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PubMed2003

Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination?

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.

Endometriosis↗

PubMed2004

Coping with infertility: a body-mind group intervention programme for infertile couples.

BACKGROUND: The recognition of the distressing character of infertility diagnosis and treatment has led to the development of several psychosocial interventions for infertile couples. At the Leuven University Fertility Centre, a body-mind marital group intervention was developed to help infertile couples cope with the distress related to infertility. METHODS AND RESULTS: This treatment programme was originally adapted from a mind-body approach, but integrated concepts and techniques from body-oriented therapy, art therapy and multi-family group therapy. In this paper, the therapeutic foundations, treatment goals and practical implications of the mind-body marital group intervention are outlined. Further, the treatment procedure is explained in detail and illustrated by clinical vignettes. CONCLUSIONS: Although the first clinical impressions about the usefulness of the body-mind group programme in fertility clinics seem promising, further research is needed to assess its effectiveness.

Adaptation, Psychological↗

PubMed1995

An infertility primer for family therapists: II. Working with couples who struggle with infertility.

The distress of infertility and its medical treatments are profound, and the effects reverberate in each partner, the couple dyad, and the couple's relationships with family, friends, and medical systems. Yet family therapists, like others in our society, are often uninformed or misinformed about the experience of infertility. While the legacies of infertility may be painful and enduring, they often remain unspoken, and hence may be overlooked in standard interviews. This article describes the experiences of couples struggling with infertility, most of whom have sought medical intervention, and it provides treatment interventions for guiding couples through this difficult and often uncharted terrain. Case vignettes derived from 2 years of this clinical research study are included.

Adaptation, Psychological↗

PubMedDate not supplied

Maternal identity and early mothering behavior in previously infertile and never infertile women.

The differences in maternal identity and early mothering behavior were compared in previously infertile and never infertile women in this pilot study to evaluate the relationship between previous infertility and the early maternal experience. Women were tested by questionnaire, observation, and interview. No significant differences were noted between groups for quantitative early mothering behavioral measurements. Previously infertile mothers demonstrated lower postpartum maternal identity scores, delay in preparation of the home environment, and less self-confidence.

Adult↗

PubMed1998

[Cytotoxic activity of NK cells in the presence of the peritoneal fluid fro women with unexplained infertility and with endometriosis related infertility].

We examined peritoneal fluid obtained during laparoscopy in the aspect of its influence on cytotoxic activity of NK cells. We showed significant suppression of this activity in women with unexplained infertility. The suppression of NK activity was also present in women fertile and infertile both, with severe endometriosis. These results may indicate the immunological disorders in unexplained infertility and in endometriosis-related infertility.

Ascitic Fluid↗

PubMed1999

Immunological assessment of infertility by estimation of antisperm antibodies in infertile couples.

160 clinical samples were collected from 40 infertile couples with unexplained infertility. The samples collected included serum and seminal plasma of the male partners and serum and cervical mucus samples of the female partners. 25 fertile healthy couples were investigated as controls. All the samples collected were then tested for class-specific antisperm antibodies by an Enzyme linked immunosorbent assay (ELISA). Antisperm antibodies were detected in 30% of the infertile couples which included 25% female and 10% male partners. Amongst the cases positive for antisperm antibodies, antibodies were detected most frequently in female sera 58.4% followed by male sera 33% and 25% in cervical mucus. The isotyping of antisperm antibodies in various samples showed IgG to be the most frequent type specific antibody followed by IgM & IgA types of antibodies. ELISA has provided a relatively simple, reliable and highly reproducible method of detection of antisperm antibodies. Thus application of antisperm antibody testing especially in cervical mucus should become an integral part of the investigation of immunologic infertility.

Adult↗

PubMed1989

Mesterolone and idiopathic male infertility: a double-blind study. World Health Organization Task Force on the Diagnosis and Treatment of Infertility.

A prospective randomized double-blind study was undertaken to assess the effect on male fertility of 6 months' treatment with the synthetic androgen mesterolone. The study was performed in seven centres and 248 infertile couples were recruited. All men and their partners were investigated according to the standardized WHO protocol--Investigation and Diagnosis of the Infertile Couple. Following this investigation, 157 couples were selected in whom the male diagnosis was primary idiopathic testicular failure or idiopathic low sperm motility; the female partner had no demonstrable cause for infertility or was under successful treatment for a minor endocrine problem. The remaining 91 couples admitted were either incompletely investigated or had some additional factor associated with infertility. Men received either 150 or 75 mg mesterolone daily or placebo. Response was assessed in terms of semen characteristics and the partner's pregnancy rate. The cumulative life table pregnancy rates among all couples 8 months after randomization were 9 +/- 3% (+/- standard error), 12 +/- 4% and 16 +/- 4% in the placebo, 75 and 150 mg mesterolone groups, respectively. The ratios of the pregnancy rates compared to placebo were 1.3 (0.5-3.2) and 1.8 (0.7-4.4) for the 75 and 150 mg mesterolone groups respectively. Among the subset of 157 couples satisfying the strict eligibility criteria, the pregnancy rates were 11 +/- 5%, 12 +/- 5% and 19 +/- 6% in the placebo, 75 and 150 mg mesterolone groups, respectively. The corresponding ratios of pregnancy rates to the placebo group were 1.2 (0.4-3.4) and 1.8 (0.6-5.3) for the 75 and 150 mg mesterolone groups respectively. There were no significant changes semen quality during the course of the study, apart from an increase in sperm concentration 3 months after the start of treatment. The increase was greatest among the placebo treated group, but did not differ significantly between treatment groups.

Adult↗

PubMedDate not supplied

Scanning electron microscopic study on the shape of infertile seminiferous tubules: a hypothesis of pathogenesis of idiopathic male infertility.

The shape of infertile seminiferous tubules was studied on testicular biopsied specimens from patients with idiopathic male infertility using the scanning electron microscope. A parallel study of the same sections was performed by ordinary light microscopy. Normal seminiferous tubules were revealed to be shaped like a weaving cylinder, whereas infertile seminiferous tubules were strangulated in various places, or appeared similar to a tail-like rope which became gradually more slender. These strangulated or slender parts of tubules seemed to correspond to the smaller tubules with thickened tubular walls that were recognized under the light microscope. It is suggested that these thickened tubular walls suppress spermatogenesis by a nutritional disturbance, and the strangulations of infertile tubules interfere with sperm transport by tubular blockage or germinal disorganization and interrupted contractions of the tubules.

Adult↗

PubMed1995

The pregnancy rates of cohorts of idiopathic infertility couples gives insights into the underlying mechanism of infertility.

OBJECTIVES: To determine causes of "idiopathic" infertility, the IVF-ET experience of three cohorts of couples with this diagnosis was examined. DESIGN: Three cohorts of idiopathic infertility couples undergoing IVF-ET: a "failed IUI" group, three previous controlled ovarian hyperstimulation (COH)-IUI cycles with no pregnancies; a "conversion" group, patients converted during a COH-IUI cycle to IVF-ET because of excess follicle numbers; and a "direct IVF" group, patients proceeding directly to IVF-ET were compared. SETTING: A tertiary referral reproductive medicine unit. PARTICIPANTS: Forty-one idiopathic infertility couples. INTERVENTION: In vitro fertilization-ET. MAIN OUTCOME MEASURES: Number of oocytes retrieved, percent oocytes fertilized, number embryos per ET, implantation rate, percent pregnancy per cycle. RESULTS: The cohorts had similar fertilization rates and mean (+/- SD) number of pre-embryos transferred. The conversion group demonstrated a higher pregnancy rate (PR) per cycle and a higher E2 concentration than the other groups. The PR of 35.0% in the direct IVF group appeared higher than the 16.7% rate observed in the failed IUI group. CONCLUSIONS: Our observation of a lower PR in couples in the failed IUI group (16.7%) than in couples in the direct IVF group (35.0%) suggests pre-embryo developmental problems or implantation problems as likely important etiologies for a large proportion of idiopathic infertility couples. However, as the conversion group demonstrated both a significantly higher E2 concentration ([E2]) and per cycle PR than the other cohorts with similar fertilization and pre-embryo transfer rates. Subjects converted in a COH-IUI cycle to IVF-ET are thus either more likely to produce pre-embryos more genetically capable of continued development to implantation stage (i.e., better oocytes recruited and fertilized) or due to the higher [E2] to have endometrium more receptive to implantation. Neither undiagnosed tubal factors nor fertilization problems appear to be major etiologic contributors.

Adult↗

PubMed1993

[Diagnostic methods for finding causes of infertility, results of HSG examination and laparoscopy in infertile women examined at the gynecologic ward of the city hospital].

The paper presents diagnostic methods employed at the Gynaecological Ward of the City Hospital in Pruszków and the results of HSG and laparoscopy examination, with special attention being drawn to the usefulness of these methods in finding out the causes of infertility. 51 patients with primary and second infertility were examined. HSG and laparoscopy make it possible to diagnose correctly the cause of infertility. They also enable adequate and early classification of patients for further diagnosis and treatment at highly specialized centres dealing with the problems of infertility.

Female↗

PubMed2000

Investigation of the infertile couple: investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal.

At present, several of the elements in widespread use in basic infertility testing are in dispute, marked variability exists in the work-up among specialists, and practice patterns are influenced both by modern assisted reproductive technologies (ART) and the increasing age of couples seeking help for infertility. This article is intended to stimulate the debate on a possible (lack of) usefulness of conventional methods of infertility evaluation in relation to both the modern techniques of assisted reproduction and the woman's age.

Coitus↗

PubMed2000

Infertility and psychosexual disorders: relationship in infertile couples.

175 consecutive infertile couples were interviewed together and individually in accordance with a 25 point questionnaire. Amongst the males, premature ejaculations 66% was most common problem followed by erectile dysfunction 15%, decreased libido 11% and orgasmic failure 8%. Amongst females dyspareunia 58%, decreased libido 28% and orgasmic failure 14% were most common problems. Various type of misconceptions were also observed in the infertile couples. Lack of sexual awareness and education formed an important part of observations. Psychosexual dysfunction and infertility was found to occur, in a large number of couples, together in association. Most common cause for this problem seems to be ignorance and lack of sex education.

Adult↗

PubMed1979

Treating the emotional aspects of infertility: counseling services in an infertility clinic.

The physician treating the infertile couple, while attempting to diagnose and treat the cause of that problem, all too frequently overlooks the emotional aspects of involuntary sterility. Infertility can cause tremendous strains on the patients, either individually or as a couple. An approach to meeting these needs can be achieved through a program of counseling, provided as a service in an infertility center.

Counseling↗

PubMed1991

Ectopic pregnancy and infertility following treatment of infertile couples: a follow-up of 929 cases.

A follow-up analysis was made of 929 infertile couples, with special attention paid to ectopic pregnancy. The conception rate was 46%, and 9% of the pregnancies were ectopic. Previous ectopic pregnancy, an industrial occupation and smoking reduced the fecundity and increased the risk of ectopic pregnancy. Tubal damage as a verified reason for infertility and its treatment also increased the risk of ectopic pregnancy. Stepwise logistic regression analysis showed the strongest association with ectopic pregnancy to exist in the case of women with a previous ectopic pregnancy (9.9-fold risk) rather than women with primary infertility. Treatment of tubal damage by salpingostomy entailed a 6.0-fold risk and treatment by other methods a 2.8-fold risk. Women working in industry had a 3.5-fold risk of ectopic pregnancy compared with those in other professions.

Abortion, Spontaneous↗

PubMed2004

Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology?

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.

Adult↗

PubMed1983

Macrophages and infertility: oviductal macrophages as potential mediators of infertility.

Human peritoneal macrophages have previously been shown to phagocytize normal sperm. We had hypothesized that if macrophages were present in the distal oviducts, they could interfere with fertilization by phagocytizing sperm in vivo. The present study was designed to determine whether functional macrophages are present in the human oviducts, and to determine the relationship between oviductal and peritoneal macrophages. Forty patients undergoing laparotomy for sterilization or evaluation of infertility or other gynecologic factors were studied. Infertile patients with endometriosis had more peritoneal macrophages than did fertile normal women or infertile women with distal or proximal tubal obstruction. Oviductal macrophages were observed in all patients. The oviductal macrophages were indistinguishable from the peritoneal macrophages, as judged by similar morphologic features, adherence to plastic, phagocytosis of polystyrene spheres and IgG-coated erythrocytes, and presence of peroxidase and alpha-naphthylbutyrate esterase. Patients with endometriosis had the highest numbers of oviductal macrophages, while those patients with distal tubal obstruction had extremely few oviductal macrophages. The results suggest that oviductal macrophages may arise from peritoneal macrophages that migrate into the oviducts.

Adult↗

PubMed1983

Behavioral and emotional factors: comparisons of anovulatory infertile women with fertile and other infertile women.

This controlled study compared behavioral and emotional factors in a group of anovulatory infertile women requesting treatment to achieve pregnancy. The sample comprised 49 women with secondary amenorrhea or oligomenorrhea in the treatment group, 141 women in the fertile comparison group, and 104 women with diagnoses other than anovulation in an infertile comparison group. Scores on the Hopkins Symptom Checklist (HSCL-90), the Eysenck Personality Inventory, the Langner Screening Scale, a Mood Analog Scale, and the Minnesota Multiphasic Personality Inventory (MMPI) were in the normal range and did not differ significantly between the groups. On other measures, the treatment group rated itself significantly less potent than to partner, mother, or father and reported more inhibited sexual attitudes than the comparison groups. Conclusions were that neurotic personality structure or psychopathology were not significantly greater in the treatment group than in the comparison groups. Whether the lower self-esteem and inhibited sexual attitudes of the treatment group resulted from or preceded infertility could not be determined.

Anovulation↗

PubMed1990

The mind/body program for infertility: a new behavioral treatment approach for women with infertility.

There is increasing evidence that a behavioral treatment approach might be efficacious in the treatment of the emotional aspects of infertility and may lead to increased conception rates. The first 54 women to complete a behavioral treatment program based on the elicitation of the relaxation response showed statistically significant decreases in anxiety, depression, and fatigue as well as increases in vigor. In addition, 34% of these women became pregnant within 6 months of completing the program. These findings established a role for stress reduction in the long-term treatment of infertility. They further suggest that behavioral treatment should be considered for couples with infertility before or in conjunction with reproductive technologies such as intrauterine insemination and gamete intrafallopian transfer.

Cognition↗