Seeking Fertility Treatment Research Articles

S&T-09 THE FERTILITY QUALITY OF LIFE AND SEXUAL DYSFUNCTION IN MEN SEEKING FERTILITY TREATMENT

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-09 THE FERTILITY QUALITY OF LIFE AND SEXUAL DYSFUNCTION IN MEN SEEKING FERTILITY TREATMENT Zhe Zhang, Hui Jiang, Yuzhuo Yang, Hongliang Zhang, Haocheng Lin, Lianming Zhao, Wenhao Tang, Defeng Liu, Jiaming Mao, and Kai Hong Zhe ZhangZhe Zhang More articles by this author , Hui JiangHui Jiang More articles by this author , Yuzhuo YangYuzhuo Yang More articles by this author , Hongliang ZhangHongliang Zhang More articles by this author , Haocheng LinHaocheng Lin More articles by this author , Lianming ZhaoLianming Zhao More articles by this author , Wenhao TangWenhao Tang More articles by this author , Defeng LiuDefeng Liu More articles by this author , Jiaming MaoJiaming Mao More articles by this author , and Kai HongKai Hong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2838AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infertility has been reported to have a negative effects on sexual function, especially in men. With the rapid increase in the number of men seeking fertility treatment, there is urgent to better understand the interrelationship between the fertility quality of life and sexual function. The aim of this study was to investigate the fertility quality of life (FertiQoL) and the prevalence of erectile dysfunction (ED) and premature ejaculation (PE) in infertile men. METHODS In a cross-sectional study, a total of 351 men seeking fertility treatment completed a questionnaire about sexual experiences and quality of life. ED was evaluated through the International Index of Erectile Function-15 (IIEF-5), ejaculation status was determined by the PE diagnostic tool (PEDT), and the quality of life was measured using the FertiQoL tool. RESULTS Reliability analyses for the FertiQoL tool demonstrate sufficiently strong fit (Cronbach’s alpha=0.891). Social and relational domains of FertiQoL were lower in infertile men compared that reported in other countries. ED was found in 125 (35.6%) and PE in 90 (25.6%) subjects. The emotional, mind/body, relational and social domain scores of FertiQoL were positively associated with IIEF-5 score whereas scores were negatively associated with PEDT score. In a logistic multivariate model, emotion, relational and social domains were significantly associated with ED, while only emotion domain was related to PE. Furthermore, our data suggested that overweight, family type (extended family), smoking, infertility reason (male factor infertility) and infertility type (primary infertility) are risk factors for ED and PE, and duration of infertility also affect erectile function. The education level, family income and the treatment of infertility had no significant effect on sexual experience. CONCLUSIONS ED and PE are prevalent among infertile men, who also have poor FertiQoL related to social and relationships, and the emotional, mind/body, relational and social domains of FertiQoL may be associated with sexual dysfunction in infertile men. The quality of life markedly affects sexual function during fertility treatment and should be taken into adequate account and addressed as an important element of infertility health care. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e311 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Zhe Zhang More articles by this author Hui Jiang More articles by this author Yuzhuo Yang More articles by this author Hongliang Zhang More articles by this author Haocheng Lin More articles by this author Lianming Zhao More articles by this author Wenhao Tang More articles by this author Defeng Liu More articles by this author Jiaming Mao More articles by this author Kai Hong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Understanding the patient experience: comparing carriers and non-carriers as identified by an expanded screening panel

BACKGROUND: Expanded carrier screening (ECS) is routinely offered to patients seeking fertility treatment. ECS provides an abundance of information for patients, which may inform reproductive decisions. However this volume of information may be perceived as causing anxiety, particularly for individuals identified as carriers. OBJECTIVE: Our aim was to assess the effect of ECS results on patients identified as carriers compared to non-carriers. MATERIALS & METHODS: Patients who underwent ECS were sent a survey 3 weeks after results were reported. Post-test genetic counseling (GC) was offered to all patients. Consenting participants were asked to report 1) with whom they discussed their results and 2) how often they felt a number of emotions post-test. Responses were compared between carriers and noncarriers. RESULTS: 420 patients completed the survey and were eligible for analysis. 178 were identified as carriers (42%). Post-test GC was received by 158 (89%) of carriers. When asked to report with whom they discussed results, carriers were significantly more likely to have discussed results with family members (p 1⁄4 0.0003). Among both carriers and non-carriers, most participants reported not discussing their results with a primary care provider/other medical professional. When reporting on emotions felt post-test, carriers felt anxious, nervous, and a loss of control significantly more often than non-carriers (p1⁄45.689e-05; Fisher p1⁄4 0.0005). While the difference here was significant, the overall frequency of feeling said emotions was low; the large majority of both carriers and non-carriers felt this way rarely/never. CONCLUSIONS: It is expected that carriers may feel anxiety regarding their results. However, even among carriers, the majority reported feeling these emotions rarely/never. This may be due to post-test GC. The benefit of ECS pairedwith GC extended to participants’ families, as carriers reported discussing results with their family members. Participants reported not discussing their results with other medical professionals. The clinical impact of this is important; despite discussing their results with a genetics professional, carriers may feel anxiety regarding how their carrier status affects other areas of their health. These emotions could be mitigated by the sharing of results with other healthcare providers. Future studies around facilitation of such discussions and the impact of post-test genetic counseling will be important, as will implementation of pre-test counseling for patients undergoing screening. FINANCIAL SUPPORT: Kumar, Yarnall, and Lee are employees of Recombine.

PGD management scheme for older females with balanced translocations: Do older females have less chance of balanced embryo transfer?

Carriers of reciprocal and Robertsonian translocations have a higher risk of experiencing infertility and repeated miscarriages. It is well established that with advancing maternal age, the risk of aneuploidies in embryos increases. In this study, the chance of developing balanced embryos in translocation carriers with advanced maternal age was analyzed to establish a management scheme for couples seeking fertility treatment and preimplantation genetic diagnosis (PGD). Biopsy was performed on cleavage-stage embryos. Multicolor fluorescence in situ hybridization was used for PGD. The translocation carriers underwent a total of 55 cycles of PGD. Genetics diagnosis and cycle outcomes of PGD cases were examined. This study showed that the chance of obtaining a balanced embryo from the Robertsonian translocation carriers was significantly less when the maternal age is advanced. Similar rates for balanced embryos were obtained from the reciprocal translocation carriers. The results of this study show that maternal age plays an important role and that genetic counselling and planning for a PGD cycle in translocation carriers, particularly for Robertsonian carriers, must be accordingly adapted.

Testicular lactate content is compromised in men with Klinefelter Syndrome

Klinefelter syndrome (KS) is the most common genetic cause of human infertility, but the mechanism(s) responsible for its phenotype remain largely unknown. KS is associated with alterations in body composition and with a higher risk of developing metabolic diseases. We therefore hypothesized that KS men seeking fertility treatment possess an altered testicular metabolism profile that may hamper the nutritional support of spermatogenesis. Testicular biopsies from control (46, XY) (n = 6) and KS (47, XXY) (n = 6) individuals were collected and analyzed by proton high-resolution magic-angle spinning nuclear magnetic resonance spectroscopy. The mRNA and protein expression of crucial glycolysis-associated enzymes and transporters were evaluated in parallel by quantitative PCR and Western blot, respectively. Our data revealed altered regulation of glucose transporters (GLUT1 and GLUT3); phosphofructokinase 1, liver isoform (PFKL); and lactate dehydrogenase A (LDHA) expression in the testis of KS patients. Moreover, we detected a severe reduction in lactate and creatine accumulation within testicular tissue from KS men. The aberrant levels of the biomarkers detected in testicular biopsies of KS men may therefore be associated with the infertility phenotypes presented by these men. Mol. Reprod. Dev. 83: 208-216, 2016. © 2015 Wiley Periodicals, Inc.

Polycystic Ovarian Syndrome and Eating Disorder Quality of Life: A Pilot Study

Objective: To compare ‘quality of life related to eating and exercise’ (QOL ED) in women with and without PCOS who are seeking fertility treatment. Method: Twenty-one women with and 128 women without PCOS aged 20 to 46 years attending IVF clinics in Sydney, Australia participated. Participants completed the QOL ED questionnaire containing six eating disorder subscores and a global score. Multivariate analyses included age and Body Mass Index (BMI) as covariates and logistic regression included current BMI. Results: Women with PCOS had significantly poorer QOL ED global scores and poorer eating behaviour, eating disorder feelings, psychological feelings and acute medical subscores. The total PCOS group was best represented by current BMI and the acute medical subscore. The non-obese PCOS group (BMI 19 to 29.9 kg/m2) was best represented by the eating disorder feelings subscore (reflecting a preoccupation with control of body weight and eating). Women with PCOS were significantly more likely to obtain a QOL ED global score above a non-eating disorder range (total sample 17% versus 8%; non-obese women 44% verses 12%) and a global score consistent with the presence of a current diagnosis of an eating disorder (total group 14.6% versus 2.3%; non-obese 22.2% versus 1.8%). Conclusion: These findings support assessment of disordered eating and lifestyle change as the first-line treatment of women with PCOS irrespective of BMI.

Changes in the semen quality among 5739 men seeking infertility treatment in Northern Norway over past 20 years (1993–2012)

Semen quality plays a pivotal role in sustaining the fertility rate and healthy population growth. Therefore, assessment of temporal trends in the semen quality provides valuable public health information. We analyzed the semen quality parameters of 5739 North Norwegian men among consecutive couples attending the fertility clinic of University Hospital of North Norway for investigation and/or treatment from 1993 to 2012. The seminal fluid volume, sperm concentration, and total sperm count were found to have gradually decreased during the past 20 years. The proportion of hypospermic, azoospermic, and oligozoospermic men had increased by 24.6% ( p < 0.001), 109.5% ( p < 0.001), and 9.5% ( p = 0.05), respectively, in the last decade (2003–2012) compared to the first decade (1993–2002). The parameters of semen quality are rapidly deteriorating in North Norwegian men seeking fertility treatment.

The urgent need for a multi-disciplinary core outcome set for the reporting of obstetric antiphospholipid antibody syndrome

Background Obstetric antiphospholipid antibody syndrome (OAPS) is associated with adverse pregnancy outcomes. A systematic review (2004) demonstrated diversity in published studies, making it difficult to interpret the outcomes in various subgroups with OAPS. Clinicians (and patients) are divided about the efficacy of any treatment, given the heterogeneity of the patient populations studied, endpoints, outcome measures reported and treatments used. Many of these patients are being cared for by their rheumatologist, haematologist, obstetrician and fertility specialists – who may have different recommendations concerning the need for lowmolecular weight heparin (LMWH). Women who have sought fertility treatment are finding it difficult to discontinue their LMWH despite the lack of evidence for its efficacy. The lack of consensus on therapeutic measures between various clinical specialities and patients often leads to poor patient experience. Patient involvement in the decision making process in these studies have not been reported; it could be the prime motivation for clinicians to continue prescribing LMWH despite the lack of demonstrable efficacy. Hence we need to develop a core outcome set so that clinicians from various subspecialities and patients will be able to assess each of these studies in a standardised fashion.

Absence or presence? Complexities in the donor narratives of single mothers using sperm donation.

STUDY QUESTIONHow do single mothers who have conceived a child via anonymous or identity-release sperm donation represent the donor?SUMMARY ANSWERWhile the majority of mothers described their anonymous and identity-release donors as symbolically significant to their families, others were more likely to emphasize that their lack of information limited their thoughts about him.WHAT IS KNOWN ALREADYThere is limited understanding of the factors that impact upon how single mothers represent the donor, and whether or not they are determined by specific donor programmes (anonymous or identity-release).STUDY DESIGN, SIZE, DURATIONQualitative interviews were conducted with 46 women who had treatment at a UK licensed fertility clinic during the years 2003–2009. Twenty mothers (43%) had used an anonymous donor, and 26 (57%) had used an identity-release donor.PARTICIPANTS/MATERIALS, SETTING, METHODSAmong the 46 mothers interviewed, all had at least one child conceived via donor insemination who was between the ages of 4 and 9 years. Mothers were heterosexual and were currently without a live-in and/or long-term partner. Interview data were analysed qualitatively according to the principles of thematic analysis.MAIN RESULTS AND THE ROLE OF CHANCEFindings indicated marked diversity in single mothers' representations of the donor. Most (n = 27) mothers talked about the donor as symbolically significant to family life and were likely to describe the donor as (i) a gift-giver, (ii) a gene-giver and (iii) a potential partner. Others (n = 16) talked about the donor as (i) unknown, (ii) part of a process and (iii) out of sight and out of mind. There were mothers with anonymous and identity-release donors in each group. Several mothers explained that their feelings about the donor had changed over time.LIMITATIONS, REASONS FOR CAUTIONAll mothers conceived at a licensed fertility clinic in the UK. Findings are limited to individuals willing and able to take part in research on donor conception.WIDER IMPLICATIONS OF THE FINDINGSThe study offers greater insight into the factors influencing the donor narratives produced in single-mother families. It has implications for the counselling and treatment of single women seeking fertility treatment with donor gametes in both anonymous and identity-release programmes. Given that the number of clinics offering identity-release programmes worldwide seems to be increasing, the finding that single women may have varying preferences with regard to donor type, and varying interest levels with regard to donor information, is important. It is recommended that clinicians and other fertility clinic staff guard against making assumptions about such preferences and any thoughts and feelings about the donor or donor information on the basis of marital status.STUDY FUNDING/COMPETING INTEREST(S)This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.

An internet forum analysis of stigma power perceptions among women seeking fertility treatment in the United States

Infertility is a condition that affects nearly 30 percent of women aged 25–44 in the United States. Though past research has addressed the stigmatization of infertility, few have done so in the context of stigma management between fertile and infertile women. In order to assess evidence of felt and enacted stigma, we employed a thematic content analysis of felt and enacted stigma in an online infertility forum, Fertile Thoughts, to analyze 432 initial threads by women in various stages of the treatment-seeking process. We showed that infertile women are frequently stigmatized for their infertility or childlessness and coped through a variety of mechanisms including backstage joshing and social withdrawal. We also found that infertile women appeared to challenge and stigmatize pregnant women for perceived immoral behaviors or lower social status. We argue that while the effects of stigma power are frequently perceived and felt in relationships between infertile women and their fertile peers, the direction of the enacted stigma is related to social standing and feelings of fairness and reinforces perceived expressions of deserved motherhood in the United States.

Associations between paternal urinary phthalate metabolite concentrations and reproductive outcomes among couples seeking fertility treatment.

Limited evidence suggests that male exposure to ubiquitous environmental phthalates may result in poor reproductive outcomes among female partners. This analysis included male-female couples undergoing in vitro fertilization (IVF) and/or intrauterine insemination (IUI). We evaluated associations between the geometric mean of paternal specific gravity-adjusted urinary phthalate concentrations prior to the female partners' cycle and fertilization, embryo quality, implantation, and live birth using generalized linear mixed models. Two-hundred eighteen couples underwent 211 IVF and 195 IUI cycles. Trends were observed between paternal urinary mono-3-carboxypropyl phthalate (MCPP; P=0.01) and mono(carboxyoctyl) phthalate (MCOP; P=0.01) and decreased odds of implantation. MCPP and MCOP were also associated with decreased odds of live birth following IVF (P=0.01 and P=0.04, respectively), and monobutyl phthalate above the first quartile was significantly associated with decreased odds of live birth following IUI (P=0.04). However, most urinary phthalate metabolites were not associated with these reproductive outcomes. Selected phthalates were associated with decreased odds of implantation and live birth.

The psychosocial impact of infertility among women seeking fertility treatment

The psychosocial impact of infertility among women seeking fertility treatment

Psychiatric disorders among infertile men and women attending three infertility clinics in Riyadh, Saudi Arabia.

BACKGROUND AND OBJECTIVESNo study has assessed psychiatric disorders among infertile men and women seeking fertility treatment in Saudi Arabia. Therefore, we sought to measure the rate of psychiatric disorders in this population.DESIGN AND SETTINGSThis was a cross-sectional observational study among patients attending infertility clinics at three referral hospitals in Riyadh, Saudi Arabia, between January 2013 and September 2014.PATIENTS AND METHODS406 patients (206 women and 200 men) participated in the study. The approved Arabic version of the MINI tool was used to assess 18 common psychiatric illnesses.RESULTSThe response rate was 81%. Of the men surveyed, only 4.5% self-reported having a psychiatric disorder. Of the women surveyed, only 10.2% reported having a psychiatric disorder. However, using the MINI scale, psychiatric illness was documented in 30% of males and 36.9% of females. The most common diagnoses for both genders were depression (21.7%) and anxiety (21.2%). Significantly more females than males exhibited suicidality and depression. In contrast, significantly more males than females had bipolar disorders and substance-related disorders. A low monthly income among male and female participants and polygamy among female participants were significantly associated with psychiatric disorders.CONCLUSIONSThis study shows that a higher prevalence of psychiatric disorders, particularly depression and anxiety, among infertile men and women in Saudi Arabia is associated with lower income and polygamy. This study highlights the importance of integrated care for alleviating the psychological burden of this unfortunate population and improving outcomes and quality of life. This study also encourages follow-up studies that aim to further understand the complex relationship between fertility and psychological well-being.

Metabolic fingerprints in testicular biopsies from type 1 diabetic patients.

Diabetes mellitus (DM) is a metabolic disease that has grown to pandemic proportions. Recent reports have highlighted the effect of DM on male reproductive function. Here, we hypothesize that testicular metabolism is altered in type 1 diabetic (T1D) men seeking fertility treatment. We propose to determine some metabolic fingerprints in testicular biopsies of diabetic patients. For that, testicular tissue from five normal and five type 1 diabetic men was analyzed by high-resolution magic-angle spinning (HR-MAS) nuclear magnetic resonance (NMR) spectroscopy. mRNA and protein expression of glucose transporters and glycolysis-related enzymes were also evaluated. Our results show that testes from diabetic men presented decreased levels of lactate, alanine, citrate and creatine. The mRNA levels of glucose transporter1 (GLUT1) and phosphofructokinase1 (PFK1) were decreased in testes from diabetic men but only GLUT3 presented decreased mRNA and protein levels. Lactate dehydrogenase (LDH) and glutamate pyruvate transaminase (GPT) protein levels were also found to be decreased in testes from diabetic men. Overall, our results show that T1D alters glycolysis-related transporters and enzymes, compromising lactate content in the testes. Moreover, testicular creatine content was severely depressed in T1D men. Since lactate and creatine are essential for germ cells development and support, the data discussed here open new insights into the molecular mechanism by which DM promotes subfertility/infertility in human males.

Smoking in infertile women with polycystic ovary syndrome: baseline validation of self-report and effects on phenotype.

Do women with polycystic ovary syndrome (PCOS) seeking fertility treatment report smoking accurately and does participation in infertility treatment alter smoking? Self-report of smoking in infertile women with PCOS is accurate (based on serum cotinine levels) and smoking is unlikely to change over time with infertility treatment. Women with PCOS have high rates of smoking and it is associated with worse insulin resistance and metabolic dysfunction. Secondary study of smoking history from a large randomized controlled trial of infertility treatments in women with PCOS (N = 626) including a nested case-control study (N = 148) of serum cotinine levels within this cohort to validate self-report of smoking. Women with PCOS, age 18-40, seeking fertility who participated in a multi-center clinical trial testing first-line ovulation induction agents conducted at academic health centers in the USA. Overall, self-report of smoking in the nested case-control study agreed well with smoking status as determined by measure of serum cotinine levels, at 90% or better for each of the groups at baseline (98% of never smokers had cotinine levels <15 ng/ml compared with 90% of past smokers and 6% of current smokers). There were minor changes in smoking status as determined by serum cotinine levels over time, with the greatest change found in the smoking groups (past or current smokers). In the larger cohort, hirsutism scores at baseline were lower in the never smokers compared with past smokers. Total testosterone levels at baseline were also lower in the never smokers compared with current smokers. At end of study follow-up insulin levels and homeostatic index of insulin resistance increased in the current smokers (P < 0.01 for both) compared with baseline and with non-smokers. The chance for ovulation was not associated with smoking status, but live birth rates were increased (non-significantly) in never or past smokers. The limitations include the selection bias involved in our nested case-control study, the possibility of misclassifying exposure to second hand smoke as smoking and our failure to capture self-reported changes in smoking status after enrollment in the trial. Because self-report of smoking is accurate, further testing of smoking status is not necessary in women with PCOS. Because smoking status is unlikely to change during infertility treatment, extra attention should be focused on smoking cessation in current or recent smokers who seek or who are receiving infertility treatment. Sponsored by the Eugene Kennedy Shriver National Institute of Child Health and Human Development of the U.S. National Institutes of Health. ClinicalTrials.gov numbers, NCT00068861 and NCT00719186.

Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis.

In 1908, Cullen described the first cases of cystic adenomyosis in his textbook on adenomyomata. Although not very common, with the introduction of noninvasive imaging techniques such as magnetic resonance imaging (MRI) and 3-D transvaginal ultrasound, an increasing number of cases have been reported. Patients primarily complain of severe dysmenorrhea, chronic pelvic pain, and dysfunctional uterine bleeding. Currently, it is unclear whether adenomyosis and, more specifically, cystic adenomyosis can be an underlying reason for impaired fertility and reproductive outcome. With the postponement of childbearing, the number of patients with adenomyosis and cystic adenomyosis seeking fertility treatment is increasing. Therefore, in these patients, uterine exploration should include not only the evaluation of the endometrial cavity but also the exploration of the sub-endometrial zone. Indirect imaging techniques, combined with office mini-hysteroscopy, offer the possibility of complete uterine exploration. Two patients with cystic adenomyosis are described in this paper: one had the chief complaint of menorrhagia and the other was referred for evaluation of infertility and severe dysmenorrhea. The aim of these case reports is to present hysteroscopic dissection and ablation of adenomyotic cysts as an alternative procedure for the surgical management of this condition.

Association between anti-mullerian hormone (AMH) and time-to-pregnancy (TTP) among women in the effects of aspirin on gestation and reproduction (eager) trial

Although recent studies suggest that lower AMH is associated with reduced fecundity among women seeking fertility treatment, less is known regarding associations with TTP among women with a history of 1-2 prior pregnancy losses and no history of infertility. The objective was to assess a possible association between preconception AMH levels with TTP.

The effect of coping styles on mental health outcomes for women receiving IVF treatment

People cope with the stress of fertility treatment in different ways. Some use approach-oriented strategies (e.g., planning), whereas others use avoidance-oriented strategies (e.g., denial). This study evaluated whether these respective coping styles predict mental health outcomes for women seeking fertility treatment.

The prevalence of CHD7 missense versus truncating mutations is higher in patients with Kallmann syndrome than in typical CHARGE patients.

Mutations in CHD7, a gene previously implicated in CHARGE (coloboma, heart defect, choanal atresia, retardation of growth and/or development, genital hypoplasia, ear anomalies) syndrome, have been reported in patients presenting with Kallmann syndrome (KS) or congenital hypogonadotropic hypogonadism (CHH). Most mutations causing CHARGE syndrome result in premature stop codons and occur de novo, but the proportion of truncating vs nontruncating mutations in KS and CHH patients is still unknown. The objective of the study was to determine the nature, prevalence, mode of transmission, and clinical spectrum of CHD7 mutations in a large series of patients. We studied 209 KS and 94 CHH patients. These patients had not been diagnosed with CHARGE syndrome according to the current criteria. We searched for mutations in 16 KS and CHH genes including CHD7. We found presumably pathogenic mutations in CHD7 in 24 KS patients but not in CHH patients. Nontruncating mutations (16 missense and a two-codon duplication) were more prevalent than truncating mutations (three nonsense, three frame shift, and a splice site), which contrasts with patients presenting with typical CHARGE syndrome. Thus, the clinical spectrum associated with CHD7 mutations may be partly explained by genotype/phenotype correlations. Eight patients also had congenital deafness and one had a cleft lip/palate, whereas six had both. For 10 patients, the presence of diverse features of the CHARGE spectrum in at least one relative argues against a de novo appearance of the missense mutation, and this was confirmed by genetic analysis in five families. Considering the large prevalence and clinical spectrum of CHD7 mutations, it will be particularly relevant to genetic counseling to search for mutations in this gene in KS patients seeking fertility treatment, especially if KS is associated with deafness and cleft lip/palate.

Genetic associations with diminished ovarian reserve: a systematic review of the literature.

Diminished ovarian reserve (DOR) affects 10% of women seeking fertility treatment. Although it is much more prevalent than premature ovarian failure, less is known about its etiology. The purpose of this article is to review the possible genetic causes of, and associations with, pathologic DOR. A systematic review was conducted using PubMed from 1966 through November 2013. Twenty-one articles identified genes associated with DOR: one gene mutation (FMR1), three polymorphisms (GDF9, FSHR, and ESR1), and seven genes differentially expressed between women with DOR and controls (AMH, LHCGR, IGF1, IGF2, IGF1R, IGF2R and GREM1). Six candidate genes were discovered in mice, including Foxl2, Gdf9, Bmp15, Aire, Wnt4, and Gpr3. Two case reports of chromosomal translocations were also identified. While the etiology of pathologic DOR is likely multifactorial, it is possible that many cases attributed to an idiopathic cause may have a genetic component. Larger studies are needed to expose the impact gene mutations, polymorphisms, and epigenetics have on pathologic DOR.

A Comparison of Immigrant and Canadian-Born Patients Seeking Fertility Treatment

The present study examined whether public funding for in vitro fertilization (IVF) in Quebec, Canada was associated with differential access among Canadian-born infertility patients and those born outside of Canada. Anonymous demographic questionnaires were completed at 3 time points: 2weeks before the implementation of public funding, 2weeks after, and 8months later. Almost half the patients were not born in Canada and of these, 35% were recent immigrants to Canada. While patients born outside Canada were generally better educated than Canadian-born patients, they were more likely to be unemployed and have lower incomes. Following public funding, there was an overall increase in patients with lower incomes and lower levels of education. Canadian-born patients were more likely than immigrant patients to consult for secondary infertility. Patients born outside Canada tended to be older and nulliparous, suggesting that they may have delayed treatment seeking due to financial and other barriers. The results indicate that public funding reduces health disparities in access to IVF.