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PubMed1988

Leydig cell function in infertile men with idiopathic oligospermic infertility.

To evaluate Leydig cell function in men with idiopathic oligospermic infertility and its eventual role in their infertility, plasma LH, testosterone (T), 17-hydroxyprogesterone (170HP), and estradiol levels as well as plasma T/LH and 170HP/T ratios were measured in 103 such men, subdivided into different groups according to their plasma FSH levels. The results were compared to results in normal young fertile men, the subgroup of men with idiopathic oligospermic infertility who within 12 months after consultation succeeded in impregnating their partner, infertile men with a history of undescended testes (excryptorchid men), and men with Klinefelter's syndrome. As a tentative parameter of androgen insensitivity, an androgen insensitivity index [LH (IU/L) X T (nMol/L)] was calculated. Although all men with idiopathic infertility had plasma T and LH levels within the normal range, LH levels increased and T/LH ratios decreased with increasing FSH levels, while the 170HP/T and estradiol/T ratios were independent of the FSH levels and T/LH ratios. The decreased T/LH ratios in the presence of normal T levels suggest compensated Leydig cell insufficiency, which possibly contributes to the infertility. Indeed, none of the men (n = 12) with normal FSH levels but a T/LH ratio lower than 1.50 achieved fatherhood within 12 months of follow-up, although all other hormonal parameters were within the normal range. During the same period 25 men with T/LH ratios greater than 1.50 succeeded in impregnating their partners (P less than 0.05). In infertile excryptorchid men and even more so in men with Klinefelter's syndrome, plasma T levels and T/LH ratios were significantly decreased, the decrease being greater than in patients with idiopathic azospermia with similar FSH levels. None of the excryptorchid men with normal FSH levels but T/LH ratios below 1.50 fathered a child during the follow-up study. We suggest that the T/LH ratio is an additional useful prognostic parameter of infertility. Plasma T levels were increased in 15% of patients with idiopathic infertility, but increased plasma LH together with increased T levels (increased androgen resistance index) were found in only 1 man. An increased index, however, was found in 6 azoospermic excryptorchid men and 4 of 28 men with Klinefelter's syndrome. Taken together these data suggest that this index is not a reliable parameter of androgen resistance.

17-alpha-Hydroxyprogesterone↗

PubMedDate not supplied

Screening for infertility in Indonesia. Results of examination of 863 infertile couples.

During a five-year study, 863 infertile couples were examined by a quite simple screening procedure, adapted to the facilities or a rural hospital. Tubal obstruction, with an incidence of 45.4% appeared to be the most prominent cause of infertility. The second most important factor was poor semen quality, which accounted for 32.4%. Azoospermia was found in 12% of all semen samples, and a sperm count below 5 million/ml in 8.7%. Disturbances in ovulation were responsible for 13% of the infertility. Comparison of the causes of primary and secondary infertility demonstrated the greater role played by the semen factor in primary infertility and of the tubal factor in secondary infertility. Accordingly, the female-male ratio in secondary infertility was much higher than in primary infertility.

Fallopian Tube Patency Tests↗

PubMed1994

Vascular resistance in uterine and ovarian arteries: its association with infertility and the prognosis of infertility.

In this study we investigated the blood flow in uterine (u.a.) and ovarian arteries (o.a.) in healthy women and infertility patients and the relationship of vascular resistance to the etiology and the prognosis of infertility. A total of 101 consecutive infertility patients referred to hospital for investigations were studied by Doppler ultrasound. Couples with male infertility were excluded. The control group comprised 19 healthy women having regular menstrual cycle and no history of infertility. The pulsatility index (PI) in o.a. and u.a. was measured in pre- and post-ovulatory phase of the menstrual cycle. The PI values of the controls were compared with those of the patients with various infertility etiologies. The PI values of the infertility patients who subsequently delivered were compared with those of the patients failing to deliver. Infertility patients had high PI in o.a. and u.a. in the luteal phase more often than controls. High vascular resistance in u.a. and o.a. in the luteal phase reduce the take-baby-home rate.

Adult↗

PubMed1997

Cumulative pregnancy rates in couples with anovulatory infertility compared with unexplained infertility in an ovulation induction programme.

Using a retrospective analysis, we compared cumulative pregnancy rates, early pregnancy failure rates and multiple pregnancy rates in couples with polycystic ovarian syndrome (PCOS) (n = 148), hypogonadotrophic or eugonadotrophic hypogonadism (n = 91) and unexplained infertility (n = 117), who were treated in an ovulation induction clinic between January 1991 and December 1995. The women were treated with either human menopausal gonadotrophin (HMG) or purified follicle stimulating hormone (FSH). The cumulative pregnancy rate (derived from life-table analysis) after four ovulatory treatment cycles was 70% in the PCOS group, 74% in the hypogonadism group and 38% in the unexplained infertility group. The cumulative pregnancy rate in the unexplained infertility group was significantly lower than the other groups (P < 0.001) but there was no significant difference between PCOS and hypogonadism using the log rank test. The early pregnancy failure rate was 25% in the PCOS group, 27% in the hypogonadism group and 26% in the unexplained infertility group (chi(2) = 0.132, not significant). The multiple pregnancy rate was 20% in the PCOS group, 30% in the hypogonadism group and 17% in the unexplained infertility group (chi(2) = 2.105, not significant). Treatment of anovulatory infertility using HMG or FSH is effective irrespective of the cause. Couples with unexplained infertility are less successfully treated using HMG: correction of unexplained infertility may involve more than simple correction of possible subtle ovulatory defects.

Adult↗

PubMed1988

Incidence of infertility of immune origin in a group of marriages with unexplained infertility.

This study was designed to estimate the incidence of infertility of immune origin in a group of 102 married couples with unexplained infertility, out of a total of 1346 couples being treated for infertility. The tests included microagglutination of spermatozoa, microzone sera immunoelectrophoresis and sera immunodiffusion methods. In this group the sera of 23 (22.55%) women and 21 (20.58%) men contained antibodies, and these seemed to be the only cause of infertility. In relation to the total number of 1346 couples, infertility of immune origin was found in 1.70% of female and 1.56% of male partners. Conjugal immune-origin infertility was present in 0.56% of marriages. Out of 1346 treated infertile marriages, an immunologic factor was evidently the only cause of infertility in 2.57%.

Autoantibodies↗

PubMed1996

Interleukins-6 and -8 levels in sera and cervical mucus of fertile, idiopathic infertile, and immunoinfertile women: implication in infertility.

PROBLEM: The purpose of this study was to investigate the levels of interleukin-6 and -8 (IL-6 and IL-8) in sera and cervical mucus of infertile (idiopathic and immunoinfertile) women and to compare the levels with those in age-matched normally cycling fertile women. METHODS: Levels of IL-6 and IL-8 were measured in the sera and cervical mucus of fertile and infertile women by the enzyme-linked immunosorbent assay (ELISA). A non-parametric Mann-Whitney test was used to evaluate significance between the means. Linear regression analysis of IL-6 and IL-8 concentrations in serum versus cervical mucus and with antisperm antibody titers was performed by condition as well as all groups together. P < 0.05 was considered significant. RESULTS: Both IL-6 and IL-8 were detected in sera and cervical mucus of fertile as well as infertile groups. Although serum levels of IL-6 and IL-8 were significantly different between fertile and infertile groups, the differences were more pronounced in the cervical mucus samples. Cervical mucus of idiopathic and immunoinfertile women demonstrated significantly (P = 0.002 to < 0.0001) greater concentrations of IL-6 and IL-8 compared to fertile controls. In general, there was no significant correlation between the serum and cervical mucus IL-6 and IL-8 levels, whether analyzed by condition or all groups together. CONCLUSIONS: Elevated levels of IL-6 and IL-8 in cervical mucus of infertile groups may play a role in etiology of idiopathic and immunologic infertility. These findings suggest that the measurements of cytokines (especially IL-6 and IL-8) in cervical mucus may provide a tool for specific diagnosis and possibly treatment of infertility, especially idiopathic infertility.

Antibodies↗

PubMed2006

Infertility, infertility treatment, and congenital malformations: Danish national birth cohort.

OBJECTIVES: To examine whether infertile couples (with a time to pregnancy of > 12 months), who conceive naturally or after treatment, give birth to children with an increased prevalence of congenital malformations. DESIGN: Longitudinal study. SETTING: Danish national birth cohort. PARTICIPANTS: Three groups of liveborn children and their mothers: 50,897 singletons and 1366 twins born of fertile couples (time to pregnancy < or = 12 months), 5764 singletons and 100 twins born of infertile couples who conceived naturally (time to pregnancy > 12 months), and 4588 singletons and 1690 twins born after infertility treatment. MAIN OUTCOME MEASURES: Prevalence of congenital malformations determined from hospital discharge diagnoses. RESULTS: Compared with singletons born of fertile couples, singletons born of infertile couples who conceived naturally or after treatment had a higher prevalence of congenital malformations-hazard ratios 1.20 (95% confidence interval 1.07 to 1.35) and 1.39 (1.23 to 1.57). The overall prevalence of congenital malformations increased with increasing time to pregnancy. When the analysis was restricted to singletons born of infertile couples, babies born after treatment had an increased prevalence of genital organ malformations (hazard ratio 2.32, 1.24 to 4.35) compared with babies conceived naturally. No significant differences existed in the overall prevalence of congenital malformations among twins. CONCLUSIONS: Hormonal treatment for infertility may be related to the occurrence of malformations of genital organs, but our results suggest that the reported increased prevalence of congenital malformations seen in singletons born after assisted reproductive technology is partly due to the underlying infertility or its determinants. The association between untreated infertility and congenital malformations warrants further examination.

Cohort Studies↗

PubMed1996

Functional infertility and femininity: a comparison of infertile women and their mothers.

The hypotheses that functionally infertile women and their mothers will express more difficulties in femininity and motherhood than organically infertile women and their mothers, and that mothers of functionally infertile women will evince less such difficulties were investigated with groups of functionally infertile women, former mechanically infertile women, and their mothers (n = 20, each). The results showed significantly more difficulties in the functional daughters/mothers groups. Each daughters' group scored similar to their respective mothers. There were significant correlations between the results of the daughters and their mothers only for the functionally infertile group. While the existence of a conflicted maternal background was demonstrated, difficulties in femininity and motherhood did not appear to constitute a sufficient cause for functional infertility.

Adult↗

PubMed2006

Relationship between epidemiological features and aetiology of male infertility as diagnosed by a comprehensive infertility service provider.

This study examined the relationship between demographic features and aetiological causes of male infertility. Primary infertility was the presentation in 78% of patients. The incidence of varicocele was the highest (31%), whereas only 4.6% had vasectomy reversal and 7.4% of men were diagnosed with idiopathic infertility. Using the chi-squared test, there was no significant difference in the incidence of different causes of infertility among different ethnic groups (White, African-American, Asian, Hispanic, and other). Furthermore, there was no increased incidence of infertility aetiology with any particular occupation, race, religion, smoking or alcohol intake. In this study population, there was no association between the various risk factors (occupation, smoking, alcohol intake, and race) and the aetiologies of infertility. The proportion of patients diagnosed with idiopathic infertility was significantly less than reported in the literature.

Alcohol Drinking↗

PubMed2007

Infertility, infertility treatment and twinning: the Danish National Birth Cohort.

BACKGROUND: We have previously observed that an increasing time to pregnancy (TTP) is associated with a reduced frequency of twin deliveries in couples not receiving infertility treatment. By using updated information, we assessed the frequencies of dizygotic (DZ) and monozygotic (MZ) twin deliveries as a function of infertility (TTP > 12 months), as well as infertility treatment. METHODS: From the Danish National Birth Cohort (1997-2003), we identified 51 730 fertile couples with TTP 12 months and 5163 infertile couples who conceived after treatment. Information on zygosity, available for part of the cohort (1997-2000), was based on standardized questions on the similarities between the twins at the age of 3-5 years. RESULTS: Compared with fertile couples, the frequency of DZ twin deliveries was lower for infertile couples conceiving naturally (odds ratio 0.4, 95% confidence interval 0.2-0.7) and was much higher for infertile couples conceiving after treatment (17.3, 14.4-20.7). The frequency of DZ twin deliveries decreased with TTP in untreated couples, whereas the frequency of MZ twin deliveries remained constant. CONCLUSIONS: The frequency of DZ twin deliveries decreased with TTP and substantially increased with infertility treatment, whereas MZ twin deliveries remained substantially unchanged.

Adult↗

PubMed1985

Sperm survival studies in peritoneal fluid from infertile women with endometriosis and unexplained infertility.

Peritoneal fluid (PF) volume and sperm survival (motility and velocity) were studied in PF from women with unexplained infertility, infertile women with endometriosis and fertile women without endometriosis using a laser light scattering technique. PF volume was significantly larger in the group of women with unexplained infertility (P less than 0.025) and in infertile women with endometriosis (P less than 0.003) when compared with fertile women. There was a significant reduction in the percentage motile sperm in women with unexplained infertility (P less than 0.001) and in infertile women with endometriosis when compared with fertile women (P less than 0.001). In infertile women with endometriosis a positive correlation was observed between peritoneal fluid volume and reduction in the percentage of motile sperms (P less than 0.01).

Body Fluids↗

PubMed1999

[The evaluation of 156 cycles of intracytoplasmic sperm injection in the management of male infertility and idiopathic infertility].

OBJECTIVE: The aim of this study was to examine, retrospectively, the efficacy of intracytoplasmic sperm injection (ICSI) in the treatment of male infertility and idiopathic infertility. METHODS: From November 1995 to January 1998, 140 couples (156 cycles) received ICSI because of severe male factor infertility or idiopathic infertility in our assisted reproductive technology center. The treatment cycles were divided into two groups, group I included 74 cycles done before May 1997, group II included 82 cycles done after May 1997. Mature oocytes were selected for microinjection. RESULTS: No differences were observed between the two groups in the number of mature oocyte and the total cleavage rate. Oocyte survival rate, normal fertilization rate, embryos of good morphology rate and clinical pregnancy rate were significantly higher in group II than that in group I. CONCLUSION: ICSI procedure does affect the quality of embryos. With the improvement of ICSI technique, ICSI should be the treatment of choice for male infertility and idiopathic infertility.

Adult↗

PubMed1996

The economics of infertility: developing an infertility managed-care plan.

Infertility is a natural disorder for developing a managed-care plan. Infertility has a clearly defined end point. The treatment regimens and protocols used for treating infertile couples have predictable outcomes; it is possible to develop rational treatment plans over a limited period of time. It is not unreasonable for infertile couples to share the cost of treatment and for the physician-providers to share the economic risk by providing a bundle of optimal services at a fixed price. We present the theoretic basis for an infertility managed-care plan and the requirements for developing a plan that can be sold in the marketplace. Finally, we discuss some of the consequences of an infertility managed-care plan on physician relationships, physician manpower, research, and education.

Clinical Protocols↗

PubMed2003

Analysis of 508 infertile male patients in south-western Finland in 1980-2000: hormonal status and factors predisposing to immunological infertility.

OBJECTIVE: To analyse the factors predisposing to male immunological infertility from the hospital records of 508 patients that had been treated for infertility in the Turku University Central Hospital from 1980 to 2000. In addition, the hormonal status was investigated at the beginning of treatment. RESULTS: Patients with a history of mumps, or either a fresh varicocele or a history of varicocele had statistically significant lower levels of MAR antisperm antibodies (ASAs) than patients with no such conditions. Repair of varicocele (either surgical or embolisation), showed a statistically significant enhancement of the total sperm cell counts in ejaculates, but it appeared not to have any influence on other parameters of the semen analysis (mobility and morphology). Of all male infertility patients, 66.3% had normal hormonal status at the beginning of treatment, 12.6% of patients had hypotestosteronemia and 22.1% had subclinical hypogonadism. Patients with subclinical hypogonadism had lower total sperm cell count in ejaculates than patients with normal hormonal status although they had statistically significant more offspring. In addition, it appeared that mumps orchitis as well as smoking and alcohol abuse are risk factors for subclinical hypogonadism. CONCLUSION: No clear predisposing factor for male immunological infertility could be found. However, patients with subclinical hypogonadism differed from other male infertility patients and thus may form a special group among the male infertility patients.

Alcoholism↗

PubMed2000

Infertility as a transformational process: a framework for psychotherapeutic support of infertile women.

The purpose of this qualitative descriptive study was to investigate the phenomenon of infertility as experienced by infertile women. A purposive sample of 25 infertile women participated in the study. Data were extracted from taped interviews and the researcher's observational field notes. Data analysis was conducted according to the techniques described by Miles and Huberman (1994). Participant responses to interviews were categorized by examining the interview transcripts and identifying significant statements and meanings. Themes which emerged from the statements were then ascertained and cross-case comparisons were made in order to confirm or to reconsider these themes. Five key themes emerged from the data: failure to fulfill a prescribed societal norm, assault on personal identity, mourning, transformation, and restitution. The women experienced infertility as a transformational process in which they mourned their loss of reproductive function and parenting roles and struggled to make restitution for the perceived stigma and powerlessness associated with nonfulfillment of a prescribed societal norm, the exclusion from cherished societal rituals, and the deprivation of ties of descent. Findings from this study have provided a framework for increased awareness of the phenomenon of infertility and for the essential components of supportive counseling or psychotherapy, regardless of the outcome of the infertility experience.

Adult↗

PubMed2004

Impaired Leydig cell function in infertile men: a study of 357 idiopathic infertile men and 318 proven fertile controls.

To investigate whether an impaired Leydig cell function is present in severely oligospermic men, serum testosterone (T), LH, estradiol (E(2)), and SHBG levels in 357 idiopathic infertile men were compared with levels in 318 proven fertile men. In addition, the T/LH ratio, E(2)/T ratio, and calculated free T index (cFT) were compared between the two groups.A shift toward lower serum T levels, cFT, and T/LH ratio and higher serum LH, E(2), and E(2)/T levels was observed in the group of infertile men. On average, the infertile men had 18, 26, and 34% lower serum T, cFT, and T/LH levels, respectively, and 19, 18, and 33% higher serum LH, E(2), and E(2)/T levels, respectively, than the fertile men. Twelve percent of the infertile men had a serum T level that fell below the 2.5 percentile of the fertile levels, and 15% of the infertile men had a LH level that was above the 97.5 percentile of the fertile levels.Thus, the group of infertile men showed significant signs of impaired Leydig cell function in parallel to their impaired spermatogenesis. The association of decreased spermatogenesis and impaired Leydig cell function might reflect a disturbed paracrine communication between the seminiferous epithelium and the Leydig cells, triggered by distorted function of the seminiferous epithelium. On the other hand, the parallel impairment of spermatogenesis and Leydig cells may reflect a congenital dysfunction of both compartments caused by a testicular dysgenesis during fetal/infant development.

Adult↗

PubMed1996

Infertile women with and without endometriosis: a case control study of luteal phase and other infertility conditions.

OBJECTIVE: To assess the relationship in infertile women between endometriosis and luteal phase defects and other infertility conditions. SETTING: University Medical School. DESIGN: Case-control study. PATIENTS: One hundred and seventy-four infertile women with endometriosis and 174 infertile women without endometriosis, all of them studied by laparoscopy. The inclusion criteria were failure of six cycles of ovulation stimulation or abnormal preliminary study (abnormal pelvic physical, hysterosalpingographic or ultrasound findings). RESULTS: The frequency of out-of-phase biopsies (16.1% vs 16.7%) as well as other endometrial abnormalities were similar in endometriosis associated infertility (EAI) and in non-endometriosis infertility (NEI). Mean progesterone and prolactin levels, as well as the proportion of abnormal progesterone levels (37.4% vs 44.3%) and of hyperprolactinemia (12.9% vs 13.2%) were similar in EAI and NEI. The frequency of uterine myomas was similar in both groups. Sperm characteristics were not better in EAI than in NEI. Higher endometriosis stages were not associated with a higher frequency of the aforementioned conditions. CONCLUSION: Luteal phase defects, sperm abnormalities and myomas are no more common in EAI than in NEI or in advanced stages of endometriosis.

Adult↗

PubMed2003

Epidemiology of infertility: social problems of the infertile couples.

Infertility is of public health importance in Nigeria and many other developing nations because of its high prevalence and especially due to its serious social implications. A review of the epidemiology of infertility in Nigeria and other parts of Sub-Saharan Africa is presented and socio-cultural issues including the social impact on couples are discussed. The major cause of infertility in Africa is infection--STDs, post-abortal and puerperal sepsis. Beliefs about causes, and failure of orthodox methods of treatment have led many couples to seek solution from traditional doctors and faith healers without success. Infertility causes marital disharmony, which often leads to divorce. Women are often blamed for the infertility and men engage in polygyny in an attempt to have children. The couple can also suffer stress from the management of the infertility. Adoption is not popular and assisted reproduction has medico-legal implications. Preventive measures are suggested, including counselling at every stage of the management.

Adult↗