Seeking Infertility Treatment Research Articles

Prevalence of endometriosis in women undergoing laparoscopic surgery for various gynecological indications: a Jordanian multi-center retrospective study

BackgroundEndometriosis, a condition that significantly impacts the quality of life for affected women, manifests with a spectrum of symptoms ranging from mild discomfort to severe pelvic pain, dysmenorrhea, dyspareunia, and infertility. A previous single-center study suggested an elevated prevalence of endometriosis in Jordan, prompting the need for larger studies to confirm these findings.MethodsWe conducted a cross-sectional study involving a sample of 866 women who underwent various laparoscopic procedures for different indications at the Department of Obstetrics and Gynecology at Jordan University Hospital and Al-Karak Governmental Hospital, two tertiary referral hospitals in Jordan between January 2015 and March 2023.ResultsOur study included 866 patients who underwent gynecological laparoscopic surgery between 2015 and 2023, with a mean age of 33.80 ± 7.7 years. Of these, 89 women were diagnosed with endometriosis, resulting in an overall prevalence of 10.3%. Diagnostic laparoscopy was the most common procedure, performed on 28.4% of patients. Infertility was the most common indication, observed in 34.5% of patients. Endometriosis was significantly more prevalent in patients with chronic pelvic pain (29.7%) and less prevalent in those seeking treatment for infertility (13.8%), ectopic pregnancy (1.1%), and family planning (0%). Endometriosis was significantly less prevalent in patients undergoing laparoscopic salpingectomy or salpingostomy (3.7%). Backstep-wise multivariate regression analysis suggested that endometriosis may be associated with higher age (OR 1.04, 95%CI 1.00 to 1.07, p = 0.027), lower BMI (OR 0.92, 95%CI 0.87 to 0.98, p = 0.007), lower number of parities (OR 0.72, 95%CI 0.6 to 0.86, p < 0.001), and fewer cesarean sections (OR 0.53, 95%CI 0.32 to 0.87, p = 0.013).ConclusionThis is the most extensive Jordanian study assessing the prevalence of endometriosis in women undergoing gynecological laparoscopy. Our results suggest that the prevalence of endometriosis among Jordanian women remains high, albeit lower than previously reported. The study uncovered that age, BMI, parity number, and cesarean sections are predictors of endometriosis. Future research may explore causative reasons for the higher prevalence of endometriosis and the influence of other comorbidities, medications, and lifestyle factors.

Association of sleep disturbances with diminished ovarian reserve in women undergoing infertility treatment

With an aging population seeking infertility treatment, diminished ovarian reserve (DOR) is a prevalent indication for assisted reproductive technology (ART). This study aims to investigate the relationship between sleep parameters and DOR among women attending an infertility clinic. Methods We consecutively enrolled women attending an infertility clinic from July 2020 to June 2021. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale(ESS), and STOP-Bang Questionnaire to assess self-reported sleep quality. DOR-related indices including antral follicle count, anti-Müllerian hormone(AMH), follicle-stimulating hormone (FSH) were evaluated. A total of 979 women were enrolled, with 148 classified into the DOR group and 831 in the non-DOR group. The DOR group was notably older compared to the non-DOR group. Analysis showed that the DOR group exhibited significantly shorter sleep onset latency (p = 0.001) and shorter total sleep duration (p = 0.014) compared to the non-DOR group. Logistic regression analysis identified age, PSQI-sleep latency, and PSQI score as independent factors associated with an increased risk of DOR(all p < 0.05). Furthermore, stratified analysis by age group revealed that snoring and PSQI-sleep latency were particularly notable risk factors for DOR among women aged 35 years and older (OR = 2.489, p = 0.040; OR = 2.007, p = 0.008, respectively). Our study highlights that shorter sleep onset latency and shorter total sleep duration may be associated with DOR among women undergoing ART treatments. Particularly noteworthy, snoring and sleep latency were identified as additional risk factors for DOR among women aged 35 years and older.

Phosphatidylserine-Positive Live Sperm as a Biomarker of Fertility Status: Evidence from Patients Undergoing Varicocele Treatment

Purpose: Phosphatidylserine exposed on live and motile sperm is necessary for sperm:egg fusion, and emerging data suggest it is a biomarker for fertilization competent sperm. Men with varicocele often display infertility, and one of the known causes is poor sperm quality. Here, we sought to determine whether the percentage of phosphatidylserine-positive live sperm (PS+ live sperm) could serve as a reliable indicator of male fertility. Materials and Methods: Semen samples from cryo-banked pregnancy-proven donors, from self-identified pregnancy-reported donors, and from men seeking infertility treatment for varicocele were analyzed for phosphatidylserine exposure on live sperm. Semen samples were also analyzed premicrosurgical and postmicrosurgical varicocele repair to determine whether varicocele repair led to a change in the percentage of PS+ live sperm. Results: Semen samples from “pregnancy-proven” donors (n = 31) had 82% ± 2% PS+ live sperm and samples from “self-identified pregnancy-reported” donors (n = 34) had 87% ± 1%. Men presenting with a varicocele (n = 80) had significantly lower PS+ live sperm with 68% ± 3%. PS+ live sperm correlated with reported pregnancies in patients with varicocele, whereas total motile sperm count did not. Varicocele repair (n = 10) led to a significant increase in PS+ live sperm, and 2 of the patients reported pregnancies after varicocele repair. Conclusions: These results suggest that the percentage of PS+ live sperm in an ejaculate correlates with male fertility status and could help in guiding treatment options for patients with varicoceles.

(079) RELIGION’S IMPACT ON DECISION MAKING AND COPING FOR MALE-FACTOR INFERTILITY COUPLES

Abstract Introduction With ideas such as God’s command to “be fruitful and multiply” in both Jewish and Christian texts and the Vatican’s disapproval of the use of in vitro fertilization (IVF), religious identities of male-factor infertility patients may affect how patients engage in reproductive health care. Objective The goal of this study is to assess the saliency of religious beliefs on the male-factor infertility patient. Methods A REDcap survey was sent to patients who presented for an infertility visit between 10/2/2022-10/2/2023. Using a 4-point Likert Scale and written responses, participants reflected on their religion’s role in their selection of treatment. Written responses were analyzed for common themes and results were reported using descriptive statistics. Results 73% of respondents (n = 285/392) identified with a religion (90% a form of Christian, 3.2% Non-Orthodox Jewish, 3.2% Muslim, and 3.6% Other Religions). Non-Denominational (ND) or Protestant (P) Christians, Catholics, and Muslims reported that their religion encouraged the use of expanded infertility treatment rather than caused hesitancy (Table 1). Among written responses, IVF or Intrauterine Insemination was the most suggested infertility treatment (47.5% (n = 19/40)), and donor sperm or egg was the most discouraged (52% (n = 12/23)). Muslims were most likely to report discouragement of donor sperm or egg (n = 6/9 (66.7% of Muslims)). 243 participants provided written insight into their religious views of infertility treatment. Aside from no religious impact (45.7%), the most common themes were: no personal conflict with religious views (20.7%), reproduction as a core religious tenet (10.7%), and the unity of religion and science (9.9%). A small number of participants (7.9%) discussed having disagreed with or gone against their religion’s views, the majority of which were Catholic (n = 13/17 (76.5%)). Conclusions Religion was an encouraging factor for most male patients seeking infertility treatment. However, physicians should still take care to acknowledge differences among religions, recognizing that certain treatment options may cause discomfort in religious patients. Disclosure No.

Target trial emulation of preconception serum vitamin D status on fertility outcomes: a couples-based approach

To evaluate associations between preconception 25-hydroxyvitamin D (25(OH)D) levels and biomarkers in female and male partners on live birth (LB), pregnancy loss, and semen quality. Secondary analysis using the folic acid and zinc supplementation trial of couples seeking infertility treatment at four US centers (2013-2017). A target trial emulation framework was applied to estimate associations. Couples were observed for 9 months or through pregnancy. Clinics that provide reproductive endocrinology and infertility care in the US. Couples seeking infertility treatment. Preconception concentrations of 25(OH)D (primary) and associated biomarkers: vitamin D binding protein, calcium, free vitamin D, bioavailable vitamin D. Live birth and pregnancy loss were ascertained via self-report and medical records. Semen quality was ascertained 6 months after enrollment. Log-binomial regression estimated risk ratios and 95% confidence intervals (CIs). Individual and joint models and effect measure modification by preconception body mass index were considered. Among 2,370 couples, 19.5% of females and 29.9% of males were 25(OH)D deficient. Females with sufficient status had a 28%-higher likelihood of LB than deficient females (95% CI, 1.05-1.56). Female and male 25(OH)D status were associated with LB among those with normal body mass index (sufficient vs. deficient: female adjusted risk ratio [aRR], 1.39; 95% CI, 1.00-1.99; male aRR, 1.51; 95% CI, 1.01-2.25) and among obese female partners (sufficient vs. deficient: aRR, 1.33; 95% CI, 0.95-1.85). Couples whose both partners had higher 25(OH)D status had increased likelihood of LB (both not deficient vs. both deficient aRR, 1.26; 95% CI, 1.00-1.58). No associations were observed with pregnancy loss or semen quality. Similar results were found for all biomarkers except calcium. Preconception vitamin D status and bioavailability impact fertility among couples seeking infertility therapy, likely unrelated to semen quality. Body mass index stratified analyses demonstrated heterogeneous associations. NCT01857310.

Exploring depressive symptoms and coping strategies in Chinese women facing infertility: A cross-sectional observational study.

Infertility can lead to significant psychological distress among women, yet the roles of hope and resilience in mitigating depressive symptoms remain inadequately explored, particularly within the Chinese context. We performed a cross-sectional observational study to investigate the psychological impacts of infertility among Chinese women as well as to discern whether hope and resilience can influence their depressive symptoms. We recruited 364 Chinese women seeking infertility treatment in the Shandong region. Participants completed validated assessments including the Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale, and Herth Hope Index. Demographic and clinical data were also collected. We observed elevated levels of depressive symptoms and anxiety among women with infertility. Particularly, demographic factors such as an older age, rural residence, lower income, lower education, adverse life events, and longer infertility duration were associated with increased depressive symptoms. Individuals who experienced adverse life events were at a 2.42-fold increased risk of developing depressive symptoms (P = .04). Depressive symptoms were inversely correlated with both hope levels (r = -0.25; P < .05) and resilience levels (r = -0.32; P < .05). Hope levels were positively correlated with resilience (R = 0.67; P < .05). After controlling for the interaction of hope and resilience, we found that only depressive symptoms and resilience were negatively correlated. The psychological burden of infertility among Chinese women is widespread and affects many individuals from different demographic backgrounds. Interventions aimed at increasing resilience may be helpful to mitigate depressive symptoms.

Risks of Placental Abruption and Preterm Delivery in Patients Undergoing Assisted Reproduction

Patients using assisted reproductive technology (ART) may need additional counseling about the increased risks of placental abruption and preterm delivery. Further investigation into the potential additive risk of ART and placental abruption is needed. To ascertain the risk of placental abruption in patients who conceived with ART and to evaluate if placental abruption and ART conception are associated with an increased risk of preterm delivery (<37 weeks' gestation) over and above the risks conferred by each factor alone. This cross-sectional study used data from the National Inpatient Sample, which includes data from all-payer hospital inpatient discharges from 48 states across the US. Participants included women aged 15 to 54 years who delivered from 2000 through 2019. Data were analyzed from January 17 to April 18, 2024. Pregnancies conceived with ART. Risks of placental abruption and preterm delivery in ART conception compared with spontaneous conceptions. Associations were expressed as odds ratios (ORs) and 95% CIs derived from weighted logistic regression models before and after adjusting for confounders. The relative excess risk due to interaction (RERI) of the risk of preterm delivery based on ART conception and placental abruption was also assessed. Of 78 901 058 deliveries, the mean (SD) maternal age was 27.9 (6.0) years, and 9 212 117 patients (11.7%) were Black individuals, 14 878 539 (18.9%) were Hispanic individuals, 34 899 594 (44.2%) were White individuals, and 19 910 807 (25.2%) were individuals of other races and ethnicities. Of the total hospital deliveries, 98.2% were singleton pregnancies, 68.8% were vaginal deliveries, and 52.1% were covered by private insurance. The risks of placental abruption among spontaneous and ART conceptions were 11 and 17 per 1000 hospital discharges, respectively. After adjusting for confounders, the adjusted OR (AOR) of placental abruption was 1.42 (95% CI, 1.34-1.51) in ART pregnancies compared with spontaneous conceptions, with increased odds in White women (AOR, 1.42; 95% CI, 1.31-1.53) compared with Black women (AOR, 1.16; 95% CI, 0.93-1.44). The odds of preterm delivery were significantly higher in pregnancies conceived by ART compared with spontaneous conceptions (AOR, 1.46; 95% CI, 1.42-1.51). The risk of preterm delivery increased when patients had both ART conception and placental abruption (RERI, 2.0; 95% CI, 0.5-3.5). In this cross-sectional study, patients who conceived using ART and developed placental abruption had a greater risk of preterm delivery compared with spontaneous conception without placental abruption. These findings have implications for counseling patients who seek infertility treatment and obstetrical management of ART pregnancies.

Burden of Infertility, Its Risk Factors, Perceptions and Challenges Faced by Women of Peri-urban Community from Ahmedabad City: Mixed Method Study.

Infertility is globally prevalent and India accounts for 25% of the global burden, but it is still a neglected reproductive health issue. To estimate the prevalence of infertility, its determinants, perception and challenges faced by couples from the peri-urban area of Ahmedabad City. A community-based cross-sectional study was conducted in peri-urban areas of Ahmedabad City. For quantitative data collection, 689 couples were selected through probability proportion-based sampling (PPBS). Data was collected through a questionnaire during (1) phase I for socio-demographic details of the community and identification of eligible couples, (2) phase II for assessing the presence of infertility and its risk factors along with the assessment of depression and anxiety, and (3) phase III for Clinico-social profiling of all infertile couples (detected during second phase). Some of these women were involved in qualitative components to know the perceptions, challenges, etc. faced while seeking infertility treatment. Study population of 917 families (n = 3891) yielded 689 women of reproductive age group (RAG) with a period prevalence of 7.4% (5.5%-9.4%); separately being 3.5% and 3.9% for primary and secondary type respectively. Socio-demographic determinants like age, education, occupation, addiction, and lifestyle-related illnesses like diabetes and hypertension exhibited no significant association with infertility. However, asthma, mental illnesses, and hormonal diseases like polycystic ovarian disease (PCOD) were associated and exhibited a significant association with infertility. Preventable risk factors like reproductive tract/sexually transmitted infections (RTI/STI) showed a significantly positive association with infertility. The period prevalence of infertility was 7.4%, with the secondary type being more common. Asthma, mental illness, RTI/STI and age at menarche showed significant association. Screening and treatment for RTI/STI can prevent complications like infertility. Stigma associated with infertility and lack of treatment facilities in the government sector makes it difficult to deal with and neglected health problems.

Emotional risk factors before in vitro fertilization among infertile couples in daily clinical practice in Sari in 2020–2022

Background and AimThe relationship between psychological factors and treatment outcomes with assisted reproductive technology has sparked considerable debate. This study aims to investigate the emotional risk factors in couples seeking infertility treatment using assisted reproductive technology in Sari, Iran, from 2020 to 2022.Materials and methodsThis research is a cross-sectional study and emotional risk factors and other related factors were examined using the Persian version of the SCREENIVF demographic, social, and clinical status questionnaire, social, and clinical status questionnaire before using Assisted reproductive technology in 460 infertile couples selected from infertility treatment centers in Sari City, Iran. The samples were randomly selected using a table of random numbers. Data analysis was performed using SPSS version 22 software.ResultsThe mean age of the male and female participants were 31.70 ± 5.71 and 35.22 ± 5.48, respectively. The results regarding emotional risk factors and other related factors revealed that the variables of remarriage (P = 0.048) and exposure of spouse to emotional risk factors (P = 0.001), history of depression disorder (P = 0.007), and history of anxiety disorder (P = 0.009) were significantly correlated with the exposure of women to emotional risk factors. Furthermore, men’s exposure to emotional risk factors was significantly correlated with primary education (P = 0.026) and diploma (P = 0.043) levels, age (P = 0.006), and wife’s exposure to emotional risk factors (P = 0.001).ConclusionBy identifying infertile couples who are at risk of emotional risk factors, healthcare professionals can provide appropriate support and interventions to mitigate the emotional challenges associated with infertility. This proactive approach can significantly enhance couples undergoing infertility treatment’s well-being and mental health.

Klinefelter syndrome: etiology and clinical considerations in male infertility†.

Klinefelter syndrome (KS) is the most prevalent chromosomal disorder occurring in males. It is defined by an additional X chromosome, 47,XXY, resulting from errors in chromosomal segregation during parental gametogenesis. A major phenotype is impaired reproductive function, in the form of low testosterone and infertility. This review comprehensively examines the genetic and physiological factors contributing to infertility in KS, in addition to emergent assisted reproductive technologies, and the unique ethical challenges KS patients face when seeking infertility treatment. The pathology underlying KS is increased susceptibility for meiotic errors during spermatogenesis, resulting in aneuploid or even polyploid gametes. Specific genetic elements potentiating this susceptibility include polymorphisms in checkpoint genes regulating chromosomal synapsis and segregation. Physiologically, the additional sex chromosome also alters testicular endocrinology and metabolism by dysregulating interstitial and Sertoli cell function, collectively impairing normal sperm development. Additionally, epigenetic modifications like aberrant DNA methylation are being increasingly implicated in these disruptions. We also discuss assisted reproductive approaches leveraged in infertility management for KS patients. Application of assisted reproductive approaches, along with deep comprehension of the meiotic and endocrine disturbances precipitated by supernumerary X chromosomes, shows promise in enabling biological parenthood for KS individuals. This will require continued multidisciplinary collaboration between experts with background of genetics, physiology, ethics, and clinical reproductive medicine.

Effect of intraovarian platelet-rich plasma injection on IVF outcomes in women with poor ovarian response: the PROVA randomized controlled trial.

Does intraovarian platelet-rich plasma (PRP) injection increase the number of mature oocytes obtained after controlled ovarian stimulation (COS) in young women with poor ovarian response (POR) undergoing IVF? Intraovarian PRP injection procedure does not improve mature oocyte yield after COS in women less than 38 years old with an established IVF history of POR. POR is frequently encountered among the infertile population and the number of women seeking infertility treatment related to POR is increasing. Effective treatment options for this patient population to conceive with autologous oocytes are lacking. Case series and cohort studies suggest that intraovarian PRP injection may improve follicular recruitment in women with premature ovarian insufficiency (POI) and POR, yet robust randomized studies have not been performed to date to determine the clinical utility of this intervention. This was a multi-center randomized controlled trial (RCT) conducted at university-affiliated reproductive centers in the USA and Turkey, between January 2020 and November 2022. Patients who met inclusion criteria (<38 years old, two or more prior cycles with <3 oocytes retrieved; and without single gene disorders, prior ovarian surgery, endometriomas, BMI >35 kg/m2, or severe male factor infertility) were randomized to either the PRP or control group. Patients in both groups subsequently underwent COS, oocyte retrieval, ICSI, preimplantation genetic testing for aneuploidy (PGT-A), and single euploid embryo transfer. Number of metaphase II (MII) oocytes obtained was the primary outcome. Secondary outcomes included ovarian reserve tests (antral follicle count [AFC] and anti-Müllerian hormone [AMH]), blastocyst and euploid blastocyst yields, and sustained implantation. The study was powered to detect a difference of one mature oocyte obtained at oocyte retrieval. In total, 83 patients met inclusion criteria and were randomized to receive autologous intraovarian PRP injection (n = 41) or to no intervention (n = 42). No significant differences were observed in number of MII oocytes retrieved per cycle (2.8 ± 2.4 vs 3.1 ± 3.3 in PRP vs control, respectively; P = 0.9), blastocysts (1.0 ± 1.3 vs 1.3 ± 2.1, P = 0.8), or euploid blastocysts (0.8 ± 1.1 vs 0.9 ± 1.6; P = 0.5). Similarly, no differences were observed in the likelihood of obtaining at least one euploid blastocyst (45% vs 37%, P = 0.4; relative risk [RR], 95% CI = 0.9, 0.6-1.2) or the rate of sustained implantation (31% vs 29%, P = 0.9; RR 1.0, 0.7-1.3). Posttreatment AFC (7.9 ± 4.5 vs 6.8 ± 4.8, P = 0.3) and AMH (0.99 ± 0.98 vs 0.7 ± 0.6, P = 0.2) were also not different between the groups. Results from this RCT may not be generalizable to other PRP preparations owing to heterogeneity and lack of standardization. The control groups did not undergo a sham ovarian injection, which would have been relevant had the results shown benefit of PRP injection. Only patients with POR were included in this study, and these results may not be generalizable to more severe diminution of ovarian reserve, as seen with POI. The intraovarian PRP injection procedure does not improve mature oocyte yield or other parameters of IVF outcome in women less than 38 years old with an established IVF history of POR. The results from this study do not support the use of intraovarian PRP injection in this population. Departmental funds were used and no external funding was requested for this study. ES is a consultant for and receives grant funding from the Foundation for Embryonic Competence. All other authors have no conflict of interest to declare. Clinicaltrials.gov Registry Identifier: NCT04163640. 15 November 2019. 24 February 2020.

Anxiety, Depression, and Quality of Life Among Infertile Women: A Case-Control Study.

Introduction Pregnancy holds significant cultural and social value for women. However, women facing challenges in conceiving often grapple with emotional distress, including depression and anxiety. The connection between psychological elements (stress, anxiety, and depression) and infertility is complex, influenced by multiple factors, and bidirectional. Infertile women are more likely to develop mental illnesses, marital dissatisfaction, and impaired quality of life compared to the individuals of the fertile group. Thus, the study aimed to assess levels of anxiety, depression, and quality of life among infertile women compared to fertile women. Methods This case-control study conducted at a tertiary care center recruited 100 nulliparous women between the age group of 20 and 38 years with primary or secondary infertility, while those with male factor infertility were excluded. The control group (N=100) comprised normal parous women who had at least one child. The primary objective of the study was to assess the impact of infertility on the mental health and quality of life of women seeking infertility treatment. Outcome measures included standardized tools such as the WHOQOL-BREF questionnaire to assess the quality of life across multiple domains (e.g., physical, psychological, social, and environmental) as well as the Depression Anxiety and Stress Scale (DASS-21) to measure levels of anxiety, depression, and stress. Cronbach's alpha was used to measure the tool's reliability. A P value of <0.05 was considered statistically significant. Results Baseline sociodemographic parameters were comparable between the two groups. The mean age of infertile women was 30.6±3.9 years compared to 31.5±3.2 years in fertile women (P=0.076). Using the WHOQOL-BREF scale, we found that the quality of life was better in the fertile group compared to the infertile group through all the physical, psychological, social, and environmental domains (P<0.001). The infertile group had a significantly higher number of women with anxiety, depression, and stress. The questionnaires showed high internal reliability. Conclusion Infertile women experienced a lower quality of life in various domains, higher levels of anxiety, and increased rates of depression compared to fertile counterparts. The study findings underscore the multidimensional impact of infertility, emphasizing the need for comprehensive healthcare approaches to address the psychosocial challenges faced by women undergoing infertility treatment.

(184) The Prevalence of Sexual Dysfunction in Women Seeking Infertility Treatment in Vietnam

Abstract Introduction Sexual function plays a crucial role in women's psychosocial and overall well-being, significantly impacting their quality of life. Any decline in sexual function can have detrimental effects on the affected individuals' quality of life Objective (i) To describe the prevalence of sexual dysfunction in women seeking infertility treatment at the Andrology and Fertility Hospital of Hanoi, Viet Nam, and (ii) to analyze the factors associated with sexual dysfunction in the study population. Methods This was a cross-sectional descriptive study. All women (1.039) seeking infertility treatment at the Andrology and Fertility Hospital from December 30, 2022, to March 30, 2023 participate in the study. They were invited to scan a QR code and complete the research questionnaire. Female sexual dysfunction is assessed based on the FSFI scale included six domains: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain (comprising 19 questions). The data were extracted into Excel, cleaned, and analyzed using STATA 17.0 software. The analysis of factors associated with female sexual dysfunction was conducted using logistic regression models. Results Among the 1039 participants in the study, the mean age was 30.9±5.3 years. The overall score for female sexual dysfunction was 25.09 ± 6.20, with individual component scores. The prevalence of female sexual dysfunction was 49.7%. There is a positive correlation among the six components of female sexual dysfunction, p&amp;lt;0.01. In the multivariate regression model, the risk of female sexual dysfunction is higher among individuals who work away from home, have an underweight body mass index, have a poor relationship with their partner, have had no sexual intercourse in the past 4 weeks, experience fear of pain, anxiety, and body image concerns during sexual activity, have infrequent or no discussions with their partner regarding sexual desires, preferred positions, and stimulation, and are dissatisfied with their sexual life. Conclusions Half of the women seeking infertility in late-stage medical care experience sexual dysfunction. Factors that increase the risk of sexual dysfunction include having a job far from home, being underweight based on body mass index, having a poor overall relationship with a partner, not engaging in sexual activity in the past four weeks, fear of pain, anxiety, body image concerns during sexual intercourse, and limited or lack of communication with a partner about sexual issues such as desires, preferred positions, and stimulation. Additionally, dissatisfaction with one's sexual life contributes to the occurrence of sexual dysfunction. Therefore, early screening and timely intervention are necessary for this group of individuals. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Andrology and Fertility Hospital of Hanoi.

Anxiety, depression, and infertility-specific distress among women with female factor infertility.

This study aimed to evaluate whether anxiety, depression, and infertility-specific distress differ among women with female infertility who are trying to conceive and/or seeking infertility treatment. Women with diagnosed female factor infertility in the past 2 years (N = 188) completed demographic questions, and measures of infertility-specific distress, anxiety, and depression. The majority of the sample were actively trying to conceive (78.7%, n = 148) and approximately one third (33.5%, n = 63) were undergoing fertility treatment. Anxiety and depression scores did not differ based on trying to conceive or treatment-seeking, although these subgroups reported higher levels of need for parenthood and rejection of a childfree lifestyle. High levels of mood and anxiety are experienced by women with female infertility. Although infertility-specific distress is experienced more so by women with anxiety and depression, a substantial proportion of those without mental health conditions had high levels of distress, underscoring the need for screening and treatment.

The effect of anti mullerian hormone and follicle stimulating hormone discordance on oocyte quality and live birth rates

Evaluating ovarian reserve is crucial in infertility treatment to determine the appropriate approach and predict success rates. Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) are key parameters commonly used for this purpose, and they usually yield consistent results. A good ovarian reserve is typically indicated when FSH is below 10 IU/ml and AMH is 1 ng/ml or higher. However, in clinical practice, these parameters often conflict, with one suggesting a good ovarian reserve while the other indicates a diminished one. AMH is known to predict oocyte count effectively, but its ability to predict live births is weaker. This study aimed to investigate which parameter is more useful in predicting oocyte count, quality, and live birth outcomes in cases of discordance. This retrospective study was conducted on 82 patients who sought infertility treatment at Assisted Reproductive Techniques Center of Gülhane Training and Research Hospital between January 1, 2016, and December 31, 2020. Data collected included age, AMH and FSH levels, number of retrieved oocytes, mature (M2) oocytes, pregnancy outcomes, and embryos obtained. Statistical analyses were performed using SPSS 25.0. Normal distribution was assessed using the Kolmogorov-Smirnov test and graphical methods. Independent t-tests and One-Way ANOVA were used for normally distributed data, with a significance level set at p=0.05. Patients were divided into two groups: AMH &lt;1 ng/ml &amp; FSH ≥10 IU/ml, and AMH ≥1 ng/ml &amp; FSH &lt;10 IU/ml. Patients with AMH &lt;1 ng/ml were older and shorter (p&lt;0.05). This group also had fewer retrieved oocytes and M2 oocytes (p&lt;0.05). However, no significant differences were observed between the groups regarding live births, miscarriages, or embryo counts(p&gt;0.05). In cases of discordance, AMH is more reliable for predicting oocyte quantity and quality, while neither AMH nor FSH is superior in predicting live birth outcomes. Both markers have limitations in estimating live birth probabilities.

Silent struggles: Unveiling the unspoken epidemic of domestic violence against infertile women in Egypt

BackgroundGlobally, the issue of domestic violence (DV) against women remains a paramount concern in public health. However, a distinct facet of this challenge revolves around DV targeting women grappling with infertility, presenting a unique nexus with their overall well-being. This study endeavors to unravel the prevalence, associated determinants, and diverse manifestations of domestic violence against infertile women. MethodsThe investigation unfolded within the Center for the Diagnosis and Treatment of Delayed Reproduction and the Gynecological Outpatient Clinic at Beni-Suef University spanning from the first of March to the end of July 2022. Employing a cross-sectional descriptive approach, the study engaged 200 infertile women actively seeking infertility treatment. Data acquisition transpired through an interview questionnaire tailored for the purpose. ResultsAmong surveyed women, 69.0 % reported experiencing physical violence due to infertility, while 65.5 % reported verbal violence. Additionally, 36.5 % reported incidents of sexual violence, and 47.0 % reported being subjected to financial violence. Statistical analyses revealed noteworthy correlations between physical and verbal violence and various factors, including age (p = 0.013), types of infertility (p = 0.001), gender of children (p = 0.006, p < 0.0001), and frequency of coitus (p = 0.019, p = 0.012), respectively. Conclusion and recommendationsDomestic violence exerts a profound impact on the general well-being of women, particularly affecting their emotional and social dimensions. This study underscores a heightened prevalence of violence among infertile women, with verbal abuse emerging as the predominant form. Recognizing the pivotal role of domestic violence in women's health, it becomes imperative for healthcare professionals to proactively identify at-risk individuals. Tailored interventions, such as comprehensive training programs encompassing communication skills and problem-solving approaches, should be devised and implemented. Moreover, counseling sessions should involve both spouses, elucidating the detrimental effects and challenges associated with all forms of violence.

Risk factors for infertility and barriers to treatment in Tanzania: a survey and medical records study.

The burden of infertility is serious for women in high-fertility countries. We sought to identify demographic, behavioral/environmental, and reproductive risk factors for various infertility factors (i.e., ovarian, tubal, uterine/cervical, male/other) among women seeking infertility treatment in central Tanzania; to determine the association between pelvic inflammatory disease (PID) and tubal factor infertility (TFI); and to identify barriers to infertility treatment by women's home regional zone. We conducted a cross-sectional survey of women seeking infertility treatment in Dodoma, Tanzania from January-March 2020. We surveyed 168 participants aged 18-49 years and reviewed their medical records to confirm infertility status and potential risk factors. We estimated prevalence ratios for factors associated with infertility using logistic regression. Treatment barriers were compared by women's regional zone to see if barriers varied geographically. The median age of participants was 32 years (range: 18-48). Infertility factors did not vary greatly by patient demographics, behavioral/environmental, or reproductive risk factors. Approximately 31.48% of women had PID diagnoses. Those with PID had 1.94 (95% CI: 1.30, 2.90) times the prevalence of TFI diagnosis as those with other infertility factors, after adjusting for age, pesticide use, alcohol use, age at sexual debut, prior obstetric events, and family history of infertility. Logistical barriers to treatment, such as time and cost, were more frequently reported than emotional, stigma, or other barriers, regardless of regional zone. PID was strongly associated with TFI after adjustment for confounders. Infertility treatment access due to cost remains a challenge in Tanzania.

#330 : Factors Affect Infertile Woman to Access Infertility Services in Central Java, Indonesia

Background and Aims: Infertility is defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse and approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. However, infertility has a strong social impact in the culturally and socioeconomically diverse Indonesia, both in cities and rural areas. A woman who experiences infertility is seen as an abnormality or weakness of that person because it is closely related to her deterministic nature to conceive and give birth. The high percentage of female factors in relation to infertility and the existing studies on the infertility related factors in women leads to the researcher interest to study the factors influencing infertility in women. In this study we analyzed some factors affect access to infertility services, especially for the women. Method: This method of research is cross sectional study. An interviewer-administered survey was conducted with 30 infertile women recruited in Moewardi Hospital between April until June 2023. Participants were randomized-selected, and data was described to statistical analysis. Inclusion criteria: Women aged 20-45 years, experiencing infertility problems &gt;1 year, willing to be interviewed, seeking infertility treatment, able to conduct interviews, not currently undergoing an IVF program. Exclusion criteria: malignant disease, moderate IVF program, pregnancy. The data was analyzed using SPSS 25 and significant if the p value &lt;0.05. Results: There was a significant relationship between several factors such as discrimination (p=0.003), culture (p=0.015), and knowledge (p=0.019) to access infertility services. Meanwhile, there was no significant association between financial factors (p=0.766) and gender sensitivity (p=0.064) with access ability to infertility services among infertile women. Conclusion: Infertile women who experience discrimination, cultural pressure, and have better knowledge related to infertility will find it easier to access infertility services.

Psychometric and clinical assessment of the Persian-SCREENIVF among infertile couples

There is a significant rate of infertility and subsequent psychological problems among couples worldwide. Screening and treatment of the emotional burden of infertility and related Assistant Reproductive Therapies help to improve the quality of life of infertile people. Specific instruments which measure infertility-related status are more accurate. This study aimed to validate the SCREENIVF questionnaire to be used for the psychological screening and care of couples who seek infertility treatment. This quantitative psychometric study was run in infertility private and governmental clinics in XXX on 344 infertile women and men. They filled Persian-SCREENIVF. The Rasch-Andrich rating scale model was applied to investigate the psychometric quality of the survey. Additionally, structural equation modelling was run for model fit and construct validity as well. Moreover, multivariate analysis of variance (MANOVA) was applied to examine the effects of demographic variables on the extracted constructs of the instrument in the population of the study. The results revealed five constructs in the questions with the corresponding items. Overall, the demographic variables have no contribution to these five constructs. Persian-SCREENIVF can be used for further studies about emotional disturbances in infertility problems.

Human Menopausal Gonadotropins in Combination for Stimulation does not Improve IVF Outcomes in POSEIDON Group 4 Patients, When Compared to Recombinant Follicle Stimulating Hormone Alone: A Prospective Randomized, Non-Blinded, Controlled Pilot Trial

Background: To evaluate whether the addition of human menopausal gonadotropin (HMG) during the early follicular phase of controlled ovarian stimulation improves clinical outcomes in patients classified as group 4 on the Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number (POSEIDON) classification. Methods: A prospective, randomized, and non-blind controlled trial was conducted, involving 172 patients seeking infertility treatment with an indication for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Among them, 78 patients were randomly assigned to the HMG/follicle stimulating hormone (FSH) group, receiving 75 IU of HMG for FSH on either day 2 or day 3 of menstruation, while 94 patients were assigned to the FSH monotherapy group. Results: The total dose of gonadotropin used in the HMG/FSH group (2510.77 ± 368.11) was higher than that in the FSH alone group (2310.98 ± 641.33), indicating greater medication usage (p &lt; 0.001). In terms of the mean number of retrieved oocytes and good quality embryos, the HMG supplementation group demonstrated a slight increasing trend (3.79 and 1.43, respectively) compared to the FSH alone group (3.44 and 1.16, respectively), though these differences did not show statistical significance. There is no significant difference in the outcomes of ongoing pregnancy rates, biochemical pregnancy rates, or clinical pregnancy rates per end-cycle or embryo transfer cycle between the two groups. Conclusion: The addition of HMG to FSH during the early follicular phase for IVF/ICSI did not provide any benefits for patients classified as group 4 on the POSEIDON classification. Clinical Trial Registration: The study was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn), registration number: ChiCTR2100043040.