Subgroups Of Infertile Women Research Articles

Hysteroscopic detection of chronic endometritis: Evaluating proposed hysteroscopic features suggestive of chronic endometritis

PurposeTo evaluate the proposed criteria in a large sample and in additional subgroups in order to test the validity of the hysteroscopic features widely-accepted as suggestive of CE. Method(s)All patients (n: 2675) underwent outpatient hysteroscopy, with the vaginoscopic approach technique. Hysteroscopic features such as, stromal oedema, diffuse or focal hyperaemia, “strawberry aspect”, micropolyposis and endometrial polyps, are often indicate the presence of chronic endometritis. All hysteroscopic features, alone and in combination were applied in 7 (seven) different subgroups of the sample: total sample, women in reproductive age, women with infertility issues/IVF screening, women with history of recurrent miscarriages, menopausal women, and women with hysteroscopic indication of Abnormal Uterine Bleeding (AUB) in women of reproductive age and postmenopausal bleeding (PMB). From each case, endometrial samples were obtained and immunohistochemistry, identifying CD-138, was applied in order to diagnose CE. Result(s)A total of 2675 patients were included of which, 1444 women were found with at least one of the proposed hysteroscopic features mentioned above. Stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” in combination with micropolyposis demonstrated higher rates of diagnostic accuracy in the detection of CE correlated to histologic confirmation. Micropolyposis, stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” offer great diagnostic accuracy in the hysteroscopic detection of Chronic Endometritis, regardless reproductive status and/or clinical presentation. Endometrial polyps are not valid hysteroscopic features in cases of suspected CE. Conclusion(s)Diagnostic hysteroscopy can accurately diagnose cases of CE, based on stromal oedema, focal or diffuse hyperaemia and “strawberry aspect”, in combination with micropolyposis. In subgroups of infertile women, higher diagnostic accuracy based on the hysteroscopic features mentioned, was more likely to be achieved. Whether endometrial polyps are suggestive of CE, when identified during office hysteroscopy, remains controversial.

Unexplained infertility patients present the mostly impaired levels of progesterone receptors: Prospective observational study

Τo assess the endometrial expression of progesterone receptors in various subgroups of infertile women during implantation window. ΜETHODS: A prospective observational study was performed during March 2013-February 2017. Infertile women were categorized to those with tubal factor, ovarian failure, endometriosis or unexplained infertility. Endometrial biopsy was obtained on 7th-8th postovulatory day. Total progesterone receptors' PR(A+B) and type-B receptors' (PR-B) expression were compared between all categories of infertile and fruitful controls. There were overall 30 patients with tubal factor infertility (group 1), 30 with ovarian failure (group 2), 20 with endometriosis (group 3) and 20 with unexplained infertility (group 4). The control group consisted of 30 fertile patients. Patients with unexplained infertility presented the lowest levels of epithelial endometrial expression both regarding PR(A+B) and PR-B receptors. PgR(A+B) h-score in luminal epithelial cells was 106.4±14.7 for cases with unexplained infertility vs 219.7±15.8 for controls (P<.001). Similarly, PgR(A+B) h-score in glandular epithelial cells was 109.7±13.9 vs 220.1±17.2 (P<.001). Relative remarks were made for type-B progesterone receptors. Εndometrial expression of progesterone receptors is impaired in women with unexplained infertility. Therapeutic strategies targeting on improving progesterone receptors' expression may significantly affect final reproductive outcome.

Protein C Activity in Women With Unexplained Infertility

Objectives: The relation between thrombophilia and infertility has drawn the attention in last few years. Most studies investigating the effect of inherited thrombophilia on infertility studied the relationship between thrombophilia and implantation failure. It was found to be a possible cause of impaired implantation in some subgroups of infertile women. Still thrombophilia screening in general infertile population is unjustified and in fact may lead to increased patient anxiety after a positive test result together with the increased cost. Due to the poor information available concerning the relationship between inherited thrombophilia and infertility, we performed a case–control study in order to evaluate the prevalence of protein C activity in women with unexplained infertility. Materials & Methods: This is a case–control study conducted to evaluate the prevalence of protein C activity in women with unexplained infertility conducted at Ain-Shams University Maternity Hospital. 48 women with unexplained primary infertility and another 48 fertile women of matched age group as their control were recruited from July 2011 to January 2013. Using the BIOPHEN Protein C 2.5 assay, protein C was measured following a specific activation with Protac, an enzyme extracted from snake venom. Activated protein C (APC) then specifically cleaves the specific substrate SaPC-21, releasing para-Nitroaniline (pNA), and its color is measured at 405 nm. 2(4.2%) cases of protein C deficiency were encountered in the unexplained infertility group while none found in the control group.Results: This study failed to find relationship between protein C activity and unexplained infertility compared to normal fertile population. In spite of finding 2 cases with protein C deficiency in the unexplained infertility sample population and none in the control group, this difference failed to reach significance (P=0.495 and P=0.076 respectively).Conclusion: In conclusion, this study failed to find any association between protein C activity and unexplained infertility.

LIF endometrial expression is impaired in women with unexplained infertility while LIF-R expression in all infertility sub-groups

The main objective of our study was to study LIF and LIF-R endometrial expression during the implantation window in the various sub-groups of infertile women according to infertility cause. A prospective observational case-control study was performed from March 2013 to February 2016. Infertile women consisted of the patients’ group (group 2) while fertile women were the control group (group 1). Infertile women were divided according to infertility cause in women with tubal factor (group 2a), poor ovarian reserve (group 2b), endometriosis (group 2c) and unexplained infertility (group 2d). Endometrial biopsy was performed on 7th–8th postovulatory menstrual day. Leukemia Inhibitory Factor (LIF) and LIF-Receptor (LIF-R) expression in epithelial and stromal cells were assessed with Immunohistochemistry (IHC). There were 20 infertile with poor ovarian reserve, 15 with tubal factor, 10 with endometriosis and 15 with unexplained infertility included in the analysis. LIF expression in patients with unexplained infertility was significantly compared with controls (P=0.006). No significant difference was observed between patients with tubal factor, poor ovarian reserve and endometriosis compared with control group (P=0.78, P=0.44 and P=0.56 respectively). Analysis of LIF-R expression in sub-categories of infertility indicated that expression was significantly decreased in all sub-groups of infertility. Our study indicated impaired LIF expression levels only in women with unexplained infertility, while LIF-R expression was impaired in all sub-groups of infertile women. Further multicenter prospective studies should be performed in order to assess the exact etiopathogenetic role of these cytokines in the molecular background of infertility.

Sexual functioning and quality of life of Hong Kong Chinese women with infertility problem

Infertility is estimated to affect 10–15% of couples in industrialized countries and many of them are under tremendous stress. Stress can lead to poor quality of life and sexual dysfunction in general, but little is known about their prevalence in infertile women. We, therefore, conducted this cross-sectional survey in two primary care subfertility clinics between August 2012 and April 2013. A total of 159 women completed two validated Chinese questionnaires: Female Sexual Function Index and core Fertility Quality of Life. The overall Female Sexual Function Index score (mean ± SD) of the whole group was 24.99 ± 4.22. Using the urban Chinese cut-off, the prevalence of female sexual dysfunction, low desire, arousal disorder, lubrication disorder, orgasmic disorder and sexual pain were 32.5%, 15.7%, 19.3%, 22.3%, 33.1% and 15.1%. The core Fertility Quality of Life score of the whole group was 59.76 ± 13.59 and the subgroup of infertile women with sexual dysfunction (n = 50) had significantly lower mean core Fertility Quality of Life score than those without sexual dysfunction (n = 109) (55.03 versus 61.88) (p = 0.005). Among the subscales, the relational score had the strongest correlation with sexual dysfunction. Infertile women with sexual dysfunction had significantly worse quality of life especially in the relational aspect.

Aberrant claudin-4 transcript levels in eutopic endometrium of women with idiopathic infertility and minimal endometriosis

Claudin-4 (CLDN4) is a transmembrane protein, responsible for cellular contact and organization. A different expression of claudin 4 in the endometrium, depending on the menstrual cycle and with peak at the aim of the 'implantation window', has been observed. CLDN4 is believed to play an important role in embryo implantation. The aim of the study was to compare the mRNA CLDN4 expression levels in two subgroups of infertile women (idiopathic infertility or minimal endometriosis) and compare them to fertile controls. The study included 36 women with idiopathic infertility and 24 with minimal endometriosis. The control group comprised 26 women. Eutopic endometrium samples were collected with a Pipelle device during the implantation window. Firstly mRNA was extracted from the endometrium and reverse transcribed into cDNA. Real time PCR was used for the assessment of relative expression levels. The observed transcription level of CLDN4 did not differ statistically between the studied groups, but was significantly higher when compared to controls. Exceedingly high levels of CLDN4 might negatively influence fertility rates.

Peritoneal fluid cytokines and sICAM-1 in minimal endometriosis: search for discriminating factors between infertility and/or endometriosis

Objective:To evaluate cytokine levels (IL-1β, TNF-α, IL-6, IL-8), soluble intercellular adhesion molecule-1 (sICAM-1) and number of macrophages in peritoneal fluid (PF) of women with no minimal endometriosis and associated (or not) infertility in order to discriminate between infertility and/or endometriosis. Study design:Cytokines and sICAM-1 were measured by using quantitative enzyme-linked immunosorbent assay (ELISA) while the macrophages were identified by May-Grunwald-Giemsa and non-specific esterase staining and presented as medians. The measurements were performed in 78 women belonging to four selected subgroups according to their endometriosis and/or infertility status. Statistical analysis was performed using Kruskal–Wallis non-parametric ANOVA test. Additionally, discriminant function analyses were performed. Results:We have found the most elevated macrophage numbers in the groups of women with endometriosis. IL-1β did not present any statistically significant values differentiating the analysed subgroups. IL-6 (110.0pg/ml) and TNF-α exhibited the highest concentrations (statistically significant) in a group of fertile women with endometriosis. IL-8 clearly differentiated between the subgroups with infertility and sICAM-1 was statistically significantly elevated in the subgroups of infertile women. In the forward discriminant analysis, when subdividing the studied population according to its infertility status (we considered macrophages, IL-8 and IL-6 in order of probability values), we have found striking probability value of 92% for the correct classification into an infertile population. Conclusion:Out of the range of the analysed factors we have found only the sICAM-1 to be singled out between the standard discriminant analysis and the forward one. However, this important flagging molecule might be of considerable value for discrimination between different types of pathology at the level of immune effector function. The increased levels of TNF-α and IL-6 signified a group of fertile women with endometriosis; however only IL-6 presented a discriminating value in multifunctional analysis of examined subgroups. The analysed range of factors had a greater tendency to discriminate between infertility status rather than endometriosis.

Pregnancy following advanced laparoscopic surgery for the treatment of infiltrative rectovaginal and rectosigmoid colon endometriosis.

Objective: Provide the results of treating advanced infiltrative rectosigmoid colon and rectovaginal septum endometriosis by videolaparoscopic surgery. Design: A follow-up of up to 36 months of 83 women treated for severe endometriosis due to infertility and pelvic pain. Materials/Methods: 83 women, aged 27–39 years suffering from primary (n = 58) and secondary (n = 25) infertility and associated pelvic pain underwent surgery. None of the patients with secondary infertility had a liveborn child and 2 patients had experienced 3 miscarriages. All patients were followed by the investigators. Work-up included detailed H&P, rectal ultrasound, colonoscopy and MRI when necessary. All women were treated with long-acting GnRHa for 2–3 mo before surgery. Laparoscopic meticulous excision of endometriotic implants and nodules, dissection of pararectal space, enterolysis, ureterolysis, presacral neurectomy, and additional treatment-oriented eradication of endometriosis were carried out. Laparoscopic bowel resection and reanastomosis were conducted in 3 women. Results: Patients were discharged within 36–96 hours depending on the extension of the procedure. 76 (92%) patients experienced substantial to complete pain relief immediate. 41 (49%) patients conceived during the follow-up treatment and 34 (17 from each subgroup of infertile women) went on to deliver a liveborn child. 10 women conceived after 1–3 cycles of ovulation induction and the remaining conceived spontaneously. 9 patients experienced 13 first-trimester spontaneous abortions; 5 miscarriages from the primary infertile women had chromosomal abnormalities while these genetic flaws were observed in 2 out of 6 abortions in the secondary infertile women. Post-op fever (5%), adynamic ileus, wound and shoulder pain were the most common complications. Conclusions: Infertility and pain associated to severe infiltrative rectovaginal and rectosigmoid colon endometriosis can be effectively treated with extensive laparoscopic surgery, resulting in excellent pregnant outcome.

Importance of chlamydial antibodies in acute salpingitis in central Africa.

Of 35 women with acute salpingitis on laparoscopy, 86% had chlamydial antibodies at a titre of 1/16 or higher and 49% at a titre of 1/512 or higher. Geometric mean titres of chlamydial antibodies correlated significantly with a laparoscopic observation of chronic salpingitis (p less than 0.001), with a history of infertility (p less than 0.05), and with severe inflammation (p less than 0.10), but not with a history of salpingitis or a positive cervical culture for Chlamydia trachomatis. In the subgroup of infertile women, the geometric mean titre of antibodies to chlamydiae correlated significantly with the presence of chronic salpingitis (p less than 0.005). These data indicate that chlamydial infections play a major part in salpingitis and infertility in central Africa. In this area, which is known as the "infertility belt", programmes to control chlamydial infections should be implemented.