Relationships between female infertility and female genital infections and pelvic inflammatory disease: a population-based nested controlled study

Association between bacterial vaginosis, Chlamydia trachomatis infection and tubal factor infertility in Bukavu, Democratic Republic of Congo

BACKGROUND

Tubal factor infertility (TFI) is common in sub-Saharan Africa and often secondary to pelvic inflammatory disease (PID). Anaerobes associated with bacterial vaginosis (BV) are also found in PIDs widely dominated by Chlamydia trachomatis (C. trachomatis), whose role in TFI is better demonstrated than that of BV.

OBJECTIVES

To determine the prevalence of BV and C. trachomatis and to investigate the association between BV, C. trachomatis and TFI.

METHODS

We included 137 patients treated for infertility between January 2020 and November 2021. Cases were defined as women with infertility aged 18-45 years presenting with TFI (n = 52), and controls as infertile women in the same age groups without TFI (n = 85). Data on social habits, life style and infertility parameters were collected, and we performed screening for BV and C. trachomatis. Multiple regression was used to measure associations.

RESULTS

The prevalence of BV and C. trachomatis was 42.3% (58/137) and 23.4% (32/137), respectively. BV (61.5% vs 30.6%, p<0.001) and C. trachomatis (48.1 vs 8.2%, p<0.001) were more frequent in cases of TFI. BV and C. trachomatis increased the risk of TFI approximately 4-fold [aOR: 3.77 (1.61-8.83), p=0.002] and 14-fold [aOR: 13.77 (4.59-41.27), p<0.001], respectively.

CONCLUSION

BV and C. trachomatis infection are strongly associated with TFI in Bukavu. Prevention and screening should be implemented to reduce the risk of TFI.

The role of systemic immune inflammation index in predicting treatment success in tuboovarian abscesses

PURPOSE

The aim of this study was to determine the predictability of the systemic immune inflammation index (SII) on the response to medical treatment in tubo-ovarian abscess (TOA).

METHODS

296 patients with TOA in a tertiary center were enrolled in the study. Patients were divided into two groups: Group1 (n  =  165) included patients in whom medical treatment was successful, and Group2 (n  =  131) included patients in whom surgery was required. Demographic, sonographic and laboratory findings were compared between groups. SII was calculated using peripheral blood parameters [SII  =  (platelets ∗ neutrophils)/lymphocytes].

RESULTS

Age, BMI, gravida, parity, smoking and menopausal status, CRP levels of patients were similar in both groups (p  >  0.05). Mass size (4.398 ± 0.306 vs 7.683 ± 0.689, p  <  0.001), white blood cell (WBC) (8685.08 ± 3981.98 vs 9994.35 ± 4468.024, p = 0.008), Hb (12.18 ± 1.65 vs 11.68 ± 1.65, p = 0.010), platelet to lymphocyte ratio (PLR) (151.26 ± 74.83 vs 230.77 ± 140.25, p < 0.001), neutrophil to lymphocyte ratio (NLR) (4.21 ± 3.27 vs 6.07 ± 6.6, p  =  0.003), monocyte to lymphocyte ratio (MLR) (0.300 ± 0.177 vs 0.346 ± 0.203, p = 0.041) and SII (1014.18 ± 781.71 vs 2094.088 ± 2117.58, p < 0.001) were statistically higher in group 2. ROC Analysis was used to determine the predictability of the variables and PLR (AUC = 0.718, p  <  0.001), NLR (AUC = 0.593, p  =  0.593), MLR (AUC = 0.576, p  =  0.024), SII (AUC  =  0.723, p  <  0.001) and size of mass (AUC = 0.670, p  <  0.001) were found to be significant. The SII, size of mass and bilateral involvement of adnexa were found to be the strongest prognostic factors for surgical intervention (OR:1.004 (1.002-1.005), OR:1.018 (1.010-1.027), OR:3.397 (1.338-8.627); p  <  0.001, p  <  0.001, p  =  0.010 resspectively).

CONCLUSION

SII, size of mass and bilaterality can be used to predict medical treatment success in patients with TOA.

Patterns of pediatric and adolescent female genital inflammation in China: an eight-year retrospective study of 49,175 patients in China

Background

Genital inflammation is one of the most frequent clinical complaints among girls, which was easily overlooked by the general public. This study aimed to investigate the patterns and epidemiological characteristics of pediatric and adolescent female genital inflammation in China.

Methods

A retrospective observational study (2011 to 2018) was conducted among all female patients under the age of 0-18 years at the Department of Pediatric and Adolescent Gynecology of The Children's Hospital, Zhejiang University School of Medicine. Data were collected from the electronic medical records. The abnormal vaginal discharge of patient was collected for microbiological investigation by bacterial and fungal culture. Descriptive analysis was conducted to evaluate the genital inflammation pattern and epidemiological characteristics, including age, season, and type of infected pathogens.

Results

A total of 49,175 patients met the eligibility criteria of genital inflammation and 16,320 patients later came to the hospital for follow-up over the study period. The number of first-visit increased gradually from 3,769 in 2011 to 10,155 in 2018. The peak age of the first visit was 0-6 years old. Non-specific vulvovaginitis, lichen sclerosis, and labial adhesion were the top three genital inflammation. Among the top five potential common pathogens of vaginal infection, the prevalence of Haemophilus influenzae cases was the highest (31.42%, 203/646), followed by Streptococcus pyogenes (27.74%, 176/646), Candida albicans (14.09%, 91/646), Escherichia coli (8.51%, 55/646), and Staphylococcus aureus (6.35%, 41/636). The specific disease categories and pathogens of genital inflammation vary by age groups and season.

Conclusion

Our study summarizes the pattern of pediatric and adolescent female genital inflammation over an 8-year period in China, emphasizing the need for more public awareness, healthcare services and research in this field.

Diagnosed Gonorrhea Among Privately Insured Women: Analysis of United States Claims Data

Background: Gonorrhea incidence in the United States has risen by nearly 50% in the last decade, while screening rates have increased. Gonorrhea sequelae rates could indicate whether increased gonorrhea incidence is due to better screening. We estimated the association of gonorrhea diagnosis with pelvic inflammatory disease (PID), ectopic pregnancy (EP), and tubal factor infertility (TFI) in women and detected changes in associations over time. Materials and Methods: This retrospective cohort study included 5,553,506 women aged 18-49 tested for gonorrhea in the IBM MarketScan claims administrative database from 2013-2018 in the United States. We estimated incidence rates and hazard ratios (HRs) of gonorrhea diagnosis for each outcome, adjusting for potential confounders using Cox proportional hazards models. We tested the interaction between gonorrhea diagnosis and the initial gonorrhea test year to identify changes in associations over time. Results: We identified 32,729 women with a gonorrhea diagnosis (mean follow-up time in years: PID = 1.73, EP = 1.75, TFI = 1.76). A total of 131,500 women were diagnosed with PID, 64,225 had EP, and 41,507 had TFI. Women with gonorrhea diagnoses had greater incidence per 1000 person-years for all outcomes (PID = 33.5, EP = 9.4, TFI = 5.3) compared to women without gonorrhea diagnoses (PID = 13.9, EP = 6.7, TFI = 4.3). After adjustment, HRs were higher in women with a gonorrhea diagnosis vs. those without [PID = 2.29 (95% confidence interval, CI: 2.15-2.44), EP = 1.57, (95% CI: 1.41-1.76), TFI = 1.70 (95% CI: 1.47-1.97)]. The interaction of gonorrhea diagnosis and test year was not significant, indicating no change in relationship by initial test year. Conclusion: The relationship between gonorrhea and reproductive outcomes has persisted, suggesting a higher disease burden.

Tubal Blockage Surgery: A Retrospective Cohort Study on Clinical Characteristics and Reproductive Outcomes Within Six Years

Introduction and objectives This research undertakes a comprehensive evaluation of demographic information and medical antecedents, in addition to intraoperative observations, for patients diagnosed with tubal obstruction. Furthermore, we delineate the therapeutic procedures implemented to achieve bilateral tubal patency. The overarching objective of this study is to ascertain the efficacy of the aforementioned therapeutic procedures and to establish an optimal timeframe before the necessity for exogenous intervention becomes apparent. Material and methods This study conducted a retrospective analysis of patients diagnosed with infertility due to tubal obstruction at the Oradea County Clinical Hospital, spanning a six-year period from 2017 through 2022. We evaluated numerous factors, including demographic data of the patients, intraoperative observations, and the exact site of the obstruction within the fallopian tubes. Additionally, we monitored patients post-procedure to assess their potential for fertility following the intervention. Our study involved a comprehensive examination of 360 patients in total. The primary objectives of our research were to provide clinicians with significant insights regarding the likelihood of spontaneous conception subsequent to surgical interventions and to propose guidelines on establishing an adequate waiting period prior to recommending other interventions. We employed a mix of descriptive and inferential statistical methods to analyze the data amassed. Results This study encompassed an initial patient population of 360 included in the study following specific exclusion criteria; the remaining 218 patients constituted the study cohort. The mean±SD age of the patients was 27.9±4.4. Out of the entire cohort, 47 patients presented with minimal adhesions, while 117 patients exhibited blockages in one fallopian tube. A total of 54 patients were diagnosed with bilateral tubal defects. Post-intervention, patients were monitored and it was noted that 63 patients achieved pregnancy. The correlation analysis indicated the significant impact of tubal defect characteristics and patient age on fertility outcomes. The most favorable fertility outcomes were observed to be influenced by factors such as patient age and blockage location, while a higher body mass index (BMI) was found to exert a negative impact on fertility. Temporal analysis revealed that 52 patients conceived within the initial six months post-intervention, whereas only 11 patients became pregnant in the subsequent months. Conclusions Our research indicates that age, parity, and tubal damage severity predict tubal intervention success. Fimbriolysis was the most successful, while outcomes for salpingotomy varied. Conception significantly declined 12 months post-intervention, suggesting this is a reasonable waiting limit for a successful pregnancy.

Satisfaction with the life of Polish women experiencing domestic violence

Introduction

Domestic violence against a woman, inflicted by her husband/partner, disrupts the socially recognized model of partnership and family life and endangers the health and life of the victim. The aim of the study was to assess the level of satisfaction with the life of Polish women experiencing domestic violence and compare it to results of women not experiencing domestic violence.

Methods

A cross-sectional study was conducted on a convenience sample of 610 Polish women divided in two groups: victims of domestic violence (Group 1, n = 305) and women not experiencing domestic violence (Group 2, n = 305).

Results and Conclusions

Most Polish women experiencing domestic violence are characterized by low life satisfaction. The mean value of life satisfaction in Group 1 was 13.78, SD = 4.88, significantly lower when compared to Group 2 (M = 21.04, SD = 5.61). Their satisfaction with life is related, among other things, to the form of violence inflicted upon them by their husband/partner. Abused women with low life satisfaction are most often victims of psychological violence. The most common cause is the perpetrator's addiction to alcohol and/or drugs. Assessment of their life satisfaction is unrelated to help-seeking and to the occurrence of violence in their family home in the past.

Autologous Human Mesenchymal Stem Cell-Based Therapy in Infertility: New Strategies and Future Perspectives

Infertility could be associated with a few factors including problems with physical and mental health, hormonal imbalances, lifestyles, and genetic factors. Given that there is a concern about the rise of infertility globally, increased focus has been given to its treatment for the last several decades. Traditional assisted reproductive technology (ART) has been the prime option for many years in solving various cases of infertility; however, it contains significant risks and does not solve the fundamental problem of infertility such as genetic disorders. Attention toward the utilization of MSCs has been widely regarded as a promising option in the development of stem-cell-based infertility treatments. This narrative review briefly presents the challenges in the current ART treatment of infertility and the various potential applications of autologous MSCs in the treatment of these reproductive diseases.

Chlamydia infection, PID, and infertility: further evidence from a case–control study in China

Background

Chlamydia trachomatis infection and pelvic inflammatory disease (PID) are well-known risk factors for female infertility. But there is limited evidence from China. This study aimed to further explore the associations between previous/current chlamydial infection, PID, and infertility in China.

Methods

We performed a 1:2 matched case–control study with two control groups: pregnant controls and non-pregnant controls in China in 2019. Women diagnosed with infertility were selected as cases (n = 255). Controls were selected based on the following criteria: Pregnant women who were documented in the selected hospitals were chosen as Pregnant controls (n = 510), and people who sought health care in Obstetric/Gynecologic clinics, Family Planning clinics, Dermatology and STD Department or Urological department were selected as Non-pregnant controls (n = 510). Infertility induced by male factors and people who used antibiotics in the vagina within two weeks were excluded. The first-stream specimen of urine samples was tested for chlamydia by nucleic acid amplification testing (NAAT). Conditional logistic regression was used to estimate the association.

Results

The prevalence of previous chlamydial infection and PID were significantly higher in cases (2.4%, 17.3%) than in controls (Non-pregnancy: 0.4%, 3.0%; Pregnancy: 0.4%, 9.0%). The current chlamydial infection rates were 5.9%, 7.3%, and 7.1% in infertile, pregnant, and non-pregnant women, respectively. After adjusting for confounders, PID largely elevated the risk of infertility (using non-pregnant controls: adjusted OR = 2.57, 95% CI 1.51, 4.39; using pregnant controls: adjusted OR = 6.83, 95% CI 3.47, 13.43). And the positive association between PID and tubal infertility was more obvious for both groups. For current chlamydial infection, none of the odds ratios were significant at the 0.05 level, while small sample size limited the evaluation of an association between prior chlamydial infection with infertility.

Conclusions

Previous PID was indicated to largely increase the risk of infertility, especially tubal infertility. And there should be continuing emphasis on highly sensitive and specific biomarker for prior chlamydial infection.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01874-z.

2,3,5,4′-Tetrahydroxystilbene-2-O-β-D-Glucoside improves female ovarian aging

Reduced fertility associated with normal aging may reflect the over-maturity of oocytes. It is increasingly important to reduce aging-induced infertility since recent trends show people marrying at later ages. 2,3,5,4′-Tetrahydroxystilbene-2-O-β-D-glucoside (THSG), a polyphenol extracted from Polygonum multiflorum, has been reported to have anti-inflammatory and anti-aging properties. To evaluate whether THSG can reduce aging-related ovarian damage in a female mouse model of aging, THSG was administered by gavage at a dose of 10 mg/kg twice weekly, starting at 4 weeks of age in a group of young mice. In addition, the effect of THSG in a group of aged mice was also studied in mice starting at 24 weeks of age. The number of oocytes in the THSG-fed group was higher than in the untreated control group. Although the percentage of secondary polar bodies (PB2) decreased during aging in the THSG-fed group, it decreased much more slowly than in the age-matched control group. THSG administration increased the quality of ovaries in young mice becoming aged. Western blotting analyses also indicated that CYP19, PR-B, and ER-β expressions were significantly increased in 36-week-old mice. THSG also increased oocyte numbers in aged mice compared to mice without THSG fed. Studies of qPCR and immunohistochemistry (IHC) analyses of ovaries in the aged mice groups were conducted. THSG increased gene expression of anti-Müllerian hormone (AMH), a biomarker of oocyte number, and protein accumulation in 40-week-old mice. THSG increased the expression of pgc1α and atp6, mitochondrial biogenesis-related genes, and their protein expression. THSG also attenuated the fading rate of CYP11a and CYP19 associated with sex hormone synthesis. And THSG maintains a high level of ER-β expression, thereby enhancing the sensitivity of estrogen. Our findings indicated that THSG increased or extended gene expression involved in ovarian maintenance and rejuvenation in young and aged mice. On the other hand, THSG treatments significantly maintained oocyte quantity and quality in both groups of young and aged mice compared to each age-matched control group. In conclusion, THSG can delay aging-related menopause, and the antioxidant properties of THSG may make it suitable for preventing aging-induced infertility.

Increased serum LOXL2 concentration in pelvic inflammatory disease with pelvic adhesion

Background

Lysyl oxidase-like 2 (LOXL2) belongs to a family of the LOX secretory enzyme, which involves the cross-linkage of extracellular matrix (ECM) proteins. Here, we aimed to analyze the correlation between serum LOXL2 and pelvic adhesion in chronic pelvic inflammatory disease (PID).

Methods

A total of 143 patients with PID and 130 healthy controls were included in this study. The serum levels of LOXL2 were measured using enzyme-linked immunosorbent assay (ELISA) kits. The patients were divided into non-adhesion group (102 cases) and adhesion group (41 cases).

Results

It was found that the serum level of LOXL2 expression was elevated in PID patients compared with healthy controls, and was elevated in PID patients with pelvic adhesion compared to patients without adhesion. In all PID patients, serum LOXL2 level was positively correlated with matrix metalloproteinases-9 (MMP-9), transforming growth factor-β (TGF-β1), whole blood viscosity (WBV) at low shear rate (LSR), WBV at high shear rate (HSR), and hematocrit (HcT). Multivariate logistic regression analysis showed that serum LOXL2 level was an independent risk factor for pelvic adhesion in PID patients (OR = 1.058; 95% CI = 1.030–1.086, P < 0.001).

Conclusions

Serum LOXL2 level not only predicts the presence of PID, but serum LOXL2 concentration is also associated with the presence of pelvic adhesions.

Impact of governmental support to the IVF clinical pregnancy rates: differences between public and private clinical settings in Kazakhstan-a prospective cohort study

OBJECTIVES

Infertility rates have been increasing in low-income and middle-income countries, including Kazakhstan. The need for accessible and affordable assisted reproductive technologies has become essential for many subfertile women. We aimed to explore whether the public funding and clinical settings are independently associated with in vitro fertilisation (IVF) clinical pregnancy and to determine whether the relationship between IVF clinical pregnancy and clinical settings is modified by payment type.

DESIGN

A prospective cohort study.

SETTING

Three private and two public IVF clinics located in major cities.

PARTICIPANTS

Women aged ≥18 seeking first or repeated IVF treatment and agreed to complete a survey were included in the study. Demographical and previous medical history data were collected from a survey, while clinical data from medical records. The total response rate was 14%.

PRIMARY AND SECONDARY OUTCOME MEASURES

Clinical pregnancy was defined as a live intrauterine pregnancy identified by ultrasound scan at 8 gestational weeks. The outcome data were missing for 22% of women.

RESULTS

Out of 446 women in the study, 68.2% attended private clinics. Two-thirds of women attending public clinics and 13% of women attending private clinics were publicly funded. Private clinics retrieved, on average, a higher number of oocytes (11.5±8.4 vs 8.1±7.2, p<0.001) and transferred more embryos (2.2±2.5 vs 1.4±1.1, p<0.001) and had a statistically significantly higher pregnancy rate compared with public clinics (79.0% vs 29.7%, p<0.001). Publicly funded women had on average a higher number of oocytes retrieved and a statistically significantly higher probability of clinical pregnancy (RR=1.23, 95% CI 1.02 to 1.47) than self-paid women, after adjusting for covariates. There was no statistically significant interaction between clinical setting and payment type.

CONCLUSIONS

Private clinics and public funding were independently associated with higher IVF clinical pregnancy rates. There is also a need to further investigate whether the increase in public funding will influence clinical pregnancy rates.

Fibronectin Molecular Status in Plasma of Women with Endometriosis and Fertility Disorders

The diagnosis of endometriosis and fertility disorders is difficult; therefore, it is necessary to look for reliable biomarkers. Analysis of the molecular status of fibronectin as a key player in repair and wound healing processes, as well as in coagulation and fibrinolysis pathways, is justified. ELISA and SDS-agarose immunoblotting were applied to determine the fibronectin concentration and presence and occurrence of soluble FN-fibrin complexes in the blood plasma of women with endometriosis (n = 38), fertility disorders (n = 28) and the healthy group (n = 25). The concentration of fibronectin in the blood plasma of women with endometriosis (292.61 ± 96.17 mg/L) and fertility disorders (287.53 ± 122.68 mg/L) was significantly higher than in the normal group (226.55 ± 91.98 mg/L). The presence of FN-fibrin complexes of 750, 1000, 1300, 1600 and 1900 kDa in the plasma of women with endometriosis and fertility disorders was shown. The presence of FN-fibrin complexes with a molecular mass of more than 1300 kDa in women with endometriosis and infertility and the complete absence of these complexes in healthy women may indicate an increased and chronic activation of coagulation mechanisms in these patients. The presence of complexes of high molecular mass may be one of the biomarkers of fertility disorders in women.

The Role of AIRE Deficiency in Infertility and Its Potential Pathogenesis

The increasing number of patients with infertility is recognized as an emerging problem worldwide. However, little is known about the cause of infertility. At present, it is believed that infertility may be related to genetic or abnormal immune responses. It has long been indicated that autoimmune regulator (AIRE), a transcription factor, participates in immune tolerance by regulating the expression of thousands of promiscuous tissue-specific antigens in medullary thymic epithelial cells (mTECs), which play a pivotal role in preventing autoimmune diseases. AIRE is also expressed in germ cell progenitors. Importantly, the deletion of AIRE leads to severe oophoritis and age-dependent depletion of follicular reserves and causes altered embryonic development in female mice. AIRE-deficient male mice exhibit altered apoptosis during spermatogenesis and have a significantly decreased breeding capacity. These reports suggest that AIRE deficiency may be responsible for infertility. The causes may be related to the production of autoantibodies against sperm, poor development of germ cells, and abnormal ovarian function, which eventually lead to infertility. Here, we focus on the potential associations of AIRE deficiency with infertility as well as the possible pathogenesis, providing insight into the significance of AIRE in the development of infertility.

The role of genital mycoplasma infection in female infertility: A systematic review and meta-analysis

PROBLEM

Recent studies show that lower genital tract infection with genital mycoplasma may be associated with the pathology of female infertility. However, this association remains controversial due to the variable prevalence, sample sizes, and different methods used to diagnose genital mycoplasma infection. The aim of the present meta-analysis was to gain better understanding of the specific impact of genital mycoplasma on female infertility.

METHOD OF STUDY

A systematic review of literature on the association of genital mycoplasma (Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum) infection and female infertility was performed using three electronic databases: PubMed, Scopus, and CINAHL, from January 2000 to January 2020. Pooled odds ratio (OR) and 95% confidence intervals for genital mycoplasma infection and female infertility were derived from a fixed effects model.

RESULTS

This meta-analysis included eight studies conducted in six countries. Based on the results, women with infertility had a statistically higher odds of having any genital mycoplasma infection (p < .0001) compared to the control group. The pooled OR of all the included studies was 3.82 (95% CI: 2.55, 5.72). There was an unremarkable heterogeneity in all the studies included in this meta-analysis (I²  = 0%, p = .48). A subgroup analysis also showed that M. genitalium, M. hominis, and U. urealyticum infections are significantly associated with female infertility.

CONCLUSION

Our meta-analysis showed a significant association between M. genitalium, M. hominis, and U. urealyticum infections and female infertility. This evidence supports the development of guidelines for the diagnosis and treatment of genital mycoplasma infections to prevent female infertility.

Periodontal and caries status in unexplained female infertility: A case-control study

BACKGROUND

The aim of this study was to investigate the possible association between maternal periodontal disease and dental caries that affect oral health and unexplained infertility.

METHODS

This cross-sectional case-control study included 50 fertile women and 50 women with unexplained infertility aged 21 to 39 years. Dental and periodontal parameters were examined to evaluate the oral health of the participants. According to the new periodontal disease classification, periodontitis severity was determined.

RESULTS

In infertile women, the number of advanced caries lesions, the percentage of bleeding on probing (BOP), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were higher (P < 0.05). The DMFT and mean plaque index (PI) were not statistically different between the two groups. The PISA and PESA values were higher in women with unexplained infertility than in fertile women (P = 0.005 and P = 0.002, respectively). In multivariate analysis showed that association of DMFT and BOP variables with periodontitis was found to be significant for all women included in the study and for infertile women only (P = 0.000 and P = 0.012 for DMFT, respectively; P = 0.000 and P = 0.016 for BOP, respectively).

CONCLUSION

The chronic inflammatory environment caused by periodontitis and advanced carious lesions in women with unexplained infertility should be of great concern as it may have a role in the etiology of infertility.

Fuke Qianjin Combined with Antibiotic Therapy for Pelvic Inflammatory Disease: A Systematic Review and Meta-Analysis

Background

Pelvic inflammatory disease (PID) without timely and proper treatment can cause long-term sequelae; meanwhile, patients will be confronted with the antimicrobial resistance and side effects. Chinese patent medicine as a supplement is used to treat PID with satisfactory clinical efficacy. This study evaluated the efficacy and safety of Fuke Qianjin (FKQJ) combined with antibiotics in the treatment of PID.

Methods

Eight electronic databases and other resources were searched to make a collection of the randomized controlled trials (RCTs) from 1990 to 2019. The RCTs contrasting the effect of FKQJ combined with antibiotics regimens and antibiotics alone in reproductive women with PID were included. The antibiotics regimens are all recommended by the guidelines. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality of the included studies. Then, the meta-analyses were performed by RevMan 5. 3 software if appropriate.

Results

Twenty-three RCTs (2527 women) were included in this review. The evidence showed that FKQJ combined with antibiotics improved the markedly effective rate compared to antibiotics alone group (RR = 1.38, 95% CI 1.27 to 1.49, I² = 42%), shortened the improvement time of low abdominal pain (MD = −1.11, 95% CI −1.39 to −0.84, I² = 38%), and increased the rate of lower abdominal pain improvement (RR = 1.35, 95% CI 1.19 to 1.55, I² = 0). The implementation of adjuvant reduced the recurrent rate compared with antibiotics alone (RR = 0.27, 95% CI 0.13 to 0.56, I² = 0%).

Conclusions

Based on available evidence, FKQJ combined with antibiotics therapy have certain outcomes on increasing the markedly effective rate, decreasing the recurrent rate compared with antibiotics alone group. This therapy appears to improve lower abdominal pain and curtail the relief time. Due to the low quality and the risk of bias, any high-quality evidence or longer follow-up period should be advisable and necessary in the future.

Human immunodeficiency: Extragonadal comorbidities of infertility in women

Introduction

Infertility is mediated by several changes system‐wide. These changes are likely to cause other systems‐related pathologies, such as changes in systemic immune response, particularly inflammatory response can lead to cardiovascular diseases and breast cancer.

Methods

These morbidities can exist immediately or years after the diagnosis of infertility. Therefore, understanding the mechanism is important to move toward therapeutic interventions.

Results

Several extragonadal pathologies are reported due to infertility, as well as, how these might also contribute to reproductive disabilities. Detailed evidence are still not present that can give stronger result.

Conclusion

This review highlights some of the most frequent comorbidities that are seen in infertile women, hence requiring a need for complete clinical screening and care, as well as diagnosis and treatment in early stages.

Determinants of Infertility among Married Women Attending Dessie Referral Hospital and Dr. Misganaw Gynecology and Obstetrics Clinic, Dessie, Ethiopia

Background

Infertility is the inability to become pregnant after one year of sexual intercourse without the use of contraception. Epidemiological data suggest that 10 to 15% of couples around the world are suffering from infertility. The exact meaning of marriage is mainly fulfilled if the couple conceives and bears children. Failure of this often leads to unhappy married lives, divorces, and high levels of psychiatric morbidity. There is scarcity of data about determinants of infertility in Ethiopia. Therefore, the aim of this study is to identify the determinants of infertility among married women attending Dessie Referral Hospital and Dr. Misganaw gynecology and obstetrics specialty clinic, Dessie, Ethiopia, 2019.

Methods

An institution-based case-control study was conducted on 281 participants. The participants were selected by a systematic random sampling technique. Data were collected using a structured interviewer-administered questionnaire. Data were entered into EpiData version 3.1 and exported to SPSS version 23 for analyses. Variables with p < 0.25 in bivariable logistic regression were entered into multivariable logistic regression. Odds ratio with its 95% confidence interval was estimated to measure the direction and strength of the association. The level of statistical significance was set at p < 0.05.

Results

The determinants of women's infertility were age at the first pregnancy (AOR = 2.89; 95% CI: 1.105, 7.564), age at menarche (AOR = 3.2; 95% CI: 1.278, 7.975), menstruation flow in days (AOR = 4.17; 95% CI: 0.062, 0.929), multiple sexual partners (AOR = 5.33; 95% CI: 2.124, 13.397), and history of STI (AOR = 2.79; 95% CI: 1.088, 7.159).

Conclusion

Age at the first pregnancy, age at menarche, multiple sexual partners, number of days of menstruation flow, and history of STI were determinants of women's infertility. Infertility may bring about unhappy married lives, divorces, and high levels of psychiatric morbidity. Therefore, couples need to have heath education about risk factors for infertility.