Timing Of Intercourse Research Articles

Intrauterine Insemination vs Timed Intercourse in Letrozole and FSH-stimulated Cycles in Dysovulatory Infertility

Intrauterine Insemination vs Timed Intercourse in Letrozole and FSH-stimulated Cycles in Dysovulatory Infertility

Impact of repeated ovarian hyperstimulation on the reproductive function

One of six couples (17.5 % of the adult population) worldwide is affected by infertility during their lifetime. This number represents a substantial increase in the prevalence of this gynecological condition over the last decade. Ovulatory dysfunction and anovulation are the main causes of female infertility. Timed intercourse, intrauterine insemination, and assisted reproductive technology (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), are the most common interventions for infertile couples. Ovulation induction protocols for IVF/ICSI routinely use supraphysiological doses of gonadotropins to stimulate many preovulatory follicles. Animal and human studies suggested that ovarian hyperstimulation, alone or repeatedly, for ART cycles can induce changes in the immune response and increase the oxidative stress (OS) in the ovarian microenvironment. The consequences of repeated ovarian hyperstimulation on the human ovary remain poorly understood, particularly in relation to the effects of ovarian stimulation on the immune system and the potential for ovarian stimulation to cause OS. Animal studies have observed that repeated cycles of ovarian hyperstimulation can accelerate ovarian aging. Changes in ovarian hormone levels, accelerated loss of ovarian reserve, disorders in ovarian ultrastructure, ovarian senescence, and decreased reproductive performance represent possible long-term effects of repeated ovarian hyperstimulation. The short and long-term impact of the combination of antioxidant agents in ovarian hyperstimulation protocols in women undergoing ART must urgently be better understood. The recent increase in the number of ART and fertility preservation cycles may accelerate ovarian aging in these women, promoting consequences beyond the reproductive function and including health deterioration.

Comparison of Letrozole vs Clomiphene Citrate for induction of ovulation in polycystic ovarian syndromeAn Iraqi study

Polycystic ovary syndrome is a common endocrine disorder in young women and manifests as infertility in 55-75%. Clomiphene citrate is still the standard drug for inducing or augmenting ovulation. It is not, however, equally successful in all situations. L Metromile is an aromatase inhibitor and is one of the alternative treatments to Clomiphene. This study aims to answer the question (does letrozole add anything to the art Of ovulation induction and represent a real alternative to Clomiphene? To compare the effects of letrozole (5 mg) and clomiphene citrate (100 mg) for ovulation induction in women with polycystic ovary syndrome. A prospective randomized trial study was done at Tikrit Teaching Hospital. The study comprised a total of 40 infertile women with polycystic ovary syndrome; Patients were randomized to treatment with 5 mg Of letrozole daily (20 patients) or 100 mg of clomiphene citrate daily (20 patients) for 5 days starting on day 3 Of menses. Timed intercourse was advised 24-36 hours after hCG injection. Then, both groups were followed by sonography every other day from day 10 Of the menstrual cycle for the number and size Of follicles and endometrial thickness were assessed. The study revealed that the C . C group induce ovum with size > 18mm 12 (60%) versus 17 (85%) among Letrzol group, while < 18mm in about 8 C.C group as compared with 3 (15%) in Letrzol group, this relation was statistically not significant. The study revealed that C.C group induce > 1 follicle 8 (40%) versus 2 (10%) among Letrzol group, while I follicle induced in about 6 (30%) in C.C group as compared with 16 (80%) in Letrzol group, this relation was statistically significant. The endometrium thickness was 4-5 mm in 14 (70%) among C.C group, and 17 (85%) in Letrzol group , while uterine thickness was 6-9.5mm in 6 (30%) among C.C group and 3 (15%) among Letrzol group, this relation was statistically not significant, study conclude that Letrozole should be considered as first line drug to get away from clomiphene's unwanted effects like thin endometrium and multifolliculogesis.

Understanding Fertile Window: A Key to Pregnancy as well as Contraception

Abstract: Though population explosion is a major problem of the world today, infertility also exists and needs attention. Understanding reproductive health, the menstrual cycle, and adopting natural methods by couples can manage both fertility as well as infertility. During the preparation of the present review article, several search engines, such as Research Gate, Google Scholar, shodhganga, Scopus, emerging source citation index, chemical abstract services, academic journals database, open access medical journals, scirus, journal informatics, and various referred and nonreferred journals were used for the extraction of scientific information. Hence, this article has been prepared meticulously, which would help married couples in adopting an effective life plan for managing their reproductive activities. It explains about means of avoiding unwanted pregnancies using some naturally proven methods available. It also addresses issues related to infertility. Understanding ovulation symptoms and the fertile window is the key to determining the right time for intercourse in order to avoid or plan pregnancy. The ovulation technique uses the indicators of ovulation to determine the fertile window. A rise in body temperature and changes in cervical mucus (wet, clear, slippery) are the best indicators of ovulation. Understanding the concept of the fertile window enables women to strategically plan the timing of intercourse in order to either facilitate conception or prevent it.

THU627 Fertility Outcomes And Anti Mullerian Hormone Levels In Women With Hypopituitarism

Abstract Disclosure: V.W. Fitz: None. C.O. Sailer: None. I. Remba-Shapiro: None. N. Bomani Gonzalez: None. W. Pierre: None. C. Bormann: None. I. Souter: None. L.B. Nachtigall: None. Background: Disruption of the hypothalamic-pituitary-gonadal (HPG) axis due to pituitary gland disorders presents a challenge for patients who desire conception. Women with hypopituitarism often require assisted reproductive technology (ART) to conceive. Anti-Mullerian Hormone (AMH) has been established as a marker of ovarian reserve in patients with normal HPG function, however, levels in women with hypopituitarism have not been reported. In this cohort, we investigate pre-conception AMH levels, reproductive treatments and fertility outcomes in women with hypopituitarism. Methods: We reviewed a large database and identified 19 patients with hypopituitarism who had undergone fertility treatment and 142 age-matched controls with male factor infertility. Clinical characteristics and AMH levels are shown using mean (SD) or median (IQR). AMH ratio using the lower limit of normal as denominator is used to normalize to the reference range as several assays with different reference ranges were used during the timeframe of data collection. Mann-Whitney U was used to compare AMH levels. A p value of <0.05 was considered statistically significant. Results: Patients with hypopituitarism and controls had a mean age of 33.4 years (2.5) and 33.3 years (2.2) p=0.857, at initial fertility evaluation, respectively. 17/19 (89.5%) patients in the hypopituitarism group experienced spontaneous menarche and had a post-pubertal onset of hypopituitarism. Hormonal deficiencies included GH (9), ACTH (8), TSH (10), FSH/LH (13), and vasopressin (3). Causes of hypopituitarism included 8 pituitary adenomas (7 functioning and 1 non-functioning), 3 Rathke’s cleft cysts, 4 intracranial neoplasms, 2 congenital or idiopathic hypopituitarism and 1 intracranial trauma. Median AMH level was 2.60 ng/mL (0.90-3.50) vs. 3.48ng/mL (1.99-4.70) p=0.017, and AMH ratio was 3.11ng/mL (1.13-4.17) vs. 4.11ng/mL (2.60-6.25) p=0.070, in the hypopituitary group and in controls, respectively. Among the 19 patients with hypopituitarism, 13 underwent ovulation induction (OI) with intrauterine insemination (IUI) or timed intercourse (TIC), 12 underwent in vitro fertilization (IVF), and 6 were treated with both OI and IVF. 18/19 (94.7%) conceived and 16/19 (84.2%) had a livebirth. Four patients (21%) conceived spontaneously. Among the patients who underwent OI, 4/13 (30.8%) had ≥1 livebirth with a median of 2 cycles (range 1-4) until first birth. Among the patients who underwent IVF, 10/12 (83.3%) had ≥ 1 livebirth with a median of 1.50 cycles (range 1-4) until first birth. Conclusions/Impact: Patients with hypopituitarism conceive through a variety of assisted reproductive technologies and may conceive spontaneously. Overall, AMH levels are comparable to age matched controls. Reproductive interventions among women with hypopituitarism are successful, with most patients achieving at least one livebirth. Presentation: Thursday, June 15, 2023

Artificial intelligence in the service of intrauterine insemination and timed intercourse in spontaneous cycles

To develop a machine learning model designed to predict the time of ovulation and optimal fertilization window for performing intrauterine insemination or timed intercourse (TI) in natural cycles. A retrospective cohort study. A large invitro fertilization unit. Patients who underwent 2,467 natural cycle-frozen embryo transfer cycles between 2018 and2022. None. Prediction accuracy of the optimal day for performing insemination or TI. The data set was split into a training set including 1,864 cycles and 2 test sets. In the test sets, ovulation was determined according to either expert opinion, with 2 independent fertility experts determining ovulation day ("expert") (496 cycles), or according to the disappearance of the leading follicle between 2 consecutive days' ultrasound examinations ("certain ovulation") (107 cycles). Two algorithms were trained: an NGBoost machine learning model estimating the probability of ovulation occurring on each cycle day and a treatment management algorithm using the learning model to determine an optimal insemination day or whether another blood test should be performed. The estradiol progesterone and luteinizing hormone levels on the last test performed were the most influential features used by the model. The mean numbers of tests were 2.78 and 2.85 for the "certain ovulation" and "expert" test sets, respectively. In the "expert" set, the algorithm correctly predicted ovulation and suggested day 1 or 2 for performing insemination in 92.9% of the cases. In 2.9%, the algorithm predicted a "miss," meaning that the last test day was already ovulation day or beyond, suggesting avoiding performing insemination. In 4.2%, the algorithm predicted an "error," suggesting performing insemination when in fact it would have been performed on a nonoptimal day (0 or -3). The "certain ovulation" set had similar results. To our knowledge, this is the first study to implement a machine learning model, on the basis of the blood tests only, for scheduling insemination or TI with high accuracy, attributed to the capability of the algorithm to integrate multiple factors and not rely solely on the luteinizing hormone surge. Introducing the capabilities of the model may improve the accuracy and efficiency of ovulation prediction and increase the chance of conception. HMC-0008-21.

Identification of potential key genes related to idiopathic male infertility using RNA-sequencing data: an in-silico approach

Among reproductive health problems, idiopathic infertility affects married couples. The current diagnosis of male infertility focuses on the concentration, motility, and morphology of sperm in the ejaculate. Since the molecular mechanism of idiopathic infertility is unknown, identification of Differentially Expressed Genes (DEGs) among the control and idiopathic infertile male can shed light on diagnosis and treatment. Here, we analyzed the dataset GSE65683 to identify DEGs in idiopathic human sperm in three groups of patients: (i) Timed Intercourse (TIC); (ii) Intrauterine Insemination (IUI); and (iii) Assisted Reproductive Technology (ART). The enrichment analysis was carried out using DAVID (Database for Annotation, Visualization and Integrated Discovery) and GeneCodis for the DEGs. Protein-Protein Interaction (PPI) network of these DEGs were constructed using the STRING database. The network parameters such as degree and betweenness were calculated to select the important hubs. In total, 118 DEGs in TIC, 446 in IUI, and 188 in ART were identified. PPI network was constructed and identified critical top hub genes such as ACTB, BTBD6, EIF2S3, EIF3A, EIF4E, POLR2L, RPL4, RPL7, RPS11, RPL13, RPS15, RPL23, RPL27, RPL9, RPLP0 and UBA52 that may play an essential role in idiopathic male infertility. Thus, the identified hub genes may provide an insight into the molecular mechanism and contribute to discovering novel therapeutic targets and developing new strategies for idiopathic male infertility.

Luteal phase support with progesterone does not improve pregnancy rates in patients undergoing ovarian stimulation with letrozole

Research questionDoes luteal phase support with vaginal progesterone improve clinical pregnancy rates in patients undergoing ovarian stimulation with letrozole? DesignThis was a retrospective cohort study of patients undergoing ovarian stimulation with letrozole paired with intrauterine insemination (IUI) or timed intercourse (TIC) from January 2018 to October 2021. The primary outcome of clinical pregnancy rate (CPR) was calculated for cycles with and without luteal phase progesterone support. Univariate logistic regressions were done to evaluate predictor variables for CPR. Clinically important covariates including age, body mass index, anti-Müllerian hormone concentration, diagnosis of ovulatory dysfunction and multifollicular development were included in a multivariate analysis evaluating the relationship between luteal progesterone use and odds of clinical pregnancy. Secondary outcomes including spontaneous abortion, biochemical pregnancy and ectopic pregnancy were calculated. Live birth rates were calculated for cycles in a secondary analysis. ResultsA total of 492 letrozole ovarian stimulation cycles in 273 patients were included. Of these cycles, 387 (78.7%) used vaginal progesterone for luteal support and 105 (21.3%) did not. The unadjusted CPR per cycle was 11.6% (45/387) with progesterone and 13.3% (14/105) without progesterone (P = 0.645). After adjusting for significant covariates including age, BMI, diagnosis of ovulatory dysfunction and multifollicular development, the odds for clinical pregnancy were not significantly improved in cycles with exogenous progesterone (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.48–2.75, P = 0.762). A follow-up analysis demonstrated that live birth rate was 10.7% (41/384) with and 12.5% (13/104) without luteal progesterone, respectively (P = 0.599). ConclusionsLuteal support with vaginal progesterone does not significantly improve CPR in ovarian stimulation cycles using letrozole.

High incidence of sexual dysfunction and timed intercourse was found only in infertile males who with known impairment of sperm quality for a long period: evidence from a hospital-based cross-sectional study

BackgroundInfertile men with higher sexual dysfunction risk and increased psychological burden, were also associated with more inclined to timed intercourse. Decreased semen quality may have adverse effects on male sexual function. However, it is also likely that many of these sequences do not play a direct role, those negative consequences may depend mainly on the later failed attempting pregnancy. Research is limited in this area.MethodsThis cross-sectional study was based on a group of 509 men who were assessed for couple’s infertility at the First Hospital of Jilin University between June 2021 and October 2021. All the men completed a comprehensive questionnaire, and then were divided in two groups. Group A included patients who either never received a routine infertility work-up or done so recently within the last 6 months. Group B included patients who previously received a sperm quality assessment at least 6 months or more prior. Patients were further categorized into three subgroups according to the severity of the decreases in their sperm parameters: severe, mild-moderate, and normozoospermic.ResultsThe prevalence of erectile dysfunction was higher in Group B Mild-Moderate and Group B Severe in comparison to Group A (OR=1.86 [1.07–3.24], P = 0.027; OR=5.312 [2.69–10.49], P < 0.001, respectively). No significant differences were found between Group A and Group B-normozoospermic. Similar results were observed in the prevalence of premature ejaculation between the groups. Timed intercourse was seen in 11.8% (20/170) of men in Group A and 16.2% (19/117) in Group B-normozoospermic. It was more commonly practiced among infertile men in Group B-Mild-Moderate and Group B Severe, as 28.2% (44/156) and 25.7% (17/66) of these couples had attempted to conceive through timed intercourse (P < 0.001).ConclusionsOur findings indicate that the severity of sperm quality impairment was negatively associated with sexual dysfunction only in infertile men who with known impairment of sperm quality for a long period. Timed intercourse was more common among these couples. For those individuals had never test their sperm quality, although more than half of these patients showed a decrease in sperm quality, the incidence of sexual dysfunction is relatively low and were comparable to those men examined previously known as normozoospermic.

O-178 Timed intercourse for couples trying to conceive: an updated Cochrane systematic review and meta-analysis

Abstract Study question Does timing intercourse around the ‘fertile window’ using ovulation detection methods increase the chance of pregnancy in couples trying to conceive? Summary answer This update suggests that timed intercourse using urinary ovulation detection may increase the chances of pregnancy in couples trying to conceive. What is known already Development of health apps has surged, with many tracking menstrual cycles, generating ‘fertile window’ predictions for couples hoping to conceive as well as avoid pregnancy. Adjuncts have been marketed to improve the accuracy of ovulation detection, using LH/oestrogen urinary tests and fertility-based awareness method (FAMB) biosensors. These may all influence sexual behaviours, making timed intercourse more widely practiced. Thus, there is an increased need for clinicians and couples to understand the effectiveness of these methods and potential adverse effects such as stress. Study design, size, duration A Cochrane systematic review and meta-analysis was performed. The Cochrane Gynaecology and Fertility (CGF) Group trials register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO were searched in January 2022 to identify relevant randomised controlled trials (RCTs). In addition, relevant references lists were checked, and study authors were contacted to obtain unpublished data. Participants/materials, setting, methods Participants: Couples (fertile and subfertile) trying to conceive. Intervention: Timed intercourse using ovulation detection methods such as digital apps, LH/oestrogen urine ovulation tests, and FABM. Comparison: Intercourse not timed around the ‘fertile window’. Two independent authors screened studies and extracted data. Risk ratios (RR) were calculated for dichotomous data and mean differences (MD) for continuous data, with 95% confidence intervals (CI). Heterogeneity was examined via the I² statistic. Main results and the role of chance In this update, 881 references were screened. Six studies were included, involving 2,374 women. We are uncertain whether timed intercourse using FAMB resulted in a difference in live birth (RR 0.92, 95%CI 0.73 to 1.16, I²= 0%, 2 studies, 160 women: low-certainty evidence). No other studies reported live birth. We are uncertain whether timed intercourse using FAMB resulted in a difference in clinical or self-reported pregnancy (RR 0.96, 95% CI 0.8 to 1.15, I²=0, 2 studies, 160 women; low-certainty evidence). However, timed intercourse using urinary ovulation detection was associated with higher clinical or self-reported pregnancy (RR 1.28, 95% CI 1.10 to 1.50, I²=0, four studies, 2214 women; moderate-certainty evidence). This suggested that if the chance of a clinical or self-reported pregnancy following intercourse without ovulation prediction is assumed 18%, the chance following timed intercourse with urinary ovulation detection would be 20% to 28%. Subgroup analysis of all ovulation detection methods showed no difference between couples trying to conceive for under 12 months versus couples trying for over 12 months (subfertile). Finally, we are uncertain whether timed intercourse using urinary ovulation detection resulted in a difference in stress (MD 1.98, 95 CI% -0.87 to 4.83, 1 study, 77 women, low-certainty evidence). Limitations, reasons for caution Insufficient studies reported our specified outcomes including live birth (primary outcome), time to pregnancy, stress, and quality of life. Moreover, there were insufficient studies with large sample sizes assessing FABM, a key method used in timed intercourse and fertility apps. Wider implications of the findings This update provides evidence for the practice of timed intercourse using urinary ovulation detection. However, the majority of menstrual cycle apps use FABM for which there is currently insufficient evidence to support the use of when trying to conceive. This review highlights key areas where future research should be conducted. Trial registration number not applicable

O-270 Neurodevelopment at 5 years of age for preterm-born children according to mode of conception: a cohort study

Abstract Study question Do neurodevelopmental outcome at 5 ½ years of age of children born preterm differ according to the mode of conception (spontaneous versus Medically-Assisted Reproduction (MAR)) ? Summary answer There was no evidence of an impact of the mode of conception on neurodevelopmental outcomes at 5 ½ years of age. What is known already Preterm delivery is a risk factor for sub-optimal neurological development. Pregnancies conceived after Medically-Assisted Reproduction – which includes in vitro fertalisation (IVF), IVF with intracytoplasmic insemination (IVF-ICSI), as well as intra-uterine insemination (IUI) following induction of ovulation (IO) or timed intercourse (TIC) following IO – have a higher risk of preterm delivery. Few studies have evaluated the outcome at more than 2 years of age of such preterm-born children. Study design, size, duration The French prospective, national cohort study “EPIPAGE-2” collected information about all births below 35 weeks GA in 546 maternity hospitals in France in 2011.Children born below 27 weeks’ GA were recruited over 8 months, those born between 27 and 31 completed weeks GA over 6 months, and those between 32 and 34 weeks GA over five weeks. Participants/materials, setting, methods Only children born between 24 and 34 weeks’ GA were included. At birth, maternal, obstetric and neonatal data were obtained from medical records and mothers were interviewed to obtain information on their social characteristics and pregnancy. Surviving children were seen by trained investigators at 5 ½ years of age: this included medical and neurodevelopmental examinations, and parents completed a questionnaire. Birth following MAR was compared to that following natural conception. Main results and the role of chance 4349 children who survived to 5 ½ years of age were included: 814 in the ART group and 3535 in the spontaneously conceived group. No difference in cerebral palsy (aOR=1.00, 95% CI 0.67-1.49), neurodevelopmental disabilities (aOR=1.09; 95% CI 0.82-1.45) and developmental coordination disorders (aOR=0.75; 95% CI 0.50-1.12) were found between children born following MAR and children born following spontaneous conception after adjustment for sociodemographic factors. For proportions of IQ &amp;lt; 1 SD and &amp;lt;2 SD, there were no significant differences between the ART group and the spontaneous pregnancy group (respectively, aOR= 0.99 95% CI 0.80-1.23, and aOR=1.14; 95% CI 0.83-1.56). In subgroup analyses, no differences were seen between children born following IO or IUI nor among those conceived through IVF or IVF-ICSI when compared to children conceived spontaneously. Limitations, reasons for caution The main difficulty in prospective cohort studies is loss to follow-up. We are further reassured because analyses using complete cases found very similar results. We were limited in the extent of our analyses by the infertility treatment information available. Furthermore, we could not study outcomes for children born from donated gametes. Wider implications of the findings To our knowledge, this is the first published study evaluating multiple dimensions of longer term neurodevelopment among children born preterm according to the mode of conception. The large, prospectively-collected national cohort meant we could study several neurodevelopmental outcomes taking into consideration important confounding factors with sufficient power. Trial registration number CPP-2873

P-118 Timed Intercourse exacerbates the risk of sexual dysfunction in men &amp;amp; women without an improvement in time to pregnancy

Abstract Study question Investigate the differences in sexual dysfunction and time to pregnancy between infertile couples pursuing timed intercourse and Regular Intercourse (RI at least twice a week). Summary answer TI significantly increased the risk of SD compared to RI for both males and females after adjusting all other contributing factors. What is known already Timed Intercourse (TI) involves aligning sexual intercourse to the time around ovulation to increase the chance of conception in couples trying to conceive. Whilst TI is often advocated to increase conception rates and potentially accelerate the time to pregnancy (TTP) for infertile couples, the stressful nature of this approach may be associated with adverse effects such as sexual dysfunction (SD) within the couple. Study design, size, duration This prospective cohort study recruited 371 infertile couples who had been trying to conceive for more than a year, presenting to three regional infertility clinics between January 2016 and December 2018. 283 couples pursued TI and 88 couples pursued RI for a year, with all couples having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Participants/materials, setting, methods The SD score of both partners was assessed at the first visit using the validated Arizona Sexual Experiences Scale (ASEX) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). TTP was determined using Kaplan Meier Analysis in couples for whom natural conception was possible and no reversible fertility pathology was identified. Main results and the role of chance Timed Intercourse (TI) involves aligning sexual intercourse to the time around ovulation to increase the chance of conception in couples trying to conceive. Whilst TI is often advocated to increase conception rates and potentially accelerate the time to pregnancy (TTP) for infertile couples, the stressful nature of this approach may be associated with adverse effects such as sexual dysfunction (SD) within the couple. TI significantly increased the risk of SD compared to RI for both males (Odds ratio [OR] 15.24, 95% confidence interval [CI] 7.96-29.15) and females (OR 5.52, 95% CI 2.38- 12.78), after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI carried a higher risk of developing erectile dysfunction, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. The TTP for natural conception was similar between TI and RI (p = 0.1365). Limitations, reasons for caution TI, a well-known strategy for increasing conception rates, did not improve time to natural conception compared to regular sexual intercourse. In contrast, the risk of sexual dysfunction in both men and women was significantly higher in TI, compared with RI. Wider implications of the findings This large study raises the question of effectiveness of the long-held belief that TI (intercourse limited around the ovulation-time, based on different methods of ovulation-prediction) improves pregnancy outcomes. Trial registration number N/A

Sexual Health-related Quality of Life in Women with Pulmonary Arterial Hypertension: Compensating for Loss.

Rationale: Health-related quality of life in patients with pulmonary arterial hypertension (PAH) has become increasingly important in disease management as numerous treatment options have improved prognosis and time to clinical worsening. Sexual health-related quality of life (SHRQoL) is poorly understood in patients with PAH, but previous work has shown that patients may face unrecognized challenges, especially related to parenteral prostanoid analogue therapies. Objectives: Using qualitative methods, to describe challenges and perspectives related to SHRQoL among women with PAH. Methods: We conducted 13 semistructured in-depth interviews at the Pulmonary Hypertension Association's International Pulmonary Hypertension Conference and Scientific Sessions among female attendees with World Symposium on Pulmonary Hypertension group 1 PAH. A coding structure using both deductive and inductive coding was developed to organize and analyze data using applied thematic analysis. Salient themes were identified and are presented here using summary and illustrative quotations. Results: Ninety-two percent (12 of 13) of participants reported declines in the frequency of sex after diagnosis of PAH. A significant portion (62% [8 of 13]) experienced fear of having sexual intercourse because of cardiopulmonary symptoms. All participants (100% [13 of 13]) reported compensatory behaviors/strategies during and around sexual intercourse; some participants on subcutaneous prostanoids also reported timing intercourse to coincide with infusion site changes and, as a result, interrupted treatment during this time. Participants reported changing positions during sex to reduce breathlessness, and some reported removing oxygen to avoid interrupting intimacy. Most participants endorsed negative body image related to their medications, external oxygen supplementation, and/or body weight fluctuations (54% [7 of 13]). Many participants revealed that they had never discussed sexual practices with healthcare professionals and desired increased communication and discussion with their providers. Conclusions: Women with PAH face significant burdens and challenges regarding SHRQoL. PAH therapies directly affect SHRQoL. Further targeted qualitative and quantitative studies are needed to better characterize and improve SHRQoL in patients with PAH.

Timed intercourse in association with controlled ovarian hyperstimulation as the first-line treatment of couples with unexplained subfertility.

To report on the pregnancy outcomes of timed intercourse (TI) with controlled ovarian hyperstimulation (COH) as the first-line treatment of unexplained subfertility, and provide some evidence on the factors involved. The records of couples treated between January 2016 and March 2019 were retrospectively analyzed. Couples were selected for TI based on standard infertility evaluation. Semen analysis by swim-up was conducted and the total motile sperm count (TMSC) obtained. The main outcome measured was the clinical pregnancy rates. Data were analyzed with t test, Pearson's Chi-squared test, and the Wald test for logistic regression with p≤0.05. The records of 275 couples (449 cycles) were included in the analysis. Patients underwent TI up to six attempts. Patient- and cycle-based pregnancy rates were 18.55% and 13.14%, respectively. Eight patients got pregnant twice, resulting in a cumulative pregnancy rate of 21.4%. Women that did not get pregnant demonstrated a statistically higher mean age value than women who did (p=0.0186). Logistic regression indicated that for every year added to the woman's age, the chances of pregnancy reduced by 6.45%, and for cycles with TMSC ≥ 5 million, the chances of pregnancy were 1.91 times higher when compared to TMSC < 5 million. TI with COH should be considered as the first-line treatment for selected couples with unexplained subfertility before more traumatic and costly IVF treatments were considered. The findings can assist doctors to conduct a more educated counselling concerning the chances patients have to get pregnant with TI.

DIFFERENCES IN ANXIETY CONCERNING THE COVID-19 VIRUS AND COVID-19 VACCINE BETWEEN WOMEN UNDERGOING INFERTILITY TREATMENT AND THOSE NOT PURSUING TREATMENT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people. With the development and administration of the SARS-CoV-2 vaccines, there is growing evidence to suggest that there has been reduced transmission of the virus. However, the novelty of the vaccine has raised many questions for infertility patients due to the lack of research. This study examines the perceived anxiety level of patients at a fertility clinic in Manhattan who are undergoing infertility treatments, such as Timed Intercourse (TIC), Intrauterine Insemination (IUI), and In-Vitro Fertilization (IVF).

Effect of Ubiquinol supplementation on ovulation induction in Clomiphene Citrate resistance

BackgroundClomiphene Citrate is considered the gold-standard for induction of ovulation and has been used for several years to treat PCOS related infertility. Unfortunately, 15-40% of women with PCOS are resistant to Clomiphene Citrate. The study aimed to evaluate potential benefits of adding the active form of Coenzyme Q10 (Ubiquinol) to Clomiphene Citrate compared with Human Menopausal Gonadotropins (hMG) in Clomiphene Citrate resistant PCOS patients. 148 PCOS Patients with Clomiphene Citrate resistance were randomized into two groups (A and B). In group A, controlled ovarian stimulation was done by Clomiphene Citrate 150 mg daily (from 2nd till 6th day of cycle) together with Ubiquinol starting from 2nd day till day of hCG triggering in a dose of 100 mg orally once daily. In group B, hMG was given from 2nd day of the cycle in a dose ranging from 75 to 225 IU. Serial transvaginal ultrasonography was done starting on cycle day 8 and continued till size of leading follicle reaches 18 mm or more then ovulation triggering was done. Thereafter, patients were advised for a timed intercourse (TI) after 36 hours. A blood sample was withdrawn seven days after hCG triggering, for measurement of serum progesterone. If the Patient presented with a missed period for one week, a serum sample was sent for β-hCG.ResultsThere were no statistically significant differences (P > 0.05) between studied groups regarding; number of cases reaching mature follicular size, number of stimulated cycles, endometrial thickness on the day of hCG triggering, mid-luteal serum progesterone, positive serum pregnancy test and clinical pregnancy rate.ConclusionsAddition of Ubiquinol to Clomiphene Citrate improved ovarian responsiveness in Clomiphene Citrate resistant patients with results comparable to conventional hMG stimulation protocol.

Higher ovulation rate with letrozole as compared with clomiphene citrate in infertile women with polycystic ovary syndrome: a systematic review and meta-analysis.

Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. According to the latest guidelines, letrozole should be considered as the first-line pharmacological treatment for women with WHO Group II anovulation or PCOS. However, the use of letrozole as an ovulation induction agent is not FDA or EMA approved, and its use is "off-label." The main concern with respect to letrozole regards its potential teratogenic effect on the fetus. To determine whether the probability of ovulation is higher with letrozole as compared to clomiphene citrate (CC) in anovulatory women with PCOS. Randomized controlled trials (RCTs) comparing letrozole versus CC used for ovulation induction in infertile women with PCOS followed by timed intercourse (TI) or intrauterine insemination (IUI) were included in this meta-analysis. Primary outcome was ovulation. Secondary outcomes were live birth, clinical pregnancy, miscarriage, multiple pregnancy, and congenital anomalies. Subgroup analysis included patients who received letrozole or CC as first-line treatment, and patients with PCOS diagnosed according to the Rotterdam criteria. Twenty-six RCTs published between 2006 and 2019, involving 4168 patients who underwent 8310 cycles of ovulation induction, were included. The probability of ovulation was significantly higher in letrozole as compared to CC cycles (RR: 1.148, 95% CI: 1.077 to 1.223, 3017 women, 19 trials, I2: 47.7%, low-quality evidence). A higher probability of ovulation is expected in infertile patients with PCOS treated with letrozole as compared to CC. The higher ovulation rate might have contributed to the higher clinical pregnancy and live birth rate. This finding is also true for patients who were administered letrozole as first-line treatment. CRD42019125166.

Predictive Factors of Conception and the Cumulative Pregnancy Rate in Subfertile Couples Undergoing Timed Intercourse With Ultrasound.

The aim of this study was to determine predictive factors for pregnancy and assess the cumulative pregnancy rate (CPR) and live birth rate (CLBR) in subfertile couples undergoing timed intercourse (TI) using ultrasound. This retrospective cohort study included 285 women (854 cycles) who started TI with ultrasound between January 2017 and October 2019. The overall clinical pregnancy rate was 28.1% (80/285) per couple and 9.4% (80/854) per cycle. Pregnant women had a higher body mass index (BMI), higher percentage of irregular menstrual cycles, a shorter duration of subfertility, lower serum follicle-stimulating hormone levels, and higher anti-Müllerian hormone levels than non-pregnant women. A longer duration of subfertility (≥24 months vs. <12 months; odds ratio: 0.193; 95% confidence interval: 0.043-0.859) and endometriosis (vs. ovulatory factors; odds ratio: 0.282; 95% confidence interval: 0.106-0.746) as causes of subfertility were unfavorable factors that independently affected clinical pregnancy. In subgroup analysis, old age ≥ 35 years [vs. < 35 years; odds ratio: 0.279; 95% confidence interval: 0.083-0.938), a longer duration of infertility ≥24 months (vs. <24 months; odds ratio: 0.182; 95% confidence interval: 0.036-0.913) and a higher BMI ≥ 25 kg/m2(vs. >25 kg/m2; odds ratio: 3.202; 95% confidence interval: 1.020-10.046) in couples with ovulatory factor and a longer duration of infertility ≥24 months (vs. <24 months; odds ratio: 0.185; 95% confidence interval: 0.042-0.819) in couples with non-ovulatory factors were significant independent predictive factors for pregnancy. No significant differences were found in the cycle characteristics between pregnant and non-pregnant women. The CPR substantially increased during the first three cycles and significantly increased until the sixth cycle. No significant increase was observed in the CPR after the sixth cycle. The CLBRs substantially increased during the first three cycles and significantly increased until the fourth cycle. No significant increase was observed in the CLBRs after the fifth cycle. When comparing CPRs and CLBRs according to subfertile causes, CRPs was significantly different and CLBRs was different with borderline significance. Our findings may indicate that women with a longer duration of subfertility or subfertility due to endometriosis have poor outcomes during TI with ultrasound. Women who failed to achieve conception by the fourth or fifth cycle of TI with ultrasound may be encouraged to consider advancing to the next treatment strategy.

Sporadic anovulation is not an important determinant of becoming pregnant and time to pregnancy among eumenorrheic women: A simulation study.

Attaining pregnancy is conditional upon a series of complex processes, including adequately timed intercourse, ovulation, fertilisation, and implantation. Anovulation is a first-line treatment target for couples with difficulty conceiving and is frequently examined in studies of fecundability. To identify whether sporadic anovulation is an important determinant of cumulative pregnancy rates and time to pregnancy among fertile women with regular menstrual cycles. We simulated cumulative pregnancy rates and time to pregnancy for 12 consecutive menstrual cycles among 100000 women based on data-driven probabilities of implantation, fertilisation, ovulation, and intercourse occurring in the fertile window. We assumed anovulation probabilities of 1%, 8%, or 14.5% and intercourse averaging once per week, every other day, or daily. The model incorporated reductions in implantation and fertilisation rates for successive cycles of non-pregnancy. After 12 cycles, a reduction in the per cycle incidence of anovulation from 14.5% to 1% resulted in a 4.0% higher cumulative pregnancy rate (86.7% vs 90.7%) and similar time to pregnancy (1-cycle median difference). In contrast, increasing mean unscheduled sexual intercourse frequency from weekly to every other day was associated with a 5-cycle median reduction in time to pregnancy (weekly: 7 cycles; every other day or daily: 2 cycles) and a 28.9% increase in the cumulative pregnancy rate (weekly: 59.9%, every other day: 88.8%; daily: 91.6%). In presumed fertile women with regular menstrual cycles, routine investigation of anovulation may not be an informative outcome in studies of fecundability, and routine testing to ensure ovulation and treatment of anovulation are unlikely to be medically necessary. While biomarkers or cervical fluid may help time intercourse to the fertile window, time to pregnancy can also be improved through increasing the frequency of unscheduled intercourse. These findings need corroboration in large preconception time to pregnancy studies.

Comparison of the role of letrozole &amp; clomiphene citrate as a first line ovulation induction drug in infertile women with polycystic ovary syndrome

To compare the role between Clomiphene Citrate &amp; letrozole for infertile patients with Polycystic Ovary Syndrome as an ovulation induction agent &amp; which drug can be chosen as a first line ovulation induction agent in future.: This prospective study was carried at SSIMS &amp; RC OBG OPD. Total 50 patients of PCOS (diagnosed by Rotterdam criterion) were included in this study. In this clinical trial out of 50 patients, 25 patients received Clo miphene Citrate 100mg (n=25) and rest 25 patients received Letrozole 2.5mg (n=25) daily since day 2-6 or3-7 of menstrual cycle. Follicular respose was carried out from day 9 by trans-vaginal sonogram till atleast 1 mature follicle (18-22mm) was detected &amp; hCG was administered at a dose of 5000 IU. Timed intercourse was advised 24-36 hours after hCG injection. The number of Follicles, Endometrial Thickness, Ovulation rate &amp; Pregnancy rate were measured in both groups. Monofollicular development was statistically significantly, greater in the Let group (CC 61.9%, Let 86.9%). There was also statistically significant difference between the two groups in endometrial thickness (CC 7.86±1.25mm, Let 9.18±1.49mm). Similarly, The ovulation rate was 84%% in CC group and 92% in Let group. The pregnancy rate was 20% in CC group and 36% in Let group. Letrozole might be an acceptable alternative to clomiphene citrate to induce ovulation and pregnancy in PCOS patients.