DOCSLIB.ORG

Comparison of Letrozole with Timed Intercourse Versus Clomiphene Citrate with Intrauterine Insemination in Patients with Unexplained

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comparison of Letrozole with Timed Intercourse Versus Clomiphene Citrate with Intrauterine Insemination in Patients with Unexplained The Journal of Reproductive Medicine® Comparision of Letrozole with Timed Intercourse Versus Clomiphene Citrate with Intrauterine Insemination in Patients with Unexplained Infertility Jorge Rodriguez-Purata, M.D., Joseph Lee, B.A., Michael Whitehouse, B.A., Benjamin Sandler, M.D., Alan Copperman, M.D., and Tanmoy Mukherjee, M.D. OBJECTIVE: To evaluate outcomes of patients with PRs after timed IUI were also significantly higher in the unexplained infertility who underwent letrozole (LET)– LET versus CC­stimulated group (12.3% vs 11.5%). stimulated controlled ovarian stimulation (COS) with Moreover, clinical PRs in LET with IC were significant­ timed sexual intercourse ly higher than CC with IUI (IC) as compared to patients (15.0% vs. 11.5%). treated with clomiphene We suggest that physicians CONCLUSION: Unex­ citrate (CC) and intrauterine consider LET and timed IC plained infertility patients insemination (IUI). who underwent LET stimu­ STUDY DESIGN: A non­ rather than CC and IUI for … lation with IC were found to randomized, retrospective unexplained infertility. have better pregnancy out­ study where unexplained in­ comes as compared to those fertility patients (n=7,764) who underwent timed IC or underwent a COS cycle with both LET and timed IC IUI with CC stimulation. (J Reprod Med 2016;61:000– or with CC and IUI from January 2010–June 2014. 000) One group consisted of patients who completed a COS cycle with LET and were instructed to have sexual IC. Keywords: artificial insemination; clomiphene; The other included patients were treated with CC and clomiphene citrate; fertility agents, female; in vitro underwent IUI. Pregnancy rates (PRs) were compared fertilization; infertility; intercourse; intrauterine between groups. insemination; letrozole; pregnancy rates; unex- RESULTS: No statistical difference was observed in plained infertility. each group’s age or serum follicule­stimulating hor­ mone levels. A statistical significance in LET versus Nearly 30% of couples trying to conceive are di- CC­stimulated groups was observed for mean endome­ agnosed with unexplained infertility, and a uni- trial thickness (8.3±1.7 vs. 7.9±1.8 mm) and follicular form protocol of management has yet to be agreed response (2.0±1.0 vs. 2.3± 1.3), respectively. Clinical upon. To a large extent, this has resulted in treat- PRs after timed IC were significantly higher in the LET ment regimens that are determined by physician versus CC­stimulated group (15.0% vs 11.8%). Clinical preference.1 A diagnosis of unexplained infertil- From Reproductive Medicine Associates of New York, and the Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York. Address correspondence to: Joseph Lee, B.A., Reproductive Medicine Associates of New York, 635 Madison Avenue, 10th Floor, New York, NY 10022 ([email protected]). Financial Disclosure: The authors have no connection to any companies or products mentioned in this article. 0024-7758/16/6100-00–0000/$18.00/0 © Journal of Reproductive Medicine®, Inc. The Journal of Reproductive Medicine® 1 2 The Journal of Reproductive Medicine® ity is typically made after confirmation of normal sensitivity to FSH without antagonizing ERs, thus ovarian reserve and ovulatory markers, tubal pa- avoiding an antiestrogenic affection on the endo- tency, and partner semen analysis.2 Controlled metrial lining.5 Although LET stimulation can re- ovarian stimulation (COS) is generally considered sult in some side effects such as hot flashes, muscle a first-line treatment in patients with unexplained aches, and gastrointestinal disturbances,19 the side infertility, and several agents with different modes effect profile is typically well tolerated. Further- of action are commonly employed. more, LET appears to cause fewer congenital ab- Two oral agents that have been widely used for normalities in comparison to CC.18 Although both COS are the selective estrogen receptor modulator CC and LET have both been widely utilized for clomiphene citrate (CC) and the third generation COS in IUI protocols, the choice of agent is largely aromatase nonsteroidal inhibitor (AI) letrozole a matter of physician discretion, and the current (LET). CC clomiphene citrate has been widely used opinion favors LET to increase PRs.20 worldwide, and it is the first choice in normo- To date, several prospective, randomized stud- gonadotropic oligo/amenorrheic infertility (World ies and metaanalyses comparing these agents have Health Organization [WHO] group 2).3 CC is a non- contributed to our current knowledge base.5-7 LET steroidal triphenylethylene derivative that exhibits has appeared to be just as safe and effective as CC. both estrogenic agonist and antagonist properties, However, small sample sizes (<100 patients) and although its estrogenic agonist properties man- conflicting studies have left physicians indefinite ifest only when endogenous estrogen levels are as to the significance and applicability of prior extremely low.4 CC acts by binding to estrogen results. Recently, LET has been advocated as the receptors (ERs) in the hypothalamus, causing a optimal agent for ovulation induction due to an perceived drop in circulating estrogens, which observed decrease in the frequency of its side increases gonadotropin secretion by the pituitary effects, thus leading to an increasingly favorable and subsequent ovulation.5 Various adverse ef- attitude in its use for standard care in many cen- fects have been described, mainly secondary to its ters. We previously conducted a retrospective anal- antiestrogenic action, including hot flashes, pre- ysis that compared LET versus CC efficacy com- menstrual syndrome–like symptoms, suboptimal bined with IUI in patients with unexplained infer- endometrial thickness, and decreased cervical tility and demonstrated a trend towards higher PRs mucus production, all of which are also associ- with LET usage.21 ated with reducing pregnancy rates. Lastly, CC is Given the fact that LET is associated with min- more likely to produce a multifollicular response, imal antiestrogenic effects, we postulated that the potentially increasing the multiple pregnancy use of IUI would not enhance the PR of LET cycles. rates.6,7 Laterally with CC treatment, intrauter- In order to test this hypothesis, we compared re- ine insemination (IUI) has been widely used to productive outcomes in patients with unexplained circumvent the poor cervical mucus production, infertility who underwent a LET cycle with timed and human chorionic gonadotropin (hCG) trigger sexual intercourse (IC) to those who underwent a is typically employed in those cycles in an effort CC cycle with timed IUI. to appropriately time insemination procedures.8,9 Nevertheless, although the routine use of timed Materials and Methods IUI has been shown to be beneficial by numerous Patient Information studies, overall outcomes remain ambiguous, with This observational, retrospective cohort study was many previous reports not supporting its use.10-15 performed at an academic, private fertility practice. Letrozole is a potent, reversible AI approved by We reviewed the electronic medical records of all the FDA as a chemotherapeutic agent in postmeno- patients undergoing treatment with CC or LET pausal women with metastatic cancer16; it has been from January 2010 to June 2014. The choice of COS used in reproductive medicine since 2001.17 When protocol was determined by the treating physician. aromatization of androgens is inhibited, the re- Patients <40 years of age diagnosed with unex- sulting reduction of circulating estrogens pro- plained infertility (normal ovarian reserve screen- motes the growth of ovarian follicles through the ing [day 3 FSH ≤12.5 mUI/mL, day 3 estradiol ≤80 increased secretion of follicle-stimulating hormone pg/mL, and AMH ≥1 ng/mL]) with partners having (FSH), yielding a transient intraovarian androgen- normal semen analysis according to WHO param- ic environment. This appears to increase follicular eters22 were included in the study. Only cycles Volume 61, Number 0-0/Month-Month 2016 3 timed with r-hCG were included. Patients who Secondary end points were the number of mature had a canceled cycle or were still undergoing a follicles (≥14 mm) and endometrial thickness (mm), treatment cycle were excluded from this analysis. as measured by transvaginal ultrasound on the day of hCG trigger. Ovulation Induction Letrozole (Femara, Novartis, East Hanover, New Statistical Analyses Jersey) or CC (Clomid, Sanofi-Aventis, Bridge- Statistical analyses were performed using the SPSS water, New Jersey) were administered starting on statistical package (IBM, Armonk, New York). Con- cycle day 3 until cycle day 7 of a spontaneous or tinuous variables were assessed by Student’s t test a progesterone-induced cycle. Initial dosages of or by Wilcoxon rank sum test if the data did not 5 mg and 100 mg were used with LET and CC, appear normally distributed. Categorical variables respectively, until ovarian response was observed. were assessed by χ2 tests or two-tailed Fisher’s Monitoring by transvaginal ultrasound was per- exact tests in cases of small cell frequencies. A formed starting on cycle day 12 until a dominant probability value (p value) of <0.05 was consid- follicle (≥20 mm) was observed, and then ovula- ered statistically significant. tion triggering medication was prescribed; endo- Because of its retrospective nature informed con- metrial thickness and pattern (I, II, or II) were sent was not necessary. The study protocol
Load more

Recommended publications
  • Artificial Insemination
    Ch36-A03309.qxd 1/23/07 5:16 PM Page 539 Section 6 Infertility and Recurrent Pregnancy Loss Chapter Artificial Insemination 36 Ashok Agarwal and Shyam S. R. Allamaneni INTRODUCTION widely available, the terms homologous artificial insemination and heterologous artificial insemination were used to differentiate Artificial insemination is an assisted conception method that can these two alternative sources. However, the use of these bio- be used to alleviate infertility in selected couples. The rationale medical terms in this manner is at variance with their scientific behind the use of artificial insemination is to increase the gamete meaning, where they denote different species or organisms (as in, density near the site of fertilization.1 The effectiveness of artificial e.g., homologous and heterologous tissue grafts). insemination has been clearly established in specific subsets of In the latter half of the 20th century, the terms artificial infertile patients such as those with idiopathic infertility, infertility insemination, donor (AID) and artificial insemination, husband related to a cervical factor, or a mild male factor infertility (AIH) found common use. However, the widespread use of the (Table 36-1).2,3 An accepted advantage of artificial insemination acronym AIDS for acquired immunodeficiency syndrome resulted is that it is generally less expensive and invasive than other in the replacement of AID with therapeutic donor insemination assisted reproductive technology (ART) procedures.4 (TDI). An analogous alternative term for AIH has not evolved, This chapter provides a comprehensive description of probably in part because of the increasingly common situation indications for artificial insemination, issues to consider before where the woman’s partner is not her legal husband.
    [Show full text]
  • Unexplained Infertility
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, University of Helsinki, Finland UNEXPLAINED INFERTILITY Studies on aetiology, treatment options and obstetric outcome RITA ISAKSSON ACADEMIC DISSERTATION To be presented by permission of the Medical Faculty of the University of Helsinki for public criticism in the Auditorium of the Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Haartmaninkatu 2, Helsinki, on October 18th, 2002, at 12 noon. Helsinki 2002 1 Supervised by Docent Aila Tiitinen, M.D., Ph.D. Department of Obstetrics and Gynaecology Helsinki University Central Hospital Docent Bruno Cacciatore, M.D., Ph.D. Department of Obstetrics and Gynaecology Helsinki University Central Hospital Reviewed by Docent Anne-Maria Suikkari, M.D., Ph.D. The Family Federation of Finland, Infertility Clinic, Helsinki Docent Aydin Tekay, M.D., Ph.D. Department of Obstetrics and Gynaecology Oulu University Central Hospital Offi cial opponent Docent Hannu Martikainen, M.D., Ph.D. Department of Obstetrics and Gynaecology Oulu University Central Hospital ISBN 952-91-5071-7 (print) ISBN 952-10-0712-5 (PDF) Yliopistopaino Helsinki 2002 2 To my family 3 CONTENTS LIST OF ORIGINAL PUBLICATIONS ....................................................................7 ABBREVIATIONS .................................................................................................
    [Show full text]
  • Definitions and Relevance of Unexplained Infertility in Reproductive Medicine 5
    Definitions and Relevance of Unexplained Infertility 1 in Reproductive Medicine Sandro C. Esteves, Glenn L. Schattman and Ashok Agarwal Infertility is customarily defined as the inability of a sexually infertility can result from congenital or acquired urogenital active couple with no contraception to achieve natural preg- abnormalities, urogenital tract infections, increased scrotal nancy within one year [1]. The American Society for Repro- temperature such as a consequence of varicocele, endocrine ductive Medicine (ASRM) considers infertility as a disease, disturbances, genetic abnormalities, immunological factors, which by definition is ‘‘any deviation from or interruption of lifestyle habits (e.g., obesity, smoking, and use of gonado- the normal structure or function of any part, organ, or system toxins), systemic diseases, erectile dysfunction, and incor- of the body as manifested by characteristic symptoms and rect coital habitus. Unfortunately, owed to limitations in our signs; the etiology, pathology, and prognosis may be known understanding of the events that take place during natural or unknown’’ [2, 3]. conception, and in view of the crude diagnostic tests avail- It has been estimated that 15 % of couples seek medical able to identify potential abnormalities, the cause of infertil- assistance for infertility, and the origins of the problem seem ity is not determined in nearly half of the cases. Moreover, to be equally distributed between male and female partners approximately 5 % of couples remain unwillingly childless [1]. Taking into account a global perspective and a world despite multiple interventions [1, 8, 9]. population of 7 billion people, these figures indicate that ap- Infertility of unknown origin comprises both idiopathic proximately 140 million people (2.2 %) face infertility [4, 5].
    [Show full text]
  • Male Infertility Is a Women's Health Issue—Research and Clinical
    cells Review Male Infertility is a Women’s Health Issue—Research and Clinical Evaluation of Male Infertility Is Needed Katerina A. Turner 1 , Amarnath Rambhatla 2, Samantha Schon 3, Ashok Agarwal 4 , Stephen A. Krawetz 5, James M. Dupree 6 and Tomer Avidor-Reiss 1,7,* 1 Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; [email protected] 2 Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA; [email protected] 3 Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, L4000 UH-South, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA; [email protected] 4 American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; [email protected] 5 Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA; [email protected] 6 Department of Urology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48019, USA; [email protected] 7 Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA * Correspondence: [email protected] Received: 25 February 2020; Accepted: 14 April 2020; Published: 16 April 2020 Abstract: Infertility is a devastating experience for both partners as they try to conceive. Historically,when a couple could not conceive, the woman has carried the stigma of infertility; however, men and women are just as likely to contribute to the couple’s infertility.
    [Show full text]
  • Folate, Hormones and Infertility
    Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 987 Folate, Hormones and Infertility Different factors affecting IVF pregnancy outcome TIINA MURTO ACTA UNIVERSITATIS UPSALIENSIS ISSN 1651-6206 ISBN 978-91-554-8919-9 UPPSALA urn:nbn:se:uu:diva-220476 2014 Dissertation presented at Uppsala University to be publicly examined in Gustavianum, Auditorium Minus, Akademigatan 3, Uppsala, Thursday, 22 May 2014 at 09:15 for the degree of Doctor of Philosophy (Faculty of Medicine). The examination will be conducted in Swedish. Faculty examiner: Associate Professor Sven-Eric Olsson (Institutionen för kliniska vetenskaper, Danderyds sjukhus (KI DS)). Abstract Murto, T. 2014. Folate, Hormones and Infertility. Different factors affecting IVF pregnancy outcome. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 987. 57 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-554-8919-9. Various hormones have been studied as regards prediction of pregnancy outcome after infertility treatment, but no ideal candidate has been found. Folate and genetic variations in folate metabolism have also been associated with infertility, but it remains unclear how these factors affect IVF pregnancy outcome. It is known that infertility is associated with active folic acid supplement use, but the effect of socioeconomic and lifestyle factors on folic acid supplement use in infertile women has not been well investigated. The overall aim of this work was to obtain information on the prediction of live birth, and to study factors affecting the role of folate and folic acid intake in relation to IVF pregnancy outcome. Infertile women with various infertility diagnoses were studied. Healthy, fertile non-pregnant women were used as controls in three of the studies.
    [Show full text]
  • Success of Controlled Ovarian Hyperstimulation and Intrauterine Insemination in Couple with Unexplained Infertility
    J Women’s Health Dev 2020; 3 (2): 077-091 DOI: 10.26502/fjwhd.2644-28840019 Research Article Success of Controlled Ovarian Hyperstimulation and Intrauterine Insemination in couple with Unexplained Infertility Nazdar Raouf1*, Roj Hikmat², Aveen Munib³, Maida Shamdeen4, Ramadhan Salahaldeen5, Hameed Abdullah6 ¹Duhok Obstetrics and Gynecology Teaching Hospital, Kurdistan, Iraq ²Senior Registrar, Duhok Obstetrics and Gynecology Teaching Hospital, Kurdistan, Iraq ³Infertility and IVF center, College of Pharmcy, Azadi Teaching Hospital, Duhok, Iraq 4Obstetrics and Gynecology Department, Duhok Medical College, Azadi Teaching Hospital, Iraq 5Duhok Medical College, Azadi Teaching Hospital, Kurdistan, Iraq 6Neonatal Intensive Care Unit, Hevi Pediatrics Teaching Hospital, Duhok, Iraq *Corresponding Author: Nazdar Raouf, Duhok Obstetrics and Gynecology Teaching Hospital, Kurdistan, Iraq, Tel: + (964) 7504863598; Email: [email protected] Received: 05 April 2020; Accepted: 18 April 2020; Published: 23 April 2020 Citation: Nazdar Raouf, Roj Hikmat, Aveen Munib, Maida Shamdeen, Ramadhan Salahaldeen, Hameed Abdullah. Success of Controlled Ovarian Hyperstimulation and Intrauterine Insemination in couple with Unexplained Infertility. Journal of Women’s Health and Development 3 (2020): 077-091. Abstract Background: Management of unexplained infertility remains largely empirical, the therapeutic approach should be individualized taking into account patient age and duration of infertility, treatments include expectant observation with timed intercourse
    [Show full text]
  • Comparison of the Efficacy of Letrozole and Gonadotropin Combination Versus Gonadotropin Alone in Intrauterine Insemination Cycl
    ORIGINAL ARTICLE East J Med 25(3):427-433, 2020 DOI: 10.5505/ejm.2020.24993 Comparison of The Efficacy of Letrozole and Gonadotropin Combination Versus Gonadotropin Alone In Intrauterine Insemination Cycles In Patients With Unexplained Infertility Süleyman Cemil Oğlak1*, Mehmet Nafi Sakar2, Serhat Ege1, Serap Mutlu Özçelik Otçu1, Mehmet Obut3, Bekir Kahveci4, İsmail Yıldız5 1Health Sciences University, Diyarbakır Gazi Yaşargil Training and Research Hospital, Department of Obstetrics and Gynaecology, Diyarbakır, Turkey 2Memorial Diyarbakır Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey 3Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey 4Çukurova University School of Medicine, Department of Obstetrics and Gynaecology, Adana, Turkey 5Dicle University School of Medicine, Department of Biostatistics, Diyarbakır, Turkey ABSTRACT This study aimed to determine the outcomes of combined treatment of letrozole (LTZ) with recombinant follicle - stimulating hormone (rFSH) in comparison with rFSH alone in intrauterine insemination (IUI) cycles. This study consisted of 86 patients who experienced 106 IUI cycles. Patients were classified into two treatment groups: group I underwent a combination of LTZ plus rFSH, and group II received rFSH alone. Ovulation was triggered with human chorionic gonadotropin (hCG), and IUI performed 36 hours later. The number of follicles ≥18 mm, endometrial thickness, required dose of FSH, duration of ovulation induction (OI), clinical pregnancy rates, multiple pregnancy rates, spontaneous abortion rates, and live birth rates were evaluated. The total required rFSH dose during the OI was significantly lower in the LTZ-rFSH combination group than the rFSH alone group (401.2±177.1 IU and 770.1±345.8 IU, respectively, p<0.001).
    [Show full text]
  • Effects on Follicular Diameter and Endometrial Thickness in Polycystic Ovary Syndrome
    European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 07, 2020 Clomiphene Citrate and Anastrozole : Effects on Follicular Diameter and Endometrial Thickness in Polycystic Ovary Syndrome Yashinta Sampeliling1, Andi Mardiah Tahir2,Eddy Hartono3, Firdaus Kasim4 1,2,3Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Hasanuddin 4Faculty of Public Health, Universitas Hasanuddin, Dr. Wahidin Sudirohusodo General Hospital, Makassar Abstract Objective: To compare the effects of clomiphene citrate and anastrozole on follicular diameter and endometrial thickness in women with polycystic ovary syndrome (PCOS). Methods: This prospective study was conducted at the private-practice setting. The study group consisted of 14 patients who received clomiphene citrate 50 mg and 14 patients received anastrozole 1 mg on day 3 of menstruation for 5 days. Follicular diameter and endometrial thickness were measured with transvaginal ultrasound on day 12 of menstruation. Results: The mean diameter of follicles in the clomiphene citrate group was not significantly differ compared with anastrozole group (13.35±4.72 mm vs 10.92±4.29 mm; p>.05, respectively). A similar effect also observed in endometrial thickness for both study groups (8.51±1.88 mm in anastrozole vs 7.49±2.09 mm in clomiphene citrate; p>.05). Conclusion: Clomiphene citrate and anastrozole were not significantly improved follicular diameter dan endometrial thickness in polycystic ovary syndrome. Keywords : Clomiphene citrate, anastrozole, PCOS 1. INTRODUCTION Polycystic ovary syndrome (PCOS) occurs in 15-20% of reproductive women according to the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). Fifty to seventy percents of PCOS cases are caused by insulin resistance.1 This syndrome is characterized by chronic anovulation with exaggerated biochemical and/or clinical of androgens and without other diseases of the adrenal gland, thyroid or pituitary in similar features.
    [Show full text]
  • Altered Follicular Fluid Metabolic Pattern Correlates with Female Infertility and Outcome Measures of in Vitro Fertilization
    International Journal of Molecular Sciences Article Altered Follicular Fluid Metabolic Pattern Correlates with Female Infertility and Outcome Measures of In Vitro Fertilization Giacomo Lazzarino 1,† , Romina Pallisco 2,†, Gabriele Bilotta 2,†, Ilaria Listorti 2,†, Renata Mangione 3,4, Miriam Wissam Saab 5, Giuseppe Caruso 6 , Angela Maria Amorini 5 , Maria Violetta Brundo 7 , Giuseppe Lazzarino 5,8,* , Barbara Tavazzi 3,4,* and Pasquale Bilotta 9 1 UniCamillus—Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy; [email protected] 2 Alma Res Fertility Center, Laboratory of Andrology and Embriology, Via Parenzo 12, 00198 Rome, Italy; [email protected] (R.P.); [email protected] (G.B.); [email protected] (I.L.) 3 Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of Rome, Largo F. Vito 1, 00168 Rome, Italy; [email protected] 4 Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy 5 Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; [email protected] (M.W.S.); [email protected] (A.M.A.) 6 Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; [email protected] 7 Department of Biology, Geology and Environmental Sciences, Section of Animal Biology, University of Catania, Via Androne 81, 95124 Catania,
    [Show full text]
  • Natural Cycle In-Vitro Fertilization in Couples with Unexplained Infertility: Impact of Various Factors on Outcome
    Human Reproduction vol.12 no.ll pp.2402-2407, 1997 Natural cycle in-vitro fertilization in couples with unexplained infertility: impact of various factors on outcome F.Zayed1'3, E.A.Lenton1'2 and I.D.Cooke2 The first live birth following IVF occurred in 1978 and was a consequence of IVF performed in the natural cycle 'Sheffield Fertility Centre, 26 Glen Road, Sheffield S7 IRA and 2University Department of Obstetrics and Gynaecology, of a woman with tubal infertility (Edwards et al, 1980). Downloaded from https://academic.oup.com/humrep/article/12/11/2402/664697 by guest on 30 September 2021 Jessop Hospital for Women, Sheffield S3 7RE, UK This success encouraged a number of groups to attempt NIVF, but they experienced difficulties (Johnston et al, 3To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Jordan University of Science and 1981; Jones et al, 1982). NIVF was quickly abandoned in Technology, P.O. Box 962106, Amman-11196, Jordan favour of stimulated IVF (SIVF), which yielded higher pregnancy rates as a consequence of transferring several This study evaluated outcome in 117 couples with un- embryos (Wood et al, 1985; Testart et al, 1986). However, explained infertility who underwent 162 attempts at recently interest in NIVF has revived because of concerns natural cycle in-vitro fertilization (NIVF) between 1991 surrounding ovarian stimulation. These include ovarian and 1993. An egg was obtained in 138 cycles and a hyperstimulation syndrome, multiple pregnancies (Rizk single embryo was transferred in 89 cycles. There were 16 et al, 1991; Tan et al, 1992), a possible decrease in implantations (four biochemical pregnancies, three clinical endometrial receptivity (Paulson et al, 1990), the emotional abortions and nine live births).
    [Show full text]
  • The Optimal Evaluation of the Infertile Male: AUA Best Practice Statement
    The Optimal Evaluation of the Infertile Male: AUA Best Practice Statement Panel Members: AUA Staff: Jonathan Jarow, MD, Chairman Heddy Hubbard, PhD, MPH, FAAN, Mark Sigman, MD, Facilitator Cynthia Janus, MLS, Michael Folmer, Kebe Kadiatu Peter N. Kolettis, MD, Larry R. Lipshultz, MD, Consultant: R. Dale McClure, MD, Joan Hurley, JD, MHS Ajay K. Nangia, MD, Cathy Kim Naughton, MD, Gail S. Prins, PhD, Jay I. Sandlow, MD, Peter N. Schlegel, MD Table of Contents Abbreviations and Acronyms ...................................................................................................... 2 Introduction ................................................................................................................................... 3 Methodology .................................................................................................................................. 4 Evaluation goals ............................................................................................................................ 6 When to do a full evaluation for infertility ................................................................................. 7 Components of a full evaluation for male infertility .................................................................. 7 Required evaluation components for every patient ..................................................................... 7 Medical history ------------------------------------------------------------------------------------------ 7 Physical examination -----------------------------------------------------------------------------------
    [Show full text]
  • Unexplained Infertility
    Unexplained Infertility Kaylen M. Silverberg, M.D. Thomas C. Vaughn, M.D. Texas Fertility Center Austin, Texas Introduction Infertility is generally defined as the inability to conceive following one year of unprotected intercourse. This definition is often modified in couples where the female partner is 35 years of age or older, such that an infertility evaluation may be encouraged following only 6 months of unsuccessful attempted conception. Up to 30% of couples presenting with this chief complaint are eventually diagnosed as having unexplained infertility.1 Couples with unexplained infertility are thought to represent either a subpopulation of patients in the lower extreme end of the normal distribution of fertility, or a group of patients with a defect in fecundity not detected by the routine infertility evaluation.2 When compared to “normal, fertile” patients, couples with unexplained infertility demonstrate both diminished and delayed fecundity. Untreated, their pregnancy rates have been reported to be 34% within 6 months, 76% within 2 years, and 87% within 5 years.3 In a review of previously published prospective, randomized trials, Guzick et al determined the cycle fecundity rate with expectant management in couples with unexplained infertility to be 1.3-4.1% - compared to the generally accepted cycle fecundity of 20% in proven fertile couples. 4 This chapter will provide a critical, evidence based review of both the diagnosis and treatment of unexplained infertility. Diagnosis Traditionally, a diagnosis of unexplained infertility is made only when the basic infertility evaluation fails to reveal an obvious abnormality. This diagnosis therefore implies that a couple has evidence of normal, timely ovulation, adequate sperm production, fallopian tube patency, normal integrity of the endometrial cavity, adequate cervical mucus production, timely development of endometrial secretory change, and no evidence of pelvic endometriosis.
    [Show full text]