Successful Infertility Treatment Research Articles

Assessing Student and Physician Fertility Awareness Utilizing the Fertility and Infertility Treatment Knowledge Score (FIT-KS).

Medical trainees are delaying childbearing due to competing demands of career, financial constraints, and limited parental leave. Delaying childbearing increases the risk of obstetric complications, with up to one-quarter of female physicians facing infertility. Education on family planning and fertility is rarely discussed among medical trainees, and research on medical trainees' knowledge of fertility and infertility is minimal. Subjects included medical students, residents, fellows, and attendings assigned female at birth. The distributed survey included the Fertility and Infertility Treatment Knowledge Score (FIT-KS) instrument to assess for fertility and infertility knowledge. Outcome measures include participant age, stage of training, parity, specialty, and FIT-KS. Of the 291 participants included in the final analysis, participants scored an average of 20/29 (69%) on the FIT-KS. Around 44.8% (n=130) of participants overestimated the fecundability of a 30-year-old woman, and 36.9% (n=107) underestimated the chance of miscarriage in peak reproductive years. Five out of eight questions pertaining to infertility treatment had a <50% correct response rate. About 76.6% (n=216) of participants underestimated in vitro fertilization (IVF) success for a woman <35 years old, and 56% (n=158) overestimated the success of IVF for a woman >44 years old. Around 43.6% (n=123) of participants overestimated the average cost of IVF. Of the main outcome measures, only those participants representing obstetrics and gynecology (OB-GYN) performed better on average than all other specialties (FIT-KS=21.7 vs. 19.5). Participants overestimated fecundity with increasing age and had insufficient knowledge of infertility treatment success. More awareness and early discussion about family planning and fertility goals are needed in medical training.

Is there any difference in Lactobacillus abundance between age groups during ovarian stimulation in fresh in vitro fertilization (IVF) cycles?

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To investigate an influence of age and body mass index (BMI) as determinants of infertility treatment success in vitro fertilization (IVF) procedures confirmed so far, on the amount of &amp;lt;em&amp;gt;Lactobacillus&amp;lt;/em&amp;gt; spp. (LS) and &amp;lt;em&amp;gt;Gardnerella vaginalis&amp;lt;/em&amp;gt; (GV) in the endometrium in fresh IVF cycles at the time of embryo transfer.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; This a prospective single-centre study included patients who underwent fresh embryo transfer (ET) in a private IVF Centre. A catheter tip for embryo transfer was used for collecting samples from the endometrial cavity. Real time polymerase chain reaction (RT PCR) was used to determine LS and GV quantity. Patients were divided into two age groups: &amp;amp;lt;35 years and &amp;amp;ge;35 years. Normal BMI group included patients with 18.-24.9 kg/m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;, and the in-creased BMI group patients with BMI &amp;amp;ge; 25kg/m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; Tips for embryo transfer catheters were positive on LS in 55 (96.4%) patients. The median of quantification cycle of RT-PCR (Cq RT-PCR) for LS was 33, and 31 for the younger and older groups, respectively. Twenty-one (36.8%) patients tested positive for GV. The median of Cq RT-PCR for GV was 33 and 34 for the younger and older groups, respectively. There were 36 patients with normal and 18 with increased BMI. BMI showed no correlation with LS amount in the endometrial cavity.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; Aging affects the endome-trial microbiome resulting in an increase of &amp;lt;em&amp;gt;Lactobacillus&amp;lt;/em&amp;gt; number, but not the number of GV.&amp;lt;/p&amp;gt;

Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes

Affective temperaments have been shown to robustly affect infertility treatment success. However, identification of possible mediating factors through which they exert their influence is still lacking. A growing number of results suggest that adherence to recommended treatments may be such a mediator, on the one hand, because affective temperaments are known to influence adherence and, on the other hand, because non-adherence negatively influences the treatment outcome. Recommended treatment of infertility involves, beyond medications, dietary and lifestyle changes. The aim of this retrospective cohort study was to evaluate whether adherence to physician-prescribed diet and physical activity recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Among 308 women who underwent infertility treatment in an Assisted Reproduction Center, affective temperaments, adherence to diet, adherence to physical exercise, and infertility treatment success (clinical pregnancy) were assessed besides detailed medical history and demographic parameters. Associations between affective temperaments, adherence to diet and recommended physical activity, and assisted reproduction outcomes were analyzed using generalized linear models and causal mediation analysis. Adherence to physical activity didn’t have an effect, but diet adherence increased the odds of infertility treatment success by 130% suggesting its role as a potential mediator. Based on causal mediation analysis, higher depressive and anxious temperament scores were directly associated with 63% and 45% lower odds of achieving clinical pregnancy, respectively, with effects not mediated by diet adherence. Higher irritable temperament scores indirectly decreased the odds of achieving clinical pregnancy by 14%, mediated by diet adherence; while higher cyclothymic temperament scores decreased the odds of achieving clinical pregnancy both directly by 51% and indirectly, mediated by diet adherence by 11%. Our results suggest that diet adherence mediates the mechanism by which irritable and cyclothymic affective temperaments influence IVF treatment success. Since adherence is a modifiable risk factor of infertility treatment success, screening for affective temperaments may help to identify potentially high-risk non-adherent patient groups and offer patient-tailored treatment, which may help increase the chances of a successful pregnancy and live birth in women undergoing IVF treatment.

Revitalizing classical Ayurveda practice in urban India—Contribution of Vaidya V. R. Padmanabha Rao

Abstract The renaissance of Ayurveda in contemporary times owes much to the remarkable contributions of exemplary practitioners. This paper explores the journey of Dr. V. R. Padmanabha Rao (1953–2020), an Ayurveda clinician who not only demonstrated excellence in clinical practice but also spearheaded the creation of “Agnivesha Ayurveda Anushthana,” an exclusive organization devoted to the education and training of Ayurveda doctors. Dr. Rao played a pivotal role in influencing and guiding numerous Ayurveda graduates to transition from allopathy to Ayurvedic clinical practice. His therapeutic knowledge was disseminated in a number of national and international forums, especially with regard to his successful treatment of male infertility. Central to his teachings was the concept of “How to be a successful Ayurveda clinician,” anchored in the three pillars of dual diagnosis (integrated Ayurveda and modern methods), the utilization of self-prepared classical medicines (single-herb therapy), and the cultivation of excellent clinical and administrative skills including documentation of clinical cases.

Dominant depressive, anxious and cyclothymic affective temperaments lower the chance of infertility treatment success

IntroductionAffective temperaments can play a significant role in the development, progression and outcome of various somatic diseases, as well as in the effectiveness of their treatment. Although infertility is influenced by both physical and psychological factors, the relationship between affective temperaments and infertility treatment success remains unexplored.ObjectivesThe aim of this retrospective cohort study was to assess how dominant affective temperaments influence the outcome of infertility treatments.MethodsData was collected from a cohort of infertile women who underwent infertility treatment at an Assisted Reproduction Center in Budapest, Hungary. The study recorded treatment success defined as clinical pregnancy, detailed medical history, demographic parameters, and administered the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). TEMPS-A scores then were classified into nondominant and dominant temperaments for each scale, based on their score being above or below the mean+2 standard deviation for the given temperament. The predictive value of dominant temperaments on assisted reproduction outcomes were analyzed by multivariate logistic regression models, using age, BMI and previous miscarriage as covariates.ResultsIn the cohort of 578 women who underwent infertility treatment, besides age, BMI, and previous miscarriage, dominant depressive, anxious and cyclothymic temperament decreased the odds of achieving clinical pregnancy by 85% (p=0.01), 64% (p=0.03), and 60% (p=0.050), respectively).ConclusionsThe findings of this study suggest that dominant affective temperaments have a significant impact on the outcomes of infertility treatments. As a clinical consequence, creening for affective temperaments, Identifying dominant affective temperaments, stratifying high-risk patient groups, and offering personalized treatment options may enhance the likelihood of successful pregnancy and live birth for women undergoing in vitro fertilization treatment.Disclosure of InterestNone Declared

Maternal-infant and paternal-infant attachment levels after successful infertility treatment and affecting factors: A descriptive cross-sectional study

PurposeThis study aimed to determine the levels of maternal and paternal attachment and the factors that affect them in individuals who had a baby after infertility treatment. MethodsThis study followed a descriptive cross-sectional design in accordance with STROBE guidelines. The research was conducted in the infertility clinic of a university hospital and included 128 participants, consisting of 64 mothers and 64 fathers. Data were collected using the ‘Personal Information Form-Mother’, ‘Personal Information Form-Father’, ‘Maternal Attachment Inventory (MAI)’, and ‘Postnatal Paternal-Infant Attachment Questionnaire (PPAQ)’. ResultsThe study found that the mothers had an average MAI score of 102.35 ± 3.05, while the fathers had an average PPAQ score of 82.21 ± 4.27. A significant correlation was observed between the mothers' MAI score and the duration of their marriage. Similarly, a significant correlation was observed between the fathers' PPAQ score and the duration of their marriage, the duration of their infertility diagnosis, and the duration of their infertility treatment (p < 0.05). The correlation analysis between the MAI score and the mean score of the PPAQ's subscale of pleasure in interaction was weakly significant and positive (r = 0.26; p = 0.032). However, there was no significant relationship between the MAI score and the PPAQ score (r = 0.18; p = 0.146). ConclusionsThe study findings indicate that parents who conceive through infertility treatment exhibit high levels of attachment to their babies. Healthcare professionals should assess the attachment levels of both mothers and fathers who have undergone infertility treatment and be mindful of the factors that influence it.

Prevalence of Depression among Infertile Couples Attending a Tertiary-Care Infertility Clinic

BACKGROUND: A large number of people are affected by infertility in their life time indicating that this is a major health challenge globally. Infertility is currently being thought-about as a medical and social condition which can cause social, emotional and psychological distress. It is estimated that psychological factors have an important role in the pathogenesis of infertility. Although depression has been described as a common consequence of infertility, very little has been documented related to its prevalence and severity, especially in India. This might be because those who fall outside the normal range of depression inventories are poorly reported or because of the fact that the psychological impact of infertility differs from that due to other medical conditions. Addressing the psychological issues during infertility treatment is now considered important. This is because of the increasing awareness that depression could be the cause of infertility, its consequence, or both and may interfere success of infertility treatment and the ability to tolerate on-going treatment. Treatments for infertility have effects on estrogen and progesterone levels. These hormones influence mood of the woman through their actions on serotonin. On the other hand emotional distress itself can suppress ovarian function or implantation resulting in decreased fertility and reduced response to its treatment. This interaction creates a vicious circle between depression and infertile status and can result in treatment dropouts or treatment failure. This study aimed to assess the prevalence of depression among infertile couples attending a tertiary care infertility clinic. METHODS: A Hospital based cross sectional study was conducted and a calculated sample of 126 couples with infertility attending the infertility clinic were consecutively enrolled into the study after obtaining consent. Data was collected using an interviewer-administered semi-structured questionnaire and depression was assessed using PHQ9 depression tool. A couple was considered to have depression if at least one of the partners had depression. Data was analysed using SPSS version 16. Quantitative variables were expressed as mean and standard deviation and qualitative variables as proportions. Chi-square test of independence and Fisher's Exact Test were used to test the association between categorical variables. RESULTS: The prevalence of depression among infertile couples was 51.6 %( n=65). Depression was more prevalent in females (48.4% n=61) than in males (33.3% n=42) and when the reason for infertility was female-related. There was a significant risk of development of depression when the other partner had depression (p=0.001, Odds ratio=25.196). CONCLUSION: Females are often blamed for childlessness especially in rural India resulting in an increased prevalence of depression among infertile females. Efforts should be taken to educate people about infertility so that there is less pressure on infertile couples. Counseling methods, especially supportive psychotherapy and interventions to decrease and prevent the development of severe depression among these patients should be considered.

Affective temperaments show stronger association with infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions

Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history, and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analyzed using multivariate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores > 4 (OR = 0.51 CI 0.35–0.74, p < 0.001), depressive scores > 9 (OR = 0.59 CI 0.4–0.87, p = 0.009) and anxious scores > 9 (OR = 0.45 CI 0.31–0.66, p < 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively. Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments may be related to the outcome of infertility treatments. Thus, screening for affective temperaments may help identify high-risk patient groups and offer patient-tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment.

Case Report: Breaking barriers - Pregnancy achieved by intracytoplasmic sperm injection of a zona-free oocyte

The zona pellucida is a protective layer surrounding the oocytes and early-stage embryos. It is said to be essential for the process of fertilisation and protecting the pre-implantation embryo. Absence of zona pellucida can pose great problems during in vitro fertilisation (IVF), like impaired fertilisation, polyspermy and hindered embryo development, thus leading to a low implantation rate and unsuccessful pregnancy outcome. This case report demonstrates the successful treatment of primary infertility in a 35-year-old female with significantly low anti-Mullerian hormone (AMH) levels and limited ovarian reserve. Her husband (41 years) had oligoasthenozoospermia. The couple had been trying to conceive for two years before seeking medical assistance. Following an unsuccessful intrauterine insemination (IUI) attempt, the decision was made to pursue IVF with ovarian stimulation. Two oocytes were retrieved after ovum pickup, one of which was at the germinal vesicle (GV) stage and later degenerated, while the other was without the zona pellucida. In this case, the intracytoplasmic sperm injection (ICSI) of zona-free oocyte was chosen to prevent polyspermy, resulting in successful fertilization. The embryo progressed to the eight-cell stage and was transferred on day three. A positive beta-human chorionic gonadotropin (β-hCG) test confirmed pregnancy fourteen days later. In assisted reproductive techniques (ART), zona-free oocytes are a common occurrence, but fertilizing those oocytes is not common; they are usually considered to be of no use and rejected. In the present case, we realized that zona-free gametes are not only capable of getting fertilized and developing into good-quality embryos, but also give successful pregnancy outcomes.

Maternal and Fetal Outcome Following Post In vitro Fertilization and Embryo Transfer Pregnancy: A Prospective Observational Study

Abstract Background: While the majority of in vitro fertilization (IVF)-conceived children are healthy, IVF has been associated with an increased risk of adverse obstetric and perinatal outcomes including hypertensive disorders of pregnancy, preterm labor and preterm delivery, and low birth weight (LBW). Objective: The objective of the study is to assess pregnancy, maternal, and perinatal outcomes in patients undergoing IVF embryo transfer (IVF-ET) at tertiary care center in North India. Methodology: It was a prospective observational study carried out for duration of 20 months among women who conceived following an IVF-ET. The sample size was 107 consecutive mothers and data were collected using a predesigned semi-structured study pro forma. Detailed menstrual, obstetric, and medical histories of each patient were noted. Findings of the general, physical, systemic, and obstetrical and gynecological examination were noted for all patients. Results: One hundred and seven mothers who fulfilled the study criteria were included. Of these, 4 had an abortion. Rest of the 103 mothers were included in the final analysis. The mean age of the mothers was 30.39 ± 4.7, ranging from 22 to 50 years. Twin pregnancy rate was 45.7%. All were dichorionic-diamniotic twins. Based on gestational age, 5% were extreme preterm births, 14% were very preterm births, 32% were late preterm births, and 48% were early-term births. Normal vaginal delivery (NVD) occurred in 26.2% of the mothers, elective lower-segment cesarean section (LSCS) in 21.4%, emergency LSCS in 51.4%, and one case had vacuum delivery. Hence, NVD occurred in 27% and 73% had LSCS. With respect to neonates born to study participants, 8% were extremely LBW, 7.3% were very LBW, 46% were LBW, and the rest 38.7% weighed 2.5 kg or more at birth. Conclusion: IVF-ET is a safe and highly successful treatment for infertility. Many of adverse outcomes are largely due to an increased risk of multiple gestations in IVF. Patients with infertility are likely to be older and have preexisting comorbid conditions such as hypertension, diabetes, insulin resistance, or other endocrinopathies which may predispose them to adverse obstetric and perinatal outcomes. It is also recommended that patients should be given adequate preconception counseling regarding increased maternal as well as neonatal risk.

Assisted hatching in cryopreservation protocols in patients with tuboperitoneal infertility

At present, the problem of increasing the effectiveness of programs of assisted reproductive technologies and successful infertility treatment is still relevant. Assisted hatching used in the devitrificated embryo transfer facilitates the exit of the embryo from the pellucide zone. Yet the clinical efficacy of assisted hatching is relevant and debatable. There are no clear indications for the use of this technology, and no groups of patients have been identified.The aim of the study. To assess the effectiveness of laser hatching in the frozenthawed embryo transfer programs in patients with tuboperitoneal infertility.Materials and methods. We examined 300 women with tuboperitoneal infertility who had their embryos frozen for transfer. Inclusion criteria: age from 18 to 35 years; tuboperitoneal infertility; embryos cryopreserved for transfer. Exclusion criteria: age more than 36 years; other infertility factors. Women were divided into 2 groups: group 1 – women who had a frozen-thawed embryo transfer with preliminary laser hatching (n = 137); group 2 – control group (n = 163).Results. There were no differences between the groups in the mean age, body mass index and the age at menarche. According to the results of the embryological stage, there were also no differences in the number and quality of frozen embryos. The pregnancy rate in the group with preliminary laser hatching was 44.5 %, which is significantly higher than in the control group (42.3 %; р ≤ 0.001). We also found statistically significant differences in pregnancy outcomes: in the frequency of spontaneous miscarriages – 13.1 % and 20.2 % respectively (p ≤ 0.001), in the frequency of term deliveries – 30.7 % and 22.1 % respectively (p ≤ 0.001).Conclusion. In our study, the using laser hatching in women with tuboperitoneal infertility positively affected the embryos implantation in the cryopreservation protocols. Pregnancy and live birth rates are higher after using hatching technology, and the frequency of miscarriages up to 12 weeks is lower. This provide an opportunity to further study the effect of hatching on long-term outcomes, such as gestation course and childbirth.

Assessing Fertility Awareness in Female Medical Students, Trainees, and Attending Physicians [ID: 1374645

INTRODUCTION: The incidence of female physician infertility is greater in comparison to the general public. In this study, we utilized a validated instrument to assess fertility and infertility knowledge among biologically female medical students, trainees, and attending physicians. METHODS: The validated Fertility &amp; Infertility Treatment Knowledge Score (FIT-KS) instrument was distributed from April 2022 to July 2022 to biologically female medical students, trainees, and attending physicians. Demographics were obtained to assess for differences between groups via contingency table analysis. The IRB found this study exempt. RESULTS: Participants answered 20 of the 29-item FIT-KS instrument correctly. Nine items had a less than 50% correct response rate, four pertained to fertility knowledge, and five pertained to infertility treatment knowledge. Most participants (81.4%) correctly identified the years of peak fertility, but 44.8% overestimated the fecundity of a 30-year-old woman and 36.9% underestimated the chance of miscarriage in peak reproductive years. Most participants (76.6%) underestimated in vitro fertilization (IVF) success for a woman under 35 year old and overestimated IVF success for a woman over 44 year old (56.0%). Obstetrics and gynecology performed significantly better on the FIT-KS instrument overall in comparison with other specialties. No differences in performance were present based on participant age, parity, or position. CONCLUSION: Female medical students and physicians recognize that fecundity decreases with age but overestimate successful pregnancy rates with increasing age. In concordance with low knowledge surrounding infertility treatment success, medical trainees are underequipped to make informed family planning decisions while in medical training.

Effect of hyperthymic affective temperament on infertility treatment success is mediated by adherence to recommended lifestyle changes

Effect of hyperthymic affective temperament on infertility treatment success is mediated by adherence to recommended lifestyle changes

Effects of obesity on the serum BMP15, GDF9, and kisspeptin concentrations in women of reproductive age.

As BMP15, GDF9, and kisspeptin all play critical roles in folliculogenesis and fertilization, investigating the possible relationship between obesity and these three factors could prove crucial in relation to understanding the role of obesity in infertility. Thus, the present study sought to determine the effects of obesity on the serum BMP15, GDF9, and kisspeptin concentrations in women of reproductive age. Ninety female participants were equally divided into three groups: class-1 obese (n=30), class-2 obese (n=30), and normal weight (control; n=30). The participants' serum BMP15, GDF9, and AMH concentrations were measured. Moreover, the serum kisspeptin concentrations were evaluated in the class-1 obese and control groups by means of the enzyme-linked immunosorbent assay (ELISA) method while the participants were in their menstrual period. The serum BMP15 and kisspeptin concentrations were found to be much higher in the control group than in both obese groups (p=0.001 and p=0.01, respectively). While the GDF9 concentration exhibited a statistically significant positive correlation with age, the BMP15 concentration exhibited a positive correlation with the kisspeptin and LH concentrations in the control group. In addition, a positive correlation was identified between the BMP15 concentration and both age and the glucose level and a negative correlation with the insulin level in both the obese groups. Obesity appears to reduce the serum BMP15 and kisspeptin concentrations in obese women of reproductive age. This reduction may represent a milestone in reproductive dysfunction and may be used to predict the success of infertility treatment in obese women.

Status of maternal serum B vitamins and pregnancy outcomes: New insights from in vitro fertilization and embryo transfer (IVF-ET) treatment.

The influence of B vitamins on human fertility and infertility treatments remains elusive. Therefore, this study investigated the association of most B vitamins with IVF-ET outcomes. A total of 216 subjects aged <35 year in their first oocyte retrieval cycle were recruited. Blood samples from the participants were collected before the oocyte pick-up procedure, and serum levels of riboflavin, niacin, pantothenic acid, vitamin B6 (including PA and PLP), folate, and methylmalonic acid (MMA) were detected using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Endpoints were classified into three groups according to tertiles (lower, middle, and upper) of each vitamin index, and the association of the serum vitamin status with intermediate and clinical outcomes was analyzed using a generalized estimating equation model. Higher riboflavin levels were associated with elevated probabilities of high-quality embryos, as well as clinical pregnancy after embryo transfer. A greater likelihood of transferable embryos was found in the middle tertile of serum folate. Similarly, a negative correlation of serum MMA, a marker of vitamin B12 deficiency, with high-quality embryos was identified. No significance was observed for other vitamins in terms of all endpoints. Therefore, sufficient levels of pre-conception riboflavin, folate, and vitamin B12 are recommended for successful infertility treatment and pregnancy planning; further evidence is needed to confirm our conclusion.

Mutations in Caveolin Binding Motif Alter Human Follicle Stimulating Hormone Receptor Signaling

Globally, there are about 48 million couples and 186 million individuals of reproductive age that are affected by infertility. Some cases of infertility in both men and women have been attributed to impaired follicle stimulating hormone (FSH) signaling. Lack of proper function of the cognate receptor for FSH (FSHR) could contribute to infertility since the biochemical signal generated by FSH binding to FSHR stimulates the production of a sperm‐stabilizing protein in males and follicle maturation in females. It has been demonstrated that human FSHR (hFSHR) localizes to lipid rafts, which are rigid and detergent‐resistant microdomains in the cell membrane. Their structure is in part due to having higher concentrations of cholesterol and sphingolipids compared to the surrounding plasma membrane. Additionally, some lipid rafts are characterized by the presence of the protein caveolin. Signaling pathways for some cell surface receptors have been demonstrated to be regulated by residency in lipid raft domains either by separating the related molecules inhibiting premature signaling or by co‐localizing the related molecules to facilitate signaling. Based on evidence that FSHR forms direct protein‐protein interactions with caveolin, it was hypothesized that disruption of the caveolin binding motif (CBM), a conserved peptide sequence present in proteins associated with caveolin, would affect hFSHR signaling. In hFSHR this sequence is found in transmembrane helix 4 between amino acids 479‐489. The current study investigated the effect of mutations in the CBM on hFSHR signaling. The mutants were created via site‐directed mutagenesis and expression vectors were transfected in HEK293 cells. Cells stably expressing the mutant FSHRs underwent western blot analysis for qualitative comparison of signaling. Mutations in all four conserved phenylalanine residues of the CBM resulted in much higher signaling compared to the wild‐type and at a faster rate of activation. Elevated signaling at shorter FSH treatment times suggest that the mutated receptor might be more sensitive to FSH and may hint at the role of the caveolin interaction in regulating hFSHR signaling. Because current infertility treatments are costly, tend to have low success rates, and are not accessible to everyone, a greater understanding of FSH signaling pathways could lead to the design of more successful infertility treatment methods.

Prevalence and correlates of infertility related psychological stress in women with infertility: a cross-sectional hospital based survey

BackgroundPsychological stress is commonly found among infertile women. Untreated stress can affect negatively the success of infertility treatment. Most of the available knowledge is generated from developed countries and is largely based on women undergoing In vitro fertilization (IVF) treatment. However, very little is known on infertile women from Ethiopia including other countries in East Africa. The aim of this study was to determine the prevalence of psychological stress and possible demographic-clinical correlates in Ethiopian women suffering from infertility.MethodThis cross sectional descriptive correlation study was conducted from May to August, 2021 involving 96 women undergoing a non-IVF treatment for infertility at Gandhi Memorial and Tikur Anbessa hospitals. The sampling was continuous and based on inclusion criteria that include infertility duration of a minimum one year, female sex and Ethiopian nationality. Data on Infertility related stress was collected using the Copenhagen Multi‐Centre Psychosocial Infertility-Fertility Problem Stress questionner administered by an interviewer. The socio demographic and clinical factors were collected using Amharic version of structured interviewer administered questionnaire and chart review. The analysis of relationship between infertility related stress and background variables was done with an independent sample t-test or one-way ANOVA statistics supplemented with effect size assessment.ResultsThe prevalence of infertility related stress was overall 92.71% (95% CI, 87–98%). The personal, marital, and social subdomain mean scores (SD) were 2.74 (.80), 1.54 (.81) and 1.90 (.80), respectively. Infertility related stress was higher for those women who were: aged above 35, living in a cohabitation marital type, has no living children, and with 4–6 years duration of infertility (all P < 0.05). Whereas, there was insufficient evidence to suggest that infertility related stress varies by education, income, knowledge of cause of infertility or history of past treatment (all P > 0.05).ConclusionsThe prevalence of psychological stress among Ethiopia women having infertility was very high. The results provide preliminary evidence that infertility related stress is associated with age, marital status, motherhood status and duration of infertility. Responsible bodies need to avail psychological screening and services prioritizing women at higher risk of developing stress.

Source of human oocytes for infertility treatment and fertility preservation

Abstract The source of human oocytes is directly associated with the success of infertility treatment and fertility preservation. The number of oocytes obtained is possibly correlated with the success rate in terms of live birth rates. However, oocyte quality must be refined such that the number of oocytes is not positively correlated with the quality of oocytes. Different ovarian stimulation protocols can be used to obtain numerous oocytes. However, oocyte quality should be considered the most important factor affecting infertility treatment and fertility preservation. Infertile women are generally willing to take health-related risks to achieve a live birth, and ovarian stimulation using high-dose hormonal treatments may be harmful for both women and infants. Therefore, successful infertility treatment and fertility preservation should be defined as the birth of a healthy baby at term without compromising the health and safety of the mother and infant. Therefore, the source of high-quality oocytes must be carefully considered prior to infertility treatment and fertility preservation.

Autologous Intrauterine Platelet Rich Plasma Versus G-CSF instillation for Improvement of Endometrial Growth and Vascularity in Recurrent in Vitro Fertilization Failure

Background: in vitro fertilization [IVF] is an expensive, cumbersome yet most successful treatment for infertility. Inspite of its success, at the most 40% of the procedure only result in good outcome. Often at times which can be very frustrating and disappointing journey for the couple as well as the clinicians who despite of strict adherence to treatment protocols fail to produce result, it is mostly attributed to implantation failure, which is mostly due to poor receptivity of the endometrium. Several treatments ranging from chinese acupuncture to hormones to endometrial injury all have been treat with not definitive treatment. Autologous platelet rich plasma (PRP) and G-CSF have come up to be exciting new therapy in that aspect. In neutrophilic granulocytes, platelet-rich plasma (PRP) has been shown to increase endometrial development and receptivity, whilst G-CSF has been shown to promote the growth of stem cells and progenitor cells. This study offers an intriguing perspective on the two medications in comparison.&#x0D; Materials and Methods: It is a prospective ,cross-sectional, single blind study, conducted over a period of 6 months in 25 women who had failed to conceive after one or more embryo transfers with high-quality embryoswomen having a poor endometrial pattern, as defined by an endometrial thickness of less than 7mm despite conventional treatment with estradiol valerate (up to 12 mg/day), or suboptimal endometrial vascularity, defined as &lt; zone 2 as determined by applebaum's criteria, success of which was measured in number of clinical pregnancies resulted.&#x0D; Results: The mean PRP endometrial thickness was 5 mm which significantly increased to 7.34 mm post platelet rich plasma, against post-G-CSF endometrial thickness was 8.02 mm from 6.03mm pre infusion. Out of 10 cases who were infused with PRP,7 of them showed good vascularity (more than or equal to zone 3)out of 10 of those were given G-CSF,5 of them showed good vascularity. Number of clinical pregnancies resulted after instillation of PRP were 4 while 3 in case of G-CSF group.&#x0D; Conclusion: It can be concluded that although both PRP and G-CSF are equally effective in increasing endometrial thickness but endometrial vascularity is better inproved with platelet rich plasma, clinical pregnancy rates were also better with PRP but being a small sample study it was not significant statistically.

Striving for motherhood after uterus transplantation: a qualitative study concerning pregnancy attempts, and the first years of parenthood after transplantation.

How do women experience attempts to become pregnant, and the first years of motherhood, after uterus transplantation (UTx)? Women who try to become pregnant after UTx experience the general strains typically associated with infertility and childlessness, such as failure of embryo transfer (ET), and specific worries about graft survival but when they become mothers they essentially feel like other mothers, with the associated rewards and stresses. UTx has proven to be a successful treatment for absolute uterine factor infertility (AUFI). Although UTx seems to have a positive effect on self-image there is a lack of knowledge about how women who have received uterine grafts experience pregnancy attempts, pregnancy itself and the first years of motherhood. This prospective cohort study included the seven participants in the first UTx trial who had experienced surgically successful grafts. Pregnancy was attempted using ET 12 months after transplantation. Structured interviews were performed once a year for 5 years after transplantation. Six of the seven participants (mean age 29.3 years at UTx) had AUFI owing to the congenital absence of the uterus, while the seventh woman had undergone a hysterectomy. Post-transplantation, yearly interviews (2013-2018) were performed, comprising a total of 34 interviews. Interview data were analysed thematically. All seven participants achieved pregnancy during the study period and six became mothers. Experiencing the previously unimaginable was classed as an overarching theme with the following underlying themes: The yoke of childlessness; Going through the impossible and Motherhood as surreal and normal. The results showed that the women who try to achieve motherhood after UTx generally describe their situation as manageable and present strains comparable to other women undergoing infertility treatments. The fact that all participants came from one centre is a limitation. There are real psychological strains in motherhood after UTx, such as the concern the women expressed relating to health of the child and the effects of immunosuppressants. These findings are in line with those of other women who became pregnant after transplantation of organs other than the uterus. The results show that extra psychological support and attention should be given to those with repeated pregnancy failures or unsuccessful outcomes. In the cases where women became mothers, attention needs to be given to the possible worries connected to the UTx, but in other respects, they should be treated like any mother-to-be. Funding was received from the Jane and Dan Olsson Foundation for Science; Knut and Alice Wallenberg Foundation. A.L.F. grant from the Swedish state under an agreement between the government and the county councils; Swedish Research Council. The authors have no competing interests. NCT01844362.