Women Attending Fertility Clinics Research Articles

Assisted Reproductive Technology Results Using Donor or Partner Sperm: A Danish Nationwide Register-Based Cohort Study.

This was a nationwide cohort study based on Danish health registers focusing on assisted reproductive technology (ART) treatments in women using donor or partner sperm from 2007 to 2017. Women using donor sperm were subdivided into groups based on relationship status: women with male partners, single women, or women with female partners. The live birth adjusted odds ratios (aORs) after the IUI treatments in women using donor sperm compared with women using partner sperm were 1.48 (95% CI: 1.38-1.59) in women with male partners using donor sperm, 1.20 (95% CI: 1.13-1.28) in single women, and 1.46 (95% CI: 1.32-1.62) in women with female partners. The live birth aORs after IVF treatments in women using donor sperm compared with women using partner sperm were 1.16 (95% CI: 1.02-1.32) in women with male partners using donor sperm, 0.88 (95% CI: 0.80-0.96) in single women, and 1.20 (95% CI: 1.00-1.44), in women with female partners. The use of donor sperm was associated with a higher chance of a live birth after the IUI treatments, but there was no difference after the IVF treatments. Our study invites healthcare professionals to increase their attention toward the different needs and fertility issues of all women attending fertility clinics.

Urinary concentration of selected nonpersistent endocrine disrupting chemicals—reproductive outcomes among women from a fertility clinic

Parabens and benzophenones are compounds widely used in cosmetics and personal care products. Although human exposure is widespread there is a limited number of epidemiological studies assessing the relationship between exposure to these chemicals and female reproductive health. The aim of the study is to explore the relationship between paraben and benzophenone concentrations and reproductive outcomes among women attending a fertility center. This prospective cohort included 450 women undergoing in vitro treatment (IVF) at fertility clinic in Poland. The validated gas chromatography ion-tap mass spectrometry to assess concentrations of parabens in urine (methyl (MP), ethyl (EP), propyl (PP), butyl paraben (BP)) and benzophenone-3 (BP-3) was used. To explore the relationship between concentrations of examined chemicals and reproductive outcomes (methaphase II (MII) oocyte yield, total oocyte yield, implantation rate, fertilization rate, clinical pregnancy, live births), multivariable generalized linear mixed model was used for the analysis. Increased exposure to butyl paraben was associated with a significant decrease in MII oocyte count (p = 0.007) when exposure to BP was treated as the continuous variable. Additionally, the exposure to BP in the highest quartile of exposure also decreases MII oocyte count (p = 0.02) compared to the lowest quartile. Urinary concentrations of BP were not related to total oocyte count, fertilization and implantation rate, clinical pregnancy, and live birth when the exposure variable was continuous variable or in the quartiles of exposure. Exposure to MP, EP, PP, the sum of examined parabens, and benzophenone-3 were not related to any of the examined reproductive outcomes. Exposure to butyl paraben was associated with a decrease in MII oocyte count among women attending fertility clinic rinsing concerns that exposure may have a potential adverse impact on embryological outcomes. The results emphasize the importance to reduce chemicals in the environment in order to minimize exposure. As this is the first study showing such an association, further research is needed to confirm these novel results in other populations.Graphical

Polycystic ovarian syndrome among women diagnosed with infertility in the Gulf Cooperation Council countries: A protocol for systematic review and meta-analysis of prevalence studies.

Polycystic ovarian syndrome, a common endocrine disorder, is an important cause of infertility among women of reproductive age. Within the Gulf Cooperation Council countries, polycystic ovarian syndrome is found to affect women increasingly. No study has been carried out to critically summarize the evidence on the prevalence of polycystic ovarian syndrome among women suffering from infertility in these countries. This protocol aims to conduct a systematic review and meta-analysis of the studies reporting the prevalence of polycystic ovarian syndrome among women seeking infertility treatment in the six Gulf Cooperation Council countries (Bahrain, Kuwait, Oman, Saudi Arabia, Qatar, and United Arab Emirates). The systematic review and meta-analysis will follow the following method. Five databases, including PubMed, Embase, CINAHL, Web of Science, and SCOPUS, will be searched for observational studies using a combination of relevant keywords and Medical Subject Headings from inception of databases. Two reviewers will screen titles and abstracts, followed by a full-text search based on the eligibility criteria. The main outcome is to measure the proportion of women who have polycystic ovarian syndrome among infertility-diagnosed patients. In addition, the risk of bias in the included studies will be assessed using the national institute of health quality assessment tool for observational studies. The random-effects method of the analysis with the inverse variance will be used to calculate the pooled prevalence of polycystic ovarian syndrome-attributed infertility. Variation in prevalence estimates will be calculated using subgroup analysis based on study and patients' characteristics and publication bias will be assessed via funnel plot inspection and Eggar's test. A critical assessment of evidence on the prevalence of polycystic ovarian syndrome in women attending fertility clinics is helpful in risk quantification, enabling better planning for managing infertility in women with polycystic ovarian syndrome. This protocol has been registered with PROSPERO, protocol registration number (CRD42022355087).

Association between chemical mixtures and female fertility in women undergoing assisted reproduction in Sweden and Estonia

ObjectiveWomen of reproductive age are exposed to ubiquitous chemicals such as phthalates, parabens, and per- and polyfluoroalkyl substances (PFAS), which have potential endocrine disrupting properties and might affect fertility. Our objective was to investigate associations between potential endocrine-disrupting chemicals (EDCs) and female fertility in two cohorts of women attending fertility clinics. MethodsIn a total population of 333 women in Sweden and Estonia, we studied the associations between chemicals and female fertility, evaluating ovarian sensitivity index (OSI) as an indicator of ovarian response, as well as clinical pregnancy and live birth from fresh and frozen embryo transfers. We measured 59 chemicals in follicular fluid samples and detected 3 phthalate metabolites, di-2-ethylhexyl phthalate (DEHP) metabolites, 1 paraben, and 6 PFAS in >90% of the women. Associations were evaluated using multivariable-adjusted linear or logistic regression, categorizing EDCs into quartiles of their distributions, as well as with Bayesian Kernel Machine Regression. ResultsWe observed statistically significant lower OSI at higher concentrations of the sum of DEHP metabolites in the Swedish cohort (Q4 vs Q1, β = -0.21, 95% CI: −0.38, −0.05) and methylparaben in the Estonian cohort (Q3 vs Q1, β = -0.22, 95% CI: −0.44, −0.01). Signals of potential associations were also observed at higher concentrations of PFUnDA in both the combined population (Q2 vs. Q1, β = −0.16, 95% CI -0.31, −0.02) and the Estonian population (Q2 vs. Q1, β = −0.27, 95% CI -0.45, −0.08), and for PFOA in the Estonian population (Q4 vs. Q1, β = −0.31, 95% CI -0.61, −0.01). Associations of chemicals with clinical pregnancy and live birth presented wide confidence intervals. ConclusionsWithin a large chemical mixture, we observed significant inverse associations levels of DEHP metabolites and methylparaben, and possibly PFUnDA and PFOA, with OSI, suggesting that these chemicals may contribute to altered ovarian function and infertility in women.

The relationship between vaginal pH and bacterial vaginosis as diagnosed using qPCR in an asymptomatic subfertile population.

Bacterial vaginosis (BV) is a dysbiosis of the vaginal microbiome and a condition found in 20-30% of all women. Literature describing the possible link between BV and subfertility is increasing. Newer techniques such as quantitative polymerase chain reactions (qPCR) detect BV more accurately than traditional methods but come with high costs. The association between pH and BV as diagnosed using traditional methods is well-established in a symptomatic population. This study is the first to investigate the association between pH and BV diagnosed by qPCR in an asymptomatic subfertile population and to examine the usefulness of pH as a means of cost reduction. Data of 170 pH-qPCR combinations were used from a prospective cohort study examining bacterial vaginosis in a subfertile population. 102 women received a vaginal swab and pH measurement at baseline and subsequent advanced reproductive technology (ART) treatments. The swabs are analysed using the AmpliSens®Florocenosis/Bacterial vaginosis-FRT qPCR kit. pH is strongly associated with BV as diagnosed by qPCR (OR 3.06, p = 0.000, CI 1.65-5.68). The cut-off point for pH ≥ 4.7 maximised diagnostic performance [AUC 0.74 (CI 0.66-0.83), sensitivity 76%] and reduced costs by 60%. This study shows that the vaginal pH for a multi-ethnic, asymptomatic population of women attending fertility clinics is strongly associated with BV qPCR outcome. Using the cut-off of pH of 4.7 has a high sensitivity for diagnosis of BV by qPCR and can be achieved at a cost reduction of 60%.

Awareness, perceived efficacy, and utilization of assisted reproductive technologies among women attending fertility clinic in a Nigerian tertiary health institution: a cross-sectional study.

Introductioninfertility is a source of distress for couples considering the high accolade placed on having children in family settings in Nigeria. Assisted reproductive technologies (ARTs) offer a chance for parenthood to couples. However, studies on knowledge of ARTs abound in Nigeria but no previous studies exist on the extent of utilization of assisted reproductive technologies. This study thus explored the level of awareness, perceived efficacy, and utilization of ARTs among women attending fertility clinics in a Nigerian Tertiary Health Institution.Methodsthis cross-sectional study which utilized a self-administered questionnaire was adopted for this study. The questionnaire contains five sections with sections A to E bordering on demographics, awareness, perceived efficacy, utilization, and factors influencing utilization respectively.Resultsone hundred and seven women with infertility problems, aged between 26 and 35 years with a mean age of 31.46 ±5.72 participated in the study. Sixty-two patients (57.9%) were aware of ARTs while 97 (90.7%) believed that ART cannot address male infertility. Only 27 (25.2%) admitted to having used ART procedures before while 82 patients (76.6%) stated that the cost of the procedure was the major hindrance to use.Conclusionawareness of ARTs is average while there is low utilization and perceived efficacy of ART. The high cost of the procedure remains the major setback to its utilization.

P-711 Differences in live birth results using donor or partner semen in single women, same-sex and different-sex couples. A Danish Nationwide register-based Cohort Study

Abstract Study question Are there any differences in the chance of a live birth using donor or partner semen in the different groups of women attending fertility clinics? Summary answer The chance of a live birth improves using donor semen for Intrauterine Insemination (IUI) treatments. No difference is observed for In Vitro Fertilization (IVF) treatments. What is known already Few studies regarding the efficacy of ART treatments using donor semen are available and most of them focus only on IUI treatments. Moreover, they usually do not take into account the different groups of women utilizing them or possible differences with the use of male partner semen. Study design, size, duration Danish nationwide cohort study based on health registers including all ART treatments from 2007 to 2017. The number of treatments in women using donor semen was 31540 for IUI and 7770 for IVF. For women using partner semen the number of treatments was 80949 for IUI and 74425 for IVF. ART treatments in women using donor semen were further subdivided into three groups based on women's relationship status: different-sex couples single women, and same-sex couples. Participants/materials, setting, methods Live birth chance per ART treatment cycle, IUI or IVF, using donor or partner semen has been assessed. In a subanalysis, the difference in a live birth was also evaluated comparing women using partner semen and women using donor semen stratified according to the partner with whom they attend the fertility clinics. The crude and confounders adjusted odds ratio (OR and aOR) were obtained by multilevel logistic regression. Main results and the role of chance A live birth was obtained in 13.9% of IUI treatments in women using donor semen compared to 12.3% in women using partner semen with an aOR of 1.33 (95% CI: 1.27-1.40). More in detail, for different groups of women using donor semen the aOR of live birth after IUI treatments was: aOR 1.48 (95% CI: 1.38-1.59) in women with male partners using donor semen, aOR 1.20 (95% CI: 1.13-1.28) in single women and aOR 1.46 (95% CI: 1.32-1.62) in women with female partners using donor semen. For what concern IVF treatments, 20.7% of treatments in women using donor semen and 25.7% of treatments in women using partner semen resulted in a live birth. The aOR was 0.99 (95% CI: 0.92-1.06). Moreover, for the different groups of women using donor semen compared to women using partner semen, the aOR of live birth after IVF treatments was: aOR 1.16 (95% CI: 1.02-1.32) in women with male partners using donor semen, aOR 0.88 (95% CI: 0.80-0.96) in single women, and aOR 1.20 (95% CI: 1.00-1.44), in women with female partners using donor semen. Limitations, reasons for caution Being an observational study, it is not possible to exclude the presence of unknown confounders or residual confounding which might affect the results. Wider implications of the findings This is one of the few studies assessing the ART success chances using donor or partner semen with attention to the now diverse population groups receiving ART treatments. We hope our results would be useful to healthcare professionals to better advise and help all women and couples attending fertility clinics Trial registration number not applicable

The impact of the COVID-19 pandemic on women seeking fertility treatment: the patient’s perspective

PurposeThis study sought the views of women with impaired fertility on the impact of the COVID-19 pandemic on their fertility treatment and psychological wellbeing.MethodsA cross-sectional, anonymous, online questionnaire was completed in June–December 2020 by 249 women attending fertility clinics across Germany. All women seeking treatment in fertility clinics were eligible to participate. The online survey covered questions about the patient’s quality of life, their opinions about the professional societies’ recommendations and their effects as well as any concerns about infection with SARS-CoV-2.ResultsThree-quarters of participants disagreed with the pausing of fertility treatments. Women who participated from October to December 2020, when the incidence rate was high, were as likely to disagree as participants that participated from June to September 2020 (73% vs 79%, p = 0.3). Seventy-two participants (29%) had their appointments cancelled. Nearly all (97%) reported being upset by this, with 40 (56%) reporting that they were extremely or very disappointed about the cancellation. Women who had to wait 10 weeks or longer were more likely to be upset by the postponement or cancellation of their appointment than women who had to wait a shorter amount of time (p = 0.01). Many participants (41%) were worried about possible negative effects a SARS-CoV-2 infection might have related to their fertility, pregnancy or unborn child.ConclusionPostponement of treatments increased distress among patients and should be avoided when possible. Fertility clinics must provide information about the current state of knowledge of SARS-CoV-2 infections in pregnancies and options for immunization.

P–759 The impact of the COVID–19 pandemic on women seeking fertility treatment in Germany: the patient´s perspective

Study questionThis cross-sectional survey sought the views of women seeking fertility treatment on the impact of the COVID–19 pandemic on their fertility treatment and attitudes.Summary answerMost respondents worried the recommendations to postpone treatment would reduce their chances of pregnancy and were concerned about negative effects of SARS-Cov–2 infections on pregnancy.What is known alreadyIn spring 2020, the recommendations of ESHRE and German professional societies to postpone fertility treatments resulted in limited or closed services from mid-March to early May in many clinics. Previous studies reported that postponing fertility clinic appointments causes psychological distress, with most patients saying they would have preferred to continue treatment. While no similar studies are available from Germany, where COVID–19 incidence was relatively low, concerns of the patients about possible consequences of a treatment delay and a SARS-CoV–2 infection on fertility and pregnancy remain unknown.Study design, size, durationThis cross-sectional, anonymous, online questionnaire was completed in June-December 2020 by 249 women attending fertility clinics across Germany. The women were recruited using leaflets, directly by study personnel either in person or by telephone, or via online support group forums for fertility patients.Participants/materials, setting, methodsAll women seeking treatment in fertility clinics were eligible to participate. The online survey covered questions about the patient’s quality of life, their opinions about the professional societies’ recommendations and their effects as well as any concerns about infection with SARS-CoV–2. Statistical analysis was conducted using SPSS Version 27.Main results and the role of chanceThree-quarters of participants disagreed with the pausing of fertility treatments. Women who participated from October-December 2020, when the incidence rate was high, were as likely to disagree as participants that participated from June-September 2020 (73% vs 79%, p = 0.3). Nearly all participants (95%) were concerned that treatment delays would reduce their chances of pregnancy. 72 participants (29%) had their appointments cancelled. Nearly all (97%) reported being upset by this, with 40 (56%) reporting that they were extremely or very disappointed about the cancellation. Women coming for follow-up appointments and women who had to wait 10 weeks or longer were more likely to be upset by the postponement or cancellation of their appointment (p = 0.016 and p = 0.012, respectively).Nearly all (97%) of the participants were worried about possible negative effects a SARS-CoV–2 infection might have related to their fertility, pregnancy or unborn child. Sixty-one percent stated they were very or moderately concerned about the negative influence the infection might have on the womańs own health during pregnancy and 60% were very to moderately concerned about potential negative effects for the unborn child. However, only 26% reported they were very or moderately concerned about the potential negative effects of an infection on fertility.Limitations, reasons for cautionThe main limitations of this study are the possibility of selection bias as people with strong opinions are more likely to have participated and the lack of information on non-responders due to the study design. Also, the Covid–19 pandemic is evolving continuously meaning that participantś opinions may vary over time.Wider implications of the findings: Postponement of treatments increased distress among patients and should be avoided when possible. If unavoidable, follow-up patients should be prioritised for treatment and the length of postponement should be minimised. Fertility clinics must provide information about the current state of knowledge of SARS-Cov–2 infections in pregnancies and options for immunization.Trial registration numberNot applicable

Clinical Background and Detection of Chlamydia trachomatis Antigen among Infertile Women Attending University of Maiduguri Teaching Hospital, Nigeria

Background: Chlamydia trachomatis infection is an established cause of pelvic inflammatory disease (PID), ectopic pregnancy, chronic pelvic pain and infertility among women. It is the most common bacterial sexually transmitted disease in the world. The infection is largely asymptomatic.
 Aim: The study was carried out to determine the Clinical background as well as detect the Chlamydia trachomatis antigen among infertile women attending University of Maiduguri Teaching Hospital (UMTH).
 Methods: A survey on the Clinical background and antigens to Chlamydia trachomatis was carried out among infertile and post natal women attending fertility Clinic UMTH. A total of 65 endocervical swab samples were collected from the aforementioned group of subjects within the age of 18-47 years, out of which 45 were collected from infertile women while the remaining 20 were obtained from post-natal women to serve as control subjects. The samples were analysed by using Chlamydia Rapid Test device swab/urine (Abon Biopharm(Hangzhou), Co., Ltd) that work on the principle of immunochromatographic technique.
 Results: Highest number of infertility was observed on women within the age of 30-35 years (33.3%). The result shows that those that attained tertiary educational level have the highest number of infertility (60%). The study demonstrated highest number of infertility among female civil servants (53.3%) followed by full-time house wife (33.3%). More infertility was observed among women who are not engaged in the use of contraceptive measures (95.6%). The overall result from this study shows no prevalence (0.0%) of C. trachomatis genital infection among infertile women in UMTH.
 Conclusion: Further research using more sensitive and specific procedures for the detection of C. trachomatis from clinical specimens such as nucleic acid amplification tests and cell culture are recommended among infertile women in Borno State, Nigeria.

Impact of Age on Hormonal Profiles of Sub-Fertile Women Attending Fertility Clinic in Umuahia, Abia State, South Eastern Nigeria

Aim: This study evaluated the impact of age on the hormonal profiles of women diagnosed with infertility in a Fertility Clinic in Abia State, South-East, Nigeria. Methodology: Subjects comprised of 200 females: 150 subjects and 50 controls, aged < 20 and up to 49 years, stratified into age < 20 years (control), age 20 - 29 years (group 1), age 30 - 39 years (group 2) and age 40 - 49 years (group 3). About 5 ml of blood samples for anti-Mullerian, follicle stimulating, luteinizing, estradiol, and prolactin hormones determinations were collected on day 2 - 3 of spontaneous menstrual cycle from all groups and control and analyzed using enzyme-linked immunosorbent assay. The FSH/LH ratio of all groups was also calculated. The data were analyzed statistically and values considered significant at p < 0.05. Result: The means ± SEM of serum anti-Mullerian hormones were 1602.44 ± 54.42 pg/ml (control), 848.06 ± 23.04 pg/ml (group 1), 26.74 ± 1.28 pg/ml (group 2), 10.37 ± 1.26 pg/ml (group 3) values for follicle stimulating hormone in the control subjects was 4.90 ± 0.22 mIU/ml, 12.59 ± 0.79 mIU/ml (group 1), 30.59 ± 1.31 mIU/ml (group 2), and 41.59 ± 1.59 miU/ml (group 3). Similarly, the mean ± SEM of luteinizing hormone of control, group 1, group 2 and group 3 were 5.01 ± 0.22 mIU/ml, 15.02 ± 1.13 mIU/ml, 42.71 ± 1.82 mIU/ml and 58.22 ± 2.62 mIU/ml respectively while for estadiol the values were 63.16 ± 1.95 pg/ml, 94.10 ± 5.56 pg/ml, 58.84 ± 4.01 pg/ml and 36.7 ± 1.59 pg/ml for control, group 1, group 2 and group 3 respectively. The mean ± SEM of FSH/LH ratio for the control and experimental subjects were 0.98 ± 0.01, 0.89 ± 0.02, 0.74 ± 0.03 and 0.75 ± 0.02 for control, group 1, group 2 and group 3 respectively. The comparison of the means showed significant difference (p < 0.0001). The hormonal parameters were also positively and negatively correlated amongst each. Conclusion: The evaluation of levels of the hormonal parameters across the age ranges of the population studied shows that women within the control and experimental group 1 (<20 years and 20 - 29 years) have a better chance of achieving pregnancy naturally.

Perceived Barriers of Child Adoption: A Qualitative Study among Women with Infertility in Northern Ghana.

Background Having a child is important among married women in Northern Ghana. Among married women, infertility is the main factor causing childlessness. Child adoption provides an alternative for married women to have children. The purpose of the study was to explore the perceived barriers of child adoption among women with infertility. Methods The study used an exploratory qualitative approach to understand barriers of child adoption. The study was conducted among 15 women attending fertility clinic in a mission hospital in Northern Ghana. Participants were purposively recruited and data collected by individual face-to-face in-depth interviews. The interviews were audio-recorded, transcribed, and analysed using content analysis. Data were collected between January and March, 2016, in an office in the hospital. Results The results suggest that barriers of child adoption include negative reaction of husbands, psychological dissatisfaction, and family dynamics. It was realised that husbands' reaction includes preference for biological children and marrying of second wives. Child adoption was psychologically dissatisfying to participants with some suggesting that it will make no difference and is a sign of acceptance of defeat in the quest to have biological children. The study findings also suggested that family dynamics that could hinder the practice of child adoption includes high value for blood relations, blaming of the woman, unpredictable family influence, discrimination against the adopted child, and family not allowing the adopted child to inherit property. Conclusion The preference for biological children is by far an outstanding barrier and a major influence of all the emanating barriers associated with child adoption. There is the need for public education and special counselling session for husbands and other family members on child adoption as an alternative solution for infertility.

Relationship of maximum follicular size, age of woman, and reproductive implications in women attending fertility clinic in St. Margaret's Hospital, Lokoja, using Creighton Model FertilityCare™ System and NaProTECHNOLOGY

Background: Some authorities have found that, when the mean follicular diameter is >25 mm, the follicle is considered large, and these authorities are convinced that large follicles are biomarkers to ovarian pathology. Several studies have been carried out to determine the optimal maximum follicular size (MFS) that will be adequate before the use of human chorionic gonadotropin trigger to induce ovulation. None of these studies have considered the woman's age as a factor. An in vitro fertilization-based study has also shown that large leading follicles did not result in higher percentage of matured oocytes, and they even result in a lower live birth rate; however, we note that the ages of the women were not specifically mentioned in connection with the problems of large follicle. Subjects and Methods: We set out in this study to evaluate the relationship between the MFS and the woman's age both in our control group (fertile women) Group (A) and in the women attending fertility clinic Group (B). Using the Creighton Model Fertility Care System and NaProTECHNOLOGY, it was possible to determine when to start follicular tracking and also determine ultrasound diagnosis of ovulation by recording the MFS and the reduced size. Results: In both Group A and Group B, we discovered that the MFS reduces as woman's age increases. We also discovered that the average MFS in the Group B was higher for age compared with the Group A (P = 0.0043). There was also an association between these bigger follicles for age and low mid-luteal progesterone. This is probably the first study that describes the association of follicular size and woman's age and its possible link with ovulation defects. Recommendation: We have proposed that this phenomenon of large matured maximum follicle for age could be a contributory factor to infertility and miscarriages. We propose further studies to verify this hypothesis. Conclusion: Despite the high percentage of complete rupturing of follicles in the AB cycles in the Group (B) there are very high proportion having low mid luteal (P+7) Progesterone. This may be due to pathologies associated with big follicles for woman's age. The E2/Pg ratio study in luteal phase strongly suggested that the women in Group (B) that may have fertility challenge are those in subgroup of AB in Group (B). Therefore matured follicular size should be considered with the woman's age. If the follicles grows bigger away from the range for a woman's age it may be the marker for infertility or reproductive health challenges.

Is the likelihood of spousal violence lower or higher among childless women? Evidence from Nigeria demographic and health surveys

BackgroundFew studies have been able to determine whether the likelihood of spousal violence is higher or lower among childless women compared with women who have children. This is because most studies linking childlessness and spousal violence were either qualitative or were conducted among childless women attending fertility clinics. In the fewer quantitative studies that linked childlessness and spousal violence, results are mixed and yet to be verified in Nigeria using nationally representative sample data. The current study addresses this knowledge gap by raising the research question: is the likelihood of spousal violence lower or higher among childless women?MethodsThe study analysed data from 2008 and 2013 Nigeria Demographic and Health Surveys. Only women aged 35–49 years are included in the analysis. The outcome variable was spousal violence, while the key explanatory variable was parity status categorised into childless, have only one child, and have two or more children. Selected individual-level and community-level variables were included as additional explanatory variables. The multilevel mixed-effects logistic regression analysis was applied in four nested models using Stata 12.ResultsIn Model 1, result show 57% more likelihood of spousal violence among women who have two or more children compared with childless women (OR = 1.570: CI: 1.074–2.294). In Model 2, women who have two or more children were 52.3% more likely to experience spousal violence compared with childless women (OR = 1.523; CI: 1.037–2.247). In Model 3, the likelihood of spousal violence was 67.2% higher among women who have two or more children compared with childless women (OR = 1.672; CI: 1.140–2.452). In the full model, women who have two or more children were 50.8% more likely to experience spousal violence compared with childless women (OR = 1.508; CI: 1.077–2.234). The Intra-Class Correlation (ICC) provides evidence to support community contributions to prevalence of spousal violence.ConclusionsThe likelihood of spousal violence is lower among childless women in Nigeria. Causes of spousal violence against women cut across individual, family, and community characteristics irrespective of childlessness or number of children. Current Behaviour Change Communication should be strengthened by adequate enforcement of the newly enacted Violence Against Persons (Prohibition) Act of 2015.

Role of IgG Chlamydia antibody in predicting tubal factor infertility

Background and Objectives: Infertility is not a health problem, but a serious psychological trauma that affects the social status of women in the society. Treatment of infertility imposes a heavy economic burden on the family. Infertility can be due to a single or combination of causes and identification of the cause is essential for the proper management. Chlamydia trachomatis is one of the most common causes of tubal factor infertility. No recent study has been done in Kerala to assess the burden of C. trachomatis in genitourinary infections. The aim of the study was to assess the role of C. trachomatis IgG antibody in patients with tubal factor infertility among women with primary or secondary infertility attending the fertility clinic in a tertiary care hospital in Kerala. Materials and Methods: The study was done for one year and the sample size included 95 cases and 63 age-matched controls. Tubal disease was diagnosed by laparoscopy or hysterosalpingography. Serum samples of all the patients and controls were tested for C. trachomatis IgG antibodies by enzyme-linked immunosorbent assay. Results: Of the 95 patients with tubal pathology, 14 (14.7%) had antibodies to C. trachomatis. Of the 63 patients with normal tubes, 12 (19%) had antibodies. However, of the 26 patients who were positive for Chlamydia antibodies, 14 (53.8%) had tubal disease. Conclusions: The prevalence of Chlamydia IgG in our study among women attending fertility clinic for the treatment of primary or secondary infertility is 26/158 (16.5%). Fifty-one (81%) patients had normal tubes.

The experiences of women with polycystic ovary syndrome on a very low-calorie diet.

Polycystic ovary syndrome (PCOS) is variously reported to affect between 5% and 26% of reproductive age women in the UK and accounts for up to 75% of women attending fertility clinics due to anovulation. The first-line treatment option for overweight/obese women with PCOS is diet and lifestyle interventions. However, optimal dietary guidelines are missing, with very little research having been done in this area. This paper presents the findings from a qualitative study (using semistructured interviews) of ten obese women who had PCOS and who had used LighterLife Total (LLT), a commercial weight loss program which utilizes a very low-calorie diet in conjunction with behavioral change therapy underpinned by group support. We investigated the women’s history of obesity, their experiences of other diets compared with LLT, and the on-going impact that this has had on their lives. Findings show that most women reported greater success using this weight loss program in terms of achieving and maintaining weight loss when compared with other diets. Furthermore, all the women nominated LLT as their model weight loss intervention with only a few modifications.

GnRH agonist trigger and a freeze-all strategy to prevent ovarian hyperstimulation syndrome: a retrospective study of OHSS risk and pregnancy rates.

To analyse the data from all controlled ovarian hyperstimulation antagonist cycles that used an agonist trigger and a freeze-all strategy to quantify the risk of ovarian hyperstimulation syndrome (OHSS) and subsequent pregnancy rates. A retrospective study of all women attending fertility clinics at IVF Australia, Sydney, undergoing controlled ovarian hyperstimulation (COH) using an antagonist protocol that had a subsequent gonadotropin-releasing hormone (GnRH) agonist trigger and freezing of all oocytes or embryos. The primary outcome measure was to determine the rate of OHSS. The secondary outcome measure was the clinical pregnancy rate. We collected data for 123 women. 25.2% were undergoing oocyte freezing and 74.8% underwent embryo freezing. There were no cases of OHSS, either early or late onset. The pregnancy rate was 31.7% after the first frozen cycle transfer with a cumulative pregnancy rate of 50% after two frozen embryo transfers. Our results support the hypothesis that a GnRH agonist trigger and a freeze-all approach prevents OHSS with a good pregnancy rate.

Assisted reproductive technology results: why are live-birth percentages so low?

The present bioessay aims to analyze the impact of parental age, cause of infertility, embryo chromosomal anomalies, assisted reproduction technology (ART) treatments, and environmental and occupational exposures to xenobiotics on ART results, particularly on live-birth percentages per transfer. Special attention is paid to analyzing the effects of these factors on the mitochondrial, genetic, and epigenetic traits of gametes and embryos to ascertain the molecular/cellular mechanisms responsible for the relatively low percentages of live births reported year after year in ART cycles. The bias of age distribution of women attending fertility clinics toward the late thirties and beyond and the high incidence of mosaicism found in pre-implantation embryos emerge as the two biggest players in this scenario. Parental reproductive aging and some causes of infertility are associated with mitochondrial, genetic, and epigenetic alterations to gametes. ART treatments such as ovarian stimulation, gamete/embryo cryopreservation, oocyte in vitro maturation, intracytoplasmic sperm injection, in vitro culture system, and embryo biopsy may also induce epigenetic changes in gametes and/or pre-implantation embryos. Finally, exposure to numerous environmental chemicals is linked to sperm genetic and epigenetic defects. Whereas the selective transfer of euploid blastocysts may improve implantation and pregnancy percentages, especially in reproductively older women, it does not guarantee the total absence of mitochondrial and/or epigenetic defects in embryos. The presence of induced and/or inherited DNA epigenetic disturbances in ART offspring is unlikely to be prevented, even by replacing the whole cytoplasm of oocytes using nuclear-genome-transfer technology.

Prevalence of Infertility and Acceptability of Assisted Reproductive Technology among Women Attending Gynecology Clinics in Tertiary Institutions in Southwestern Nigeria

This study is aimed to assess the level of awareness and perceptions of Assisted Reproductive Technology among women attending fertility clinics in Osun State South West Nigeria. A total of 257 women attending gynecology clinics in Osun State teaching hospitals (LAUTECH and OAU Teaching Hospitals) were recruited through systematic sampling technique, using a pre-tested, semi-structured, interviewer administered questionnaire. Only 46% of the respondents were aware of ART. About 73.5% of those that were aware would opt for it. Thirty five point six percent of those who rejected IVF claimed that the cost was high, 31.1% of them believed that only God gives babies while 18.9% of was the opinion that the procedure may fail. 25.6% believed ART babies are artificial babies. Only 24.3% knew where the services were offered while 16.5% were only aware of the cost. 192(76.8%) has a positive attitude to ART. Duration of infertility, being married and high educational status were the predictors of being aware of ART, giving support for ART and opting for ART as a solution to the problem of infertility. There was a low awareness about ART and educational status influenced level of awareness. There is need to put in more efforts in spreading the knowledge of in-vitro fertilization in developing countries like Nigeria. Efforts should be made to make the procedure more affordable and accessible.

Acceptability of child adoption in the management of infertility: A survey of women attending fertility clinics in the tertiary facilities in Lagos

Introduction: Infertility is a major social problem with public health relevance in developing countries, with prevalence levels up to 30%. In contrast, the available treatment options for infertile couples are limited. Most times, the cost of this treatment is far beyond the reach of the common man and the success rates recorded with these treatments are minimal. This study was carried out to determine the knowledge, attitude, and practice of child adoption among infertile women attending fertility clinics in the public health facilities in Lagos, and to identify factors that may influence the willingness to adopt among these women. Materials and Methods: A descriptive cross-sectional study was conducted in the three government-owned tertiary fertility clinics in Lagos (namely the Lagos University Teaching Hospital (LUTH), the Lagos State University Teaching Hospital (LASUTH), and the Federal Medical Center (FMC) Ebute-Metta) among 355 infertile women attending these clinics. Results: The majority of the respondents (90.1%) had heard of child adoption before and 28.7% of them had a good knowledge of the processes and legalities involved in child adoption. Almost two-thirds (63.7%) expressed their willingness to adopt, while 58.6% of the respondents felt that an adopted child could never be compared to a biological child. Factors that were significantly associated with the attitude toward child adoption included the level of education of the respondent, their religion, marital status, knowledge of child adoption, and duration of infertility (P < 0.05). Discussion: The high level of willingness to adopt in contrast to the low level of practice among infertile women in Lagos indicates the scope for advocacy and public enlightenment to integrate adoption into the arsenal of management of infertility.