Unexplained Infertile Women Research Articles

Diminished Frequency of Menstrual and Peripheral Blood NKT-Like Cells in Patients With Unexplained Recurrent Spontaneous Abortion and Infertile Women.

Systemic monitoring of immune system may not precisely outline the local immune status in the uterus. This survey is a continuation of our previous studies on potential usefulness of menstrual blood (MB) immunophenotyping as a tool for investigation of immunological disturbances in pregnancy-related disorders. Peripheral blood (PB) and MB from healthy fertile (n = 15), unexplained recurrent spontaneous abortion (URSA; n = 15), and unexplained infertile women (n = 8) were collected simultaneously in the second day of their menstrual cycle and frequency of natural killer T (NKT)-like cell subpopulations were assessed by flow cytometry. Menstrual blood of all experimental groups contained higher percentage of TCRαβ+, CD45RO+, and CD16- NKT-like cells compared to corresponding PB. Frequency of MB NKT-like cells in unexplained infertile participants was lower than fertile and URSA groups. Compared to normal participants, patients with URSA had lower frequency of PB TCRαβ+ and higher CD16+, while in infertile woman frequencies of PB CD45RO+, CD45RO-, CD16-, IL17+, and MB CD45RO+ NKT-like cells were lower. Although, PB and MB seemingly have the same histological nature, our results showed that MB contained different composition of NKT-like subsets with different cytokine profiles and could be viewed as one potential biological sample for evaluation of patients with infertility and URSA.

Contraceptive Sperm Agglutinating Proteins Identified in Staphylococcus warneri, Natural Microflora of an Infertile Woman.

Staphylococcus warneri, isolated from the cervix of an adult female with unexplained infertility, was found to agglutinate human spermatozoa in vitro leading to their death. A genomic library of S. warneri was generated using pSMART-Escherichia coli vector-host system. Approximately 3500 transformants were screened and four showed sperm agglutinating activity. Sperm agglutinating proteins (SAPs) were partially purified from the positive transformants and were found to agglutinate sperms in vitro. Cloned ORFs in positive transformants were sequenced and ORF finder identified them as endonuclease, accessory secretory protein-Asp1, accessory secretory protein-Asp2 and signal transduction protein. Mannose was found to competitively inhibit sperm agglutination, indicating that SAPs in S. warneri bind to mannose in glycoprotein receptors on the surface of sperms for agglutination. This is the first report on identification of SAPs which may be responsible for unexplained infertility in women and may be used as contraceptive agents.

Reproductive outcomes of office hysteroscopic metroplasty in women with unexplained infertility with dysmorphic uterus.

Objective:The correlation between dysmorphic uterus and infertility still remains enigmatic. We evaluated the reproductive outcomes of metroplasty via office hysteroscopy in unexplained infertile women with dysmorphic uteri.Materials and Methods:In this retrospective cohort study, metroplasty via office hysteroscopy using a bipolar system was performed to 272 women with unexplained infertility with dysmorphic uteri from January 2013 to January 2016. Of all the patients, 162 had primary infertility, and 110 had secondary infertility.Results:In the primary infertility group, the clinical pregnancy rate was 45.68% (74/162) and the live birth rate was 38.9% (63/162), and in the secondary infertility group, the clinical pregnancy rate was 55.45% (61/110) and the live birth rate was 49% (54/110) after metroplasty. In the secondary infertility group, the miscarriage rate and especially the ectopic pregnancy rate declined dramatically [from 84.5% (93/110) to 9.8% (6/61) and from 15.5% (17/110) to 1.6% (1/61), respectively] (p<0.01).Conclusion:Reproductive outcome can be impaired by Müllerian anomalies, hence, infertile women with dysmorphic uteri should undergo hysteroscopy to improve reproductive outcomes. Our study demonstrated that office hysteroscopic metroplasty of a dysmorphic uterus might improve fertility, particularly in patients with unexplained infertility with dysmorphic uteri, which was an ignored factor previously. Office hysteroscopy is an alternative option in terms of non-invasive procedure.

The impact of plasma SOCS3 levels and endometrial leukocytes on unexplained infertility

Background/aim: To investigate the possible differences in endometrial leukocyte subtype distribution between women with unexplained infertility and normal fertile women and to determine whether there is a correlation between endometrial leukocyte counts and plasma cytokine levels in unexplained infertility. Materials and methods: This case-control study involved 79 infertile and 40 fertile women. Peripheral venous blood samples and endometrial samples were obtained on day 21 of the menstrual cycle. Plasma interleukin-4 (IL4), IL6, IL10, IL17, IL35, interferongamma (IFN-g), tumor necrosis factor-alpha (TNF-a), transforming growth factor-beta (TGF-b), and suppressor of cytokine signaling-3 (SOCS3) levels were determined by enzyme-linked immunosorbent assay. Endometrial CD8, CD56, and CD163 counts were detected by immunohistochemistry. Results: CD8 and CD56 counts were significantly higher, while CD163 count was significantly lower in infertile women than in fertile women. Plasma SOCS3, IL35, and IL4 levels of the infertile group were significantly lower than those of the fertile group (P < 0.01); the remaining cytokine levels were significantly higher in the infertile group than in the fertile group (P < 0.01). Conclusion: We observed aberrant cytotoxic immune activity in infertile women. The interaction between plasma SOCS3 levels and staining degree of endometrial leukocytes may be either the reason for or result of infertility leading to unavailability of the environment for implantation.

Overexpression of Endometrial Estrogen Receptor-Alpha in The Window of Implantation in Women with Unexplained Infertility.

BackgroundFailure in the endometrial receptivity may account for a significant number of infertility cases including unexplained infertility in women. Reduction in the endometrial estrogen receptor-alpha (ER-α) expression during implantation may be a critical event that coincides with the expression of specific genes and the formation of a receptive endometrium. The aim of the present study was to assess the expression of ER-α in the mid-secretory phase in the endometrium of women with unexplained infertility.Materials and MethodsThis case-control study was carried out on randomly selected fertile (n=10) and infertile (n=16) women whose source of infertility remained unexplained. We evaluated the expression of ER-α and glycode-lin-A (GdA) through mRNA level measurement with real-time polymerase chain reaction (PCR) in the endometrium of fertile women and patients suffering from unexplained infertility and fertile women. Endometrial biopsies of each subject were collected during a single menstrual cycle 7 days after the peak of luteinizing hormone (LH+7).ResultsEndometrial expression level of ER-α was significantly (P<0.05) higher in the patients with unexplained infertility compared to the control. Significantly (P<0.05) lower levels of GdA expression were seen in women with unexplained infertility. A statistically non-significant negative correlation was observed between ER-α and GdA mRNA expression.ConclusionOur findings demonstrate that reduction in the endometrial GdA expression is associated with elevated expression of ER-α in mid-luteal phase. Disruption in the endometrial ER-α expression, which leads to defects in uterine receptivity, may contribute to unexplained infertility.

The effectiveness, safety, and economic evaluation of Korean medicine for unexplained infertile women: A multi-center, prospective, observational study protocol: Erratum.

The effectiveness, safety, and economic evaluation of Korean medicine for unexplained infertile women: A multi-center, prospective, observational study protocol: Erratum.

Leptin as a Predictive Marker in Unexplained Infertility in North Indian Population.

According to WHO, the primary infertility in India is about 3.9% (age-standardized to 25-49 year) and 16.8% (age-standardized to 15-49 year), using the "age but no birth" definition. Several factors which affect fertility include low sperm production in men, poor egg quality and blocked fallopian tubes in women and also hormonal imbalances. Leptin plays a critical role in women's reproduction and neuroendocrine health. It is used for treating exercise-induced bone loss, eating disorders and infertility. To evaluate the serum leptin levels in Indians and to ascertain the relationship between serum leptin levels, Unexplained Infertility (UI) and related variables [height, weight, Waist Hip Ratio (WHR), Body Mass Index (BMI)] between obese infertile, non-obese infertile and healthy subjects. The present case-control study was conducted at the Department of Obstetrics and Gynaecology, King George's Medical University (KGMU), Lucknow, India and funded by Department of Science and Technology, New Delhi, India. The study included 229 female participants in the age group of 18-40 years (120 cases and 109 controls) who were randomly selected. The blood samples were collected from the Infertility Clinic, Queen Mary's Hospital, KGMU, Lucknow, India. All the participants underwent complete physical examination. Initially, the participants were categorized into fertile and infertile groups, they were further divided on the basis of BMI, normal (BMI- 18.5-24.5) and overweight or obese (BMI≥25). Leptin level was measured by Active Human Leptin ELISA kit and BMI of all subjects was calculated in kg/m2 (weight in kg and height in m). A highly positive linear correlation (R=0.754, p<0.001) was found between BMI and serum leptin in unexplained infertile women, which indicates a strong relationship between BMI and serum leptin. The variation in serum leptin is explained by the independent variable, BMI. There was a partial positive linear correlation between BMI and serum leptin in the control group. Statistically there was no significant correlation (R=0.109, p=0.258) between BMI and serum leptin in the control group. The present study clearly demonstrates that level of leptin is higher in unexplained infertile than in the fertile group, and also shows that a strong relationship exists between BMI and serum leptin in the obese group. Serum leptin level was significantly higher in obese than non-obese subjects. Thus, leptin is an important factor for normal reproductive function. Obesity, the main cause of infertility may be controlled by regulating the leptin concentration.

Serum carcinogenic antigen (CA)-125 and CA 19-9 combining pain score in the diagnosis of pelvic endometriosis in infertile women

Objective: To define the utility of serum carcinogenic antigen (CA)-125 and CA 19-9 combining pain score in the prediction of pelvic endometriosis in infertile women. Materials and Methods: Serum CA-125 and CA 19-9 were measured using immunoradiologic methods during the follicular phase preceding laparoscopy for infertility. Values obtained were correlated with the occurrence and severity of endometriosis. Receiver operating characteristic (ROC) curve was applied to assess the utility of serum CA-125, CA 19-9, and pain score in preoperative preparation. Cut-off value of CA-125 and CA 19-9 was defined. Results: The study enrolled 294 infertile women receiving laparoscopy between July 2010 and September 2011. Ninety-four patients were diagnosed with endometriosis and 200 patients without. Preoperative serum CA-125 and CA 19-9 levels were significantly different between the two groups. ROC curve analyses ofserum CA-125 and CA 19-9 set a cut-off value of 18.25 IU/ml and 13.15 IU/ml, producing a sensitivity of 64.8% and 84.8%, a specificity of 81.9% and 51.6%, a positive predictive value (PPV) of 63.6% and 46.1%, and a negative predictive value (NPV) of 81.0% and 87.4%, respectively. Combined-analyses of CA-125 and CA 19-9 produced a sensitivity of 72.4%, a specificity of 81.9%, a PPV of 62.3%, and a NPV of 81.8%. Combined-analyses of serum CA-125, CA 19-9 and pain score produced a sensitivity of 71.0% and a specificity of 74.0%. Conclusions: Preoperative CA-125 and CA 19-9 levels combining pain score can be useful for the prediction of pelvicendometriosis and may be included in the evaluation of unexplained infertile women.

Progesterone: a little-known role of the well-known hero

Endometrial polyps and chronic endometritis are two most common causes of unexplained infertility in women of reproductive age.The aim of our study was to conduct a comparative analysis of the hormonal homeostasis and the state of the receptor apparatus of the endometrium in women of reproductive age with endometrial polyps and micropolyps.For a research 4 groups of women were chosen: 34 women with endometrial polyps (IA group), 36 patients with endometrial polyps and micropolyps (IB group), 30 women with micropolyps (IІ group) and 30 healthy women (ІІІ group). In all groups of women the content in blood serum for 3–5 day of a menstrual cycle of gonadotropic hormones (follicle-stimulating hormone, luteinizing hormone) and sex steroid hormones (estradiol, prolactin) was studied, for 21 days of a cycle estimated the content of progesterone. Level of an expression of receptors of progesterone and estrogen estimated in endometrium and at endometrial polyps, also in І a cycle phase.The conducted research revealed reliable decrease in level of progesterone at women with endometrial polyps against the background of lack of significant changes in the receptor device. At patients with micropolyps the tendency to a hypoprogesteronemia was also observed, but changes in an expression of steroid receptors it was not also revealed.The authors conclusion is the low concentration of progesterone initiate non-hormonal pathophysiological mechanisms of development of endometrial polyps which should be considered at purpose of antirecurrent therapy.Thus, in case of progesteron deficit perverse mechanisms literally overlap in an attempt to start the process of tumor. Inflammation is an important component of the physiological menstrual cycle, during prolonged hypoprogesteronemia it becomes pathological. It is directly involved in the formation of such a microenvironment for endometrium in which the mechanisms of fibrosis fully realize their potential, cell proliferation and angiogenesis, creating a strong foundation for the subsequent formation and growth of endometrial polyps. To date, it is proved that an imbalance in estrogen-progesterone system actually increases the risk of developing endometrial polyps, but not always through steroid receptors.

Presence of HHV-6A in Endometrial Epithelial Cells from Women with Primary Unexplained Infertility.

To elucidate the roles of human herpesvirus (HHV)-6 primary unexplained infertile women, a prospective randomized study was conducted on a cohort of primary unexplained infertile women and a cohort of control women, with at least one successful pregnancy. HHV-6 DNA was analyzed and the percentage and immune-phenotype of resident endometrial Natural Killer (NK) cells, as the first line of defense towards viral infections, was evaluated in endometrial biopsies. Cytokine levels in uterine flushing samples were analyzed. HHV-6A DNA was found in 43% of endometrial biopsies from primary unexplained infertile women, but not in control women. On the contrary, HHV-6B DNA was absent in endometrial biopsies, but present in PBMCs of both cohorts. Endometrial NK cells presented a different distribution in infertile women with HHV6-A infection compared with infertile women without HHV6-A infection. Notably, we observed a lower percentage of endometrial specific CD56brightCD16- NK cells. We observed an enhanced HHV-6A-specific endometrial NK cell response in HHV-6A positive infertile women, with a marked increase in the number of endometrial NK cells activating towards HHV-6A infected cells. The analysis of uterine flushing samples showed an increase in IL-10 levels and a decrease of IFN-gamma concentrations in infertile women with HHV6-A infection. Our study indicates, for the first time, that HHV-6A infection might be an important factor in female unexplained infertility development, with a possible role in modifying endometrial NK cells immune profile and ability to sustain a successful pregnancy.

A shift in the balance of T17 and Treg cells in menstrual blood of women with unexplained recurrent spontaneous abortion

To determine usefulness of menstrual blood for assessment of differential frequency of T cell subsets, peripheral blood (PB) and menstrual blood (MB) from healthy fertile (n=15), unexplained recurrent spontaneous abortion (URSA) women (n=15) and unexplained infertile women (n=8) were collected in the second day of menstrual bleeding. Frequency of T cell subsets was measured by flow cytometry. URSA and unexplained infertile patients had higher frequency of TCRαβ+CD3+CD56− and CD45RO+ T cells as well as CD45RO+/CD45RO− ratio in PB as compared to MB. Frequency of CD3+TCRγδ+ cells in PB of unexplained infertile and MB of URSA patients were significantly lower than that in fertile group. In all groups MB contained higher percentage of CD4+CD25+Foxp3+ regulatory and lower percentages of CD16+ T cells compared to PB. T17 cells (CD3+CD56−IL-17+) was found to be significantly higher in MB of only fertile and unexplained infertile subjects and not URSA patients in comparison with PB. Compared to PB, only fertile women had higher T17:Treg ratio in their MB. URSA women had significantly lower MB T17 cells and T17:Treg ratio compared to those in fertile and unexplained infertile women. Based on the findings presented here, we speculate that MB has its own unique immune milieu which is not solely continuation of the immune environment of secretory endometrium. Indeed, immunophenotyping of MB immune cells could potentially be a useful tool for investigation of immunological disturbances in pregnancy-related disorders.

Comparison of Serum Leptin Level in Women with Unexplained Infertility and Fertile Women in Iran.

Various studies have been conducted on the role of leptin in the different types of infertility, including endometriosis, polycystic ovaries and male infertility; however, only a few studies have been conducted on the effect of leptin on unexplained infertility. The purpose of the present study was therefore to compare serum leptin levels in women with unexplained infertility and fertile women as a contributing factor to female infertility in Iran. The present case-control study was conducted on 40 women with unexplained infertility and 30 fertile women who met the inclusion criteria (FSH<10, BMI<30, normal AMH and AFC and age under 35). Serum leptin levels were analyzed on the third day of menstruation by ELISA method. Although the mean serum leptin level was higher in women with unexplained infertility (31.20±2.83ng/ml) than in fertile women (24.89±2.93ng/ml), no statistically significant differences were observed between the two groups (P=0.13). No statistically significant relationship was found between serum leptin levels in the two groups. In addition, there were no significant relationships between leptin and other predisposing factors such as hormone profile and antral follicle count.

NMR-based metabonomics for understanding the influence of dormant female genital tuberculosis on metabolism of the human endometrium.

Does investigation of metabolic perturbations in endometrial tissue of women with dormant genital tuberculosis (GTB) during the window of implantation (WOI) assist in improving the understanding of endometrial receptivity? In dormant GTB cases significant alterations in endometrial tissue metabolites occur, largely related to energy metabolism and amino acid biosynthesis in dormant GTB cases. As an intracellular pathogen, Mycobacterium tuberculosis strongly influences the metabolism of host cells causing metabolic dysregulation. It is also accepted that dormant GTB impairs the receptive status of the endometrium. Global metabolic profiling is useful for an understanding of disease progression and distinguishing between diseased and non-diseased groups. Endometrial tissue samples were collected from patients reporting at the tertiary infertility care center during the period September 2011-March 2013. Women having tested positive for GTB were considered as the study group (n = 24). Normal healthy women undergoing sterilization (n = 26) and unexplained infertile women with repeated IVF failure (n = 21) volunteered to participate as controls. Endometrial tissue samples were collected 6-10 days after confirmation of ovulation. PCR and BACTEC-460 culture were used for diagnosing GTB. Proton nuclear magnetic resonance (1H NMR) spectra of tissue were recorded using a 700 MHz Bruker Avance AV III spectrometer. Following phase and baseline correction of all NMR spectra by Bruker Topspin 2.1 software, spectral peak alignment of the data was performed. Multivariate analysis was applied to all spectra and individual metabolites identified and multiple correlation analysis was performed. Leucine, isoleucine, acetate, lactate, glutamate, glutamine, methionine, lysine, creatine, glycogen, glycine, proline and choline were found to be significantly increased (P < 0.05) in endometrial tissue of women with dormant GTB compared with unexplained infertile women with repeated implantation failure. Valine, citrate, succinate and aspartate were also observed to be significantly up-regulated (P < 0.01). Furthermore, a significant decrease in glucose (P < 0.05), threonine (P < 0.05), tyrosine (P < 0.01) and phenylalanine (P < 0.0001) was observed in women with dormant GTB. Pearson's correlation analysis between the expression of various endometrial receptivity markers and metabolites showed a significant negative correlation (-0.236 to -0.545, P < 0.05). Also, the metabolites were positively correlated with endometrial receptivity markers (0.207 to 0.618, P < 0.05). It is often difficult to diagnose dormant GTB because it tends to exist without any clinical signs or symptoms. In addition, the diagnosis of GTB by culture remains a challenge due to low detection rates and its paucibacillary nature. Testing for prostate-specific antigen or the Y chromosome in order to account for the possible influences of recent exposure to semen on endometrial metabolism would be important. The metabolic changes associated with the dormant tubercle infection are of potential relevance to clinicians for the treatment of dormant GTB-related infertility. Government of India, Indian Council of Medical Research. There are no conflicts of interest.

Comparison of Uterine Receptivity between Fertile and Unexplained Infertile Women by Assessment of Endometrial and Subendometrial Perfusion Using Contrast-Enhanced Ultrasound: Which Index is Better—Peak Intensity or Area under the Curve?

The goal of this study was to compare uterine receptivity between women with normal fertility and those with unexplained infertility during natural cycles by assessment of endometrial and subendometrial perfusion using contrast-enhanced ultrasound (CEUS). We wanted to determine the better index: peak intensity (PI) or area under the curve (AUC). Thirty women with unexplained infertility were recruited into the study group, and 30 women with normal fertility were recruited into the control group. All women underwent CEUS during the late proliferative phase, ovulation phase, and implantation window of a menstrual cycle. Endometrial PI, endometrial AUC, subendometrial PI and subendometrial AUC were analyzed. In the late proliferative phase, the control group had a significantly higher endometrial PI (p < 0.001) as well as subendometrial PI (p < 0.001) and AUC (p = 0.004) than the study group. In the ovulation phase, the control group had a significantly higher endometrial PI (p < 0.001) and AUC (p = 0.021), as well as subendometrial PI (p < 0.001) and AUC (p = 0.003). During the implantation window, there were no significant differences between the two groups. Only subendometrial PI underwent a significant periodic change during the menstrual cycle in both groups. This finding was further confirmed by evaluation of the microvessel density of endometria. In conclusion, CEUS can be used to assess endometrial and subendometrial perfusion to evaluate uterine receptivity. Subendometrial PI was the most sensitive index compared with endometrial PI, endometrial AUC and subendometrial AUC.

Prevalence and correlation of Neisseria gonorroheae, Mycoplasma hominis and Ureaplasma urealyticum antibodies in unexplained infertile women having positive post coital test

The probability that a vaginal infection can interfere with fertility is often overlooked. The microorganisms, their products may inhibit sperm morphol-ogy and motility. Abnormal cervical mucus and sperm interactions clarify infertility in 5% to 10% of couples with a fertility problem. The aim of this research study was to estimate the prevalence of Gonococcal (IgG), Myco-plasma hominis (IgG) and Ureaplasma urealyticum (T. mycoplasma) (IgG) antibodies in unexplained infertile women having positive post coital test (PCT). Blood samples of 50 positive PCT identified infertile females and 50 healthy pregnant females (age group of 24-36 yrs) were collected and ana-lyzed for Gonococcal (IgG), M. hominis (IgG) and T. mycoplasma (IgG) anti-bodies by ELISA technique. In the study group patients, only 12 % cases (6/ 50) were positive for IgG gonococcal antibodies but no any positive case was found in control group. 28% cases (14/50) were found positive for M. homi-nis IgG antibodies in study group patients and only 10 % cases (5/50) were positive in control group. Results statistically were insignificant. In case of T. mycoplasma IgG antibodies, 76% (38/50) infertile women were observed as positive while only 24% (12/50) cases of control group were found positive for the same (p &lt; 0.001). The results were not significant for gonococcal and M. hominis antibodies but were highly significant for U. urealyticum IgG an-tibodies and it was concluded that it may be a cause of infertility in positive PCT cases as no any other known reason of infertility is noticed in such cases.

Açıklanamayan infertilite etiyolojisinde olası risk faktörü olarak herediter trombofilinin yeri

Objective: Unexplained infertility represents one of the most common diagnoses among infertile couples. In this study we investigated the impact of inherited thrombophilia as a risk factor in unexplained infertility. Material and Methods: In this study, genetic mutations of prothrombin gene G20210A, Factor V Leiden and methylene tetrahydrofolate reductase (MTHFR) C677T, as well as D-Dimer levels were investigated in 25 women diagnosed with unexplained infertility and 25 healthy fertile women. Results: In the present study, among unexplained infertile women and the control group, MTHFR C677T, prothrombin G20210A mutations and D-Dimer levels did not have a statistically significant difference (p>0.05). Factor V Leiden mutation was not observed in either group. Conclusion: Currently, there still are unclear points in the etiopathogenesis of unexplained infertility. As a result of our findings, although we did not observe a significant association between hereditary thrombophilia and unexplained infertility, the presence of a number of studies with contradictory findings demands future research with large sample sizes to clarify this issue.

Do Endometrial Movements Affect The Achievement of Pregnancy during Intrauterine Insemination?

This study was aimed to assess the effect of endometrial movements on pregnancy achievement in intrauterine insemination (IUI) cycles. The population of this observational study was composed of unexplained infertility couples undergoing first-time IUI with clomiphene citrate between September 2010 and October 2011. Not only endometrial movements, but also thickness, volume, pattern, and echogenic change of endometrium were analyzed prospectively in prediction of pregnancy. The total number of 241 cycles of IUI with 49 intrauterine pregnancies (20.3%) was analyzed. Pregnancy was not related to endometrial thickness and endometrial volume, but significantly related to endometrial movements associated with the number of contraction, strong movement, cervicofundal direction, and hyperechoic change (p<0.05). Pregnant group showed higher cervicofundal movement rate (89.8 vs. 75.5%). For IUI cycles stimulated by clomiphene citrate in unexplained infertility women, endometrial movements on the day of IUI could be a predictor of pregnancy.

Mycobacterium tuberculosis infection in women with unexplained infertility

Genital tuberculosis (GTB) is an important cause of female infertility, especially in developing countries. The positive results of polymerase chain reaction (PCR) in endometrial GTB in the absence of tubal damage raise the possibility of the detection of sub-clinical or latent disease, with doubtful benefits of treatment. To evaluate the mycobacterium tuberculosis infection in endometrial biopsy samples collected from unexplained infertile women attending Yazd Research and Clinical Center for Infertility by using PCR techniques. In this cross sectional study, 144 infertile women with unexplained infertility aged 20-35 years old and normal Histro-saplango graphy findings were enrolled. Endometrial biopsy samples from each participant were tested for mycobacterium tuberculosis detecting by PCR. In 93 patients, peritoneal fluid was also taken for culture and PCR. The PCR results of endometrial specimens were negative in all cases, demonstrating that there was no GTB infection among our patients. Our results showed that GTB could not be considered as a major problem in women with unexplained infertility. Although, studies have indicated that PCR is a useful method in diagnosing early GTB disease in infertile women with no demonstrable evidence of tubal or endometrial involvement.

Lower values of VEGF in endometrial secretion are a possible cause of subfertility in non-atopic asthmatic patients

Objective: Using endometrial secretion analysis, we assessed whether altered inflammatory cytokine levels can be detected in the uterine environment in asthma patients, thereby providing a possible cause of reduced fertility in asthmatics. Methods: Forty-four unexplained infertile women (aged 28–44) underwent asthma and allergy testing, questionnaires, endometrial secretion and blood samples in the mid-secretory phase of the menstrual cycle (day 19–23) during assisted reproduction. Differences in cytokines and growth factors were analyzed. Results: Mean log-VEGF in uteri was lower in asthma patients compared with controls (2.29 versus 2.70, p = 0.028). This was mainly due to lower values of VEGF among women with non-atopic asthma compared with women with atopic asthma (1.86 versus 2.72, p = 0.009) and with healthy controls (1.86 versus 2.70, p = 0.01). Asthma treatment status had no effect on VEGF levels in uteri. Serum high sensitivity CRP was negatively correlated with VEGF in endometrial secretions. No other significant correlations were observed between peripheral blood values and markers found in utero. Conclusion: Asthma is associated with lower values of VEGF in uterine endometrial secretions, which might affect the receptiveness of the endometrium and thereby increase time to pregnancy. The effect appears to be associated with non-atopic asthma with general increased systemic inflammation.

Uterine and ovarian arteries blood flow during the mid luteal phase in women with unexplained infertility

Abstract Objective Altered utero-ovarian blood flow has been claimed to be a subtle cause of unexplained infertility. The aim of this study was to compare between the flow velocity indices in the uterine and ovarian arteries during the luteal phase in fertile and unexplained infertility women. Study design Observational, cross section, controlled study done at the departments of Obstetrics and Gynecology, Benha Faculty of Medicine, Egypt, during the period from October 2010 to October 2011. Patients and methods Two groups each of 30 cases and aged 20-25 years were studied. A control group of fertile women who got pregnant within one year of marriage, and a study group of women with unexplained infertility were included. Trans-vaginal pulsed color Doppler ultrasound was done at days 21–23 of the cycle to measure uterine and ovarian arteries resistance and pulsation indices. Outcome measures Mean uterine and ovarian arteries resistance and pulsation indices in both groups and their values in the diagnosis of altered blood flow in unexplained infertility were measured. Results Women with unexplained infertility had significantly higher uterine and ovarian arteries pulsation index ( P Conclusions Unexplained infertility is associated with decreased uterine and ovarian arteries blood flow during the luteal phase. More studies are needed to support this conclusion and to evaluate the possible role of perfusion enhancer drugs in increasing utero-ovarian blood flow and enhancing pregnancy.