Quality of life among infertile PCOS patients.

OBJECTIVE: To investigate whether quality of life differs between PCOS and non-PCOS infertile women. STUDY DESIGN: Two questionnaire forms of quality of life (PCOSQ, SF-36) were given to 238 women. Patients were asked to answer all of the questions in both of the questionnaires. Of these 238 women, only 49 infertile PCOS patients, 47 infertile non-PCOS patients and 62 fertile PCOS patients filled the forms completely. RESULTS: Both PCOSQ and SF-36 scores are lowest in infertile PCOS group. Although total PCOSQ score of infertile non-PCOS group was better than non-infertile PCOS and fertile PCOS groups; there was trend for lower scores when infertility is added on PCOS status. CONCLUSION: The quality of life is lowest among infertile PCOS women. Both PCOS and infertility as individual factors may have negative impact in quality of life of reproductive age women.

[Epidemiological features of parasitary invasis in women of reproductive age with disorders of reproductive health].

OBJECTIVE: The aim: The purpose of this study is to analyze the frequency and structure of parasitic lesion in women with reproductive health disorders. PATIENTS AND METHODS: Materials and methods: The immune-enzyme method tested immunoglobulins IgG to ascaris, lamblia, toxocara. Determination of the presence of pinworm eggs (sticky tape and perianal scrape method) and ascarid (methods of K.Cato, F.Fueleborna and E.S.Schulman). RESULTS: Results: In women with complicated obstetric anamnesis, parasitic invasions occurred in (52.3 ± 5.0)% (Χ² = 34.9, p <0.01; 95% CI = 42.5-62.1). Enterobiasis was detected in (12,0 ± 3,3)% of patients, acarida eggs in (29,3 ± 4,6)%, positive titers of IgG to ascaris - in (11.5 ± 3.2)%, IgG to lamblia in - 7.5%, IgG to toxocara 3.5%, the combined detection - in (11.5 ± 3.2)% of the examined group. In patients of the control group, parasitic invasions were detected in (13.1 ± 3.4)%. The prevalence of parasitic lesion in women with primary infertility (58.0 ± 4.9)% (OR = 8.9; 95% CI = 5.2-15.3; p <0.01), in planning pregnancy (25, 7 ± 4.4)% (OR = 2.3, 95% CI = 1.3-4.0). The most significant aggressive parasite in women with complicated obstetric anamnesis, reproductive loss and infertility is ascariasis (95% CI 6.1-38; p <0.001). In women with parasitic lesion revealed the dominance of pathology of the mammary glands, gastrointestinal tract, acne, pathology of the urinary system, thyroid gland. CONCLUSION: Conclusions: The obtained results make it possible to recommend parasite examination in women with infertility and complicated obstetric anamnesis.

Cross-sectional interview study of fertility, pregnancy, and urogenital schistosomiasis in coastal Kenya: Documented treatment in childhood is associated with reduced odds of subfertility among adult women.

BACKGROUND: Previous research has documented an increased risk of subfertility in areas of sub-Saharan Africa, as well as an ecological association between urogenital schistosomiasis prevalence and decreased fertility. This pilot project examined reproductive patterns and the potential effects of childhood urogenital Schistosoma haematobium infection and individual treatment experience on adult subfertility among women who were long-term residents in an S. haematobium-endemic region of coastal Kenya. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed findings from 162 in-depth interviews with women of childbearing age in a rural, coastal community, linking them, if possible, to their individual treatment records from previous multi-year longitudinal studies of parasitic infections. Reproductive histories indicated a much local higher local rate of subfertility (44%) than worldwide averages (8-12%). Although, due to the very high regional prevalence of schistosomiasis, a clear relationship could not be demonstrated between a history of S. haematobium infection and adult subfertility, among a convenience sub-sample of 61 women who had received documented treatment during previous interventional trials, a significant association was found between age at first anti-schistosomal treatment and later fertility in adulthood, with those women treated before age 21 significantly less likely to have subfertility (P = 0.001). CONCLUSIONS/SIGNIFICANCE: The high subfertility rate documented in this pilot study suggests the importance of programs to prevent and treat pelvic infections in their early stages to preclude reproductive tract damage. The available documented treatment data also suggest that early anti-schistosomal treatment may prevent the fertility-damaging effects of urogenital schistosomiasis, and lend support for programs that provide universal treatment of children in S. haematobium-endemic regions.

Urinary estrogen metabolites and self-reported infertility in women infected with Schistosoma haematobium.

BACKGROUND: Schistosomiasis is a neglected tropical disease, endemic in 76 countries, that afflicts more than 240 million people. The impact of schistosomiasis on infertility may be underestimated according to recent literature. Extracts of Schistosoma haematobium include estrogen-like metabolites termed catechol-estrogens that down regulate estrogen receptors alpha and beta in estrogen responsive cells. In addition, schistosome derived catechol-estrogens induce genotoxicity that result in estrogen-DNA adducts. These catechol estrogens and the catechol-estrogen-DNA adducts can be isolated from sera of people infected with S. haematobium. The aim of this study was to study infertility in females infected with S. haematobium and its association with the presence of schistosome-derived catechol-estrogens. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was undertaken of female residents of a region in Bengo province, Angola, endemic for schistosomiasis haematobia. Ninety-three women and girls, aged from two (parents interviewed) to 94 years were interviewed on present and previous urinary, urogenital and gynecological symptoms and complaints. Urine was collected from the participants for egg-based parasitological assessment of schistosome infection, and for liquid chromatography diode array detection electron spray ionization mass spectrometry (LC/UV-DAD/ESI-MSn) to investigate estrogen metabolites in the urine. Novel estrogen-like metabolites, potentially of schistosome origin, were detected in the urine of participants who were positive for eggs of S. haematobium, but not detected in urines negative for S. haematobium eggs. The catechol-estrogens/ DNA adducts were significantly associated with schistosomiasis (OR 3.35; 95% CI 2.32-4.84; P≤0.001). In addition, presence of these metabolites was positively associated with infertility (OR 4.33; 95% CI 1.13-16.70; P≤0.05). CONCLUSIONS/SIGNIFICANCE: Estrogen metabolites occur widely in diverse metabolic pathways. In view of the statistically significant association between catechol-estrogens/ DNA adducts and self-reported infertility, we propose that an estrogen-DNA adduct mediated pathway in S. haematobium-induced ovarian hormonal deregulation could be involved. In addition, the catechol-estrogens/ DNA adducts described here represent potential biomarkers for schistosomiasis haematobia.

Reproductive implications of exposure to Toxoplasma gondii and Neospora caninum in western grey kangaroos (Macropus fuliginosus ocydromus).

Australian marsupials are thought to be particularly vulnerable to pathologic impacts of Toxoplasma gondii, and they may be similarly affected by Neospora caninum. Pathology due to either organism could be expressed as reduced female reproductive performance. We studied adult female western grey kangaroos (Macropus fuliginosus ocydromus) from suburban Perth, Western Australia, between May 2006 and October 2008. We used indirect fluorescent antibody tests to look for evidence of exposure to T. gondii and N. caninum in M. fuliginosus ocydromus and tested the association between their reproductive performance and a positive test result. Although 20% of plasma samples collected from 102 female kangaroos were positive for T. gondii and 18% were positive for N. caninum, we found no association between positive results and reproductive performance. Further study will be required to clarify if, and under what circumstances, T. gondii and N. caninum are pathogenic to macropod marsupials.

Seroprevalence of Toxoplasma gondii infection in female sterility patients in China.

Toxoplasmosis is an important parasitic disease worldwide and is related to certain psychiatric disorders and sterility. In the present study, serum samples from 882 female sterility patients and 107 pregnant-puerperant women were assayed for anti- T. gondii IgG antibodies using ELISA. The overall T. gondii seroprevalence was 14.8%. In the female sterility patients, 15.9% (140/882) were seropositive and, in the pregnant-puerperant women, 5.6% (6/107) were positive for anti- T. gondii IgG antibodies. There was a significant difference between the 2 groups ( P < 0.05). The samples were further divided into 5 groups based on age, but no significant difference was found among the 5 groups (P > 0.05). Results of the present study argue for more attention to prevention of T. gondii infection in the female population and, in particular, women of childbearing age.

[Retrospective evaluation of Toxoplasma gondii seropositivity in fertile and infertile women]. / Fertil ve Infertil Kadinlarda Toxoplasma gondii Seropozitifliginin Retrospektif Olarak Degerlendirilmesi.

Toxoplasma gondii infection is associated with a wide spectrum of clinical pictures in man, changing from asymptomatic infection to severe central nervous system disease. It has been well documented that toxoplasmosis is of crucial importance especially for pregnant women and immunocompromised patients. In addition to the risks of gestation complications and congenital infections, it has been suggested that toxoplasmosis has some unfavorable effects on reproductive capacity in both men and women. The data obtained from limited studies performed in animal models as well as in infertile couples, have supported the relationship between toxoplasma and infertility. The hypothesis concerning infertility mechanisms due to T.gondii in females include development of endometritis and fetal rejection due to local release of T.gondii from latently located cysts in endometrial tissue on stimulation during plansenta formation; impaired folliculogenesis in ovaries and uterine atrophy and reproductive failure due to hypothalamic dysfunction as a result of chronic toxoplasmosis. The aim of this retrospective study was the comparative evaluation of toxoplasma seropositivity rates of fertile and infertile female spouses who were admitted to an in vitro fertilization (IVF) center in Ankara, between 2004-2009 period, from different geographical regions of Turkey. A total of 1314 women (mean age: 31.8 ± 5.6 years) were included to the study. In the study group, 376 (28.6%) were positive for T.gondii IgG, 5 (0.4%) were positive for IgG + IgM and 1 (%0.07) was positive only for IgM antibodies, while total toxoplasma seropositivity was 29.1% (382/1314). Of the 1117 evaluated couples, women with well-defined cause of infertility due to male factors have been grouped as fertile (n= 495) and the others were accepted as infertile (n= 622). Toxoplasma IgG seropositivity was found in 145 (29.3%) of fertile and in 179 (28.8%) of infertile women and the difference between the seropositivity rates was not statistically significant (p= 0.851). Comparison of seropositive and seronegative women in view of demographic characteristics revealed that seropositivity rate increased with age (mean ages were 33.0 ± 5.3 and 31.4 ± 5.6, respectively; p< 0.001); the rate was significantly higher in housewives than women with different occupations (31.4% and 25.7%, respectively; p= 0.003) and higher in women who inhabited in Mediterranean region than in Central Anatolia region (46.4% and 27.2%, respectively; p= 0.019). There were no statistically significant correlation between the seropositivity rates and abortion history and cause of infertility (p> 0.05). In conclusion, these data did not indicate a relationship between toxoplasmosis and female infertility, however advanced molecular, serological and clinical studies are needed for the confirmation of this hypothesis.

Fluke infertility: the late cost of a quick swim.

Schistosomiasis in the returning traveler is closely associated with fresh water exposure in sub-Saharan Africa and is commonly asymptomatic. We describe two patients who presented with unusual gynecological presentations of schistosomiasis many years after travel to endemic areas. The manifestations of female genital schistosomiasis are discussed.

Infectious causes of reproductive disorders in cattle.

The incidences of reproductive disorders in bovine are increasing over years. This scenario is further aggravating due to more emphasis on selection and rearing of animal for specific commercial purposes which compromises livestock reproduction. Reproductive disorders like infertility and abortions in cattle are major problems in the bovine industry. The reproductive disorders might be caused by several different agents such as physical agents, chemical agents, biological agents, etc. Also, the causative agent and pathogenesis of reproductive disorders are influenced by various factors including environmental factor. The exact causes may not be evident and are often complicated with multiple causative agents. Thus, there is a need for multi-faceted approach to understand correlation of various factors with reproductive performance. Of the agents, infectious biological agents are significant cause of reproductive disorder and are of high priority in the bovine industry. These factors are not only related to the prosperity of bovine industry but are also important from public health point of view because of their zoonotic potentials. Several infectious agents like bacterial, viral, protozoon, chlamydial and fungal agents are known to have direct impact on reproductive health of cattle. These diseases can be arranged and discussed in different groups based on the causative agents.

Gardnerella, Trichomonas vaginalis, Candida, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in the genital discharge of symptomatic fertile and asymptomatic infertile women.

This study aimed to establish the different prevalence of the microorganisms investigated in the two groups considered: fertile women with symptoms and asymptomatic women with infertility problems. The data from women (n= 952) investigated for two years for quality of genital discharge and the presence of Gardnerella vaginalis, Trichomonas vaginalis, Candida species, Streptococcus agalactiae, Mycoplasma hominis, Ureaplasma urealyiticum and Chlamydia trachomatis were retrospectively analyzed. In the population of fertile women with symptoms the microrganisms most frequently involved are Gardnerella vaginalis (26.6%), Candida species (12.1%) and Streptococcus agalactiae (9.2%). The genital discharges of asymptomatic women with infertility problems are characterized by a prevalence of Gardnerella vaginalis (19.7%), Enterobacteriaceae or Enterococci (12.1%) and Streptococcus agalactiae (8.6%). The reduction of vaginal lactobacilli flora and the presence of an elevated number of polymorphonucleates in the vaginal discharge are important parameters to consider for the evaluation of the health status of the human female urogenital tract. Our results indicate that is important to culture the vaginal discharge for Streptococcus agalactiae and for prevalence of Enterobacteriaceae and Enterococci. Lastly, the reasons for the prevalence of some microorganisms (Gardnerella vaginalis, Enterobacteriaceae and Enterococci, Streptococcus agalactiae) in the population of infertile asymptomatic women need to be better analyzed especially after the recent studies correlating idiopathic infertility with the presence of cervical cytokines in women with an abnormal vaginal flora.

Parasitic castration of a vertebrate: Effect of the cymothoid isopod, Anilocra apogonae, on the five-lined cardinalfish, Cheilodipterus quinquelineatus.

Parasitic castration, the specific blocking of host reproductive output by an individual parasite, is a host-parasite interaction common to many invertebrates, particularly crustaceans, echinoderms and molluscs. It can reduce host density, alter host population dynamics and the evolution of host life history traits. Here we show that parasitisation by a single female cymothoid isopod, Anilocra apogonae, castrates its vertebrate host, the five-lined cardinalfish, Cheilodipterus quinquelineatus. Parasitised male fish fail to mouthbrood their young. The gonads of parasitised fish are smaller and parasitised female fish have substantially fewer and smaller ova than do the gonads of unparasitised fish. As for parasitic castrators of invertebrate hosts, A. apogonae on C. quinquelineatus are uniformly dispersed amongst infested hosts (one adult female isopod per host), are site specific, and their body size is highly correlated with that of their host. These isopods are large relative to the body size of their hosts, averaging 3.8% of the weight of the host. Parasitised fish also weigh less and are shorter than unparasitised fish of the same age. Despite the presence of other potential hosts, A. apogonae only infests C. quinquelineatus. The consistency of the ecological correlates amongst known parasitic castrators suggests that the parasitic castrator host-parasite relationship will be recognised for other parasites of vertebrates.

Huge filarial elephantiasis vulvae in a Nigerian woman with subfertility.

Filariasis is a helminthic infection caused by tissue nematodes. It is estimated that at least 120 million people are infected worldwide and another 1 billion are "at risk" of infection. The prevalence is increasing due to uncontrolled urbanization in many of the endemic countries. The geographical distribution is determined mainly by climate and the distribution of the mosquito vector. We report a case of huge filarial elephantiasis of the vulva, in a 40-year-old multipara with background history of secondary infertility. She had excision of the elephantoid vulva lesion under general anaesthesia. A nontender irreducible pedunculated mass (25 cmx21 cm) with a large stalk arising from the right groin down to the ipsilateral labia majora was removed. A similar mass on the left groin, measuring 10 cmx6 cm was removed. Diagnosis was confirmed at histopathologic analysis of the excised masses. Patient was placed on diethyl carbamazine.

Tritrichomonas foetus damages bovine oocytes in vitro.

Tritrichomonas foetus is an extracellular parasite of the urogenital tract in cattle. It causes infertility and abortion, but there is no documented information on the susceptibility of bovine oocytes to the parasite, except by one article that claimed no effects of T. foetus on oocytes or embryos. The aim of the present study was to study the effects provoked by T. foetus when in interaction with bovine oocytes. Oocytes were obtained from cow ovaries and divided into two groups: (1) one group contained cumulus cells, whereas (2) a second group was denuded from these cells. Light microscopy, video microscopy and scanning electron microscopy (SEM) revealed that exposure of oocytes to T. foetus caused rapid adhesion of the trichomonads to cumulus cells and to the zona pellucida (ZP). Motile parasites were observed for 12 h. The ZP was completely damaged, and the parasites were able to infiltrate beneath the ZP and reached the oocytes directly when the oocytes were denuded of the cumulus cells. Both the oocytes and the cumulus cells exhibited morphological characteristics compatible with apoptosis after interaction with T. foetus, such as chromatin condensation, the presence of several cytoplasmic vacuoles, with intact cellular membranes and organelles. The results from this study demonstrate that when a large number of T. foetus interacts with oocytes in vitro damage and apoptosis are provoked in the cow's reproductive cells. The behavior of this parasite as one of the causes of cattle infertility is discussed.

[Uro-genital schistosomiasis with S. haematobium and infertility in Niger. Prospective study of 109 cases]. / Bilharziose uro-genitale a S. haematobium et infertilite au Niger. Etude prospective à propos de 109 consultantes.

Schistosomiasis represents the second most endemic diseases following malaria. It is now endemic in 76 countries of the world, and it is estimated that more than 200 million persons are infected. The objective of this work is to help in the improvement of knowledge about Female Genital Schistosomiasis (FSG) effects on the women reproductive. A transversal prospective survey during six months, on women consulting for infertility in the health reproductive center of Niamey. The women included (109 persons) have been asked and consulted in gynecology, cervical smears urine pathology, urine ragent strips test, vesico-renal and gynecologic trans-abdominal ultrasound, hysterosalpingography (HSG) and cervical biopsy on infected patients. The infestation prevalence at S.haematobium was 38,5%. The infected persons have presented more gyneco-obstétrical symptomatology than the non infested ones. The proportion of exocervicite was 31,0% by clinical examination. The cervical biopsy done on 26 bilharziosis patients confirmed the frequence of highs chronic exocervicites (50%) and leucoplasia (11,5%). Echography and HSG noticed that the bilharzios patients can let develop other annexiel pathologies such as: ovary cyst, peri-tuboovary adhesions and wide ovaries. The symptomatology felt by infested women showed the parasitose consequence on women in endemic area. The treatment in o large schaddle by the national program allows to reduce morbidity caused by that infection in Niger.

Evaluation of relationship between repeat breeding and Fasciola hepatica and hydatid cyst infections in cows in Elazig district of eastern Turkey.

Sera samples from 89 dairy cows with repeat breeding and 111 healthy pregnant dairy cows (controls) from Elazig province of eastern Turkey were tested for presence of Fasciola hepatica and Hydatid cyst antibodies by use of an indirect enzyme linked immunosorbent assay (indirect-ELISA). One hundred and twenty one (60.5%) and 93 (46.5%) cows were found to be positive to F. hepatica and Hydatid cyst antibodies, respectively. Fifty two of 89 cows (58.4%) with a history of repeat breeding were seropositive to F. hepatica, and 43 of 89 (48.3%) were seropositive to Hydatid cyst antibodies. Whereas, seropositivity rates were 62.1% (69/11) for F. hepatica and 45% (50/111) for Hydatid cyst in healthy pregnant cows (control group). There were no statistically relationship between infected and control group (P>0.05). In conclusion, we could not detect any relationship between repeat breeding and F. hepatica and Hydatid cyst infections in cattle.

Filariasis infection is a probable cause of implantation failure in in vitro fertilization cycles.

OBJECTIVE: To describe a parasitic infection that probably affected the implantation of good-quality embryos in an in vitro fertilization (IVF) cycle. DESIGN: Case report. SETTING: Tertiary care center in a university hospital. PATIENT(S): A 36-year-old Caucasian female with primary unexplained infertility. The patient underwent two cycles of IVF with good-quality embryos transferred; however, no pregnancy ensued despite adequate luteal support. INTERVENTION(S): In vitro fertilization cycles, CBC, blood smear, evaluation for eosinophilia including serological evaluation for parasitic infections. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): Following treatment for filariasis, a repeat IVF cycle using the same stimulation protocol yielded a full-term pregnancy. CONCLUSION(S): This case is of particular importance because, to our knowledge, it is the first to describe a parasitic infection that probably affected the implantation of good-quality embryos in IVF cycles.

Hidatidosis ovárica / Ovarian echinococcosis

Se reporta un caso excepcional de hidatidosis ovárica en una paciente joven, con esterilidad primaria. Se evalúan los métodos de diagnóstico, el tratamiento, la evolución clínica y el posible efecto en la fertilidad.

A study on Trichomoniasis vaginalis and female infertility.

A total of 280 patients, 240 infertile and 40 pregnant were subjected to thorough history taking, general and local examination for exclusion of organic lesion, laboratory investigations to exclude parasitic, bacterial and fungal infections. Sterile vaginal swab from the posterior fornix was taken, and examined by wet smear preparation, Giemsa staining and cultivation on C.P.L.M. medium for trichomoniasis infection. The mean age of the infertile group was 25.75+/-3.92, and of the control group was 21.6+/-2.38 (in years). The mean duration of infertility was 2.81+/-1.51 (years). Out of 240 infertile women, 18.75% complained of discharge, 17.5% itching, 15.42% dysuria, 14.58% dyspareunia, and 10% had cervical lesion. Of the 40 controls, 5% complained of discharge, 2.5% complained of itching, dysuria, dyspareunia, but none had cervical lesion. Of the total cases (280), 36 (12.9%) had T. vaginalis. The clinical data observed were significantly higher among the infertile group than the control group. Cultures were positive in 14.58% of the infertile group and 2.5% in the control group. The difference between the 2 groups was statistically significant. No doubt, T. vaginalis plays an important role in female infertility.