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1.
BMC Womens Health ; 24(1): 280, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38720297

RESUMO

BACKGROUND: Infertility is a marginalized sexual and reproductive health issue in low-resource settings. Globally, millions are affected by infertility, but the lack of a universal definition makes it difficult to estimate the prevalence of infertility at the population level. Estimating the prevalence of infertility may inform targeted and accessible intervention, especially for a resource-limited country like Ethiopia. This study aims to estimate the prevalence of female infertility in Ethiopia using the Demographic and Health Survey (DHS) through two approaches: (i) the demographic approach and (ii) the current duration approach. METHODS: Data from 15,683 women were obtained through the 2016 Ethiopian DHS. The demographic approach estimates infertility among women who had been married/in a union for at least five years, had never used contraceptives, and had a fertility desire. The current duration approach includes women at risk of pregnancy at the time of the survey and determines their current length of time-at-risk of pregnancy at 12, 24, and 36 months. Logistic regression analysis estimated the prevalence of infertility and factors associated using the demographic approach. Parametric survival analysis estimated the prevalence of infertility using the current duration approach. All estimates used sampling weights to account for the DHS sampling design. STATA 14 and R were used to perform the statistical analysis. RESULTS: Using the demographic definition, the prevalence of infertility was 7.6% (95% CI 6.6-8.8). When stratified as primary and secondary infertility, the prevalence was 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5-10.1), respectively. Using the current duration approach definition, the prevalence of overall infertility was 24.1% (95% CI 18.8-34.0) at 12-months, 13.4% (95% CI 10.1-18.6) at 24-months, and 8.8% (95% CI 6.5-12.3) at 36-months. CONCLUSION: The demographic definition of infertility resulted in a lower estimate of infertility. The current duration approach definition could be more appropriate for the early detection and management of infertility in Ethiopia. The findings also highlight the need for a comprehensive definition of and emphasis on infertility. Future population-based surveys should incorporate direct questions related to infertility to facilitate epidemiological surveillance.


Assuntos
Infertilidade Feminina , Humanos , Etiópia/epidemiologia , Feminino , Adulto , Prevalência , Infertilidade Feminina/epidemiologia , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Inquéritos Epidemiológicos , Gravidez
2.
BMC Infect Dis ; 24(1): 480, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38730346

RESUMO

BACKGROUND: Tubal factor infertility (TFI) is common in sub-Saharan Africa and often secondary to pelvic inflammatory disease (PID). Anaerobes associated with bacterial vaginosis (BV) are also found in PIDs widely dominated by Chlamydia trachomatis (C. trachomatis), whose role in TFI is better demonstrated than that of BV. OBJECTIVES: To determine the prevalence of BV and C. trachomatis and to investigate the association between BV, C. trachomatis and TFI. METHODS: We included 137 patients treated for infertility between January 2020 and November 2021. Cases were defined as women with infertility aged 18-45 years presenting with TFI (n = 52), and controls as infertile women in the same age groups without TFI (n = 85). Data on social habits, life style and infertility parameters were collected, and we performed screening for BV and C. trachomatis. Multiple regression was used to measure associations. RESULTS: The prevalence of BV and C. trachomatis was 42.3% (58/137) and 23.4% (32/137), respectively. BV (61.5% vs 30.6%, p<0.001) and C. trachomatis (48.1 vs 8.2%, p<0.001) were more frequent in cases of TFI. BV and C. trachomatis increased the risk of TFI approximately 4-fold [aOR: 3.77 (1.61-8.83), p=0.002] and 14-fold [aOR: 13.77 (4.59-41.27), p<0.001], respectively. CONCLUSION: BV and C. trachomatis infection are strongly associated with TFI in Bukavu. Prevention and screening should be implemented to reduce the risk of TFI.


Assuntos
Infecções por Chlamydia , Chlamydia trachomatis , Infertilidade Feminina , Vaginose Bacteriana , Humanos , Feminino , Adulto , Vaginose Bacteriana/epidemiologia , Vaginose Bacteriana/microbiologia , Vaginose Bacteriana/complicações , Chlamydia trachomatis/isolamento & purificação , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/complicações , Prevalência , Adulto Jovem , Adolescente , República Democrática do Congo/epidemiologia , Pessoa de Meia-Idade , Infertilidade Feminina/microbiologia , Infertilidade Feminina/epidemiologia
3.
Front Endocrinol (Lausanne) ; 15: 1343176, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38742200

RESUMO

Study objective: To investigate whether different timings of GnRH-a downregulation affected assisted reproductive outcomes in infertile women with moderate-to-severe intrauterine adhesions (IUAs) accompanied by adenomyosis. Design: A retrospective case series. Setting: An assisted reproductive technology center. Patients: The study reviewed 123 infertile women with moderate-to-severe IUAs accompanied by adenomyosis undergoing their first frozen-thawed embryo transfer (FET) cycles between January 2019 and December 2021. Measurements and main results: The majority of patients had moderate IUA (n=116, 94.31%). The average Basal uterine volume was 73.58 ± 36.50 cm3. The mean interval from operation to the first downregulation was 21.07 ± 18.02 days (range, 1-79 days). The mean duration of hormone replacement therapy (HRT) was 16.93 ± 6.29 days. The average endometrial thickness on the day before transfer was 10.83 ± 1.75 mm. A total of 70 women achieved clinical pregnancy (56.91%). Perinatal outcomes included live birth (n=47, 67.14%), early miscarriage (n=18, 25.71%), and late miscarriage (n=5, 7.14%). The time interval between uterine operation and the first downregulation was not a significant variable affecting live birth. Maternal age was the only risk factor associated with live birth (OR:0.89; 95% CI: 0.79-0.99, P=0.041). Conclusions: The earlier initiation of GnRH-a to suppress adenomyosis prior to endometrial preparation for frozen embryo transfer did not negatively impact repair of the endometrium after resection.


Assuntos
Adenomiose , Transferência Embrionária , Endométrio , Hormônio Liberador de Gonadotropina , Infertilidade Feminina , Nascido Vivo , Humanos , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Adulto , Estudos Retrospectivos , Gravidez , Endométrio/efeitos dos fármacos , Endométrio/patologia , Nascido Vivo/epidemiologia , Infertilidade Feminina/terapia , Transferência Embrionária/métodos , Taxa de Gravidez , Coeficiente de Natalidade , Aderências Teciduais , Fertilização in vitro/métodos
4.
Reprod Health ; 21(1): 61, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698459

RESUMO

Vitamin D is a fat-soluble steroid hormone that was initially known only for regulating calcium and phosphorus levels and maintaining bone health. However, it was later discovered that many organs express vitamin D metabolizing enzymes and have a ligand for vitamin D, which regulates the expression of an extensive assortment of genes. As a result, vitamin D is indispensable for the proper function of organs, and its deficiency is believed to be a critical factor in symptoms and disorders such as cardiovascular diseases, autoimmune diseases, and cancers. The significance of vitamin D in reproductive tissues was recognized later, and studies have revealed its crucial role in male and female fertility, as well as proper reproductive function during pregnancy. Vitamin D deficiency has been identified as a risk factor for infertility, gonadal cancers, pregnancy complications, polycystic ovary syndrome, and endometriosis. However, data investigating the association between vitamin D levels and reproductive disorders, including endometriosis, have encountered inconsistencies. Therefore, the present study aims to review existing research on the effect of vitamin D on proper reproductive function, and the role of deficiency in reproductive diseases and specifically focuses on endometriosis.


Assuntos
Endometriose , Deficiência de Vitamina D , Vitamina D , Humanos , Endometriose/metabolismo , Feminino , Vitamina D/sangue , Vitamina D/metabolismo , Deficiência de Vitamina D/complicações , Gravidez , Reprodução/fisiologia , Infertilidade Feminina/etiologia
5.
Front Endocrinol (Lausanne) ; 15: 1343803, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38745952

RESUMO

Purpose: This study aims to retrospectively estimate cumulative reproductive outcomes in women with primary ovarian insufficiency (POI) in assisted reproductive technology (ART) therapy. Methods: A total of 139 patients diagnosed with POI were reviewed in this study. Firstly, they were divided into two groups according to oocyte origin: using their own oocytes (OG group) or accepting oocyte donations (OD I group). Secondly, the patients were split depending on the pregnancy outcome. In the OG group, nine patients decided to use others' oocytes after a failure of attempting to use their own, and this population was the oocyte donation II group (OD II group). Results: There were 88 patients who used their own oocytes, while 51 patients accepted oocyte donations. In the OG group, there are only 10 (7.2%) patients who got pregnant, and patients in the OD group had worse hormone levels (FSH 71.37 ± 4.18 vs. 43.98 ± 2.53, AMH 0.06 ± 0.04 vs. 1.15 ± 0.15, and AFC 0.10 ± 0.06 vs. 1.15 ± 0.15) and more years of infertility (5.04 ± 0.48 vs. 3.82 ± 0.30), which explained why they choose oocyte donation. In all the three groups, baseline characteristics were comparable between pregnant women and non-pregnant women. Of the 10 pregnant patients in the OG group, four of them used luteal-phase short-acting long protocol and had pregnancies successfully in their first cycles. Conclusion: Ovarian stimulation in POI women requires more cost and time. For those with a stronger desire to have genetic offspring, luteal-phase short-acting long protocol may help them obtain pregnancy rapidly.


Assuntos
Doação de Oócitos , Resultado da Gravidez , Insuficiência Ovariana Primária , Técnicas de Reprodução Assistida , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Insuficiência Ovariana Primária/terapia , Adulto , Taxa de Gravidez , Indução da Ovulação/métodos , Infertilidade Feminina/terapia
6.
Front Endocrinol (Lausanne) ; 15: 1269382, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38745960

RESUMO

Thin endometrium (TE) is defined as a mid-luteal endometrial thickness ≤7mm. TE can affect endometrial tolerance, leading to lower embryo implantation rates and clinical pregnancy rates, and is also associated with impaired outcomes from assisted reproductive treatment. Herein, we systematically review TE causes, mechanisms, and treatments. TE pathogenesis has multiple causes, with the endometrium becoming thinner with age under hormonal influence. In addition, uterine cavity factors are important, as the inflammatory environment may affect expressions of certain genes thereby inhibiting endometrial stromal cell proliferation and promoting apoptosis. Long-term oral contraceptive use or the use of ovulation-promoting drugs are also definite factors contributing to endometrial thinning. Other patients have primary factors, for which the clinical etiology remains unknown. The main therapeutic strategies available for TE are pharmacological (including hormonal and vasoactive drugs), regenerative medicine, intrauterine infusion of growth factor-granulocyte colony-stimulating factor, autologous platelet-rich plasma, and complementary alternative therapies (including traditional Chinese herbal medicine and acupuncture). However, the associated mechanisms of action are currently unclear. Clinical scholars have proposed various approaches to improve treatment outcomes in patients with TE, and are exploring the principles of efficacy, offering potentials for novel treatments. It is hoped that this will improve TE tolerance, increase embryo implantation rates, and help more couples with infertility with effective treatments.


Assuntos
Endométrio , Humanos , Endométrio/patologia , Feminino , Infertilidade Feminina/terapia , Gravidez , Implantação do Embrião
7.
Front Endocrinol (Lausanne) ; 15: 1376800, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38715795

RESUMO

Background: Although studies on the effects of diet on fertility has progressed, some cumulative evidence has piled against popular hypotheses. The aim of our study was to investigate the effects of 31 diets including 23 individual dietary intakes and 8 dietary habits on infertility in men and women. Methods: The datas of diets and infertility were collected from genome-wide association studies (GWAS). Mendelian randomization (MR) methods were used to analyze causal relationships. Multivariate MR (MVMR) adjusted for the effects of other exposures on causality. And MR-Egger, Cochran's Q, radial MR, and MR-PRESSO tests were employed to assess heterogeneity and horizontal pleiotropy. Results: Our study found that coffee intake (OR, 3.6967; 95% CI, 1.0348 - 13.2065; P = 0.0442) and cooked vegetable intakes (OR, 54.7865; 95% CI, 2.9011 - 1030.5500; P = 0.0076) increased the risk of male infertility. For women, beer was a risk factor for infertility (OR, 4.0932; 95% CI, 1.8728 - 8.9461; P = 0.0004); but processed meat was negatively associated with infertility (OR, 0.5148; 95% CI, 0.2730 - 0.9705; P = 0.0401). MVMR demonstrated selenium as a protective factor against female infertility (OR, 7.4474e-12; 95% CI, 5.4780e-22 - 1.0125e-01; P = 0.0314). Conclusion: We found the causal relationships between four diets and infertility. We look forward to more high-quality epidemiologic studies to prove our conclusions.


Assuntos
Dieta , Estudo de Associação Genômica Ampla , Infertilidade Feminina , Infertilidade Masculina , Análise da Randomização Mendeliana , Humanos , Feminino , Masculino , Infertilidade Masculina/genética , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/etiologia , Infertilidade Feminina/genética , Infertilidade Feminina/etiologia , Fatores de Risco , Comportamento Alimentar , Adulto , Café/efeitos adversos
8.
BMC Womens Health ; 24(1): 279, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714986

RESUMO

BACKGROUND: Infertility remains a serious health concern for Ethiopian women. Most of its treatment approaches entail controlled ovarian stimulation, the responses of which vary. However, there are no data on ovarian response to stimulation or its predictors in our situation. Thus, the current study aimed to assess the ovarian response to controlled stimulation and identify predictors. METHODS: A retrospective follow-up study was undertaken from April 1, 2021, to March 31, 2022, among patients who had first-cycle controlled ovarian stimulation at St.Paul's Hospital Fertility Center in Addis Ababa, Ethiopia. Clinical data were extracted using a checklist. SPSS-26 for data analysis and Epidata-4.2 for data entry were employed. The binary logistic regression model was fitted. A p-value < 0.05 indicated a significant association. The ROC curve was used to determine cutoff values and identify accurate predictors. RESULTS: A total of 412 study participants were included in the final analysis. The patients had a mean age of 32.3 ± 5.1 years (range: 20 - 4). The good ovarian response rate was 67% (95% CI: 62.2-71.5). An anti-Mullerian hormone (AMH) concentration < 1.2ng/ml (AOR = 0.19, 95% CI (0.06-0.57)), an antral follicle count (AFC) < 5 (AOR = 0.16, 95% CI (0.05-0.56)), and an induction length < 10 days (AOR = 0.23, 95% CI (0.06-0.93)) were significantly associated with ovarian response. The prediction accuracies for the AFC and AMH concentrations were 0.844 and 0.719, respectively. The optimal cutoff point for prediction was 5.5 AFC, which had a sensitivity of 77.2% and a specificity of 72.8%. However, its positive and negative predictive values were 85.2% and 61.1%, respectively. For AMH, the optimal cutoff value was 0.71ng/mL, with a corresponding sensitivity and specificity of 65.2% and 66%. At this value, the positive and negative predictive values were 63.8% and 67.3%, respectively. CONCLUSION: Only two-thirds of our patients achieved a good ovarian response. Induction duration, AMH concentration, and AFC were found to be predictors, with the AFC being the strongest predictor. Therefore, the AFC should be performed on all of our patients, and the AMH is selectively employed. Future research must verify the best cutoff points and investigate additional factors affecting ovarian response.


Assuntos
Hormônio Antimülleriano , Infertilidade Feminina , Indução da Ovulação , Humanos , Feminino , Adulto , Etiópia , Indução da Ovulação/métodos , Estudos Retrospectivos , Hormônio Antimülleriano/sangue , Hormônio Antimülleriano/análise , Infertilidade Feminina/terapia , Infertilidade Feminina/sangue , Adulto Jovem , Seguimentos , Gravidez , Ovário/fisiologia
9.
Natl Health Stat Report ; (202): 1-19, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38722687

RESUMO

Objectives-Using National Survey of Family Growth data from 2015-2019, this report presents updated national estimates of infertility in U.S. women and men and estimates of impaired fecundity (physical ability to have children) in U.S. women. Detailed demographic breakdowns are also presented, and overall estimates for 2015-2019 are compared with those for 2011-2015. Methods-Data for this report come primarily from the 2015-2019 National Survey of Family Growth, which consisted of 21,441 interviews with men and women ages 15-49, conducted from September 2015 through September 2019. The response rate was 65.9% for women and 62.4% for men. Results-The percentage of women ages 15-44 who had impaired fecundity did not change between 2011-2015 and 2015-2019. The percentage of married women with impaired fecundity also remained stable over this time period. Among all women, 13.4% of women ages 15-49 and 15.4% of women ages 25-49 had impaired fecundity in 2015-2019. The percentage of married women ages 15-44 who were infertile rose from 2011-2015 (6.7%) to 2015-2019 (8.7%). Among married and cohabiting women ages 15-49 in 2015-2019, 7.8% had infertility. Both infertility and impaired fecundity were associated with age for nulliparous (never had a live birth) women after adjusting for other factors. Some form of infertility (either subfertility or nonsurgical sterility) was seen in 11.4% of men ages 15-49 and 12.8% of men ages 25-49 in 2015-2019. . Conclusion-Although these findings are not nationally representative, this report illustrates how linked NHCS-HUD data may provide insight into maternal health outcomes of patients who received housing assistance compared with those who did not.


Assuntos
Infertilidade , Humanos , Estados Unidos/epidemiologia , Adulto , Feminino , Adolescente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infertilidade/epidemiologia , Infertilidade Feminina/epidemiologia , Infertilidade Masculina/epidemiologia , Fertilidade
10.
Front Endocrinol (Lausanne) ; 15: 1352770, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38699387

RESUMO

Background: The efficiency of different first-line treatments, such as first-line surgery and assisted reproductive technology (ART), in women with deep infiltrating endometriosis (DIE) is still unclear due to a lack of direct comparative trials. This systematic review and meta-analysis aim to elucidate and compare the efficacies of first-line treatments in patients with DIE, with an emphasis on fertility outcomes. Methods: An exhaustive search of PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane trial registry, Google Scholar, and Clinicaltrials.gov databases was done to identify studies directly comparing first-line surgery and assisted reproductive technology (ART) for DIE, and reporting fertility-related outcomes. Pooled estimates for each of the binary outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). The results were pooled using a random-effects model with the Mantel-Haenszel technique. Results: Our results show that pregnancy rate per patient (OR, 1.47; 95% CI, 0.59 to 3.63), pregnancy rate per cycle (OR, 1.16; 95% CI, 0.45 to 2.99), and live births per patient (OR, 1.66; 95% CI, 0.56 to 4.91) were comparable in DIE patients, treated with surgery or ART as a first line of treatment. When both complete and incomplete surgical DIE excision procedures were taken into account, surgery was associated with a significant enhancement in the pregnancy rate per patient (OR, 1.63; 95% CI, 1.11 to 2.40). Conclusion: The available evidence suggests that both first-line surgery and ART can be effective DIE treatments with similar fertility outcomes. However, further analysis reveals that excluding studies involving endometriomas significantly alters the understanding of treatment efficacy between surgery and ART for DIE-associated infertility. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=426061, identifier CRD42023426061.


Assuntos
Endometriose , Infertilidade Feminina , Taxa de Gravidez , Técnicas de Reprodução Assistida , Humanos , Endometriose/cirurgia , Feminino , Gravidez , Infertilidade Feminina/cirurgia , Infertilidade Feminina/terapia
11.
FASEB J ; 38(9): e23622, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38703029

RESUMO

Endometriosis (EMs)-related infertility commonly has decreased endometrial receptivity and normal decidualization is the basis for establishing and maintaining endometrial receptivity. However, the potential molecular regulatory mechanisms of impaired endometrial decidualization in patients with EMs have not been fully clarified. We confirmed the existence of reduced endometrial receptivity in patients with EMs by scanning electron microscopy and quantitative real-time PCR. Here we identified an lncRNA, named BMPR1B-AS1, which is significantly downregulated in eutopic endometrium in EMs patients and plays an essential role in decidual formation. Furthermore, RNA pull-down, mass spectrometry, RNA immunoprecipitation, and rescue analyses revealed that BMPR1B-AS1 positively regulates decidual formation through interaction with the RNA-binding protein insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2). Downregulation of IGF2BP2 led to a decreased stability of BMPR1B-AS1 and inhibition of activation of the SMAD1/5/9 pathway, an inhibitory effect which diminished decidualization in human endometrial stromal cells (hESCs) decidualization. In conclusion, our identified a novel regulatory mechanism in which the IGF2BP2-BMPR1B-AS1-SMAD1/5/9 axis plays a key role in the regulation of decidualization, providing insights into the potential link between abnormal decidualization and infertility in patients with EMs, which will be of clinical significance for the management and treatment of infertility in patients with EMs.


Assuntos
Endometriose , RNA Longo não Codificante , Proteínas de Ligação a RNA , Adulto , Feminino , Humanos , Receptores de Proteínas Morfogenéticas Ósseas Tipo I/metabolismo , Receptores de Proteínas Morfogenéticas Ósseas Tipo I/genética , Decídua/metabolismo , Decídua/patologia , Endometriose/metabolismo , Endometriose/genética , Endometriose/patologia , Endométrio/metabolismo , Endométrio/patologia , Infertilidade Feminina/metabolismo , Infertilidade Feminina/genética , Infertilidade Feminina/patologia , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Proteínas de Ligação a RNA/metabolismo , Proteínas de Ligação a RNA/genética , Transdução de Sinais , Células Estromais/metabolismo , Proteínas Smad , Adulto Jovem
12.
Front Immunol ; 15: 1368572, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38698852

RESUMO

Introduction: Interferon-gamma (IFN-γ) is pivotal in orchestrating immune responses during healthy pregnancy. However, its dysregulation, often due to autoimmunity, infections, or chronic inflammatory conditions, is implicated in adverse reproductive outcomes such as pregnancy failure or infertility. Additionally, the underlying immunological mechanisms remain elusive. Methods: Here, we explore the impact of systemic IFN-γ elevation on cytotoxic T cell responses in female reproduction utilizing a systemic lupus-prone mouse model with impaired IFN-γ degradation. Results: Our findings reveal that heightened IFN-γ levels triggered the infiltration of CD8+T cells in the pituitary gland and female reproductive tract (FRT), resulting in prolactin deficiency and subsequent infertility. Furthermore, we demonstrate that chronic IFN-γ elevation increases effector memory CD8+T cells in the murine ovary and uterus. Discussion: These insights broaden our understanding of the role of elevated IFN-γ in female reproductive dysfunction and suggest CD8+T cells as potential immunotherapeutic targets in female reproductive disorders associated with chronic systemic IFN-γ elevation.


Assuntos
Linfócitos T CD8-Positivos , Interferon gama , Animais , Feminino , Interferon gama/metabolismo , Camundongos , Linfócitos T CD8-Positivos/imunologia , Modelos Animais de Doenças , Lúpus Eritematoso Sistêmico/imunologia , Útero/imunologia , Infertilidade Feminina/imunologia , Hipófise/imunologia , Hipófise/metabolismo , Camundongos Endogâmicos C57BL , Gravidez , Prolactina/metabolismo , Ovário/imunologia
13.
Medicine (Baltimore) ; 103(18): e37886, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38701292

RESUMO

INTRODUCTION: Resistant ovary syndrome (ROS) represents a rare reproductive endocrine disorder that is predominantly associated with infertility, characterized by heightened endogenous gonadotropin levels in the presence of a normal ovarian reserve. Patients with ROS typically exhibit a poor response to exogenous gonadotropins during controlled ovarian stimulation (COS). Due to the absence of a universally accepted effective COS protocol, this study aims to contribute to the existing body of literature by detailing 2 successful pregnancies achieved through conventional in vitro fertilization (c-IVF) in patients with ROS, and through retrospective analysis, seeks to elucidate the factors contributing to the successful ovarian stimulation in these cases, with the ultimate goal of establishing clinical guidelines for ROS management. PATIENT CONCERNS: The central challenge addressed in this study pertains to the effective induction of oocyte maturation during c-IVF COS in ROS patients. DIAGNOSIS: The study focuses on 2 infertile women diagnosed with ROS who sought to conceive via c-IVF. INTERVENTIONS: The patients were subjected to a COS protocol involving pituitary downregulation followed by ovarian stimulation using recombinant follicle-stimulating hormone (r-FSH) and human menopausal gonadotropin (HMG), preceded by 3 cycles of hormone replacement therapy (HRT) pretreatment. OUTCOMES: The proposed protocol elicited a favorable ovarian response, culminating in the retrieval of numerous mature oocytes and the development of multiple viable embryos via c-IVF, ultimately leading to successful live births post-embryo transfer. CONCLUSIONS: Our study suggests that the outlined COS protocol may serve as a viable treatment option for ROS patients aspiring to conceive through c-IVF, thereby potentially expanding the therapeutic repertoire for this challenging condition.


Assuntos
Fertilização in vitro , Infertilidade Feminina , Indução da Ovulação , Humanos , Feminino , Indução da Ovulação/métodos , Fertilização in vitro/métodos , Adulto , Infertilidade Feminina/terapia , Gravidez , Doenças Ovarianas/tratamento farmacológico , Hormônio Foliculoestimulante/sangue , Hormônio Foliculoestimulante/administração & dosagem
14.
Front Endocrinol (Lausanne) ; 15: 1379109, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38737557

RESUMO

Introduction: The impact of the obesity pandemic on female reproductive capability is a factor that needs to be investigated. In addition, the link between endometrial thickness and in vitro fertilization (IVF) outcomes is contentious. Goal: Our goal was to analyze the association among endometrium development, hormone levels, embryo quality, clinical pregnancy, anamnestic parameters, and body mass index (BMI) in women receiving IVF treatment. Patients and methods: 537 participants undergoing IVF/ICSI cycles with successful oocyte retrieval were enrolled. Subjects were divided into four BMI based groups: underweight (UW; n=32), normal weight (NW; n=324), overweight (OW; n= 115), obesity (OB; n=66). Anthropometric and anamnestic parameters, characteristics of stimulation, endometrial thickness on the day of hCG injection, at puncture, at embryo transfer, FSH, LH, AMH, partner's age and the semen analysis indicators, embryo quality, clinical pregnancy, were recorded and analyzed. Support Vector Machine (SVM) was built to predict potential pregnancies based on medical data using 22 dimensions. Results: In accordance with BMI categories, when examining pregnant/non-pregnant division, the average age of pregnant women was significantly lower in the UW (30.9 ± 4.48 vs. 35.3 ± 5.49 years, p=0.022), NW (34.2 ± 4.25 vs. 36.3 ± 4.84 years, p<0.001), and OW (33.8 ± 4.89 vs. 36.3 ± 5.31 years, p=0.009) groups. Considering FSH, LH, and AMH levels in each BMI category, a statistically significant difference was observed only in the NW category FSH was significantly lower (7.8 ± 2.99 vs. 8.6 ± 3.50 IU/L, p=0.032) and AMH (2.87 ± 2.40 vs. 2.28 ± 2.01 pmol/L, p=0.021) was higher in pregnant women. There were no further statistically significant differences observed between the pregnant and non-pregnant groups across any BMI categories, especially concerning endometrial development. Surprisingly, BMI and weight correlated negatively with FSH (r=-0.252, p<0.001; r=-0.206, p<0.001, respectively) and LH (r= -0.213, p<0.001; r= -0.195, p<0.001) in the whole population. SVM model average accuracy on predictions was 61.71%. Discussion: A convincing correlation between endometrial thickness development and patients' BMI could not be substantiated. However, FSH and LH levels exhibited a surprising decreasing trend with increasing BMI, supporting the evolutionary selective role of nutritional status. Our SVM model outperforms previous models; however, to confidently predict the outcome of embryo transfer, further optimization is necessary.


Assuntos
Índice de Massa Corporal , Endométrio , Fertilização in vitro , Taxa de Gravidez , Humanos , Feminino , Fertilização in vitro/métodos , Gravidez , Adulto , Endométrio/patologia , Prognóstico , Obesidade , Infertilidade Feminina/terapia , Transferência Embrionária/métodos , Injeções de Esperma Intracitoplásmicas , Magreza
15.
J Affect Disord ; 356: 300-306, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38583599

RESUMO

BACKGROUND: Assisted reproductive technologies (ARTs) have become the main treatment for infertility. ART treatment can be a stressful life event for infertile females. Whether there is an association between ARTs and postpartum depressive symptoms (PDS) has not been established. METHODS: PubMed, MEDLINE, EMBASE, PsycINFO, and CNKI were searched. The pooled outcome was the difference in incidence of PDS within 1 year postpartum between ARTs and the spontaneous pregnancy group. RESULTS: A total of 12 cohort studies, which were conducted in eight developed countries and two developing countries, were involved. In total, 106,338 pregnant women, including 4990 infertile females with ARTs treatment and 101,348 women with spontaneous pregnancy, were enrolled in our final analysis. ARTs women had a lower incidence of PDS compared to the spontaneous pregnancy group according to a random effect model (OR = 0.83, 95 % CI: 0.71-0.97, p = 0.022, I2 = 62.0 %). Subgroup analyses indicated that studies on late PDS (follow-up: 3-12 months postpartum) were more heterogeneous than those on early PDS (follow-up: <3 months postpartum) (I2 = 24.3 % vs. I2 = 0 %, interaction p-value < 0.001). There was a strong relationship between ARTs and late PDS (OR = 0.65, 95 % CI: 0.55-0.77, p < 0.001). Therefore, the possible source of heterogeneity was the postpartum evaluation time, which was confirmed by post-hoc meta-regression. LIMITATIONS: Some underlying confounders, such as previous psychiatric illness, the limited availability of ARTs, and ethnic disparities, cannot be ignored and may have biased interpretation of the results. CONCLUSION: The available data suggested that ARTs were associated with lower incidence of PDS, especially when follow-up lasted over 3 months. However, these findings should be interpreted with caution. Better-designed trials are needed to confirm this association.


Assuntos
Depressão Pós-Parto , Técnicas de Reprodução Assistida , Humanos , Feminino , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/terapia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Gravidez , Adulto , Infertilidade Feminina/psicologia , Infertilidade Feminina/terapia , Incidência
16.
Curr Opin Obstet Gynecol ; 36(3): 181-185, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38656810

RESUMO

PURPOSE OF REVIEW: This article reviews recent advances in ultrasound elastography in diagnosing and evaluating the normal nongravid uterus and the infertile uterus in the gynecologic patient. RECENT FINDINGS: Focusing on the most recent primary literature, studies have demonstrated new findings among a breadth of gynecologic clinical settings. Studies in the nongravid uterus have found that menopausal status, age, and menstrual phase have not been associated with changes in uterine tissue stiffness. Focusing on myometrial disease, there have been conflicting data regarding the ability to distinguish uterine fibroids from adenomyosis. One area of expanding research surrounding uterine elastography includes the infertile population, where ongoing studies attempt to provide a predictive model using shear wave elastography (SWE) in patients undergoing in-vitro fertilization. SUMMARY: Ultrasound elastography has become an increasingly studied and utilized tool in assessing physiologic and pathologic processes in the field of gynecology. Evaluating tissue stiffness through strain and SWE can serve to improve diagnosis of various uterine and cervical lesions, as well as prognosticate outcomes after fertility treatments. This growing area of research will continue to establish the role and application of ultrasound elastography into clinical practice.


Assuntos
Técnicas de Imagem por Elasticidade , Infertilidade Feminina , Útero , Humanos , Feminino , Técnicas de Imagem por Elasticidade/métodos , Útero/diagnóstico por imagem , Infertilidade Feminina/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Doenças Uterinas/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Adenomiose/diagnóstico por imagem
17.
Curr Opin Clin Nutr Metab Care ; 36(3): 134-147, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38656809

RESUMO

PURPOSE OF REVIEW: The analysis of microbiome in association with female health is today a "hot topic" with the main focus on microbes in the female reproductive tract. Nevertheless, recent studies are providing novel information of the possible influence of the gut microbiome on gynecological health outcomes, especially as we start to understand that the gut microbiome is an extended endocrine organ influencing female hormonal levels. This review summarizes the current knowledge of the gut microbes in association with gynecological health. RECENT FINDINGS: The gut microbiome has been associated with endometriosis, polycystic ovary syndrome, gynecological cancers, and infertility, although there is a lack of consistency and consensus among studies due to different study designs and protocols used, and the studies in general are underpowered. SUMMARY: The interconnection between the gut microbiome and reproductive health is complex and further research is warranted. The current knowledge in the field emphasizes the link between the microbiome and gynecological health outcomes, with high potential for novel diagnostic and treatment tools via modulation of the microenvironment.


Assuntos
Endometriose , Microbioma Gastrointestinal , Síndrome do Ovário Policístico , Saúde Reprodutiva , Humanos , Feminino , Microbioma Gastrointestinal/fisiologia , Endometriose/microbiologia , Síndrome do Ovário Policístico/microbiologia , Genitália Feminina/microbiologia , Neoplasias dos Genitais Femininos/microbiologia , Infertilidade Feminina/microbiologia , Doenças dos Genitais Femininos/microbiologia
18.
Medicine (Baltimore) ; 103(15): e37725, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38608124

RESUMO

Worldwide, an estimated 48 million couples and 186 million individuals are infertile, according to estimates from the World Health Organization. Ethiopia has a higher rate of infertility than the World Health Organization estimated for the entire world. Though research on the issue of infertility is growing both globally and in Ethiopia, not much has been studied. Therefore, the main objective of this study was to explore the psychological and coping strategies of infertile women in Bichena town, Ethiopia. The study followed a qualitative research approach and a descriptive phenomenological design. Data were collected through in-depth interviews with 15 infertile women using a purpose-sampling technique. Thematic analysis was the method of data analysis. The findings of this study indicated that stress, anxiety, depression, low self-esteem, and sexual dissatisfaction were the main psychological challenges that infertile women experience. Infertile women also used a variety of coping strategies, such as religious strategies, traditional strategies, medical strategies, and other strategies (marital separation and acceptance). The study concluded that infertile women in the study area were challenged by psychological factors and used different coping strategies to manage their ongoing problems. This study also has theoretical implications for the current literature and practical implications for infertile women, non-governmental organizations, community and health professionals.


Assuntos
Infertilidade Feminina , Feminino , Humanos , Etiópia , Capacidades de Enfrentamento , Ansiedade , Transtornos de Ansiedade
19.
Int J Mol Sci ; 25(7)2024 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-38612425

RESUMO

Resveratrol is a polyphenol present in various plant sources. Studies have reported numerous potential health benefits of resveratrol, exhibiting anti-aging, anti-inflammatory, anti-microbial, and anti-carcinogenic activity. Due to the reported effects, resveratrol is also being tested in reproductive disorders, including female infertility. Numerous cellular, animal, and even human studies were performed with a focus on the effect of resveratrol on female infertility. In this review, we reviewed some of its molecular mechanisms of action and summarized animal and human studies regarding resveratrol and female infertility, with a focus on age-related infertility, polycystic ovary syndrome, and endometriosis.


Assuntos
Endometriose , Infertilidade Feminina , Animais , Feminino , Humanos , Infertilidade Feminina/tratamento farmacológico , Resveratrol/farmacologia , Resveratrol/uso terapêutico , Endometriose/tratamento farmacológico , Polifenóis , Envelhecimento
20.
Front Endocrinol (Lausanne) ; 15: 1374382, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38654928

RESUMO

Millions of women worldwide are infertile due to gynecological disorders, including premature ovarian insufficiency, polycystic ovary syndrome, Asherman syndrome, endometrial atrophy, and fallopian tube obstruction. These conditions frequently lead to infertility and have a substantial impact on the quality of life of the affected couples, primarily because of their psychological implications and high financial costs. Recently, using platelets to stimulate cell proliferation and tissue differentiation has emerged as a promising approach in regenerative medicine. Platelet-rich plasma (PRP) shows considerable potential for promoting endometrial hypertrophy and follicle development, making it a promising therapeutic option for tissue repair or replacement. This review provides an overview of the recent advancements and underlying mechanisms of PRP therapy for various female reproductive diseases and presents new therapeutic options for addressing female infertility.


Assuntos
Infertilidade Feminina , Plasma Rico em Plaquetas , Humanos , Feminino , Infertilidade Feminina/terapia , Doenças do Sistema Endócrino/terapia , Doenças dos Genitais Femininos/terapia , Animais
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