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Advances in Medical Sciences Mar 2020Infertility and subfertility affect a significant part of the population. Among various definitions of this pathology, the most common one is provided by the World... (Review)
Review
Infertility and subfertility affect a significant part of the population. Among various definitions of this pathology, the most common one is provided by the World Health Organisation; it says that infertility is 'a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourses'. The global prevalence of infertility is about 50-70 million couples. Since the process of human reproduction involves a large number of factors, a broad spectrum of infertility tests might be applied. Some of the tests focus directly on the pregnancy, some are only partially effective, whereas others should not be recommended for infertile couples. The aim of this review is to present a critical evaluation of the infertility diagnostic process and to discuss the recommendations for its most effective treatment.
Topics: Female; Humans; Infertility, Female; Infertility, Male; Male; Pregnancy
PubMed: 31923772
DOI: 10.1016/j.advms.2019.12.008 -
Journal of Assisted Reproduction and... Aug 2010Endometriosis is a debilitating condition characterized by high recurrence rates. The etiology and pathogenesis remain unclear. Typically, endometriosis causes pain and... (Review)
Review
Endometriosis is a debilitating condition characterized by high recurrence rates. The etiology and pathogenesis remain unclear. Typically, endometriosis causes pain and infertility, although 20-25% of patients are asymptomatic. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue. Current therapeutic approaches are far from being curative; they focus on managing the clinical symptoms of the disease rather than fighting the disease. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. The benefits of these treatments have not been entirely demonstrated, particularly in terms of expectations that women hold for their own lives. Although theoretically advantageous, there is no evidence that a combination medical-surgical treatment significantly enhances fertility, and it may unnecessarily delay further fertility therapy. Randomized controlled trials are required to demonstrate the efficacy of different treatments.
Topics: Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female
PubMed: 20574791
DOI: 10.1007/s10815-010-9436-1 -
Obstetrics and Gynecology Clinics of... Dec 2012Endometriois has been associated with infertility; however, the mechanisms by which it affects fertility are still not fully understood. This article reviews the... (Review)
Review
Endometriois has been associated with infertility; however, the mechanisms by which it affects fertility are still not fully understood. This article reviews the proposed mechanisms of endometriosis pathogenesis, its effects on fertility, and treatments of endometriosis-associated infertility. Theories on the cause of the disease include retrograde menstruation, coelomic metaplasia, altered immunity, stem cells, and genetics. Endometriosis affects gametes and embryos, the fallopian tubes and embryo transport, and the eutopic endometrium; these abnormalities likely all impact fertility. Current treatment options of endometriosis-associated infertility include surgery, superovulation with intrauterine insemination, and in vitro fertilization. We also discuss potential future treatments for endometriosis-related infertility.
Topics: Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female; Insemination, Artificial; Pelvic Pain; Precision Medicine; Pregnancy; Reproductive Techniques, Assisted; Superovulation
PubMed: 23182559
DOI: 10.1016/j.ogc.2012.10.002 -
Fertility and Sterility Nov 2021Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all the relevant factors with an... (Review)
Review
Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all the relevant factors with an initial emphasis on the least invasive methods for detecting the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of in fertile women, and it replaces the document of the same name, last published in 2015 (Fertil Steril 2015;103:e44-50). This guidance is intended for any provider evaluating women for infertility.
Topics: Cervix Uteri; Fallopian Tubes; Female; Fertility; Humans; Infertility, Female; Ovarian Reserve; Ovary; Ovulation; Predictive Value of Tests; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Risk Factors; Treatment Outcome
PubMed: 34607703
DOI: 10.1016/j.fertnstert.2021.08.038 -
Fertility and Sterility Jun 2019This issue's of Views and Reviews considers the origins of lifetime health established around the time of conception in some prevalent conditions related to infertility....
This issue's of Views and Reviews considers the origins of lifetime health established around the time of conception in some prevalent conditions related to infertility. Reviews will look at the effects of advanced paternal and maternal age, the influence of the severe sperm factor, and the impact of some endocrinopathies commonly seen in infertile couples, especially women, like polycystic ovary syndrome, under- and overweight, diabetes, and thyroid disorders. The aim of this Views and Reviews section is to summarize current evidence on the consequences of these conditions on postnatal health to encourage research in this field and the need to develop strategies and preventative measures to reduce or prevent unfavorable outcomes in future generations.
Topics: Adolescent; Child; Child Health; Child of Impaired Parents; Child, Preschool; Disease Susceptibility; Female; Fertility; Health Status; Humans; Infant; Infant, Newborn; Infertility, Female; Infertility, Male; Male; Maternal Age; Maternal Health; Paternal Age; Reproductive Techniques, Assisted; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 31155112
DOI: 10.1016/j.fertnstert.2019.04.043 -
Frontiers in Endocrinology 2022The regulation of the female reproductive system is one of the most relevant actions of thyroid hormones. Adequate thyroid hormones production is essential for normal... (Review)
Review
The regulation of the female reproductive system is one of the most relevant actions of thyroid hormones. Adequate thyroid hormones production is essential for normal menstrual function and fertility as well as for the successful maintenance of pregnancy. The relationship between reproductive failure and thyroid disorders is particularly relevant and attracts attention worldwide. Thyroid autoimmunity (TAI), defined by the presence of circulating antithyroid antibodies targeting thyroid peroxidase (TPOAb) and thyroglobulin (TgAb), is prevalent among women of reproductive age and is the most frequent cause of thyroid dysfunction. Several studies addressed the association between TAI, thyroid function, and fertility as well as pregnancy outcome after spontaneous or assisted conception. Infertility, miscarriages, and fetal-maternal complications are described in overt autoimmune hypothyroidism. More debatable is the role of mild thyroid dysfunction, mainly subclinical hypothyroidism (SCH), and TAI in the absence of thyroid dysfunction in infertility and reproductive outcome. Assisted reproductive technology (ART) has become an integral element of care for infertility. Women with TAI undergoing ART are of particular interest since they carry a higher risk of developing hypothyroidism after the ovarian stimulation but whether TAI, in absence of thyroid dysfunction, adversely affects ART outcome is still controversial. Likewise, the role of levothyroxine (LT4) in improving fertility and the success of ART in euthyroid women with TAI is unclear. This review discusses the role of TAI, in the absence of thyroid dysfunction, in infertility and in ART outcome.
Topics: Autoimmunity; Female; Humans; Hypothyroidism; Infertility, Female; Pregnancy; Reproductive Techniques, Assisted; Thyroid Diseases; Thyroxine
PubMed: 35721757
DOI: 10.3389/fendo.2022.768363 -
Obstetrical & Gynecological Survey Sep 2016Until recently, adenomyosis has been associated with multiparity, not impaired fertility. Currently, adenomyosis is diagnosed with increasing frequency in infertile... (Review)
Review
Until recently, adenomyosis has been associated with multiparity, not impaired fertility. Currently, adenomyosis is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy until their late 30s or early 40s. Although an association between adenomyosis and infertility has not been fully established, based on the available information, recent studies suggested that adenomyosis has a negative impact on female fertility. Several uncontrolled studies with limited data also suggested that treatment of adenomyosis may improve fertility. This article discusses (i) the hypothesis and epidemiology of adenomyosis, (ii) diagnostic techniques, (iii) clinical evidence of correlation between adenomyosis and infertility, (iv) proposed mechanism of infertility in women with adenomyosis, (v) different treatment strategies and reproductive outcomes, and (vi) assisted reproductive technology outcome in women with adenomyosis.
Topics: Adenomyosis; Diagnostic Imaging; Disease Management; Female; Humans; Infertility, Female; Outcome and Process Assessment, Health Care; Pregnancy; Reproductive Health; Reproductive Techniques, Assisted; Risk Factors
PubMed: 27640610
DOI: 10.1097/OGX.0000000000000346 -
Fertility and Sterility Apr 2022This month's Views and Reviews provides insights into one of the most difficult clinical care populations: individuals with low ovarian reserve and limited response to... (Review)
Review
This month's Views and Reviews provides insights into one of the most difficult clinical care populations: individuals with low ovarian reserve and limited response to stimulation. After a discussion of available definitions of "poor ovarian response" and how new definitions are improving the characterization of the individual patient and our ability to offer prognosis, we review alternative strategies for management. The first chapter presents options for pretreatment, including hormonal manipulation and nutriceuticals. The second chapter discusses the potential benefit of more gentle stimulation in this population. Subsequent chapters address adjuvants during stimulation, alterations of final oocyte maturation and processes in the laboratory, and finally when and how to stop treatment.
Topics: Female; Humans; Infertility, Female; Ovarian Diseases; Ovarian Reserve; Ovulation Induction
PubMed: 35367010
DOI: 10.1016/j.fertnstert.2022.02.026 -
Fertility and Sterility Mar 2014The fecundity of women decreases gradually but significantly beginning approximately at age 32 years and decreases more rapidly after age 37 years. Education and... (Review)
Review
The fecundity of women decreases gradually but significantly beginning approximately at age 32 years and decreases more rapidly after age 37 years. Education and enhanced awareness of the effect of age on fertility are essential in counseling the patient who desires pregnancy. Given the anticipated age-related decline in fertility, the increased incidence of disorders that impair fertility, and the higher risk of pregnancy loss, women older than 35 years should receive an expedited evaluation and undergo treatment after 6 months of failed attempts to conceive or earlier, if clinically indicated. In women older than 40 years, more immediate evaluation and treatment are warranted.
Topics: Adult; Age Factors; Aging; Female; Fertility; Humans; Infertility, Female; Middle Aged; Patient Education as Topic; Pregnancy; Reproductive Techniques, Assisted
PubMed: 24559617
DOI: 10.1016/j.fertnstert.2013.12.032 -
Frontiers in Endocrinology 2020This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female... (Review)
Review
CAPSULE
This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems.
BACKGROUND
Infertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply.
OBJECTIVE
The aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems.
METHODS
Prominent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called "InfertilItaly group", used available evidence to develop this expert position.
OUTCOMES
Starting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures.
CONCLUSIONS
This expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.
Topics: Expert Testimony; Female; Humans; Infertility, Female; Infertility, Male; Male; Practice Guidelines as Topic; Risk Factors
PubMed: 33542705
DOI: 10.3389/fendo.2020.591837