Successful Spontaneous Pregnancy Research Articles

If CE affects infertile women’s outcomes after surgery?

ObjectiveTo investigate the prevalence of chronic endometritis (CE) in infertile patients and whether it affects spontaneous pregnancy after reproductive surgery in infertile patients. Materials and methodsIn this study, we collected clinical information on infertility patients who underwent reproductive surgery at the Reproductive Medicine Centre of the Second Hospital of Lanzhou University from 2021.1 to 2022.8. All patients underwent laparoscopic and hysteroscopic surgery. Tubal lubrication was performed concurrently with endometrial sample collection and pathological examination. The specimens were immunohistochemically stained with CD38 and CD138, and those who tested positive at the same time were diagnosed with chronic endometritis. As of 2023.9, the patients were followed up by telephone to determine whether chronic endometritis impacted postoperative pregnancy. OutcomeA total of 81 patients were finally included in the study. Of these, 25 were in the chronic endometritis group, and 56 were in the non-chronic endometritis group. There were no appreciable differences between the two groups’ demographic statistics. Furthermore, neither the bilateral appendages nor the uterus’s intraoperative conditions showed a statistically significant difference. Patients in the chronic endometritis group had a longer time to conception from the time of surgery (7 (6.00–11.75) vs. 10 (6.50–16.00), p = 0.467) and a lower rate of spontaneous pregnancies (8/25 = 32.00 % vs. 28/55 = 50.00 %, p = 0.132) than patients with non-chronic endometritis. Among the patients who had successful spontaneous pregnancies after surgery, approximately 77.14 % had live births and 22.86 % had miscarriages, and the live birth rate between the two groups was not significantly different. (21/28 = 75.00 % vs 7/8 = 87.50 %, p = 0.651) ConclusionChronic endometritis affects approximately 31.82% of infertile patients, and following reproductive surgery, it has no discernible impact on spontaneous pregnancy.

Impact of Hydroxyurea to Treat Haematological Disorders on Male Fertility: Two Case Reports and a Systematic Review.

Hydroxyurea (HU) is a cytoreductive agent used as standard treatment option for sickle cell anaemia/disease (SCD), essential thrombocythemia (ET), and polycythaemia vera (PV). Despite its overall good safety profile, its use also in relatively young patients raises an interest on its potential impact on spermatogenesis. To perform a systematic review of all published articles investigating fertility in male patients affected by SCD, ET, and PV and treated with HU. Two paradigmatic case reports of patients affected by PV and ET, respectively, have been also reported. PubMed, EMBASE, and Cochrane databases were queried for all the published studies indexed up to November 15th, 2022. A combination of the following keywords was used: "hydroxyurea," "fertility," "male," "sperm," "sickle cell anaemia," "sickle cell disease," "essential thrombocythemia," "polycythaemia vera." Of 48 articles identified, 8 studies, involving 161 patients, were eligible for inclusion. Overall, the number of spermatogonia per round cross section of seminiferous tubule were decreased in patients with SCD compared to healthy males. HU treatment was always associated with a worsening of semen parameters, even up to azoospermia. Notably, treatment discontinuation was associated with an improvement of semen parameters and a trend toward normalization in the case of PV and ET, with a less clear amelioration in men with SCD. In both our patients with either PV or ET, HU discontinuation was associated with a significant improvement of spermatogenesis with successful spontaneous pregnancies. Published evidence do not consistently report normalization of spermatogenesis after HU discontinuation in SCD cases. Conversely, the literature almost consistently reported an improvement of semen parameters at the discontinuation of HU therapy in PV and ET cases. Our real-life two cases confirmed those findings. The willing of fatherhood and the need for effective fertility treatment warrant further research to improve work-up management in men with hematological disorders.

Successful spontaneous pregnancy after simultaneous kidney and pancreas transplant.

SynopsisGood and meticulous pre‐pregnancy follow up and a multidisciplinary approach is of crucial importance for a successful pregnancy outcome after pancreas and kidney transplantation.

Does Insulin Resistance (IR) Have an Impact on The Reproductive and Fertility Potential in Polycystic Ovary Syndrome (PCOS) Women? : Review Article

Backgrounds: Polycystic ovary syndrome is the most common endocrine and reproductive disorder in the reproductive-age women. Among the pathological changes that are responsible for the development of polycystic ovary syndrome (PCOS), hyperinsulinemia due to increased insulin resistance (IR) is common and usually associated with a higher rate of ovulatory dysfunction and sub-fertility. In addition, those women have poor quality oocytes with low fertilization capability and poor quality embryos. So, insulin has a role in the reproductive function and fertility potential of reproductive age women. Conclusion: Females with PCOS usually exhibit an extreme difficulty in achieving either a successful spontaneous or assisted pregnancy. Hyperinsulinemia / insulin resistance and reproductive dysfunction should be well understood as can as possible in order to achieve an effective treatment plan to increase the chance of a successful uncomplicated pregnancy.

Effects of Medicines and Supplements on Spontaneous Pregnancy and Semen Parameters in Male Infertility: A Systematic Review Update and Network Meta-Analysis

In this study, we used a network meta-analysis (NMA) to compare the effectiveness of medicines and supplements for idiopathic male infertility and to identify the best treatment. Medline, Excerpta Medica Database (EMBASE), Ovid, and China National Knowledge Infrastructure (CNKI), were searched for the period from January 1990 to June 2021 using the keywords “male infertility,” “medical therapy,” “supplement/nutrient therapy,” and related terms. Randomized controlled trials (RCTs) investigating medicines (mainly follicle-stimulating hormone (FSH), androgen, and clomiphene/tamoxifen) or supplements (mainly zinc, selenium, vitamin C or E, carnitine, coenzyme Q10 (CoQ10), or combined treatment) for idiopathic infertile men were selected for meta-analysis. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) was used for data extraction, and a risk-of-bias tool and grades of recommendation, assessment, development, and evaluation (GRADE) system adapted to the NMA were employed to assess the quality of the evidence. The primary outcomes were live birth and spontaneous pregnancy rate (SPR). The secondary outcomes were sperm parameters (including concentration, progressive motility, and morphology) and side effects. In total, 65 RCTs involving 7541 men with sperm abnormalities but normal hormone levels were included. A total of 36 studies reported SPR but only three reported live birth rates. The quality of the included studies was found to be moderate to high. Compared with a placebo or being untreated, carnitine plus vitamins significantly improved SPR (relative risk (RR) = 3.7, 95% confidence interval (95%CI), 1.6–8.5); fatty acids significantly increased sperm concentrations (mean difference (MD) = 12.5 × 10 6 mL −1 , 95%CI, 3.1 × 10 6 –22.0 × 10 6 ); and selective estrogen receptor modulator (SERM) plus CoQ10 significantly improved sperm progressive motility (MD = 11.0%, 95%CI, 0.1%–21.9%) and normal sperm morphology (MD = 11.0%, 95%CI, 4.6%–17.4%). The most optimal intervention was carnitine plus vitamins and fatty acids for SPR and sperm concentrations, respectively, even after excluding trials at a high risk of bias. Compared with a placebo or being untreated, FSH (RR = 4.9, 95%CI, 1.1–21.3) significantly increased SPR, whereas SERM plus kallikrein increased sperm concentration (MD = 16.5 × 10 6 mL −1 , 95%CI, 1.6 × 10 6 –31.4 × 10 6 ), and SERM plus CoQ10 significantly improved sperm progressive motility (MD = 11.3%, 95%CI, 7.3%–15.4%) and normal morphology (MD = 11.2%, 95%CI, 5.4%–16.9%) in men with oligoasthenozoospermia (OA). In terms of side effects, fatty acids and pentoxifylline were associated with foul breath and/or a bad taste (RR = 8.1, 95%CI, 1.0–63.5) and vomiting (RR = 8.0, 95%CI, 1.0–63.0), respectively. In conclusion, the optimal treatment for male infertility for live birth is still unknown. Carnitine plus vitamins and FSH are likely to be better than other therapies in achieving successful spontaneous pregnancy in couples overall and in couples with men with OA, respectively. The efficacy of other treatments on pregnancy outcomes warrants further verification.

Presence of antiphospholipid antibodies is associated with increased implantation failure following in vitro fertilization technique and embryo transfer: A systematic review and meta-analysis.

A systematic review and meta-analysis was conducted comparing the presence of anti-phospholipid (anti-PL) antibodies between women of reproductive age, without diagnosis of antiphospholipid syndrome, who experienced at least two implantation failures following in vitro fertilization and embryo transfer (IVF-ET), and either women who had a successful implantation after IVF-ET or women with at least one successful spontaneous pregnancy or unselected healthy fertile women with no history of IVF-ET. Systematic search of the literature and meta-analysis of the relevant studies studying presence of antiphospholipid antibodies in women experiencing at least two implantation failures in IVF-ET as compared to either women who had a successful implantation after IVF-ET or/and women with at least one successful spontaneous pregnancy or unselected healthy fertile women with no history of IVF-ET. Six hundred ninety-four published reports were retrieved; 17 of them fulfilled the inclusion criteria set. Presence of either any type of anti-phospholipid or anticardiolipin antibodies or lupus-anticoagulant in women experiencing at least two implantation failures in IVF-ET was associated with increased implantation failure compared to women who had a successful implantation after IVF-ET (relative risk, RR: 3.06, 5.06 and 5.81, respectively). Presence of either anticardiolipin or lupus-anticoagulant or anti-beta2 glycoprotein-I or anti-phosphatidylserine antibodies in women experiencing at least two implantation failures in IVF-EΤ was associated with increased implantation failure compared to unselected healthy fertile women with no history of IVF-ET (RR:13.92, 6.37, 15.04 and 164.58, respectively). The prevalence of antiphospholipid antibodies, particularly that of anti-beta2 glycoprotein-I and anti-phosphatidylserine antibodies, in women experiencing at least two implantation failures in IVF-ET without diagnosis of antiphospholipid syndrome is significantly greater than either in women who had a successful implantation after IVF-ET or women with at least one successful spontaneous pregnancy or unselected healthy fertile women with no history of IVF-ET. PROSPERO ID: CRD42018081458.

A successful spontaneous pregnancy after surgery and chemotherapy in a patient with recurrent dysgerminoma

Abstract Dysgerminoma comprises 3%–5% among ovarian malignancies, mostly seen in adolescent and early adult women. The recurrence rate is approximately 10%–20%, occurring within 2 years of diagnosis, and has been reported that more than 75% occur in the 1st year. A 19-year-old nulligravid initially presented with severe abdominal pain, who underwent emergency exploratory laparotomy and left salpingo-oophorectomy, whose histopathologic result revealed dysgerminoma, Stage IC2. Recurrence of dysgerminoma was noted on the contralateral ovary 10 months after for which she had undergone another surgery for wedge resection of the right ovarian mass and complete surgical staging. She received adjuvant chemotherapy without complications. Despite two consecutive surgeries and chemotherapy, she had conceived naturally and her pregnancy was carried to term with no complications and delivered to a live baby girl by normal spontaneous delivery. This case is a proof of how fertility-sparing surgeries and chemotherapy in dysgerminoma can successfully preserve reproductive functions for future conceptions.

Successful Mestrual Regularity and Spontaneous Pregnancies with a Resveratrol-Based Multivitamin Supplement in Women with Idiopathic Premature Ovarian Insufficiency

Abstract Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian activity before the age of 40 years and is characterized by menstrual disturbance, follicle stimulating hormone (FSH) concentration above 40 IU/l and infertility. In some patients the best option is to conceive spontaneously since many treatment strategies remain unsuccessful or involve eggs donation. In this case report series, we describe the effects of a resveratrol-based multivitamin supplement containing trans-resveratrol, folic acid, vitamin B6, B12 and D, in six women with poor prognosis of pregnancy due to POI and evaluate the achievement of desired conception. These women, aged less then 40 years, suffered from menstrual irregularities, anovulation and infertility. They all had normal karyotype, and no history of ovarian surgery, radiation exposure or chemotherapy. Blood test showed at least two values of FSH above 40 IU/l. Four out of six patients with POI conceived after 3-6 months of a resveratrol-based multivitamin supplement, ultimately giving birth to a full-term baby. Regular menstrual cycle was restored in all patients after two to four months the start of treatment. In conclusion the treatment with a resveratrol-based supplement improved menstrual regularity and suggest a useful potential of this supplementation in some cases of POI.

Successful spontaneous pregnancy after transphenoidal surgery and bilateral adrenalectomy for Cushing’s disease: A case report

Successful spontaneous pregnancy after transphenoidal surgery and bilateral adrenalectomy for Cushing’s disease: A case report

Endometrial Osseus Metaplasia during Infertility Evaluation: A Case Series

Aims: To highlight the pathogenesis of endometrial osseus metaplasia, its importance as a rare cause of infertility and the benefit of hysteroscopic evaluation of infertile women with risk factors for osseus metaplasia.
 Presentation of Case: A diagnosis of endometrial osseus metaplasia was confirmed histologically in three women undergoing diagnostic hysteroscopy as part of infertility evaluation. They all had chronic vaginal discharge and a preceding history of induced second trimester abortion. Two of the patients were referred for evaluation before in-vitro-fertilization (IVF). Hysteroscopy was done with a 30° telescope, initially using a 2-channel diagnostic sheath, which was later replaced with a 4-channel operating sheath for tissue retrieval.
 Discussion: Endometrial osseus metaplasia is a rare condition characterized by the presence of mature or immature bone in the endometrial cavity. Endometrial retention of embryonic tissue following an abortion is the commonest theory of etio-pathogenesis. It is an important cause of infertility and while other causes of infertility can be easily by-passed in an IVF cycle, endometrial factors may not be addressed by IVF alone, as a defective endometrium is a risk for failure. Although there is no consensus on routine hysteroscopy for women undergoing IVF, it is the mainstay of evaluation and treatment of women with endometrial osseus metaplasia.
 Conclusion: Only complete removal of metaplastic tissue would restore fertility, in patients with osseus metaplasia. Hysteroscopy done in infertile women with risk factors for endometrial osseus metaplasia may enhance early treatment and ultimately increase successful spontaneous and IVF pregnancy rates.

Successful spontaneous pregnancy in a nullipara with acquired gynaetresia: A case report

Background: Gynaetresia is the narrowing or complete occlusion of the vagina which may be congenital or acquired. Acquired gynaetresia is commoner in Nigeria due to female genital mutilation and vaginal insertion of herbs. Gynaetresia is a public health issue that requires a great attention to prevent all its associated morbidities. Objective: To report a case of nullipara with acquired gynaetresia that presented in labour. Methods: The case note of the patient and how she was managed were reviewed. Relevant review of the literature on the subject was also done. Results: She was a 24 year old Primary Health Care (PHC) booked Gravida 3 Para 0+2, a trader with secondary level of education who presented in labour ward of Rivers State University Teaching Hospital (RSUTH) at an unknown gestation. She was referred from the PHC on account of labour pains of 6 hours duration and a dense fibrotic tissue sealing off most of the vaginal wall. There was a history of passage of herbal concoction in her vagina 14 months prior to presentation to induce abortion. She had emergency lower segment Caesarean Section (C/S) and outcome was a live male baby who weighed 3kg with a good APGAR score. She did well post operatively, was counseled for vaginoplasty and discharged home with her baby on the 5thpost-operative day in good clinical state. Conclusion: Acquired gynaetresia due to vaginal insertion of herbal pessaries is a preventable condition if only our women in this part of the world are made to understand the significance and implications of this act. This is by educating the public on the morbidities associated with this condition.

Successful spontaneous pregnancy in a nullipara with acquired gynaetresia: A case report

Successful spontaneous pregnancy in a nullipara with acquired gynaetresia: A case report

Successful spontaneous pregnancy and successful delivery in a patient with severe 11-beta hydroxylase deficiency

Successful spontaneous pregnancy and successful delivery in a patient with severe 11-beta hydroxylase deficiency

Puberty and fertility in classic galactosemia

Classic galactosemia is a rare inborn error of galactose metabolism with a birth prevalence of about 1/30,000–60,000. Long-term complications occurring despite dietary treatment consist of premature ovarian insufficiency (POI) and neurodevelopmental impairments. We performed with the French Reference Centers for Rare Diseases a multisite collaborative questionnaire survey for classic galactosemic patients. Its primary objective was to assess their puberty, pregnancy, gonadotropic axis, and pelvic morphology by ultrasound. The secondary objective was to determine predictive factors for pregnancy without oocyte donation. Completed questionnaires from 103 patients, 56 females (median age, 19 years (3–52 years)) and 47 males (median age, 19 years (3–45 years)), were analyzed. Among the 43 females older than 13 years old, mean age for breast development first stage was 13.8 years; spontaneous menarche occurred in 21/31 females at a mean age of 14.6 years. In these 21 women, 62% had spaniomenorrhea and 7/17 older than 30 years had amenorrhea. All age-groups confounded, FSH was above reference range for 65.7% of the patients, anti-Müllerian hormone and inhibin B were undetectable, and the ovaries were small with few or no follicles detected. Among the 5 females who sought to conceive, 4 had pregnancies. Among the 47 males, 1 had cryptorchidism, all have normal testicular function and none had a desire to conceive children. Thus, spontaneous puberty and POI are both common in this population. Spontaneous menarche seems to be the best predictive factor for successful spontaneous pregnancy.

A Comparative Study on Segmental Micro-Anatomy of the Human Fallopian Tube

Background: The Fallopian tubes serve as a bridge between the ovary and uterus and is divided into infundibular, ampullary, isthmic, and intramural segments from lateral to medial. Each segment is structurally and functionally equipped to perform specific functions. The maintenance of normal micro-anatomy of each segment is very important for successful spontaneous pregnancy. This study has compared the histological features of the isthmus, ampulla, and infundibulum. Materials and Methods: Tissue bits were taken from isthmus, ampulla, and infundibulum of Fallopian tubes of 100 women of reproductive age group and these were subjected to routine histological processing, and slides were stained with hematoxylin and eosin. The mean value of the number of primary mucosal folds and muscle thickness of each segment was calculated and compared with each other. Results: In the ampullary and infundibular region, there were primary, secondary, and tertiary folds with a mean value of 33.42 ± 4.49 and 31.53 ± 4.92, respectively. In the region of the isthmus, there were few primary mucosal folds with a mean value of 8.31 ± 0.9. The muscular layer was found thickest inthe isthmus with a mean value of 7.72 ± 0.76 mm and in the region of ampulla and infundibulum, the mean values were 4.39 ± 0.57 mm and 3.43 ± 0.48 mm, respectively. Conclusion: The ampullary region has maximum number of branching mucosal folds which ensure close contact with the developing embryo and provides nutrition. At infundibulum also there were numerous mucosal folds which help in accommodating the large number of ciliated cells which plays a major role in ovum pick up and transport as the muscle layer was found to be very thin in this region. The peristaltic contraction of thick muscle layer in the isthmus plays a very important role in the transport of embryo as only a few mucosal folds were found in this region.

Successful spontaneous pregnancy after pelvic radiotherapy for a sacral giant cell tumor: A case report

AbstractGiant cell tumors are rare benign bone tumors that are locally destructive, but rarely metastasize. Here, we report the case of a young girl with an inoperable sacral giant cell tumor who received radical pelvic radiotherapy and thereafter had unassisted conception with successful delivery.

Successful Spontaneous Pregnancy and Live Birth in a Woman With Premature Ovarian Insufficiency and 10 Years of Amenorrhea: A Case Report

Background: Primary ovarian insufficiency (POI) is a devastating diagnosis for reproductive-aged women due to the associated infertility and other serious health consequences. Spontaneous pregnancy without hormone replacement therapy (HRT) and/or assisted reproductive technology (ART) rarely occurs in POI patients, particularly in those patients with long-term amenorrhea.Case: On March 4, 2019, a 31-year-old Chinese POI patient visited our hospital for a spontaneous pregnancy after 10 years of amenorrhea and discontinuation of HRT 4 years prior. The patient had menarche at the age of 13, with 3 years of regular menstruation followed by amenorrhea occurring at the age of 20. POI was diagnosed by several hospitals; chromosome examination revealed a normal 46, XX karyotype. Treatment with estradiol valerate and progesterone did lead to resumed menstruation, while amenorrhea resumed after withdrawal of HRT. The patient married at the age of 23 and tried to conceive by HRT until the age of 25; her beta-human chorionic gonadotropin (HCG), estrogen (E2), and progesterone levels were 32987.7~119151.4 mIU/ml, 671.0~>1,000 pg/mL, and 6.6~27.9 ng/ml, respectively. On March 22, 2019, ultrasonography showed an intrauterine pregnancy with a normally developed gestational sac sized 45 × 42 × 32 mm with a 17 mm crown-rump length. On October 29, a 3,400 g healthy girl baby was delivered; the patient had a spontaneous delivery with natural labor.Conclusion: Spontaneous pregnancy is possible in women with POI and 10 years of amenorrhea.

A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

Childbirth close to natural menopause: does age at menopause matter?

Does a successful spontaneous pregnancy in the years close to natural menopause depend on age at menopause? This was a retrospective population-based study of 4157 parous postmenopausal women in Norway, born during the years 1925-1940. Data were obtained by two self-administered questionnaires in the HUNT2 Survey (1995-1997). We calculated the proportions of women who gave birth within 5 years and within 10 years prior to menopause both among all women, and according to categories of age at menopause. Overall, 2.7% (114/4157) of all women gave birth within 5 years, and 11.7% (487/4157) gave birth within 10 years, prior to menopause. Among women with menopause before the age of 45 years, 23.5% (81/344) gave birth within 5 years, and 55.5% (191/344) gave birth within 10 years, before menopause. Among the women with menopause at the age of 55 years or older, no women (0/474) gave birth within 5 years, and 0.2% (1/474) gave birth within 10 years, prior to menopause. More than half of the women with menopause before the age of 45 years gave birth within the 10 years before natural menopause, whereas virtually no women with menopause at the age of 55 years or older did. Thus, the length of the sterile interval before natural menopause may vary by age at menopause.

Evaluation of gonadotropin-replacement therapy in male patients with hypogonadotropic hypogonadism.

Hypogonadotropic hypogonadism (HH) is a rare disease in which medical treatment has a high success rate to achieve fertility. This study aimed to analyze the efficacy of hormone replacement therapy and determine predictive factors for successful spermatogenesis and spontaneous pregnancy in patients with idiopathic HH. A total of 112 patients with low testosterone (T), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and normal prolactin levels were diagnosed with HH and administered LH and FSH analogs as hormone replacement therapy. During treatment, 96 (85.7%) patients had sperm present in ejaculate samples. Among these patients, 72 were married and wanted a child. Of these 72 patients, 48 (66.7%) of couples had pregnancies from natural conception. After initiation of treatment, the mean time for the appearance of sperm in semen was 9.48 months. There were no significant differences between baseline FSH, T, and LH levels; however, older age, larger testicular size, and low rate of undescended testes were favorable factors for successful spermatogenesis. Larger testicular size and older age were also the main predictive factors for natural conception. We found that patients with undescended testes had a younger age, smaller testes, and lower T levels compared with patients exhibiting descended testes. The rate of sperm found in the ejaculate was not significantly decreased in patients with undescended compared with descended testis (73.7% vs 87.6%, P = 0.261). The medical approach for males with HH and azoospermia provides a successful treatment modality in regard to successful spermatogenesis and achievement of pregnancy.