Seeking Fertility Treatment Research Articles

Testing a New Group Intervention for Couples Seeking Fertility Treatment: Acceptability and Proof of Concept

This study tested the acceptability and preliminary efficacy of a novel group intervention for couples seeking fertility treatment. Twenty-nine couples completed psychological, relational, and sexual outcome measures pre- and post-intervention. Repeated-measures ANOVAs revealed significant reductions in terms of depressive symptoms, rejection of childfree lifestyle, and stress related to the need for parenthood. The results also revealed improvements in marital benefits and fertility-related emotional and relational quality of life. Couples’ high participation rates and reported treatment satisfaction indicate adequate acceptability. These results support the preliminary success of the intervention in reducing the psychological and relational burden for couples undergoing fertility treatment.

Clinical management of females seeking fertility treatment and of pregnant females with eating disorders.

The presence of eating disorders (EDs) might have a significant impact upon pregnancy, birth, and the offspring's well-being. Thus, several specific aspects are to be considered by medical professionals when females with EDs either become pregnant or intend to undergo fertility treatment. Clinical management algorithms for gynaecologists and fertility specialists are missing. Here, based on currently available evidence on the topic, specific clinical recommendations are presented. Treatment by a mental health professional may be necessary for pregnant females suffering from acute EDs or prior to fertility treatment. Because the regulation of the menstrual cycle is known to be induced in the course of ED-specific treatment due to weight gain and eating behaviour stabilization, the necessity and drawbacks of fertility treatments in females with EDs are discussed.

The association of urinary phosphorous-containing flame retardant metabolites and self-reported personal care and household product use among couples seeking fertility treatment

BackgroundPhosphorous-containing flame-retardants (PFRs) are widely detected. They are used both as a flame retardant as well as plasticizer.MethodsA subset of 230 women and 229 men were recruited from Massachusetts General Hospital fertility clinic between 2005 and 2015. At each visit, participants completed a questionnaire of personal care product (PCP) and household product (HP) use. Metabolites [bis(1,3-dichloro-2-propyl) phosphate, diphenyl phosphate (DPHP), isopropylphenyl phenyl phosphate (ip-PPP), tert-butylphenyl phenyl phosphate and bis(1-chloro-2-propyl) phosphate] were measured in urine (1–5 samples; n = 638 women, n = 335 men). Associations were assessed using generalized mixed models, adjusted for SG, age, BMI, smoking, education, and season.ResultsIn women, moisturizer (60%), nail polish remover (77%), and nail polish (134%) use were associated (p < 0.05) with an increase in DPHP concentrations, while ip-PPP concentrations increased 21–27% with conditioner, cosmetics, deodorant, and hair product use. Mouthwash and vinyl glove use were associated with a respective 31% and 92% increase in DPHP among men.ConclusionsOur exploratory analysis suggests PFRs may be used as a plasticizer in consumer products, and nail polish use contributes to internal DPHP exposure. Further research is needed to understand how PFRs are used in these products and how it relates to exposure.

Public perspectives on placing age limits on men and women seeking fertility treatment

To assess public attitudes toward placing age limits on men and women seeking fertility treatment. Cross-sectional web-based survey. Not applicable. A nationally representative sample of 1,427 adults in the United States. Not applicable. Support for placing age limits on people seeking fertility treatment. Sixty-seven percent of respondents supported placing age limits on women, whereas 57% supported placing age limits on men seeking fertility treatments. Sixty-four percent agreed with current American Society for Reproductive Medicine guidelines that ET should not be undertaken beyond age 55years. Whereas 55% of respondents supported placing age limits on both men and women, 12% supported age limits on women but not men, and 3% supported age limits on men but not women. Men were more likely to answer discordantly when compared with female respondents. Individuals older than 50years, who lived in the western United States, or with a personal knowledge of someone who used assisted reproductive technology were more likely to support age limits on both women and men seeking fertility treatments. Sexual minorities, people without biological children, and single, long-term partnered or divorced/widowed respondents were less likely to support age limits on men or women seeking fertility treatments. Fifty-five percent of respondents in a nationally representative sample support upper age limits on both men and women seeking fertility treatments. Support was associated with various demographic characteristics. Men were more likely than women to support age limits only on women.

The Association of Appendectomy, Adhesions, Tubal Pathology, and Female Infertility.

Background and Objectives:The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility.Methods:We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation.Results:In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727).Conclusion:Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.

Efficient treatment of chronic endometritis through a novel approach of intrauterine antibiotic infusion: a case series

BackgroundEarly diagnosis and efficient management of Chronic Endometritis (CE) in patients seeking fertility treatment are two components every practitioner wishes to address. With respect to endometrial restoration, antibiotic treatment appears to perform well. However, regarding the improvement of In Vitro Fertilization (IVF) success rates, literature evidence is inconclusive, and consensus on optimal treatment has yet to be reached. This manuscript uniquely brings to literature the first report on effective employment of intrauterine antibiotic infusion to treat CE and contribute to addressing the infertility related to it.Case presentationIn this case series, we present 3 patients reporting numerous previous failed IVF attempts accompanied with diagnosed CE which failed to be properly treated in the past. Following initial assessment in our clinic and verification of CE findings, an oral antibiotic regime was administered based on the infectious agent detected. Re-evaluation concluded slightly improved microbiological environment in the endometrium but persisting inflammation. Antibiotic intrauterine infusion was proposed to the patients as an alternative practice. All our patients achieved a pregnancy shortly following intrauterine treatment with one patient reporting a live birth of twin babies and two patients currently reporting an ongoing pregnancy.ConclusionsThe implications of this case series contribute to medical knowledge and extend to both effective treatment of CE and subsequent management of related infertility. The current line of treatment of CE through oral antibiotic regimes highlights the need for exploring new options and calls for larger studies on the clinical implication of their use. This novel approach enabled natural conception for patients presenting with established Recurrent Implantation Failure (RIF) having undergone numerous futile IVF attempts. The clinical impact from the practitioner’s perspective is considerable allowing for an alternative line of treatment that merits further investigation.

AyoWahlbergGood Quality: The Routinization of Sperm Banking in ChinaBerkeley, CA: University of California Press, 2018. 248 p. $34.95 (pbk.)

AyoWahlbergGood Quality: The Routinization of Sperm Banking in ChinaBerkeley, CA: University of California Press, 2018. 248 p. $34.95 (pbk.)

Exposure to phthalates in couples undergoing in vitro fertilization treatment and its association with oxidative stress and DNA damage

This prospective study of 599 couples seeking fertility treatment and who were recruited between 2015 and 2017 was conducted to (a) explore the associations between phthalate exposure and in vitro fertilization (IVF) outcomes; and (b) examine the implication of oxidative stress as a mediator of these. We measured eight phthalate metabolites in two spot urine samples; oxidative stress biomarkers such as malondialdehyde, 8-hydroxy-2-deoxyguanosine, hydrogen peroxide, catalase (CAT), and total antioxidant capacity in follicular fluid and seminal plasma. We also examined DNA damage in sperm and granulosa cells. Couples were exposed to a broad range of phthalate compounds and seven metabolites were detected in over 94% of the urine samples, whereas monobenzyl phthalate was found in only 24% of women and 26% of men. Our results showed high levels of seven urinary phthalate metabolites (except monobenzyl phthalate) and a notable increase in many oxidative stress markers in both follicular fluid and seminal plasma. However, their associations with exposure were rather limited. Multivariate binomial regression modeling showed higher levels of follicular CAT levels reduced the probability of fertilization rate (≤ 50%) [Adjusted relative risk (RRadj) = 0.52, p = 0.005] and unsuccessful live birth (RRadj = 0.592, p = 0.023). We observed a 46% decrease in the probability of clinical pregnancy in association with an elevated percentage of DNA in the tail (RRadj = 0.536, p = 0.04). There was a 32% and 22% increase in the probability of clinical pregnancy and unsuccessful live birth associated with higher levels of mono-(2-ethylhexyl) phthalate (RRadj = 1.32, p = 0.049) and monoethyl phthalate (RRadj = 1.22, p = 0.032) in women, respectively. In contrast, the probability of clinical pregnancy reduced by 20% with higher levels of mono-(2-ethyl-5-carboxypentyl) phthalate (RRadj = 0.797, p = 0.037) and 19.6% with mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) (RRadj = 0.804, p = 0.041) in men. Other oxidative stress biomarkers or urinary phthalate metabolites showed suggestive relationships with certain IVF outcomes. Lastly, our results demonstrated that elevated levels of CAT in follicular fluid might have a positive impact on fertilization rate ≥ 50% and successful live birth. CAT seems to play a potential role in mediating the relationship between the risk of poor fertilization rate and MEOHP and mono-isobutyl phthalate. Additional data are required to understand the clinical implications of oxidative stress and its contribution to the reproductive toxicity of phthalate exposure.

Fertility awareness and knowledge among Indian women attending an infertility clinic: a cross-sectional study

BackgroundTo evaluate fertility knowledge and awareness among infertile women attending an Indian assisted fertility clinic and their understanding of the menstrual cycle, how age affects fertility and need for assisted fertility treatment.MethodsA cross sectional study was conducted including 205 women seeking fertility treatment at an assisted reproductive unit between March 2017 to August 2017. Patients were interviewed with the help of structured questionnaire by a fertility counsellor. The previous studies were reviewed and a questionnaire was made according to our patient profile and sociodemographic characteristics. Knowledge and awareness was stratified according to socioeconomic status (SES).ResultsMost women (59%) were aged between 20 to 30 years indicating concern about their fertility and need for evaluation. More than half (63%) women were from the middle socio-economic strata. Knowledge about fertility and reproduction was low: 85% were not aware of the ovulatory period in the menstrual cycle, only 8% considered age more than 35 years as the most significant risk factor for infertility and most were unaware of when to seek treatment for infertility after trying for pregnancy. Less than half of women understood the need for assisted fertility treatment and donor oocytes in advanced age.ConclusionsMost Indian women across different SES are unaware of the effect of age on fertility. Targeted educational interventions are needed to improve knowledge regarding ideal age of fertility, factors affecting fertility potential and fertility options available for sub-fertile couples. Fertility counselling and information should be provided to young people at every contact with health care professionals.

The Association of Urinary Phosphorous-Containing Flame Retardant Metabolites and Self-Reported Personal Care and Household Product Use among Couples Seeking Fertility Treatment

Background Phosphorous-containing flame-retardants (PFRs) are widely detected. Increased exposure to PFRs has been associated with disrupting the endocrine and reproductive systems of animals and h...

Public perspectives on placing age limits on men and women seeking fertility treatment

While the ASRM recommends that fertility treatments of women over the age of 55 should be discouraged, there are no suggested age guidelines for men. The objective of this study was to assess the US general public’s opinion regarding the upper age limit of parenthood and attitudes toward placing age limits on both men and women seeking fertility treatment. Cross-sectional web-based survey A nationally representative sample of adult US residents (balanced on gender, race and ethnicity, and age) completed an online questionnaire in February 2016. Demographic characteristics associated with support for age limits on men and women seeking fertility treatment, as well as with discordant responses (supporting age limits for one gender but not the other), were evaluated. Respondents who support age limits were compared with those who were neutral or in opposition using chi-squared tests and log binomial regression, adjusted a priori for age and gender, to calculate risk ratios (RR) and 95% confidence intervals (CI). Of the 1,574 respondents, 1,427 (91%) completed the survey. 46% of respondents felt that the oldest age a woman should carry a pregnancy was 45-54 years. 32% respondents that felt that the oldest age a woman should become a non-biological mother (such as adoptive, or using a gestational carrier with donor egg) was 55-64. Similarly, 473 (33%) respondents felt that the oldest age a man should become a father (biological or adoptive) was 55-64. Support for placing age limits on women and men seeking fertility treatments were 70% and 57% of respondents, respectively. While 55% supported placing age limits on both men and women, 213 (15%) answered discordantly, with 12% supporting age limits on women but not men, and 3% supporting age limits on men but not women (p<0.0001). Male survey respondents were more likely to answer discordantly when compared to female respondents (RR: 1.45, CI 1.08-1.95). Individuals older than 50, who lived in the Western US, or had a personal knowledge of someone who used ART were more likely to support age limits on both women and men seeking fertility treatments. Republicans (compared to Democrats) were more likely to support age limits on women. Sexual minorities (compared to heterosexuals), people without biological children, and single, long-term partnered and divorced/widowed respondents (compared to married respondents) were less likely to support age limits on men or women seeking fertility treatments. 55% of respondents in a nationally representative sample support upper age limits on both men and women seeking fertility treatments. Support was associated with various demographic characteristics. Men were more likely than women to support age limits only on women.

The fertility quality of life and sexual dysfunction in men seeking fertility treatment

The fertility quality of life and sexual dysfunction in men seeking fertility treatment

Prevalence of fragile X premutation carriers among female patients seeking fertility treatments

Prevalence of fragile X premutation carriers among female patients seeking fertility treatments

The effect of endometriosis on live birth rate and other reproductive outcomes in ART cycles: a cohort study.

Study questionWhat is the effect of endometriosis compared to unexplained subfertility on live birth rate in women undergoing IVF and embryo transfer (ET)?Summary answerEndometriosis decreases live birth rate in women undergoing IVF-ET treatment, particularly with increasing severity of the disease.What is known alreadyEndometriosis affects up to 50% of women seeking fertility treatment and is known to reduce fecundity. There remains a debate as to effects of endometriosis on the outcomes of IVF treatment, with live birth being a secondary outcome or not reported in most studies.Study design, size, durationA retrospective cohort study analyzing data of IVF treatment cycles from January 2000 to December 2014 was carried out.Participants/materials, setting, methodsWomen with endometriosis (n = 531) and women with unexplained subfertility (n = 737) undergoing a first cycle of IVF-ET in a tertiary fertility treatment center were included in the study. The primary outcome was live birth. Other outcome measures were response to ovarian stimulation, embryo development and implantation rate. Bivariate and multivariate logistic regression analysis was performed and differences compared using Chi squared test of Student’s t-test as appropriate.Main results and the role of chanceWomen with endometriosis had 24% less likelihood of a live birth when compared to those with unexplained subfertility [odds ratio (OR) 0.76 (95% CI, 0.59–0.98) P = 0.035]. This effect became more apparent with increasing severity of endometriosis. Using multivariable logistic regression analysis, the trend for lower live birth rate remained but did not reach statistical significance [adjusted OR 0.76 (95% CI 0.56–1.03), P = 0.078]. Women with endometriosis were as likely as those with unexplained subfertility to have a singleton live birth when two embryos were transferred as opposed to a single ET [OR 1.38 (95% CI 0.73–2.62), P = 0.32 and OR 3.22 (95% CI 1.7–6.05), P = 0.0003, respectively]. Compared to women with unexplained subfertility, those with endometriosis had fewer oocytes retrieved [(10.54 (95% CI 10.13–0.95) and 9.15 (95% CI 8.69–9.6), respectively], lower blastocyst transfer [OR 0.24 (95% CI 0.12–0.5), P = 0.0001] and a significantly reduced implantation rate [OR 0.73 (0.58–0.92), P = 0.007].Limitations reasons for cautionThe study is limited by a retrospective design. By limiting the study to a single ET cycle, it was not possible to assess the cumulative outcome including use of all frozen embryos.Wider implications of the findingsEndometriosis has similar phenotypes among women in different populations and would be expected to have a similar effect on fertility. These results are therefore generalizable to other populations of women.Study funding/competing interest(s)None.Trial registration numberNot applicable.

Association of Thyroid Function and Autoimmunity with Ovarian Reserve in Women Seeking Infertility Care.

While overt thyroid disease is a well known risk factor for infertility, the potential consequences of mild thyroid dysfunction or thyroid autoimmunity remain unknown. Experimental studies suggest a considerable role for thyroid hormone in the physiological mechanisms of ovarian reserve, but translation of such findings to human studies remains rare. A potential role for thyroid function in female reproduction could be especially relevant when the cause of infertility remains unknown, such as in women with diminished ovarian reserve (DOR) or unexplained infertility. The aims of this study were to investigate the association of thyroid function and autoimmunity with markers of ovarian reserve day 3 follicle-stimulating hormone (FSH) concentrations and antral follicle count (AFC), and to investigate whether thyroid function or autoimmunity may have different effects in women with DOR or unexplained infertility. Thyrotropin, free thyroxine, thyroxine, free triiodothyronine (fT3), triiodothyronine, thyroid peroxidase antibodies (TPOAbs), and thyroglobulin antibodies (TgAbs), as well as AFC and the day 3 FSH concentration, were measured among women seeking fertility treatment at the Massachusetts General Hospital Fertility Center. Multiple linear or mixed regression models were used to study the association of thyroid function or autoimmunity with AFC or day 3 FSH. In the total study population (436 women, 530 AFC measurements), there was no association of thyroid function or TPOAb positivity with AFC. However, TgAb positivity was associated with a higher AFC (mean difference = 3.4 [95% confidence interval (CI) 1.8-5.1], p < 0.001). In women with DOR or unexplained infertility, lower fT3 and TPOAb positivity were associated with a lower AFC (fT3: continuous nonlinear association, p = 0.009; TPOAb positivity: -2.3 follicles [confidence interval -3.8 to -0.5], p = 0.01), while TgAb positivity was not associated with AFC. Neither thyroid function nor thyroid antibody positivity was associated with the day 3 FSH concentration. This study found that lower fT3 and TPOAb positivity are associated with a lower AFC in women with DOR or unexplained infertility. Future studies are required to replicate these findings and further elucidate the role of TgAbs and underlying mechanisms through which thyroid function and autoimmunity is associated with ovarian reserve.

Infertility patients' need and preferences for online peer support.

This study sought to determine the level of interest in online peer support among infertility patients, factors associated with such interest, and preferences for features of an online peer support network. A sample of 236 men and 283 women (n = 519) seeking fertility treatment were recruited from four clinics in Ontario and Quebec, Canada. Participants completed an anonymous online questionnaire assessing demographics, perceived stress and fertility characteristics, in addition to interest in and preferences for online infertility peer support. Most men (80.1%) and women (89.8%) expressed interest in online peer support, with perceived stress being related to interest among both men and women. Non-White ethnicity and lower income were related to greater interest among men. Patients reported a preference for mobile accessibility, monitored peer-to-peer communication, and links to information. Men and women, particularly those with high levels of perceived stress, expressed interest in online peer support and shared similar preferences for features irrespective of fertility characteristics. Demographic characteristics and perceived stress were related to a desire for more personalized support options.

Paternal age and assisted reproductive technology: problem solver or trouble maker?

In our society, the number of couples with advanced reproductive age seeking fertility treatment is increasing steadily. While the negative effect of female age on assisted reproductive technology (ART) outcomes is well established, the impact of paternal age needs to be clarified. We reviewed the current literature to determine whether advanced paternal age affects the results of ART and the health of resulting offspring. We found that the published literature is overall supportive of a positive association between advanced paternal age (>40 years) and semen quality deterioration. However, the existing evidence does not corroborate nor discard the influence of advanced paternal age on ART outcomes. Similarly, the effect of paternal age on the health of ART offspring remains equivocal, although data from naturally-conceived children clearly indicates that advanced paternal age increases the frequency of genetic, neurodevelopmental, and psychiatric diseases in the progeny. Noteworthy, the current literature is limited and subjected to bias due to the impact of maternal age as a critical confounder. Health care providers should discuss with concerned couples the available options to counteract the possible negative influence of advanced paternal age on ART outcomes and health of resulting offspring. These include identification and treatment of underlying conditions with potential negative long-term effects on fertility, sperm freezing at a young age, and use of antioxidant supplements for men at risk of excessive oxidative stress. Aged male partner from couples undergoing ART, in particular men of 50 years and older, should consider use of preimplantation genetic testing as a means to detect embryo abnormalities and select euploid embryos for transfer to the uterine cavity.

045 The Fertility quality of life and Sexual dysfunction in men seeking fertility treatment

To investigate the fertility quality of life (FertiQoL) and the prevalence of erectile dysfunction (ED) and premature ejaculation (PE) in infertile men. 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 simplified International Index of Erectile Function (IIEF-5), ejaculation status was determined by the PE diagnostic tool (PEDT), and the quality of life was measured using the FertiQoL tool. Reliability analyses for the FertiQoL tool demonstrate a sufficiently strong fit (Cronbach’s alpha=0.891). Social and relational domains of FertiQoL were lower in infertile men compared with that reported in other countries. ED and PE were found in 125 (35.6%) and 90 (25.6%) subjects respectively. The emotional, mind/body, relational and social domain scores of FertiQoL were positively associated with the IIEF-5 score whereas the scores were negatively associated with the PEDT score. In a logistic multivariate model, emotional, relational and social domains were significantly associated with ED, while only the emotional domain was related to PE. Furthermore, our data suggested that overweight, extended family, smoking, male factor infertility and primary infertility are risk factors for ED and PE, while the duration of infertility only affect erectile function. However, the education level, family income and the treatment of infertility had no significant effect on sexual experience.

Fertility patients demonstrate an unmet need for the provision of psychological information: A cross sectional study

ObjectivesTo examine the provision of information by health care providers (HCPs) to fertility patients about accessing psychological resources. MethodsThis study utilized data from a cross-sectional survey of 659 male and female patients seeking fertility treatment at clinics in Toronto and Montreal. Regression analyses were used to assess if sociodemographic and treatment variables were associated with the receipt of information, the desire for information, the helpfulness of the information, and the likelihood that participants had sought counselling. ResultsThe majority of respondents (79.8%) said that their HCP had not given them information about accessing psychological resources. Of the patients who did not receive this information, most (60%) said that they wanted it. Regression analysis revealed that immigrants, women, and patients with higher perceived stress scores were significantly more likely to desire this information. Furthermore, having received this information was associated with increased odds of counselling seeking (odds ratio = 3.31, p = 0.013). ConclusionFertility patients demonstrated an unmet need for information about accessing psychological resources, and HCPs may play an integral role in bridging this information gap. Practice ImplicationsTo improve the patient-centeredness of fertility care, HCPs should be proactive in informing all patients about how to access psychological resources.

A pilot longitudinal study of anti-Müllerian hormone levels throughout gestation in low risk pregnancy.

BackgroundAnti‐Mϋllerian hormone (AMH) plays an important role regulating ovarian sensitivity to follicle‐stimulating hormone and luteinizing hormone in folliculogenesis. Anti‐Mϋllerian hormone is well established as a biomarker of ovarian reserve but may also have utility in predicting pregnancy outcomes. Few studies have described AMH levels in pregnancy and, among those that have, most have used cross‐sectional study designs and are limited to participants seeking fertility treatment. Our aim was to analyze AMH longitudinally in low‐risk pregnancies.MethodsWe conducted a prospective cohort study at Baystate Medical Center, a large tertiary care hospital in Springfield, MA, USA. We recruited women (n = 30) with low risk, singleton pregnancies, aged 18 to 35 years, with BMI between 18 and 40 kg/m2, and without preexisting disease. Anti‐Mϋllerian hormone (pmol/L) was measured in plasma samples collected at 5 prenatal care visits throughout gestation.ResultsAnti‐Mϋllerian hormone levels varied significantly over gestation (Friedman's analysis of variance, P value < .0001). At gestational weeks 7 to 10, average AMH was 36.7 pmol/L (standard error = 8.1) and at weeks 34 to 37 was 9.5 pmol/L (standard error = 1.9). Initial AMH varied between women, and an overall significant log‐linear decline was observed.ConclusionsAnti‐Mϋllerian hormone varies between women and declines exponentially during pregnancy. The biological mechanism of the heterogeneity of AMH decline over gestation is unclear. Future studies evaluating AMH throughout pregnancy that also assess gravid health and pregnancy outcomes are warranted.