Women Seeking Infertility Treatment Research Articles

Exploring depressive symptoms and coping strategies in Chinese women facing infertility: A cross-sectional observational study.

Infertility can lead to significant psychological distress among women, yet the roles of hope and resilience in mitigating depressive symptoms remain inadequately explored, particularly within the Chinese context. We performed a cross-sectional observational study to investigate the psychological impacts of infertility among Chinese women as well as to discern whether hope and resilience can influence their depressive symptoms. We recruited 364 Chinese women seeking infertility treatment in the Shandong region. Participants completed validated assessments including the Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale, and Herth Hope Index. Demographic and clinical data were also collected. We observed elevated levels of depressive symptoms and anxiety among women with infertility. Particularly, demographic factors such as an older age, rural residence, lower income, lower education, adverse life events, and longer infertility duration were associated with increased depressive symptoms. Individuals who experienced adverse life events were at a 2.42-fold increased risk of developing depressive symptoms (P = .04). Depressive symptoms were inversely correlated with both hope levels (r = -0.25; P < .05) and resilience levels (r = -0.32; P < .05). Hope levels were positively correlated with resilience (R = 0.67; P < .05). After controlling for the interaction of hope and resilience, we found that only depressive symptoms and resilience were negatively correlated. The psychological burden of infertility among Chinese women is widespread and affects many individuals from different demographic backgrounds. Interventions aimed at increasing resilience may be helpful to mitigate depressive symptoms.

Effect of intraovarian platelet-rich plasma injection on IVF outcomes in women with poor ovarian response: the PROVA randomized controlled trial.

Does intraovarian platelet-rich plasma (PRP) injection increase the number of mature oocytes obtained after controlled ovarian stimulation (COS) in young women with poor ovarian response (POR) undergoing IVF? Intraovarian PRP injection procedure does not improve mature oocyte yield after COS in women less than 38 years old with an established IVF history of POR. POR is frequently encountered among the infertile population and the number of women seeking infertility treatment related to POR is increasing. Effective treatment options for this patient population to conceive with autologous oocytes are lacking. Case series and cohort studies suggest that intraovarian PRP injection may improve follicular recruitment in women with premature ovarian insufficiency (POI) and POR, yet robust randomized studies have not been performed to date to determine the clinical utility of this intervention. This was a multi-center randomized controlled trial (RCT) conducted at university-affiliated reproductive centers in the USA and Turkey, between January 2020 and November 2022. Patients who met inclusion criteria (<38 years old, two or more prior cycles with <3 oocytes retrieved; and without single gene disorders, prior ovarian surgery, endometriomas, BMI >35 kg/m2, or severe male factor infertility) were randomized to either the PRP or control group. Patients in both groups subsequently underwent COS, oocyte retrieval, ICSI, preimplantation genetic testing for aneuploidy (PGT-A), and single euploid embryo transfer. Number of metaphase II (MII) oocytes obtained was the primary outcome. Secondary outcomes included ovarian reserve tests (antral follicle count [AFC] and anti-Müllerian hormone [AMH]), blastocyst and euploid blastocyst yields, and sustained implantation. The study was powered to detect a difference of one mature oocyte obtained at oocyte retrieval. In total, 83 patients met inclusion criteria and were randomized to receive autologous intraovarian PRP injection (n = 41) or to no intervention (n = 42). No significant differences were observed in number of MII oocytes retrieved per cycle (2.8 ± 2.4 vs 3.1 ± 3.3 in PRP vs control, respectively; P = 0.9), blastocysts (1.0 ± 1.3 vs 1.3 ± 2.1, P = 0.8), or euploid blastocysts (0.8 ± 1.1 vs 0.9 ± 1.6; P = 0.5). Similarly, no differences were observed in the likelihood of obtaining at least one euploid blastocyst (45% vs 37%, P = 0.4; relative risk [RR], 95% CI = 0.9, 0.6-1.2) or the rate of sustained implantation (31% vs 29%, P = 0.9; RR 1.0, 0.7-1.3). Posttreatment AFC (7.9 ± 4.5 vs 6.8 ± 4.8, P = 0.3) and AMH (0.99 ± 0.98 vs 0.7 ± 0.6, P = 0.2) were also not different between the groups. Results from this RCT may not be generalizable to other PRP preparations owing to heterogeneity and lack of standardization. The control groups did not undergo a sham ovarian injection, which would have been relevant had the results shown benefit of PRP injection. Only patients with POR were included in this study, and these results may not be generalizable to more severe diminution of ovarian reserve, as seen with POI. The intraovarian PRP injection procedure does not improve mature oocyte yield or other parameters of IVF outcome in women less than 38 years old with an established IVF history of POR. The results from this study do not support the use of intraovarian PRP injection in this population. Departmental funds were used and no external funding was requested for this study. ES is a consultant for and receives grant funding from the Foundation for Embryonic Competence. All other authors have no conflict of interest to declare. Clinicaltrials.gov Registry Identifier: NCT04163640. 15 November 2019. 24 February 2020.

Anxiety, Depression, and Quality of Life Among Infertile Women: A Case-Control Study.

Introduction Pregnancy holds significant cultural and social value for women. However, women facing challenges in conceiving often grapple with emotional distress, including depression and anxiety. The connection between psychological elements (stress, anxiety, and depression) and infertility is complex, influenced by multiple factors, and bidirectional. Infertile women are more likely to develop mental illnesses, marital dissatisfaction, and impaired quality of life compared to the individuals of the fertile group. Thus, the study aimed to assess levels of anxiety, depression, and quality of life among infertile women compared to fertile women. Methods This case-control study conducted at a tertiary care center recruited 100 nulliparous women between the age group of 20 and 38 years with primary or secondary infertility, while those with male factor infertility were excluded. The control group (N=100) comprised normal parous women who had at least one child. The primary objective of the study was to assess the impact of infertility on the mental health and quality of life of women seeking infertility treatment. Outcome measures included standardized tools such as the WHOQOL-BREF questionnaire to assess the quality of life across multiple domains (e.g., physical, psychological, social, and environmental) as well as the Depression Anxiety and Stress Scale (DASS-21) to measure levels of anxiety, depression, and stress. Cronbach's alpha was used to measure the tool's reliability. A P value of <0.05 was considered statistically significant. Results Baseline sociodemographic parameters were comparable between the two groups. The mean age of infertile women was 30.6±3.9 years compared to 31.5±3.2 years in fertile women (P=0.076). Using the WHOQOL-BREF scale, we found that the quality of life was better in the fertile group compared to the infertile group through all the physical, psychological, social, and environmental domains (P<0.001). The infertile group had a significantly higher number of women with anxiety, depression, and stress. The questionnaires showed high internal reliability. Conclusion Infertile women experienced a lower quality of life in various domains, higher levels of anxiety, and increased rates of depression compared to fertile counterparts. The study findings underscore the multidimensional impact of infertility, emphasizing the need for comprehensive healthcare approaches to address the psychosocial challenges faced by women undergoing infertility treatment.

(184) The Prevalence of Sexual Dysfunction in Women Seeking Infertility Treatment in Vietnam

Abstract Introduction Sexual function plays a crucial role in women's psychosocial and overall well-being, significantly impacting their quality of life. Any decline in sexual function can have detrimental effects on the affected individuals' quality of life Objective (i) To describe the prevalence of sexual dysfunction in women seeking infertility treatment at the Andrology and Fertility Hospital of Hanoi, Viet Nam, and (ii) to analyze the factors associated with sexual dysfunction in the study population. Methods This was a cross-sectional descriptive study. All women (1.039) seeking infertility treatment at the Andrology and Fertility Hospital from December 30, 2022, to March 30, 2023 participate in the study. They were invited to scan a QR code and complete the research questionnaire. Female sexual dysfunction is assessed based on the FSFI scale included six domains: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain (comprising 19 questions). The data were extracted into Excel, cleaned, and analyzed using STATA 17.0 software. The analysis of factors associated with female sexual dysfunction was conducted using logistic regression models. Results Among the 1039 participants in the study, the mean age was 30.9±5.3 years. The overall score for female sexual dysfunction was 25.09 ± 6.20, with individual component scores. The prevalence of female sexual dysfunction was 49.7%. There is a positive correlation among the six components of female sexual dysfunction, p&amp;lt;0.01. In the multivariate regression model, the risk of female sexual dysfunction is higher among individuals who work away from home, have an underweight body mass index, have a poor relationship with their partner, have had no sexual intercourse in the past 4 weeks, experience fear of pain, anxiety, and body image concerns during sexual activity, have infrequent or no discussions with their partner regarding sexual desires, preferred positions, and stimulation, and are dissatisfied with their sexual life. Conclusions Half of the women seeking infertility in late-stage medical care experience sexual dysfunction. Factors that increase the risk of sexual dysfunction include having a job far from home, being underweight based on body mass index, having a poor overall relationship with a partner, not engaging in sexual activity in the past four weeks, fear of pain, anxiety, body image concerns during sexual intercourse, and limited or lack of communication with a partner about sexual issues such as desires, preferred positions, and stimulation. Additionally, dissatisfaction with one's sexual life contributes to the occurrence of sexual dysfunction. Therefore, early screening and timely intervention are necessary for this group of individuals. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Andrology and Fertility Hospital of Hanoi.

Risk factors for infertility and barriers to treatment in Tanzania: a survey and medical records study.

The burden of infertility is serious for women in high-fertility countries. We sought to identify demographic, behavioral/environmental, and reproductive risk factors for various infertility factors (i.e., ovarian, tubal, uterine/cervical, male/other) among women seeking infertility treatment in central Tanzania; to determine the association between pelvic inflammatory disease (PID) and tubal factor infertility (TFI); and to identify barriers to infertility treatment by women's home regional zone. We conducted a cross-sectional survey of women seeking infertility treatment in Dodoma, Tanzania from January-March 2020. We surveyed 168 participants aged 18-49 years and reviewed their medical records to confirm infertility status and potential risk factors. We estimated prevalence ratios for factors associated with infertility using logistic regression. Treatment barriers were compared by women's regional zone to see if barriers varied geographically. The median age of participants was 32 years (range: 18-48). Infertility factors did not vary greatly by patient demographics, behavioral/environmental, or reproductive risk factors. Approximately 31.48% of women had PID diagnoses. Those with PID had 1.94 (95% CI: 1.30, 2.90) times the prevalence of TFI diagnosis as those with other infertility factors, after adjusting for age, pesticide use, alcohol use, age at sexual debut, prior obstetric events, and family history of infertility. Logistical barriers to treatment, such as time and cost, were more frequently reported than emotional, stigma, or other barriers, regardless of regional zone. PID was strongly associated with TFI after adjustment for confounders. Infertility treatment access due to cost remains a challenge in Tanzania.

P-585 Iron intake in relation to ovarian reserve among women seeking infertility treatment

Abstract Study question Is there an association between iron intake and ovarian reserve among women seeking fertility care? Summary answer Supplemental iron intake above 45mg/d is associated with lower ovarian reserve among women seeking fertility care. What is known already Although the literature regarding iron intake in relation to ovarian reserve is scant and inconsistent, some evidence suggest that iron may have gonadotoxic effects. Study design, size, duration Observational study including 582 female participants attending the Massachusetts General Hospital Fertility Center (2007–2019) enrolled in the Environment and Reproductive Health (EARTH) Study Participants/materials, setting, methods Iron intake was estimated using a validated food frequency questionnaire (FFQ). Markers of ovarian reserve included antral follicle count (AFC) (assessed via transvaginal ultrasound) and day 3 FSH, both obtained during the course of infertility evaluation. The association between iron intake and ovarian reserve was evaluated using Poisson regression models for AFC and quantile regression models for day 3 FSH adjusted for age, menstrual cycle characteristics, physical activity, carbohydrate intake and total energy intake. Main results and the role of chance Participants had a median age of 35 years and median total iron intake of 29 mg/d. Total iron intake was inversely related to AFC and this association was driven by intake of supplemental iron. Compared to women with a supplemental iron intake ≤20mg/day, women consuming 45-64mg/d of supplemental iron had a 17% (-35%, 0.3%) lower AFC and women consuming ≥65mg/d of supplemental iron had a 32% (-54%, -11%) lower AFC after adjusting for potential confounders (p, linear trend=0.003). Similarly, in multivariable-adjusted analysis, day 3 FSH levels were 0.9 (0.5, 1.3) IU/mL higher among women with a supplemental iron intake ≥65mg/d when compared to women with a supplemental iron intake ≤20mg/d (p, linear trend=0.02). Limitations, reasons for caution Iron intake was estimated using a method that relies on self-report and we had no biomarkers of iron status in our participants. Also, only 36 women consumed ≥45mg/d of supplemental iron. Wider implications of the findings Since all study participants were seeking fertility treatment, our findings may not apply to women in the general population. Although our findings are consistent with studies of women with iron overload, given the paucity of literature on this topic it is essential that this question is revisited in future studies. Trial registration number Not applicable, not a randomized trial

Level of Stress and Perceived Social Support among Women Seeking Infertility Treatment: An Exploratory Study

Infertility is frequently a secret battle, and depressive symptoms are more common in infertility patients than in cancer patients. Around 60–80 million couples worldwide have infertility, which has a wide range of effects on many different dimensions. Despite this, it is progressive in nature. Traditional conceptions of reproductive awareness included understanding of female anatomy and physiology and how it relates to family planning, as well as the possibility that couples might be somewhat exposed to the causes of infertility. The present study aims to assess the level of stress and perceived social support among women seeking infertility treatment. A quantitative approach with exploratory design was used to conduct the study at selected infertility clinic, Saveetha Medical College &amp;Hospital with the sample size of 60 using non probability purposive sampling technique. The demographic and clinical variables of the women were collected by semi-structured questionnaire. The perceived stress scale “BDI” was used to evaluate the level of stress the and Multidimensional scale of perceived social support “MSPSS” was used for determination of perceived social support. The results the study revealed that the mean score of stress among women seeking infertility treatment was 20.97±6.85 and the mean score of perceived social support was 3.72±1.43. The Correlation value of r = -0.447 shows a mild negative correlation which was found to be statistically significant at p&lt;0.05 level. This clearly infers that when the perceived social support among women seeking infertility treatment increases their stress level decreases. Although the infertility clinic has formal requirements for psychological counseling for infertility patients, there is acknowledgement that incorporating psychological interventions into routine practice at ART clinics is beneficial.

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).

O-229 To remove or not to remove - debate continues

Abstract Fibroids and Fertility - To remove or not to remove debate continues Uterine fibroids (leiomyomas or myomas) are the most common benign pelvic tumors in reproductive age women. Fibroids are increasingly found in women seeking infertility treatment because of longer reproductive timeline &amp; current trend to postpone childbearing. Fibroids adversely affect the female fertility by distortion of uterine cavity, thinning of endometrium, reduced blood supply in endometrium &amp; myometrium, increased contractility of uterus and hormonal changes. Fibroids also exert global effect on endometrial receptivity through molecular signaling. Women with submucosal myomas experience significantly lower implantation, clinical pregnancy, ongoing pregnancy, and live birth rates, and higher miscarriage rates. The need and effect of myomectomy on submucous myoma is acknowledged in literature. Subserosal fibroids, do not affect fertility and removal is not advisable prior to IVF. There is heterogenicity in the studies reporting the effect of intramural fibroids on fertility. Some have reported an association between intramural fibroids and reduced chance of pregnancy and increased rates of early pregnancy loss. The effect of fibroids which are in close proximity to the endometrium &amp; are 100% intramural (FIGO type 3 and 4) on fertility has been investigated by many researchers. The endometrial cavity may not be distorted by these fibroids, yet they can affect fertility because of their proximity to the uterine cavity. Studies have shown that both size of the fibroid and distance of fibroid from endometrial cavity are important factors, which determine the effect of intramural fibroids on fertility. The production of transforming growth factor beta-3b (TGF- b3), is increased as size of the fibroid increases and impairs the endometrial receptivity. Fibroids causing menorrhagia are likely to affect endometrial receptivity. In women with infertility, an effort should be made to adequately evaluate and classify fibroids, particularly those impinging on the endometrial cavity, using transvaginal ultrasound, hysteroscopy, hysterosonography, or magnetic resonance imaging. (Evidence III-A) Submucosal fibroids are managed hysteroscopically. The fibroid size should be &amp;lt; 5 cm, although larger fibroids have been managed hysteroscopically, but repeat procedures are often necessary. ( III-B). In women with otherwise unexplained infertility, submucosal fibroids should be removed in order to improve conception and pregnancy rates. ( II-2A). Removal of subserosal fibroids is not recommended. (III-D). Whether to surgically remove intramural fibroids not distorting the endometrial lining (FIGO types 3–4) for improving fertility in asymptomatic infertile patients has been a subject of debate since long. The studies favoring myomectomy indicate that It is better to perform myomectomy prior to ART cycle women with reduced ovarian reserve, advanced maternal age, recurrent pregnancy loss or previous failed IVF cycles. Decision for a particular approach for myomectomy - via a laparotomy, laparoscopy or hysteroscopy should be based on the size and location of fibroid and experience of surgeon. There is fair evidence to recommend against myomectomy in women with intramural fibroids more than 3–4 cm before ART cycle (hysteroscopically confirmed intact endometrium) and otherwise unexplained infertility, regardless of their size (II-2D). Surgery in patients with intramural fibroids presenting with infertility, should be considered to be a risky procedure, not only because of the limited evidence of the efficacy of myomectomy on reproductive outcomes but also because of the potential for several surgery-related complications. We need to investigate other modalities such as uterine artery embolization and magnetic resonance-guided focused ultrasound. The observed lack of consensus regarding recommendations for myomectomy in case of infertile patients with intramural fibroid is mainly because of heterogenicity of the studies. The decision to perform myomectomy on intramural fibroids should be individualized (III-C)

Comparison of Efficacy Between Vaginal Sildenafil and Granulocyte-Colony Stimulating Factor (G-CSF) in Improving Endometrial Thickness (ET) in Infertile Women.

BackgroundInfertility is presently an emanating preventive medicine issue with some severe societal repercussions associated with it. In India, approximately a score percent of couples bear the burden of infertility. Moreover, the declining fertility rates despite effective artificial reproductive techniques and increasing development of modern reproductive medicine from the last two censuses pose an alarm to the demographic progression data. Many studies have highlighted the importance of shifting the research focus to endometrial receptivity for increasing clinical pregnancy. Objective This research aims to compare the efficacy of treatments of vaginal sildenafil citrate and granulocyte-colony stimulating factor (G-CSF) intrauterine injection in increasing endometrial thickness (ET).Methodology This was a randomized control trial (RCT) conducted over a two months period. Women seeking infertility treatment were recruited from the hospital's gynecological outpatient department (OPD). After the subjects gave informed consent, their history, clinical examination, and investigations were assessed. From the sixth day of the menstrual cycle, group A and group B had serial trans-vaginal ultra-sonographic evaluations for baseline endometrial thickness measurements. From day six to day 12 of the menstrual cycle, patients of group A were requested to self-administer per vaginal sildenafil citrate 25 mg every six hours. ET was evaluated sonographically on day 12 and day 14 of their menstrual cycle. Patients of group B received G-CSF 300 mcg/ml as intrauterine instillation on day 10 and were evaluated sonographically on day 12 and day 14 of their menstrual cycle. Patients then underwent additional therapy in the form of intrauterine injection (IUI), intracytoplasmic sperm injection with/without embryo transfer (ICSI/ET), or a natural cycle. Paired as well as unpaired t-tests were applied to the study groups to detect significant differences in the measurement of endometrial thickness before and after treatment.ResultsIt was noticed that both sildenafil and G-CSF are agents for increasing endometrial thickness. The mean increase in endometrial thickness in the sildenafil treated group was 3.87 mm, while the mean increase in endometrial thickness in G-CSF treated group was 3.27 mm.Conclusion This study has evidence of better results in improving endometrial thickness in infertile women by using vaginal sildenafil with respect to endometrial growth with an intrauterine infusion of granulocyte colony-stimulating factor (filgrastim, G-CSF).

In Vivo and In Vitro Matured Oocytes From Mice of Advanced Reproductive Age Exhibit Alternative Splicing Processes for Mitochondrial Oxidative Phosphorylation.

The mean age of women seeking infertility treatment has gradually increased over recent years. This has coincided with the emergence of in vitro maturation (IVM), a method used in assisted reproductive technology for patients with special requirements. However, when compared with conventional in vitro fertilization, IVM is associated with poor embryonic development potential and low live birth rates, thus limiting the widespread application of this technique. In this study, we performed RNA-sequencing transcriptomic assays and identified a total of 2,627 significant differentially expressed genes (DEGs) between IVM oocytes and in vivo matured oocytes from mice of advanced reproductive age. Next, Kyoto Encyclopedia of Genes and Genomes pathway analysis was used to identify the potential functions of the DEGs. The most significantly enriched pathway was oxidative phosphorylation (OXPHOS). In addition, we constructed a protein-protein interaction network to identify key genes and determined that most of the hub genes were mtDNA-encoded subunits of respiratory chain complex I. Antioxidant supplementation lead to an increase in ATP production and reduced the gene expression profile of the OXPHOS pathway in the IVM group. Moreover, alternative splicing (AS) events were identified during in vivo or in vitro oocyte maturation; data showed that skipped exons were the most frequent type of AS event. A number of genes associated with the OXPHOS pathway exhibited alterations in AS events, including Ndufa7, Ndufs7, Cox6a2, Ndufs5, Ndufb1, and Uqcrh. Furthermore, the process of IVO promoted the skipping of exon 2 in Ndufa7 and exon 3 in Ndufs7 compared with the IVM oocytes, as determined by semi−quantitative RT−PCR. Collectively, these findings provide potential new therapeutic targets for improving IVM of aged women who undergo infertility treatment.

THE PSYCHOLOGICAL IMPACT OF THE COVID-19 PANDEMIC ON WOMEN PREGNANT FOLLOWING ART: A LONGITUDINAL STUDY

Longitudinal evaluation of the psychological impact of the COVID-19 pandemic on pregnant women following assisted reproductive technology (ART) and to compare them to women seeking infertility treatment.

Comparing infertility-related stress in high fertility and low fertility countries

We surveyed 169 women seeking infertility treatment in Central Tanzania using an abbreviated version of the Fertility Problem Inventory (FPI) to measure infertility-related stress. We compared our FPI results to similar studies in another high fertility country (Ghana) and in three low fertility countries (the US, Canada, and Italy).Tanzanian women reported higher infertility-related stress than women in low-fertility countries but lower stress than Ghanaian women. Infertility-related stress is a serious concern for women in high-fertility countries, who experience greater pressure to have children. These findings underscore the need for increased access to infertility treatment and addressing community infertility norms.

Factor Structure of the Pittsburgh Sleep Quality Index among Women Undergoing Infertility Treatment: A Confirmatory Factor Analysis

Background and Objective: People that undergo assisted infertility treatments experience more sleep problems. Although Pittsburgh Sleep Quality Index (PSQI) frequently has been used as a sleep quality assessment scale in different clinical and non-clinical settings, different sample characteristics may account for different structures. The current study aimed to evaluate the factor structure of PSQI among women seeking infertility treatment in Iran.&#x0D; Materials and Methods: Using a convenience sampling method, 157 infertile women or women whose husbands had infertility problems were included in a cross-sectional study in Royan Institute, a main referral infertility center in Tehran, Iran. The factor structure of PSQI was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).&#x0D; Results: The Cronbach’s alpha coefficient for PSQI was 0.65. A two-factor model was extracted by EFA; 56% of the total variance was accounted for by this model. The results of CFA indicated that extracted model obtained acceptable fit statistics [comparative fit index (CFI) = 0.942, standardized root mean square residual (SRMR) = 0.042, root mean square error of approximation (RMSEA) = 0.128, χ2 = 19.8, degree of freedom (df) = 12, P = 0.071] compared to other original single-factor or 3-factor models.&#x0D; Conclusion: Our results revealed the limited usefulness of single-factor structure of PSQI. A two-factor model of Persian version of PSQI should be used to assess sleep problems among women seeking assisted infertility treatments.

Anti-Mullerian Hormone Levels in Indian Women Seeking Infertility Treatment: Are Indian Women Facing Early Ovarian Senescence?

Background:Antimullerian hormone (AMH) is a key marker of ovarian reserve and predictor of response to fertility treatment.Aim:To understand the prevalence of low ovarian reserve in Indian women seeking infertility treatment, compare their AMH with age-matched fertile Indian controls and understand ethnic differences with Caucasian women.Setting and Design:Retrospective observational study done as collaboration between our in vitro fertilization centre and a laboratory with Pan-India presence.Materials and Methods:Women aged 20–44 years were selected as Group A (seeking infertility treatment n = 54,473), Group B (conceived naturally in the past; n = 283) and Group C (data of Caucasian women; n = 718). Serum AMH levels were measured and descriptive analysis done.Statistical Analysis:Descriptive statistics and Chi-square test.Results:In Group A, 28.7%, 48.7% and 70.6% of women aged <30 years, 30–34 years and 35–39 years had serum AMH levels ≤2 ng/mL and the proportions were higher than Group B. The rate at which median AMH decreased was 1.1–2 times faster in Group B as compared to Group C. The decrease in median AMH across age groups in Group A was similar to Group B.Conclusions:Indian women in their late twenties and early thirties visiting fertility centers showed a worrisome trend of low AMH. Our study can be used as a reference for those women considering postponing pregnancy. It may be time to look at intangible cultural factors linked to social habits, ethnicity, diet, genetic predispositions, and environmental factors like endocrine disrupting chemicals contributing to premature ovarian senescence.

Predictors of phthalate metabolites in urine and follicular fluid and correlations between urine and follicular fluid phthalate metabolite concentrations among women undergoing in vitro fertilization

BackgroundPhthalate metabolites in follicular fluid (FF) may negatively affect normal folliculogenesis; however, the predictors of phthalate metabolite concentrations in urine and FF and relationships between urine and FF phthalate metabolite concentrations among women undergoing in vitro fertilization (IVF) are poorly understood. ObjectiveTo investigate predictors of phthalate metabolites in urine and FF and correlations between urine and FF phthalate metabolite concentrations among women undergoing IVF. MethodWe recruited 305 women seeking infertility treatment at a reproductive center in Wuhan, China, from October to November 2016. Information regarding demographic characteristics, personal care product use and plastic material contact was obtained through direct interviews. Concentrations of 8 phthalate metabolites in urine and FF samples were measured using high-performance liquid chromatography and tandem mass spectrometry. Associations regarding metabolite concentrations in urine and FF samples were analysed by Spearman's correlation and linear regression. Generalized linear regression was used to examine potential predictors of phthalate metabolite concentrations in urine and FF. ResultsWeak to moderate associations between urine and FF samples were found for monoethyl phthalate (MEP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) (correlation coefficient: MEP, 0.350; MEOHP, 0.377); no associations were observed for other metabolites. The predictive powers of urinary metabolite concentrations in determining FF metabolite concentrations were uniformly low, with R2 ≤ 0.113. Body mass index (BMI) and educational level were inversely associated with the urinary concentrations of certain metabolites. Higher household income, intake of bottled drinks within 48 h, and use of shower gel and soap were frequently associated with higher urinary metabolite concentrations. BMI, higher household income and use of disposable plastic cups within 48 h were associated with higher metabolite concentrations in FF. ConclusionPhthalate metabolite concentrations in urine and FF vary according to sociodemographic characteristics and lifestyle factors. Phthalate metabolite concentrations in urine may not be appropriate for estimating ovary phthalate exposure.

Prevalence and risk factors for domestic violence against infertile women in a Turkish setting

ObjectiveOur objective was to estimate the prevalence and risk factors for domestic violence among women seeking infertility treatment at an IVF center. Study designThis cross-sectional study was conducted with 423 infertile women who referred to the IVF Center in the southwest of Turkey between 1 January and 31 July 2016. The women were interviewed without their male partners by using the questionnaire and Infertile Women’s Exposure to Violence Determination Scale. ResultsA total of 306 participants (72%) declared having experienced domestic violence. It was found that 30% of the women exposed to violence stated that they were subject to physical violence, 6% to sexual violence, 62% to emotional violence, and 19% to economic violence. It was determined that the total mean score obtained by the women exposed to violence from Infertile Women’s Exposure to Violence Determination Scale was 120.04 ± 12.69 and when it was evaluated based on the total mean scores to be obtained from the scale, level of violence experienced by the women was found to be severe. ConclusionsThe rate of exposure to violence was determined to be high in women included in the study. The most common type of domestic violence is psychological violence.

Urinary phthalate metabolites in relation to serum anti-M\xfcllerian hormone and inhibin B levels among women from a fertility center: a retrospective analysis

BackgroundPhthalates, a class of endocrine disruptors, have been demonstrated to accelerate loss of ovarian follicle pool via disrupting folliculogenesis, and lead to diminished ovarian reserve. However, human data are limited. Here, we aimed to examine whether urinary phthalate metabolites are correlated with markers of ovarian reserve among women attending a fertility clinic.MethodsWe measured eight phthalate metabolites in urine samples collected from 415 women seeking infertility treatment at the Reproductive Medicine Center of Tongji Hospital, Wuhan, China. Data on measures of ovarian reserve, as indicated by serum anti-Müllerian hormone (AMH) and inhibin B (INHB) levels, were retrieved retrospectively through electronic medical charts. Multivariate linear models were performed to estimate the associations of urinary phthalate metabolites and serum AMH and INHB. We further explored the potential nonlinearity of the relationships with restricted cubic spline analysis.ResultsOverall, we found largely null associations between urinary phthalate metabolites and serum AMH. The multivariable adjusted differences in serum INHB levels comparing the highest quartile of urinary MEHP to the lowest were − 18.29% (95% CI: − 31.89%, − 1.98%; P-trend = 0.04). Women in the second to fourth quartiles of MEOHP had a significant decrease of − 23.74% (95% CI: −35.85%, − 9.24%), − 19.91% (95% CI: −33.30%, − 3.82%) and − 20.23% (95% CI: −34.43%, − 2.96%), respectively, in INHB levels compared to the first quartile. In the spline analysis, we identified a nonlinear relationship between MEOHP exposure and serum INHB.ConclusionsWe provided evidence for a negative association between urinary concentrations of certain phthalate metabolites and serum INHB levels, suggesting an adverse effect of phthalates exposure on growing antral follicles. Whether phthalates exposure at environmentally level will pose a risk for ovarian reserve needs further investigation.

Desire for a child and eating disorders in women seeking infertility treatment.

ObjectivesThe purpose of this study was to evaluate the prevalence of EDs in women seeking treatment for infertility, and to better characterize their clinical profile.Study designSixty participants completed self-report measures that assessed EDs, desire for a child, body preoccupations, quality of life, anxiety and depression.ResultsTen patients (17%) met criteria for a past or current ED. We showed a significant association between greater body dissatisfaction and a more ambivalent desire for a child. Furthermore, an ED was associated with (i) a lower quality of life, and (ii) more anxiety disorders.ConclusionScreening for a history of ED in infertile women is recommended to plan for adapted care regarding infertility but also regarding ED and psychiatric comorbidities. Therefore, the assessment has to take into account the desire for a child and the body satisfaction, that are essential parts of the ED process on the one hand and infertility process on the other. This could help with the infertility treatment and the prevention of negative maternal and fetal outcomes.

Chronic hepatitis B virus infection and history of pelvic surgery in women seeking infertility treatment

Chronic hepatitis B virus infection and history of pelvic surgery in women seeking infertility treatment