to be a positive factor for the occurrence treatment independent pregnancy in subfertile couples. In existing prediction models for treatment independent pregnancy, secondary subfertility increases the probability of pregnancy with a factor 1.5 to 2 as compared to primary subfertility. Unfortunately, these models do not take the nature of prior pregnancy into account. It is unlikely that a prior ectopic pregnancy has the same predictive impact as a prior live birth or a prior induced abortion.

IUI in male subfertility: are we able to select the proper patients?

There is at this time no indication as to which semen parameters from the fertility work-up discriminate between couples with male subfertility who will and will not benefit from intrauterine insemination (IUI). This study evaluated the predictive capacity of semen parameters (both pre- and post-wash) and antisperm antibodies (ASA) obtained during the fertility work-up on IUI outcome in couples with male subfertility in a retrospective cohort study. It included 290 couples, who underwent 722 IUI cycles. The overall ongoing pregnancy rate was 9% per cycle. Model I, with female age, duration of subfertility, secondary subfertility, the presence of anovulation, cervical hostility and cycle number had an area under the curve (AUC) of 0.59. Adding the presence of ASA to this model improved the AUC to 0.65 (model II). Further addition of the post-wash total motile count (TMC) to the model with ASA (model III) improved the AUC to 0.67. Using the models to exclude couples from IUI due to low expected pregnancy rates would increase the pregnancy rate to 11% per cycle with model I, and to 14% per cycle for model II and for model III. In conclusion, in the selection of patients with male subfertility for IUI, the use of prediction models including ASA can increase the efficiency of IUI.

Office transvaginal hydrolaparoscopy for early diagnosis of pelvic endometriosis and adhesions

Study Objective: To evaluate the feasibility of a new endoscopic technique, transvaginal hydrolaparoscopy, for early office screening of subfertile women. Design. Retrospective, descriptive feasibility study (Canadian Task Force classification II-2). Setting. Office in an infertility center. Patients. One hundred fifty-seven continuous women with primary or secondary subfertility. Interventions. Under local anesthesia, a Veress needle-cannula system was inserted into the posterior fornix with peritoneal distention by saline. Measurements and Main Results. Access was achieved in 95% of patients. In 58.5% the findings were normal and in 28% an explorative or operative laparoscopy was indicated. No major complication occurred. Patients' pain scores were similar to those for office hysteroscopy. Conclusions. Transvaginal hydrolaparoscopy was successfully performed in the office. The technique allows early and complete endoscopic screening of subfertile women.

Cumulative probability of achieving an ongoing pregnancy after in-vitro fertilization and intracytoplasmic sperm injection according to a woman's age, subfertility diagnosis and primary or secondary subfertility.

The aim of this study was to estimate reliable cumulative probabilities of achieving an ongoing pregnancy after successive in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, according to a woman's age, subfertility diagnosis and primary or secondary subfertility. Therefore reasons for quitting treatment without achieving an ongoing pregnancy were taken into account. Moreover, we studied whether there were trends in cumulative probabilities after adjustment for potential confounding effects of the other two characteristics, duration of subfertility, year of first treatment and reason for quitting treatment. In total, 2984 IVF/ICSI cycles were performed in 1315 couples at the University Hospital Nijmegen, The Netherlands, between 1991 and 1998. The 'realistic' cumulative probability of achieving an ongoing pregnancy was 54.5% after five consecutive IVF/ICSI cycles, which was about 10% lower (absolute value) than the optimistic probability calculated by life-table analysis and about 10% higher (absolute value) than the most pessimistic estimate. Women of 35 years or younger had a higher probability of achieving an ongoing pregnancy than the older women. As ICSI is now an option, there were no obvious differences between the subfertility diagnosis subgroups. The cumulative probability after the first two IVF/ICSI cycles was higher in women with secondary subfertility than in those with primary subfertility; this advantage disappeared after further treatment. These trends remained valid after adjustment for confounding factors.

Human fertility does not decline: evidence from Sweden

Objective: To assess changes in human fertility over time. Design: Time-trend analyses and age-period-cohort modeling. Setting: Sweden, 1983–1993. Patient(s): All primiparous women aged ≥20 years during the study period. There were 401,653 women who were identified through the nationwide Medical Birth Register. Intervention(s): None. Main Outcome Measure(s): Risk of subfertility, defined as ≥1 year of involuntary childlessness. Result(s): Subfertility problems decreased dramatically over successive maternal birth cohorts. Further, the risk of subfertility increased with age and decreased with increasing formal education. Conclusion(s): A decrease in male fertility cannot be ruled out on the basis of these results, but if present, it is minor and totally outweighed by other favorable developments. As the main explanation for our findings, we propose a decrease in the prevalence of secondary subfertility as a result of the eradication of gonorrhea.

Clinical aspects in the surgical treatment of varicocele in subfertile men. I. Comparison of observed and expected pregnancy rates

Ninety-six couples, consulting for primary (n = 73) or secondary (n = 23) infertility, and thought to be infertile due to a varicocele in the husband associated with sperm abnormalities, were subjected to a follow-up study. Of these, 57 were surgically corrected and 39 were not, depending only on the patient's choice. All women were intensively treated where necessary. From our data we conclude that (1) fertility prognosis is significantly better in couples with secondary subfertility than in couples with primary subfertility, (2) surgical correction of varicocele in cases of secondary subfertility does not increase subsequent pregnancy rates, and (3) surgical correction of varicocele in cases of primary subfertility significantly increases subsequent pregnancy rates, since cumulative observed pregnancy rates are more than double the cumulative theoretically expected treatment-independent pregnancy rates.

Immunity to Modified Seminal Plasma Antigens Associated with Subfertility

Abstract. The technique of counterimmunoelectrophoresis (CIE) has been used to detect precipitin reactions between sera from subfertile and fertile patients and seminal plasma antigens. Freshly ejaculated seminal plasma lacked antigenicity detectable by CIE. Seminal plasmas obtained as part of routine semen analyses and therefore left to stand for varying periods, showed activity. In a study of 60 spouse seminal plasmas which were collected in routine fashion and then incubated at 37°C, antigenic activity appeared after varying periods of incubation. Activity was most commonly detected after 18 hours' incubation usually lasting for 6 hours or more. A pool of 37 seminal plasmas (PSP), which was rendered antigenic by incubation, reacted on CIE with 156 (85.7%) of 182 sera from subfertile patients and with 80 (63.0%) of 127 sera from fertile women. In three of the positive sera, the immunoglobulin fraction was recovered and found to contain the components binding with PSP antigen. The PSP material was bacteriologically contaminated and on culture 7 bacterial types were isolated–pseudo‐monas aeruginosa, proteus mirabilis, bacillus subtilis, non‐haemolytic and haemolytic diphtheroids, mucoid E. coli, and streptococcus faecalis. Pooled cell free extracts (CFE) from these bacteria reacted with 154 (84.6%) of the subfertility patients and 68 (53.5 %) of the comparison subjects. Use of a 3‐well CIE procedure revealed the presence of some of these CFE bacterial antigens in PSP. A component distinct from the bacterial antigens was observed in PSP. This antigenic component is thought to represent seminal plasma antigen(s) resulting from bacterial action. Its appearance is induced by contact of seminal plasma with any of the 7 bacterial types, but not by incubation of sterile seminal plasma alone, or in combination with CFE or bacterial protease. A proportion of the bacterial antigen(s) was heat labile. Those that were thermostable were removed from PSP by absorption with chicken anti‐bacterial antisera. The absorbed PSP reacted with 58 (31.2%) of the subfertile subjects and 15 (11.8%) of the fertile women. The subfertile group was subdivided into primary and secondary subfertility, and again according to whether conception occurred during the course of the study. A difference in CIE positivity was observed in the secondary, but not in the primary, subfertile women. Twenty‐two (61.1 %) of the 36 secondary subfertile women who failed to conceive were CIE positive, in contrast to 6 (20.7%) of the 29 women who became pregnant (p<0.005).