Female infertility affects millions of couples worldwide and is estimated to account for one-third of all cases of infertility. The purpose of this article is to review the uses of both off-label ...treatments and those approved by the US Food and Drug Administration for female infertility, by examining the mechanism of action, the side-effect profile, fetal anomaly risks, and contraindications for the various drugs.
Objective To determine whether the period of ejaculatory abstinence (EA) influences the total antioxidant capacity (TAC) of semen or lipid peroxidation (LPO) of sperm membranes. Design A prospective ...experimental trial. Setting Academic medical center for reproductive endocrinology and infertility. Patient(s) Forty men from infertile couples planning intrauterine insemination. Intervention(s) Men provided semen specimens after EA periods of 1 and 4 days. Main Outcome Measure(s) Semen analysis, peroxidase staining, and assays for seminal TAC and sperm membrane LPO, with measures compared between days 1 and 4 within individuals (internal control) using paired t tests. Result(s) The shorter period of EA (1 day vs. 4 days) resulted in statistically significant decreases in semen volume (−24%), sperm density (−28%), and total sperm count (−3.2%). There was a statistically significant increase in TAC with the shorter period of EA (1 day) compared with 4 days of EA. No difference was detected in sperm membrane LPO comparing 1 day of EA and 4 days of EA. Conclusion(s) Higher seminal TAC obtained after a shorter period of EA could diminish oxidative stress–induced sperm damage by a mechanism independent of LPO. Shorter periods of EA may thus improve sperm quality by protecting from reactive oxygen species damage, even though lower numbers of motile sperm are produced after a shorter period of EA. This would be consistent with prior research indicating improved results after intrauterine insemination under these circumstances.
The incidence of subclinical hypothyroidism (SCH) in pregnancy was classically thought to be low; however, with new definition of normal TSH range in pregnancy, there has been an increase in the ...percentage of women who meet classification for SCH. The diagnosis of SCH is important not only for monitoring for maternal conversion to overt hypothyroidism, but also for identifying obstetric and neonatal outcomes related to SCH. Although there have been proven associations between maternal overt hypothyroidism and adverse obstetric and neonatal outcomes, there has been conflicting data on the correlation between SCH and these outcomes. Recent data from a meta-analysis found an increased risk of pregnancy loss, placental abruption, premature rupture of membranes, and neonatal death for women with SCH compared to euthyroidism in pregnancy. Research studies have not demonstrated a distinct benefit from treatment of SCH, and the professional societies are divided on their recommendations for treating SCH. Additionally, universal screening of SCH is controversial at present.
Hysteroscopy requires accurate collection of unabsorbed distension media to measure patient fluid absorption. We assessed the effectiveness and usability of a novel total capture drape compared with ...a standard drape during hysteroscopy.
Simulation trials were followed by an early-phase study to compare fluid-capture efficiency and measures of drape usability during hysteroscopy randomizing the total capture drape compared with a standard drape.
Simulation trials indicated complete collection of unabsorbed fluid with the total capture drape and progressive loss of unabsorbed fluid with the standard drape. An early-phase study with 68 women found no statistical difference between groups for the hysteroscopic fluid deficit, but saw fewer cases with lost fluid in the total capture drape compared with the standard drape. Direct observation and focus group data indicated a trend for better capture of unabsorbed fluid with the total capture drape, along with increased usability once surgeons became familiar with correct placement.
Simulation and early-phase study results are favorable for the total capture drape, demonstrating comparable fluid collection with the standard drape. With repeated use and in-service training, surgeons expressed greater confidence in the accuracy of the hysteroscopic fluid deficit with the total capture drape compared with the standard drape. Design modifications should improve overall usability and fluid-capture efficiency.
To determine whether biochemical or clinical markers of androgenic activity predict live birth rate with ovarian stimulation in the unexplained infertility population.
Secondary analysis of the ...Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial.
Multicenter university-based clinical practices.
Nine hundred couples with unexplained infertility were included. Women were 18–40 years old with regular menses, a normal uterine cavity, at least one patent fallopian tube, and a male partner with ≥5 million motile sperm. Women were randomized to receive gonadotropin, clomiphene, or letrozole with IUI for four or fewer four treatment cycles. Women were evaluated for biochemical (total testosterone, DHEAS, and free androgen index) and clinical markers of androgenic activity (sebum, acne, and hirsutism). Multivariable logistic regression models adjusting for treatment group, maternal age, and body mass index were performed.
None.
The primary outcome was live birth. Secondary outcomes included conception, clinical pregnancy, and pregnancy loss.
When comparing 900 women in the AMIGOS trial based on quartiles of serum TT, women were of younger age, higher body mass index, and higher waist circumference with increasing TT. Increasing quartiles of TT also showed increasing DHEAS and free androgen index values. Serum androgens were not associated with outcomes of live birth, conception, clinical pregnancy, or pregnancy loss. Clinical androgen markers were not associated with pregnancy outcomes.
In a randomized cohort of women with unexplained infertility, biochemical and clinical measures of androgens did not predict live birth rate after ovarian stimulation treatment.
NCT 01044862.
Androgenización y tratamiento de fertilidad en mujeres con infertilidad inexplicada
Determinar si los marcadores bioquímicos y clínicos de actividad androgénica pueden predecir la tasa de recién nacido vivo con estimulación ovárica en población con infertilidad inexplicada.
análisis secundario del estudio clínico Assesment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS).
Clínicas universitarias multicéntricas.
Novecientas parejas con infertilidad inexplicada fueron incluidas. Las mujeres se encontraban entre 18 y 40 años de edad con menstruaciones regulares, una cavidad uterina normal, por lo menos una trompa de Falopio permeable, y una pareja masculina con ≥ 5 millones de espermatozoides móviles. Las mujeres fueron randomizadas para recibir gonadotropinas, clomifeno o letrozol con inseminación intrauterina por cuatro ciclos o menos de 4 ciclos. Las mujeres fueron evaluadas con marcadores bioquímicos (testosterona total, DHEAS e índice de andrógenos libres) y marcadores clínicos de actividad androgénica (piel grasa, acné, hirsutismo) . Se realizaron modelos de regresión logística multivariable por grupo de tratamiento, edad materna e índice de masa corporal.
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El resultado principal fue recién nacido vivo. Resultados secundarios incluyeron gestación, gestación clínica y pérdida gestacional.
Cuando se compararon 900 mujeres en el estudio AMIGOS basados en cuartiles de testosterona total sérica, las mujeres eran más jóvenes, con mayor índice de masa corporal, y con mayor circunferencia de cadera a medida que aumenta la testosterona total sérica. Mayores cuartiles de testosterona total también mostraron niveles aumentados de DHEAS e índice de andrógenos libres. Los andrógenos séricos no se asociaron con resultados de recién nacido vivo, gestación clínica o pérdida gestacional. Los marcadores clínicos de androgenización no se asociaron con resultados gestacionales.
En una cohorte randomizada con infertilidad inexplicada, los marcadores bioquímicos y clínicos de andrógenos no predicen la tasa de recién nacido vivo después de tratamiento de estimulación ovárica.
Objective To assess whether blood type was associated with diminished ovarian reserve (DOR) (day-3 follicle-stimulating hormone level >10 IU/L), controlling for history of tobacco smoking, body mass ...index (BMI), history of endometriosis, ovarian surgery, previous pregnancy, and maternal age. Design Cross-sectional study. Setting Academic medical center, Division of Reproductive Endocrinology and Infertility. Patient(s) Women undergoing in vitro fertilization (IVF) from 2006–2011 (n = 305). Intervention(s) None. Main Outcome Measure(s) Presence of DOR in relation to a patient's blood type. Result(s) Other investigators have reported an increased risk for DOR in patients with blood type O and a protective effect on ovarian reserve for blood type A. We observed no association between a woman's blood type and DOR. We found an increased risk for DOR in patients aged 35 and older. Obesity (BMI ≥30 vs. BMI <25) was associated with lower odds of DOR. Conclusion(s) In comparison with blood type A, blood type O is not associated with an increase in DOR. We found no clinical implications for using blood type as a risk factor for DOR.
Objective To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology ...database for 2004–2006. Design Retrospective cohort. Setting Clinic-based data. Patient(s) The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen. Intervention(s) None. Main Outcome Measure(s) Clinical intrauterine gestation (presence of gestational sac) and live birth (≥22 weeks gestation and ≥300 g birth weight). Result(s) Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters. Conclusion(s) Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies.
Management strategies for overweight and obese women with polycystic ovarian syndrome (PCOS) who desire fertility should include weight loss. Even a small reduction in body weight can improve ...ovulatory function and pregnancy rate and reduce adverse obstetric outcomes. New data suggest that letrozole should be considered as the new first-line medical treatment of anovulatory infertility in PCOS over clomiphene citrate. Second-line treatments for anovulatory infertility include in vitro fertilization, gonadotropins, or ovarian drilling.
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