International Journal Of Fertility and Sterility
Volume:3 Issue: 2, Aug-Sep 2009

This article provides an overview of the psychological and social implications of infertility. After describing the evolution of current theoretical understanding in this area، it outlines typical emotional and gender-specific reactions as well as the impact of infertility on the concept of identity and loss. Key questions are presented that medical professionals can use in order to facilitate communication with patients and in order to gain a first understanding of the psychosocial impact infertility has for them. In concludes by highlighting the need to integrate psychosocial counselling into medical treatment، not only as counselling provides vital emotional support، but also because it can contribute towards reducing the drop-out rate in treatment.

The effect of smoking cigarettes is followed by diverse effects on ovaries and developing follicles but the effect of passive smoking on ovarian function is unknown. On the other hand, the ovarian response to induction is a very important step in assisted reproduction. The aim of this study is to compare ovarian response in passive smokers and non-passive smokers in an assisted reproductive program. In a cohort study at the Isfahan Fertility and Infertility Center, there were 72 women in the passive smoker group and 72 women in the non-passive smoker group who underwent an assisted reproductive technology (ART) program. The follicle number at administration of human chorionic gonadotropin (HCG), number of gonadotropin ampoules and duration of super ovulation induction were compared. Statistical analyses indicated that the number of mature follicles in the passive smoker group was not different from the control group; but the number of unresponsive cycles to super ovulation in the passive smoker group (33.3%) was significantly higher than the control group (12.5%). Duration of induction and number of gonadotropin ampoules were not different between the two groups. The results of this study show that exposure to second-hand smoke increases the chance of unresponsiveness to ovulation induction. This condition may be due to the result of decline in ovarian reserve in second-hand smokers. The duration of induction and number of gonadotropin ampules is similar in the two groups. Furthermore, the results show that exposure to cigarette smoke does not clinically impact women with good ovarian reserve.

To assess the usefulness of premature luteinization hormone (LH) surge prevention in an intrauterine insemination (IUI) cycle by GnRH antagonist administration. Sixty patients with unexplained or mild male infertility or minimal to mild endometriosis were enrolled in this prospective randomized controlled trial. There were twenty patients in group A (with GnRH antagonist) and 40 patients in group B (without GnRH antagonist). In all of the participants, clomiphene citrate and human menopausal gonadotropin (CC+HMG) were used for ovarian stimulation. When at least one follicle with ≥ 16 mm diameter was seen, LH surge was checked by a urinary LH kit. In patients with negative results, human chorionic gonadotropin was continued in both groups, but in group A 0.25 mg Ganirelix SQ was administered for two days,, then in both groups human chorionic gonadotropin (HCG) was injected on the third day and IUI was done 36-40 hours later. Ongoing pregnancy was the primary outcome. Baseline characters and clinical parameters were similar in both groups with the exception of ≥14 mm follicles which were higher in group A (p value= 0.003). The pregnancy rate in both groups was not significantly different, although it was higher in group B (10% in group A and 15% in group B). At least in CC+HMG stimulated cycles for IUI, the occurrence of premature LH surge could have a useful rule and GnRH antagonist administration could be an inappropriate intervention.

The outcomes of such pregnancies have been rarely evaluated in our country. A descriptive study was planned to assess the health and condition of neonates conceived with assisted techniques in a one year period. At Royan Institute, Tehran, 443 women who became pregnant by one of the assisted techniques in vitro fertilization (IVF), intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI) enrolled in a descriptive study during 16 month period beginning on September, 2007. The sampling method used was non-incidental, consecutive. Questionnaires regarding the contents of the baby birth card were completed after interviews with the mothers. The time from fertilization of the ovum until delivery was considered as the gestational (conception) age. Pregnant mothers were under periodic evaluation until delivery. Women with stillborn babies were followed via phone contact. From a total of 443 conceptions, there were 13 (2.9%) pregnancies demised in utero (stillbirths) and 10 (2.6%) who died during the neonatal period. Additionally, 133 (43%) infants were born after multifetal pregnancies and 96 (31%) infants were prematurely born. There were 106 (34.3%) infants with low birth weight (LBW; less than 2500 g), of which 83 (78.3%) LBW infants were multiplets. After completion of the study, 71 women were still passing their pregnancy period and no assessed. The most important factor for untoward perinatal events was multifetal pregnancy. Such pregnancies were more frequently complicated and higher risk. Low birth weight and prematurity were more frequent in singletons conceived by assisted techniques in respect to control singletons.

Poly cystic ovarian syndrome (PCOS) is the most prevalent endocrinopathy among women and the most common underlying diagnosis for anovulatory infertility. The role of insulin-resistance (IR) and hyperinsulinemia in pathophysiology and clinical manifestations of the syndrome depicts the importance of evaluation of the efficacy of insulin reducing medications. N acetyl cysteine (NAC) inhibits oxidative stress and prevents hyperglycemia induced insulin resistance. This study aims at evaluating the effects of NAC on manifestations of the disease as well as improvement of fertility status. Through a prospective double-blind clinical trial, 46 patients were randomly divided into one intervention and one control group. The two groups were treated for six weeks after similarity was allocated. All clinical and biochemical indicators were recorded in the early follicular phase both before and after treatment. From each group, 18 patients were ultimately evaluated. In the first group, ovulation rate increased as compared to the control group. A significant decrease in weight, body mass index (BMI), and waist/hip ratio was also observed. Fast blood sugar (FBS), serum insulin, total cholesterol, low density lipoprotein (LDL) levels, and HOMA-IR index also dropped while high density lipoprotein HDL levels elevated significantly. No significant change was reported in luteinizing hormone (LH), FSH, PRL, LH/FSH levels and glucose/insulin ratio. The control group remained unchanged. N- Acetyl Cysteine improves lipid profile, hormonal levels, ovulation status, and long-term health of women with PCOS. Considering its limited adverse effects, it can be regarded as a substitute for insulin reducing medications in treatment of these patients.

Vulvovaginal candidiasis is the most common fungal disease in sexually active women of which Candida albicans is the primary etiologic agent. This cross-sectional study was performed to determine the etiologic agents of vulvovaginal candidiasis amongst 2000 women who presented to the Gynecological Center of Babol Shahid Yahyanejad Educational Hospital from 2006-2007 with symptoms of vulvovaginal candidiasis. Discharge and pruritus were the most common symptoms in patients (80%). There were 42 out of 97 (43.3%) specimens which were positive for yeast. Of these, 80.95% belonged to Candida albicans and 14.29% were Candida krusei. Discharge and pruritus were the most common symptoms of vulvovaginal candidiasis. In our study, C. albicans was the most common species isolated from the specimens.

Specific growth factors and feeder layers seem to have important roles in in vitro embryonic stem cells (ESCs) differentiation. In this study,the effects of bone morphogenetic protein 4 (BMP4) and mouse embryonic fibroblasts (MEFs) co-culture system on germ cell differentiation from mouse ESCs were studied. Cell suspension was prepared from one-day-old embryoid body (EB) and cultured for four days in DMEM medium containing 20% fetal bovine serum (FBS) in the following groups: simple culture (SC), simple culture with BMP4 (SCB), co-culture (CO-C) and co-culture with BMP4 (CO-CB). Expression of piwi-like homolog 2 (Piwil2), the germ cell-specific gene, was evaluated in the different study groups by using quantitative real time polymerase chain reaction (RT-PCR). Testis was used as a positive control. The maximum and minimum Piwil2 expression was observed in SC and SCB groups, respectively. A significant difference was observed in Piwil2 expression between SCB and other study groups (p<0.05). The findings of this study showed that neither the addition of BMP4 in culture medium nor the use of MEFs as a feeder layer have a positive effect on late germ cell induction from mouse ESCs.

During Assisted Reproductive Technology (ART) procedures, the transfer of a single embryo dramatically reduces the rate of multiple pregnancy. Proper information, therefore, should be delivered to patients before embryo transfer. In many countries, regulations limit, according to age of the patient, the number of embryos to be transferred. Selective fetal reduction should not be considered as a suitable alternative to a single embryo transfer policy. The international federation of obstetricians and gynaecologists (FIGO) recommendations on Multifetal reduction outline that the priority should be a careful planning and monitoring of infertility treatment for the reduction or avoidance of multiple pregnancy.