Consultation and treatment behaviour of infertile couples in China: a population-based study.

RESEARCH QUESTION: The prevalence of infertility in couples actively trying to conceive is 25%. What is the consultation-seeking behaviour, diagnosis and related treatment in infertile couples across China? DESIGN: Large cross-sectional population-based study in 2010-2011, in which 25,270 couples from eight provinces/municipalities in China were approached by a multistage stratified cluster sampling strategy. RESULTS: Among the 2680 couples reporting infertility, 1246 infertile couples consulted a fertility doctor. Age of the couple, man's body mass index and women's educational level were found to be associated with consultation behaviour. After the fertility work-up, diagnoses were tubal infertility (n = 353, 28.3%), unexplained infertility (n = 311, 25.0%), male infertility (n = 234, 18.8%), ovulatory disorder (n = 194, 15.6%) and endometriosis (n = 34, 2.7%), while 8.6% (n = 107) were not classified. Most couples received non-assisted reproductive technology (ART) fertility treatment (n = 906, 89.3%), with a proportion using traditional Chinese medicine (TCM) (n = 298, 29.4%). Intrauterine insemination (n = 62, 6.1%) and IVF/intracytoplasmic sperm injection (n = 57, 5.6%) were less frequent. Medical treatment and outcomes among five subtypes of infertility were also reported: about 30% of couples with unexplained infertility (n = 94, 30.3%) or male infertility (n = 67, 29.0%) used TCM to treat infertility. Apart from patients with endometriosis, of whom 20.6% (n = 7) received ART, patients with other infertility subtypes rarely received ART. For subsequent fertility outcome, 94% of them did not achieve a pregnancy. CONCLUSION: The prevalence of infertility in China is high, but the uptake of treatment is relatively low.

The effectiveness of Korean herbal medicine in infertile men with poor semen quality: A prospective observational pilot study.

We examined the effects and safety of Korean herbal medicine (MYOMI-14) to treat infertile men with low semen quality. This study included 17 patients who received MYOMI-14 for 10 weeks. The primary outcomes were the mean differences between sperm test values. The secondary outcomes were changes in the Fertility Quality of Life and the difference in skin temperature between the thigh and scrotum. Adverse events were also monitored. The average values of sperm concentration, sperm progressive motility and total motile sperm count significantly improved after MYOMI-14 treatment (36.2%, 51.7% and 55.5%, respectively; p < 0.05). The core Fertility Quality of Life and the difference in skin temperature between the thigh and scrotum did not change significantly. No adverse events were observed. MYOMI-14 improved the semen quality of infertile men without adverse effects. Additional studies in a larger population and longer prospective randomised clinical trials are needed to confirm these results.

Spirituality, infertility-related stress, and quality of life in Brazilian infertile couples: Analysis using the actor-partner interdependence mediation model.

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

Exploring involuntary childlessness in men - a qualitative study assessing quality of life, role aspects and control beliefs in men's perception of the fertility treatment process.

The goal of this study was to explore the experience and perception of men during the diagnosis of infertility and subsequent treatment, and the impact on role concepts, control beliefs, and quality of life on these processes. Furthermore, it aimed to derive improvements in how men should be counselled. A qualitative study was conducted. It consisted of 13 semi-structured individual interviews with men undergoing or about to start fertility treatment at Heidelberg University Hospital. Data were analyzed using a grounded theory approach. Men emphasized the rare opportunities for being involved in treatment, lack of control and the ambivalence of social support. Furthermore, their experiences differed enormously regarding the cause of infertility and the period for which they were preoccupied with the topic. Dealing with involuntary childlessness is challenging for all men. Nevertheless, participants revealed major differences in dealing with fertility treatment in relation to role concepts, control beliefs, social support and the cause of infertility. The significance of diverse causes of infertility and the need for men to adopt certain roles ought to be more valued and a holistic approach improving quality of life enhanced.

THE EFFECT OF GADOLINIUM ORTHOVANADATE NANOPARTICLES BY NEONATAL INDUCED REPRODUCTIVE DISEASE IN MALE RATS.

For the purpose to develop of method for treatment of male hypofertility the efficiency of gadolinium orthovanadate nanoparticles (NP GdVO4) in rats with neonatal induced reproductive disease, has been investigated. The progeny of intact rats parents were exposed to emotional stress (Maternal separation stressn) and received an excessive amount of the blend of phytoestrogens (Ph) with mother's milk (1st group) from 3 to 22 day life. At the age of 10 months males received NP GdVO4 (0.33 mg/kg; 2nd group) or speman (158 mg/kg; 3rd group) with feed over the 70 days. Sexual behavior and fertility of males were investigated; the integrated indicator of reproductive potential (FI) was calculate and was estimated with the data of animals from group Control who were given vehicle (water). In the 1st group sexual behavior of males was characterized by accelerating sexual responses on female (double shortening of mounting and intromission latency) and a reduced ability to achieve ejaculation and to start the second round of copulations. The less females have been inseminated by these males (67% vs. 91% in Control group), but almost all became pregnant. As a result of the neonatal induction deterioration in the quality of male gametes intrauterine pregnancy loss increased more than twice, and the total number of foetus decreased (on 21%). These changes have led to a reduction of the male integrated indicator of reproductive potential (Fi) in 2.6 times compared with control animals. Using a NP GdVO4 rehabilitated male sexual behaviour indicators to Control group level, resulting in an increase in the number of fertilized females (up to 95%). In pregnant females decreased fetal losses (up to 15.2% vs. 18.1% in control, p<0,05) and increase in the number of fetuses (on 25%, p<0,05) that shows an improvement in the quality of sperm. The integrated indicator of reproductive potential (F1) increased to (8.3 ± 0.5) vs. (3.0 ± 0.3) u. in the 1st group (without treatment), that statistically higher than in groups Control and 3rd. Application of NP GdVO4 in rats with neonatal inductive pathology of the reproductive function and metabolic disorders normalizes sexual behaviour, the quality of sperm that restores male fertility and improves reproductive potential much more efficiently than the reference drug speman.

[Stress and fertility]. / A stressz és a fertilitás.

In Western countries, sperm quality and fertility of men significantly worsened. Female infertility does not show a better trend either. Subtle defects in the reproductive functions can not be explained by the current methods, and "unexplained infertility" is becoming a more common diagnosis. Every year 1 million couples seek expensive and time consuming fertility treatment in the world. Deeper understanding of an unhealthy lifestyle and the environmental damages may lead to personalized treatments to increase the chance of conception.The effects of various stressors on the male and female reproductive performance were scientifically substantiated by Selye and coworkers in 1976. Cognitive therapy methods can be applied against emotional stressors, supplementation by antioxidants against reactive oxygen compounds, and administration of vitamins and trace elements, especially when deficiency is found, may help before medical intervention on a rational and economical way in the fight against infertility.

The work of a woman is to give birth to children: cultural constructions of infertility in Nigeria.

Infertility is a condition loaded with meaning spanning across biomedical, psychological, social, economic, cultural and religious spheres. Given its disruptive power over women's lives, it provides a unique lens through which issues of kinship, gender, sexuality, cosmology and religion can be examined. The paper presents the results of an ethnographic study of infertility in Central Nigeria. Explanatory models of infertility were variegated, encompassing biomedical, folk and religious elements. Like other ethnographic studies of help seeking for infertility in Nigeria, among this group resort was made to biomedical treatments, traditional healers and religious healing with no one system being hegemonic. The findings of this study accord with studies of infertility in other cultural groups indicating the disruptive influence of missing motherhood.

Indigenous knowledge systems and attitudes towards male infertility in Mhondoro-Ngezi, Zimbabwe.

Male impotence and infertility are health and social problems that have resulted in significant suffering to men the world over. From an African perspective, and in Zimbabwe in particular, the taboo nature of male impotence and infertility carries a lot of mystique. Based on evidence from focus-group discussions, in-depth and key-informant interviews, this study reveals rural Shona people to have indigenous knowledge systems that trigger the investigation of signs of impotence (perceived as associated with male infertility) at infancy, puberty and after marriage. Male infertility carries overtones of failure, frustration, pain, social ostracism, stigma, marital instability, discomfiture and suicide. Intervention strategies to remedy perceived problems were exclusively sociocultural, involving the administration of traditional herbs and traditional healers' divination. Given the existence of indigenous knowledge systems for the investigation and mediation of male impotence and infertility, it is worth incorporating traditional healers in future strategies targeting these emasculating conditions.

Paternal work stress and prolonged time to pregnancy.

OBJECTIVE: The aim of this study was to explore an association between psychosocial stress at work in married men and their spouses' prolonged time to pregnancy (TTP). METHODS: All married male workers of a large Korean petrochemical enterprise and their wives fulfilling the selection criteria were included. Main selection criteria were lack of use of contraceptives and experienced pregnancy in recent past. Data were available from 322 couples. Psychosocial stress at work was measured by the effort-reward imbalance questionnaire. Prolonged TTP was measured by the "TTP questionnaire". RESULTS: After adjustment for confounding effects of demographic and life-style characteristics and benzene exposure, delayed TTP, defined by frequency of first-cycle pregnancy, was associated with one standard deviation (SD) increase of the effort-reward ratio in the chronically stressed group of married men (OR = 0.47; 95% CI = 0.22-0.99) in logistic regression analysis. A similar, but somewhat weaker effect, was found for the overall group (OR = 0.67; 95% CI = 0.47-0.94). CONCLUSIONS: Paternal stress at work, as measured by effort-reward imbalance, seemed to be associated with a decreased number of conceptions in the first menstrual cycle.

Use of alternative and hormonal therapies in male infertility.

OBJECTIVES: To examine the patterns of use of alternative and hormonal therapies in men presenting for infertility evaluation. METHODS: We administered a questionnaire on the use of alternative and hormonal therapies to 500 consecutive men presenting for infertility evaluation at our male infertility clinic. The questionnaire asked about the use of specific therapies (eg, vitamins, herbal medicine, or hormones), the monthly cost of these therapies, and whether the principal healthcare provider had been made aware of the use of therapies. RESULTS: Of the 481 men who completed the questionnaire, 147 (31%) admitted to using one or more alternative therapies. Most of the men using alternative therapies (92 of 147, 63%) were taking one or more antioxidant vitamins or minerals (ie, vitamins C, E, selenium, zinc), and 18 men admitted to using herbal medicines. Of concern, 25 men reported using agents with clear hormonal activity (testosterone, clomiphene citrate), and 6 of these men had not informed their principal healthcare provider of this. CONCLUSIONS: Our data suggest that a significant percentage ( approximately 30%) of men presenting for infertility evaluation do use alternative therapies. It is important to inquire about the use of these therapies because some of these treatments may be toxic to the gonads.

[Invisible fathers: child development and family dynamics after heterologous insemination]. / Unsichtbare Väter: Kindliche Entwicklung und Familiendynamik nach heterologer Insemination (DI).

This study presents the long term outcome of the psychotherapy of a girl over seven years, which was born after donor insemination (DI) and aged eight became ill with a compulsive disorder. Aspects of child development, communication within the family and family dynamics related to this specific constellation are pointed out. This case-study presents one of the very few supplements to statistic data elaborated about assitsed-reproduction-families. Implications for individual therapy and therapeutic management of the family are discussed according to development of bonding and identity of the DI-child, father's role, dynamics of the couple and the incognito of the "invisible father".

[Effect of ecdystene on parameters of the sexual function under experimental and clinical conditions]. / Vliianie ékdistena na pokazateli polovoi funktsii v éksperimente i klinicheskikh usloviiakh.

The effects of ecdysterone and the related drug ecdysten on the sexual activity were studied under experimental and clinical conditions. A 10-day administration of ecdysterone (5 and 10 mg/kg, p.o.) improved behavioral characteristics of the sexual function in rats, the effect being especially pronounced during the fist days of experiment. The administration of ecdysten to men with the infertility diagnosis (disturbed spermatogenesis as a complication of some urologic diseases) increased the copulative function and improved the sperm quality. The administration of ecdysten to patients in the stage of recovery upon myocardial infarction also improved the sexual function.

Psychiatric morbidity in couples attending a fertility service.

The structured clinical interview for diagnosis (axis 1) according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-III-R) was used to assess psychiatric morbidity in 110 infertile patients. They were divided into two groups according to whether referral to the service of psychosomatic medicine was deemed advisable by the physician in charge. Psychiatric disorders were diagnosed in 39 of 56 (69.6%) patients in the referred group and in 13 of 54 (24.1%) in the non-referred group. Psychiatric morbidity was found in 61.1% of females and 21% of males. Adjustment disorders were found in 59.6% (31/52) of all patients, in 59% (24/39) of patients among the referred group and in 61.5% (8/13) of patients among the non-referred group. Fourteen (67%) of 21 women in the referred group with adjustment disorders suffered from anxiety. In addition, 33.3% of patients in the non-referred group showed important psychological dysfunction, although DSM-III-R criteria were not met. Psychiatric morbidity was significantly associated with the number of treatment cycles and female gender in the whole study population, as well as with the type and length of infertility in the non-referred group. Psychological services in an infertility clinic help to identify at an early stage those individuals who are more likely to be vulnerable. This would enable psychological interventions to be targeted towards those in greater need.

Male partners in infertile couples. Personal attitudes and contact with the Norwegian health service.

The present study summarizes the results of a questionnaire sent to 312 men involved in a fertility investigation. The answers illustrate the psychological problems linked to the infertile state, indicate that men are generally well orientated about the extent of the problem and imply an increasing negative attitude to donor insemination. In the majority of cases, the infertile couples first contacted a gynecologist rather than a general practitioner or other specialist. In over one third of the cases, this contact occurred within the first 12 months of attempting to procure a pregnancy. In most cases, the male partner was already involved in the fertility investigation at the start. Approximately one fifth had at some time consulted fringe medicine (e.g. homeopathy or acupuncture).

Idiopathic anejaculation treated by electroejaculation.

Idiopathic anejaculation is a relatively rare cause of sexual dysfunction that usually presents as an infertility problem. When such patients have nocturnal emissions the problem is usually considered psychogenic and referral is made to a psychiatrist. Various treatments for this condition have been described including psychotherapy, sexual, marital and behavioral therapy, vibratory stimulation of the penis and pharmacotherapy. A patient with idiopathic anejaculation referred by an infertility clinic is described in which all of the above treatments failed over a five-year period. A newly described procedure in humans, electroejaculation, was employed to obtain semen which was used to artificially inseminate the wife resulting in the first reported successful pregnancy by electroejaculation done for idiopathic anejaculation.

[Correlation of psychological changes and spermiogram improvements following acupuncture]. / Korrelation psychischer Veränderungen und Spermiogrammverbesserungen nch Akupunktur.

The purpose of the study was to find the correlation between the effect of acupuncture on fertility and psychological effects. To investigate its influence on male subfertility, 28 patients received acupuncture treatment after informed consent. We evaluated subjective parameters by written psychological tests, while objective parameters consisted of measuring concentration, volume and motility in the spermiogram before and after acupuncture. There was a significant increase in sperm quality in all parameters but volume. The psychological test showed no change caused by acupuncture. Hence, we believe, that the effect of acupuncture on sperm quality is not caused by placebo-mechanisms.