Spontaneous Pregnancy and Unexplained Infertility: A Gift With Many Whys
... However, POR women are not menopausal, so they still have chance for spontaneous pregnancy. The chance of spontaneous conception is higher in younger women and is intensely associated with the duration of infertility [4,39]. The spontaneous pregnancy rate is reported 17% among women who formerly achieved pregnancy through ART and 2.2% to 14.2% among women with the extreme form of POR [4,39]. ...
... The chance of spontaneous conception is higher in younger women and is intensely associated with the duration of infertility [4,39]. The spontaneous pregnancy rate is reported 17% among women who formerly achieved pregnancy through ART and 2.2% to 14.2% among women with the extreme form of POR [4,39]. The present study reported 5% spontaneous pregnancy in POR women treated with PRP. ...
Context
The effect of platelet-rich plasma (PRP) on ovarian reserve markers in poor ovarian response (POR) is challenging.
Aim
This systematic review and meta-analysis was, therefore, designed to evaluate the effectiveness of intra-ovarian injection of autologous PRP on improving ovarian reserve markers and assisted reproductive technology (ART) outcomes in infertile women with POR.
Methods
A systematic search was conducted for the efficacy of intra-ovarian injection of autologous PRP on the improvement of ovarian reserve markers and ART outcomes in infertile women with POR. The methodological quality of the included studies was checked and eligible studies were included in the meta-analysis to find pooled results. Keywords were primary ovarian insufficiency, premature menopause, poor responder, poor ovarian response, diminished/decreased ovarian reserve, platelet-rich plasma, and intra-ovarian or a combination of them. The effect of PRP on fertility indices was evaluated using the standardized mean difference (SMD). The analysis was performed through STATA version 13.
Key results
13 studies containing 1289 patients were included. Mean age, body mass index (BMI) and duration of infertility was 37.63 ± 2.66 years, 24 ± 1.23 kg/m² and 4.79 ± 1.64 years, respectively. Most of the studies measured the outcomes 2–3/3 months after intra-ovarian injection of autologous PRP. The antral follicular count (AFC) after treatment by PRP is higher with an SMD of 0.95 compared to before treatment. The day 3 follicle-stimulating hormone (FSH) after treatment by PRP is lower with an SMD of − 0.25 compared to before treatment. The day 3 estradiol (E2) after treatment by PRP is higher with an SMD of 0.17 compared to before treatment. The anti-Mullerian hormone (AMH) after treatment by PRP is higher with an SMD of 0.44 compared to before treatment. The total oocytes number after treatment by PRP is higher with an SMD of 0.73 compared to before treatment. The number of MII oocytes after treatment by PRP is higher with an SMD of 0.63 compared to before treatment. The number of cleavage-stage embryos after treatment by PRP is higher with an SMD of 1.31 compared to before treatment. The number of day 5 embryo after treatment by PRP is higher with an SMD of 1.28 compared to before treatment. Pooled estimation of a meta-analysis of prevalence studies reported a prevalence of 22% for clinical pregnancy, 5% for spontaneous pregnancy and 21% for ongoing pregnancy following PRP therapy.
Conclusion
Intra-ovarian injection of PRP improved ovarian reserve markers with increasing AFC, serum level of AMH and day 3 E2 and decreasing serum level of day 3 FSH. In addition, this treatment improved ART outcomes through the increasing of number total oocytes, number of MII oocytes, number of cleavage-stage embryos and number of day 5 embryos in POR women.
Implications
Although treatment of POR women remains challenging, the use of intra-ovarian injection of autologous PRP in POR patients prior to IVF/ICSI cycles is a sign of new hope for increasing the success of IVF/ICSI. However, further well-organized, randomized controlled trials should be conducted to substantiate this result and recommend intra-ovarian injection of PRP as part of routine treatment in women with POR.
... Unfortunately, sex becomes a "necessity" when a couple struggles to conceive. 9,10,11 Infertility is a risk factor for sexual dysfunction (SD). 9,10,11,12,13,14,15,16,17,18,19,20 TI adds to SD in both the partners by forcing them to engage in sex around the fertile period. ...
... 9,10,11 Infertility is a risk factor for sexual dysfunction (SD). 9,10,11,12,13,14,15,16,17,18,19,20 TI adds to SD in both the partners by forcing them to engage in sex around the fertile period. 7,9,13,21,22,23 In contrast, regular intercourse (RI) two to three times a week had been recommended for the couples trying to conceive. ...
Objective: To study the differences in sexual dysfunction (SD) and time to pregnancy (TTP) between infertile couples pursuing timed intercourse (TI- around the time of ovulation) and regular intercourse (RI- at least twice a week). Design: Prospective cohort study Setting: Infertility clinics of Kolkata over three years Population or Sample: Infertile couples pursuing TI (n=283) or RI (n=88), having no preexisting sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Methods: At the first visit, SD of both the partners was assessed using the Arizona Sexual Experiences Scale (ASEX) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The couples for whom natural conception was possible were followed up to determine TTP using Kaplan Meier Analysis. Main Outcome Measure: Differences in SD and differences in TTP. Results: TI significantly increased the risk of SD than RI for both males (Odds ratio [OR] 15.24, 95% confidence interval [CI] 7.96-29.15) and females (OR 5.52, 95% CI 2.38- 12.78). This difference persisted even after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI carried a higher risk of developing ED, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. IIEF-5 score was significantly better in the RI group than in the TI. The TTP for natural conception was similar between them (Log-rank p= 0.1365). Conclusions: TI increased the risk of sexual dysfunction without accelerating the time to achieve pregnancy, compared with RI.
... 16 Natural pregnancies occurred after a successful MAR procedure or after adoption also suggests a relevant impact of the psychological sphere on fertility. 17 In the interpretation of the high proportion of natural conception after MAR should be considered the fact that in Lombardy the access to MAR is not related to strict diagnostic criteria; thus, it is conceivable that also moderately subfertile couples may have access to MAR. Further, it should be considered that in some cases the second child is searched with another partner, thus affecting the mechanisms of couple infertility. ...
Introduction
Evidence on the role of medically assisted reproduction (MAR) in achieving the desired number of children is very limited. The aim of the current investigation was to assess the probability and the mode of conception of a second live birth according to the mode of conception of the first one.
Material and methods
This historical cohort study was based on administrative data from regional healthcare databases. Women hospitalized for childbirth in Lombardy between January 1, 2007 and December 31, 2017 were identified. The probability of a second live birth up to 2021 was estimated using the Kaplan–Meier method. We calculated this probability according to the mode of conception of the first birth, and the analysis was also performed in strata of maternal age at first birth. Cox proportional hazards models were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between mode of conception at first live birth and the probability of having a second live birth. Mothers were right‐censored if they moved out of the region, died, or did not have a second live birth by the end of follow‐up.
Results
We identified 431 333 women who had their first live birth after a natural conception and 16 837 who had their first live birth after MAR. The probability of having a second live birth was 58.6% and 32.1%, respectively in the two groups (HR = 0.68, 95% CI: 0.66–0.70). Considering solely women who naturally conceived their first live birth, the probability to have a second child with MAR was 1.1% and to have a second child naturally 59.3%. The corresponding values were 11.5% and 25.2% in the group of women with a first MAR‐mediated live birth.
Conclusions
In our cohort, one woman out of 10 having a first MAR‐mediated live birth underwent MAR programs again. Considering women who had a first natural live birth, this proportion was drastically reduced. In the field of MAR, more attention should be given to the capacity of a couple to achieve the number of desired children.
... Approximately 17% of women experience spontaneous pregnancies after successful ART treatment, while around 24% of women have spontaneous pregnancies after failed ART treatment [80][81][82][83][84]. This suggests that at least some women with a history of implantation failure may not have an irreversible defect. ...
To improve current infertility treatments, it is important to understand the pathophysiology of implantation failure. However, many molecules are involved in the normal biological process of implantation and the roles of each molecule and the molecular mechanism are not fully understood. This review highlights the hemagglutinating virus of Japan (HVJ; Sendai virus) envelope (HVJ-E) vector, which uses inactivated viral particles as a local and transient gene transfer system to the murine uterus during the implantation period in order to investigate the molecular mechanism of implantation. In vivo screening in mice using the HVJ-E vector system suggests that signal transducer and activator of transcription-3 (Stat-3) could be a diagnostic and therapeutic target for women with a history of implantation failure. The HVJ-E vector system hardly induces complete defects in genes; however, it not only suppresses but also transiently overexpresses some genes in the murine uterus. These features may be useful in investigating the pathophysiology of implantation failure in women.
... La plupart des conceptions spontanée survient dans les deux à trois ans qui suivent la tentative de FIV (5,12). En effet, l'étude allemande de Ludwig et al a retrouvé un taux de conception spontanée dans les deux ans de la réussite d'ICSI (13). Par contre, De la Rochebrochard et al en 2012 ont identifié un intervalle de 3 à 4 ans (33 mois) alors que Cahill et al en 2005 ont retrouvé eux, un délai moyen de 7 mois (6,1). ...
Introduction. Une grossesse spontanée survenant après une prise en charge en Assistance Médicale
à la procréation est un évènement rare. Méthodologie. Nous rapportons une étude descriptive
transversale rétrospective réalisée au Centre Hospitalier de Recherche et d’Application en Chirurgie
Endoscopique et Reproduction Humaine Paul et Chantal Biya (CHRACERH) entre mai 2016 et juillet
2021 soit une période de 5 ans 3 mois. Nous avons analysé les dossiers d’infertilité et obstétricaux.
Les facteurs d’intérêt étaient sociodémographiques, reproductifs, thérapeutiques et évolutifs de ces
grossesses spontanées survenant après au moins une tentative de Fécondation in vitro (FIV).
Résultats. Sur un total de 789 patientes ayant été prises en charge par stimulation ovarienne, nous
avons observé 11 grossesses spontanées après FIV soit 1,39%. Au sein des couples, l’âge moyen était
respectivement de 33,27 ans chez les femmes et 39,45 ans chez les hommes. La durée moyenne de
l’infertilité était de 4,36 ans. L’infertilité était féminine chez 6/11 couples soit 55%, masculine chez
3/11 couples soit 27,3% et mixte chez 2 couples soit 18,2%. Une obstruction tubaire était présente
chez 4/11 patientes soit 36,4%. Trois patientes sur 11 avaient un SOPK soit 27,3%. Parmi les patientes
9/11 avaient eu un échec préalable de la FIV. Le délai moyen de survenue de grossesse était de 17,
11mois. Dix grossesses sur 11 ont été menées jusqu’à terme. Conclusion. Au CHRACERH, la
grossesse spontanée après au moins une tentative de la FIV est rare ; elle survient chez les couples
avec femme jeune ayant une infertilité d’origine féminine, mais parfois des anomalies spermatiques
sévères sont présentes. Le délai entre la tentative de FIV et la conception est court et l’évolution de la
grossesse est en règle bonne.
Introduction
It is thought that both individuals are affected psychologically and sexually in couples experiencing abortion. In addition to the stress caused by infertility, sexual life may also be negatively affected in couples who experience psychogenic wear, such as abortion and curettage. The aim of this study is to evaluate male sexual functions in infertile couples with a history of abortion and male infertility component.
Methods
Five hundred forty-seven male patients’ data were evaluated retrospectively. Group 1 was the included the males of the couples without abortion history and the rest with abortion history was group 2. In addition to demographic data, abortion history, libido level, presence of morning erection and intercourse frequency were evaluated. Hormone levels of all patients were evaluated. After that we created sub-group 1 and sub-group 2 from these groups, respectively, due to whether the patients fulfilled the international index of erectile function (IIEF), Beck anxiety inventory (BAI) and Beck depression inventory (BDI).
Results
There were not any significant differences between the groups regarding psychiatric scale scores, hormone levels, libido, intercourse frequency and IIEF scores. Only orgasmic dysfunction was significant in the males of the couples with abortion history.
Conclusion
Man is not affected from abortion process in which woman get involved. Men only have orgasmic dysfunction when there is one or more abortion history in couples.
Infertility is a significant health problem and assisted reproductive technologies to treat infertility. Despite all efforts, the success rate of these methods is still low. Also, each of these methods has side effects and costs. Therefore, accurate prediction of treatment success rate is a clinical challenge. This retrospective study aimed to internally validate and compare various machine learning models for predicting the clinical pregnancy rate (CPR) of infertility treatment. For this purpose, data from 1931 patients consisting of in vitro fertilization (IVF) or intra cytoplasmic sperm injection (ICSI) (733) and intra uterine insemination (IUI) (1196) treatments were included. Also, no egg or sperm donation data were used. The performance of machine learning algorithms to predict clinical pregnancy were expressed in terms of accuracy, recall, F-score, positive predictive value (PPV), brier score (BS), Matthew correlation coefficient (MCC), and receiver operating characteristic. The significance of the features with CPR and AUCs was evaluated by Student's t test and DeLong’s algorithm. Random forest (RF) model had the highest accuracy in the IVF/ICSI treatment. The sensitivity, F1 score, PPV, and MCC of the RF model were 0.76, 0.73, 0.80, and 0.5, respectively. These values for IUI treatment were 0.84, 0.80, 0.82, and 0.34, respectively. The BS was 0.13 and 0.15 for IVF/ICS and IUI, respectively. In addition, the estimated AUCs of the RF model for IVF/ICS and IUI were 0.73 and 0.7, respectively. Some essential features were obtained based on RF ranking for the two datasets, including age, follicle stimulation hormone, endometrial thickness, and infertility duration. The results showed a strong relationship between clinical pregnancy and a woman's age. Also, endometrial thickness and the number of follicles decreased with increasing female age in both treatments.
To determine the frequency of live births following spontaneous pregnancy (BSP) and to examine their associated factors among couples who have unsuccessfully or successfully experienced fertility treatments.
Retrospective cohort.
Eight IVF centers.
A total of 2,134 couples who began IVF treatment in the centers in 2000-2002 and were followed up by a postal questionnaire sent 7-9 years after they started treatment in the inclusion center.
None.
Rates of BSP and factors associated with BSP. Univariate and multivariate analyses were conducted using logistic regression.
The BSP rate was 17% (218/1,320) among couples who had previously had a child through medical treatment and 24% (193/814) among couples who had remained childless after treatment. In both groups, the probability of BSP was higher among younger women and increased with a smaller number of IVF attempts. Probability was also higher when the cause of infertility was unexplained.
Our results should give hope to couples who have been unsuccessfully treated by IVF, especially young couples with unexplained infertility. Nonetheless, it should be remembered that the BSP rates are cumulative rates observed over a long period of time and that these couples have a very low monthly probability of conceiving.
Purpose of review:
The aim of this review is to examine the medical literature published in 2011-2012 on reports of sexual disorders in infertile couples.
Recent findings:
Ten articles on sexual disorders in infertile couples were traced. The results were very inconsistent, and the response rates of the studies were low.
Summary:
Divergent samples and assessment instruments, together with low or unknown responder rates, mean that there are no valid findings about sexual disorders in infertile couples. Further research will have to find an appropriate way of addressing these methodological shortcomings. Recent studies on infertile men and their sexuality are definitely underrepresented.
Introduction. Sexuality and the desire for a child are strongly interconnected. The same applies to sexual disorders and the unfulfilled desire for a child.Aim. This article indicates the relations between sexual disorders and the unfulfilled desire for a child and outlines the potential effects of diagnostics and treatment in the context of reproductive medicine on the couples' sexuality.Methods. A research drive was undertaken in well-established medical and psychological literature database with the keywords “infertile” or “infertility” and “sexual dysfunction” or “sexual satisfaction.”Results. Sexual dysfunctions (of organic or of psychic origin) as a cause of involuntary childlessness are relatively unusual. By contrast (temporary) sexual disorders resulting from diagnosis and medical therapy are common in couples with fertility problems, with women more frequently affected than men.Conclusions. Counseling for couples with the unfulfilled desire for a child should invariably include explicit and appropriately tactful reference to sexuality and (functional) sexual disorders by the therapist. Wischmann TH. Sexual disorders in infertile couples. J Sex Med 2010;7:1868–1876.
Objective:
To determine the incidence of spontaneous pregnancy in women who were not actively undergoing therapy after a successful attempt at IVF/intracytoplasmic sperm injection and to characterize its pattern of occurrence.
Design:
Retrospective postal questionnaire.
Setting:
An assisted reproduction unit at a university-based teaching hospital.
Patient(s):
Five hundred thirteen replies were received from 530 questionnaires mailed.
Intervention(s):
None.
Main outcome measure(s):
Spontaneous pregnancy. Women who did and did not conceive spontaneously after successful IVF treatment were compared in terms of their age, duration of infertility, previous reproductive history, and indication for treatment at the time of assisted reproduction.
Result(s):
The rate of spontaneous conception among the survey respondents was 20.7%. Younger women (</=34 years of age) had a higher rate of spontaneous conception, as did those with a shorter duration of infertility. Women with unexplained infertility and endometriosis also were more likely to conceive. Few of those who had undergone intracytoplasmic sperm injection conceived, whereas 21.6% of those whose partners had had sperm quality sufficient for IVF later conceived spontaneously.
Conclusion(s):
The chances of spontaneous conception after successful ART therapy are significant in some groups of patients. This has implications for the practice of assisted reproduction and the obstetric care of patients who conceive with treatment. Contraceptive advice may need to be provided to couples who undergo IVF/intracytoplasmic sperm injection.
Infertility has been associated with anxiety, stress, and sexual problems in both men and women.
To assess quality of life, sexual health, and depression in the female partner of infertile couples.
Couples presenting for the evaluation of infertility at two tertiary care medical centers were invited to participate in a survey study.
Female partners completed the Female Sexual Function Index (FSFI) and a modified Self-Esteem and Relationship (SEAR) Questionnaire. Male partners completed the SEAR and the International Index of Erectile Function (IIEF). Both partners completed the Center for Epidemiological Studies Depression Scale (CES-D) for depression and the Short Form-36 (SF-36) for general quality of life. Demographic, fertility, and comorbidity information was recorded.
One hundred and twenty-one couples constitute the study population. Mean female and male age was 32 +/- 5 and 35 +/- 7 years, respectively. Most (92%) couples were married. Mean duration of relationship and marriage were 6.4 +/- 3.9 and 3.8 +/- 3.2 years, respectively. Mean duration of attempted conception was 24 +/- 24 months. On CES-D, 19% of women had moderate and 13% had severe depression. Women reported significantly worse SF-36 Mental Health subscale scores (mean = 47.8, P < 0.05) compared with normative values. The mean total FSFI score was 28 +/- 7 (maximum score of 36), with 26% of the women scoring below 26.55, an established cut-off for high risk of female sexual dysfunction. FSFI scores had a modest positive correlation with male IIEF scores (r = 0.37, P < 0.01), and there was a trend toward a negative correlation with female CES-D scores (r = -0.16, P < 0.06). These relationships were maintained on multivariate analysis.
Depression and sexual dysfunction are prevalent in female partners of infertile couples. Female sexual function is positively correlated with male partner sexual function in this population.
|| Click here to download free Android application for this journal
- T H Wischmann
Wischmann TH. Sexual disorders in infertile couples. J Sex
[Downloaded free from http://www.najms.org on Saturday, March 23, 2013, IP: 151.46.144.137] || Click here to download free Android application for this journal
Med 2010;7:1868-76.
Spontaneous pregnancies among couples previously treated by in vitro fertilization
- Daifi Group
DAIFI Group. Spontaneous pregnancies among couples
previously treated by in vitro fertilization. Fertil Steril
2012;98:63-8.