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"Infertility"
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The association of female and male infertility with telomere length (Review)
Telomere length (TL) has long been associated with aging, as telomeres serve as protective caps of chromosomes, and are thus deeply involved in the preservation of genome integrity and are vital to cellular functions. Traditionally, a strong link connects aging and infertility in both sexes, with an earlier onset in females. Over the past decade, telomeres have attracted increasing attention due to the role they play in fertility. In this review, we investigated the potential positive or negative association between relative TL and different factors of female and male infertility. A systematic search of the PubMed database was conducted. Out of the 206 studies identified, 45 were reviewed as they fulfilled the criteria of validity and relevance. Following an analysis and a comparison of the study outcomes, several clear trends were observed. The majority of female infertility factors were associated with a shorter TL, with the exception of endometriosis, premature ovarian failure and clear cell carcinoma that were associated with a longer TL and polycystic ovary syndrome (PCOS), which revealed conflicting results among several studies, leading to ambiguous conclusions. Male infertility factors were associated with a shorter TL. Although this review can provide an outline of general trends in the association of TL with infertility factors, further epidemiological and original research studies are required to focus on investigating the basis of these varying lengths of telomeres.
Journal Article
Evaluation and Treatment of Infertility
Infertility is defined as the inability to achieve pregnancy after one year of regular, unprotected intercourse. Evaluation may be initiated sooner in patients who have risk factors for infertility or if the female partner is older than 35 years. Causes of infertility include male factors, ovulatory dysfunction, uterine abnormalities, tubal obstruction, peritoneal factors, or cervical factors. A history and physical examination can help direct the evaluation. Men should undergo evaluation with a semen analysis. Abnormalities of sperm may be treated with gonadotropin therapy, intrauterine insemination, or in vitro fertilization. Ovulation should be documented by serum progesterone level measurement at cycle day 21. Evaluation of the uterus and fallopian tubes can be performed by hysterosalpingography in women with no risk of obstruction. For patients with a history of endometriosis, pelvic infections, or ectopic pregnancy, evaluation with hysteroscopy or laparoscopy is recommended. Women with anovulation may be treated in the primary care setting with clomiphene to induce ovulation. Treatment of tubal obstruction generally requires referral for subspecialty care. Unexplained infertility in women or men may be managed with another year of unprotected intercourse, or may proceed to assisted reproductive technologies, such as intrauterine insemination or in vitro fertilization.
Journal Article
Investigation and management of subfertility
Subfertility affects one in seven couples and is defined as the inability to conceive after 1 year of regular unprotected intercourse. This article describes the initial clinical evaluation and investigation to guide diagnosis and management. The primary assessment of subfertility is to establish the presence of ovulation, normal uterine cavity and patent fallopian tubes in women, and normal semen parameters in men. Ovulation is supported by a history of regular menstrual cycles (21–35 days) and confirmed by a serum progesterone >30 nmol/L during the luteal phase of the menstrual cycle. Common causes of anovulation include polycystic ovary syndrome (PCOS), hypothalamic amenorrhoea (HA) and premature ovarian insufficiency (POI). Tubal patency is assessed by hysterosalpingography, hystero-contrast sonography, or more invasively by laparoscopy and dye test. The presence of clinical or biochemical hyperandrogenism, serum gonadotrophins (luteinising hormone/follicle stimulating hormone) / oestradiol, pelvic ultrasound to assess ovarian morphology / antral follicle count, can help establish the cause of anovulation. Ovulation can be restored in women with PCOS using letrozole (an aromatase inhibitor), clomifene citrate (an oestrogen antagonist) or exogenous gonadotrophin administration. If available, pulsatile gonadotrophin releasing hormone therapy is the preferred option for restoring ovulation in HA. Spermatogenesis can be induced in men with hypogonadotrophic hypogonadism with exogenous gonadotrophins. Unexplained subfertility can be treated with in vitro fertilisation after 2 years of trying to conceive. Involuntary childlessness is associated with significant psychological morbidity; hence, expert assessment and prompt treatment are necessary to support such couples.
Journal Article
P1.54 Development and evaluation of in- house multiplex real-time pcr for detection of neisseria gonorrhoeae, chlamydia trachomatis and mycoplasma genitalium infection in infertility patients
Introduction: C.trachomatis, N.gonorrhoeae and M.genitalium are important cause of infertility but detection is usually by PCR which has to be performed indvidually for each pathogen.The aim of this study was to develop In house multiplex Real time PCR assay for simultaneous detection of all these pathogens in single run and will also help in detecting co infecion if present thus saving cost and time in cases of infertility.MethodsThe Taqman probe based multiplex qPCR for detection of C.trachomatis, N.gonorrhoeae and M.genitalium was developed using different primers and probes. Analytical sensitivity of multiplex qPCR was determined using pGEMT Easy vector cloned with target genes. The detection limit for each organism was determined using 10 fold dilutions of targets. The multiplex qPCR was evaluated in 248 clinical samples i.e 98 infertile (endometrial biopsy and endocervical swabs) and 150 healthy controls (endocervical swabs). The sensitivity, specificity, positive and negative predictive value (PPV and NPV) of multiplex qPCR was calculated.ResultsThe sensitivity, specificity, PPV and NPV of new multiplex qPCR was 98.80%, 100%, 100% and 99.69% respectively compared to uniplex qPCR. The discordant result of multiplex qPCR was detected in 1 sample. Developed multiplex qPCR showed 100% sensitivity, specificity, PPV and NPV for C.trachomatis and N.gonorrhoeae respectively. The sensitivity, specificity, PPV and NPV for M.genitalium were 97.78%, 100%, 100% and 99.72% respectively. No cross-reactions were detected between target organisms or with related species.ConclusionsMultiplex In house qPCR in this study has shown high sensitivity and specificity for detection of C.trachomatis, N.gonorrhoeae and M.genitalium in infertility patients which facilitate the opportunity to be used as a rapid diagnostic tool and for initiation of early treatment in resource poor settings where syndromic approach is being followed. This assay needs to be performed on the larger sample size and using different specimens prior to large-scale screening.
Journal Article
Barren women : religion and medicine in the medieval Middle East
\"Barren Women is the first scholarly book to explore the ramifications of being infertile in the medieval Arab-Islamic world. Through an examination of legal texts, medical treatises, and works of religious preaching, Sara Verskin illuminates how attitudes toward mixed-gender interactions; legal theories pertaining to marriage, divorce, and inheritance; and scientific theories of reproduction contoured the intellectual and social landscape infertile women had to navigate. In so doing, she highlights underappreciated vulnerabilities and opportunities for women's autonomy within the system of Islamic family law, and explores the diverse marketplace of medical ideas in the medieval world and the perceived connection between women's health practices and religious heterodoxy. Featuring copious translations of primary sources and minimal theoretical jargon, Barren Women provides a multidimensional perspective on the experience of infertility, while also enhancing our understanding of institutions and modes of thought which played significant roles in shaping women?s lives more broadly. This monograph has been awarded the annual BRAIS ? De Gruyter Prize in the Study of Islam and the Muslim World.\"-- Back cover.
Book
The new arab man
Middle Eastern Muslim men have been widely vilified as terrorists, religious zealots, and brutal oppressors of women.The New Arab Manchallenges these stereotypes with the stories of ordinary Middle Eastern men as they struggle to overcome infertility and childlessness through assisted reproduction.
Drawing on two decades of ethnographic research across the Middle East with hundreds of men from a variety of social and religious backgrounds, Marcia Inhorn shows how the new Arab man is self-consciously rethinking the patriarchal masculinity of his forefathers and unseating received wisdoms. This is especially true in childless Middle Eastern marriages where, contrary to popular belief, infertility is more common among men than women. Inhorn captures the marital, moral, and material commitments of couples undergoing assisted reproduction, revealing how new technologies are transforming their lives and religious sensibilities. And she looks at the changing manhood of husbands who undertake transnational \"egg quests\"--set against the backdrop of war and economic uncertainty--out of devotion to the infertile wives they love.
Trenchant and emotionally gripping,The New Arab Mantraces the emergence of new masculinities in the Middle East in the era of biotechnology.
eBook