Types of Infertility and Its Risk Factors among Infertile Women: A Prospective Study in Dhaka City

Background: Infertility is a global health issue, and it is a multidimensional problem with social, economic, and cultural influences. Objectives: The study aimed to determine types of infertility and their contributing factors among the respondent infertile women. Methods: This prospective cross-sectional study was conducted among infertile women visiting Sir Salimullah Medical College and Hospital, Dhaka. From January to December 2020, 111 infertile women were included and evaluated for infertility types and their contributing factors. Data were collected by face-to-face interviewing, and data were analyzed statistically. Results: Primary infertility was found among 90 (81%) and secondary infertility among 21 (18.9%). Among the direct risk factors of female infertility, ovulation failure was the majority of the cases, 74 (35.1%), and its mainly observed in primarily infertile women 58 (33.9%). These observations were statistically significant. Conclusions: Infertility should be treated as a public health problem, government and non-government organizations should develop a basic policy to create effective fertility centers.

Intrafollicular Soluble RAGE Benefits Embryo Development and Predicts Clinical Pregnancy in Infertile Patients of Advanced Maternal Age Undergoing In Vitro Fertilization

Soluble receptor for advanced glycation end products（s RAGE） can decoy the toxic AGEs and is considered to be a protective factor.This study aimed to evaluate the correlation between intrafollicular s RAGE levels and clinical outcomes in infertile women of young or advanced maternal age（AMA） undergoing in vitro fertilization（IVF）.A total of 62 young women and 62 AMA women who would undergo IVF were included in this prospective study.The intrafollicular s RAGE concentration was measured to determine its association with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy in young and AMA women,respectively.Besides,correlations between sR AGE and age or follicle-stimulating hormone（FSH） were examined.We found that the intrafollicular s RAGE levels were higher in young patients than those in AMA patients,suggesting that the s RAGE levels were inversely correlated with age.In young patients,sR AGE showed no correlation with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy.But it was found that AMA patients with more retrieved oocytes,fertilized oocytes and high-quality embryos demonstrated higher sR AGE levels,which were a prognostic factor for getting clinical pregnancy independent of age or FSH level.In conclusion,the s RAGE levels decrease with age.Elevated intrafollicular s RAGE levels indicate good follicular growth,fertilization and embryonic development,and successful clinical pregnancy in AMA women,while in young women,the role of s RAGE may not be so predominant.

Effect of Yangjing Zhongyu Decoction (养精种玉汤) on MatrixMetalloproteinase-9 Expression in Endometrium and SexHormone Regulation in Women with Cryptogenic Infertility

Objective: To investigate the effect of Yangjing Zhongyu decoction (YZD, 养精种玉汤) on metalloproteinase-9 (MMP-9) and its inhibitor-1 (TIMP-1) expression and sex hormone regulation in mid-luteal phase endometrium of women with cryptogenic infertility. Methods: Twenty-two infertile women were treated with YZD for 30 days successively. During the mid-luteal phase, in situ hybridization and reverse transcription-polymerase chain reaction method was used to detect MMP-9 and TIMP-1 mRNA, and radioimmunoassay was used to determine levels of serum estradiol (E2) and progesterone (P) synchronously. Results: After treatment, the mid-luteal serum E2 and P level were 451. 501 ± 226. 342 pmol/L and 46. 502 ± 19. 948 nmol/L respectively, significantly higher than that before treatment (304.656 ± 135.853 pmol/L and 33. 782 ± 15. 459 nmol/L respectively) , the difference was significant ( P < 0. 01). Staining of MMP-9 mRNA positive granules in cytoplasm and nuclei of adeno-epithelial cell in mid-luteal phase endometrium deepened significantly, but the change in mesenchym was insignificant. The MMP-9 mRNA expression after treatment was 0.617 ± 0.186 (grey level), significantly higher than the level before treatment (0.490 ± 0. 370), comparison between them showed significant difference ( P < 0. 05 ) . Change of TIMP-1 mRNA expression in adeno-epithelial and mesenchym before and after treatment was insignificant (0. 588 ± 0. 191 vs 0. 621 ± 0. 146,P>0. 05). Correlation analysis showed that the quantitative difference of P level before and after treatment was positively correlated with the difference of MMP-9 mRNA before and after treatment (r=0. 682, P< 0.01). Conclusion: YZD could soothen Gan(肝) and nourish Shen(肾) , raise the level of mid-luteal phase serum P, and further promote MMP-9 gene expression in endometrium to benefit the degradation of extracellular matrix of endometrium, and facilitate for blastocyst implantation.Original article on CJITWM (Chin) 2004 ;24 (4): 294