Ilaria Soave

Procreative sex in infertile couples: the decay of pleasure?

BackgroundInfertility represents a major challenge to the emotional balance and sexual life of couples, with long-lasting and gender-specific effects. The objective of this study is to explore personality features of infertile patients and detect possible sexual disorders in couples undergoing infertility treatment.Materials and methodsIn this prospective study 60 infertile couples and 52 fertile control couples were asked to complete standardized and validated questionnaires: the Adjective Check List (ACL) to enquire about personality features and the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF) to assess sexual functioning of female and male partners. The study population was divided into 3 groups: Group A (N = 30, recently diagnosed infertile couples) Group B (N = 30, infertile couples already undergoing Intrauterine Insemination) and Group C (N = 52, fertile control group).ResultsInfertile patients did not display any distinguishing personality features. Regarding sexual function, men of all the three groups scored higher in both questionnaires (sexual satisfaction, desire and orgasm) than their female partners. Comparing results between groups, Group A male partners obtained lower scores in all the subscales. Women belonging to Group A and Group B showed an impairment of sexual arousal, satisfaction, lubrification and orgasm when compared to fertile controls.ConclusionsEven if at the very first stages of infertility treatment no personality disturbances can be detected, the couples’ sexual life is already impaired with different sexual disorders according to gender.

Correlation of Endocrine Disrupting Chemicals Serum Levels and White Blood Cells Gene Expression of Nuclear Receptors in a Population of Infertile Women

Significant evidence supports that many endocrine disrupting chemicals could affect female reproductive health. Aim of this study was to compare the internal exposure to bisphenol A (BPA), perfluorooctane sulphonate (PFOS), perfluorooctanoic acid (PFOA), monoethylhexyl phthalate (MEHP), and di(2-ethylhexyl) phthalate (DEHP) in serum samples of 111 infertile women and 44 fertile women. Levels of gene expression of nuclear receptors (ERα, ERβ, AR, AhR, PXR, and PPARγ) were also analyzed as biomarkers of effective dose. The percentage of women with BPA concentrations above the limit of detection was significantly higher in infertile women than in controls. No statistically significant difference was found with regard to PFOS, PFOA, MEHP and DEHP. Infertile patients showed gene expression levels of ERα, ERβ, AR, and PXR significantly higher than controls. In infertile women, a positive association was found between BPA and MEHP levels and ERα, ERβ, AR, AhR, and PXR expression. PFOS concentration positively correlated with AR and PXR expression. PFOA levels negatively correlated with AhR expression. No correlation was found between DEHP levels and all evaluated nuclear receptors. This study underlines the need to provide special attention to substances that are still widely present in the environment and to integrate exposure measurements with relevant indicators of biological effects.

Clinical outcome after IMSI procedure in an unselected infertile population: a pilot study

BackgroundTo date the IMSI procedure represents the only real-time and unstained method available to discard spermatozoa with ultrastructural defects. Several studies demonstrated that IMSI provides positive results in couples with severe male factor infertility or repeated ICSI failures. Aim of this pilot study is to evaluate the differences between IMSI and ICSI in terms of IVF outcomes in an unselected infertile patient population.MethodsThree hundred and thirty-two couples were analyzed: 281 couples underwent conventional ICSI procedure and 51 underwent IMSI technique.ResultsNo statistically significant differences were found between implantation rate (ICSI: 16,83%; IMSI: 16,67%), fertilization rate (ICSI: 77,27%; IMSI: 80,00%) and pregnancy rate (ICSI: 25,30%; IMSI: 23,50%). Both groups were comparable when considering live birth rate (ICSI: 11,39%; IMSI:13,72%), ongoing pregnancy rate (ICSI: 7,47%; IMSI: 5,88%) and miscarriage rate (ICSI: 17,78; IMSI: 5,26%). The subgroup analyses did not show a statistical difference between ICSI and IMSI neither in male factor infertility subgroup nor in patients with more than one previous ICSI attempt. A trend towards better laboratory and clinical outcomes was detected in the male factor infertility subgroup when IMSI was applied.ConclusionsOur preliminary results show that the IMSI technique does not significantly improve IVF outcomes in an unselected infertile population.

The adjuvant use of N-palmitoylethanolamine and transpolydatin in the treatment of endometriotic pain

OBJECTIVE To test the adjuvant use of the combination of N-palmitoylethanolamine and transpolydatin in the medical treatment of endometriotic pain. STUDY DESIGN We enrolled 47 patients admitted to the Outpatient Endometriosis Care Unit of Ferrara University from January 2011 to December 2011. They were divided into two groups according to the endometriosis site (group A: recto-vaginal septum; group B: ovary). One tablet, containing 400 mg of micronized N-palmitoylethanolamine plus 40 mg transpolydatin, was administered twice daily on a full stomach for 90 days. Each patient was requested to grade the severity of dysmenorrhea, chronic pelvic pain, dyspareunia and dyschezia using a 0-10 cm visual analogic scale prior to beginning treatment (T0), after 30 days (T1), 60 days (T2) and 90 days (T3). The continuous and categorical variables were compared, respectively, using Students t-test and the chi-square test. Analysis of variance for repeated measures was used to verify the reduction of endometriotic pain. RESULTS The intensity of endometriotic pain decreased significantly for both groups (p<0.0001). The efficacy of drug treatment was significant after 30 days. Pain intensity decreased equally in the two groups except for dysmenorrhea, which was reduced more rapidly in group B. CONCLUSIONS The combination of N-palmitoylethanolamine and transpolydatin reduced pain related to endometriosis irrespective of lesion site. It had a marked effect on chronic pelvic pain determined by deep endometriosis and on dysmenorrhea correlated to ovarian endometriosis.

Ovarian stimulation in women with high and normal body mass index: GnRH agonist versus GnRH antagonist

In modern society, obesity has become a major health problem and has been associated with impaired fertility. The aim of this study is to assess the role of obesity in women undergoing controlled ovarian hyperstimulation (COH) stimulated either with GnRH agonists or with GnRH antagonists. Records of 463 women undergoing in vitro fertilization (IVF) treatment were reviewed. The influence of body mass index (BMI) on treatment outcome was examined, after accounting for differences in stimulation protocols. In the agonist group (286 patients), the total amount of gonadotropins used was significantly higher in patients with a BMI ≥ 25 kg/m2, when compared to those with a normal BMI. The same result was found in the antagonist group (177 patients). No significant differences were found in length of stimulation, number of oocytes retrieved or number of embryos transferred. In both the antagonist and the agonist group, the number of clinical pregnancies was found to be higher in patients with normal BMI, suggesting that obesity could impair the ovarian response to exogenous gonadotropins. Considering the results obtained and the many theoretical advantages of GnRH antagonists, ovarian stimulation with GnRH antagonists is an efficient treatment for both women with normal and high BMI.

Impact of 677C>T Mutation of the 5,10-Methylenetetrahydrofolate Reductase on IVF Outcome: Is Screening Necessary for All Infertile Women?

AIM Polymorphisms of genes connected to folate metabolism may alter the beneficial effect of folic acid on the methyl group cycle. The most common variation is the 677C>T polymorphism of the gene of the 5,10-methylentetrahydrofolate reductase (MTHFR). The aim of this study is to investigate of what influence, if any, does MTHFR 677C>T mutation have on female fertility and on the in vitro fertilization (IVF) outcome. PATIENTS AND METHODS Data of 273 patients were retrospectively analyzed. The study group (group A) consisted of 103 women, homozygous for the MTHFR 677C>T mutant genotype. The control group (group B) consisted of 170 patients without the mutation. RESULTS A longer stimulation duration was found in group A and the total amount of recombinant follicle-stimulating hormone (r-FSH) needed was appreciably higher. The fertilization rate was significantly higher in group B, although the implantation rate and clinical pregnancies were similar in both groups. CONCLUSIONS Alteration of inherited thrombophilic factors is connected with early pregnancy loss and IVF implantation failure. Our study showed an abortion rate higher, but not statistically significant, in group A. Based on these findings, our study suggests that MTHFR 677C>T mutation does not affect the IVF outcome and patients without thrombophilic risk factors undergoing an IVF cycle should not all be screened for thrombophilic disorders.

In vitro fertilization stimulation protocol for normal responder patients.

The aim of this prospective observational study is to determine the different outcomes of IVF/ICSI treatments after using antagonists or agonists of gonadotrophin-releasing hormone (GnRH) for controlled ovarian hyperstimulation (COH) in normal responder patients. Two hundred forty-seven patients undergoing IVF treatment at the Centre of Reproductive Medicine, Rome (CERMER), from January 2005 to December 2008, were included in the study. Patients were stimulated either with a standard long protocol with GnRH agonists (n = 156) or with GnRH antagonists (n = 91). The use of GnRH antagonists resulted in a significant reduction in the duration of the stimulation (Agonist Group 14.10 ± 2.25 vs Antagonist Group 11.34 ± 2.11; p < 0.001) and in the amount of gonadotrophin (IU of r-FSH) needed (Agonist Group 1878 ± 1109 vs Antagonist Group 1331 ± 1049; p = 0.0014). Moreover a lower number of cycles were cancelled with the antagonist protocol (4.39 vs 6.41%). The GnRH antagonist protocol, when compared to the GnRH agonist one, is associated with a similar clinical pregnancy rate, similar implantation rate, significantly lower gonadotrophin requirement and shorter duration of stimulation. For this reason, GnRH antagonists might be a good treatment even for normal responder patients undergoing IVF.

Rectus abdominis muscle endometriotic mass in a woman affected by multiple sclerosis

We report a case of a rectus abdominis muscle endometriotic mass in a woman affected by multiple sclerosis. The pathogenesis of endometriosis is poorly understood but an immune system alteration could play a role in its onset and development. To date few studies have investigated the connection between autoimmune diseases and endometriosis. Multiple sclerosis is an inflammatory, autoimmune, demyelinating disease of the central nervous system. An autoimmune background might contribute both in the establishment of extrapelvic endometriotic lesions and in the possible increased risk of women with endometriosis to develop autoimmune diseases.

Sonohysterosalpingography: a suitable choice in infertility workup

PurposeTo evaluate the efficacy, compliance, and cost effectiveness of sonohysterosalpingography (HyCoSy) compared with hysteroscopy for uterine cavity evaluation and compared with RX-hysterosalpingography (RX-HSG) for tubal patency determination.MethodsThree hundred and eight infertile patients underwent HyCoSy, hysteroscopy, and RX-HSG. We compared sensitivity, specificity, positive and negative predictive values (PPV and NPV), discomfort level, and cost of all three procedures.ResultsSensitivity, specificity, PPV, and NPV were higher for HyCoSy than for hysteroscopy but the differences were not significant. HyCoSy also has the same accuracy as RX-HSG. Pain perception and cost were higher for RX-HSG and hysteroscopy than for HyCoSy.ConclusionsHyCoSy can be regarded as a procedure for initial evaluation of the uterine cavity and of tubal patency in infertile patients.

POI: Premature ovarian insufficiency/pregnancy or infertility?

Dear Editor, Premature ovarian insufficiency (POI) is a condition associated with female infertility that affects approximately 1% of women under the age of 40.[1] It is characterized by amenorrhea, hypoestrogenism and elevated level of gonadotropins. Although the causes of POI are largely unknown, autoimmune diseases, chromosomal abnormalities and environmental factors seem to play an important role in the etiopathology.[2] Most women have normal menstrual history, age of menarche and possible fertility prior the onset of POI symptoms (i.e., vaginal dryness, night sweats, or hot flushes). A definitive diagnosis of POI is difficult to make, and the diagnostic criteria are not always standard.[3] Most clinicians would make the diagnosis based on (i) 3-6 months of amenorrhea, (ii) Follicular Stimulating Hormone (FSH) levels above 40 mIU/ml and (iii) low estrogens levels.[2] In this syndrome, the ovarian failure is not permanent. Indeed, some women experience intermittent and unpredictable ovarian function and in some cases may even conceive spontaneously.[4] We report a case of a 28-year-old woman, who was presented to our infertility unit, with 16 months of primary infertility. Her personal history for previous surgery or other relevant pathologies was negative. Menarche occurred at age of 12, followed by regular menstrual bleeding. At 22, she commenced on birth-control pill that stopped 2 years later. Before starting any treatment, hormonal profile of the couple and a sperm test for the partner were planned. They all resulted normal. After 4 failed intrauterine insemination (IUI) cycles, the couple underwent 2 in vitro fertilization (IVF) cycles preceded by a karyotype analysis that resulted normal. They both ended with few oocytes retrieved (3 and 1 respectively) and none fertilized. Before all procedures, the patient was stimulated with high doses of recombinant-FSH, followed by daily dose of GnRH antagonist ganirelix when at least two follicles had reached 14 mm diameter. Ovulation triggering was performed using a subcutaneous injection of corio gonadotropin alpha. Five months after the last IVF-cycle, the patient came back referring amenorrhea. Laboratory tests revealed FSH level at 65 and 75 mUI/mL (menopause > 40 mUI/mL), estradiol (E2) at 33 and 26 pg/mL (menopause < 40 pg/mL) and anti-mullerian hormone (AMH) at 0.0 ng/mL in two serial determinations. A diagnosis of POI was made. The couple was then listed for oocyte donation. One year later, the patient experienced a menstrual bleeding and a month after a pregnancy test resulted positive. Nine months later a healthy baby was delivered. Although pregnancy in POI patients is a rare event, it should be always taken into consideration, given the possibility of spontaneous resumption of the ovarian function.