Tubal Factor Infertility Research Articles

Top-quality embryo transfer is associated with lower odds of ectopic pregnancy.

The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6-8gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n=8952) or frozen-thawed embryo transfer (n=6054). Treatments were performed during 2000-2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs 2.4%, p=0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p < 0.0001). Tubal factor infertility was diagnosed more often in ectopic pregnancy than in intrauterine pregnancies (21.2% vs 11.0%, p < 0.0001). Logistic regression revealed lower odds for ectopic pregnancy after a top-quality embryo transfer than after transfer of a non-top quality embryo (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.56-0.92, p=0.007). Transfer of two vs one embryo (OR 1.35, 95% CI 1.05-1.70, p=0.02) and tubal factor infertility (OR 2.21, 95% CI 1.68-2.91, p < 0.0001) significantly increased the risk of ectopic pregnancy. Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible.

Bisphenol A correlates with fewer retrieved oocytes in women with tubal factor infertility

Serum and urinary bisphenol A (BPA) concentrations have been associated negatively with the number of retrieved oocytes after in vitro fertilization (IVF). The impact of BPA upon women with polycystic ovary syndrome (PCOS) and women with tubal factor infertility (TFI), following IVF, was investigated. To this purpose, associations among serum and urinary and follicular fluid (FF) BPA concentrations and the number of retrieved and fertilized oocytes and comparisons between pregnancy rates were evaluated. This was a cross-sectional study conducted at a university-affiliated assisted conception unit between January and November 2019, including 93 women of reproductive age (PCOS: 45; TFI: 48) following IVF. Unconjugated FF and serum BPA concentrations and total urinary BPA concentration were measured using a novel gas chromatography-mass spectrometry method. The number of retrieved and fertilized oocytes and pregnancy rate were documented and evaluated. The number of oocytes retrieved from PCOS women was greater than that of 21 TFI women, independently of BMI. Lower FF BPA concentrations were found in all PCOS women and in overweight/obese PCOS compared to TFI women (0.50, 0.38, and 1.13ng/mL, respectively). In TFI women, FF BPA concentrations correlated negatively with the number of retrieved oocytes. Serum and FF and urinary BPA concentrations did not significantly affect the number of fertilized oocytes and pregnancy rate in both groups. FF BPA concentrations were lower in all PCOS women and in overweight/obese PCOS than in TFI women. In TFI women, FF BPA concentrations correlated negatively with retrieved oocytes. Confirmation of these findings might lead to moderation of use of BPA-containing products by women undergoing IVF.

The role of Kisspeptin, KISS1 and KISS1R genes in primary female infertility: a case‐control study of a Nigerian population

IntroductionThere is growing evidence that genetic changes are present in as many as 10% of infertile females. The Kisspeptin system plays a critical regulatory role in female reproductive functions. However, the extent of its role is not yet evident in primary infertility.ObjectiveThis study investigated the relative gene expression levels of Kisspeptin, KISS1, and KISS1R in primary infertile and fertile Nigerian females.Materials and MethodsThis is a case‐control study of 50 fertile and 54 primary infertile Nigerian females (20 to 40 years) attending the gynecology and family planning clinics of University College Hospital, Nigeria, and met the study’s inclusion criteria between August and November 2020. Basic clinical and sociodemographic information was collected from each participant using a clinical proforma. Five ml of blood samples were also collected by venepuncture from both the cases and control subjects for Kisspeptin, KISS1, and KISS1R genes analysis, using ELISA and RT‐qPCR techniques.ResultsBMI of cases was significantly different from the study controls, though both are still in the overweight category (27.98±0.87 vs. 28.18±0.59; p=0.004). Menarcheal age was not significantly different (p=0.573) but shows a significant strong association with ovarian factor infertility (p=0.008, χ2=13.839, φc= 0.458) and tubal factor infertility (p=0.025, χ2=11.111; φc=0.527). There is no change in the relative expression of Kisspeptin, Kiss1, and Kiss1R genes (P&gt;0.05). However, Kisspeptin levels in primary infertile women showed a weak negative correlation (r = ‐.305; p=0.039) and a good predictive model for Kiss1 gene expression (p=0.001; r=0.458).ConclusionFemales with primary infertility may present with overweight in no significantly different way than fertile females. Changes in the Kisspeptin levels and relative expressions of Kiss1 and Kiss1R may not be useful in diagnosing primary infertility. Menarcheal age should be investigated as an additional diagnostic indicator for tubal and ovarian factor infertility for primary infertile women.SignificanceChanges in the Kisspeptin system alone may not explain the primary female infertility due to the complexity of the disease. A look into the role of the Kisspeptin system in the specific causative factors of primary female infertility could be more revealing.

Polycystic ovary syndrome and black race are associated with increased blood pressure

IntroductionPolycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive age women and is associated with comorbidities including obesity, type II diabetes and hypertension. Few studies have focused on older reproductive age women (i.e., &gt; 30 yrs) with PCOS, when blood pressure (BP) and cardiovascular disease (CVD) risks begin to increase. We tested the hypotheses that PCOS in older reproductive age women are associated with greater systolic, diastolic, and mean BP (SBP, DBP, &amp; MAP), and that the BP relationships are independent of BMI.MethodsWe used EHR data provided by the Joint Data Analytics Team (JDAT) at the Yale School of Medicine. We examined women evaluated for new‐patient diagnoses, follow‐op, or infertility evaluations/procedures by the same provider between 10/7/11 to 12/23/15. Of the 13,951 women, n=261 with PCOS and n=168 controls (diagnosed with tubal and/or male factor infertility) were identified. BP measurements were measured at the time of or following the diagnosis of PCOS or male factor/tubal infertility. We used t‐tests to determine group differences in BP and BMI, and multivariable linear regressions to determine associations. Regressions were adjusted for age, race, and BMI; the interaction between PCOS and BMI was examined using a BMI centered product term and accounted for in the final model. The data were then stratified by BMI (obese, BMI ≥ 30 kg/m2) vs non‐obese, BMI &lt; 30 kg/m2) and a multivariable linear regression model adjusted for age and race was used to examine PCOS as a predictor of BP indices in obese versus non‐obese women.ResultsAge and BMI were greater in PCOS, (36±3 yr; 33±9 kg/m2) versus Controls (37±3 yr; 28±7 kg/m2, p&lt;0.001), while racial breakdown was similar: PCOS: 72% white, 11% black, 4% Asian, 15% Hispanic, and Controls: 60% white, 18% black, 8% Asian, 20% Hispanic. Respectively, the SBP, DBP, &amp; MAP for PCOS (122±13; 77±10; 92±10) were greater vs Controls (116±15; 73±10, 88±11, p&lt;0.001). Our multivariable linear regression model demonstrated an interaction between PCOS and BMI with negative slopes (β), (r2=0.176, β= ‐0.216, p=0.030; r2=0.181, β=‐0.294, p=0.003; r2=0.203, β=‐0.282, p=0.004, for SBP, DBP, &amp; MAP respectively). When stratified by BMI, racial breakdown for groups was similar: N=242 obese group, 67% PCOS, BMI=38 ±6 kg/m2, age=36±3 yr, 65% white, 19% black, 20% Hispanic, and N=187 non‐obese group, 52% PCOS, BMI=24±3 kg/m2, age=36±3 yr, 70% white, 7% black, 13% Hispanic. In a model adjusted for age and race, PCOS predicted SBP, DBP, and MAP in the obese group (r2=0.073, p&lt;0.001; r2=0.061, p=0.001; r2=0.073, p&lt;0.001) but not in the non‐obese group (r2=0.018, p=0.269; r2=0.034, p=0.050; r2=0.025, p=0.078). Additionally, in the obese‐group, black race significantly predicted SBP (r2=0.073, p=0.018) and MAP (r2=0.073, p&lt;0.028), although race was not a significant factor in the non‐obese group.ConclusionThese data show that in older reproductive age women with obesity, PCOS and black race are independent predictors of worsening BP indices. NIH 5 T35 HL 7649‐35.

Oxidative Stress Causing Recurrent Miscarriage and Infertility in Female Inhabitants of High Altitudes of India

Long-term exposure to altitude has been shown to have major consequences on metabolic, cardiovascular, and reproductive function. The effects of persistent hypoxia on reproductive health can be studied in a natural laboratory at high altitude. Contrary to popular belief, fertile residents appear to be largely immune to miscarriage. Infertility and recurrent miscarriage have been linked to oxidative stress in women living at high altitudes. Oxidative Stress (OS) affects gametes and their interactions. The regulation of gamete quality and gamete interaction is aided by reactive oxygen species (ROS). ROS has been implicated in oocyte formation, maturation, follicular atresia, corpus luteum function, and luteolysis in numerous human investigations. Pathologies in the female reproductive system that are precipitated by OS are comparable to those that cause male infertility. The quality of the egg and embryo, and consequently the rate of fertilization, is influenced by OS. Assisted reproductive treatments, such as IVF and ICSI, are high-tech procedures used to treat female infertility in a variety of situations. They can help women who are infertile due to causative reasons such as endometriosis or tubal factor infertility, as well as people who are infertile for no apparent reason.

Integrating lncRNAs and mRNAs Expression Profiles in Penicillin-Induced Persistent Chlamydial Infection in HeLa Cells.

Chlamydia trachomatis (C. trachomatis) is a major etiological agent of sexually transmitted infection. Some stressing conditions can result in persistent chlamydial infection, which is thought to be associated with severe complications including ectopic pregnancy and tubal factor infertility. Long noncoding RNAs (lncRNAs) have been identified as key modulators in many biological processes. Nevertheless, the role of lncRNAs in persistent chlamydial infection is still unclear. In this study, we used lncRNA and mRNA microarray to identify the global lncRNAs and mRNAs expression in penicillin-induced persistent chlamydial infection in HeLa cells as well as the control group (HeLa cells without C. trachomatis infection). Among 1005 differentially expressed lncRNAs, 585 lncRNAs were upregulated and 420 downregulated in persistent chlamydial infection, while 410 mRNAs were identified to express differentially, of which 113 mRNAs were upregulated and 297 downregulated. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis with differentially expressed genes were performed. We then constructed the lncRNA-miRNA-mRNA competing endogenous RNAs (ceRNAs) network. Four mRNAs were validated to be changed by quantitative real-time PCR which were correlated with the microarray result. Integration of protein-protein interaction network was constructed and hub genes were identified. These findings provide a new perspective on the molecular mechanisms of penicillin-induced persistent chlamydial infection.

Reproductive outcomes after laparoscopic surgery in infertile women affected by ovarian endometriomas, with or without in vitro fertilisation: results from the SAFE (surgery and ART for endometriomas) trial

We performed a retrospective cohort study, namely “Surgery and ART for Endometriomas” (SAFE) trial (Clinical Trial ID: NCT03717870), including women who underwent laparoscopic cystectomy for endometrioma before first IVF and compared their reproductive outcomes with the ones of women without endometriosis and with unexplained infertility, tubal factor or male factor infertility. We found that women who underwent previous laparoscopic cystectomy for endometrioma had higher FSH and LH levels between the 2nd and 5th day of the cycle before IVF, required higher doses of gonadotrophins for ovarian stimulation and had a lower number of retrieved oocytes compared with other types of infertility. Nevertheless, pregnancy and delivery rates remain comparable to other causes of infertility. In addition, differences in ovarian stimulation parameters between endometriosis and other types of infertility lost significance with the increase of women’s age. These pieces of information can be considered useful to make adequate counselling about reproductive outcomes for infertile women with ovarian endometriomas and allow a proper decision-making approach shared with the patient. IMPACT STATEMENT What is already known on this subject? Although endometriomas are common findings in infertile women, whether they should be surgically removed before an in vitro fertilisation (IVF) is a long-lasting debate, and current evidence does not offer a robust background to draw firm recommendations. What do the results of this study add? Women who underwent previous laparoscopic cystectomy for endometrioma need higher doses of gonadotrophins for ovarian stimulation and have a lower number of retrieved oocytes, compared with other types of infertility. Pregnancy and delivery rates remain comparable to other causes of infertility. What are the implications of these findings for clinical practice and/or further research? These pieces of information can help to make adequate counselling about reproductive outcomes for infertile women with ovarian endometriomas and allow a proper decision-making approach shared with the patient.

Independent Variables for Determining the Cumulative Live Birth Rates of Aged Patients with Polycystic Ovary Syndrome or Tubal Factor Infertility: A Retrospective Cohort Study.

ObjectiveTo assess whether women of advanced age (≥35 years) with polycystic ovary syndrome (PCOS) have the same cumulative live birth rate (CLBR) as their age-matched controls with tubal factor infertility and to determine the influencing factors on the CLBRs of aged women.DesignA retrospective cohort study.Setting and PopulationA total of 160 women of advanced age (≥35 years) with PCOS and 1073 women with tubal factor infertility were included in our study. All patients underwent their first fresh cycles and subsequent frozen cycles within in one year in our centre from 2015 to 2020.MethodsTo determine independent influencing factors on the CLBRs of these aged patients, a multivariable Cox regression model of CLBR according to the transfer cycle type was constructed. Main outcome measure(s): CLBRs.ResultThe Cox regression model of the CLBRs indicated that there was no significant difference between the PCOS group and the tubal infertility group in terms of advanced age (HR, 0.95; 95% CI, 0.71-1.27, P=0.732). The CLBR significantly decreased for women of advanced reproductive age up to 37 years of age (HR, 0.46; 95% CI, 0.39-0.56, P<0.001). The CLBR increased by 63% when more than ten oocytes were retrieved (HR, 1.63; 95% CI, 1.34-1.98, P<0.001). Patients with an AMH level above 32.13pmol/l were likely to have a 72%(HR, 1.72; 95% CI, 1.08-2.73, = 0.023) and 34% (HR, 1.34; 95% CI, 1.07-1.68, P=0.010)improvement in CLBR compared to those with an AMH below 7.85pmol/l and 7.85-32.12pmol/l, respectively.ConclusionDespite the higher number of oocytes retrieved in PCOS patients, the reproductive window is not extended for PCOS patients compared with tubal factor infertility patients. Age, AMH and the number of oocytes retrieved play crucial roles in the CLBRs of patients of advanced age (≥35 years).

Comparison Study of Infertility Issues in Rural and Urban Areas

Objective: The purpose of this study was to investigate the causes of infertility in both urban and rural regions. Materials and method: In this systematic review data published by Medline, PubMed, the science straightforward and Obs gyne online library were asked about studies published between 2000 and 2021 using specific MeSH terms. We provided data on 15 phase 6 studies undertaken at a tertiary care facility in rural and urban training locations. Results: In this study, we examined the causes of infertility variability in all habitats. Our revised study shows that fertility rates are very high in small towns and rural areas and very low in the capital, as expected. The study included 7100 married people between the ages of 15 and 49 when 2600 were infertile. The reason for infertility in a couple is assigned on the basis of history and test results. Most women in rural areas are educated. There was a substantial difference between the amount of education and occupation of the site of residence for infertile women. In both rural and urban regions, couples experiencing infertility for less than 5 years were 46 percent and 42 percent, respectively. Women with a familial history of infertility were nearly comparable. In rural places, the history of marriage is common. Female characteristics, male characteristics, and associated features have been claimed to be responsible for infertility in 40percent, 40percent and 20percent of cases, respectively. Conclusion: The poor state of education in rural areas is a major obstacle to encouraging couples to access health care in rural areas. Though PCOS is still a major issue, diseases are still a significant factor in tubal factor infertility, and smoking and liquor enhance the male factor. Most women in rural areas are illiterates. Thus our revised research shows that fertility rates are much higher in small towns and rural areas and compared with the capital due to lack of information and medical services.

Anatomical Causes of Infertility Diagnosed Using Imaging Tests in A Group of 100 Women

Background and aims. The demographics of infertility differ dramatically from one region to another. Therefore, details about the causes and distribution of infertility of different localities and regions are essential for any effective management strategy. This study aimed to evaluate the distribution of the causes of infertility in a women population attending a tertiary healthcare facility. Methods. A cross-sectional observational study conducted in a gynecology clinic on female patients who came for infertility consultation or treatment between June -2019 and December-2020. The cause of infertility was diagnosed by the history, examination and investigation. Data were arranged in tables, and the frequency of each factor was calculated and therefore the prevalence was estimated using SPSS 25. Results. secondary infertility (53%) was more prevalent than primary infertility (47%). Pelvic inflammatory disease was the leading cause (40%) and it was associated with tubal factor infertility. Second cause was polycystic ovarian syndrome (PCOS) (33%). Infertility causes changed as the age of marriage increased. In females married for less than 5 years, PCOs was the main cause of infertility. Conclusion. Causes of infertility in women change according to the age group and the age of marriage. This study shows that PID is the most common cause of infertility in females followed by PCO. A significant association between infections and tubal factor infertility was found.

Correlation between hysterosalpingography diagnosis and final hysterolaparoscopy with dye-test diagnosis in women with utero-tubal infertility: A cross-sectional study of the implication for which test should be the first-line investigation.

Objective:To assess the accuracy of hysterosalpingography in diagnosis of uterine and/or tubal factor infertility, using hysterolaparoscopy with dye test as the gold standard with an implication for which test should be the first-line investigation.Methods:A prospective cross-sectional study of 96 women who underwent hysterosalpingography and hysterolaparoscopy with dye test. All women within reproductive age group with utero-tubal infertility who underwent both hysterosalpingography and hysterolaparoscopy with dye-test procedure were included. The outcome measures were proportions of tubal blockage and intrauterine pathology. Individual and overall mean accuracy were calculated for hysterosalpingography, using hysterolaparoscopy with dye test as the gold standard. Patient had procedure of hysterosalpingography first and both laparoscopic surgeons and patients were blinded to the outcome of hysterolaparoscopy with dye test until analysis. Statistical significance was set at p < 0.05.Results:Overall, 128 women were assessed for eligibility while 96 women finally completed the study. Hysterosalpingography demonstrated diagnostic accuracy of 77.8% (p < 0.001), 76.3% (p < 0.001) and 78.3% (p < 0.001) for right, left and bilateral tubal blockage, respectively. Overall accuracy of hysterosalpingography tubal factor assessment was 77.4 ± 0.8% (95% confidence interval = 76.5% to 78.4%). Hysterosalpingography showed an accuracy of 85.7%, 86.6% and 76.7% for right, left and bilateral hydrosalpinx, respectively, given overall diagnostic accuracy of 83.0 ± 5.1% (95% confidence interval = 77.9% to 88.1%). Overall accuracy of hysterosalpingography in diagnosing intrauterine pathology was 68.5 ± 9.8% (95% confidence interval = 53.9% to 83.1%).Conclusion:Hysterosalpingography detects tubal blockade and intrauterine pathology poorly compared to hysterolaparoscopy with dye test. Hysterosalpingography may face unpredictable clinical situations biased by technological error, leading to unsuccessful evaluation and uncertain diagnosis. Although the cost-effectiveness, risk of surgery or anaesthesia flaws hysterolaparoscopy with dye test. Hysterosalpingography should not be the first-line utero-tubal assessment tool rather hysterolaparoscopy with dye test.

Randomized prospective study comparing conventional In Vitro Fertilization technique to Intravaginal Culture with the INVOCELL™ device for 3 and 5 days.

The objective was to analyse and compare the formation and quality of the embryos developed using conventional in vitro fertilization (IVF) and IVC techniques with an INVOCell™ device. Two groups were formed, with eight couples in each, one in culture for three days (D3) and another in culture for five days (D5), using intravaginal culture technique with an INVOcell device and a conventional in vitro fertilization technique. Embryo formation in Group D5 showed 46.7% (IVC) and 40% (IVF) of recovered blastocysts. In the group D5, the conventional IVF, better embryo development dynamics was observed, with 66% of expanded blastocysts, against 28% in the IVC. Group D3 showed 75% (IVC) and 53% (IVF) of embryo formation. Embryonic quality in Group D3 demonstrated that IVF embryos had a better synchrony in the number and quality of blastomeres. All embryos recovered in Group D3, in both techniques, did not show fragmentation. The pH of the medium contained in the INVOCell™ device in both Groups D5 and D3 showed no differences. The means were 7.26 and 7.25, respectively. The pH of the medium used in IVF was 7.29 in both groups. Microbiological analyzes of the culture media contained in the INVOCell™ devices used in Group D5 were negative. The results showed that the IVC technique, using the INVOCell™ device, provided a healthy and balanced environment for the development and obtaining of quality embryos with three and five days of culture.

Relevance of hysterosalpingogram (HSG) in infertility assessment at the rivers state university teaching hospital, Port Harcourt

Background: The aim of this study was to determine the relevance of Hysterosalpingogram (HSG) in current infertility management and to highlight the shortcomings of Hysterosalpingography At the Rivers State University Teaching Hospital (RSUTH), Nigeria and sub-Saharan Africa. Methods: This was a retrospective, cross-sectional study of 200 Hysterosalpingogram results of patients that were being managed for infertility from 1st January 2020 to 31st December 2021 at the Rivers State University Teaching Hospital, Port Harcourt. The HSG was done at the Radiological Department of the hospital. Data was collected from the patient case notes and from the Radiological department of RSUTH. Data were analyzed using SPSS version 25. Quantitative data were represented as mean &plusmn; SD while qualitative ones were described as frequency and percentage. Results: A total of 200 Hysterosalpingogram results of patients were analyzed. Their mean &plusmn;SD age was 33.5&plusmn;5 years. The indication for HSG was infertility for all of them. Infertility duration was greater than one year for all of them. Sixty-two (31%) had primary infertility while 138 (69%) had secondary infertility. One hundred and three (51.5%) of the patients had significant previous gynecological and obstetric history that predisposed them to tubal factor infertility. HSG findings were bilateral tubal patency in 79 cases (39.5%), Hydrosalpinx/peritubal adhesions in 11(5.5%), unilateral tubal occlusion in 14 (7%), Bilateral tubal occlusion in 35(17.5%), and intra uterine adhesion in 50 (25%). Thus, HSG investigation was able to detect the likely cause of infertility in (60.5%) of the participants. Conclusion: HSG is still the most common first-line diagnostic test to evaluate the uterine cavity and tubal pathology in infertility patients. Laparoscopy, Hysteroscopy, Transvaginal ultrasound scan, and Magnetic resonance imaging are more reliable methods of detecting tubal pathology or uterine cavity anomalies in infertility evaluation. These are not easily available in low -and -middle-income countries, especially sub-Saharan Africa and Nigeria in particular because of cost. HSG is relatively cheap and uncomplicated, which has contributed to it acquiring a primary role in assessing abnormal findings in fallopian tubes and uterine cavity.

Correlation of hysterosalpingography and laparoscopy in the detection of tubal infertility factor

Background/Aim: Around 15-20 % of couples worldwide struggle with infertility, a difficult and aggravating gynaecological issue. Conception occurs in both partners, male and female, as they are both responsible for conception. This study aimed to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the detection of tubal infertility factors, by comparing the findings of HSG with the findings of laparoscopy (LPSC). Methods: A retrospective study from 1st January 2018, to 31st December 2019, is presented. Infertile patients who underwent LPSC, HSG and ultrasound to evaluate sterility during this timeframe were included in the research. Results: The study involved 63 infertile patients with a mean lifespan of 33.3 ± 4.7 years. The conclusions of LPSC and HSG, in general, were in good correlation and the percentage of agreement among the diagnostic procedures was 77.8 %. In the case of dichotomous categories, there is a good alignment between LPSC and HSG results with a percentage of 85.7 %. Hydrosalpinx: The findings of LPSC and HSG are quite similar. The percentage of agreement among the diagnostic techniques used was 79.2 %. Canal obturation: LPSC and HSG results are in good correlation with a percentage of 78.6 %. Terminal obturation: LPSC and HSG results are also in good agreement with the calculated percentage of 82.1 %. Conclusion: In determining tubal sterility factors, there is considerable consistency between LPSC and HSG results (c = 0.68; 95 % CI 0.54-0.83). There is a good correlation between LPSC and HSG findings of dichotomous categories (ch2 = 0.63; 95 % CI: 0.41-0.86). 86.2 % of subjects with peritubular appendages and 8.8 % of subjects without peritubular appendages had hydrosalpinx, which is a statistically significant difference (ch2 = 37.957; p &lt; 0.001). Between LPSC and HSG data, there is a good agreement in the diagnosis of hydrosalpinx (c = 0.64; 95 % CI: 0.38-0.91).

Uterus Transplantation: A 50-Year Journey.

This paper provides an analysis of the last 50 years of uterus transplantation (UTx). Animal research on UTx began in the 1960s, aiming to solve tubal factor infertility. The success of in vitro fertilization shifted the focus onto uterine factor infertility. Early research in small and large animals improved following the advent of immunosuppression and established the uterus' ability to tolerate cold ischemia and to function following vessel reanastamosis. Upon the achievement of the first live birth following UTx in 2014, human research has started to focus on reducing donor morbidity, optimal immunosuppression regimes, and the development of deceased donor UTx programmes.

Factors associated with disparate outcomes among Black women undergoing in vitro fertilization

ObjectiveTo determine if Black women have worse in vitro fertilization (IVF) outcomes than women of other races/ethnicities, and to establish which factors are associated with the IVF outcomes of Black women.DesignRetrospective cohort study.SettingNot applicable.Patient(s)All patients undergoing IVF.Intervention(s)Not applicable.Main Outcome Measure(s)Spontaneous abortion rate, clinical pregnancy rate, and live birth rate.Result(s)A total of 71,389 patient cycles were analyzed. Of the 40,545 patients who were included, 6.4% of patients were Black, 62% were White, 7.3% were Hispanic/Latino, and 15% were Asian. After IVF, Black women had significantly more miscarriages than White but not Hispanic or Asian patients (8.0% Black vs. 6.9% White, 7.4% Hispanic, and 7.5% Asian). Clinical pregnancy rates were significantly lower for Black women compared with all other races (45% Black vs. 52% White, 52% Hispanic, and 53% Asian). The odds ratio (OR) of live birth from all cycles were 30% less than that for White women (OR, 1.00 Black vs. 1.43 White) and 22% less than that for Hispanic women (OR, 1.00 Black vs. 1.29 Hispanic). This statistically significant difference in the live birth rate persisted even after adjusting for patient characteristics (OR, 1.00 Black vs. 1.32 White, 1.23 Hispanic, and 1.18 Asian).Conclusion(s)Black women have worse IVF outcomes than women of all other racial backgrounds undergoing IVF. The factors associated with the disparate outcomes of Black women undergoing IVF outcomes include older age starting IVF, higher body mass index, tubal factor infertility, and diabetes.

The effect of cytokine leukemia-inhibitory factor (LIF) and interleukin-11 (IL-11) gene expression on the primary infertility related to polycystic ovary syndrome, Tubal factor, and Unexplained infertility in Turkish women

BackgroundSuccessful implantation of blastocysts is indeed an important path in mammalian reproduction that is governed by a complicated web of cytokines interactions. Leukemia inhibitory factor (LIF) and interleukin-11 (IL-11) part of the interleukin (IL)-6 groups are cytokines that are needed for effective implantation and prevent infertility symptoms. This study aimed to determine the expression level (LIF, IL-11) genes in patients with primary infertility related to polycystic ovary syndrome (PCOS), tubal factor infertility (TFI), and unexplained infertility (UI).ResultsIn this study, 75 infertility women and 40 controls were involved. The expressions of LIF and IL-11 genes were evaluated by quantitative real-time polymerase chain reaction qRT–PCR Light Cycler in patients and healthy controls. PCOS, TFI, and UI groups showed promising results regarding LIF gene, which appeared at very small levels compared to the control (p < 0.0001). Regarding IL-11, the two groups TFI and UI were significantly linked to the lower level of gene expression, while the PCOS group has no significant difference when it is compared to the control group (p < 0.0001, < 0.05, 0.19), respectively.ConclusionThe current findings show that low levels of LIF and IL-11 gene expression are linked to various primary infertility conditions, including PCOS, tubal factor, and unexplained infertility since they play a fundamental role in embryo implantation.

Anorexigenic peptide (leptin, obestatin, nesfatin-1) levels and their impact on assisted reproductive technology treatment outcomes in patients with polycystic ovary syndrome.

ObjectiveIn this study we aimed to assess anorexigenic peptide levels in patients with or without polycystic ovary syndrome (PCOS) and their effects on assisted reproductive treatment (ART) outcomes.MethodsA prospective case-control study was conducted in a tertiary care university-based ART clinic. Eighty-three patients were included in the study. The PCOS group included 41 patients, and the non-PCOS group included 42 controls. The 2003 Rotterdam criteria were used for PCOS patient selection. The ART indications in the non-PCOS group were tubal factor or unexplained infertility. Venous blood samples were taken on the third day of the menstrual cycle to determine the serum anorexigenic peptide levels. The enzyme-linked immunosorbent assay method was used for laboratory analyses.ResultsIn the PCOS group, serum obestatin levels were significantly lower than in the control group, but serum anorexigenic peptide levels were similar in PCOS patients with or without clinical pregnancy. Ovarian hyperstimulation syndrome (OHSS) was diagnosed only in PCOS patients, and the obestatin levels of OHSS patients were significantly lower than those of other PCOS patients.ConclusionsBaseline anorexigenic peptide levels did not affect the clinical pregnancy rate in ART cycles. Obestatin may play a role in the pathophysiology of OHSS. This possibility should be confirmed in further research.

Female Reproductive Health and Exposure to Phthalates and Bisphenol A: A Cross Sectional Study.

The xenoestrogenicity of some plasticisers (phthalates and bisphenol A) is documented in the literature and may pose a risk to female reproductive health. The aim of this study was to assess exposure to six phthalates. This was achieved by measuring their respective metabolites (mono-ethylphthalate (MEP); mono-n-butylphthalate (MnBP); mono-n-ottylphthalate (MnOP); and monobenzylphthalate (MBzP)), as well as the sum of two of the diethyl-hexyl phthalate metabolites-(∑DEHP) and bisphenol A (BPA) in a female population with infertility problems, and by conducting a correlation analysis between infertility factors, work activities, and lifestyle habits, in order to formulate a causal hypothesis. A cross-sectional epidemiological study was carried out and women under 43 years of age were recruited from an assisted reproduction technology (ART) center; the sample of 186 women was given a specific questionnaire and a spot urine sample was collected. Phthalate metabolites and urinary BPA were analyzed by HPLC/MS/MS. The results showed significantly higher mean values for MEP in women with recurrent pregnancy loss (RPL) (820.5 ± 1929.5 µg/g of creatinine) and idiopathic infertility (230.0 ± 794.2 µg/g of creatinine) than in women with other infertility factors (76.9 ± 171.8 µg/g of creatinine). Similarly, for MnOP levels, women with idiopathic infertility (2.95 ± 3.44 µg/g of creatinine) showed significantly higher values than women with the other infertility factors taken together (1.35 ± 2.05 µg/g of creatinine). Women with tubal factors of infertility, RPL, and endocrine dysfunctions show higher values of DEHP (p = 0.032). Considering occupations, women working in commerce showed more than twice as much urinary BPA levels (1.10 ± 0.48 µg/g of creatinine) compared to women working in other industries (0.45 ± 0.35 µg/g of creatinine). The presence of significantly higher values of certain phthalates, DEHP in particular, especially in women with RPL and idiopathic infertility, suggests a possible involvement of these compounds as competing factors in reproductive issues. The study of sources of exposure suggested that the working activity in trade, as a casher in particular, represents a major one for BPA (p = 0.015).

Impact of race versus ethnicity on infertility diagnosis between Black American, Haitian, African, and White American women seeking infertility care: a retrospective review

ObjectiveTo determine whether infertility diagnoses differ between Black ethnic subgroups.DesignRetrospective review.Settingan urban safety-net hospital.Patient(s)Women seeking infertility care between 2005 and 2015.Intervention(s)Charts of women with infertility and polycystic ovary syndrome (International Classification of Diseases, Ninth Revision diagnoses) were reviewed to confirm diagnoses. Data were stratified by race and subsequently by ethnicity to evaluate the differences in infertility diagnoses between Black American, Black Haitian, and Black African women. White American women were used as the comparison group.Main Outcome Measure(s)Infertility diagnoses between Black ethnic subgroups and White women.Result(s)A total of 358 women met the inclusion criteria, including 99 Black American, 110 Black Haitian, 61 Black African, and 88 White American women. Anovulation/polycystic ovary syndrome was the most common diagnosis in each ethnic group, accounting for 40% of infertility among White American, 57% among Black American, 25% among Black Haitian, and 21% among Black African women. There were no significant differences in the individual infertility diagnoses between Black and White women. Between ethnic subgroups, multivariate analysis showed significantly higher odds of infertility because of anovulation/polycystic ovary syndrome in Black American women compared with Black African women (odds ratio [OR], 4.9; 95% confidence interval [CI], 1.4–17.0). Compared with Black African women, higher odds of tubal factor infertility were observed in Black American (OR, 4.7; 95% CI, 1.16–18.7) and Black Haitian women (OR, 4.0; 95% CI, 1.1–14.0).Conclusion(s)Infertility diagnoses were not homogeneous across Black ethnic groups. Studies examining infertility should specify the ethnic subgroups within a race because this may affect results.