Etiological risk factors for subfertility among Palestinian women in Gaza

The inability to procreate is frequently considered a personal tragedy and a hardship for couples, impacting on the entire family and even the local community. In Gaza strip, Palestine, there has been no study on etiological risk factors for subfertility. The present study aimed to identify risk factors associated with subfertility among women in Gaza, Palestine. One hundred and sixty-nine women in the study group and 115 women in the control group were included. Cases were selected randomly from those referred to the A1 Basma Fertility Center, Gaza, Palestine. Data were collected through close-ended questionnaire, sonography, hormonal analysis and thrombophilia profile that included the methylenetetrahydrofolate reductase （MTHFR 677 C 〉 T）, factor V leiden （1691 G 〉 A） and pro- thrombin （20210 G 〉 A） genes. By using univariate analyses, the effects of different patient-related variables on the presence of subfertility were evaluated. A multiple logistic regression model was constructed, crude and adjusted odds ratios （OR） and 95% confidence intervals （95% CI） were calculated. The findings showed that 73.5 % （169/230） of the women referred to the A1 Basma Center sought treatment for subfertility. Different etiological risk factors were associated with subfertility, the most frequent of which in descending order were： thrombophilic disorders, fallopian tube problems, sex hormone abnormalities and polycystic ovary syndrome with an adjusted OR of 21.42, 13.63, 11.69 and 10.29, respectively. In conclusion, several etiological risk factors are responsible for subfertility among women in Gaza. Comprehensive evaluation of infertile women should be considered in the course of treatment; otherwise, the duration of sterility may be extended.

Clinicobiological Profile and Management Outcomes of Male Subfertility

Introduction: We aim to determine the epidemiology, clinical, paraclinical and etiologic aspects and to evaluate the management of male subfertility in urology. Methodology: We conducted a retrospective descriptive study of 137 patients referred to the urology department for male sub-fertility over a period of 4 years. The analyzed variables were: clinical, paraclinical characteristics and the post therapeutic evolution. Results: The mean age was 38.41 years (range: 24 to 67 years). The semen analysis was normal in 18 patients. The semen analysis showed oligoasthenozoospermia (45.3%) and total azoospermia (24.8%). Disease history was represented by: gonorrhea (27.7%), urogenital schistosomiasis (13.2%) and hernia repair (1.2%). The hormonal test showed abnormal hormone levels including: FSH (43.8%), LH (46.7%), testosterone (36.5%), prolactin (22.6%). The incriminated etiologic factors were: varicocele (5.8 %), smoking (23.7%), alcohol intake (25.4%) and sexually transmitted diseases (42.3%). The treatment was medical in 67.9% and surgical in 32.1% of cases. After a year of follow up, 13.9% of patient’s wives were pregnant. Conclusion: Male subfertility is common in Chad. The causes are numerous and diverse. The treatment is etiology based. A better management of sexually transmitted diseases and urogenital schistosomiasis is the best way to prevent it.

Perception of the Psychosocial Aspects of Subfertility by Parents Following Successful Medically Assisted Conception: A Qualitative Study

Nearly 5% of new-borns in the Netherlands are now born following Medically Assisted Conception (MAC), a steadily increasing number. Our qualitative study explored the subjective impact of subfertility and fertility treatment for parents who successfully achieve pregnancy following MAC and make health professionals more aware of the psychological needs of those clients. The study was based on the constructive/interpretative paradigm using a constant comparison/grounded theory design. Two men and nine women in the Netherlands who conceived as a result of MAC were interviewed in 2011. Our findings show that MAC-parents were exposed to a range of emotions such as disappointment, hope and uncertainty during the subfertile period, and these feelings were even felt after successful fertility treatment. The relationship and social support from friends and others in the same position were very important. Regarding the relationship with the partner during the subfertile period, the main thing the couple have to do is to keep talking with one another. Although they did not always agree on all issues, it was found that maintaining the communication strengthened the links between them by the end of the process. We concluded that the feelings and emotions during fertility treatment play a big role during the subfertile period and remain important during pregnancy and even after childbirth. Subfertile clients want maternity care providers to ask those who successfully achieve pregnancy following MAC about their experiences during fertility treatment, check that they still are receiving adequate social support, and involve the partner in prenatal checks.

A Review of the Impact of Covid-19 on the Male Genito-Urinary Tract

Introduction and Objectives: Since its advent in 2019, Corona Virus Disease 19 (Covid-19) has changed everyday life in many unprecedented ways. With the availability of Covid-19 vaccines, clinical practice has stepped gradually towards its everyday routine. The clinician, however, needs to address such concerns as “Can Covid-19 present with urinary tract symptoms predominantly?”, “Can the urinary tract develop long-term Covid-19 symptoms?”, “Can Covid-19 vaccines/drug therapy cause male infertility?” Methods: This mini-review of the current literature has been carried out by searching the Pubmed database. Results and Conclusions: Our literature review suggests that there is insufficient evidence to conclude a significant impact on the urinary tract from Covid-19 infection. There is supporting evidence that mRNA anti-SARS-CoV-2 vaccines are safe for male gonads. Research to further support these conclusions is required.

Endometritis associated with Enterococcus casseliflavus in a mare:A case report

Infectious endometritis is one of the main causes of subfertility/infertility in the mare. In this report, we present the first case of endometritis in mare associated with a strain of Enterococcus casseliflavus, an unusual gram-positive bacterium which can also be a zoonotic agent. Furthermore, the isolated strain showed a worrying multidrug-resistant profile. The accurate finding of a successful antimicrobial treatment and consequently,the pregnancy diagnosis indicate the importance to isolate, identify and define the antibiotic resistance profile of bacteria associated with endometritis.

Follicular fluid composition of ovulatory follicles in repeat breeder Holstein dairy cows

Objective: To examine differences in the metabolite, steroid and lipopolysaccharide of follicular fluid collected from the ovulatory follicle of Holstein repeat breeding cows, lactating cows, and virgin fertile heifers. Methods: Estrus was induced in animals possessing functional corpus luteum by intramuscular administration of prostaglandin F2α. Six to twelve hours after detection of the standing estrus, cervical samples were collected to detect subclinical endometritis via counting neutrophils on stained smears of cervical swabs. Then, follicular fluid of ovulatory follicles and serum samples were collected from repeat breeding cows (n=11), lactating cows (n=8) and virgin fertile heifers (n=10). Sodium and potassium were measured with a flame photometer method. Urea, total protein, glucose, cholesterol andβ-hydroxybutyric acid were assayed with commercial spectrophotometry kits. Chloride concentration was also measured with titration of samples against silver nitrate. Progesterone, estradiol-17βand lipopolysaccharide concentrations were measured using enzyme-linked immuno sorbent assay kits. Results: All analysis of follicular fluid samples showed that repeat breeding and lactating cows had a mean higher lipopolysaccharide concentration than that of the virgin fertile heifers (P<0.05). But concentration of serum estradiol-17βin repeat breeding and lactating cows was lower than that of virgin fertile heifers (P<0.05). In addition, the mean percentage of neutrophils in the cervical secretion of repeat breeding cows was higher than that of lactating cows (P<0.05). Conclusions: High follicular fluid concentration of lipopolysaccharide in ovulatory follicles results in the occurrence of repeat breeding syndrome in dairy cows. Further, a lower serum estradiol-17βconcentration and a higher percentage of neutrophil in the cervical secretion on the day of artificial insemination may have resulted in the occurrence of repeat breeding syndrome in dairy cows.

Importance of the Glycated Hemoglobin Assay in Congolese Women with Polycystic Ovary Syndrome: A Case-Control Study in Kinshasa, DR Congo

Context: Polycystic ovary syndrome (PCOS) is considered a syndrome related to the metabolic syndrome with a high risk for developing diabetes mellitus. The evaluation of the glycated hemoglobin (HbA1c) seems to be an interesting tool to detect states of hyperglycemia that may be associated with this syndrome and to understand her pathophysiology. Aims: The purposes of this study are to determine the profile of HbA1c in Congolese women with PCOS, to determine the frequency of states of hyperglycemia and to assess the impact of this marker on clinical signs on this syndrome. Material and methods: This is a case-control study of 130 Congolese subfertile women;65 with a diagnosis of PCOS and 65 others without PCOS. This is conducted from June 2016 to June 2019 among Congolese women of childbearing age. All these women were recruited at the subfertility outpatient clinic of the University Hospital of UNIKIN as well of the YANGA medical centers in Kinshasa, Democratic Republic of Congo. Sickle cell disease was excluded as also the cases of anemia. HbA1c was assayed via the immunoturbidimetric method and the results interpreted according to the ADA recommendations with a pathological cut-off point ≥ 6.5%. Results: Mean hemoglobin was 11.6 ± 1.2 g/dl (11.5 ± 1.1 g/dl vs. 11.8 ± 1.4 g/dl, P = 0.568). The proportion of diabetics was 1.6% (1.6% vs. 1.5%, P = 0.74). Higher HbA1c values were noted in the PCOS group compared to the control group (7.3% ± 2.1% vs. 5.6% ± 0.6%, P 0.001). The multivariate analysis showed a strong correlation between elevated HbA1c levels and PCOS (OR 14.79 (CI 5.43 - 40.32), P 0.001). In the PCOS group, higher HbA1c values were significantly correlated with a higher socio-economic status (OR 3.38 (1.67 - 8.47), P = 0.018) and with obesity (OR 3.48 IC (1.31 - 7.13) P = 0.029). A perfect, positive and significant linear correlation was found between HbA1c and fasting blood glucose (r = 0.807). 60% of women in the PCOS group had pathological values of HbA1c (≥6.5%)

Fertilization of IVF/ICSI Using Sibling Oocytes from Couples with Subfertile Male or Unexplained Infertility

The significance of the performance of conventional in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) using sibling oocytes from couples with subfertile male or unexplained infertility was evaluated. A total of 410 sibling oocyte cumulus-corona complexes (OCCC) from 21 couples with subfertile male (group A) and 11 unexplained infertile couples (group B) were randomly divided, in order of retrieval, into two groups inseminated either by conventional IVF or by ICSI. The treatment outcomes and the influence of infertility factors on fertilization in each group were compared. The results showed that although the two pronuclear (2PN) fertilization rate per injected sibling oocytes was significantly higher after ICSI (group A: 68.2 %±28.8 %; group B: 66.2 %±24.9 %) than after conventional IVF (group A: 41.8 %±32.7 %; group B: 40.1 %±22.1 %), the other variables studied included: the fertilization rates of per allocated sibling oocytes IVF/ICSI, the fertilization rates of sibling oocytes IVF/ICSI after excluding failed IVF fertilization cycles, as well as the cleavage rates of normal fertilization were not statistically significant (P>0.05). Similarly, though the total fertilization failure rate in the IVF group (group A: 42.9 %; group B: 36.4 %) was significantly higher than in the ICSI group (group A: 4.8 %; group B: 0), we did not cancel cycles due to the normal fertilization of sibling oocytes. Embryo transfer was possible in all 32 couples. There were 10 clinical pregnancies in the two groups. We also discovered a possible association between some semen parameters and sperm functions of group A, and women age and duration of infertility of group B and fertilization. It is suggested that adoption of the split IVF/ICSI technology in the above cases may help eliminate fertilization failures. This is also a useful method to investigate the effect of single factor on the employment of assisted reproductive technology.

Relationship between seminal plasma zinc concentration and spermatozoa-zona pellucida binding and the ZP-induced acrosome reaction in subfertile men

The aim of this study was to determine the relationship between seminal zinc concentration and spermatozoazona pellucida （ZP） binding and the ZP-induced acrosome reaction （ZPIAR） in subfertile men. Semen analyses and seminal zinc concentration assessments were carried out according to the World Health Organization manual for 458 subfertile men. A spermatozoa-ZP interaction test was carried out by incubating 2 × 10^6 motile spermatozoa with a group of four unfertilized oocytes obtained from a clinical in vitro fertilization programme. After 2 h of incubation, the number of spermatozoa bound per ZP and the ZPIAR of ZP-bound spermatozoa were examined. The effect of adding 0.5 mmol L^-1 zinc to the media on the ZPIAR of spermatozoa from normozoospermic men was also tested in vitro. Seminal zinc concentration positively correlated with sperm count and duration of abstinence, but negatively correlated with semen volume. On analysis of data from all participants, both spermatozoa-ZP binding and the ZPI- AR were significantly correlated with sperm motility and normal morphology, but not with seminal zinc concentration. However, in men with normozoospermic semen, the seminal zinc concentration was significantly higher in men with defective ZPIAR （ 〈 16%） than in those with normal ZPIAR （ ≥ 16% ） （P 〈 0.01）. The addition of 0.5 mmol L^-1 zinc to the culture media had no effect on spermatozoa-ZP binding, but significantly reduced the ZPIAR in vitro （P 〈 0. 001）. In conclusion, seminal zinc concentration is correlated with sperm count and the duration of abstinence in subfertile men. In men with normozoospermic semen, high seminal zinc concentration may have an adverse effect on the ZPIAR.

Live birth rates of assisted reproductive technology treatment and spontaneous conception among subfertile couples in Singapore: A follow-up study

Objective: To explore the potential predictors of a live birth (LB) outcome among subfertile couples of Asian ethnicity undergoing the first fertility treatment cycle;to assess the cumulative live birth rates after successive cycles;and to determine the incidence rate of spontaneous conception (SC).Methods:Subfertile couples were grouped according to treatment modalities at the first fertility treatment cycle: intrauterine insemination (IUI),in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and no treatment, and were followed-up for duration up to seven years. Multivariable logistic regression analysis was used for statistical analyses. Results: Age of female subjects [35-38 years, odds ratio (OR): 0.39;≥39 years, OR: 0.14], uterine factor subfertility (OR: 5.24), and treatment modalities (ORs: IUI 0.25, IVF 2.33 and ICSI 1.91) significantly predicted a LB outcome (P<0.05). The cumulative live birth rates were 11.7% IUI, 41.5% IVF, 27.5% ICSI and 22.6% from frozen embryo transfer cycles. The cumulative SC rate was 24.6% in the non-treated group and 10.7% in the treated group. All LBs from IVF cycles were delivered by the second cycle and within four years, compared to SC delivery of within five years in the non-treated group and six years in the treated group. Conclusions:Age of female subject, uterine factor and modalities of treatment are significant predictors for LB outcome at the first cycle. Higher delivery rates could be achieved following fewer successive IVF cycles and within a shorter duration compared to SC.

Hysterosalpingo-Foam Sonography to Replace HSG in Evaluating Tubal Patency in Indonesian Subfertile Patients

Aim: To evaluate whether hysterosalpingo-foam sonography (HyFoSy) can replace HSG as first-line evaluation for tubal patency in subfertile Indonesian patients by evaluating agreement level and comparing patients’ subjective complaints. Methods: Twenty subfertile female patients at Cipto Mangunkusumo Central General Referral Hospital (RSCM) from January 2018 to January 2019 were recruited conveniently to undergo both HSG and subsequent two-dimensional transvaginal HyFoSy after a minimum interval of 48 hours. Data on tubal patency and side effects inflicted by each examination within 24 hours were collected. Results: There were 20 subjects enrolled in this study. In 2 subjects, stenosis of internal uterine ostium was identified on HyFoSy procedure. Out of 36 remaining tubes undergoing adequate tubal patency evaluation by HSG and HyFoSy, agreement was seen in 81% cases (kappa value 0.42). The discordant tubal evaluation results in 7 of 36 tubes were associated with partial tubal obstruction, presence of co-existing gynaecological pathology, and tubal spasm. Less pain (p < 0.001) was experienced in HyFoSy as compared to HSG, with mean VAS of 1.8 ± 1.4 cm and 5.4 ± 2.4 cm, respectively. Seven of 20 patients experienced side effects due to HSG, such as abdominal cramp, spotting, backache, and bloating, in contrast to only one subject experiencing spotting due to HyFoSy. There was no hypersensitivity reaction observed in all subjects during HSG and HyFoSy procedure. Conclusions: HyFoSy has shown an excellent acceptance in Indonesian patients and could be a good alternative to replace HSG as a first line tubal patency examination.

Chronic epididymitis and Grade III varicocele and their associations with semen characteristics in men consulting for couple infertility

Chronic epididymitis and varicocele are frequently observed genital disorders in men consulting for couple infertility, but their impact on semen characteristics at the time of infertility consultation is still a matter of debate. We investigated 652 male partners of couples who had their first infertility consultation between 1999 and 2015 in Argentina. Men with chronic epididymitis （n = 253）, Grade III varicocele （n = 106）, and both conditions （n = 125） were compared with a control group （n = 168） composed of men without these disorders or any other recognized causes of male infertility. We showed that men who presented isolated chronic epididymitis were more likely to have high percentages of low sperm motility and abnormal sperm morphology as well as a high number of white blood cells. Men with isolated Grade III varicocele had low sperm production and motility and an increased percentage of abnormal sperm morphology. Finally, men who simultaneously presented chronic epididymitis with Grade III varicocele had a low sperm motility and increased percentage of abnormal sperm morphology as well as a high number of white blood cells. Physical examination of the genital organs may identify common disorders, potentially involved as causal factors of patient＇s infertility. These disorders are associated with specific seminal profiles that should help in identifying the best treatment from the available therapeutic options, effectiveness, safety, and allowing as much as possible natural conception.

New therapeutic approaches for endometriosis besides hormonal therapy

Objective:Endometriosis is a common gynecologic disease that frequently leading to chronic pelvic pain,severe dysmenorrhea,and subfertility.As first-line hormonal treatment can interfere with ovulation and may cause recurrent pelvic pain,exploration of new non-hormonal therapeutic approaches becomes increasingly necessary.This review aimed to evaluate the pre-clinical and clinical efficacy and safety of non-hormonal treatment for endometriosis Data sources:Databases including PubMed,Embase,Cochrane Library,SINOMED,ClinicalTrials.gov,and Google Scholar were searched up to October 2019,using search terms"endometriosis"and"non-hormonal therapy."Study selection:Twenty-four articles were reviewed for analysis,including nine animal studies and 15 human trials;all were published in English.Results:Twenty-four articles were identified,including 15 human trials with 861 patients and nine animal studies.Some agents have been evaluated clinically with significant efficacy in endometriosis-related pelvic pain and subfertility,such as rofecoxib,etanercept,pentoxifylline,N-palmitoylethanolamine,resveratrol,everolimus,cabergoline(Cb2),and simvastatin.Other drugs with similar pharmacological properties,like parecoxib,celecoxib,endostatin,rapamycin,quinagolide,and atorvastatin,have only been tested in animal studies.Conclusions:Clinical data about most of the non-hormonal agents are not sufficient to support them as options for replacement therapy for endometriosis.In spite of this,a few drugs like pentoxifylline showed strong potential for real clinical application.

Metformin treatment of high-fat diet-fed obese male mice restores sperm function and fetal growth,without requiring weight loss

Male obesity is associated with subfertility and increased disease risk of offspring.It is unknown if effects can be reversed through pharmacological interventions.Five-to 6-week-old C57BL6 male mice were fed control diet(n=10,CD)or high-fat diet(n=20,HFD)for 16 weeks.Animals fed with a HFD were then allocated to continuation of HFD(n=8)or HFD with metformin 28 mg kg1 day-1(n=8)for 6 weeks.Animals fed with CD continued on a CD(n=9).Males were mated with fertile C57BL6 females for the assessment of pregnancy and fetal growth.Sperm motility,spermatozoa and testicular morphology,sperm-zona pellucida binding,sperm reactive oxygen species(ROS)(intracellular[DCFDA],superoxide[MSR],and oxidative DNA lesions[8OHdG]),and mitochondrial membrane potential(JC1)were assessed.Metformin treatment of HFD males improved glucose toleranee(+12%,P<0.05)and reduced Homeostatic Model Assessment of Insulin Resistance(HOMA-IR;-36%,P<0.05).This occurred in the absenee of a change in body weight or adiposity.Metformin treatment of HFD-fed males restored testicular morphology(+33%,P<0.05),sperm motility(+66%,P<0.05),sperm-zona pellucida binding(+25%,P<0.05),sperm intracellular ROS concentrations(-32%,P<0.05),and oxidative DNA lesions(-45%,P<0.05)to the levels of the CD males.Metformin treatment of HFD fathers increased fetal weights and lengths compared with those born to HFD fathers(+8%,P<0.05),with fetal lengths restored to those of fetuses of CD males.Short-term metformin treatment in men who are obese could be a potential intervention for the treatment of subfertility,without the need for a reduction in body weight/adiposity.