Isabella Piva

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.

Hysterosalpingo contrast sonography (HyCoSy): let's make the point!

IntroductionThe accurate evaluation of tubal patency as well of the morphologic characteristics of the uterine cavity is a fundamental step in the diagnostic work-up for infertility. Hysteroscopy and laparoscopy and dye have long been regarded as the reference methods to assess uterine morphology and tubal patency, respectively. However, their technical and clinical limitations have supported the introduction of an emerging technique: hysterosalpingo contrast sonography (HyCoSy), which has recently been improved with the use of modern contrast agents and three-dimensional resolution.MethodsA systematic literature search was performed in electronic databases (PubMed and Scopus). Key search terms included Hysterosalpingo contrast sonography (HyCoSy), Tubal patency, Infertility, Uterine cavity, Ultrasounds.ResultsHyCoSy has proved to be as reliable as laparoscopic techniques in the assessment of tubal patency and uterine morphology, and also it overcomes such major drawbacks as hospitalization, radiation exposure, anesthesia and use of iodinated contrast media. All in all, HyCoSy is considered as a safe and well tolerated outpatient procedure, which apparently favors the onset of spontaneous pregnancies.ConclusionThis paper provides a comprehensive overview of the literature dealing with HyCoSy to support its use as a first-line technique in standard infertility work-up.

A literature review on the relationship between infertility and sexual dysfunction: does fun end with baby making?

Abstract Objective To analyse the relationship between infertility and sexuality, and the effect of assisted reproductive technology (ART) on a couples sexual relationship. Method The literature review is a result of a search that was undertaken with the keywords ‘infertility’ and ‘sexuality’ in PubMed from 2000 until 2013. Results Even though abstinence or inadequate sexual activity are often reported in infertile couples, sexual disorders rarely cause infertility. They usually arise, instead, as a result of involuntary childlessness and assisted reproduction. Qualitative studies provide a detailed description of the impact of infertility and its treatment on the couples’ sexual relationship, along with its specific gender effects, yet it is difficult to set standardised parameters to quantify sexual strain and the reliability of the studies available is limited by major drawbacks. Conclusions Appropriate measures should be designed to identify sexual disorders in infertile couples, and the medical team should be trained to deal systematically with the couples sexuality and propose strategies to overcome sexual disturbances. This approach could preserve the quality of the couples sexual relationship and maximise pregnancy chances in ART. Chinese Abstract 摘 要 目的 分析不育与性功能障碍的关系，以及辅助生育技术（assisted reproductive technology，ART) 对夫妇性关系的影响。 方法 对2000年至2013年之间PubMed上发表带有“不育”和“性欲”关键词的文献进行回顾分析。 结果 虽然经常有不育夫妇禁欲和性活动少的报道，但是性功能障碍很少引起不育。然而，常常情不自禁的无孩子的意识及辅助的生殖会影响性欲。有大量的研究对不育及其治疗对夫妇性关系的影响进行了详细的描述，然而对性活动设定标准的量化参数非常困难，因所收集的研究的存在重要的缺陷。 结论 采取适当的措施查明不育夫妇的性功能障碍，对医疗团队进行培训，对夫妇的性欲进行系统的评估，并采取适当的策略克服性功能障碍。此方法可以对夫妇性关系的质量进行评估，并且对进行ART的夫妇争取最大的怀孕机会。

Women taking the "blue pill" (sildenafil citrate): such a big deal?

For years, phosphodiesterase type 5 inhibitors have been used for the treatment of erectile dysfunctions. Due to the similarities between male and female sexual response, several studies have assessed the effects of sildenafil citrate (Viagra®) in women affected by female sexual arousal disorder. The results are still conflicting and the drug is not devoid of adverse effects. Furthermore, female sexual arousal disorder is a heterogeneous condition whose underlying causes are difficult to diagnose and appropriate treatment requires a thorough sexual, psychological, and medical history along with specialist consultations. The clinician should pursue a global approach to the patient with sexual difficulties, while non-hormonal treatment such as phosphodiesterase type 5 inhibitors (ie, sildenafil citrate) should be kept as the last option.

Should the desire for a child always be fulfilled

Over the past decades, the steady scientific progress in the field of medically assisted reproductive technology (ART) has enabled many couples to fulfill their wish for pregnancy when this event does not occur spontaneously. This wide-spreading phenomenon raises important ethical issues: a Pakistani couple recently presenting for infertility evaluation provides a good example. The male patient was overweight (BMI 1⁄4 29.5 kg/m2) and presented postaxial polydactyly of fingers and toes (Fig. 1), hyperinsulinemia, and impaired glucose tolerance, thus a Bardet-Biedl syndrome (polydactyly, pigmentary retinal dystrophy, obesity, intellectual disability, hypogonadism, and other anomalies) [1] was suspected. Isolated hypogonadotropic hypogonadism, detected by laboratory exams (follicle-stimulating hormone (FSH) 1⁄4 7 mUI/mL; lutheinizing hormone (LH) 1⁄4 5 mUI/Ml; testosterone (T) 1⁄4 2.19 ng/mL), was also consistent with this hypothesis. However, the patient did not show mental retardation or retinitis pigmentosa and hence he did not meet diagnostic criteria for such a syndrome [2]. Kallmann syndrome was also excluded, because the patient’s sense of smell was unaltered, indicating a normo-osmic idiopathic central hypogonadism. Since no defective androgenization or growth at a peripubertal age was reported and the andrological exam was normal, this conditionwas probably acquired. Polydactylity might also indicate an underlying ciliopathy [1], a disorder characterized by disruption of the function of primary cilia resulting in a singleorgan or syndromic disease [3]. Nevertheless, semen analysis revealed normal motility of spermatozoa (progressive motility 1⁄4 56%; total motility 1⁄4 100%) and hence male infertility could hardly be due to a genetically-determined dysfunction of the cilia in this case. Finally, sexual dysfunction and premature ejaculation occurred 1 month after the wedding, possibly indicating a psychological etiology of infertility [4,5]. This hypothesis is worth considering, because in Pakistan, infertility is perceived as a failure at a personal, interpersonal, or social level because of cultural customs and perceived religious dictums. The patient’s wife was affected by Hashimoto thyroiditis, which had caused considerable weight gain and hypomenorrhea in recent months. Moreover, a gynecologic exam and ultrasound enabled the detection of a paraovarian hydatid cyst, which has been recently identified as a possible underestimated cause of otherwise unexplained infertility [6]. As part of the routine assessments for infertility, the patients were also tested for hepatitis C virus (HCV) infection and proved to be serodiscordant, with HCV-infected man. A common finding in both partners was vitamin D deficiency, which was shown to be the cause of the primary hyperparathyroidism detected in the female partner (parathyroid hormone (PTH) 1⁄4 380 pg/mL; alkaline phosphatase (ALP) 1⁄4 452 U/L).

Herpes Gestationis after Ovodonation: Is Placenta the only Target of the Immune Reaction?

Herpes Gestationis (HG) is an autoimmune disorder that rarely complicates pregnancy. Its pathogenesis has not been clarified yet, as it derives from a complex interplay between immunologic, genetic, and hormonal factors. We present a case of HG occurring in a surrogate mother whose pregnancy was achieved via egg donation and in vitro fertilisation (IVF). The disease appeared at 26 weeks and 6 days of gestation and subsequently worsened despite the administration of oral and topic corticosteroids. A healthy baby was delivered at 35 weeks and 2 days of gestation by elective cesarean section and the clinical manifestations resolved in the postpartum period.

A response to Gadarowski's letter to the editor.

This discussion is meant to examine the issues raised by Gadarowski in a recent Letter to the Editor.This is a reply to http://www.hqlo.com/content/pdf/1477-7525-11-52.pdf.