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Infertility female [keywords]
- Integral Indicator of Oxidative Stress in Human Blood. [JOURNAL ARTICLE]
- Bull Exp Biol Med 2014 Oct 24.
Here we performed individual evaluation of the oxidative stress index that serves as an integral criterion for the balance of LPO-antioxidant defense system in women with endocrine pathology (type 1 diabetes mellitus and infertility with hyperprolactinemia). The state of the LPO-antioxidant defense system was estimated from blood levels of LPO substrates with conjugated double bonds, conjugated dienes, ketodienes, conjugated trienes, thiobarbituric acid-reactive substances, retinol, α-tocopherol, reduced and oxidized glutathione, and SOD activity. The use of this oxidative stress index allowed us to diagnose oxidative stress in female patients with endocrine pathology.
- Evaluation of sonohysterography in detecting endometrial polyps - 241 cases followed with office hysteroscopies combined with histopathological examination. [Journal Article]
- Wideochir Inne Tech Malo Inwazyjne 2014 Sep; 9(3):344-50.
Hysteroscopy is considered the 'gold standard' procedure in assessing uterine pathology however it is more expensive and invasive method than ultrasonography. An alternative to the diagnostic hysteroscopy is sonohysterography.To evaluate the usefulness of sonohysterography in detecting endometrial polyps in female patients diagnosed with infertility.We compared the results of sonohysterographic examinations with hysteroscopy combined with histopathological findings.All the 241 sonohysterography examinations were performed successfully. No complications were observed. Forty-three hysteroscopies (17.8%) and six sonohysterography examinations (2.5%) were performed in short total intravenous anesthesia because of a low pain threshold of the patients. After hysteroscopic resection polyps were diagnosed in 74 (30.7%) patients. In 72 cases both saline infusion sonography (sonohysterography, SIS) examination and hysteroscopy confirmed the occurrence of an endometrial polyp. In 7 examinations (4.2%) the diagnosed polyp was not confirmed in sonohysterography (false-positive results). Two SIS procedures (2.7%) did not confirm the occurrence of the polyp (false-negative results). Sensitivity, specificity accuracy and error of sonohysterography in detecting endometrial polyps were 97.3%, 95.8% 96.2% and 3.7%, respectively. Positive and negative predictive values were 91.1% (PPV) and 98.7% (NPV). The agreement between SIS and hysteroscopy combined with histopathological examination was very high (K = 0.91).Sonohysterography is a safe and highly sensitive and specific method used in diagnostics of endometrial polyps. Its results closely correspond to those obtained in a hysteroscopic examination and histopathological analysis.
- Overtreatment in couples with unexplained infertility. [JOURNAL ARTICLE]
- Hum Reprod 2014 Oct 21.
What is the percentage of overtreatment, i.e. fertility treatment started too early, in couples with unexplained infertility who were eligible for tailored expectant management?Overtreatment occurred in 36% of couples with unexplained infertility who were eligible for an expectant management of at least 6 months.Prognostic models in reproductive medicine can help to identify infertile couples that would benefit from fertility treatment. In couples with unexplained infertility with a good chance of natural conception within 1 year, based on the Hunault prediction model, an expectant management of 6-12 months, as recommended in international fertility guidelines, prevents unnecessary treatment.A retrospective cohort study in 25 participating clinics, with follow-up of all couples who were seen for infertility in 2011-2012.In all, 9818 couples were seen for infertility in the participating clinics. Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis of natural conception (>30%) within 1 year based on the Hunault prediction model. Data to assess overtreatment were collected from medical records. Multilevel regression analyses were performed to investigate associations of overtreatment with patient and clinic characteristics.Five hundred and forty-four couples eligible for expectant management were included in this study. Among these, overtreatment, i.e. starting medically assisted reproduction within 6 months, occurred in 36%. The underlying quality indicators showed that in 34% no prognosis was calculated and that in 42% expectant management was not recommended. Finally, 16% of the couples for whom a correct recommendation of expectant management for at least 6 months was made, started treatment within 6 months anyway. Overtreatment was associated with childlessness, higher female age and a longer duration of infertility. No associations between overtreatment and clinic characteristics were found.The response rate was low compared with other fertility studies. Evaluation of possible selection bias showed that responders had a higher socio-economic status than non-responders.Our findings show that developing and publishing guideline recommendations on tailored expectant management (TEM) is not enough and that overtreatment still occurs frequently. Future research should focus on tailored efforts to implement guideline recommendations on TEM.Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none.www.trialregister.nl NTR3405.
- Clinical management and therapeutic outcome of infertile couples in southeast Nigeria. [Journal Article]
- Ther Clin Risk Manag 2014.:763-8.
Infertility is highly prevalent in Nigeria and most infertile couples in southeast Nigeria are offered conventional forms of treatment, which consist mainly of ovulation induction and tubal surgery, due to limited availability and high cost of endoscopic and assisted reproductive technologies like laparoscopy and in vitro fertilization. The aim of this study was to determine the prevalence of infertility, outcome of infertility investigation, and the treatment outcome of infertile couples following therapeutic interventions in southeast Nigeria over a 12-month period.This was a prospective cross-sectional study of 218 consecutive infertile couples presenting for infertility management at the infertility clinics of two tertiary health institutions in Enugu, southeast Nigeria. Infertility investigations were carried out on these couples using the available conventional diagnostic facilities. Following the results of the investigations/diagnosis, conventional treatment was offered to the couples as appropriate. Data analysis was both descriptive and inferential at 95% confidence level.The mean age of the women was 33.5±4.62 (range: 15-49) years. Most (58.3% [n=127]) were nulliparous. The prevalence of infertility was 12.1%. Infertility was primary in 28.4% (n=62) and secondary in 71.6% (n=156). Female etiologic factors were responsible in 32.1% (n=70), male factors in 26.1% (n=57), and a combination of male/female factors in 29.4% (n=64). The etiology was unknown in 12.4% (n=27). Tubal factors 23.8 % (n=52) and ovulation failures 26.1% (n=57) are common female factors implicated. Pregnancy rate following treatment was 16.7% (n=28). Multivariate regression analysis indicates that younger age of ≤30 years, duration of infertility ≤5 years, and female factor infertility were associated with higher pregnancy outcome following treatment.The prevalence of infertility is high and pregnancy rate following conventional treatment is poor. There is a need to improve facilities for managing infertility as well as making artificial reproductive techniques readily available, accessible, and affordable.
- 3,4-Dihydroxybenzaldehyde Derived from Prunus mume Seed Inhibits Oxidative Stress and Enhances Estradiol Secretion in Human Ovarian Granulosa Tumor Cells. [Journal Article]
- Acta Histochem Cytochem 2014 Jun 28; 47(3):103-12.
Granulosa cells form ovarian follicles and play important roles in the growth and maturation of oocytes. The protection of granulosa cells from cellular injury caused by oxidative stress is an effective therapy for female infertility. We here investigated an effective bioactive compound derived from Prunus mume seed extract that protects granulosa cells from hydrogen peroxide (H2O2)-induced apoptosis. We detected the bioactive compound, 3,4-dihydroxybenzaldehyde (3,4-DHBA), via bioactivity-guided isolation and found that it inhibited the H2O2-induced apoptosis of granulosa cells. We also showed that 3,4-DHBA promoted estradiol secretion in granulosa cells and enhanced the mRNA expression levels of steroidogenic factor 1, a promoter of key steroidogenic enzymes. These results suggest that P. mume seed extract may have clinical potential for the prevention and treatment of female infertility.
- PI3K/PTEN/Akt and TSC/mTOR signaling pathways, ovarian dysfunction and infertility: an update. [JOURNAL ARTICLE]
- J Mol Endocrinol 2014 Oct 13.
Abnormalities in ovarian function including defective oogenesis and folliculogenesis represent a key female reproductive deficiency. Accumulating evidences in literature have shown that PI3K/PTEN/Akt and TSC/mTOR signaling pathways are critical regulators of ovarian function including quiescence, activation and survival of primordial follicles (PFs), granulosa cell (GC) proliferation and differentiation, and meiotic maturation of oocytes. Deregulation of these signaling pathways may contribute to infertility caused by impaired follicular development, intrafollicular oocyte development and ovulation. This article reviews the current state of knowledge on the functional role of PI3K/PTEN/Akt and TSC/mTOR pathways during mammalian oogenesis and folliculogenesis and their association with female infertility.
- Thyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility. [JOURNAL ARTICLE]
- Endocr J 2014 Oct 10.
Infertile women sometimes associated with subclinical hypothyroidism (SCH). The guidelines of the American Endocrine Society, and American Association of Clinical Endocrinologists and American Thyroid Association recommend treatment with thyroxine (T4) for patients with SCH who want to have children. We examined 69 female infertile patients with SCH and the effects of levothyroxine (l-T4) therapy on pregnancy rates and pregnancy outcomes were observed. Fifty-eight (84.1%) patients successfully conceived during the T4 treatment period (Group A), although 17 patients (29.3%) had miscarriage afterward. The remaining 11 patients continued to be infertile (Group B). The median TSH value in Group A before the T4 treatment was 5.46 μIU/mL (range 3.1-13.3) and this significantly decreased to 1.25 μIU/mL (range 0.02-3.75) during the treatment (p<0.001). The estimated duration of infertility before the T4 treatment was 2.8±1.7 years and the duration until pregnancy after the treatment was significantly shorter at 0.9±0.9 years (p<0.001). Shortening of the infertile period after the T4 therapy was observed not only in patients who were treated with assisted reproductive technology (ART) but also in patients who conceived spontaneously in Group A. Administered T4 dose was 54.3±14.2 μg before pregnancy and 68.5±22.8 μg during pregnancy (p<0.001). Anti-thyroid autoantibodies were identified in 42.0% of all patients and no significant difference was observed in positivity between Group A and Group B. High successful pregnancy rate and shorter duration of infertility until pregnancy after T4 treatment strongly suggest that T4 enhanced fertility in infertile patients with SCH.
- Clinical analysis of transvaginal hydrolaparoscopy in infertile patients. [JOURNAL ARTICLE]
- Eur J Obstet Gynecol Reprod Biol 2014 Sep 28.:208-210.
To evaluate the application of transvaginal hydrolaparoscopy for exploration of the pelvic cavity exploration in infertile women.A total of 510 infertile women were included in this study from May 1st, 2009 to April 30, 2012 in the clinic of the Hebei Research Institute for Family Planning.In 495 of 510 of the patients (97.06%), a successful operation was achieved at the first puncture. Of these 495 patients, 286 (57.78%) showed bilateral patency. Completely normal tubo-ovarian and pelvic structures were observed only in 79 patients (15.96%): 16 patients (3.23%) had bilateral tube obstruction, 18 (3.64%) had hydrosalpinx, and 8 (1.62%) had fimbrial stenosis. Pelvic abnormalities occurred in 240 patients (44.04%), including bilateral and/or unilateral tubo-ovarian adhesions in 80 patients (16.16%) and 160 (32.32%) found with adhesions in other parts of the pelvic cavity. Pelvic endometriosis was found in 82 patients (16.57%) and 19 (3.84%) had two or more lesions in the pelvic cavity. In addition, 9 cases (1.82%) of ovarian cysts, 7 (1.41%) of bilateral vesicular appendices and 43 cases (6.69%) of a unilateral vesicular appendix were observed. In addition, convoluted tubes such as bent or twisted tubes were found in 4 cases of bilateral fallopian tube occlusion patients (0.81%) and 17 cases of unilateral tubal occlusion patients (3.43%).Transvaginal hydrolaparoscopy is a feasible, safe, and cost-effective microinvasive technique. This technique can be considered as an alternative procedure for evaluating female infertility.
- Identification of Putative Fallopian Tube Stem Cells. [JOURNAL ARTICLE]
- Reprod Sci 2014 Oct 9.
Stem cells are used to repair and regenerate multiple tissues in the adult. We have previously shown that stem cells play a significant role in mediating endometrial repair and tissue regeneration. We hypothesized that the oviduct may possess a similar population of stem cells that contribute to the maintenance of this tissue. Here we identify label-retaining cells (LRCs) in the murine oviduct which indicate the presence of a stem/progenitor cell population in this tissue as well. Two-day-old CD-1 mice were injected intraperitoneally with 5-bromo-2-deoxyuridine (BrdU) or vehicle control. Female animals (n = 36 for each group) were killed at 6 weeks post injection. Reproductive tracts were removed, specimens were embedded in paraffin, and 5-µ sections were prepared. Oviduct was identified by hematoxylin and eosin staining and morphology. Immunofluorescence studies were performed on serial sections tissues (n = 12 per animal) using antibodies against BrdU. Confocal microscopy was used to identify 4',6-diamidino-2-phenylindole (DAPI)- and BrdU-stained nuclei. In the group of mice exposed to BrdU, we identified a population of LRCs in all specimens and not in controls. The putative stem cells are located at the base of each villi, suggesting the location of the stem cell niche. The number of DAPI-stained nuclei divided by the number of LRCs; LRCs constituted 0.5% of all nucleated cells. The oviduct contains a population of progenitor cells, likely used in the repair and regeneration of fallopian tube. Defective or insufficient stem cell reserve may underlie common tubal diseases, including hydrosalpinx and ectopic pregnancy.