Ultrasound Causes of Female Infertility at the Fertilia Medical Clinic in Bamako

Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultrasound. The objective of our study was to investigate the ultrasound causes likely to prevent the occurrence of pregnancy in a group of infertile and subfertile women. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between January 2017 and January 2022, which involved 250 women wishing to become pregnant (infertile or subfertile), who came for pelvic ultrasound or follicular monitoring and who agreed to participate in our study. The parameters used were ultrasound reports including uterine, ovarian and tubal pathologies. It should be noted that in some cases no ultrasound cause of infertility was found. Data were entered and analyzed in SPSS. Results: 250 women were recruited into our. The average age was 32 years with extremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 years old. 139 patients or 55.6% had secondary infertility against 44.4% primary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 patients or 19.2% had no significant ultrasound abnormality. The most represented ultrasound lesions were of uterine origin with 72.20%, 23.7% ovarian lesions and 04% tubal lesions. Uterine lesions were dominated by myomas, adenomyosis, endometrial polyps, uterine malformations and synechiae. As for ovarian lesions we noted cysts, polycystic ovary syndrome (PCOS), ovarian endometriosis, non-follicular ovaries and tubal ultrasound lesions showed unilateral or bilateral hydrosalpinx. Conclusion: In our study, ultrasound was an invaluable contribution to the diagnosis of the causes likely to explain subfertility and infertility in our respondents. She highlighted uterine, ovarian and tubal lesions, some of which could be corrected and pregnancies ensued.

Place of Selective Tubal Catheterization in the Management of Female Infertility in Togo

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction. Method: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative β-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after the failure of spontaneous tubal opacification. The parameters studied related to socio-epidemiological, clinical and radiological data. Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified;62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%. Conclusion: Selective tubal catheterization is a simple technique, without major complications with an efficiency close to natural fertility. It should be proposed as the first intention before any other procedure in the treatment of infertility by proximal tubal obstruction.

Interference with the C-terminal structure of MARF1 causes defective oocyte meiotic division and female infertility in mice

Meiosis-arrest female 1（MARF1） is a recently identified key oogenic regulator essential for the maintenance of female fertility and genome integrity in mice. However, the detailed functions and the underlying mechanisms of MARF1 remain elusive. Here, in an attempt to create a mouse model expressing fluorescent protein-tagged MARF1 to facilitate further exploration of the roles of MARF1 in oocytes, we produced a Marf1-eGFP knockin（KI） mouse line in which the C-terminal structure and function of MARF1 were interfered by its fusing eGFP peptide. Using these Marfl-eGFP-KI mice, we revealed, unexpectedly, the functions of MARF1 in the control of oocyte meiotic division.We found that the Marfl-eGFP-KI females ovulated mature oocytes with severe meiotic and developmental defects,and thus were infertile. Moreover, meiotic reinitiation was delayed while meiotic completion was accelerated in the KI-oocytes, which was coincident with the increased incidence of oocyte aneuploidy. Therefore, MARF1 is indispensable for maintaining the fidelity of homolog segregation during oocyte maturation, and this function relies on its C-terminal domains.

An evaluation of methods for the test of tubal patency in female infertility

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A Retrospective Study of the Prevalence of Female Infertility in the Southwest Region, Cameroon

Background: Infertility is a major reproductive health care problem that affects the wellbeing of women. Although views vary between cultures, infertility is seen almost exclusively as a woman’s problem in Africa with secondary infertility being the most prevalent while sexually transmitted infections the most investigated cause of infertility. Objective: The aim of this study was to determine the prevalence of female infertility in the Limbe and Buea Regional hospitals of the Southwest region of Cameroon from 2015-2019. Materials and Methods: A retrospective descriptive design was used which involved studying clinical files of women within the reproductive age group (15 - 49) with infertility problems, at the gynaecological and maternity units of the selected hospitals in the Southwest region of Cameroon over a period of five years (2015-2019). Data were collected from all files included in the study. Results: A total of 4609 females visited the two hospitals for investigation and 1111 files were identified with infertility giving prevalence of 24 %. Three hundred and forty-three (343;31%) presented with primary infertility while seven hundred and sixty-eight (768;69%) had secondary infertility. The average age of affected female was 31.5 making age the predisposing factor of infertility because after the peak of 25 years, infertility started decreasing. Employment with salary and the association between diagnosis and age had a p-value < 0.005 which was considered significant in this study. Conclusion: This study found that the prevalence of infertility in Southwest Cameroon is high with secondary infertility being most predominant among infertile women with a prevalence of 69% caused principally by sexually transmitted infection (STIs). Age and occupation were significantly associated with infertility. Routine laboratory screening of women of reproductive age may reduce the high prevalence of infertility in the study area.

The fate of surplus embryos in the setting of assisted reproductive technology:A scoping review

Objective:To identify the attitudes of infertile couples toward their surplus frozen embryos.Methods:This study was according to PRISMA-ScR as the guideline for scoping review.Studies that assessed the attitudes of patients or infertile couples who had surplus embryos were included.We conducted systematic searches in English studies from April 2011-April 2021 using 7 databases:PubMed,Science Direct,EBSCO,Scopus,the Cochrane Library,Sage Journals,and Google Scholar.Data were charted based on author,year of publication,country,purpose,data collection,key findings,and research focus/domain.Results:A total of 37 research articles were included in the analysis.Their attitudes encompassed:supporting the donation of the surplus embryos for both research and reproductive purposes,continuing to store the frozen embryos,and disposing of the surplus embryos.Conclusions:Most of the infertile patients support donating their surplus embryos for research and reproductive purposes.

Network pharmacology-based prediction and verification of the mechanism for Bushen Chengyun granule on low endometrial receptivity

Objective:Bushen Chengyun granule(BCG)is an empirical treatment for female infertility(FI)caused by low endometrial receptivity(LER)involving a poorly understood mechanism.In this study,network pharmacology was used to explore the potential therapeutic mechanism of BCG on FI caused by LER.Methods:The corresponding herb targets were obtained by conducting a search in the Traditional Chinese Medicine Systems Pharmacology Database and PubMed-reported literature.Disease targets were obtained from the following databases:Comparative Toxicogenomics Database,Human Phenotype Ontology,and Therapeutic Target Database.Treatments for LER using BCG have used target matching(BCG e LER target).Then,the predicted targets were uploaded to the Search Tool for the Retrieval of Interacting Genes/Proteins database for gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analyses.Furthermore,triptorelin acetate for injection t menotrophin t chorionic gonadotropin for injection were used to establish a mouse model of blastocyst implantation disorder and to evaluate the in vivo effect of BCG on blastocyst implantation.Results:Overall,156 bioactive chemical components and 1092 targets of BCG were identified.The results indicated that 482 biological processes(FDR<0.01)and 15 pathways(FDR<0.01)related to BCG participated in the complex treatment effects and were associated with the endocrine system,inflammatory responses,metabolism,apoptosis,ovulatory performance,and angiogenesis.Moreover,16 hub nodes of BCG including estrogen receptor(ESR1),estrogen receptor beta(ESR2),progesterone receptor,et al,were recognized as potential treatment targets and might help clarify the underlying therapeutic mechanisms of BCG for female infertility.BCG significantly increased the protein expressions of estrogen receptors and progesterone receptors.Conclusions:These findings reveal the potential therapeutic mechanism of BCG for female infertility involves low endometrial receptivity,which should be evaluated further.

News Release

The Cleveland Clinic Foundation is inviting appli-cations from persons interested in advanced training inareas of male or female infertility and sexual function.The training is designed for residents, clinicians, ARTpersonnel and scientists with background and interest inthe field of Reproductive Medicine, Andrology, andSexual Dysfunction. Selected candidates will get an op-portunity to:

The Endometrium Biopsy and Hystero-Laparoscopy in Evaluation of Women’s Infertility. A Prospective Study in Algeria

Female infertility is considered as a real obstacle to the development of a couple who cannot conceive in a natural way. The aim of this study is to evaluate female infertility using two complementary methods of exploration: hystero-laparoscopy and endometrial biopsy, to compare histopathological data with those of hystero-laparoscopy findings in the same patients, and finally assess the interest to couple both methods to detect a greater number of pathologies. Our prospective study included 64 patients aged 20 - 43 years with primary or secondary infertility for a period of 3 years ranging from 2012 to 2015 at obstetrics and gynecology department in which all patients were admitted to a hysteroscopy followed by laparoscopy. Endometrial biopsy curettage was performed and sent to the Pathological Anatomy Department for a histopathological study. On 64 infertile women explored, no pathologies were findings in 20 patients (31.3%) to the biopsy and 27 patients (42.2%) by hysteroscopy-laparoscopy. Histopathological study was in favor of dysfunctional endometrium (50%) followed by hyperplasia (10.9%). The lesions findings in the hystero-laparoscopy were in the first place uterine (18.8%) followed by equally between tubal and endometrial pathologies (10.9%). Associated diseases affecting the same organs or more were recorded with a percentage of 7.8%. The two methods have been shown effective and the most of common pathologies findings were uterine and endometrial. We concluded that the endometrial biopsy was more decisive in the exploration of endometrium pathologies while hystero-laparoscopy is more sensitive for the exploration of uterine, tubal and ovarian pathologies. Each method taken individually was revealed incomplete. It is more interesting to systematically couple the histology with endoscopic examination in order to detect a greater number of pathologies.

Chinese Medicine as Complementary Therapy for Female Infertility

Chinese medicine (CM) has been used in clinical treatment for thousands of years in China, Japan, Korea, and other countries. CM is at present attracting many attentions around the world for reproductive health care and disease prevention, including treatment of female infertility. This review focuses on the CM treatment for female infertility patients, and supplies a summary on the efficacy, safety, and mechanism of some Chinese herbal medicines, herbal medicine-derived active compounds, and acupuncture. A large number of researches have reported that CM could alleviate or even cure female infertility by regulating hormone, improving reproductive outcome of in vivo fertilization, affecting embryonic implantation, curing polycystic ovarian syndrome, endometriosis, pelvic inflammatory disease, relieving mental stress, and regulating immune system. Meanwhile, a few studies claimed that there was little adverse reaction of CM in randomized controlled trials. However, up to present there is a lack of adequate evidences with molecular mechanistic researches and randomized controlled trials to prove the CM as an effective and safe treatment for infertility. Thus, utility of CM as a complementary medicine will be a feasible method to improve the outcome of female infertility treatment.

Transcriptomic analysis of granulosa cells in patients with endometriosis-related infertility:identification of potential molecular mechanisms

Objective:To investigate the impact of endometriosis(EMS)on granulosa cell function and elucidate the molecular mechanisms involved.Methods:RNA sequencing,differential expression analysis,Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis,gene set enrichment analysis,protein–protein interaction analysis,and RT-qPCR were employed to assess the effects of EMS on granulosa cell function.Results:The results revealed significant differences in gene expression between the EMS and control groups,including genes related to immune regulatory functions and ferroptosis.Hub gene modules and hub genes were identified,including those related to cell cycle and immune and inflammatory pathways.RT-qPCR revealed significant upregulation of the hub genesCCL3 andIL1B in granulosa cells of patients with EMS.Conclusion:The results of RNA sequencing demonstrated that EMS induces significant transcriptional alterations in granulosa cells of affected patients.These findings provide important insights into the diagnosis and treatment of EMS and highlight the importance of further investigation ofCCL3 andIL1B as potential biomarkers for EMS.

腹腔镜手术对子宫内膜异位症不孕患者血清多项指标的影响

目的：观察腹腔镜手术（ LPS ）对子宫内膜异位症（ EMS ）不孕患者血清基质金属蛋白酶－9（MMP－9）、金属蛋白酶抑制因子－1（TIMP－1）和白细胞介素－2（IL－2）、白细胞介素－10（IL－10）的影响。方法选择2012年8月至2013年8月接受手术的EMS患者80例，根据手术方式的不同分为观察组（接受LPS手术治疗）和对照组（接受开腹手术治疗），每组各40例。观察两组治疗前后血清MMP－9、TIMP－1、MMP－9／TIMP－1和IL－2、IL－10、IL－2／IL－10的变化及术后6个月的受孕情况。结果观察组术后 MMP－9水平[（51．21±24．01）μg／L]比治疗前[（261．88±190．11）μg／L]明显下降，且观察组比对照组下降更明显；观察组TIMP－1水平[（45．88±11．02）μg／L]比对照组[（25．32±6．67）μg／L]明显上升（t＝4．846，P＜0．05）；观察组MMP－9／TIMP－1较对照组明显降低，差异有统计学意义（t＝3．636，P＜0．05）；两组治疗后IL－2、IL－10、IL－2／IL－10差异均有统计学意义（t＝4．228、4．415、3．396，均P＜0．05）；观察组受孕率65．0％、流产率7．7％，均优于对照组的30．0％、33．3％（χ^2＝9．825、4．060，均P＜0．05）。结论 LPS是一种治疗EMS的有效方法，可提高血清TIMP－1和IL－2水平，降低MMP9和IL－10水平；改善免疫指标，提高患者的生育能力。

Heyan Kuntai capsule versus dehydroepiandrosterone in treating Chinese patients with infertility caused by diminished ovarian reserve： a multicenter, randomized controlled trial

OBJECTIVE: To evaluate the clinical efficacy and safety of Heyan Kuntai capsule(HYKT) in treating women with infertility caused by diminished ovarian reserve(DOR).METHODS: One hundred eight eligible patientsfrom three Chinese hospitals were randomly divided into an HYKT treatment group(n = 55) or a dehydroepiandrosterone(DHEA) treatment group(n =53). Patients in the HYKT group were treated orally with four 0.5 g HYKT three times a day; patients in the DHEA group were treated with one 25.0 mg DHEA capsule three times a day. All patients were treated for 3 months and followed up over a3-month period.RESULTS: Of 108 patients, 12 dropped out: six from the HYKT group, and six from the DHEA group. Eleven patients got pregnant during the treatment. Serum anti-Müllerian hormone levels and antral follicle counts increased significantly in both groups after treatment(P < 0.05) especially in the HYKT group(P < 0.05). Serum follicle stimulating hormone(FSH) levels and FSH/luteinizing hormone ratios decreased(P < 0.05) with no significant difference between the two groups. Estradiol levels in the HYKT group and DHEA-sulfate levels in the DHEA group both increased(P < 0.05). The spontaneous pregnancy rates were 12% and 11% in the HYKT and DHEA groups, respectively(not significant). During the follow-up period, 16 patients in the HYKT group underwent in vitro fertilization-embryo transfer(IVF-ET) and the number of retrieved oocytes was(5.1 ± 1.8). In DHEA group, 20 patients underwent IVF-ET and the number of retrieved oocyte was(4.2 ± 1.9)(not significant); clinical pregnancy rates were 38% in the HYKT group and 20%in DHEA group(not significant). No significant adverse reactions were observed.CONCLUSION: HYKT can improve the ovarian re-serve and hormone levels in patients with infertility caused by DOR. Pregnancy rates after HYKT treatment were similar to those of DHEA treatment.HYKT might be an alternative to the treatment of infertility caused by DOR.

Recent advances in mammalian reproductive biology

Reproductive biology is a uniquely important topic since it is about germ cells, which are central for transmitting genetic information from generation to generation. In this review, we discuss recent advances in mammalian germ cell development,including preimplantation development, fetal germ cell development and postnatal development of oocytes and sperm. We also discuss the etiologies of female and male infertility and describe the emerging technologies for studying reproductive biology such as gene editing and single-cell technologies.

Acupuncture Treatment for 26 Cases of Polycystic Ovary Syndrome

Polycystic ovary syndrome （PCOS） is a commonly encountered disease in fertile women, clinically manifested by polymorphous comprehensive symptoms such as irregular menstruation, infertility, polytrichosis and obesity, and manifested by high levels of androgen, and no ovulation constantly shown by monophasic basal body temperature （BBT）. The therapeutic methods are medication for promoting ovulation and surgery, but, even certain therapeutic effect can be achieved, there is certain side effect and high cost. The author had treated 26 cases of PCOS by acupuncture. Now, the report is given in the following.

Treatment of Tubal Infertility Mainly by Acupoint-injection in 64 Cases

Sixty-four patients with tubal infertility were treated with a complex therapy of injection on Zigong （Ex-CA 1） and Ciliao （BL 32） and acupuncture on Qichong （ST 30）, Guilai （ST 29）,Chongmen （SP 12） and Dahe （KI 12）, and ginger-partitioned moxibustion on the lower abdomen. As a result, 31 cases were cured, 20 cases got marked effectiveness, 8 cases improved and 5 cases failed,and the total effective rate was 92.2%.

Therapeutic efficacy of moxibustion plus medicine in the treatment of infertility due to polycystic ovary syndrome and its effect on serum immune inflammatory factors

Objective:To explore the effects and related mechanism of heat-sensitive moxibustion plus clomifene citrate capsules for infertility due to polycystic ovary syndrome(PCOS).Methods:A total of 70 patients were randomized into a control group and an observation group by the random number table method,with 35 cases in each group.The control group was treated with clomifene citrate capsules,while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group.The treatment course lasted for 6 menstrual cycles.The endometrial thickness and ovarian volume of the patients were measured before and after treatment.The levels of serum sex hormones,tumor necrosis factor-α(TNF-α)and nuclear factor-κB(NF-κB)were detected.Follow-up was performed for 1 year after treatment,and the pregnancy rate was recorded.Results:After treatment,the endometrium of the patients in both groups was significantly thickened,the ovarian volume was significantly reduced,and the intra-group differences were statistically significant(all P<0.05).The endometrium thickness and ovarian volume in the observation group were significantly different from those in the control group(both P<0.05).After treatment,the levels of serum testostrn(T)and luteinizing hormone(LH)in both groups decreased significantly,the level of estradiol(E2)increased obviously,and the intra-group differences were statistically significant(all P<0.05).The levels of serum T and LH in the observation group were lower than those in the control group,and the E2 level in the observation group was higher than that in the control group,and the between-group differences were statistically significant(all P<0.05).After treatment,the levels of serum TNF-αand NF-κB of the patients in both groups decreased,and the intra-group differences were statistically significant(all P<0.05).The levels of serum TNF-αand NF-κB in the observation group were significantly lower than those in the control group(both P<0.05).After 1-year follow-up,the pregnancy rate was 20.0%in the control group,versus 51.5%in the observation group.The pregnancy rate in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:The treatment of heat-sensitive moxibustion plus clomifene citrate capsules can increase the endometrium thickness,reduce the ovarian volume,improve the status of serum sex hormone disorders,and increase the conception rate in patients with infertility due to PCOS,which may be related to the adjustment of the levels of immune inflammatory factors such as serum TNF-αand NF-κB.

Clinical Observations on Electroacupuncture-induced Ovulation in Patients with Luteinized Unruptured Follicle Syndrome

Objective： To investigate the curative effect of electroacupuncture on luteinized unruptured follicle syndrome（LUFS） and its mechanism, Methods： Sixty LUFS patients were randomly allocated to treatment （electroacupuncture） group and control （hCG） group. The follicular condition and ovarian arterial flow under color Doppler ultrasonogaphy and a change in reproductive endocrine level were observed in the patients before and after treatments. The ovulation rates and pregnancy rates were compared between the two groups, and the mechanism was investigated. Results： Both ovulation rate and pregnancy rate were significantly higher in the treatment group than in the control group （P〈0.01）. There was a significant difference in the improvement in ovarian arterial flow between the treatment and control groups （P〈0.01）. The improvement in endocrine level was significantly more marked in the treatment group than in the control group（P〈0.01）. Conclusion： Electroacupuncture has a good effect on luteinized unrupture follicle syndrome. Its mechanism may be related to the improvement in ovarian arterial blood supply and the regulation of endocrine level.

Treatment of Tubal Inflammatory Obstruction Mainly by Thunder-fire Moxibustion： A Report of 54 Cases

moxibustion of the lower cases got an Fifty-four patients with tubal inflammatory were treated by thunder-fire at Shenque （CV 8）, Guanyuan （CV 4） and Zhongji （CV 3） and the bilateral areas abdomen. As a result, 14 cases got cured, 19 cases were got a marked effect, 16 effect, 5 cases got no effect, the total effective rate was 90.7%.

Therapeutic Efficacy Observation on Electroacupuncture for Ovulatory Dysfunctional Infertility

Objective：To observe the clinical effect of electroacupuncture for ovulatory dysfunctional infertility by ovulation stimulation.Methods：A total of 65 patients were randomly allocated into a treatment group （38 cases） and a control group （27 cases）.Acupuncture plus electric stimulation was employed in the treatment group,whereas oral Clomifene Citrate Tablets in the control group,50 mg per day.Results：After six months （2 sessions） of treatment,the cure rate in the treatment group was 76.3%,versus 48.1% in the control group,showing a significant difference between the two groups （P〈0.05）.Conclusion：Electroacupuncture can obtain better cure rate than oral Clomifene Citrate Tablets for infertility via ovulation stimulation.