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Embryo culture conditions are significantly improved during uninterrupted incubation: A randomized controlled trial

Alhelou Y, Mat Adenan NA, Ali J

Reprod Biol, 2018 Mar;18(1):40-45.
PMID: 29279181 DOI: 10.1016/j.repbio.2017.12.003

A parallel group superiority prospective randomised controlled trial was devised to compare the culture characteristics of human pre-implantation stage embryos during uninterrupted culture in a time lapse incubator (TLI) versus the conventional model of interrupted culture in a standard incubator (SI) under low oxygen tension using a single step medium. 221 patients aged 35-and-under, 124 patients aged between 36 and 39 and 86 patients aged 40-and-over years were randomised and cultured either in a SI or in a TLI. Patients in the three age groups were distributed between the TLI and SI in a 1:1 ratio. The development of embryos on days 2, 3 and 5, and the clinical pregnancy and implantation rates were recorded. The fertilisation rate, development of day 2 and clinical pregnancy rates were similar in both treatments but the 8-cell development rate in all age groups combined (p = 0.016), blastocyst development rate (p = 0.0022) and the implantation rate (p = 0.0022) was significantly higher for the uninterrupted culture. These findings demonstrated significant differences between the two incubation groups. It also indicated less efficacious embryonic development with age in both treatments which appeared more pronounced in the conventional incubator. In conclusion uninterrupted culture is superior compared to the interrupted incubation culture system.

Matched MeSH terms: Infertility, Female/therapy*
Fulltext Cost-effectiveness of assisted reproductive technologies in Saudi Arabia: Comparing in vitro fertilization with intrauterine insemination

Almaslami F, Aljunid SM

SAGE Open Med, 2020;8:2050312120931988.
PMID: 32587695 DOI: 10.1177/2050312120931988

Objectives: The aim of this study was to compare the cost-effectiveness of in vitro fertilization and intrauterine insemination for the management of unexplained, mild male and mild female factor infertility in Saudi Arabia.
Methods: A cost-effectiveness analysis from a societal perspective was conducted for couples seeking assisted reproductive technology services between January and December 2016 in one of the largest private hospitals in Saudi Arabia. Activity-Based Costing and Step-Down Costing methodologies with expert interviews were used to compute the costs of in vitro fertilization and intrauterine insemination. A total of 710 assisted reproductive technology procedures were observed by the embryologist in charge. The costs calculated included direct and indirect costs. A cost-effectiveness analysis and a Monte Carlo simulation probabilistic sensitivity analysis were conducted.
Results: The average cost per in vitro fertilization and intrauterine insemination cycle was SR 27,360 (range: SR 19,541-29,618) and SR 10,143 (range: SR 7568-11,976), respectively, and the live birth rate per initiated in vitro fertilization and intrauterine insemination cycle was 20.7% and 7.9%, respectively, resulting in an average cost per live birth per in vitro fertilization and intrauterine insemination treatment cycle of SR 132,174 (95% confidence interval: 120,802-143,546) and SR 128,392 (95% confidence interval: 124,468-132,316), respectively. The incremental cost-effectiveness ratio was SR 134,508 per extra live birth implicit in a decision to treat with in vitro fertilization. Probabilistic sensitivity analysis confirms the robustness of the cost-effectiveness results.
Conclusion: This study found that from a societal perspective, one in vitro fertilization treatment cycle was more cost-effective than intrauterine insemination in Saudi Arabia.

Matched MeSH terms: Infertility, Female
Fulltext Visual disturbances with clomiphene

Ang CS

Med J Malaysia, 2002 Jun;57(2):215-7.
PMID: 24326655

Clomiphene is a widely prescribed drug for the treatment of infertility. Visual symptoms that occur as a side effect of this drug are uncommon. Some doctors may neglect to mention this side effect when prescribing clomiphene. Thus these visual disturbances can be very alarming to the patient and may also pose a hazard if the patient is doing activities such as driving or operating machinery. The patient should be told to stop taking clomiphene and ophthalmologic evaluation should be performed. Although visual disturbances generally cease on stopping clomiphene, some women may experience persistent visual disturbances.

Matched MeSH terms: Infertility, Female*
Potential use of durian fruit (Durio zibenthinus Linn) as an adjunct to treat infertility in polycystic ovarian syndrome

Ansari RM

J Integr Med, 2016 Jan;14(1):22-8.
PMID: 26778225 DOI: 10.1016/S2095-4964(16)60240-6

Infertility due to polycystic ovarian syndrome (PCOS) is a worldwide problem that is increasing at alarming rates. Insulin resistance, the prime factor of PCOS, induces comorbid metabolic syndrome as well. Durian (Durio zibenthinus Linn), a fruit of Southeast Asia, is used as a natural supplement in healthy diets. This paper is a short literature review that examines the fruit's effects against various components of metabolic syndrome and its fertility-enhancing properties in PCOS. Various published literature was reviewed to learn of the anti-inflammatory, anti-oxidant, anti-obesity, anticholesterol, and antihypoglycaemic nature of the fruit. The literature search was done using PubMed, Google Scholar and library databases. The keywords used were polycystic ovarian syndrome, infertility, metabolic syndrome and Durian zibenthinus Linn. Reviewed studies showed that the fruit is effective against various components of metabolic syndrome, but the mechanisms of action against anovulation and menstrual disturbances in PCOS have yet to be studied. The traditional use of durian as a fertility-enhancing agent needs to be validated scientifically by isolating its various components and ascertaining its fertility enhancing properties.

Matched MeSH terms: Infertility, Female/drug therapy*; Infertility, Female/etiology
Endometriosis and infertility: the role of exogenous lipid peroxides in the peritoneal fluid

Arumugam K, Dip YC

Fertil. Steril., 1995 Jan;63(1):198-9.
PMID: 7805914

OBJECTIVE: To determine if lipid peroxides were raised in the pelvic peritoneal fluid of patients with endometriosis.
DESIGN: Control study involving patients with and without endometriosis.
METHODS: The lipid peroxide (malondialdehyde) levels in the pelvic PF of 12 patients with moderate-to severe endometriosis, 15 patients with minimal-mild endometriosis and 13 patients with normal pelvises were compared.
RESULTS: The level of lipid peroxides were not affected by the presence nor the severity of endometriosis.
CONCLUSION: Accelerated lipid peroxidation does not appear to play a role in the causal relationship between endometriosis and infertility.

Matched MeSH terms: Infertility, Female/etiology*
Endometriosis and infertility: raised iron concentration in the peritoneal fluid and its effect on the acrosome reaction

Arumugam K

Hum Reprod, 1994 Jun;9(6):1153-7.
PMID: 7962392

Endometriosis and infertility are commonly associated. This study investigated the role of accelerated lipid peroxidation of spermatozoa by the peritoneal fluid of patients with endometriosis as a cause for this association. It proposes that the increased iron concentration present in the fluid of these patients acts as a catalyst for the process. Peritoneal fluid from 25 patients with endometriosis and 25 matched controls was obtained at laparoscopy. Spermatozoa were incubated in the fluid from both groups and the subsequent acrosome reaction rates analysed. The relationship between these results and iron concentration in the fluid was examined. A significant decrease in the acrosome reaction rate was seen in the endometriotic group (P = 0.034). Overall, a decrease in the acrosome reaction rate was associated with an increased iron concentration in the fluid (18 of the 25 pairs). In mild disease, (six of 11 pairs), the relationship was not as marked as that in severe disease (12 of 14 pairs). These results suggest that the peritoneal fluid in patients with endometriosis has a detrimental action on the acrosome reaction of spermatozoa in vitro.

Matched MeSH terms: Infertility, Female/complications; Infertility, Female/metabolism*
Serum prolactin levels in infertile patients with endometriosis

Arumugam K

Malays J Pathol, 1991 Jun;13(1):43-5.
PMID: 1795561

Raised prolactin levels have been implicated as a cause for infertility in patients with endometriosis. This study was done to investigate if serum prolactin levels were significantly raised in infertile patients with endometriosis. Serum prolactin levels were studied in 43 infertile patients with endometriosis. For controls, 36 infertile patients with normal pelvic findings were used. For standardization, blood samples were drawn on day 21 of the menstrual cycle. Analysis was done by radioimmunoassay using reagent kits. The mean prolactin level in the endometriotic group was 372 mIU/l (range 187-752) while that in the controls was 333 mIU/l.(range 124-767). There was no statistical difference (t = 1.12). Furthermore the accepted normal level for serum prolactin in our population is less than 540 mIU/l. These results show that there is no evidence to implicate raised prolactin levels as a cause for infertility in patients with endometriosis.

Matched MeSH terms: Infertility, Female/blood*
Endometriosis and social class

Arumugam K, Templeton AA

Med J Aust, 1990 Nov 05;153(9):567.
PMID: 2233493
Matched MeSH terms: Infertility, Female/complications
Substantial Effect of Fenugreek Seeds Aqueous Extract on Serum Estradiol Level in Ovarian Hyperstimulation Syndrome Rat Model

Ben Hameid AS, Al-Sindi TA, Allow AK, Nafie EM, Alahmad BE, Faisal GG

Oman Med J, 2019 May;34(3):238-243.
PMID: 31110632 DOI: 10.5001/omj.2019.45

Objectives: Estradiol (E2) plays an important role in the pathophysiology of ovarian hyperstimulation syndrome (OHSS). This study aimed to evaluate the effect of fenugreek seed aqueous (FSA) extract on serum E2 levels in a rat model of OHSS.
Methods: A total of 34 female Sprague Dawley rats, aged 18 days old, weighing 40 to 45 g, were randomly divided into negative control, positive control, and treatment groups. A daily dose of 1500 mg/kg per body weight of FSA extract was administrated orally to rats in the treatment group for 13 days. On day eight of the study, OHSS was induced in both positive control and treated groups by subcutaneous injection of pregnant mare's serum gonadotropin 50 IU for four consecutive days, followed by human chorionic gonadotropin 25 IU on the fifth day. The effect of FSA extract was evaluated by measuring the concentration of serum E2 using the enzyme-linked immunosorbent assay.
Results: FSA extract reduced serum E2 level significantly in the treated OHSS model (p-value < 0.050) compared to the positive control group.
Conclusions: The finding has important implications on the development of female infertility adjuvant drugs for safe assisted reproduction technology cycles in terms of OHSS prevention.

Matched MeSH terms: Infertility, Female
The use of clomiphene citrate in the treatment of infertility

Chan DP

Med J Malaya, 1970 Mar;24(3):190-3.
PMID: 4246799
Matched MeSH terms: Infertility, Female/drug therapy*
Staphylococcal infections and infertility: mechanisms and management

Dutta S, Sengupta P, Izuka E, Menuba I, Jegasothy R, Nwagha U

Mol Cell Biochem, 2020 Nov;474(1-2):57-72.
PMID: 32691256 DOI: 10.1007/s11010-020-03833-4

Infertility is a subject of worldwide concern as it affects approximately 15% of couples. Among the prime contributors of infertility, urogenital bacterial infections have lately gained much clinical importance. Staphylococcal species are commensal bacteria and major human pathogens mediating an array of reproductive tract infections. Emerging evidences are 'bit by bit' revealing the mechanisms by which Staphylococci strategically disrupt normal reproductive functions. Staphylococcal species can directly or through hematogenous routes can invade the reproductive tissues. In the testicular cells, epididymis as well as in various compartments of female reproductive tracts, the pathogen recognition receptors, toll-like receptors (TLRs), can recognize the pathogen-associated molecular patterns on the Staphylococci and thereby activate inflammatory signalling pathways. These elicit pro-inflammatory mediators trigger other immune cells to infiltrate and release further inflammatory agents and reactive oxygen species (ROS). Adaptive immune responses may intensify the inflammation-induced reproductive tissue damage, particularly via activation of T-helper (Th) cells, Th1 and Th17 by the innate components or by staphylococcal exotoxins. Staphylococcal surface factors binding with sperm membrane proteins can directly impair sperm functions. Although Staphylococci, being one of the most virulent bacterial species, are major contributors in infection-induced infertility in both males and females, the mechanisms of their operations remain under-discussed. The present review aims to provide a comprehensive perception of the possible mechanisms of staphylococcal infection-induced male and female infertility and aid potential interventions to address the lack of competent therapeutic measures for staphylococcal infection-induced infertility.

Matched MeSH terms: Infertility, Female
The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis

Hamdan M, Dunselman G, Li TC, Cheong Y

Hum. Reprod. Update, 2015 Nov-Dec;21(6):809-25.
PMID: 26168799 DOI: 10.1093/humupd/dmv035

Endometriosis is a disease known to be detrimental to fertility. Women with endometriosis, and the presence of endometrioma, may require artificial reproductive techniques (ART) to achieve a pregnancy. The specific impact of endometrioma alone and the impact of surgical intervention for endometrioma on the reproductive outcome of women undergoing IVF/ICSI are areas that require further clarification. The objectives of this review were as follows: (i) to determine the impact of endometrioma on IVF/ICSI outcomes, (ii) to determine the impact of surgery for endometrioma on IVF/ICSI outcome and (iii) to determine the effect of different surgical techniques on IVF/ICSI outcomes.

Matched MeSH terms: Infertility, Female/complications; Infertility, Female/therapy*
Clomiphene citrate in Asian women

Ken TP, Khin TS

Med J Malaya, 1970 Jun;24(4):297-9.
PMID: 4248351
Matched MeSH terms: Infertility, Female/drug therapy*
Fulltext Efficacy of danazol treatment in infertile patients with endometriosis

Kulenthran A

Med J Malaysia, 1992 Mar;47(1):11-4.
PMID: 1387442

The study was done to assess the efficacy of danazol in the treatment of infertile patients with all stages of endometriosis. The cumulative pregnancy rates in 21 patients with Stage I and II endometriosis were compared to 21 patients with Stage III and IV endometriosis. Both groups had danazol treatment for six months. All other fertility related factors were controlled for in both groups. There was a cumulative pregnancy rate of 11% (standard error 7%) at 12 months of follow-up in the group with Stage I and II disease whilst it was 26% (standard error 10%) in the group with moderate or severe disease. These results question the validity of any classification system in prognosticating for fertility in patients with endometriosis.

Matched MeSH terms: Infertility, Female/drug therapy*
Fulltext A retrospective review comparing the use of Gonal-F and Metrodin-HP for in-vitro fertilisation (IVF)

Lee C, Mak FS, Keith J, Welsh D, Yapp P, Chin R

Med J Malaysia, 2003 Mar;58(1):94-8.
PMID: 14556331

All cycles of IVF with pituitary down-regulation (n = 57) done at the Damansara Fertility Centre in the year 2000 were studied. All the 57 patients had controlled ovarian hyperstimulation, either using Metrodin HP (n = 27) or Gonal-F (n = 30). Of these, 53 patients reached oocyte pick-up, 26 patients in Metrodin HP group and 27 patients in Gonal-F group. Gonal-F resulted in a higher clinical pregnancy rate of 66.6% compared to Metrodin HP 38.5% (p < 0.05). The live birth rate tends to be higher in Gonal-F group (40.7%) compared to Metrodin HP (30.8%), (p > 0.05).

Matched MeSH terms: Infertility, Female/therapy*
Successful pregnancy outcome following gamete intra-Fallopian transfer in a patient with Müllerian dysgenesis

Lee CS, Lie AT

Reprod Biomed Online, 2012 May;24(5):547-9.
PMID: 22410277 DOI: 10.1016/j.rbmo.2012.01.021

A 29-year-old lady with Müllerian dysgenesis was keen to have a baby. Clinically, she was medium built with well-developed secondary female sexual characteristics. There was a short and blind vagina. She had undergone surgery for an imperforated hymen. Her FSH and LH concentrations were normal. Laparoscopy revealed a patent right Fallopian tube, a rudimentary right uterus and extensive pelvic endometriosis. She subsequently underwent gamete intra-Fallopian transfer (GIFT). Oocyte retrieval was carried out laparoscopically and a total of nine oocytes were retrieved. Four of the oocytes were transferred together with motile spermatozoa into the right Fallopian tube and the remaining five oocytes were inseminated with spermatozoa for IVF. Three embryos resulted and were frozen. She subsequently developed moderate ovarian hyperstimulation syndrome. Serum β-human chorionic gonadotrophin concentration 14 days after GIFT was 1612 IU/l. Her antenatal care was relatively uneventful until 31 weeks of gestation when she was diagnosed to have intrauterine growth retardation and oligohydramnios. She then underwent an emergency Caesarean section at 32 weeks of pregnancy delivering a normal baby. This case study describes a successful pregnancy outcome following gamete intra-Fallopian transfer (GIFT) in a woman with malformation of the vagina (Müllerian dysgenesis). A 29-year-old lady with Müllerian dysgenesis diagnosed at 16 years of age was keen to become pregnant. Upon examination, a decision was made for a William's vulvovaginoplasty but as the patient was indecisive the surgery was deferred. Clinically, she is a medium-built lady with well-developed secondary female sexual characteristics. There was a short and blind vagina. Her serum FSH and LH concentrations were normal. Laparoscopy revealed a patent right Fallopian tube, a rudimentary right uterus and extensive pelvic endometriosis. She subsequently underwent GIFT. Nine oocytes were retrieved through laparoscopy. Four of the oocytes were transferred together with motile sperm into the right Fallopian tube and the remaining five oocytes were inseminated with sperm for IVF. Three embryos resulted and were frozen. Serum β human chorionic gonadotrophin concentration measured 14 days after GIFT was 1612 IU/l. An abdominal ultrasonography performed at 5 weeks showed one intrauterine gestational sac. Her antenatal care was uneventful until 31 weeks of gestation when she developed a deficiency of amniotic fluid in the amniotic sac. She then underwent an emergency Caesarean section at 32 weeks of pregnancy. She delivered a healthy, normal 1.24 kg baby boy. Her post-natal care was uneventful.

Matched MeSH terms: Infertility, Female/etiology*; Infertility, Female/therapy*
SOME USES OF HYPNOSIS IN GYNECOLOGY

MUN CT

Med J Malaysia, 1964 Jun;18:223-5.
PMID: 14199437
Matched MeSH terms: Infertility, Female*
Review: Ajwa date (Phoenix dactylifera)- an emerging plant in pharmacological research

Mallhi TH, Qadir MI, Ali M, Ahmad B, Khan YH, Rehman A

Pak J Pharm Sci, 2014 May;27(3):607-16.
PMID: 24811825

Date Fruits are consumed in Arab areas for a long time as a part of essential diet. Phoenix dactylifera belongs to family Arecaceae and its leaves, barks, pits, fruits and pollens have anticancer, antioxidant, hepatoprotective, antidiabetic, antihypertensive, antiulcertavie, anti-inflammatory, antiproliferative, antimutagenic, antidiarheal, antibacterial, antifungal and antiviral potential. Besides these, Dates also increase level of estrogen, testosterone, RBCs, Hb, PCV, reticulocytes and platelet counts. It can also cure lead induced heamotoxicity, side effects of methylprednisolon, male and female infertility. It has also cerebroprotective, neuroprotective and haemopoietic activity. Phoenix dactylifera can be used for number of complications if further evaluated and isolated. The present paper is an overview of pharmacological properties of Phoenix dactylifera reported in literature.

Matched MeSH terms: Infertility, Female/drug therapy
Fulltext Electrophoretic Techniques for the Detection of Human Microsatellite D19S884

Mansor F, Zamri L, Hamzah SS

Malays J Med Sci, 2015 Mar-Apr;22(2):18-24.
PMID: 26023291 MyJurnal

The detection and analysis of microsatellites is very important for the mapping of genetic diseases because they are commonly used as genetic markers. Microsatellite marker D19S884 has been associated with polycystic ovary syndrome (PCOS), the most common reproductive endocrine disease of women in their childbearing years. It is responsible for an estimated 70% of cases of anovulatory infertility. In this work, we detected microsatellites in DNA extracted from the blood of PCOS patients.

Matched MeSH terms: Infertility, Female
Live birth rates are satisfactory following multiple IVF treatment cycles in poor prognosis patients

Mustafa KB, Keane KN, Walz NL, Mitrovic KI, Hinchliffe PM, Yovich JL

Reprod Biol, 2017 Mar;17(1):34-41.
PMID: 27964842 DOI: 10.1016/j.repbio.2016.11.004

This seven-year retrospective study analysed the live birth rate (LBR) for women undergoing IVF treatment with various antral follicle counts (AFC). The LBR decreased with lower AFC ratings, and in 290 treatment cycles for women in the poorest AFC category, ≤4 follicles (group E), the LBR was the lowest at 10.7%. The pregnancy loss rate (PLR) significantly increased with poorer AFC categories, from 21.8% in AFC group A (≥20 follicles), to 54.4% in AFC group E (p<0.0001). This trend was repeated with advancing age, from 21.6% for younger women (<35years), to 32.9, 48.5 and 100% for ages 35-39, 40-44 and ≥45 years, respectively (p<0.0001). However, LBR within the specific AFC group E cohort was also age-dependent and decreased significantly from 30.0% for <35 years old, to 13.3, 3.9 and 0% for patients aged 35-39, 40-44 and ≥45 years, respectively. Most, importantly, LBR rates within these age groups were not dependent on the number of IVF attempts (1st, 2nd, 3rd or ≥4 cycles), which indicated that cycle number should not be the primary deciding factor for cessation of IVF treatment in responding women <45years old.

Matched MeSH terms: Infertility, Female/diagnosis; Infertility, Female/therapy*

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