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Leyser-Whalen O, Bombach B, Mahmoud S, Greil AL. From generalist to specialist: A qualitative study of the perceptions of infertility patients. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:204-215. [PMID: 35036590 PMCID: PMC8753058 DOI: 10.1016/j.rbms.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
Few studies explore in-depth accounts of women's and men's experiences with, and transitions between, obstetrician/gynaecologists (OB/GYNs) and reproductive endocrinologists during infertility diagnostic and treatment processes. This study examined this subject matter with data from qualitative, in-depth, semi-structured interviews. Between April 2007 and March 2008, the first author interviewed 20 women and eight men from a large midwestern metropolitan area in the USA who had used, or were in the process of using, any fertility treatment in the 5 years preceding the interview. Six couples and 16 individuals were interviewed, resulting in narratives of 22 distinct infertility journeys. The main complaints made by respondents about OB/GYNs were that they were insufficiently concerned with providing timely treatment and that they paid insufficient attention to male partners. Women felt that their concerns were taken more seriously by reproductive endocrinologists, but complained of insensitivity, depersonalization and misinformation, and were suspicious of a profit orientation.
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Affiliation(s)
- Ophra Leyser-Whalen
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Brianne Bombach
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Sara Mahmoud
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Arthur L. Greil
- Division of Social Sciences, Alfred University, Alfred, NY, USA
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Lin YH, Ye JX, Wu ZX, Chen Y, Xia X, Qian WP. Treatment of Infertile Women with Unilateral Tubal Occlusion Diagnosed by Hysterosalpingography: The Role of Intrauterine Insemination. Curr Med Sci 2020; 40:767-772. [PMID: 32862389 DOI: 10.1007/s11596-020-2242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Abstract
The optimal assisted reproductive treatment strategy for infertile women with unilateral tubal obstruction remains uncertain. To investigate the role of intrauterine insemination (IUI) in the treatment of infertile women with unilateral tubal occlusion, the data of 148 couples were retrospectively collected and analyzed. Seventy-eight infertile women with unilateral occlusion diagnosed by hysterosalpingography (HSG) were categorized as the study group and 70 others with unexplained infertility as the control group. The study group was divided into a proximal occlusion subgroup and a mid-distal occlusion subgroup for further analysis. The main outcomes, namely the clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR), and live birth rate (LBR) per cycle, were analyzed. Our results showed a tendency of lower CPR, OPR, and LBR in the study group than in the control group, without statistical significance. Further investigations revealed that the unilateral proximal occlusion subgroup had similar CPR, OPR, and LBR as the control group, while the unilateral mid-distal occlusion subgroup had significantly lower CPR (5.1% vs. 20.0%, P=0.035), OPR (5.1% vs. 20.0%, P=0.035), and LBR (5.1% vs. 20.0%, P=0.035) than the control group. In conclusion, the clinical outcomes of IUI were worse in patients with unilateral tubal occlusion than in those with unexplained infertility. This might be primarily caused by the worse outcome of patients with unilateral mid-distal tubal occlusion instead of proximal occlusion.
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Affiliation(s)
- Yi-Hua Lin
- Department of Reproductive Center, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Jing-Xin Ye
- Department of Reproductive Center, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Ze-Xuan Wu
- Department of Reproductive Center, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Yun Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Xi Xia
- Department of Reproductive Center, Peking University Shenzhen Hospital, Shenzhen, 518036, China.
| | - Wei-Ping Qian
- Department of Reproductive Center, Peking University Shenzhen Hospital, Shenzhen, 518036, China.
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Hong X, Zhao J, Huang K, Dai Q, Zhang H, Xuan Y, Wu J, Fang S, Wang Q, Shen H, Xu Z, Zhang Y, Yan D, Qi D, Yang X, Zhang Y, Ma X, Wang B. Preconception blood pressure and time to pregnancy among couples attempting to conceive their first pregnancy. Am J Obstet Gynecol 2019; 221:470.e1-470.e10. [PMID: 31152709 DOI: 10.1016/j.ajog.2019.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/09/2019] [Accepted: 05/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association of abnormal blood pressure levels (including hypertension and prehypertension) with reduced fecundability among young childbearing-age couples is not yet elucidated completely. OBJECTIVE The purpose of this study was to investigate the association between abnormal preconception blood pressure level and time to pregnancy among couples who are attempting to conceive their first pregnancy. STUDY DESIGN A total of 2,234,350 eligible couples (with no previous gravidity and whose female partners were 20-49 years old) participated in the National Free Preconception Check-up Projects from January 1, 2015, to December 31, 2016. Each couples' preconception blood pressure levels were measured, and time to pregnancy was recorded. Cox models for discrete survival time were used to estimate fecundability odds ratios and their corresponding 95% confidence intervals after adjustment for age, ethnicity, educational level, occupation, household registration, region, tobacco exposure, alcohol intake, body mass index, duration of marriage of the couples, and fasting plasma glucose levels of the female partner. RESULTS Compared with normotensive women, those women with hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) had a 21% lower pregnancy rate (fecundability odds ratio, 0.79; 95% confidence interval, 0.78-0.81). A similar finding was found among men (fecundability odds ratio, 0.89; 95% confidence interval, 0.88-0.90). Prehypertension (systolic blood pressure between 120 and 139 mm Hg, and/or a diastolic blood pressure between 80 and 89 mm Hg) in both male and female partners was associated slightly with reduced fecundability odds ratios. Compared with couples in which both partners were normotensive, the pregnancy rate was reduced by 27% (fecundability odds ratio, 0.73; 95% confidence interval, 0.69-0.77) among couples in which both partners had hypertension. CONCLUSION Abnormal preconception blood pressure levels were associated with prolonged time to pregnancy among couples who were attempting to conceive their first pregnancy; the mechanism is worth further investigation.
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Demiray SB, Goker ENT, Tavmergen E, Yilmaz O, Calimlioglu N, Soykam HO, Oktem G, Sezerman U. Differential gene expression analysis of human cumulus cells. Clin Exp Reprod Med 2019; 46:76-86. [PMID: 31181875 PMCID: PMC6572664 DOI: 10.5653/cerm.2019.46.2.76] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/02/2019] [Indexed: 12/14/2022] Open
Abstract
Objective This study was performed to explore the possibility that each oocyte and its surrounding cumulus cells might have different genetic expression patterns that could affect human reproduction. Methods Differential gene expression analysis was performed for 10 clusters of cumulus cells obtained from 10 cumulus-oocyte complexes from 10 patients. Same procedures related to oocyte maturation, microinjection, and microarray analyses were performed for each group of cumulus cells. Two differential gene expression analyses were performed: one for the outcome of clinical pregnancy and one for the outcome of live birth. Results Significant genes resulting from these analyses were selected and the top 20 affected pathways in each group were analyzed. Circadian entrainment is determined to be the most affected pathway for clinical pregnancy, and proteoglycans in cancer pathway is the most affected pathway for live birth. Circadian entrainment is also amongst the 12 pathways that are found to be in top 20 affected pathways for both outcomes, and has both lowest p-value and highest number of times found count. Conclusion Although further confirmatory studies are necessary, findings of this study suggest that these pathways, especially circadian entrainment in cumulus cells, may be essential for embryo development and pregnancy.
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Affiliation(s)
- Sirin Bakti Demiray
- Assisted Reproduction Unit, Tepecik Education and Research Hospital, Izmir, Turkey
| | | | - Erol Tavmergen
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ozlem Yilmaz
- Department of Histology and Embryology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Nilufer Calimlioglu
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Gulperi Oktem
- Department of Histology and Embryology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ugur Sezerman
- Department of Biostatistics and Bioinformatics, Acibadem Mehmet Ali Aydinlar University, Institute of Health Sciences, Istanbul, Turkey
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Johnson JP, Schoof J, Beischel L, Schwancke C, Goldberg J, Black L, Ross L, Bhatt S. Detection of a case of Angelman syndrome caused by an imprinting error in 949 pregnancies analyzed for AS following IVF. J Assist Reprod Genet 2018; 35:981-984. [PMID: 29654525 DOI: 10.1007/s10815-018-1161-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/11/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- John P Johnson
- Medical Genetics, Shodair Children's Hospital, PO Box 5539, Helena, MT, 50604-5539, USA.
| | - Jonathon Schoof
- Medical Genetics, Shodair Children's Hospital, PO Box 5539, Helena, MT, 50604-5539, USA
| | - Linda Beischel
- Medical Genetics, Shodair Children's Hospital, PO Box 5539, Helena, MT, 50604-5539, USA.,Department of Public Health and Human Services, State of Montana, Helena, MT, USA
| | - Corbin Schwancke
- Medical Genetics, Shodair Children's Hospital, PO Box 5539, Helena, MT, 50604-5539, USA
| | | | - Lauri Black
- Pacific Reproductive Genetic Counseling, Pacifica, CA, USA
| | - Lori Ross
- Neogenomics Laboratories, Irvine, CA, USA
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Selçuk S, Küçükbaş M, Yenidede L, Kayataş Eser S, Eser A, Çam Ç, Kutlu HT. The outcomes of controlled ovarian hyperstimulation/intrauterine insemination in patients with unilateral tubal occlusion on hysterosalpingograph. Turk J Obstet Gynecol 2016; 13:7-10. [PMID: 28913081 PMCID: PMC5558359 DOI: 10.4274/tjod.88786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/15/2016] [Indexed: 12/01/2022] Open
Abstract
Objective: The aim of the present study was to evaluate the pregnancy rates of intrauterine insemination (IUI) and controlled ovarian hyperstimulation (COH) in patients with one-sided tubal occlusion on hysterosalpingography (HSG). Materials and Methods: Patients who underwent COH/IUI were enrolled into this retrospective cohort study. The patients with one-sided tubal occlusion diagnosed under HSG who met the inclusion criteria were accepted into the study group. The control group consisted of patients with unexplained infertility. The outcomes of COH/IUI were compared between the study and control groups. Results: Ninety-seven patients in the study group (n=44) and control group (n=53) who underwent COH/IUI treatment were included into study. The biochemical, clinical, and ongoing pregnancy rates were similar between patients with unilateral occlusion diagnosed under HSG and those with unexplained infertility. The spontaneous pregnancy rate within one year was higher in patients with normal HSG than in patients with unilateral tubal occlusion, but the difference did not show statistical significance. Conclusion: Infertile patients with one-sided tubal occlusion in HSG can be managed as with patients with unexplained infertility and normal HSG findings. In addition, COH/IUI may be considered as the first-line treatment option in the management of these patients.
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Affiliation(s)
- Selçuk Selçuk
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Clinics of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Küçükbaş
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Clinics of Obstetrics and Gynecology, İstanbul, Turkey
| | - Lter Yenidede
- Fatih Sultan Mehmet Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Semra Kayataş Eser
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Clinics of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ahmet Eser
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Clinics of Obstetrics and Gynecology, İstanbul, Turkey
| | - Çetin Çam
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Clinics of Obstetrics and Gynecology, İstanbul, Turkey
| | - Hüseyin Tayfun Kutlu
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Clinics of Obstetrics and Gynecology, İstanbul, Turkey
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Ngowa JDK, Kasia JM, Georges NT, Nkongo V, Sone C, Fongang E. Comparison of hysterosalpingograms with laparoscopy in the diagnostic of tubal factor of female infertility at the Yaoundé General Hospital, Cameroon. Pan Afr Med J 2015; 22:264. [PMID: 26958127 PMCID: PMC4765353 DOI: 10.11604/pamj.2015.22.264.8028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/02/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The objectives were to assess the diagnostic value of hysterosalpingography (HSG) with laparoscopy as gold standard in the evaluation of tubal patency and pelvic adhesions in women suffering from infertility. METHODS We conducted a comparative cross sectional study on 208 medical files of infertile women followed up at the Yaoundé General Hospital during a period of five years (December 2007 to December 2012). Tubal patency, hydrosalpinx and pelvic adhesions detected at HSG were compared with laparoscopic findings as the gold standard. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of HSG were calculated with 95% confidence interval (CI). RESULTS Mean age of the patients was 31.4 ± 6.45 years. Secondary infertility was the most frequent type of infertility (66.82%). HSG had a moderate sensitivity (51.0%; 95% IC. 37.5-64.4), high specificity (90.0%; 95% IC.74.4-96.5), high PPV (89.3%; 95% IC. 72.8-96.3) and a moderate NPV (52.9%; 95% IC. 39.5-65.9) in the diagnosis of bilateral proximal tubal occlusion. Concerning, distal tubal patency, HSG had a high sensitivity (86.8%; 95% IC. 76.7-92.9), low specificity (42.2%; 95% CI. 29.0-56.7), moderate PPV (69.4%; 95% IC. 58.9-78.2) and a moderate NPV (67.9%; 95% IC. 49.3-82.0) in the diagnosis of bilateral or unilateral distal tubal occlusion. However, HSG had a low diagnostic value (27.8%; 95%IC.18.8-39.0) in the pelvic adhesions. CONCLUSION HSG is of limited diagnostic value in tubal factor infertility and is of low diagnostic value for pelvic adhesions.
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Affiliation(s)
- Jean Dupont Kemfang Ngowa
- Obstetrics and Gynecology Unit, Yaoundé General Hospital, P.O. Box 5408, Yaoundé, Cameroon; Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaoundé, Cameroon
| | - Jean Marie Kasia
- Obstetrics and Gynecology Unit, Yaoundé General Hospital, P.O. Box 5408, Yaoundé, Cameroon; Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaoundé, Cameroon
| | - Nguefack-Tsague Georges
- Biostatistics Unit, Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaoundé, Cameroon
| | - Victorine Nkongo
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaoundé, Cameroon
| | - Charles Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaoundé, Cameroon
| | - Emmanuel Fongang
- Radiology Unit, Yaoundé General Hospital, P.O. Box 5408, Yaoundé, Cameroon
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Gibreel A, Eladawi N, El-Gilany AH, Allakkany N, Shams M. How do Egyptian gynecologists manage infertility? Cross-sectional study. J Obstet Gynaecol Res 2015; 41:1067-73. [PMID: 25772465 DOI: 10.1111/jog.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/19/2014] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study was to determine the knowledge and practices of a sample of Egyptian gynecologists with respect to the management and diagnosis of infertility and the variation between gynecologists according to qualifications. METHODS A questionnaire assessing knowledge, practice habits, and perception towards the management of infertility was distributed to gynecologists. Data were collected during the annual meeting of the Clinical Society of Obstetricians and Gynaecologists, which was held in Mansoura, Egypt. Two hundred and fifty-eight gynecologists attended the meeting. Two researchers distributed the questionnaires to the clinicians. Clinician responses to questions were assessed according to the National Institute of Clinical Excellence (NICE) fertility guidelines. The main outcome measures were knowledge and adherence of gynecologists to NICE infertility guidelines. RESULTS Significant differences were identified between clinicians with Master degree/Diploma and those with higher degrees (MD or PhD) with regard to knowledge as well as management options of different causes of infertility. CONCLUSION There is a need to develop and implement national strategies, including mandatory update of reproductive medicine curricula as well as providing continuous professional development programs, in order to boost infertility management in developing countries such as Egypt.
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Affiliation(s)
- Ahmed Gibreel
- Obstetrics and Gynecology Department, Mansoura University, Mansoura, Egypt
| | - Noha Eladawi
- Public Health Department, Mansoura University, Mansoura, Egypt
| | | | - Nasser Allakkany
- Obstetrics and Gynecology Department, Mansoura University, Mansoura, Egypt
| | - Maher Shams
- Obstetrics and Gynecology Department, Mansoura University, Mansoura, Egypt
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Padhee M, Zhang S, Lie S, Wang KC, Botting KJ, McMillen IC, MacLaughlin SM, Morrison JL. The periconceptional environment and cardiovascular disease: does in vitro embryo culture and transfer influence cardiovascular development and health? Nutrients 2015; 7:1378-425. [PMID: 25699984 PMCID: PMC4377860 DOI: 10.3390/nu7031378] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/22/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023] Open
Abstract
Assisted Reproductive Technologies (ARTs) have revolutionised reproductive medicine; however, reports assessing the effects of ARTs have raised concerns about the immediate and long-term health outcomes of the children conceived through ARTs. ARTs include manipulations during the periconceptional period, which coincides with an environmentally sensitive period of gamete/embryo development and as such may alter cardiovascular development and health of the offspring in postnatal life. In order to identify the association between ARTs and cardiovascular health outcomes, it is important to understand the events that occur during the periconceptional period and how they are affected by procedures involved in ARTs. This review will highlight the emerging evidence implicating adverse cardiovascular outcomes before and after birth in offspring conceived through ARTs in both human and animal studies. In addition, it will identify the potential underlying causes and molecular mechanisms responsible for the congenital and adult cardiovascular dysfunctions in offspring whom were conceived through ARTs.
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Affiliation(s)
- Monalisa Padhee
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Song Zhang
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Shervi Lie
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Kimberley C Wang
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Kimberley J Botting
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - I Caroline McMillen
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Severence M MacLaughlin
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
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Kehila M, Ben Hmid R, Ben Khedher S, Mahjoub S, Channoufi MB. [Concordance and contributions of hysterosalpingography and laparoscopy in exploration of pelvic and tubal infertility]. Pan Afr Med J 2014; 17:126. [PMID: 25374631 PMCID: PMC4218652 DOI: 10.11604/pamj.2014.17.126.3567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/16/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction La coelioscopie et l'hystérosalpingographie sont les deux procédures usuellement admises pour l'exploration tubaire et pelvienne en cas d'infertilité. Les objectifs de ce travail etaient de comparer les données de l'Hystérosalpingographie à celles de la coelioscopie chez des patientes explorées pour infertilité et voir l'apport de l'une par rapport à l'autre. Méthodes Etude prospective menée au service C du centre de maternité et de néonatologie de Tunis, s’étendant sur 15 mois, colligeant 120 patientes suivies pour infertilité ayant bénéficié d'une HSG suivie d'une coelioscopie. Résultats L’âge moyen de nos patientes était de 35,3 ans. L'infertilité était primaire dans 56,7% des cas et secondaire dans 43,7% des cas. Sa durée moyenne était de 48,9 mois. Le test statistique de concordance Kappa entre les 2 examens était de 0.42 pour les obstructions tubaires en général, de 0.48 pour les obstructions tubaires proximales et de 0.53 pour les obstructions tubaires distales indiquant une concordance modérée dans tous les cas. La coelioscopie a permis d'objectiver en plus une endométriose pelvienne dans 7% des cas, des adhérences pelviennes dans 33% des cas et des trompes perméables mais d'aspect pathologique dans 20% des cas. Conclusion Il existe un intérêt d′associer, chaque fois que c′est possible, l'HSG et la coelioscopie dans l'exploration du pelvis féminin dans le cadre de l'infertilité. Aucun de ces deux examens n'est parfait. Leurs résultats sont complémentaires.
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Affiliation(s)
- Mehdi Kehila
- Faculté de Médecine de Tunis, Service C du Centre de Maternité et de Néonatologie de Tunis, Tunis, Tunisie
| | - Rim Ben Hmid
- Faculté de Médecine de Tunis, Service C du Centre de Maternité et de Néonatologie de Tunis, Tunis, Tunisie
| | - Sonia Ben Khedher
- Faculté de Médecine de Tunis, Service C du Centre de Maternité et de Néonatologie de Tunis, Tunis, Tunisie
| | - Sami Mahjoub
- Faculté de Médecine de Tunis, Service C du Centre de Maternité et de Néonatologie de Tunis, Tunis, Tunisie
| | - Mohamed Bedis Channoufi
- Faculté de Médecine de Tunis, Service C du Centre de Maternité et de Néonatologie de Tunis, Tunis, Tunisie
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Salama AH, Hassan SS, Abo El Maged AEH. Laparoscopic assessment of infertile women with normal hysterosalpingogram. EVIDENCE BASED WOMENʼS HEALTH JOURNAL 2014; 4:122-126. [DOI: 10.1097/01.ebx.0000435392.67105.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Berker B, Şükür YE, Kahraman K, Atabekoğlu CS, Sönmezer M, Özmen B, Ateş C. Impact of unilateral tubal blockage diagnosed by hysterosalpingography on the success rate of treatment with controlled ovarian stimulation and intrauterine insemination. J OBSTET GYNAECOL 2013; 34:127-30. [DOI: 10.3109/01443615.2013.853030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Armstrong S, Akande V. What is the best treatment option for infertile women aged 40 and over? J Assist Reprod Genet 2013; 30:667-71. [PMID: 23536151 DOI: 10.1007/s10815-013-9980-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/12/2013] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To summarise the causes of decreased fecundity with age and review chronological vs biological ovarian ageing. To explore the clinician's means of assessing a woman's ovarian reserve. To review the recent literature on the effectiveness of different assisted reproductive technology (ART) techniques for women aged 40 and over and offer a single best treatment option. METHODS Pubmed and google scholar were searched for relevant articles using key words. Data were extracted based on authors, year, aims, sample and results. RESULTS Success rates for women aged 40 or over with clomiphene, IUI, IUI with FSH are all extremely low, at less than 1% live birth per cycle. However, IVF offers a success rate of around 13.7% per cycle. CONCLUSION An exploration of the effectiveness of available treatment options for older infertile women using their own gametes suggests that IVF offers the best prospects of success. Attempting treatments other than IVF will delay conception unnecessarily.
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Tsuji I, Ami K, Fujinami N, Hoshiai H. The significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by hysterosalpingography. TOHOKU J EXP MED 2013; 227:105-8. [PMID: 22687706 DOI: 10.1620/tjem.227.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the possibility for fertility. The evaluation of the fallopian tube is necessary to determine the management plan of infertility. Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions; however, HSG has limitations in detecting tubal pathology. In the current study, we evaluated the significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by HSG. Between 1997 and 2009, 127 patients with suspected tubal pathology as demonstrated by HSG underwent laparoscopy at Kinki University Hospital, and a retrospective analysis was performed. Of 87 patients with unilateral tubal pathology revealed by HSG, 20 patients (23.0%) were given an indication for assisted reproductive technology (ART), based on the laparoscopic findings. Of 40 patients with bilateral tubal pathology revealed by HSG, 33 patients (82.5%) with bilateral tubal pathology detected by laparoscopy were given a high indication for ART. Laparoscopy enables exact evaluation of the fallopian tube and selection of the optimal management plan in infertile patients with suspected tubal pathology revealed by HSG. Therefore, laparoscopy should be performed in infertile patients with suspected tubal pathology revealed by HSG, as it is of diagnostic importance.
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Affiliation(s)
- Isao Tsuji
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan.
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Yi G, Jee BC, Suh CS, Kim SH. Stimulated intrauterine insemination in women with unilateral tubal occlusion. Clin Exp Reprod Med 2012; 39:68-72. [PMID: 22816072 PMCID: PMC3398119 DOI: 10.5653/cerm.2012.39.2.68] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/07/2012] [Accepted: 06/18/2012] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the value of stimulated intrauterine insemination (IUI) in women with unilateral tubal occlusion. Methods Superovulation and IUI was performed during 2003-2010 and the medical records were reviewed retrospectively. Thirty-seven infertile women (52 cycles) with unilateral tubal occlusion diagnosed by hysterosalpingography and without other causes of infertility were selected. One-hundred fourteen patients with unexplained infertility served as a control group (182 cycles). The main outcome was the clinical pregnancy rate per cycle. Results The pregnancy rate per cycle was similar, 17.3% for the unilateral tubal occlusion group and 16.5% for the unexplained infertility group. The rate of miscarriage (11.1% vs. 23.3%) and ectopic pregnancy (11.1% vs. 6.7%) was similar between the two groups. The pregnancy rate was higher in patients with proximal occlusion (25.0%) compared with distal occlusion (13.9%) or unexplained infertility, but not statistically significant. Conclusion Stimulated IUI can be suggested as the initial treatment option in women with unilateral proximal or distal tubal occlusion.
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Affiliation(s)
- Gwang Yi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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De Wilde RL, Brosens I. Rationale of first-line endoscopy-based fertility exploration using transvaginal hydrolaparoscopy and minihysteroscopy. Hum Reprod 2012; 27:2247-53. [DOI: 10.1093/humrep/des192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Habibaj J, Kosova H, Bilali S, Bilali V, Qama D. Comparison between transvaginal sonography after diagnostic hysteroscopy and laparoscopic chromopertubation for the assessment of tubal patency in infertile women. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:68-73. [PMID: 21935964 DOI: 10.1002/jcu.20883] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 08/16/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE Diagnostic hysteroscopy has become a well-established modality for evaluating the uterine cavity, but provides no information regarding tubal patency. The aim of the present study was to investigate the diagnostic value of transvaginal sonography (TVS), performed directly after diagnostic hysteroscopy, for assessing tubal patency in infertile women, and to compare the findings with those obtained by means of laparoscopic chromopertubation. METHODS A total of 56 infertile patients were referred to our endoscopic unit for laparoscopic chromopertubation in the period from September 2008 to January 2010. Diagnostic hysteroscopy, followed by TVS, was carried out prior to laparoscopic chromopertubation. The collection of free fluid in the pouch of Douglas was accepted as evidence of tubal patency. The findings of TVS and laparoscopic chromopertubation were compared. The data were analyzed for the sensitivity, specificity, accuracy, positive-predictivevalue, and negative-predictive value of the combination of hysteroscopy and TVS in detecting unilateral or bilateral tubal patency. RESULTS The presence of fluid in the pouch of Douglas was observed in 37 of the 56 cases. In 36 of these cases, unilateral or bilateral tubal patency was confirmed by laparoscopic chromopertubation. In 17 of the remaining 19 cases (without fluid in the pouch of Douglas during ultrasound), bilateral tubal occlusion was confirmed by laparoscopic chromopertubation. Diagnostic hysteroscopy followed by TVS showed a high sensitivity and specificity for the assessment of tubal patency. CONCLUSIONS TVS performed directly after diagnostic hysteroscopy in infertile patients provides additional nformation regarding tubal patency.
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Affiliation(s)
- Julian Habibaj
- Obstetric and Gynecology University Hospital Queen Geraldine, Obstetric and Gynecology, Boulevard Zogu I, Tirana, Albania
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Jayakrishnan K, Koshy AK, Raju R. Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination. J Hum Reprod Sci 2011; 3:20-4. [PMID: 20607004 PMCID: PMC2890905 DOI: 10.4103/0974-1208.63117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 12/28/2009] [Accepted: 01/02/2010] [Indexed: 11/23/2022] Open
Abstract
CONTEXT: Women with primary infertility and no obvious pelvic pathology on clinical evaluation and imaging are either treated empirically or further investigated by laparoscopy. AIMS: The role of diagnostic laparoscopy in women who fail to conceive after empirical treatment with ovulation induction and intrauterine insemination was evaluated. SETTINGS AND DESIGN: Retrospective study at a private infertility center. MATERIALS AND METHODS: A study of patients who underwent diagnostic laparoscopy between 1st January 2001 and 31st December 2008 was performed. Those patients who had no detectable pathology based on history, physical examination, and ultrasound and had treatment for three or more cycles in the form of ovulation induction and IUI were included in the study. Moderate and severe male factor infertility and history of any previous surgery were exclusion criteria. STATISTICAL ANALYSIS USED: Data were statistically analyzed using Statistics Package for Social Sciences (ver. 16.0; SPSS Inc., Chicago). RESULTS: Of the 127 women who underwent diagnostic laparoscopy and hysteroscopy, 87.4% (n = 111) of patients had positive findings. Significant pelvic pathology (moderate endometriosis, pelvic inflammatory disease, and tubal pathology) was seen in 26.8% of cases. CONCLUSION: One in four women had significant pelvic pathology where treatment could possibly improve future fertility. Diagnostic laparoscopy has a role in infertile women with no obvious abnormality before they proceed to more aggressive treatments.
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Affiliation(s)
- K Jayakrishnan
- Fertility Research and Gynecology Centre, KJK Hospital, Trivandrum - 695 015, Kerala, India
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Yates AP, Rustamov O, Roberts SA, Lim HYN, Pemberton PW, Smith A, Nardo LG. Anti-Mullerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum Reprod 2011; 26:2353-62. [DOI: 10.1093/humrep/der182] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mitrović A, Brkić P, Jovanović T. The effects of hyperbaric oxygen treatment on vigility of spermatozoids: preliminary report. ACTA ACUST UNITED AC 2011; 98:85-90. [PMID: 21388934 DOI: 10.1556/aphysiol.98.2011.1.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to evaluate the effect of hyperbaric oxygen treatment (HBO) to the vigilance of spermatozoids. The sperm samples were obtained from the patients (n=10) with diagnosed oligospermia. The motility of spermatozoids in tested samples was not lower than 30% but it did not exceed the critical proportion of 50%. Three groups of samples were formed, with respectively 10 samples in each group. All of them were exposed to HBO conditions of 2.5 ATA for 90 minutes. Group I was exposed to HBO conditions without any addition of medium. Group II was added 5 ml of EBSS solution. Tyrode's solution in volume of 5 ml was added to group III. The evaluation of functional characteristics of sperm was carried out 30 minutes after completion of HBO treatment. Statistically significant increased in motor activity was registered in three all groups (p<0.05). The biggest increased in vigilance of spermatozoids was found in the samples of the group III (p<0.01), exceeding the critical proportion of 50% in all of the samples. The obtained results suggest that the acute exposure of the sperm samples to HBO has favorable impact to functional capacity of spermatozoids in view of their better motility.
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Affiliation(s)
- A Mitrović
- University of Belgrade, School of Medicine, Belgrade, Serbia
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Balasch J, Gratacós E. Delayed childbearing: effects on fertility and the outcome of pregnancy. Fetal Diagn Ther 2011; 29:263-73. [PMID: 21228557 DOI: 10.1159/000323142] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 11/26/2010] [Indexed: 01/29/2023]
Abstract
In modern societies, the proportion of women who delay childbearing beyond the age of 35 years has greatly increased in recent decades. They are falsely reassured by popular beliefs that advances in new reproductive technologies can compensate for the age-related decline in fertility. Yet age remains the single most important determinant of male and female fertility, either natural or treated. The consequences of advancing maternal age are not only relevant for the risk of natural and assisted conception, but also for the outcome of pregnancy. Although the absolute rate of poor pregnancy outcomes may be low from an individual standpoint, the impact of delaying childbearing from a public health perspective cannot be overestimated and should be in the agenda of public health policies for the years to come. This review summarizes available evidence regarding the impact of delaying childbearing on fertility and pregnancy outcomes.
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Affiliation(s)
- Juan Balasch
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
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22
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Silva S, Machado H. Uncertainty, risks and ethics in unsuccessful in vitro fertilisation treatment cycles. HEALTH RISK & SOCIETY 2010. [DOI: 10.1080/13698575.2010.515734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
In many modern societies, the proportion of women who delay childbearing beyond the age of 35 years has increased greatly in recent decades. They are falsely reassured by popular beliefs that advances in new reproductive technologies can compensate for the age-realted decline in fertility, but science cannot beat the biological clock. Age is the single most important determinant of male and female fertility, either natural or treated. The consequences of advancing maternal age are not only for the risk of natural and assisted conception, but also for the outcome of pregnancy. Female fertility has a 'best-before date' of 35, and for men, it is probably before age 45-50.
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Affiliation(s)
- Juan Balasch
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
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Amar-Hoffet A, Hédon B, Belaisch-Allart J. [Assisted reproductive technologies place]. J Gynecol Obstet Hum Reprod 2010; 39:S88-S99. [PMID: 21185490 DOI: 10.1016/s0368-2315(10)70034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There are three kinds of infertility treatment: medical treatment, surgical treatment and assisted reproductive technology (ART). ART includes intra uterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART technologies made a lot of progress last years and their field of applications extended. Through literature reviews, IUI is recommended for unexplained infertility and discussed for male or cervical infertility. IVF is recommended for tubal and unexplained infertility. Limits between IVF and ICSI in case of male infertility remains unclear. In non mal infertility ICSI is not recommended.
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Affiliation(s)
- A Amar-Hoffet
- Hôpital Saint Joseph, Unité de médecine de la reproduction, 26 bd de Louvain, 13008 Marseille, France
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Verhoeve HR, Coppus SFPJ, van der Steeg JW, Steures P, Hompes PGA, Bourdrez P, Bossuyt PMM, van der Veen F, Mol BWJ, van Kasteren YM, van der Heijden PFM, Schols WA, Mochtar MH, Lips GLM, Dawson J, Verhoeve HR, Milosavljevic S, Hompes PGA, van Dam LJ, Sluijmer AV, Bobeck HE, Bernardus RE, Vermeer MCS, Dorr JP, van der Linden PJQ, Roelofs HJM, Burggraaff JM, Oosterhuis GJE, Schouwink MH, Emanuel MH, Bouckaert PXJM, Delemarre FMC, Hamilton CJCM, van Hoven M, Renckens CM, Land JA, Schagen-van Leeuwen JH, Kremer JAM, van Katwijk C, van Hooff MHA, van Dessel HJHM, Broekmans FJM, Ruis HJLA, Koks CAM, Bourdrez P, Riedijk WWJ, Cohlen BJ. The capacity of hysterosalpingography and laparoscopy to predict natural conception. Hum Reprod 2010; 26:134-42. [DOI: 10.1093/humrep/deq263] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Reliability of narrow-band imaging (NBI) hysteroscopy: A comparative study. Fertil Steril 2010; 94:2303-7. [DOI: 10.1016/j.fertnstert.2009.12.083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 12/29/2009] [Accepted: 12/29/2009] [Indexed: 11/21/2022]
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Badawy A, Khiary M, Ragab A, Hassan M, Sherif L. Laparoscopy – or not – for management of unexplained infertility. J OBSTET GYNAECOL 2010; 30:712-5. [DOI: 10.3109/01443615.2010.508850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Merviel P, Lourdel E, Brzakowski M, Urrutiaguer S, Gagneur O, Nasreddine A. [Against the systematic practice of laparoscopy in infertility evaluation]. ACTA ACUST UNITED AC 2010; 38:420-3. [PMID: 20576556 DOI: 10.1016/j.gyobfe.2010.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Kamel RM. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol 2010; 8:21. [PMID: 20205744 PMCID: PMC2844387 DOI: 10.1186/1477-7827-8-21] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/06/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. OBJECTIVES The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload. METHODS A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib) by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Canadian Fertility and Andrology Society (CFAS), and Royal College of Obstetricians and Gynaecologists (RCOG). RESULTS A simple guide for the clinicians to manage the infertile couples. CONCLUSIONS The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.
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Affiliation(s)
- Remah M Kamel
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
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30
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Bahadur A, Malhotra N, Mittal S, Singh N, Gurunath S. Second-look hysteroscopy after antitubercular treatment in infertile women with genital tuberculosis undergoing in vitro fertilization. Int J Gynaecol Obstet 2009; 108:128-31. [DOI: 10.1016/j.ijgo.2009.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 08/06/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
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Alviggi C, Humaidan P, Howles CM, Tredway D, Hillier SG. Biological versus chronological ovarian age: implications for assisted reproductive technology. Reprod Biol Endocrinol 2009; 7:101. [PMID: 19772632 PMCID: PMC2764709 DOI: 10.1186/1477-7827-7-101] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 09/22/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women have been able to delay childbearing since effective contraception became available in the 1960s. However, fertility decreases with increasing maternal age. A slow but steady decrease in fertility is observed in women aged between 30 and 35 years, which is followed by an accelerated decline among women aged over 35 years. A combination of delayed childbearing and reduced fecundity with increasing age has resulted in an increased number and proportion of women of greater than or equal to 35 years of age seeking assisted reproductive technology (ART) treatment. METHODS Literature searches supplemented with the authors' knowledge. RESULTS Despite major advances in medical technology, there is currently no ART treatment strategy that can fully compensate for the natural decline in fertility with increasing female age. Although chronological age is the most important predictor of ovarian response to follicle-stimulating hormone, the rate of reproductive ageing and ovarian sensitivity to gonadotrophins varies considerably among individuals. Both environmental and genetic factors contribute to depletion of the ovarian oocyte pool and reduction in oocyte quality. Thus, biological and chronological ovarian age are not always equivalent. Furthermore, biological age is more important than chronological age in predicting the outcome of ART. As older patients present increasingly for ART treatment, it will become more important to critically assess prognosis, counsel appropriately and optimize treatment strategies. Several genetic markers and biomarkers (such as anti-Müllerian hormone and the antral follicle count) are emerging that can identify women with accelerated biological ovarian ageing. Potential strategies for improving ovarian response include the use of luteinizing hormone (LH) and growth hormone (GH). When endogenous LH levels are heavily suppressed by gonadotrophin-releasing hormone analogues, LH supplementation may help to optimize treatment outcomes for women with biologically older ovaries. Exogenous GH may improve oocyte development and counteract the age-related decline of oocyte quality. The effects of GH may be mediated by insulin-like growth factor-I, which works synergistically with follicle-stimulating hormone on granulosa and theca cells. CONCLUSION Patients with biologically older ovaries may benefit from a tailored approach based on individual patient characteristics. Among the most promising adjuvant therapies for improving ART outcomes in women of advanced reproductive age are the administration of exogenous LH or GH.
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Affiliation(s)
- Carlo Alviggi
- Dipartimento di Scienze Ostetriche e Ginecologiche - Medicina della Riproduzione, Università degli Studi di Napoli Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Colin M Howles
- Merck Serono S.A. - Geneva (an affiliate of Merck KGaA, Darmstadt, Germany), Geneva, Switzerland
| | - Donald Tredway
- Endocrinology and Reproductive Health GCDU, EMD Serono, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Rockland, MA, USA
| | - Stephen G Hillier
- University of Edinburgh, Centre for Reproductive Biology, Edinburgh, UK
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Checa MA, Alonso-Coello P, Solà I, Robles A, Carreras R, Balasch J. IVF/ICSI with or without preimplantation genetic screening for aneuploidy in couples without genetic disorders: a systematic review and meta-analysis. J Assist Reprod Genet 2009; 26:273-83. [PMID: 19629673 DOI: 10.1007/s10815-009-9328-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 07/10/2009] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To assess the efficacy of preimplantation genetic screening to increase ongoing pregnancy rates in couples without known genetic disorders. METHODS Systematic review and meta-analysis of randomized controlled trials. Two reviewers independently determined study eligibility and extracted data. RESULTS Ten randomized trials (1,512 women) were included. The quality of evidence was moderate. Meta-analyses using a random-effects model suggest that PGS has a lower rate of ongoing pregnancies (risk ratio=0.73, 95% confidence interval 0.62-0.87) and a lower rate of live births (risk ratio=0.76, 95% confidence interval 0.64-0.91) than standard in vitro fertilization/intracytoplasmic sperm injection. CONCLUSIONS In women with poor prognosis or in general in vitro fertilization program, in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic screening for aneuploidy does not increase but instead was associated with lower rates of ongoing pregnancies and live births. The use of preimplantation genetic screening in daily practice does not appear to be justified.
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Affiliation(s)
- Miguel A Checa
- Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Autonomous University of Barcelona, Passeig Marítim 25-29, Barcelona 08003, Spain.
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Devroey P, Fauser BCJM, Diedrich K. Approaches to improve the diagnosis and management of infertility. Hum Reprod Update 2009; 15:391-408. [PMID: 19380415 PMCID: PMC2691653 DOI: 10.1093/humupd/dmp012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/19/2009] [Accepted: 03/18/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26-27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.
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Affiliation(s)
- P Devroey
- Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, Brussels 1090, Belgium.
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Casals G, Ordi J, Creus M, Fábregues F, Casamitjana R, Quinto L, Campo E, Balasch J. Osteopontin and alphavbeta3 integrin expression in the endometrium of infertile and fertile women. Reprod Biomed Online 2008; 16:808-16. [PMID: 18549690 DOI: 10.1016/s1472-6483(10)60146-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Osteopontin and its receptor alpha(v)beta(3) integrin have recently been proposed as a major complex to promote embryo attachment, and thus they would be useful as markers of endometrial receptivity. In the current study alpha(v)beta(3) integrin and osteopontin expression and co-expression in in-phase and out-of-phase endometrial biopsies from normal healthy women (n = 12) and infertile patients (n = 107) were investigated. Two endometrial biopsies (post-ovulatory day +6 to +8, and 4 days later) were performed during a single menstrual cycle in each subject. Oestradiol and progesterone serum concentrations were quantified on the same days as endometrial sampling. No statistically significant difference regarding alpha(v)beta(3) integrin and osteopontin expression and their coexpression was found between fertile controls and infertile patients irrespective of endometria being in-phase or out-of-phase, infertility factors detected or whether patients became spontaneously pregnant or not. Although a co-ordinate high concentration of both glycoproteins on post-ovulatory day 8 onwards was observed, there was an evident lack of temporal co-expression of these markers during the implantation window. It is concluded that the functional significance of the osteopontin:alpha(v)beta(3) integrin complex as a marker of endometrial receptivity and implantation potential in women seems to be untenable.
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Affiliation(s)
- Gemma Casals
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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den Hartog JE, Lardenoije CMJG, Severens JL, Land JA, Evers JLH, Kessels AGH. Screening strategies for tubal factor subfertility. Hum Reprod 2008; 23:1840-8. [PMID: 18579509 DOI: 10.1093/humrep/den237] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Different screening strategies exist to estimate the risk of tubal factor subfertility, preceding laparoscopy. Three screening strategies, comprising Chlamydia trachomatis IgG antibody testing (CAT), high-sensitivity C-reactive protein (hs-CRP) testing and hysterosalpingography (HSG), were explored using laparoscopy as reference standard and the occurrence of a spontaneous pregnancy as a surrogate marker for the absence of tubal pathology. METHODS In this observational study, 642 subfertile women, who underwent tubal testing, participated. Data on serological testing, HSG, laparoscopy and interval conception were collected. Multiple imputations were used to compensate for missing data. RESULTS Strategy A (HSG) has limited value in estimating the risk of tubal pathology. Strategy B (CAT-->HSG) shows that CAT significantly discerns patients with a high versus low risk of tubal pathology, whereas HSG following CAT has no additional value. Strategy C (CAT-->hs-CRP-->HSG) demonstrates that hs-CRP may be valuable in CAT-positive patients only and HSG has no additional value. CONCLUSIONS CAT is proposed as first screening test for tubal factor subfertility. In CAT-negative women, HSG may be performed because of its high specificity and fertility-enhancing effect. In CAT-positive women, hs-CRP seems promising, whereas HSG has no additional value. The position and timing of laparoscopy deserves critical reappraisal.
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Affiliation(s)
- J E den Hartog
- Research Institute Growth and Development (GROW), Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Helmerhorst FM, van Vliet HAAM, Gornas T, Finken MJJ, Grimes DA. Intrauterine insemination versus timed intercourse for cervical hostility in subfertile couples. Obstet Gynecol Surv 2006; 61:402-14; quiz 423. [PMID: 16719942 DOI: 10.1097/01.ogx.0000219538.78851.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The postcoital test has poor diagnostic and prognostic characteristics. Nevertheless, some physicians believe it can identify scanty or abnormal mucus that might impair fertility. One way to avoid "hostile" cervical mucus is intrauterine insemination. With this technique, the physician injects sperm directly into the uterine cavity through a small catheter passed through the cervix; the theory is to bypass the "hostile" cervical mucus. Although most gynecologic societies do not endorse use of intrauterine insemination for hostile cervical mucus, some physicians consider it an effective treatment for women with infertility thought the result of cervical mucus problems. The aim of this review was to determine the effectiveness of intrauterine insemination with or without ovarian stimulation in women with cervical hostility who failed to conceive.We searched Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 2, 2005, MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), POPLINE (to June 2005), and LILACS (to June 2005). In addition, we contacted experts and searched the reference list of relevant articles and book chapters. We included randomized and quasirandomized, controlled trials comparing intrauterine insemination with intercourse timed at the presumed fertile period. Participants were women with cervical hostility who failed to conceive for at least 1 year. We assessed the titles and abstracts of 386 publications and 2 reviewers independently abstracted data on methods and results from 5 studies identified for inclusion. The main outcome is pregnancy rate per couple. We did not pool the outcomes of the included 5 studies in a meta-analysis resulting from the methodological quality of the trials and variations in the patient characteristics and interventions. Narrative summaries of the outcomes are provided. Each study was too small for a clinically relevant conclusion. None of the studies provided information on important outcomes such as spontaneous abortion, multiple pregnancies, and ovarian hyperstimulation syndrome. There is no evidence from the published studies that intrauterine insemination is an effective treatment for cervical hostility. Given the poor diagnostic and prognostic properties of the postcoital test and the observation that the test has no benefit on pregnancy rates, intrauterine insemination (with or without ovarian stimulation) is unlikely to be a useful treatment for putative problems identified by postcoital testing. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall that there is a lack of adequate studies that support that intrauterine insemination (IUI) is an effective treatment of cervical hostility, explain that the postcoital test has poor diagnostic and prognostic properties, and state that the use of both tests has no benefit on pregnancy rates. EDITOR'S NOTE Although many assisted reproductive technology (ART) programs no longer perform postcoital tests, many perform intrauterine insemination (IUI), often with gonadotropins or clomiphene citrate, in their subfertile patients. Therefore, this review article will be of value to our readers who treat subfertile patients with IUI, whether or not they perform postcoital tests. For additional explanations of the statistical tests employed in this review, see D. Grimes, KF Schulz, Obstetrical and Gynecologic Survey, 57; Supplement 3: S35, September 2002; and D. Grimes, KF Schulz, Obstetrical and Gynecologic Survey, Supplement 2, S53-S69, September 2005.-RBJ.
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Affiliation(s)
- Frans M Helmerhorst
- Department of Gynaecology, Division of Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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Horowitz E, Orvieto R, Rabinerson D, Yoeli R, Bar-Hava I. Hysteroscopy combined with hysterosalpingo contrast sonography (HyCoSy): a new modality for comprehensive evaluation of the female pelvic organs. Gynecol Endocrinol 2006; 22:225-9. [PMID: 16723310 DOI: 10.1080/09513590600647359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AIM Hysterolaparoscopy is the gold-standard procedure for mechanical evaluation of the female pelvic organs. However, it is invasive and potentially life-threatening. The purpose of the present study was to assess the value of an alternative, minimally invasive technique. METHOD All consenting women who reached the stage of mechanical evaluation in their infertility work-up were invited to participate in the study. All underwent diagnostic hysteroscopy followed by hysterosalpingo contrast sonography (HyCoSy) performed in a single session on an outpatient basis. Patient clinical data were collected prospectively. RESULTS Twenty women participated in the study, 6 with primary infertility and 14 with secondary infertility. All procedures yielded satisfactory evaluation of the uterine cavity and uterine and ovarian structures, fallopian tube patency, and relationship between the fallopian tube fimbrial edges and the ovaries. All patients were discharged within 2 h; there were no complications during or after the procedure. CONCLUSION The combination of hysteroscopy and hysterosalpingo contrast sonography (HyCoSy) can provide a comprehensive, functional and relatively non-invasive evaluation of the female pelvic organs.
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Affiliation(s)
- Eran Horowitz
- Department of Obstetrics and Gynecology, Rabin Medical Center (Golda Campus), Petah Tiqwa, Israel.
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38
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Fábregues F, Creus M, Peñarrubia J, Manau D, Vanrell JA, Balasch J. Effects of recombinant human luteinizing hormone supplementation on ovarian stimulation and the implantation rate in down-regulated women of advanced reproductive age. Fertil Steril 2006; 85:925-31. [PMID: 16580376 DOI: 10.1016/j.fertnstert.2005.09.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Revised: 09/28/2005] [Accepted: 09/28/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the effects of recombinant human luteinizing hormone (rhLH) supplementation on ovarian stimulation and implantation rate in down-regulated women of advanced reproductive age. DESIGN Prospective randomized study. SETTING University teaching hospital. PATIENT(S) A total of 120 consecutive normogonadotropic infertile women > or = 35 years old undergoing their first cycle of IVF or intracytoplasmic sperm injection (ICSI) treatment. INTERVENTION(S) Ovarian stimulation in a long agonist protocol with a combination of recombinant human follicle-stimulating hormone (rhFSH) and rhLH (group 1, n = 60) starting on day 6 of FSH stimulation until hCG at a daily fixed dose of 150 IU of rhLH, or with rhFSH alone (group 2, n = 60). MAIN OUTCOME MEASURE(S) Ovarian stimulation characteristics, ovum retrieval, and IVF/ICSI outcome. RESULT(S) The mean number of intermediate (10-14 mm) and large (> 14- < 18 mm) but not leading (> or = 18 mm) follicles was significantly lower in group 1 on the day of hCG injection. The oocyte yield and maturity as well as the number of oocytes fertilized were significantly higher in group 2 than in group 1. However, the number of patients having embryo transfer (n = 55 in both treatment groups), the number and quality of embryos replaced, the implantation rate (20.6% vs. 21.7%) and clinical pregnancy rates per embryo transfer (44% vs. 45%) were similar in groups 1 and 2. CONCLUSION(S) The rhLH supplementation does not increase ovarian response and implantation rates in patients of older reproductive age stimulated with rhFSH under pituitary suppression for assisted reproductive technologies (ARTs).
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Affiliation(s)
- Francisco Fábregues
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
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Helmerhorst FM, Van Vliet HAAM, Gornas T, Finken MJJ, Grimes DA. Intra-uterine insemination versus timed intercourse for cervical hostility in subfertile couples. Cochrane Database Syst Rev 2005; 2005:CD002809. [PMID: 16235303 PMCID: PMC6599852 DOI: 10.1002/14651858.cd002809.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The postcoital test has poor diagnostic and prognostic characteristics. Nevertheless, some physicians believe it can identify scanty or abnormal mucus that might impair fertility. One way to avoid 'hostile' cervical mucus is intrauterine insemination. With this technique, the physician injects sperm directly into the uterine cavity through a small catheter passed through the cervix; the theory is to bypass the "hostile" cervical mucus. Although most gynaecological societies do not endorse use of intrauterine insemination for hostile cervical mucus, some physicians consider it an effective treatment for women with infertility thought due to cervical mucus problems. OBJECTIVES The aim of this review was to determine the effectiveness of intrauterine insemination with or without ovarian stimulation in women with cervical hostility who failed to conceive. SEARCH STRATEGY We searched Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 2, 2005, MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), POPLINE (to June 2005) and LILACS (to June 2005). In addition, we contacted experts and searched the reference list of relevant articles and book chapters. SELECTION CRITERIA We included randomized and quasi-randomized controlled trials comparing intrauterine insemination with intercourse timed at the presumed fertile period. Participants were women with cervical hostility who failed to conceive for at least one year. DATA COLLECTION AND ANALYSIS We assessed the titles and abstracts of 386 publications and two reviewers independently abstracted data on methods and results from five studies identified for inclusion. The main outcome is pregnancy rate per couple. MAIN RESULTS We did not pool the outcomes of the included five studies in a meta-analysis due to the methodological quality of the trials and variations in the patient characteristics and interventions. Narrative summaries of the outcomes are provided. Each study was too small for a clinically relevant conclusion. None of the studies provided information on important outcomes such as spontaneous abortion, multiple pregnancies, and ovarian hyperstimulation syndrome. AUTHORS' CONCLUSIONS There is no evidence from the published studies that intrauterine insemination is an effective treatment for cervical hostility. Given the poor diagnostic and prognostic properties of the postcoital test and the observation that the test has no benefit on pregnancy rates, intrauterine insemination (with or without ovarian stimulation) is unlikely to be a useful treatment for putative problems identified by postcoital testing.
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Affiliation(s)
- F M Helmerhorst
- Leiden University Medical Center, Gynaecology & Reproductive Medicine, P.O.Box 9600, Leiden, Netherlands NL 2300 RC.
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Holden CA, McLachlan RI, Cumming R, Wittert G, Handelsman DJ, de Kretser DM, Pitts M. Sexual activity, fertility and contraceptive use in middle-aged and older men: Men in Australia, Telephone Survey (MATeS). Hum Reprod 2005; 20:3429-34. [PMID: 16172145 DOI: 10.1093/humrep/dei307] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With limited information regarding fertility and sexual activity in the older population, men's behaviour, attitudes and concerns were explored in a representative population of middle-aged and older men using the Men in Australia, Telephone Survey (MATeS). METHODS A stratified random national sample of 5990 men participated in a standardized computer-assisted telephone interview. Equal numbers in the age strata 40-49, 50-59, 60-69 and >or=70 years were surveyed with findings census-standardized to the national population. Broad aspects of men's health and well-being, including reproductive health, were explored. RESULTS The majority of men were sexually active in the last 12 months (age-standardized proportion, 78.3%) with approximately 37% of men aged >or=70 years still continuing sexual activity. Overall, 12.2% of men had never fathered children, of whom most (7.7%) had chosen not to have children. Questioning on failed attempts to produce a pregnancy suggested an involuntary infertility rate of 7.6%. The age-standardized vasectomy rate was 25.1%, with 5.6% of vasectomized men having no children. Although 9.2% of vasectomized men regretted sterilization, only 1.4% had undergone vasectomy reversal. CONCLUSIONS Continuing sexual activity, fertility and contraception needs in middle-aged and older men suggests that education and service delivery must be more appropriately directed to an ageing population.
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Affiliation(s)
- C A Holden
- Andrology Australia, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Auatralia.
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Ojha K, Philips Z, Darne FJ. Diagnosing infertility in a district general hospital: a case-note and cost analysis. HUM FERTIL 2005; 6:169-73. [PMID: 14614195 DOI: 10.1080/1464770312331369443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to observe diagnostic work-up and cost evaluation of infertile couples to identify opportunities for improvement. One hundred and seventy-four new referrals to the gynaecology clinic in a District General Hospital during 1996 and 1997 provided the cohort for analysis. Data from case notes were transferred on to data collection sheets. Data were inputted into SPSS for analysis. Primary infertility accounted for 62% of couples. One hundred and forty-two couples (81.6%) had a definitive diagnosis, and the analyses relate to these couples only. There was no single investigation performed on the whole cohort studied. Semen analysis was undertaken in 80.3% of the couples; couples with suspected male infertility were over four times more likely to have had more than two semen tests (P = 0.0005); 77.5% of couples had FSH and LH tests; and midluteal progesterone was tested in 76.1%. An increased intensity of FSH-LH hormone testing was associated with couples with anovulation (chi(2) = 6.79, P = 0.03). Serial repeat progesterone tended to be given to women with irregular or prolonged cycles (35 days or more), although this tendency was not statistically significant. The most common test for tubal patency was hysterosalpingography. Higher costs are generally associated with diagnosing endometriosis and tubal factor because of the relatively high cost of laparoscopy. The average cost of diagnosis for each patient was pound 365 and ranged from pound 64 to pound 851. In conclusion, a standard protocol of basic investigative procedures should be offered in secondary centres to all couples. Avoiding duplication and unnecessary investigations (for example, serial progesterone) may reduce costs, although offering all couples a standard protocol of tests would probably offset this observation.
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Affiliation(s)
- Kamal Ojha
- Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London SW17 0RE, UK
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42
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Gnoth C, Godehardt E, Frank-Herrmann P, Friol K, Tigges J, Freundl G. Definition and prevalence of subfertility and infertility. Hum Reprod 2005; 20:1144-7. [PMID: 15802321 DOI: 10.1093/humrep/deh870] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Infertility may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor affecting the individual spontaneous pregnancy prospect is the time of unwanted non-conception which determines the grading of subfertility. Most of the pregnancies occur in the first six cycles with intercourse in the fertile phase (80%). After that, serious subfertility must be assumed in every second couple (10%) although--after 12 unsuccessful cycles--untreated live birth rates among them will reach nearly 55% in the next 36 months. Thereafter (48 months), approximately 5% of the couples are definitive infertile with a nearly zero chance of becoming spontaneously pregnant in the future. With age, cumulative probabilities of conception decline because heterogeneity in fecundity increases due to a higher proportion of infertile couples. In truly fertile couples cumulative probabilities of conception are probably age independent. Under appropriate circumstances a basic infertility work-up after six unsuccessful cycles with fertility-focused intercourse will identify couples with significant infertility problems to avoid both infertility under- and over-treatment, regardless of age: Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with treatment they do not have a better chance of conceiving. The others may benefit from an early resort to assisted reproduction treatment.
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Affiliation(s)
- C Gnoth
- Center for Family Planning, Gynaecological Endocrinology & Reproductive Medicine Grevenbroich, Heinrich-Heine University of Duesseldorf, Germany.
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Routine office hysteroscopy in the investigation of infertile couples prior to assisted reproduction. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ics.2004.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lavy Y, Lev-Sagie A, Holtzer H, Revel A, Hurwitz A. Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology? Eur J Obstet Gynecol Reprod Biol 2004; 114:64-8. [PMID: 15099873 DOI: 10.1016/j.ejogrb.2003.09.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2002] [Revised: 05/18/2003] [Accepted: 09/10/2003] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the diagnostic benefit of laparoscopy in infertile women with normal hysterosalpingography (HSG) or suspected unilateral pathology on HSG. STUDY DESIGN Charts of infertile women that underwent complete infertility evaluation between 1996 and 1998 were retrospectively reviewed. Eighty-six patients in whom both HSG and laparoscopy were performed were included in the study. HSG results were compared with laparoscopic findings and the suggested treatment based on HSG results was compared with the treatment plan based on laparoscopic findings. RESULTS Among 63 patients with a normal HSG or suspected unilateral tubal pathology, who were assigned to ovulation induction and intrauterine insemination (IUI), 60 patients were found to have laparoscopic findings that did not necessitate any change in the original treatment plan. In three patients (4.8%), abnormalities discovered at laparoscopy were of such an extent that a change in the original treatment regimen and referral to in vitro fertilization (IVF) was needed. Among 23 patients with suspected bilateral tubal occlusion on HSG, 16 patients (69.6%) were found to have an abnormal laparoscopy with bilateral tubal adhesions, 6 patients (26%) had unilateral tubal adhesions, and 1 patient (4.3%) had pelvic adhesions with no obstruction. These latter findings led to changes in the original treatment plan of these seven patients from IVF to ovulation induction and IUI. CONCLUSIONS Laparoscopy may be omitted in women with normal HSG or suspected unilateral distal tubal pathology on HSG, since it was not shown to change the original treatment plan indicated by HSG in 95% of the patients. However, laparoscopy should be recommended in cases with suspected bilateral tubal occlusion on HSG, since it altered the original treatment plan in 30% of the patients from IVF to induction of ovulation with IUI. The reassuring results found in the present study may be related to the low prevalence of pelvic inflammatory diseases and endometriosis in our population.
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Affiliation(s)
- Yuval Lavy
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Hadassah University Hospital, Mt. Scopus, Jerusalem 91240, Israel.
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Ekerhovd E, Fried G, Granberg S. An ultrasound-based approach to the assessment of infertility, including the evaluation of tubal patency. Best Pract Res Clin Obstet Gynaecol 2004; 18:13-28. [PMID: 15123055 DOI: 10.1016/j.bpobgyn.2003.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An optimal initial infertility investigation protocol would be a process that is diagnostically accurate, expeditious, cost-effective, reliable and as minimally invasive as possible. In addition, the investigation should provide the clinician with useful prognostic information regarding possible future treatment. At present, extensive use of invasive procedures such as diagnostic hysteroscopy and laparoscopy is the standard at many fertility centres. Recent advances in gynaecological ultrasonography have shown that ultrasound can replace routine invasive investigative procedures. An ultrasound-based approach would make the basic infertility investigation less time-consuming and less expensive, but at the same time more acceptable to the majority of patients. This chapter describes an ultrasound-based approach to the assessment of infertility. In addition, the role of ultrasonography for assessment of the pelvic organs as a basic part of the initial investigation of an infertile couple is discussed and compared to more traditional invasive methods.
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Affiliation(s)
- Erling Ekerhovd
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Sahlgrenska University Hospital, SE-41345 Göteborg, Sweden
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46
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Tanahatoe SJ, Hompes PGA, Lambalk CB. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination? Hum Reprod 2003; 18:8-11. [PMID: 12525433 DOI: 10.1093/humrep/deg034] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diagnostic laparoscopy is normally the standard procedure performed as the final test in the infertility work up before progressing to infertility treatment. Recently, there has been a growing tendency to bypass diagnostic laparoscopy after a normal hysterosalpingogram and instead to start direct infertility treatment [intrauterine insemination (IUI) or IVF] for indications such as unexplained infertility, male subfertility and cervical hostility. In our clinic, laparoscopy revealed abnormalities that resulted in changed treatment decisions in 25% of the patients who would normally have been scheduled for IUI if laparoscopy had not been performed. The changed treatments mainly concerned surgery for minimal/mild endometriosis and periadnexal adhesions, both performed during the diagnostic laparoscopy. Because the effect of such interventions on the success rate of IUI has never been described, it still remains unclear whether laparoscopy is usefully performed in these cases. Therefore, further prospective studies should be performed to assess whether delaying, or bypassing entirely, diagnostic laparoscopy is more cost effective and if laparoscopic interventions for intra-abdominal abnormalities are effective in terms of higher pregnancy rates after treatment with IUI.
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Affiliation(s)
- Sandra J Tanahatoe
- Department of Obstetrics, Gynaecology and Reproductive Medicine, 'Vrije universiteit' Medical Centre PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Francavilla F, Romano R, LA Verghetta G, Bontempo G, Santucci R, Necozione S, Francavilla S. Interactive effect of semen and cervical mucus quality on postcoital test outcome: analysis from an andrological point of view. INTERNATIONAL JOURNAL OF ANDROLOGY 2002; 25:236-42. [PMID: 12121573 DOI: 10.1046/j.1365-2605.2002.00354.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study analysed the relationship between semen quality and the postcoital test (PCT) outcome in 616 couples, especially focusing on the interactive effect of semen and cervical mucus quality. When PCTs performed in the presence of unfavourable mucus were excluded, a significant correlation was found between semen parameters and PCT outcome. In oligo/asthenozoospermia, 46.7% of PCT outcomes were negative, while the remaining were positive. Notably, in the presence of an optimal mucus score, 39% of PCT outcomes were good (> or = 7 forward motile spermatozoa/high power field). In normozoospermia, 16% of PCT were negative. A suboptimal cervical mucus quality significantly affected the PCT outcome in the presence of oligo/asthenozoospermia, but not in normozoospermia. In couples with repeated PCT, a better mucus score was associated with a significant improvement of the PCT outcome. When the outcome of two PCTs performed in the same couples with an unmodified mucus score was compared, a good consistency of the results was observed. In conclusion, the PCT can provide information in additional to that obtained from conventional semen analysis, as the interactive effect of semen/cervical mucus cannot be accurately inferred from the separate evaluation of the two members of a couple.
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Affiliation(s)
- F Francavilla
- Andrologic Unit, Department of Internal Medicine, University of L'Aquila, L'Aquila, Italy.
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Fatum M, Laufer N, Simon A. Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin? Hum Reprod 2002; 17:1-3. [PMID: 11756351 DOI: 10.1093/humrep/17.1.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traditionally, a diagnosis of unexplained infertility is established only when all standard clinical investigations yield normal results. When tubal patency has been established by hysterosalpingography (HSG), laparoscopy has been suggested as a mandatory step to preclude the existence of peritubal adhesions and endometriosis as causes of infertility. In women without a previous history suggestive of tubal disease and who have a normal HSG, it was demonstrated that the probability of clinically relevant tubal disease or endometriosis is very low and that laparoscopy does not seem justified or cost effective. In the minority of these cases, laparoscopy might reveal minimal or mild endometriosis or peritubal adhesions. In these cases, either surgery or medical treatment has not been proven to improve fecundity. With the current success rates of assisted reproductive technologies (ART) and the relatively low contribution of diagnostic laparoscopy to the decision-making process of treating patients with a normal HSG, we suggest that laparoscopy should be omitted in couples suspected of having unexplained infertility. These patients should be treated by 3-6 cycles of combined gonadotrophins and intrauterine insemination, and if unsuccessful switched to ART.
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Affiliation(s)
- Mohammad Fatum
- Department of Obstetrics and Gynecology, Hadassah University hospital, Ein Kerem, Jerusalem, Israel.
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49
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Kelly SM, Sladkevicius P, Campbell S, Nargund G. Investigation of the infertile couple: a one-stop ultrasound-based approach. Hum Reprod 2001; 16:2481-4. [PMID: 11726562 DOI: 10.1093/humrep/16.12.2481] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The appropriateness of many investigations for subfertility will continue to be of debate for some time yet. Of most benefit to the concerned couple would be a process that is diagnostically accurate, expeditious and reliable. It should be performed with a minimum of invasion and provide both patient and clinician with useful prognostic information regarding possible future treatment. This article is intended to illustrate the advantages of an ultrasound-based process of subfertility investigation. Discussed is the role of ultrasound compared with more invasive investigative methods such as laparoscopy and hysteroscopy. In addition, the potential capacity of newer advanced ultrasound technologies is reviewed.
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Affiliation(s)
- S M Kelly
- Diana Princess of Wales Centre for Reproductive Medicine, St George's Hospital Medical School, London, UK.
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50
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Glazener C, Ford W. Routine postcoital testing is unnecessary. Hum Reprod 2001. [DOI: 10.1093/humrep/16.5.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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