Unexplained Infertility Patients Research Articles

Factors Affecting Pregnancy and Live Birth Rates in Gonadotropin Treated Intrauterine Insemination Cycles of Unexplained Infertile Patients

Factors Affecting Pregnancy and Live Birth Rates in Gonadotropin Treated Intrauterine Insemination Cycles of Unexplained Infertile Patients

Evaluation of endometrial receptivity in women with unexplained infertility by shear wave elastography

ObjectivesThe endometrium of most unexplained infertility (UI) patients has been altered histologically. Shear wave elastography (SWE) is utilized to assess the signature of living tissue. This study aimed to explore the value of SWE in evaluating endometrial receptivity (ER) in UI patients.MethodsIn total, 59 UI patients (UI group) and 52 normal control women (NC group) who received fertility consultation in our hospital were included between January 2022 and June 2023. We divided them into the late-proliferative phase of UI group (LPUI; n = 59), mid-secretory phase of UI group (MPUI; n = 41), late-proliferative phase of NC group (LPNC; n = 52), and mid-secretory phase of NC group (MPNC; n = 45). Transvaginal ultrasonography and SWE were performed during the LP and MP. Endometrial thickness (EMT), uterine artery pulsatility index (UA-PI), endometrial mean elasticity (E-mean), and mean shear wave velocities (SWV-mean) were measured.ResultsThere were significant differences in E-mean, SWV-mean, EMT, and UA-PI between the UI group and the NC group during both the LP and MP (p MPNC vs MPUI < 0.05, p LPNC vs LPUI < 0.05). E-mean and SWV-mean decreased with increasing EMT but increased with increasing UA-PI (p < 0.05). The most effective parameter for evaluating ER in UI patients is the E-mean (AUC = 0.89).ConclusionsUI patients exhibited thinner endometrium, increased endometrial stiffness, and poor endometrial blood perfusion. E-mean was the most effective parameter to evaluate ER in UI patients. The study preliminarily proved that SWE is a promising non-invasive tool for evaluating the condition of endometrium.Critical relevance statementThis study aimed to explore the significance of endometrial elasticity measured by SWE in evaluating patients with UI. The findings revealed a correlation between EMT, UA-PI, and E-mean. Endometrial elasticity can serve as an effective indicator for predicting ER.Key points1. To explore the significance of endometrial elasticity in assessing patients with UI.2. The endometrium of UI patient exhibited thinness, stiffness, and poor blood perfusion.3. Endometrial elasticity serves as a valuable indicator for evaluating endometrial receptivity.Graphical

Embryo quality is the main factor affecting aneuploidy in unexplained infertility patients

Embryo quality is the main factor affecting aneuploidy in unexplained infertility patients

Assisted reproductive technology outcomes and gene expression in unexplained infertility patients.

Background: Unexplained infertility (UI) can be a frustrating and challenging diagnosis for doctors and couples as it can be difficult to understand why they are unable to conceive despite increasing diagnostic tools. Assisted reproductive technology (ART) procedures have been successfully applied to many couples aiming to overcome UI. However, they can be not only expensive but also require multiple cycles to achieve a successful pregnancy. The endometrium and the follicular fluid have been investigated as target tissues not only to determine the cause of UI but also to increase conception rates. Results: In this study, we analyzed the outcomes of ART in 223 UI couples and gene expression associated with DNA modification, cell death, immune response and senescence (TET1, TET2, BCL2, BAK1, HMGA2, IL-6, IL-8) in infertile women's endometrium and follicular fluid. We found significant differences in women who successfully got pregnant compared to women unable to conceive depending on age, duration of infertility, number of retrieved oocytes, zygotes, transferred embryos. Further, the expression of genes BAK1 (pro-apoptotic), TET2 (associated with epigenetic DNA modification) and IL-6 (associated with immune responses) were significantly higher in the endometrium of women who successfully got pregnant. Conclusion: Younger parental age couples showed higher ART success rates, shorter duration of infertility, higher number of retrieved oocytes, zygotes and transferred embryos. The gene expression analysis revealed significant changes in the endometrium depending on genes associated with cell death and immune response which were upregulated in females with diagnosed unexplained infertility.

P-366 Unraveling the whole transcriptome profiles of receptive phase endometrium in infertile women

Abstract Study question Are there differential transcriptomic profiles of the receptive phase endometria in infertile women with different infertility diagnoses? Summary answer Endometrium-related pathologies such as endometriosis and RIF seemed to share similar endometrial molecular profiles in mid-secretory phase,while samples from unexplained infertility were similar to controls. What is known already Successful embryo implantation is orchestrated by the combination of a viable blastocyst, a receptive endometrium and a perfectly synchronized molecular dialogue between them. Endometrium-associated pathologies such as endometriosis and recurrent implantation failure (RIF) are suggested to hamper endometrial receptivity, but the molecular mechanisms affected in these and other infertility diagnoses such as unexplained infertility need further investigation. Previous transcriptome studies of the human endometrium have analysed different infertility diagnoses separately, but whether and to what extent receptive-phase endometrial transcriptome profiles vary between distinct infertility diagnoses is underexplored. Study design, size, duration A prospective, cross-sectional study was performed at the Reproductive Unit at the University Hospital between March 2019 and April 2021. Forty-five well-characterized infertile women (age 34.7±3.8 years, BMI 24.5±kg/m2) were recruited before starting any infertility treatment. Four groups according to different infertility diagnoses were established: endometriosis (n = 12), RIF (n = 14), unexplained infertility (n = 10), and male factor infertility as control group (n = 9). Participants/materials, setting, methods Endometrial biopsies were collected using Pipelle curette during mid-secretory phase (LH + 7) of the natural cycle. Total RNA was extracted and sequenced using Illumina NovaSeq 6000 technology. Raw sequencing data was quality assessed, pre-processed and quantified, and differential expression and enrichment analyses were performed using R software. Main results and the role of chance Differential expression analysis revealed 743, 587 and 140 differentially expressed genes (DEGs) in endometriosis, RIF and unexplained infertility, respectively, when compared to control women of the male factor infertility group. Among these, 31 genes exhibited consistent differential expression between all infertility groups. Regarding functional enrichment analyses, the detected DEGs were mainly related to immune response and inflammatory processes, supporting the involvement of these pathways in the impairment of endometrial receptivity. Interestingly, the comparison between different study groups showed similar transcriptome profiles in endometrium-associated pathologies such as endometriosis and RIF, while women with unexplained infertility had similar molecular profiles with the control group of male factor infertility. These study results indicate common molecular pathways in endometrial receptivity between infertile women with endometriosis and RIF, and between unexplained infertility and control male factor infertility patients. Limitations, reasons for caution Further research with bigger sample size is required to confirm these findings. Wider implications of the findings We identified transcriptome profiles associated with infertility diagnoses. Further, women with unexplained infertility tended to have similar molecular profiles with control women, meaning that other factors than endometrial receptivity issues could lead to their infertility. Our study helps to understand the molecular mechanisms underlying female infertility in different infertility diagnoses. Trial registration number not applicable

Effect of Fetuin-A and oxidative stress on the occurrence of unexplained infertility.

Unexplained infertility refers to a diagnosis in which all standard examinations are usually normal and is statistically seen in approximately 30-40% of infertile couples and endometriosis encountered in 25-50% of patients with unexplained infertility. Unexplained infertility is thought to be closely associated with endometriosis and serum and peritoneal fluid levels of Fetuin-A is increased in patients with endometriosis. Fetuin-A is proposed as a diagnostic marker for endometriosis and has anti-inflammatory effects on several diseases. Oxidative stress also is central to the etiopathogenesis of infertility in women. The aim of this study was to evaluate serum Fetuin-A and oxidative stress parameter concentrations impact on unexplained infertility. In the study, serum Fetuin-A, IL-1β, CA I, TAS, TOS levels, and PON and ARE enzyme activities were measured using the Enzyme-Linked ImmunoSorbent Assay in the sera of diagnosed unexplained infertility females (n=44) and controls (n=41). There was no statistically significant difference between unexplained infertile patients and control groups in terms of serum IL-1β, CA I, OSI, and PON levels (p>0.05). Serum Fetuin-A and ARE levels were significantly higher in unexplained infertility compared with the control, whereas serum TAS and TOS levels were lower (p<0.05, p<0.01, p<0.05, p<0.05, respectively). It is thought that increased Fetuin-A levels may be a response to the inflammatory process and increased ARE activity may be a sign of the impaired oxidant-antioxidant balance in unexplained infertility. This may contribute to the pathogenesis of infertility, and the data obtained will make a significant contribution to new works to be done in this sense.

Evaluation of Dysfunctional HDL by Myeloperoxidase/Paraoxonase Ratio in Unexplained Infertility Patients Undergoing IVF/ICSI

Patients with UEI (study group, n = 40) and male factor infertility (control group, n = 36) were included in this prospective study. Demographics and laboratory assessments were analyzed. Total dosages of gonadotropin were higher in UEI when compared to the control group (p = 0.033). Number of Grade 1 embryos and the quality of blastocysts were lower in UEI than in the control group (p = 0.024, p = 0.020, respectively), whereas serum MPO/PON ratio was higher in UEI (p = 0.042). Stepwise linear regression analysis revealed that serum MPO/PON ratio levels could significantly predict the duration of infertility (p = 0.012). Serum MPO/PON ratio increased in patients with UEI, whereas the number of Grade 1 embryos and the quality of blastocysts decreased. Similar clinical pregnacy rates were found in both groups but the ET on day five is associated with higher clinical pregnancy rate in the male factor infertility.

Can the Prediction of Intrauterine Insemination Results by Used Aniline Blue Stain (ABS) and Sperm Chromatin Dispersion (SCD) Levels?

Introduction: This study aimed to perform routine seminal fluid analysis, sperm DNA fragmentation, and sperm function tests at the chromatin maturation level and evaluate pregnancy in the patients passing intrauterine insemination before starting Intrauterine Insemination (IUI) method. Materials and Methods: In this prospective study, 111 couples who underwent Intrauterine Insemination (IUI) in unexplained infertility patients were admitted to Al-Farah IVF and assisted reproductive center in Baghdad, Iraq between November 2020 and February 2021 were evaluated. Semen fluid analysis was performed based on (WHO 4th) guiding rules. In addition, Sperm Chromatin Dispersion (halo test) and sperm maturation were performed with Aniline Blue Stain (ABS). Results: Sperm Chromatin Dispersion (SCD) groups were compared in terms of pregnancy outcome; the positive pregnancy rate was found to be above in the normal SCD groups (p = 0.0005). In addition, Aniline Blue Stain (ABS) groups were compared in the terms of pregnancy outcome; the positive pregnancy rate was found to be higher in the normal ABS group (p = 0.017). Conclusion: Our study showed that the use of DNA fragmentation (SCD) and sperm maturation tests (ABS) together with routine semen analysis in intrauterine insemination cases will make a significant contribution to the prediction of Intrauterine Insemination (IUI) increased results. So, these results indicate a defect in the effect of DNA fragmentation on the outcome of intrauterine insemination.

A comparison between uterine artery blood flow in fertile and unexplained infertile women by Doppler ultrasound using pulsatility index and resistance index

Background and objectives: Infertility is inability to conceive after one year of regular unprotected intercourse. Unexplained infertility is present if the basic fertility investigations are normal. The objective of this study is to investigate the use of uterine artery blood flow as a cause of unexplained infertility (using pulsatility index, resistance index) and compare them to fertile women. Methods: A prospective cohort study was performed on 70 patients (35 fertile and 35 with unexplained infertility patients) in Sulaymaniyah Maternity Teaching Hospital, Kurdistan Region, Iraq, during October 2016 to December 2017. Transvaginal color Doppler ultrasound was done in the mid luteal phase (day 21 - 24) for uterine artery by using pulsatility index and resistance index. Results: The age of the patients ranged from 20 - 39 years. The uterine artery pulsatility index was significantly higher in the unexplained infertile women (mean ± SD = 2.78 ± 0.615) than fertile women (mean ± SD = 2.42 ± 0.325). The uterine artery blood flow resistance index was significantly higher in unexplained infertile group (mean ± SD = 0.899 ± 0.066) than fertile women (mean ± SD = 0.83 ± 0.054). Conclusions: Unexplained infertility is associated with decreased uterine artery blood flow and increase uterine artery resistance (pulsatility index and resistance index) when compared with fertile women.

Common Autoimmune Antibodies in Unexplained Infertile Female Patients in Saudi Arabia.

Unexplained female infertility is a devastating health problem that has become increasingly prevalent worldwide with no specific explanation despite comprehensive evaluations. Recent data suggestthat serum autoimmune antibodies are frequently found in patients with unexplained female infertility. This study aims to identify the prevalence of common autoantibody abnormalities in females with unexplained infertility in Saudi Arabia. A cross-sectional study was conducted on female patients with unexplained infertility sequentially referred to the allergy and immunology clinic at King Abdulaziz University Hospital (KAUH). Demographics, clinical characteristics, and 12 common autoantibody immunological tests were described as frequency and percentage. The chi-square test was applied to evaluate any associations. A total of 119 females with unexplained infertility were studied; of those, 97 (81.5%) had secondary infertility. Their average age was 33.9 ± 5.6 years ranging from 23 to 49 years. The overall prevalence of a high level of at least one autoantibody (above the normal range) was 84%. The predominant high autoantibodies were antithyroglobulin in 42 (35.3%), antithyroid microsomal in 41 (34.5%), beta 2 glycoprotein IgM in 40 (33.6%), antigliadin IgA in 32 (26.9%), antinuclear in 22 (18.5%), and anticardiolipin IgM in 18 (15.1%) of the participants. The following significant associations were found in our study: secondary infertility with beta 2 glycoprotein (p = 0.022), age with antithyroglobulin (p = 0.027), and the number of pregnancies with anti-tissue transglutaminase IgG and antigliadin IgA(p = 0.015 and p = 0.043, respectively). A high level of at least one autoantibody was detected in the majority of females with unexplained infertility. Antithyroid, antiphospholipid, antigliadin, and antinuclear autoantibodies were the most commonautoantibodies.These findings may encourage autoantibody screening in infertile females to discover any potential immunopathology in further clinical studies.

Clinical pregnancy rate of women with unexplained infertility with or without cervical mucus aspiration before intrauterine insemination

Objective: To detect effect of removing cervical mucus before performing intrauterine insemination (IUI) on pregnancy rate in patients with unexplained infertility. Methods: The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital. Totally 80 patients of unexplained infertility were recruited. By computer generated block randomization in block size of 4 and 6, patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI, 40 in each group. Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7. Follicular monitoring was done and further doses given as per response; trigger was planned when 1-3 follicle reach a diameter of &gt;18 mm. IUI was planned after trigger. IUI was done as per the group allocated. Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI. The primary outcome was clinical pregnancy rate. Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted. Results: IUI was not done in 4 patients due to hyperstimulation. Pregnancies per IUI cycle occurred in 7.9% (3/38) in the cervical mucus removal group and 21.1% (8/38) in the non-removal of cervical mucus group. There was no statistically significant difference in clinical pregnancy rate between two groups (P=0.19). Conclusions: There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant. Further studies with large sample size need to be done on this intervention. Trial registration: The trial registration was done with Clinical Trial Registry-India (Registration number: CTRI/2019/03/018326).

Comparison of the Effects of GMCSF-Containing and Traditional Culture Media on Embryo Development and Pregnancy Success Rates.

The use of granulocyte macrophage colony-stimulating factor (GM-CSF)-containing medium, which is a commercial medium that is used for cultivation of embryos in in vitro fertilization (IVF) treatments, has been suggested to increase the efficiency of this procedure in patients with previous multiple unsuccessful attempts. In this retrospective study, we analyzed GM-CSF-containing embryo culture media compared with traditional culture media in terms of development of embryos, pregnancy, and ongoing pregnancy success and live birth rates. This is a prospective case control study conducted in a single center. A total of 131 unexplained infertility patients were included in the study. A cohort of 69 patients whose embryos were cultured in GM-CSF-containing medium and a control group of 62 age-matched patients whose embryos were cultured in conventional Sage One Step medium were included in the study. The major study outcomes were achievement of pregnancy and ongoing pregnancy rate at 12 weeks of gestation. The pregnancy and ongoing pregnancy rates of the patients whose embryos were cultured in GM-CSF-containing medium were 39.13% and 36.23%, respectively. These were higher than the rates of the control group, which were 30.65% and 29.03%, respectively, although this difference was not statistically significant. In addition, the 5th-day embryo transfer percentage in the GM-CSF group was higher than in the control group (34.78% versus 27.4%). The main findings of our study were that there was no difference between the GM-CSF-enhanced medium and the control group in terms of our major study outcomes. However, blastomere inequality rate and embryo fragmentation rates were lower in the GM-CSF group.

Kisspeptin: a potential therapeutic target in patients with unexplained infertility?

Kisspeptin has recently emerged as a key regulator of the reproductive axis in women. Kisspeptin, acting centrally via the kisspeptin receptor, stimulates the secretion of the gonadotrophin-releasing hormone (GnRH). To investigate serum kisspeptin levels in infertility patients for its clinical utilisation in management and understanding of the pathophysiology of infertility in a wide array of patients. This prospective case-control study analysis involved 92 primary infertile women with PCOS, diminished ovarian reserve (DOR), unexplained infertility (UEI), and male factor infertility between 20 and 42years of age. Serum samples were collected between the second and fifth day of the menstrual cycle. The kisspeptin level was determined using a human kisspeptin ELISA kit according to the manufacturer's procedure. The median value of serum kisspeptin in the PCOS infertility group was significantly higher than that in the UEI group (p = 0.011). There was a statistically significant (p = 0.015, r = -0.182) negative weak correlation found between serum kisspeptin levels and age. The optimal cutoff value obtained to differentiate the UEI from others (PCOS infertility + DOR + male factor infertility) according to the serum kisspeptin level was 214.3ng/L with a sensitivity of 55% and specificity of 80.9%. Understanding the role of kisspeptin may lead to its use as a biomarker in infertility diagnosis in UEI patients and might guide the use of kisspeptin analogues in selected patients for infertility management.

P-532 Embryo aneuploidy risk is increased in couples with unexplained infertility

Abstract Study question Are chromosomal abnormalities (aneuploidy and mosaicism) increased in couples with unexplained infertility? Summary answer Couples with unexplained infertility show higher rates of embryo aneuploidy compared to IVF with donor sperm cycles. What is known already Aneuploidy is the most common genetic abnormality found in early embryos. Although there is strong evidence about the correlation between oocyte age and aneuploidy rates, the potential contribution of additional female and male factor warrants further elucidation. Unexplained infertility is a diagnosed of exclusion affecting ∼30% of couples seeking infertility care. Recent medical evidence suggests that these couples have lower odds of having a live birth compared to their counterparts using donor sperm. Therefore, the aim of this study was to elucidate whether chromosomal abnormalities (aneuploidy and mosaicism) were increased in couples with unexplained infertility. Study design, size, duration Retrospective analysis of the chromosomic evaluation of 700 embryos coming from 220 IVF/PGT-A cycles (March 2017 - September 2021) performed in a private fertility center. The comprehensive chromosome screening included testing for aneuploidy and mosaicism. In addition, whole and segmental chromosomal alterations were also identified and reported. Participants/materials, setting, methods Participants were divided into two groups: couples with unexplained infertility (study group) and women undergoing IVF using donated sperm (control group). Only normospermic and normal sperm FISH samples were included. The Veriseq NGS (Illumina) platform was employed for PGT-A testing. An SPSSv20.0 logistic regression analysis was performed for aneuploidy and mosaicism rate. The resulted odds ratio was then adjusted to account for: female/male age, previous implantation failure, recurrent pregnancy loss, previous chromosomopathies and embryo quality. Main results and the role of chance A total of 220 PGT-A cycles were included in the analysis (study group n = 94 vs control group n = 126) comprising 700 embryos (study group n = 313 vs control group n = 387). The female age was 38.17 ± 3.6 vs 40.08 ± 2.4 and the male age was 40.57 ± 5.0 and 25.37 ± 3.8, in the study vs control groups, respectively. Unexplained infertility couples showed a higher risk for generating aneuploid embryos compared to IVF with donor sperm cycles [OR = 2.33 IC 95% (1.11-5.00)]. In addition, whole chromosomal alterations [OR = 2.11 IC 95% (1.00-4.44)] as well as segmental chromosomal alterations rate [OR = 1.38 IC 95% (0.49-3.86)], were higher in unexplained infertility couples, but without reaching statistical significance. Regarding to mosaicism rate, no significant differences were found between groups: overall [OR = 0.74 IC 95% (0.30-1.83)], whole chromosome [OR = 0.92 IC 95% (0.35-2.46)] and segmental chromosomal [OR = 0.36 IC95% (0.10-1.34)] mosaicism. Limitations, reasons for caution The inherent limitations of a retrospective analysis. Additional studies are warranted to clarify the potential factors explaining the higher embryo aneuploidy risk in this sub-set of patients. Wider implications of the findings Our data suggest an increased risk for embryo aneuploidy in unexplained infertility couples undergoing ART. Since the treatment for these couples is largely empirical, our results emphasize the importance of PGT-A analysis as a potential strategy for unexplained infertility patients. Trial registration number Not applicable

Estimation of the concentrations of manganese, nickel, and aluminum in the semen of infertile men as oxidative stress factors

Semen samples were collected from healthy people (control group for comparison), asthenospermia infertility patients, and unexplained infertility patients from male donors who attended the Fertility Center at Al-Sadr Teaching Hospital in Al-Najaf Al-Ashraf / Iraq for the period from 1/12/2020 to 25/3 /2021. The present study aims to estimate the concentration of manganese, nickel, and aluminum in semen as one of the factors that cause oxidative stress in male infertility. The atomic absorption spectrometry was used to estimate the concentrations of the elements and the statistical analysis by the Tukey One Way method in the Graph Pad Prism program to determine the relationships between the study elements and the parameters of semen in men. The results of the study showed a significant increase (P &lt; 0.05) in the level of nickel and aluminum concentrations (490 ± 27.57 and 450.3 ± 17.92 μg/L, respectively) and a significant decrease (P &lt; 0.05) in the concentration of manganese (202 ± 8.718 ppm). ) in the semen group of men with asthenospermia in comparison with the healthy fertile group (as a control group) (161.7 ± 5.963, 307.5 ± 10.58 μg/L and 309.2 ± 1.470 ppm), respectively. The results also revealed the existence of many negative relationships between the concentration of elements and semen parameters and between the same concentrations. The study concluded that the concentrations of these elements are a factor of stress oxidants that appear in cases of asthenozoospermia or may not change in other types of infertility and remain unexplained infertility.

Prognostic Gene Predictors of Gestational Diabetes in Endometrium and Follicular Fluid of Women after Infertility.

Background and objectives. Gestational diabetes mellitus is an increasingly diagnosed metabolic disorder during pregnancy with unknown pathological pathways. Taking into account the growing numbers of women who are conceiving after assisted reproductive technologies, they comprise an engaging target group for gestational diabetes mellitus etiopathogenesis research. In terms of metabolism and genetics, as the evidence shows, both unexplained infertility and gestational diabetes mellitus pose challenges for their interpretation due to the complex bodily processes. Materials and Methods. Our study examined the expression of genes (IGF2, GRB10, CRTC2, HMGA2, ESR1, DLK1, SLC6A15, GPT2, PLAGL1) associated with glucose metabolism in unexplained infertility patients who conceived after in vitro fertilization procedure, were diagnosed with GDM and their findings were compared with control population. Results. There were no significant differences in gene expression of endometrium stromal cells between healthy pregnant women and women with gestational diabetes, although the significant downregulation of CRTC2 was observed in the follicular fluid of women with gestational diabetes mellitus. Moreover, expression of HMGA2 and ESR1 was significantly reduced in FF cells when compared to endometrial cells. Conclusions. These findings may indicate about the importance of follicular fluid as an indicator for gestational diabetes and should be explored more by further research.

Assessment of vaginal and endometrial microbiota by real-time PCR in women with unexplained infertility.

Microbiota of the reproductive tract may be associated with unexplained infertility in women. We aimed to determine the derangements of vaginal and endometrial microbiota related to unexplained infertility by real-time polymerase chain reaction (real-time PCR) microbiota analyses of vaginal and endometrial samples of the unexplained infertility patients and fertile women. Twenty-six women with unexplained infertility and 26 age-matched fertile women were included. Vaginal and endometrial samples were obtained in the mid-menstrual cycle for analysis by quantitative real-time PCR method. The proportion of lactobacilli-impaired microbiota was significantly higher in the vaginal samples of unexplained infertility patients (76.9% vs. 26.9%; p < 0.001). Those with impaired lactobacilli microbiota of vaginal samples had an increased risk of 9.048 times for infertility than those with normal lactobacilli microbiota. In addition, the mean lactobacilli/total bacterial mass (TBM) ratio in the vaginal samples was significantly lower in the unexplained infertility patients (38.2% vs.76.3%; p=0.001). The present study results supported the role of vaginal and endometrial microbiota derangements in unexplained infertility. Many time-consuming and invasive methods are currently used in the diagnosis of infertility. Our study showed that the quantitative determination of lactobacilli/TBM ratio in vaginal specimens, a less invasive and easily obtainable method, could be used as a diagnostic test during the workup of couples with unexplained infertility.

Levels of anxiety sensitivity, somatosensory amplification and alexithymia in patients with unexplained infertility.

In this study, we aimed to focus on the psychological aspect of unexplained infertility by comparing their psychological features to those of infertile patients with a known causes and fertile patients. Sixty unexplained infertility patients, 50 infertile patients with a known cause and 56 fertile patients were included in the study. Patients were evaluated using socio-demographic data form, Toronto Alexithymia Scale (TAS-20), Somatosensory Amplification Scale (SAS) and Anxiety Sensitivity Index (ASI-3). No significant differences in the levels of alexithymia, somatosensory amplification and anxiety sensitivity were detected between the groups (P>.05). When the correlation of clinical scale scores with each other was analysed in the whole group of infertile patients regardless of the cause, a weak positive correlation was found between anxiety sensitivity and difficulty in identifying feelings. In our study, it has been found out that; regardless of the knowledge of the aetiology of infertility, the levels of alexithymia, somatosensory amplification and anxiety sensitivity of infertile cases did not differ from those of fertile women. However, it has been shown that as the difficulty in identifying emotions increases in infertile cases, anxiety sensitivity, which may cause psychological infertility, also increases.

Hysteroscopic evaluation of chronic endometritis incidence in unexplained infertile women with recurrent implantation failure: six years experience

Purpose: To evaluate histeroscopically-proved chronic endometritis (CE) incidence in unexplained infertility cases with recurrent implantation failure (RIF). Materials and Methods: This cross-sectional retrospective study was done on 529 participants who attended our hospital's infertility clinic from January 2014 to August 2020. The participants were at the age of 18-39 years. We divided the subjects into two groups, i.e., unexplained infertile patients with RIF (Group:1; n:187) and unexplained infertile patients without RIF (Group:2; n:342). Results: The women had a mean age of 31.6 ±5.1 years. Hysteroscopic findings were as follows:14 (2.6%) had chronic endomet-ritis, 19 (3.6%) had polyps, and 496 (93.8%) had no pathological findings. Age, BMI, AMH level, total dose of gonadotropin, duration of stimulation, number of retrieved oocytes, Metaphase II (MII), and Pronucleus (PN) showed no significant difference between the two groups. Also, infertility type (P=0.09) and smoking(P=0.5) were not statistically different between the two gro-ups. In addition, the two groups showed no statistically significant difference in polyps (p=0.8) and CE (p=0.1), while the two groups showed a statistically significant difference in endometrial pathology (p<0.001). Conclusion: In this study, it was shown that those with RIF did not show a higher incidence of CE, but endometrial pathologies were increased in this group of patients. So hysteroscopy should be done in RIF patients with unexplained infertility.

Role of prolidase activity and oxidative stress biomarkers in unexplained infertility

Our aim was to explore the significance of serum prolidase enzyme activity and oxidative stress in women with unexplained infertility (UEI). In this case-control study (n=160; 86 cases; 74 controls) prolidase enzyme activity and total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and vitamin E were measured in plasma using enzyme-linked immunosorbent assays. Prolidase enzyme activity and TAS levels were particularly higher in the patient group (P=0.013, P=0.001, respectively). Decreased OSI levels were detected in the patient group (P=0.001). There was a positive relationship of prolidase with vitamin E in both patient and control groups (r=0.892, P=0.001, and r=0.659, P=0.001, respectively). A positive, but weak, relationship was identified between prolidase activity and TOS levels and also between vitamin E and TOS levels in the UEI group (r=0.265, P=0.049, and r=0.288, P=0.014, respectively). No association was found between prolidase and TOS levels or between vitamin E and TOS levels in the control group (r=0.0097, P=0.527, and r=0.085, P=0.610, respectively). Our results showed an association between serum prolidase activity and oxidative stress in UEI patients. Further studies including greater groups are required to show the role of reactive oxygen species in UEI.