Infertility female [keywords]
- Presence of HHV-6A in Endometrial Epithelial Cells from Women with Primary Unexplained Infertility. [JOURNAL ARTICLE]
- PLoS One 2016; 11(7):e0158304.
To elucidate the roles of human herpesvirus (HHV)-6 primary unexplained infertile women, a prospective randomized study was conducted on a cohort of primary unexplained infertile women and a cohort of control women, with at least one successful pregnancy. HHV-6 DNA was analyzed and the percentage and immune-phenotype of resident endometrial Natural Killer (NK) cells, as the first line of defense towards viral infections, was evaluated in endometrial biopsies. Cytokine levels in uterine flushing samples were analyzed. HHV-6A DNA was found in 43% of endometrial biopsies from primary unexplained infertile women, but not in control women. On the contrary, HHV-6B DNA was absent in endometrial biopsies, but present in PBMCs of both cohorts. Endometrial NK cells presented a different distribution in infertile women with HHV6-A infection compared with infertile women without HHV6-A infection. Notably, we observed a lower percentage of endometrial specific CD56brightCD16- NK cells. We observed an enhanced HHV-6A-specific endometrial NK cell response in HHV-6A positive infertile women, with a marked increase in the number of endometrial NK cells activating towards HHV-6A infected cells. The analysis of uterine flushing samples showed an increase in IL-10 levels and a decrease of IFN-gamma concentrations in infertile women with HHV6-A infection. Our study indicates, for the first time, that HHV-6A infection might be an important factor in female unexplained infertility development, with a possible role in modifying endometrial NK cells immune profile and ability to sustain a successful pregnancy.
- Sharma's Python Sign: A New Tubal Sign in Female Genital Tuberculosis. [Journal Article]
- J Lab Physicians 2016 Jul-Dec; 8(2):120-2.
Female genital tuberculosis (FGTB) is an important cause of infertility in developing countries. Various type of TB salpingitis can be endosalpingitis, exosalpingitis, interstitial TB salpingitis, and salpingitis isthmica nodosa. The fallopian tubes are thickened enlarged and tortuous. Unilateral or bilateral hydrosalpinx or pyosalpinx may be formed. A new sign python sign is presented in which fallopian tube looks like a blue python on dye testing in FGTB.
- Prevalence of infertility and help seeking among 15 000 women and men. [JOURNAL ARTICLE]
- Hum Reprod 2016 Jun 30.
What is the prevalence of infertility and of help seeking among women and men in Britain?One in eight women and one in ten men aged 16-74 years had experienced infertility, defined by unsuccessfully attempting pregnancy for a year or longer, and little more than half of these people sought medical or professional help.Estimates of infertility and help seeking in Britain vary widely and are not easily comparable because of different definitions and study populations.A cross-sectional population survey was conducted between 2010 and 2012 with a sample of 15 162 women and men aged 16-74 years.Participants completed the Natsal-3 questionnaire, using computer-assisted personal interviewing (CAPI) and computer-assisted self-interview (CASI).The reported prevalence of infertility was 12.5% (CI 95% 11.7-13.3) among women and 10.1% (CI 95% 9.2-11.1) among men. Increased prevalence was associated with later cohabitation with a partner, higher socio-economic status and, for those who had a child, becoming parents at older ages. The reported prevalence of help seeking was 57.3% (CI 95% 53.6-61.0) among women and 53.2% (CI 95% 48.1-58.1) among men. Help seekers were more likely to be better educated and in higher status occupations and, among those who had a child, to have become parents later in life.These data are cross-sectional so it is not possible to establish temporality or infer causality. Self-reported data may be subject to recall bias.The study provides estimates of infertility and help seeking in Britain and the results indicate that the prevalence of infertility is higher among those delaying parenthood. Those with higher educational qualifications and occupational status are more likely to consult with medical professionals for fertility problems than others and these inequalities in help seeking should be considered by clinical practice and public health.Funding was provided by grants from the Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health. AMJ is a Governor of the Wellcome Trust. Other authors have no competing interests.
- A retrospective study of single frozen-thawed blastocyst transfer. [Journal Article]
- Clin Exp Reprod Med 2016 Jun; 43(2):106-11.
To study the clinical outcomes of single frozen-thawed blastocyst transfer cycles according to the hatching status of frozen-thawed blastocysts.Frozen-thawed blastocysts were divided into three groups according to their hatching status as follows: less-than-expanded blastocyst (≤EdB), hatching blastocyst (HgB), and hatched blastocyst (HdB). The female age and infertility factors of each group were evaluated. The quality of the single frozen-thawed blastocyst was also graded as grade A, tightly packed inner cell mass (ICM) and many cells organized in the trophectoderm epithelium (TE); grade B, several and loose ICM and TE; and grade C, very few ICM and a few cells in the TE. The clinical pregnancy and implantation rate were compared between each group. The data were analyzed by either t-test or chi-square analysis.There were no statistically significant differences in average female ages, infertility factors, or the distribution of blastocyst grades A, B, and C in each group. There was no significant difference in the clinical pregnancy and implantation rate of each group according to their blastocyst grade. However, there was a significant difference in the clinical pregnancy and implantation rate between each group. In the HdB group, the clinical pregnancy and implantation rate were similar regardless of the blastocyst quality.There was an effect on the clinical outcomes depending on whether the blastocyst hatched during single frozen-thawed blastocyst transfer. When performing single frozen-thawed blastocyst transfer, the hatching status of the frozen-thawed blastocyst may be a more important parameter for clinical outcomes than the quality of the frozen-thawed blastocyst.
- Human GV oocytes generated by mitotically active germ cells obtained from follicular aspirates. [Journal Article]
- Sci Rep 2016.:28218.
Human female germline stem cells (FGSCs) have opened new opportunities for understanding human oogenesis, delaying menopause, treating infertility, and providing a new strategy for preserving fertility. However, the shortage of adult human ovaries tissues available impedes their future investigations and clinical applications. Here, we have established FGSC lines from scarce ovarian cortical tissues that exist in follicular aspirates (faFGSCs), which are produced and discarded in in vitro fertilization centers worldwide. The faFGSCs have characteristics of germline stem cells involved in the gene expression profile, growth characteristics, and a normal karyotype consistent with that of FGSCs obtained from ovarian cortexes surgically removed from patients (srFGSCs). Furthermore, faFGSCs have developmental potentials including spontaneous differentiation into oocytes under feeder-free conditions, communicating with granulosa cells by gap junctions and paracrine factors, entering meiosis after RA induction, as well as forming follicles after injection into human ovarian cortical tissues xenografted into adult immunodeficient female mice. Lastly, we developed a strategy guiding FGSCs differentiated into germinal vesicle (GV) stage oocytes in vitro and revealed their developmental mechanisms. Our study not only provides a new approach to obtain human FGSCs for medical treatment, but also opens several avenues to investigate human oogenesis in vitro.
- Effects of gamma radiation on fetal development in mice. [Journal Article]
- Int J Reprod Biomed (Yazd) 2016 Apr; 14(4):247-54.
Many cancer patients receive radiotherapy which may lead to serious damages to the ovary storage and the matrix muscle state. Some of these patients may admit to infertility clinics for having pregnancy and on the other hand hormonal administration for superovulation induction is a routine procedure in assisted reproduction technology (ART) clinics.This study aimed to investigate fertility and fetuses of hormone treated super ovulated female mice who had received whole-body gamma irradiation before mating.Female mice were randomly categorized into a control group and 3 experimental groups including: Group I (Irradiation), Group II (Superovulation), and Group III (Superovulation and Irradiation). In hormone treated groups, mice were injected with different doses of pregnant mare's serum gonadotropin (PMSG) followed with human chorionic gonadotropin (HCG). Irradiation was done using a Co-60 gamma ray generator with doses of 2 and 4 Gy. Number of fetuses counted and the fetus's weight, head circumference, birth height, the number of live healthy fetuses, the number of fetuses with detected anomalies in the body, the sum of resorption and arrested fetuses were all recorded as outcome of treatments.In the group I and group II, increased radiation and hormone dose led to a decrease in the number of survived fetuses (45 in 2 Gy vs. 29 in 4 Gy for irradiated group) as well as from 76 in 10 units into 48 in 15 units. In the group III, a higher dose of hormone in the presence of a 2 Gy irradiation boosted the slink rate; i.e. the number of aborted fetuses reached 21 cases while applying the dose of 15 Iu, whereas 6 cases of abortion were reported applying the hormone with a lower dose. Among different parameters studied, there was a significant difference in parameters of weight and height in the mouse fetuses (p=0.01).The data indicated that use of ovarian stimulating hormones in mice that received pre mating gamma irradiation did not significantly increase the pregnancy rates.
- A population-based survey on family intentions and fertility awareness in women and men in the United Kingdom and Denmark. [JOURNAL ARTICLE]
- Ups J Med Sci 2016 Jun 27.:1-8.
Across several European countries family formation is increasingly postponed. The aims of the study were to investigate the desire for family building and fertility awareness in the UK and Denmark.A population-based internet survey was used among women (n = 1,000) and men (n = 237) from the UK (40%) and Denmark (60%). Data covered socio-demographics, family formation, and awareness of female age-related fertility. Data analysis used descriptive statistics and logistic regression analysis for studying associations between low fertility awareness and desired family formation.The majority of all participants desired two or three children. Two-thirds of the childless participants desired a first child at 30+ years, and one-fifth of the women and one-third of the men desired a last child at age 40. Overall, 83% of women and 73% of men were aware that female fertility starts to decline around 25-30 years. Men had significantly lower fertility awareness. Women who underestimated the impact of age on female fertility were significantly more likely to have a desire or attempted their first child at a higher age.Even though the majority were aware of the age-related decrease in female fertility, most desired having children at an age when female fertility has declined. Women who were not sufficiently aware of the impact of advanced age were significantly more likely to have their first child at a higher age. There is a need for developing educational programs for women and men in order to increase the population's knowledge of fertility and risk factors for infertility.
- Fertility and Childbearing Among American Female Physicians. [JOURNAL ARTICLE]
- J Womens Health (Larchmt) 2016 Jun 27.
Female physicians may experience unique challenges regarding fertility and family planning. We sought to determine childbearing patterns and decision-making among American female physicians.In 2012-2013, we surveyed a random sample of 600 female physicians who graduated medical school between 1995 and 2000. Primary outcome measures included fertility and childbearing history, reflections regarding decision-making, perceptions of workplace support, and estimations of childbearing potential.Response rate was 54.5% (327/600). A majority (82.0%) of the sample were parents, 77.4% had biological children with an average of 2.3 children. Average age at medical school graduation was 27.5 years, at completion of training (completion of medical school, residency, and/or fellowship) was 31.6 years, and at first pregnancy was 30.4 years. Nearly one quarter (24.1%) of respondents who had attempted conception were diagnosed with infertility, with an average age at diagnosis of 33.7 years. Among those with infertility, 29.3% reported diminished ovarian reserve. When asked what they would do differently in retrospect, most respondents (56.8%) would do nothing differently regarding fertility/conception/childbearing, 28.6% would have attempted conception earlier, 17.1% would have gone into a different specialty, and 7.0% would have used cryopreservation to extend fertility. Fewer of those whose first pregnancy was in medical school perceived substantial workplace support (68.2%) than those whose first pregnancies followed training (88.6%).A substantial proportion of female physicians have faced infertility or have regrets about family planning decisions and career decision-making. Combining a medical career with motherhood continues to pose challenges, meriting further investigation and targeted support.
- Antagonist protocol versus clomiphene in unexplained infertility: A randomized controlled study. [Journal Article]
- Taiwan J Obstet Gynecol 2016 Jun; 55(3):326-30.
The primary purpose of this randomized controlled trial study was to compare clinical pregnancy rates and ovulation parameters in female patients of unexplained infertility undergoing intrauterine insemination (IUI) using an antagonist protocol versus a conventional clomiphene citrate protocol.This was a multicenter parallel randomized controlled, open-label trial. A central randomization center used computer generated tables to allocate treatments. We conducted the study in two centers: Saudi Center and Samir Abbas and Assisted Reproductive Techniques Center of Cairo University, Cairo, Egypt between January 2011 and January 2014. Six hundred and twenty-two couples with unexplained infertility were randomized into two equal groups with 27 excluded after randomization: the antagonist protocol group and the clomiphene group. Antagonist protocol: human menopausal gonadotropins were given to 298 patients from Day 2 to reach a dominant follicle of 18-22 mm, intramuscularly. Then, orgalutrone (0.25 mg) was subcutaneously started from Day 6 or Day 7 until the day of human chorionic gonadotropins (hCG; that was given in the dose of 10,000 IU, intramuscularly) when follicles reached 18-22 mm. Afterward, the IUI of 0.5 mL was done from 34 hours to 36 hours using IUI catheter without guidance of ultrasonography and with an empty urinary bladder. The clomiphene citrate protocol was clomiphene citrate given 100 mg/d to 297 patients from Day 2 to Day 6 and follow up until day of hCG. The clinical pregnancy rate detected with ultrasound confirmed fetal heart pulsations at 6-weeks' gestation (4 weeks after IUI). The number of dominant follicles, level of serum estradiol, and luteinizing hormone at the day of hCG injection and the incidence of twin or triplet pregnancies in both groups were secondary outcome measures.The clinical pregnancy rate in the antagonist protocol group was significantly (p < 0.001) higher than in the clomiphene group. It was 80 patients (27%) in the antagonist protocol group versus 41 patients (14%) in the clomiphene group. The mean number of dominant follicles was significantly (p < 0.001) greater in the antagonist protocol group (4.36 ± 1.36 dominant follicles) compared with the clomiphene group (2.71 ± 0.96 dominant follicles). In addition, the rate of twin pregnancies was 15 cases in the antagonist protocol group versus six cases only in the clomiphene group (p = 0.047). The luteinizing hormone also was significantly lower in the antagonist group (2.1 ± 1.3) compared with that in the clomiphene group (9.5 ± 3.6).IUI clinical pregnancy rates were significantly higher by antagonist protocol.
- Female digit length ratio (2D:4D) and time-to-pregnancy. [JOURNAL ARTICLE]
- Hum Reprod 2016 Jun 23.
Is the female 2th- to 4th-finger ratio (2D:4D) associated with fecundity as measured by time-to-pregnancy (TTP)?Our study does not support an association between female 2D:4D and TTP.The 2th- to 4th-finger ratio (2D:4D) has been proposed as a potential indicator of greater androgen exposure during fetal development. Women exposed in utero to unbalanced steroid hormones may have impaired fecundity in the adulthood. Fecundity is often measured by TTP, an epidemiological tool commonly used to assess the impact of environmental factors in human conception.The Maternal-Infant Research on Environmental Chemicals (MIREC) Study is a pregnancy and birth cohort of 2001 women recruited before 14 weeks of gestation in 10 cities across Canada between 2008 and 2011. The present analysis is part of MIREC-CD Plus, a follow-up study in a subsample of some 800 MIREC mothers and their children from 2012 to 2015.TTP and maternal characteristics were collected from questionnaires administered during the first trimester of pregnancy as part of the MIREC study. Digital pictures of the ventral surface of both hands were obtained in the MIREC mothers at the MIREC-CD Plus follow-up study. The 2D:4D was calculated as the ratio of the second and fourth fingers of each hand. The exposure of interest was the 2D:4D of the women categorized by tertiles, or dichotomized as ≥1 (index finger longer than the ring finger) or <1 (ring finger longer than the index finger, implying greater androgen exposure during fetal development). The final sample included 696 mothers. Statistical analyses included discrete-time Cox proportional hazard models, allowing adjustment for potential confounding factors.There was no evidence of diminished/increased fecundability according to the 2D:4D, neither on the right nor on the left hand. In our analysis by tertiles, the smallest 2D:4D (i.e. higher androgen exposure during fetal life) resulted in FORs higher than 1 (i.e. shorter TTP) in both hands, although this was not statistically significant (FOR 1.19 [95% CI 0.93, 1.51] in the right hand and 1.16 [95% CI 0.91, 1.47] in the left hand). In the dichotomous analysis, 2D:4D <1 resulted in FORs higher than 1 (i.e. shorter TTP), but this was also not statistically significant (FOR 1.08 [95% CI 0.88, 1.33] in the right hand and 1.14 [95% CI 0.92, 1.42] in the left hand). Our large sample size resulted in a high statistical power to exclude an association between female 2D:4D and TTP.The MIREC Study is a cohort of pregnant women, and therefore, women with infertility were excluded by design from our study.Our data do not provide evidence for an association between female 2D:4D and fecundity as measured by TTP. Whether the female 2D:4D is a marker of in utero androgen exposure and whether it is associated with fecundity have yet to be determined.The MIREC Study was funded by Health Canada's Chemicals Management Plan, the Canadian Institute of Health Research (CIHR grant # MOP - 81285), and the Ontario Ministry of the Environment. MIREC-CD Plus was funded by Health Canada's Chemicals Management Plan Research Fund. The 2D:4D component was funded by a research grant from the CIHR-Quebec Training Network in Perinatal Research (QTNPR). M.P. Vélez was supported by a CIHR Fellowship Award, and a QTNPR scholarship. P. Monnier is supported by the Research Institute of the McGill University Health Centre. W.D Fraser is supported by a CIHR Canada Research Chair. There are no conflicts of interest to declare.