Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
19,982
result(s) for
"Infertility, Female"
Sort by:
Vitamin D Deficiency Is Associated With Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility
Abstract
Context
The impact of vitamin D deficiency on the success of ovarian stimulation according to underlying infertility diagnosis has not been investigated.
Objective
To evaluate the relationship between vitamin D deficiency and reproductive outcomes after ovarian stimulation in women with either polycystic ovary syndrome (PCOS) or unexplained infertility.
Design
Retrospective cohort study.
Setting
Analysis of randomized controlled trial (RCT) data.
Participants
Participants from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) RCT (n = 607); participants from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) RCT of unexplained infertility (n = 647).
Interventions
Serum 25(OH)D levels measured in banked sera.
Main Outcome Measures
Primary: live birth; secondary: ovulation (PPCOS II), pregnancy, and early pregnancy loss.
Results
In PPCOS II, subjects with vitamin D deficiency [25(OH)D < 20 ng/mL or 50 nmol/L] were less likely to ovulate (adjusted OR, 0.82; 95% CI, 0.68 to 0.99; P = 0.04) and experienced a 40% lower chance of live birth (adjusted OR, 0.63; 95% CI, 0.41 to 0.98; P = 0.04) than those not deficient. In AMIGOS, no significant association between vitamin D deficiency and live birth was noted. In pregnant subjects from both studies, vitamin D deficiency was associated with elevated risk of early pregnancy loss (OR, 1.6; 95% CI, 1.0 to 2.6; P = 0.05).
Conclusions
In this investigation of women pursuing ovarian stimulation, the association between vitamin D deficiency and diminished live birth relied on carrying the diagnosis of PCOS and was not observed in unexplained infertility. Given the generally modest success of ovarian stimulation, addressing vitamin D deficiency may prove an important treatment adjunct for many infertile women.
In women with infertility undergoing ovarian stimulation, pretreatment vitamin D deficiency is associated with diminished live birth rates in those with PCOS but not those with unexplained infertility.
Journal Article
Growth hormone alleviates oxidative stress and improves the IVF outcomes of poor ovarian responders: a randomized controlled trial
Background
Oxidative stress (OS), defined as an imbalance between excessive reactive oxygen species (ROS) and/or reactive nitrogen species (RNS) production and antioxidant insufficiency, has been suggested to be involved in the pathogenesis of poor ovarian response (POR). Growth hormone (GH) can reduce OS in some cell types. This study investigated whether GH can improve OS and the in vitro fertilization and embryo transfer (IVF-ET) outcomes of poor ovarian responders.
Methods
This study enrolled 105 patients with POR and 58 patients without POR (controls) who were diagnosed according to the Bologna criteria and underwent conventional IVF-ET. Poor ovarian responders were randomly assigned to two groups: the POR-GH group, which received pretreatment with GH 4 IU/d on day 2 of the previous menstrual cycle before IVF until the trigger day, and the POR-C group, which received no pretreatment. OS markers in follicular fluid (FF), ROS levels in granulosa cells (GCs), and the IVF outcomes of the groups were compared.
Results
Endometrial thickness on trigger day, the number of cleaved embryos, the number of higher-quality embryos, and the rates of embryo formation, higher-quality embryo formation, implantation and clinical pregnancy were significantly increased in the POR-GH group compared with the POR-C group (
P
< 0.05). Moreover, compared to those in the non-POR group, FF malondialdehyde (MDA), total oxidant status (TOS), oxidative stress index (OSI) and ROS levels in GCs were significantly higher, whereas superoxide dismutase (SOD) and the total antioxidant capacity (TAC) were significantly lower in the POR-C group (
P
< 0.05). Furthermore, compared with those in the POR-C group, the FF TAC was significantly increased in the POR-GH group, and TOS, OSI and intracellular ROS levels were significantly reduced (
P
< 0.05).
Conclusions
Pretreatment with GH alleviates OS and improves oocyte quality and IVF outcomes of poor ovarian responders.
Trial registration
Chinese Clinical Trial Registry.
ChiCTR1900021269
. Registered 8 February 2019,
http://www.chictr.org.cn/edit.aspx?pid=35837&htm=4
.
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
Sleep Habits of Women With Infertility
Abstract
Context
Sleep plays important roles in metabolic and reproductive function, and polycystic ovary syndrome (PCOS) is associated with sleep disturbances, including increased prevalence of obstructive sleep apnea.
Objective
We sought to evaluate sleep parameters in infertile women with PCOS compared with women with unexplained infertility (UI) and identify risk factors for disturbed sleep.
Methods
At private and academic ambulatory gynecology and infertility practices, we evaluated a prospective cohort of women diagnosed with PCOS or UI from 2 randomized clinical trials. We included 1603 infertile women enrolled in 2 concurrent randomized clinical trials. The main outcome measures were self-reported sleep measures.
Results
Sleep duration <6 hours (6.1% vs 2.7%; P < .001), habitual snoring (37.8% vs 19.0%; P < .001), and clinical sleepiness (12.0% vs 8.6%; P < .026) were more common in women with PCOS than those with UI. After adjusting for covariates, PCOS and elevated fasting insulin were associated (P = .010) with clinical symptoms of obstructive sleep apnea (OSA) diagnosis, whereas PCOS, elevated insulin (P = .003), WC >88 cm (P = .003), and current smoking (P = .012) were associated with habitual snoring. Clinical depression score (P < .001) and PCOS diagnosis (P = .002) were associated with perceived daytime sleepiness. Short sleep duration and clinical symptoms of OSA were not associated with conception and live birth rates.
Conclusion
Infertile women with PCOS more commonly report sleep disturbances than those with UI. Markers of insulin resistance are associated with previous diagnosis of OSA, habitual snoring, and short sleep duration. The presence of clinical symptoms of OSA or short sleep duration does not affect fertility treatment response.
Journal Article
Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial
Women with obesity and infertility are counseled to lose weight prior to conception and infertility treatment to improve pregnancy rates and birth outcomes, although confirmatory evidence from randomized trials is lacking. We assessed whether a preconception intensive lifestyle intervention with acute weight loss is superior to a weight neutral intervention at achieving a healthy live birth.
In this open-label, randomized controlled study (FIT-PLESE), 379 women with obesity (BMI ≥ 30 kg/m2) and unexplained infertility were randomly assigned in a 1:1 ratio to 2 preconception lifestyle modification groups lasting 16 weeks, between July 2015 and July 2018 (final follow-up September 2019) followed by infertility therapy. The primary outcome was the healthy live birth (term infant of normal weight without major anomalies) incidence. This was conducted at 9 academic health centers across the United States. The intensive group underwent increased physical activity and weight loss (target 7%) through meal replacements and medication (Orlistat) compared to a standard group with increased physical activity alone without weight loss. This was followed by standardized empiric infertility treatment consisting of 3 cycles of ovarian stimulation/intrauterine insemination. Outcomes of any resulting pregnancy were tracked. Among 191 women randomized to standard lifestyle group, 40 dropped out of the study before conception; among 188 women randomized to intensive lifestyle group, 31 dropped out of the study before conception. All the randomized women were included in the intent-to-treat analysis for primary outcome of a healthy live birth. There were no significant differences in the incidence of healthy live births [standard 29/191(15.2%), intensive 23/188(12.2%), rate ratio 0.81 (0.48 to 1.34), P = 0.40]. Intensive had significant weight loss compared to standard (-6.6 ± 5.4% versus -0.3 ± 3.2%, P < 0.001). There were improvements in metabolic health, including a marked decrease in incidence of the metabolic syndrome (baseline to 16 weeks: standard: 53.6% to 49.4%, intensive 52.8% to 32.2%, P = 0.003). Gastrointestinal side effects were significantly more common in intensive. There was a higher, but nonsignificant, first trimester pregnancy loss in the intensive group (33.3% versus 23.7% in standard, 95% rate ratio 1.40, 95% confidence interval [CI]: 0.79 to 2.50). The main limitations of the study are the limited power of the study to detect rare complications and the design difficulty in finding an adequate time matched control intervention, as the standard exercise intervention may have potentially been helpful or harmful.
A preconception intensive lifestyle intervention for weight loss did not improve fertility or birth outcomes compared to an exercise intervention without targeted weight loss. Improvement in metabolic health may not translate into improved female fecundity.
ClinicalTrials.gov NCT02432209.
Journal Article
Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome
This double-blind, multicenter, randomized trial showed that letrozole, as compared with clomiphene, was associated with higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome.
The polycystic ovary syndrome, which is diagnosed on the basis of hyperandrogenism, oligo-ovulation with associated oligomenorrhea, and polycystic ovaries on ultrasonography, affects 5 to 10% of reproductive-age women and is the most common cause of anovulatory infertility.
1
Although the syndrome is a complex reproductive–metabolic disorder, the hypothalamic–pituitary axis has been the target of first-line ovulation-induction therapy. Clomiphene citrate, a selective estrogen-receptor modulator that antagonizes the negative feedback of estrogen at the hypothalamus with a consequent increase in ovarian stimulation by endogenous gonadotropin, has been used for this indication for decades.
Clomiphene has drawbacks, including its overall poor efficacy (only a . . .
Journal Article
Randomized Trial of a Lifestyle Program in Obese Infertile Women
In this randomized trial, rates of vaginal birth of a healthy singleton at 2 years of follow-up were not higher among obese women who received a 6-month lifestyle intervention before infertility treatment than among those who received prompt infertility treatment.
Obesity is a major public health problem.
1
In most developed countries, 14 to 20% of women of reproductive age are obese (body-mass index [BMI; the weight in kilograms divided by the square of the height in meters], ≥30), whereas in some countries, the prevalence of obesity is as high as 60%.
1
Obesity negatively affects female reproductive health because it is associated with increased risks of menstrual dysfunction, anovulation, and infertility.
2
–
4
Success rates with ovulation induction and assisted reproductive techniques are lower among obese infertile women than among normal-weight women.
5
,
6
The risks of miscarriage,
6
,
7
gestational diabetes, hypertensive disorders, . . .
Journal Article