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PubMedDate not supplied

Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. World Health Organization Task Force on the Prevention and Management of Infertility.

BACKGROUND AND OBJECTIVES: Sparse data exist for quantifying the association between Chlamydia trachomatis infection, salpingitis, and tubal infertility. GOAL OF THIS STUDY: To investigate the impact of Neisseria gonorrhoeae and C. trachomatis in tubal infertility. STUDY DESIGN: This was a multicenter case-control study that compared women who have bilateral tubal occlusion with other infertile women and age-matched pregnant control subjects. Reproductive and sexual history were recorded, and immunoglobulin G antibodies to C. trachomatis and N. gonorrhoeae were measured. RESULTS: Women with past chlamydial or gonococcal infections or both were significantly more likely to have bilateral tubal occlusion. The majority of women with bilateral tubal occlusion reported no history of pelvic inflammatory disease symptoms. Other infertile women had a prevalence of C. trachomatis antibodies (60%), which was similar to that of patients with bilateral tubal occlusion (71%). CONCLUSION: Sexually transmitted infections, especially C. trachomatis, are associated with tubal infertility. Because they usually cause no symptoms, public health efforts to prevent tubal infertility should focus on identifying infections in the lower genital tract before they ascend.

Adult↗

PubMed1982

Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women.

To test the widely accepted--but not well-supported--impression that endometriosis and infertility are associated, we compared the prevalence of endometriosis visualized at laparoscopy in 100 patients being evaluated for infertility and in 200 fertile control subjects (two age-matched to each patient) undergoing tubal ligation. The extent of endometriosis and adhesions noted in the operative reports was classified according to the system proposed by The American Fertility Society. Endometriosis was found in 21 of the 100 infertile patients--mild in 11, moderate in 8, severe in 2. It was found in 4 (2%) of the 200 controls and was mild in all 4. Thus, endometriosis is more often present, and more often severe, among infertile patients. The risk of infertility was estimated to be almost 20 times greater with endometriosis than without. These data support the clinical impression that an association exists.

Adult↗

PubMed1985

Treatment of idiopathic infertility, cervical mucus hostility, and male infertility: artificial insemination with husband's semen or in vitro fertilization?

Couples with male infertility (n = 86), idiopathic infertility (n = 68), and cervical mucus hostility (n = 48) of a long duration were treated either by in vitro fertilization (IVF) or artificial insemination with husband's semen (AIH). The incidence of pregnancy per cycle in couples in whom the male partner was infertile was significantly (P less than 0.01) higher after IVF, compared with AIH (21% versus 5%, respectively). The differences were most apparent in couples with asthenospermia (47% versus 0%, respectively); no significant difference was found when the infertility was caused by oligospermia only (11% versus 9%, respectively). More patients with idiopathic infertility became pregnant after one cycle with IVF, compared with AIH (20% versus 8%, respectively); but, because of intragroup disparity in size, this difference was not significant. A highly significant difference (P less than 0.01) was found after one attempt with IVF, compared with AIH, in patients with cervical mucus hostility (38% versus 3%, respectively).

Cervix Mucus↗

PubMed1987

The association between smoking and female infertility as influenced by cause of the infertility.

Smoking histories were compared in 901 women with infertility of different types and 1264 women admitted for delivery at seven collaborating hospitals. The relative risk for infertility associated with cigarette smoking prior to the infertility diagnosis for nulliparous cases or first live birth for controls was calculated using a multivariate logistic-regression model to control for potential confounding factors, including center, age, religion, education, number of sexual partners, and contraceptive use. The adjusted risk for infertility attributed primarily to cervical factor (n = 96) was 1.7 (P = 0.04), to tubal disease unrelated to endometriosis (n = 225) was 1.6 (P = 0.009), to ovulatory factor (n = 389) was 1.0 (not significant [NS]), and to endometriosis (n = 191) was 0.9 (NS). The authors conclude that cigarette smoking is significantly associated only with certain types of primary female infertility.

Adult↗

PubMed1998

Artificial insemination by husband in unexplained infertility compared with infertility associated with peritoneal endometriosis.

There have been numerous inconclusive studies examining the differences between unexplained and peritoneal endometriosis-associated infertility. Hence, the choice of artificial reproductive technique may be difficult. This prospective study compares outcome in couples with unexplained infertility and with minimal or mild endometriosis-associated infertility, undergoing treatment with ovarian stimulation combined with artificial insemination by husband. No differences were found between the unexplained infertile and the endometriosis group as to patient characteristics, response to ovarian stimulation and semen qualities. There was a significantly higher total pregnancy rate, with more multiple gestations, in the unexplained infertile compared with the endometriosis group. The difference in outcome could reflect differences in pathogenesis and aetiology for the two groups.

Adult↗

PubMed1996

Anti-seminal plasma antibodies associated with infertility: I. Serum antibodies against normozoospermic seminal plasma in patients with unexplained infertility.

PROBLEM: To determine whether patients whose infertility remains unexplained (by routine physical and laboratory investigations including sperm antibody testing) exhibits significantly elevated humoral anti-seminal plasma immune responses in comparison to fertile individuals. METHOD: Sera from 72 infertile couples were examine by ELISA for the presence of antibodies against normozoospermic seminal plasma (NSP). A group of 36 fertile individuals was used to determine the level of physiological reactivity. Kibrick's and Friberg's sperm-agglutination tests were employed to distinguish patients routinely diagnosed as immunologically infertile. RESULTS: Anti-NSP reactivity was elevated in 18% of male and 26% of female patients. In the female patients, the prevalence rate for elevated anti-NSP reactivity was significantly higher among partners of positive men. In only 4% the positive anti-NSP results coincided with sperm-agglutinating antibodies. CONCLUSION: NSP constituents other than sperm-coating antigens might interfere with infertility related autoimmune imbalance. The identification of the corresponding NSP antigens might help to resolve more cases of unexplained infertility.

Adult↗

PubMed2004

Genetic aspects of human male infertility: the frequency of chromosomal abnormalities and Y chromosome microdeletions in severe male factor infertility.

OBJECTIVE: The main purpose of this study is to detect the frequency and type of both chromosomal abnormalities and Y chromosome microdeletions in patients with severe male factor infertility and fertile control subjects. The association between the genetic abnormality and clinical parameters was also evaluated. METHODS: This study was carried out in 208 infertile and 20 fertile men. Results of 208 patients, 119 had non-obstructive azoospermia and 89 had severe oligoasthenoteratozoospermia (OAT). Seventeen out of 119 (14.3%) azoospermic patients and two out of 89 (2.2%) patients with OAT had Y chromosome microdeletions. In total, 19 cases with deletions were detected in 208 infertile men, with a frequency of 9.1%. The AZFc locus, mainly DAZ gene cluster was the most frequently deleted region. Five other cases with azoospermia (4.2%) and two cases with OAT (2.2%) had a chromosomal abnormality, with a total number of seven (3.4%). Including Y chromosome deletions and structural chromosome abnormalities, the rate of genetic abnormalities was 12.5% (26/208) in our patients. On the other hand, 20 men with proven fertility and fathers of five cases with microdeletions were genetically normal. Y chromosome deletions and chromosomal abnormalities were associated with various histological alterations in testis. Sertoli cell-only (SCO) syndrome and maturation arrest predominated in these cases, whereas hypospermatogenesis occurred more frequently in genetically normal patients. CONCLUSION: Various chromosomal abnormalities and deletions of Y chromosome can cause spermatogenic breakdown resulting in chromosomally derived infertility. All these findings strongly support the recommendation of genetic screening of infertile patients.

Chromosome Deletion↗

PubMed2004

Investigation of the infertile couple: when is the appropriate time to explore female infertility?

While the appropriate method for the investigation of female infertility continues to be debated, the timing of the investigation has received less attention. The current approach is time-consuming, and paradoxically may lead to overtreatment as well as undertreatment. Recent findings on fecundity and the conception window in humans have important implications for the timing of the investigation of female infertility. The findings support the view that fertility-oriented intercourse may have a major impact in reducing the time to pregnancy. Procedures for the investigation of female infertility are becoming less invasive and more accurate, while the therapies for infertility are more effective. It is proposed that under appropriate circumstances female infertility should be investigated after 6 months of fertility-oriented intercourse.

Coitus↗

PubMed2003

Examining congruence between partners' perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples.

Because studies examining the emotional impact of infertility-related stress generally focus on individuals, there has been little research examining how relationship and individual variables are linked. The purpose of this study was to explore the impact of congruence (e.g., agreement) between partner's perceived infertility-related stress and its effects on depression and marital adjustment in infertile men and women. Couples referred for infertility treatments at a University-affiliated teaching hospital completed the Fertility Problem Inventory (FPI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS) 3 months prior to their first treatment cycle. Study findings show that men and women in couples who perceived equal levels of social infertility stress reported higher levels of marital adjustment when compared to men and women in couples who perceived the stress differently. In addition, women in couples who felt a similar need for parenthood reported significantly higher levels of marital satisfaction when compared to women in couples where the males reported a greater need for parenthood. While couple incongruence was unrelated to depression in males, incongruence over relationship concerns and the need for parenthood was related to female depression. These findings provide initial support for the theory that high levels of agreement between partners related to the stresses they experience help them successfully manage the impact of these stressful life events. Possibilities for future research examining the construct of couple congruence are discussed.

Adult↗

PubMed1985

Animal models of male infertility: mice bearing single-gene mutations that induce infertility.

Genetically defined mouse models of male infertility are described in the present report. The mice were rendered infertile by one of the following gene mutations: Ames dwarf, dwarf, flipper-arm, hightail, hypothyroid, little, pygmy, stubby. The effects of each gene mutation on testicular steroidogenesis and spermatogenesis were elucidated by a comparison of the mutant mice to their normal siblings. Testicular steroidogenesis was assessed directly by determining steroid secretion by testes perfused in vitro. The study provides the first comprehensive assessment of testicular function in the mutant mice. The eight gene mutations can be classified into two groups based on the results. One group of gene mutations (Ames dwarf, dwarf, flipper-arm, pygmy) specifically depress spermatogenesis and testicular steroidogenesis. The infertility of these mutant mice can be linked to the lowered total sperm production. The second group of gene mutations (hightail, hypothyroid, little, stubby) do not specifically depress either spermatogenesis or testosterone secretion. Subsequently, the etiology of the male infertility of the second group of mutant mice is unknown. We propose that these mutant mice provide valuable experimental tools for the study of male infertility and male reproduction.

Animals↗

PubMed1992

Attitudes about infertility interventions among fertile and infertile couples.

BACKGROUND: There has been marked progress in the development of infertility interventions. This paper reports attitudes about 11 interventions for infertility. METHODS: Face-to-face interviews were conducted with each member of 185 infertile and 90 presumed fertile couples in southeastern Michigan. RESULTS: Seven of these interventions were generally viewed favorably and four were generally viewed negatively, regardless of the couple's fertility status. Infertile couples viewed all interventions, except for adoption, more favorably than did fertile couples. Multidimensional scaling was used to cluster the interventions according to similarity in endorsement. These clusters form a continuum from interventions that allow only one member of the couple to be a biological parent to the most noninvasive techniques. All clusters remain roughly equidistant from adoption, in which neither member of the couple is a biological parent. CONCLUSIONS: Interventions that produce a child who is biologically related to only one member of the couple were viewed most negatively. Members of couples who were receiving fertility treatment made finer discriminations among infertility interventions than did individuals who had not received treatment.

Adoption↗

PubMed1991

Infertility-associated endometrial cancer risk may be limited to specific subgroups of infertile women.

Data from previous studies suggest that infertility is a risk factor for endometrial cancer. We used data from the Cancer and Steroid Hormone Study to further characterize this relationship. The subject group comprised 399 women ages 20-54 with newly diagnosed epithelial endometrial cancer ascertained through six cancer registries. The control group comprised 3040 women in the same age range selected by random-digit telephone dialing from the same geographic areas where cancer patients resided. Compared with women who reported no fertility problem, women with physician-diagnosed infertility who had reported at least 2 years of infertility had an odds ratio for endometrial cancer, adjusted for age, of 1.7 (95% confidence interval 1.1-2.6). Women who reported infertility resulting from ovarian factors had an adjusted odds ratio of 4.2 (95% confidence interval 1.7-10.4). These results suggest that factors such as anovulation may explain much of the increased risk of endometrial cancer found among subgroups of infertile women.

Adult↗

PubMed1983

The relationship of tubal blockage, infertility of unknown cause, suspected male infertility, and endometriosis to success of in vitro fertilization and embryo transfer.

The success of in vitro fertilization (IVF) and embryo transfer has been examined with regard to five categories of infertility over a 2-year period. Fertilization rates in vitro were highest in women with bilateral tubal blockage and women treated for endometriosis. There was a significant reduction of approximately 13% in the fertilization rate of couples with idiopathic infertility and women who had failed to conceive after 12 cycles of artificial insemination by donor. A further substantial reduction in the fertilization rate occurred when the husband had low quality semen, particularly when no abnormality was detected in the wife. Repeated IVF in couples with idiopathic infertility eventually resulted in fertilization. It is recommended that donor spermatozoa not be used for cases of idiopathic infertility, but it may be needed in cases of poor semen quality. There were no differences in the pregnancy rates following embryo replacement in any of the groups studied, nor was there any detectable effect of age on fertilization or pregnancy rates up to the age of 44 years.

Adult↗

PubMed1988

Risk factors for tubal infertility among infertile and fertile women.

Data regarding previous pelvic inflammation, abdominal surgery, endometriosis, obstetrical anamnesis, usage of IUD, occurrence of abdominal pain, vaginal discharge and metrorrhagia were obtained from 120 women with tubal infertility and compared to similar data from 126 pregnant women. Previous abdominal surgery, especially pelvic surgery was the most frequent risk factor present in 59% of the infertile women followed by pelvic inflammation (42%) and endometriosis (10%). In 23% of the infertile women there was no history of abdominal surgery, inflammation or endometriosis. Abdominal surgery, inflammation, ectopic pregnancy, salpingectomy and ovarian resection were significantly more frequent among the women with tubal infertility than among the pregnant women. Finally, there was no significant difference in the occurrence of appendectomy, IUD usage, induced or spontaneous abortion.

Abdomen↗

PubMedDate not supplied

A cytogenetic study of Kuwaiti couples with infertility and reproductive disorders: short arm deletion of chromosome 21 is associated with male infertility.

Chromosomal anomalies may be a reason for both male and female infertility. The aim of this study was to investigate the contribution of chromosomal abnormalities in sterile couples from Kuwait. A total of 118 patients with clinical diagnosis of infertility was analyzed using cytogenetic banding techniques. Common chromosomal abnormalities were detected in 12 patients. We describe here one new case of an infertile male with the karyotype 46,XY, del(21)(pter;q11.2). The overall incidence of 11% abnormality indicates that routine chromosome analysis of infertile couples in Kuwait should be considered before the planning of intracytoplasmic sperm injection.

Adult↗

PubMed2001

Should all infertile males undergo urologic evaluation before assisted reproductive technologies? Two cases of testicular cancer presenting with infertility.

OBJECTIVE: To report two cases of testicular cancer in patients presenting with infertility. DESIGN: Case reports. SETTING: University-affiliated urology practice. PATIENT(S): Two men presenting with infertility. INTERVENTION(S): Complete history and physical, hormonal assays, semen analysis, scrotal ultrasound, radical orchiectomy. MAIN OUTCOME MEASURE(S): Testicular pathology specimens. RESULT(S): Testicular cancer was diagnosed in two men sent to a urology clinic for infertility treatment. CONCLUSION(S): A thorough evaluation should be completed in all males in couples presenting with infertility.

Adult↗

PubMed1988

Laser vaporization of endometriosis in an infertile population: the role of complicating infertility factors.

One hundred twenty-two infertility patients with endometriosis were evaluated and treated using laparoscopy and laser vaporization to provide immediate elimination of all intraperitoneal disease. Ninety-five couples (77.8%) had one or more infertility factors (other than endometriosis) contributing to their infertility. Cervical factors, male factors, and luteal defects were associated with significantly decreased pregnancy rates, despite the use of laser vaporization. The number of contributing factors seemed to be unrelated to the likelihood of success in achieving pregnancy. The authors emphasize the need for total evaluation of other infertility factors in these patients. Such factors should be corrected prior to the use of laser laparoscopy, if possible, and dealt with on a continuing basis following use of this technique.

Endometriosis↗

PubMedDate not supplied

Infertile couples' perceptions of infertility support-group participation.

Although nursing authors recommend that infertile clients be referred to infertility support groups, no study has identified the benefits of participation in such groups. This exploratory descriptive study investigated the benefits of infertility support-group participation as perceived by 16 men and 22 women. A questionnaire developed and used for the study consisted of open- and closed-ended questions and included a 42-item Infertility Support Group Perception Scale for which an internal consistency reliability of .91 was established. Most important, least important, anticipated, and unanticipated benefits perceived by the total group, male and female subgroups, and participation subgroups were explored. We found that significantly fewer men than women initially wanted to join the group (p less than .01), but both men and women perceived similar amounts of benefit. Anticipated and unanticipated benefits differed between men and women. Length of membership and frequency of attendance were both positively correlated with amount of benefits perceived.

Adult↗