Cases Of Unexplained Infertility Research Articles

The Prevalence of Endometriosis in Patients with Unexplained Infertility.

Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.

Etiology of Male Infertility: an Update.

Spermatogenesis is a complex process of germ cell division and differentiation that involves extensive cross-talk between the developing germ cells and the somatic testicular cells. Defective endocrine signaling and/or intrinsic defects within the testes can adversely affect spermatogenic progression, leading to subfertility/infertility. In recent years, male infertility has been recognized as a global public health concern, and research over the last few decades has elucidated the complex etiology of male infertility. Congenital reproductive abnormalities, genetic mutations, and endocrine/metabolic dysfunction have been demonstrated to be involved in infertility/subfertility in males. Furthermore, acquired factors like exposure to environmental toxicants and lifestyle-related disorders such as illicit use of psychoactive drugs have been shown to adversely affect spermatogenesis. Despite the large body of available scientific literature on the etiology of male infertility, a substantial proportion of infertility cases are idiopathic in nature, with no known cause. The inability to treat such idiopathic cases stems from poor knowledge about the complex regulation of spermatogenesis. Emerging scientific evidence indicates that defective functioning of testicular Sertoli cells (Sc) may be an underlying cause of infertility/subfertility in males. Sc plays an indispensable role in regulating spermatogenesis, and impaired functional maturation of Sc has been shown to affect fertility in animal models as well as humans, suggesting abnormal Sc as a potential underlying cause of reproductive insufficiency/failure in such cases of unexplained infertility. This review summarizes the major causes of infertility/subfertility in males, with an emphasis on infertility due to dysregulated Sc function.

Subfertility versus ART: unraveling the origins of fetal cardiac programming.

Do spontaneously conceived (SC) fetuses from subfertile couples show the same signs of cardiac remodeling as those observed after IVF treatments? As opposed to fetuses from IVF, SC fetuses from subfertile couples do not show cardiac remodeling and present a similar cardiac structure and function to those of SC fetuses from fertile couples. Subjects conceived by IVF present signs of cardiac remodeling and suboptimal function in utero and during childhood, including larger atria, more globular and thicker ventricles, reduced longitudinal motion, and impaired relaxation as compared to SC individuals from fertile couples. There are no previous publications investigating the independent cardiac programming effects of infertility in SC fetuses from subfertile couples (with time-to-pregnancy (TTP) over 12 months). A prospective cohort study of 289 singleton pregnancies exposed and not exposed to subfertility recruited from 2019 to 2021, including 96 SC pregnancies from fertile couples (TTP under 12 months), 97 SC from subfertile couples (TTP over 12 months), and 96 from IVF after fresh embryo transfer. Fetal echocardiography was performed in all pregnancies. Epidemiological data and perinatal outcomes were collected in all pregnancies. The overall attrition rate was 15.7%. SC from subfertile couples and IVF pregnancies were identified as eligible at pregnancy diagnosis, and eligible SC pregnancies from fertile couples who attended our maternal-fetal unit were invited to participate at third trimester, being matched to the other groups by maternal age. Fetal echocardiography was performed at 29-34 weeks of pregnancy to assess cardiac structure and function, and results were adjusted by parental age, maternal smoking status, child's birth order, birthweight centile, gestational age, and estimated fetal weight at scan. Parental age, ethnicity, BMI, and smoking exposure, median gestational age and estimated fetal weight were similar in all study groups. There were no significant differences in infertility duration or etiology between the subfertile and the IVF populations (TTP: subfertile median 35 months (interquartile range 20-48) versus IVF: 47 (25-61); P-value = 0.051). While both fertile and subfertile SC groups presented similar fetal cardiac results, IVF fetuses showed larger atria (right atria-to-heart ratio: IVF mean 18.9% (SD 3.4) versus subfertile 17.8% (3.5) versus fertile 17.6% (3.3); adjusted P-value < 0.001), more globular ventricles (right ventricular sphericity index: IVF 1.56 (0.25) versus subfertile 1.72 (0.26) versus fertile 1.72 (0.26); <0.001), and thicker myocardial walls (relative wall thickness: IVF 0.86 (0.22) versus subfertile 0.64 (0.13) versus fertile 0.64 (0.18); <0.001). Whereas SC fetuses from fertile and subfertile couples had preserved cardiac function, IVF fetuses showed signs of suboptimal systolic and diastolic function, with reduced tricuspid ring displacement (IVF 7.26 mm (1.07) versus subfertile 8.04 mm (1.18) versus fertile 7.89 mm (1.51); <0.001) and increased left myocardial performance index (IVF 0.49 (0.08) versus subfertile 0.45 (0.09) versus fertile 0.45 (0.10); <0.001). A sub-analysis including only unexplained infertility cases in subfertile SC and IVF groups showed similar results. The fetal cardiac changes reported here are subclinical, and most of the cardiovascular parameters were within normal ranges. Although echocardiographic changes are recognized as potential cardiovascular risk factors, their association with long-term cardiovascular disease remains to be demonstrated. Subfertility per se does not seem to be associated to fetal cardiac remodeling, which has been previously described in IVF fetuses. Future studies are warranted to further investigate other factors related to the observed fetal cardiac changes associated with ART. This project has been partially funded with support from the Erasmus + Programme of the European Union (Framework Agreement number: 2013-0040). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use, which may be made of the information contained therein. Additionally, the research leading to these results has received funding from 'la Caixa' Foundation under grant agreement LCF/PR/GN18/10310003, the Instituto de Salud Carlos III (PI15/00130, PI16/00861, PI17/00675, PI18/00073, INT21/00027)-co-funded by the European Union, Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK) and AGAUR 2017 SGR grant no 1531. The authors have no conflicts of interest to declare. N/A.

Biochemical Enzymatic Study of Infertility

This study dealt with the issue of unexplained infertility in men, as it included the measurement of many biochemical variables in the semen plasma, where all of the variables total cholesterol, albumin, thiol group, manganese and zinc were measured TAC. where the results showed the presence of many significant differences between the measured variables when comparing the disease group With the control group, which indicates the different effects of these variables on patients with unexplained infertility. Also, during this study, the effect of hyaluronidase enzyme was followed up and studied by studying the activity of the enzyme as well as the purification stages of the enzyme and estimating the approximate molecular weight using the technique of gel filtration, ion exchange and electro-migration technique (SDS) This enzyme plays a pivotal role in the fertilization process, and any difference in the effectiveness of this enzyme leads to cases of unexplained infertility.

P-771 Subfertility versus in vitro fertilization procedures: unravelling the origins of fetal cardiac remodeling in assisted reproductive technologies

Abstract Study question Do spontaneously conceived (SC) fetuses from subfertile couples present signs of cardiac remodeling as those observed after in vitro fertilization (IVF) treatments? Summary answer SC fetuses from subfertile couples do not associate cardiac remodeling, and their cardiac structure and function are similar to those of SC from fertile couples. What is known already Fetuses and children from IVF associate cardiac remodeling and suboptimal function, including dilated atria, more globular and thicker ventricles, reduced longitudinal motion and impaired relaxationin uteroand after birth. Fetal cardiac changes have been demonstrated both after fresh and frozen embryo transfer. The SC fetuses used as ‘controls’ in our previous publications were conceived by fertile couples thus making it difficult to separate the contribution of infertilityper sefrom the IVF procedures on cardiac programming. There are no previous cardiovascular studies investigating the independent effects of infertility in SC fetuses from subfertile couples (time-to-pregnancy (TTP) over 12 months). Study design, size, duration Prospective cohort study of 289 singleton pregnancies recruited from 2017 to 2021, including 96 SC pregnancies from fertile couples (TTP less than 12 months), 97 SC from subfertile couples (TTP over 12 months) and 96 from IVF after fresh ET. Fetal echocardiography was performed in all pregnancies. Epidemiological data and perinatal outcomes were collected in all pregnancies. Participants/materials, setting, methods IVF pregnancies from our centre were identified as eligible at pregnancy diagnosis. Eligible SC pregnancies from fertile and subfertile couples who attended our Maternal-Fetal Unit were invited to participate at third trimester, being matched to the IVF pregnancies by maternal age. Fetal echocardiography was performed at 29-34 weeks of pregnancy to assess cardiac structure and function. Echocardiographic comparisons were adjusted by nulliparity, birthweight centile, gestational age and estimated fetal weight at scan. Main results and the role of chance Parental age, ethnicity, body mass index and smoking exposure, median gestational age and estimated fetal weight were similar in all study groups. There were no significant differences in infertility duration or aetiology between the subfertile and the IVF populations (TTP: subfertile median 30 months [IQR 20-54] versus IVF: 47 [25-61]; p-value=0.052). While both fertile and subfertile SC groups presented similar fetal cardiac results, IVF fetuses showed larger atria (right atria-to-heart ratio: IVF mean 18.9% [SD 3.4] versus subfertile 17.8% [3.5] versus fertile 17.6% [3.3]; adjusted P-value&amp;lt;0.001), more globular ventricles (right ventricular sphericity index: IVF 1.56 [0.25] versus subfertile 1.72 [0.26] versus fertile 1.72 [0.26]; &amp;lt;0.001), and thicker myocardial walls (relative wall thickness: IVF 0.86 [0.22] versus subfertile 0.64 [0.13] versus fertile 0.64 [0.18]; &amp;lt;0.001). Whereas SC fetuses from fertile and subfertile couples had preserved cardiac function, IVF fetuses showed signs of suboptimal systolic and diastolic function with reduced tricuspid ring displacement (IVF 7.26 mm [1.07] versus subfertile 8.04 mm [1.18] versus fertile 7.89 mm [1.51]; &amp;lt;0.001) and increased left myocardial performance index (IVF 0.49 [0.08] versus subfertile 0.45 [0.09] versus fertile 0.45 [0.10]; &amp;lt;0.001). A sub-analysis including only unexplained infertility cases in subfertile SC and IVF groups showed similar results. Limitations, reasons for caution The fetal cardiac changes reported here are subclinical, with most cardiovascular parameters lying within normal ranges. Although echocardiographic changes are recognized as potential cardiovascular risk factors, their association with long-term cardiovascular disease remains to be proven. Wider implications of the findings Subfertility per se does not seem to be associated to fetal cardiac remodeling, which have been previously described in IVF fetuses. Future studies are warranted to further investigate the factors related to fetal cardiac changes associated to ART. Trial registration number Not a trial

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.

O-115 Parental whole-exome sequencing allows the discovery of genetic causes of extreme IVF phenotypes such as oocyte/embryo developmental arrest and recurrent low fertilization

Abstract Study question Do whole-exome sequencing (WES) data from infertile women provide valuable information for the discovery of genes/pathways involved in extreme IVF phenotypes, i.e. oocyte/embryo developmental arrest? Summary answer The development of a specific bioinformatic WES pipeline revealed known and new candidate genes/pathways for isolated oocyte/embryo developmental failure,providing the foundation to scale up research. What is known already The use of IVF has made it possible to identify extreme and isolated infertility phenotypes such as recurrent low oocytes maturity (LMR), recurrent low fertilization rate (LFR), or preimplantation developmental arrest (PDA) that would remain concealed in natural conception attempts. Recent applications of WES in families with such extreme adverse IVF phenotypes have led to the discovery of new genes and pathways affecting unique functions of gametes and exclusive mechanisms necessary for early embryo development. Here, we apply a tailored bioinformatic approach to WES from women displaying extreme IVF phenotypes to discover new causative genes/pathways involved in unexplained infertility. Study design, size, duration Twenty-two infertile consanguineous women(December 2018-September 2020) suffering from long-term unexplained infertility. Eight cases were classified as PDA (&amp;lt;20% normally developed embryos in &amp;gt; 2 IVF cycles), 8 as LMR (&amp;lt;20% mature oocytes in &amp;gt; 2 IVF cycles), 4 as LFR (&amp;lt;20% of normally fertilized oocytes in &amp;gt; 2 IVF cycles). Two women with recurrent IVF failure (&amp;gt;10 IVF cycles) were also included. A control set of 1660 WES from oocyte donors was used to control for false-positive discoveries. Participants/materials, setting, methods WES at 30X was performed on enrolled women’s gDNA using Illumina short-reads technology. Following annotation, variants were filtered to prioritize putative detrimental variants in genes relevant for oocyte/embryonic development using a previously developed and validated pipeline that minimizes false-positive discoveries. Runs of homozygosity (ROH) within each sample were identified using Refined IBD software. Individual-level single-cell RNAseq (scRNAseq) dataset from 18 human oocytes was used to verify the expression of the identified target genes. Main results and the role of chance The variant prioritization pipeline employed identified 1,160 unique variants in 1,017 genes (average per sample 59.9 sd 8.5). 453 variants were private to this study compared to the 1000 Genomes and gnomAD databases, 3% affecting splicing and/or the gene product length. Significant 5-fold enrichment of 41 genes involved in DNA-damage and repair pathways commonly associated with ovarian function/oocyte quality was observed (p &amp;lt; 0.001). TP53/AKT pathway also showed significant 5-fold enrichment for 45 genes (p &amp;lt; 0.001). This finding is consistent with the known relationship between infertility and cell-cycle/cancer genes. Overall, 66.4% (675/1,017; 95%CI:63.4-69.3) of the targeted genes were expressed in MII human oocytes. Two women (9%) were homozygous carriers of missense pathogenic variants in known candidate genes previously associated to oocyte/embryo developmental arrest (TRIP13, chr5_901344_C/T, CADD percentile 0.999; PADI6, chr1_17394384_C/G, CADD percentile 0.999). Remarkably, four additional women were carriers of high-impact variants in JAKMIP1, a member of a recently characterized family of proteins involved in various cellular processes, including cytoskeleton rearrangement, cell polarization, and intracellular transport. High-impact JAKMP1 variants were never observed in the oocyte donor control dataset. JAKMIP1 mRNA was detected in each individual biological replicate of scRNAseq analysis of MII oocytes with a mean of 6 transcripts per million. Limitations, reasons for caution Functional analysis is ongoing to validate the newly identified genes, data need to be verified in different ethnicities. Nevertheless, this study demonstrates the establishment of a specific and scalable analytical framework that can be employed for the identification of genetic causes in unexplained infertility cases characterized by defective developmental patterns. Wider implications of the findings Scaling up this investigative approach would provide an effective strategy for discovering new genes/pathways in what is considered idiopathic infertility, further defining precision reproductive medicine interventions. Importantly, this study revealed lesions in genetic patterns involved in chronic diseases providing a molecular footprint of the well-established link between infertility and comorbidities. Trial registration number none

Value of Laparoscopy in Diagnosis of Endometriosis in Unexplained Infertility Cases.

Value of Laparoscopy in Diagnosis of Endometriosis in Unexplained Infertility Cases.

Autologous Platelet Rich Plasma (A-PRP) in Unexplained Infertility: A Revolution in Reproductive Medicine

Background: Any treatment for unknown infertility is empiric by default, and the broad range of treatment, including expectant management, superovulation, IUI, IVF and IVF–intracytoplasmic sperm injection, reflects the uncertainty with this diagnosis. There are limited data to support the efficacy of many of these treatments, and no uniform protocol exists in clinical practice. Autologous platelet rich plasma (A-PRP) can be a novel technique which has never been explored before much in this field. Objective: To compare autologous platelet rich plasma with expectant management in cases of unexplained infertility. Materials and methods: All cases (50) of primary unexplained infertility were treated with either A-PRP or by expectant management on the basis of their endometrial thickness (7 mm). All cases of thin endometrium (<7 mm) were subjected to A-PRP (25 cases). Whereas rest of the cases (25 in number) was monitored as per expectant management protocol for a maximum of three cycles after which they were switched over to being treated with PRP. The main outcomes measured were number of follicles, endometrial thickness, pregnancy rate and miscarriage rates. The statistical analysis was evaluated with IBM SPSS Statistics for Windows, Version 24.0, IBM Corp, and Chicago, IL. Results: Out of 46 patients, 25 patients (54.35%) got conceived with a single dose of intra-uterine autologous platelet rich plasma injection, which was found to be statistically highly significant. The correlation analysis with Spearman’s Rank correlation coefficient (rho ρ) was 0.891 which show highly positive correlation between intrauterine autologous platelet rich plasma injection and pregnancy rate and 0.247 which show weakly positive correlation between expectant management and pregnancy rate. Conclusion: Autologous platelet rich plasma (A-PRP) is a novel technique than can treat unexplained infertility with favorable outcomes.

Outcome of Intra Uterine Insemination in Sahara International Fertility Centre Pokhara, Nepal

Introduction: The incidence of infertility is about 10 to 15 % among reproductive age group. The cause of infertility may be either due to male factor or female factor or both. The main aim of this study was to evaluate the success rate of intrauterine insemination (IUI) in a private centre of Pokhara.&#x0D; Materials and Methods: This was a centre based retrospective study done in private fertility centre. Sub-fertile couples who were treated from January 1st 2015 to December 31st 2016 were enrolled for the study. Couples with unexplained male factor, ovulatory dysfunction, unilateral tubal occlusion and ejaculatory dysfunction were included in this study. Three hundred and eighty IUI cases were retrospectively reviewed. Clinical pregnancy rate was the primary outcome.&#x0D; Result: The success rate of IUI was 15.7%. It was higher among unexplained infertility cases. Clinical pregnancy rate was directly associated with the age of the patients, indications of infertility and number of cycles.&#x0D; Conclusion: Success rate of IUI in infertile couples who had unexplained infertility, tubal factor, ovulatory dysfunction was higher than male factor infertility and ejaculatory dysfunction.

Midkine can be evaluated as a new ovarian reserve marker at polycystic ovary syndrome cases except for unexplained infertility cases

Midkine can be evaluated as a new ovarian reserve marker at polycystic ovary syndrome cases except for unexplained infertility cases

Spermatozoa: A Historical Perspective.

The 100,000th scientific article on the subject of spermatozoa was recently published. Numerous studies evaluated the characteristics of this important cell that led to tremendous discoveries. Since its first observation and description in 1677, many important characteristics have been described regarding this highly fascinating gamete. In this review, we intend to provide a historical account of the numerous milestones and breakthroughs achieved related to sperma- tozoa. We conducted a review of the literature by selecting the most important subjects with regards to spermatozoa. Since their discovery by van Leeuwenhoek, spermatozoa have been studied by scientists to better understand their physiology and process of interaction with their female counterpart, the oocyte, in order to treat and resolve infertility problems. Three centuries after van Leeuwenhoek’s discovery, the 100,000th article about these cells was published. It is encouraging that sperm research reached this landmark, but at the same time it is clear that further research on male reproductive physiology and spermatozoa is required to shed more light on their function and pathology in order to reduce the number of unexplained infertility cases.

Clinical utility of sperm DNA fragmentation testing: a requisite to infertility practice.

Conventional semen analysis is the routine test performed during the evaluation of a couple’s fertility status. The test is cost-effective and easy to perform and at the same time provides essential information on quantitative semen parameters such as semen volume, sperm motility, concentration, viability and morphology. Most practitioners consider a male partner normal or abnormal merely looking at a semen report. Notwithstanding that a semen analysis can provide significant information on sperm fertility parameters as predictive for fertilization; it does not forecast sperm functional and qualitative defects such as sperm DNA integrity, oxidative stress and antisperm antibodies (1,2). It also makes decision making difficult for the providers in certain clinical situations because of it’s inherit variability (3). Further, the advent of assisted reproductive technology (ART) has revolutionized the infertility treatment by offering, classic In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) in patients with abnormal semen parameters (4). On the other hand failed Intra Uterine Insemination (IUI), IVF/ICSI cycles and pregnancy loss have been reported in cases where semen parameters were normal (4,5). Additionally, the limitations of conventional semen analysis are extended into unexplained infertility cases where men had normal sperm parameters (6,7).

Effect of Gonadotropin Types and Indications on Homologous Intrauterine Insemination Success: A Study from 1251 Cycles and a Review of the Literature.

Objective To evaluate the IUI success factors relative to controlled ovarian stimulation (COS) and infertility type, this retrospective cohort study included 1251 couples undergoing homologous IUI. Results We achieved 13% clinical pregnancies and 11% live births. COS and infertility type do not have significant effect on IUI clinical outcomes with unstable intervention of various couples' parameters, including the female age, the IUI attempt rank, and the sperm quality. Conclusion Further, the COS used seemed a weak predictor for IUI success; therefore, the indications need more discussion, especially in unexplained infertility cases involving various factors. Indeed, the fourth IUI attempt, the female age over 40 years, and the total motile sperm count <5 × 106 were critical in decreasing the positive clinical outcomes of IUI. Those parameter cut-offs necessitate a larger analysis to give infertile couples more chances through IUI before carrying out other ART techniques.

Comparative Evaluation of Follicular Development and Endometrial Thickness in Spontaneous and Clomiphene Citrate Induced Cycle in Unexplained Infertility

Background: Unexplained infertility is one of the major causes of female infertility and ovulation induction is used as a standard treatment for such cases. Clomiphene citrate is commonly used drug for induction of ovulation. Aims: To assess follicular growth, endometrial thickness and timing of ovulation in Spontaneous and Clomiphene Citrate Induced Cycle in Unexplained Infertility. Material and Methods: This prospective study was conducted in Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India, after taking ethical clearance from institutional ethical committee. A total of thirty unexplained infertility cases were enrolled in the study. Each woman was evaluated by transvaginal ultrasound, first on day 3 of menstrual cycle for baseline assessment, then from day eight, every alternate day until ovulation. They were evaluated first in a spontaneous cycle followed by an induced cycle with clomiphene citrate 50 mg daily for 5 days from day 3 to 7 of cycle. SPSS software and paired t-test were used for analyzing the results. P value less than 0.05 was considered for statistical significance. Results: The leading follicular diameter was significantly larger, endometrial thickness was significantly diminished and ovulation occurred earlier in Clomiphene Citrate induced cycle when compared to spontaneous cycle. Conclusion: Clomiphene citrate induced cycles showed different follicular growth, endometrial thickness and timing of ovulation compared to spontaneous cycles.

May Underdiagnosed Nutrition Imbalances Be Responsible for a Portion of So-Called Unexplained Infertility? From Diagnosis to Potential Treatment Options.

The aim of the study was to investigate whether women affected by unexplained infertility may have undiagnosed dietary imbalances which negatively affect fertility. Secondarily, we investigated whether varying degrees of nutritional abnormalities may benefit from different periconceptional dietary supplementations, evaluating the most effective intervention in improving pregnancy rate after in vitro fertilization (IVF). We conducted a survey on 2 cohorts of patients (group A: unexplained infertility and group B: healthy first trimester spontaneous pregnancies) with the scope of investigating and comparing their dietary status discriminating women without dietary abnormalities (cohort 1) from those with abnormalities exclusively in micronutrient intake (cohort 2) or combined abnormalities in both micronutrient and macronutrient intake and associated obesity (cohort 3). All women included in group A were offered the opportunity to receive a prescription for one of the 3 designated daily dietary supplementation schemes (subgroups A1, A2, and A3) which were to be implemented in the 3 months immediately prior to beginning IVF treatment. When compared with fertile women, patients having unexplained infertility showed significant abnormalities in dietary habits. These differences ranged from a minimal imbalance in micronutrient intake (potentially avoidable with dietary supplementation) to severe combined macronutrient and micronutrient imbalance frequently associated with obesity (partially amendable by inositol supplementation and frequently requiring long-term dietary reeducation before establishment of fertility). Nutritional investigation and treatment may explain and resolve a portion of cases of unexplained infertility, improving the outcome of IVF treatment and, with minimal imbalances, likely restore spontaneous fertility.

Pregnancy Predictors after Intrauterine Insemination in Cases of Unexplained Infertility: A Prospective Study.

Introduction. Aim of the study was to find the effect of various prognostic factors in cases of unexplained infertility undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). Methods. 146 cases of unexplained infertility were included. A maximum of 3 cycles of IUI were done with clomiphene citrate/HMG. Ovulation trigger was given when the largest follicle diameter was >18 mm, and IUI was planned 36 hours later. Luteal phase support was given for 15 days, urine pregnancy test was done on day 15, ultrasonography was done at 7 weeks, and pregnancy was followed up till delivery. Results. A total of 146 couples have undergone 239 cycles of IUI out of which 27 had UPT positive after 15 days. 14.8% had 1st-trimester abortion while 3.7% were ectopic. 86.3% were singleton pregnancies and 13.6% were twins. CPR was 11.29% per cycle and 18.4% per couple; LBR was 9.2% per cycle. Apart from duration of stimulation (p = 0.037) and number of treatment cycles (p = 0.045), no other factors had significant prognostic value. Conclusion. For unexplained infertility, IUI can be done to provide patients with the time that they need before moving on to IVF while providing a respectable chance of pregnancy.

IVF-ICSI Split Insemination Reveals those Cases of Unexplained Infertility Benefitting from ICSI Even when the DNA Fragmentation Index is Reduced to 15% or Even 5%

IVF-ICSI Split Insemination Reveals those Cases of Unexplained Infertility Benefitting from ICSI Even when the DNA Fragmentation Index is Reduced to 15% or Even 5% Purpose The aim of the study was to assess the fertilization rate (FR) of randomized sibling oocytes inseminated by conventional IVF or ICSI in couples with unexplained infertility. Methods The 16-month study was conducted at an established private IVF facility. Oocytes recovered from couples with normal semen parameters and normal DNA fragmentation index (DFI; <30%), were randomly allocated to IVF or ICSI and the FR (2PN/MII) was assessed. Pregnancy outcome following embryo transfers were analyzed with regards to either IVF-embryo vs. ICSI-embryo, and in relation to DFI levels. Results Of 585 oocytes retrieved from 38 patients, 463 were mature (MII). The ICSI group generated a significantly higher number of 2PN embryos with a mean FR of 83.4% vs. 67.6% (p<0.05). There were no cases of complete fertilization failure (CFF) in the ICSI group, but there were 7.9% in the IVF group. The significant difference of FR was observed only when the DFI level was ≥ 15% and if such cutoff was applied, the CFF cases would be reduced to 2.6%. Of the 30 patients who had fresh embryo transfers performed, the ICSI group showed a higher pregnancy rate (69.2% vs. 58.8%; N.S.) with a significantly higher mean DFI value in the non-pregnant group (p<0.05). Conclusions IVF-ICSI split insemination can reveal those cases which will benefit from ICSI even where semen parameters and DFI are normal; however if the DFI is reduced to a 15% cut-off level, the rate of CFF will be minimized, but not completely excluded, even at 5%..

Clinical significance of nonspecificity of antiphospholipid antibodies in recurrent abortions and unexplained infertility.

Background:Antiphospholipid antibodies (APLA) are acquired autoantibodies directed to phospholipids which are associated with slow progressive thrombosis and infarction of placenta. Infertility and recurrent pregnancy loss may occur because of impaired trophoblast function, placental infarction, and abnormal blood clotting.Aim:To evaluate APLA (IgG and IgM) in cases of infertility and recurrent abortions.Materials and Methods:A prospective study comprising 70 subjects was carried out. Fifty cases of unexplained infertility and recurrent abortions (25 each) constituted the study group. Twenty healthy multipara females of same reproductive age group constituted the control group. Venous blood samples were collected, and serum was analyzed for two types of APLA (IgG and IgM) by ELISA method.Results:The mean IgM and IgG levels in recurrent abortions group were 8.10 MPL-U/ml and 6.17 GPL-U/ml, respectively whereas in control group, the levels were 4.67 MPL-U/ml and 4.53 GPL-U/ml, respectively. The difference was statistically nonsignificant. The mean IgM and IgG levels in unexplained infertility group were 7.30 MPL-U/ml and 6.12 GPL-U/ml, respectively whereas in control group, the levels were 4.67 MPL-U/ml and 4.53 GPL-U/ml, respectively. Again the difference was statistically nonsignificant.Conclusions:The present study concludes that there is no significance of raised APLA in cases of infertility and recurrent abortions.

자궁내 인공수정 시술을 받은 원인불명 난임진단 여성의 임신성공 영향 요인: 배란유도 유형을 중심으로

Purpose: The purpose of this study is to identify factors influencing the pregnancy rate among unexplained infertile couples who received treatments of assisted reproductive technology (ART) and intra-uterine inseminations (IUI). Methods: The medical records of 24,201 cases of unexplained infertility among a total of 31,684 intrauterine insemination treatment cases, (which benefited by ‘National Medical-aid Program for ART in 2011’) were used for this analysis. Results: Woman’s age (OR = 0.94), frequency of IUI (OR= 0.86), and treatment type (OR= 1.54) were significant factors on pregnancy rates in the logistic regression analysis. Conclusion: Factors, such as the age of the infertile woman, frequency of IUI, and treatment type used to induce ovulation were shown to positively influence pregnancy rate. However, the age of the spouse was not a significant variable. Infertile couples having unprotected sexual intercourse with unexplained infertility had priority. The results demonstrated that about 70% of infertile Korean couples had unexplained infertility. This was a higher rate of unexplained infertility than that of the clinical standard. Therefore, we should assess for causes through future studies. In addition, affective or emotional factors influencing unexplained infertility need to be researched further.