Uterine Leiomyomas as a Risk Factor for Infertility.

About one-fifth of couples has fertility problems in Western countries. Male factors are present in about half of them, either alone or in combination with female causes. Therefore, both partners should be evaluated simultaneously. The fertility status and/or specific conditions of each partner influence the clinical and treatment approach. This article summarizes in a practical way when, how, and why the male partner of an infertile couple should be investigated. The available evidence and international guidelines were used, interpreting, discussing, and expanding them from personal decades-long experience in this field. The aim is to delineate the most appropriate clinical approach for the male partner of infertile couples, considering traditional and emerging technologies and laboratory analyses in the context of their clinical significance. Components of the initial evaluation in men without known risk factors for infertility should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, scrotal ultrasound, and transrectal ultrasound are suggested in most men and are mandatory when specific risk factors for male infertility are known to be present or when the initial screening demonstrated abnormalities. Full examination, including genetic tests, testicular histology, or additional tests on sperm, is clinically oriented and/or suggested after the results of initial investigations.

Background: Hysterosalpingography (HSG) is a minimally invasive tool with reasonable specificity and sensitivity which is effective in diagnosing tubal factor infertility. Objective: This study determines the pattern of infertility, the risk factors for infertility in women presenting for HSG, and documented HSG findings among women with infertility at Aminu Kano Teaching Hospital (AKTH), Kano. Materials and Methods: This was a retrospective study of HSG findings among infertile women who presented for HSG between January 2016 and December 2018 in AKTH. The register for HSG was reviewed at the Radiology Department, and information obtained from the record included the age, file number, and the outcome of HSG. The corresponding files of the patients were then retrieved from the Central Medical Records Department. Information obtained from the case notes were age, parity, type of infertility, and risk factor for infertility. Results: During the study period, there were 400 cases of infertility who presented to the gynecological clinic, out of which 250 patients presented for HSG. One hundred and forty-four case notes were retrieved giving a retrieval rate of 57%. Majority of the women who had HSG during this study were aged between 26 and 30 years. Secondary infertility was predominant over primary infertility which occurred in 86 (59.7%) of the patients. Among the 144 patients who were examined, 71 (49.3%) of the women had an abnormal finding. Bilateral tubal blockage was the predominant abnormal finding on HSG, found in 27 (18.7%) patients. Right tubal blockage occurred more than left tubal blockage, which was seen in 15 (10.4%) and 13 (9.0%) patients, respectively. Regarding uterine pathology, uterine fibroid occurs most in the women accounting for 11 (7.6%) when compared to uterine adhesions which were found in only 4 (2.7%) women. Conclusion: Even though uterine adhesions were significant findings, bilateral tubal blockage and uterine fibroid were the main HSG findings in AKTH within the study period.

BackgroundThe World Health Organization reported that more than 10 % of women are severely affected by infertility, making the condition a major worldwide public health problem. Lead (Pb), cadmium (Cd), and arsenic (As) are environmental pollutants that may contribute to reproductive disorders. This cross-sectional study investigated the association between blood concentrations of Pb, Cd, and As and risk factors for infertility in women.MethodsWomen who were infertile (N = 310) or pregnant (N = 57) were recruited from the gynecology and obstetrics department of a hospital. The participants were interviewed to obtain their sociodemographic, reproductive, and lifestyle information. The concentrations of Pb, Cd, and As in their blood samples were measured using inductively coupled plasma mass spectrometry.ResultsOur findings suggested that the concentrations of Pb and As, but not Cd, were significantly higher in the blood of infertile women than in that of pregnant women. A higher percentage of the infertile women consumed more alcohol, used Chinese herbal medicine more frequently, and lacked physical activity compared with the pregnant women. After accounting for potentially relevant predictors, we observed that blood Pb levels might be elevated by using Chinese herbal medicine 1–6 times per week (aOR = 2.82, p = 0.05). In addition, engaging in physical activity 1–2 times per week (aOR = 0.37, p = 0.05) might assist in reducing Pb accumulation in infertile women, though the p value was borderline.ConclusionsLack of physical activity and frequent use of Chinese herbal medicine may be associated with elevated blood Pb levels in infertile women. Chinese herbal medicine use was observed to increase the Pb body burden of both infertile and pregnant women in this study. The risk–benefit for Chinese herbal medicine intake should be evaluated by women of childbearing age.

There are many known and unknown risk factors affecting fertility. Nowadays although infertility risk factors have been revealed with the researches carried out today, studies are still going on for many factors brought about by modern life. Nurses should be aware of risk factors that negatively affect fertility in order to prevent deterioration of fertility abilities of individuals. Infertility nurses should assess life-style behaviors in detail while taking anamnesis from couples who have fertility problems or apply for long-term and financially expensive treatment methods such as assisted reproductive techniques. In addition, nurses should do counseling to couples on lifestyles that have an impact on the fertility of individuals and follow the current literature on the subject. Especially risky lifestyle behaviors should be improved if there is no time problem for the couple. Otherwise, treatment strategies should be developed to change these behaviors and individual care plans should be provided to individuals about healthy lifestyle behaviors. In addition, nurses should train couples for risk factors. In this context, the risk factors causing the infertility and nursing roles will be discussed in our review.
 Key words: Ä°nfertilty, Risk Factors, Nursing, Role

While ongoing research continues to identify new causes for decreased sperm counts and idiopathic infertility, little objective data are known regarding public knowledge and perception of male infertility. In this study, we aim to better characterize male infertility knowledge across educational status, personal experience with infertility, socioeconomic characteristics, and income level. Participants were asked to identify, among other factors, out-of-pocket treatment cost, insurance coverage, and potential risk factors for infertility. Then, a scoring system was developed to objectively quantify overall understanding of male infertility and named Knowledge of Male Fertility (KM-Fert). Results were compared by socioeconomic status and education level, with a sub-analysis of healthcare professionals (HCPs). A total of 242 respondents completed the survey. Only 67.4% of respondents (n=163) identified testosterone therapy as a risk factor for male infertility, while other commonly understood risk factors (e.g., smoking or obesity) were correctly identified by a large majority. Median KM-Fert score of reproductive urology subspecialists was a perfect score of 10. This was significantly higher than other respondents {10 [interquartile range (IQR): 9.25, 10] vs. 7 (IQR: 5, 8), P<0.001}. Education level influenced KM-Fert score (P<0.001). Post-hoc analysis demonstrated a significantly higher median score for medical school graduates versus all other education levels except for nurse practitioner or physician assistant graduates (P=0.28). The general population has variable knowledge surrounding male fertility, and there is an opportunity for non-urology providers to improve their knowledge, screening, and referrals for reproductive-aged males. Reproductive urologists may be the ideal group to educate fellow HCPs.

Cryptorchidism is the most frequent anatomic anomaly observed in an endocrine gland. It is a wellidentified risk factor in infertility and testicular cancer. It is believed that increased generation of free radicals and oxidants play an important role in the resulting testicular damage. The present study investigated the role of a-tocopherol (vitamin E) as an antioxidant in protecting the testis against damage in experimental cryptorchidism. Thirty six Sprague - Dawley rats weighing 250 – 280 g were divided into three groups; A, B and C, with Group A (intact rats) as control. All rats in Group B and C were rendered bilaterally cryptorchid by anchoring the upper pole of testis to the anterior abdominal wall. Group C rats in addition received vitamin E at 25 mg/kg body weight intramuscularly daily. Fifty six days after cryptorchidism induction, bilateral testicular weight, bilateral testicular volume, bilateral caudal epididymal sperm characteristics, bilateral testicular histology and serum hormone levels were all tested. Most of the above parameters were significantly lower (P profiles than those of the untreated cryptorchid rats. Experimental cryptorchidism did not affect the plasma testosterone levels. The results indicated that vitamin E moderated the deleterious effects of experimental cryptorchidism.

Background: Azoospermia is a risk factor for infertility affecting approximately 1% of the male population. Genetic factors are associated with non-obstructive azoospermia (NOA). Pygo2 and PRDM9 genes are involved in the spermatogenesis process. The present study aimed to assess the association of single nucleotide polymorphism (SNP) in the Pygo2 (rs61758740 and rs61758741) and PRDM9 (rs2973631 and rs1874165) genes with idiopathic azoospermia (IA).Methods: A cross-sectional study was conducted from October 2018 to August 2019 at Rooya Infertility Centre (Qom, Iran). A total of 100 infertile patients with NOA and 100 men with normal fertility were enrolled in the study. Tetra-primer amplification refractory mutation system-PCR method was used to detect SNPs rs61758740, rs61758741, and rs2973631. The restriction fragment length polymorphism method was used for SNP rs1874165. In addition, luteinizing, follicle-stimulating, and testosterone hormone levels were measured.Results: The results showed a significant increase in luteinizing and follicle-stimulating hormone levels in the patient group (P<0.001), but a non-significant difference in testosterone levels in both groups. SNP rs61758740 (T>C) was associated with the increased risk of azoospermia (OR: 2.359, 95% Cl: 1.192-4.666, P=0.012). SNP rs2973631 showed a significant difference in genotype frequency between the patient and control groups in the dominant, recessive, and codominant models. However, in the case of SNP rs1874165, the difference was significant in the dominant, codominant, and overdominant models.Conclusion: There is an association between azoospermia and SNPs in Pygo2 and PRDM9 genes in Iranian infertile male patients with IA. SNPs can be considered a risk factor for male infertility. It should be noted that this article was published in preprint form on the website of europepmc (https://europepmc.org/article/ppr/ppr416800).

The main purpose of this project is to verify whether there is a difference in the expression of aryl hydrocarbon receptor (AhR) between varicocele (VC) and normal male semen, and determine whether there is a connection with the parameters of semen analysis. The risk factors of infertility in patients with VC were also studied. Semen samples were collected for semen analysis and Western blot. Logistic regression was used to investigate the risk factors associated with infertility in patients with VC. Men with VC had lower AhR expression compared to healthy men; correlation analysis results showed that: AhR expression in patients with VC group was significantly positively correlated with sperm concentration and sperm motility; significantly negatively correlated with the diameter of spermatic veins during Valsalva and the percentage of abnormal sperm morphology; the research results of related risk factors show that the risk of infertility of patients with grade III is 1.67 times that of patients with grades I and II. For each unit of abnormal sperm morphology, the risk of infertility increases 1.04 times. Sperm concentration, total sperm viability and each unit the expression of AhR protein decreases the risk of infertility by 3%, 9% and 11% respectively.

ObjectiveThe objective of our study was to characterize the sperm parameters of men consulting for infertility in our fertility center.MethodsThe study included 3,025 patients investigated from September 2021 to July 2023. Demographic data, infertility risk factors, and the primary or secondary nature of infertility were recorded for each patient. The sperm parameters were analyzed according to World Health Organization (WHO) criteria (2021).ResultsThe average age of the patients was 40 years. The average duration of infertility was 5.5 years. Primary infertility was noted in 2,736 patients (88.97%). The most common risk factors for infertility were occupational exposure, followed by varicocele. Lifestyle factors associated with male infertility included smoking (24.29%), alcohol consumption (12.49%), and high temperature exposure (30.08%). Spermogram abnormalities were observed in 78.71% of cases. Spermocytogram abnormalities were found in 63.1% of cases. Sperm count, morphology, total motility, and vitality below WHO (2021) reference values were found in 25.60%, 34.13%, 32.29%, and 62.46% of the analyzed samples, respectively. Seminal fluid analysis revealed oligozoospermia in 29.07% of cases, asthenozoospermia in 24.68%, and azoospermia in 17.56%. Oligo-astheno-necrospermia was the most frequently observed combined abnormality (10.0%).ConclusionThis study showed a high rate of abnormal semen quality in male partners of infertile couples. Male infertility is often multifactorial and results in quantitative and/or qualitative sperm abnormalities.

To investigate the prevalence of infertility and its risk factors in the fertile-age couples of Beijing, China. A cross-sectional survey on the prevalence and risk factors was conducted from July 2007 to May 2008 in 7 Beijing districts. The districts were subdivided into the administrative units of "communities". A total of 33 communities were sampled and households selected randomly within each community. Of 5862 couples (women aged 20 - 49 years) who were eligible for an interview, 5632 (96.07%) provided information in relation to all the questionnaire questions. The other couples did not participate because they were not at home for the interview, or became incapacitated, refused or others. The trained interviewers administered a detailed questionnaire to each study couple at their home, collecting the relevant information about contraception, sexual practices, marriage and a complete pregnancy history. The definition of infertility in the study was "a noncontracepting couple who want another child or a child if childless tried to conceive for at least 2 years" following the WHO recommendation([c2]). The study protocol was approved by the ethics committee of National Research Institute for Family Planning (NRIFP). A total of 97 couples were classified as infertile. And the total prevalence of infertility in 7 Beijing districts was 1.72%. The standardized prevalence of infertility was 2.1%. 57 (58.76%) couples were classified as of primary infertility and 40 (41.24%) of secondary infertility. So the prevalence of primary and secondary infertilities were 1.01% and 0.71% respectively. In women, the prevalence of infertility was the highest in the age group of 20 - 29 (3.13%) and the lowest in the age group of 40 - 49 (1.38%). The prevalence rate of infertility in the women whose marriage age were younger than 20 years or elder than 29 years of age was apparently higher than those of the 20 - 29 years old. The risk factors of infertility were tuberculosis (TB), endometriosis (EM) and pelvic infection disease (PID). The prevalence rate of infertility declines with age in women. Both EM and PID are the risk factors for infertility.

Background: Body mass and body size may influence uterine leiomyoma development in Asian populations. Methods: We examined the associations of body mass index, weight change, and childhood, adolescent or current body size with history of uterine leiomyoma in the Korea Nurses’ Health Study. History of uterine leiomyoma and anthropometric factors were assessed through self-administered questionnaires. We included only women who had experienced pregnancies to avoid detection bias. As a result, a total of 5670 women were included and 560 women reported that they had uterine leiomyoma. The median age of women was 38 years. We calculated odds ratios(OR)s and 95% confidence interval (95% CI)s adjusted for potential risk factors for uterine leiomyoma. Results: Current body mass index was associated with higher odds of having uterine leiomyomas; multivariate OR (95% CI) was 1.52(1.03-2.25; P for trend = 0.003) comparing ≥27.5 with 18.5-23 kg/m2. Body size in adulthood was associated with increased odds of having uterine leiomyomas (P for trend = 0.002), whereas childhood or adolescent body size was not. Also, women with greater change in body weight since the first year of college tended to have higher odds of having uterine leiomyomas, compared to those whose weight had been stable. Conclusion: We found that body mass and weight gain in adulthood were associated with increased odds of having uterine leiomyoma in Korean women, but body mass in early life was not. Citation Format: Jung Eun Lee, Ji Eun Lee, Eunyoung Cho, Hee Jung Jang, Heeja Jung, Hea-Young Lee, Su Kim, Ok Soo Kim. Body mass, weight, and body size and uterine leiomyoma in the Korea Nurses’ Health Study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3738. doi:10.1158/1538-7445.AM2015-3738

Infertility is a burning issue in reproductive health. Scenario has changed since last couple of years among the Bangladeshi population. It is well recognized that the concept of family planning and its implementation is a successful project by the government of Bangladesh. In recent years we are observing the increases trends of the prevalence of infertility in our daily practice. Infertility is defined as the inability of a couple to achieve of pregnancy after 12 months of regular, unprotected intercourse. The infertility treatment imposes a substantial financial burden for the family and as well as for the society

To determine whether previous Chlamydia trachomatis (CT) infection among sexually active women is significantly associated with a diagnosis of infertility. A prospective descriptive study was conducted in Lleida Health Region (Spain). Women who attended medical consultations for infertility at a public university hospital in 2021 were included in the study. Data were collected during January and February 2022 using the hospital's electronic records and clinical interviews. The study revealed that having immunoglobulin (Ig)G antibodies for CT was associated with an increased rate of infertility compared to patients with negative titers(p-value < 0.05). Age was also associated with infertility. There was no statistically significant difference among the other characteristics studied, such as previous sexually transmitted infections (STI), previous miscarriages, preliminary cervical lesions, and levels of follicle-stimulating hormone (FSH), estradiol, thyroid-stimulating hormone (TSH), prolactin, and anti-mullerian hormone (p-value > 0.05). The study showed a high prevalence of infertility among women who had IgG CT antibodies. Although more studies should be conducted, promoting strategies among young women to control this infection may help reduce infertility.

Objective: To investigate the reproductive health status of female workers in a railway system and possible influencing factors. Methods: From January to June, 2016, a cross-sectional epidemiological investigation was performed to collect 2 165 female workers aged 17-55 years. A women's health questionnaire was used to collect the data on their occupation and health, and their reproductive health status was analyzed. Results: The female workers exposed to occupational hazards had significantly higher incidence rates of gynecological diseases, abnormal menstruation, and infertility than those not exposed to such hazards (χ(2)=32.29, 12.42, and 4.23, respectively, all P<0.05) . There were significant differences in the incidence rates of gynecological diseases, abnormal menstruation, adverse pregnancy outcomes, and pregnancy complications between the female workers with different working forms and states (χ(2)=17.19, 23.03, 200.65, and 21.28, respectively, all P<0.05) . There were significant differences in the incidence rates of gynecological diseases, abnormal menstruation, and pregnancy complications between the female workers with different behavioral habits (χ(2)=15.65, 36.23, and 25.35, respectively, all P<0.05) . The logistic regression analysis showed that exposure to occupational hazards, married state, medium-grade professional title or above, work in shifts, sitting for a long time, standing for a long time, and video operation were risk factors for gynecological diseases, and the prevalence rate of gynecological diseases increased with age. Exposure to occupational hazards, night shifts, staying up late, and sitting for a long time were risk factors for abnormal menstruation. Exposure to occupational hazards was a risk factor for infertility. Medium-grade professional title or above was a risk factor for adverse pregnancy outcomes. Married state, medium-grade professional title or above, standing for a long time, and high mobility in job form and state were risk factors for pregnancy complications. Conclusion: Exposure to occupational hazards, job form and state, and unhealthy behavioral habits may affect reproductive health status in female workers in the railway system.

Background: Homocysteine is an intermediate in methionine metabolism required for the biosynthesis of nucleic acids. Hyperhomocysteinemia affects various organ systems and also has been implicated as a risk factor for infertility. Elevated levels result either from genetic mutations of the enzymes catalyzing the metabolic pathway or deficiency of micronutrients required as co-enzymes for the same. The aim of this cohort study was to evaluate serum homocysteine levels and MTHFR gene 677C&gt;T mutation and to establish a possible relation between hyperhomocysteinemia, genetic polymorphism and female infertility. Methods: Ninety-five infertile women were enrolled over a period of one year and categorized as unexplained, anovulatory and male partner factor infertility according to the etiology. Thirty-one age-matched fertile women were enrolled as controls. Serum homocysteine levels were evaluated and genetic analysis for MTHFR gene mutation 677C&gt;T was done. Results: Mean homocysteine levels for the women in three infertile groups were comparable (group I - 16.21 ± 3.39 µmol/l, group II - 16.36 ± 3.56 µmol/l, group III - 16.98 ± 3.14 µmol/l) within the groups as well as with the fertile group (15.85 ± 9.3 µmol/l) with no statistically significant difference (P = 0.573). Prevalence of hyperhomocysteinemia was 86.3% for infertile group and 90.3% for fertile group. Nineteen heterozygous (CT) and 3 homozygous (TT) mutations were noted among infertile subjects and 8 heterozygous (CT) mutations among fertile subjects prevalence being similar for both the groups. Conclusions: Significant prevalence of hyperhomocysteinemia and MTHFR polymorphism was observed in the studied population. The study did not establish a positive role of hyperhomocysteinemia and MTHFR mutation in female infertility.