Research Articles/Case Summaries (May): Infertility and Reproductive Health

This compilation presents a selection of recent research articles and case summaries from May 2024, delving into diverse facets of infertility, reproductive health, and the impact of various interventions and societal factors. These studies offer valuable insights into the experiences of individuals facing infertility, the effectiveness of different treatment approaches, and the broader public health implications.

1. An investigation of the effects of infertility on Women’s quality of life: a case-control study

Synopsis: In studies comparing infertile women to fertile women, infertile women often report lower scores in quality of life (QOL) sub-scales related to mental, physical, and environmental health. However, they may experience a higher score in the social health sub-scale compared to fertile women. This suggests that while infertility can negatively impact overall well-being and health-related aspects, social interactions and support networks may play a crucial role in mitigating some of these effects on social health.

2. Investigating the association between infertility and psychological distress using Australian Longitudinal Study on Women's Health (ALSWH)

Synopsis: This study emphasizes infertility as a complex stressor linked to anxiety, stress, and depression, with significant and lasting mental health impacts. It argues for infertility to be prioritized in public health strategies, specifically within Australia's National Women's Health Strategy 2020–2030. Key implications include: Improving assessment of infertility issues beyond clinical management; Ensuring equitable access and affordability of infertility treatments; Implementing regular mental health screenings for all patients, with accessible support services. Furthermore, infertility is identified as a growing global health concern exacerbated by factors like human overpopulation, resource consumption, and climate change. Environmental health impacts human fertility and overall well-being, highlighting the need for broader attention to issues such as climate change mitigation and sustainable population management.

3. Experiencing Male Infertility: A Review of the Qualitative Research Literature

Synopsis: This article reviews qualitative research on men's experiences of infertility, highlighting themes such as infertility as a crisis, societal expectations of men to 'be strong,' stigma, and the desire for fatherhood. It calls for future research to explore men's emotional responses, support-seeking behaviors, masculinity's role in infertility, and the broader impacts on their lives. This aims to give greater voice to men in a field traditionally focused on women's experiences of infertility.

4. Reducing day 3 baseline monitoring bloodwork and ultrasound for patients undergoing timed intercourse and intrauterine insemination treatment cycles

Synopsis: This study demonstrates a successful multi-modal quality improvement (QI) intervention aimed at reducing unnecessary vitamin D (D3) bloodwork and transvaginal ultrasound (TVUS) in fertility medicine. By promoting resource stewardship, healthcare providers strive to deliver high-quality, cost-effective care with tests conducted when medically indicated. This initiative not only saves healthcare expenditure but also alleviates time constraints for both patients and providers while decreasing the potential risk of COVID-19 exposure.

5. Research on infertility: Which definition should we use?

Synopsis: The definition of infertility established by the World Health Organization (WHO), which defines it as the inability to conceive after 24 months of trying to get pregnant, is widely recommended for clinical practice and research across various disciplines. This standardized definition provides clarity and consistency in diagnosing infertility, facilitating effective communication and treatment planning among healthcare professionals and researchers worldwide.

6. Gaps in male infertility health services research

Synopsis: Health services research integrates qualitative and quantitative methods to investigate healthcare systems comprehensively. In the context of male infertility, it serves as a potent tool to assess both strengths and weaknesses within the field, driving necessary changes. Currently, incomplete data on male infertility contributes to barriers in evaluation and treatment, perpetuating a cycle that hinders knowledge acquisition, patient care enhancement, and policy transformation. Enhancing existing databases, educating non-specialists in male infertility, and leveraging diverse media channels represent potential solutions to break this cycle and improve outcomes in male reproductive health.

7. Prevalence of intimate partner violence against infertile women in low-income and middle-income countries: a systematic review and meta-analysis

Synopsis: This systematic review and meta-analysis examined the prevalence of intimate partner violence (IPV) against infertile women in low- and middle-income countries (LMICs). Findings reveal that approximately 36% of infertile women experience IPV over a 12-month period, and 47% experience it over their lifetime. Psychological violence was the most common form, followed by physical violence, sexual violence, and economic coercion. Compared to the general female population, infertile women are at higher risk of experiencing physical and sexual violence. The study calls for standardized data collection methods, population-based surveys, and tailored interventions to address this significant public health issue effectively.

8. Intracytoplasmic sperm injection versus conventional in-vitro fertilisation for couples with infertility with a non-severe male factor: a multicentre, open-label, randomised controlled trial

Synopsis: In couples facing infertility where the male factor is non-severe, studies indicate that Intracytoplasmic Sperm Injection (ICSI) does not enhance the live birth rate compared to conventional In Vitro Fertilization (IVF). Considering that ICSI involves additional invasiveness, costs, and potential risks to offspring health, its routine use is not recommended for this population.

9. Trends in semen parameters of infertile men in South Africa and Nigeria

Synopsis: This study documents a significant decline in semen parameters among men attending fertility clinics in South Africa and Nigeria from 2010 to 2019. Asthenozoospermia and teratozoospermia have become the leading causes of male infertility in Nigeria and South Africa, respectively, with ageing identified as a contributing factor. Further research is needed to explore the broader causes of increasing male factor infertility globally. Limitations include analysis limited to two African countries and exclusion of data from the general population and hormone profiles, underscoring the need for future studies to address these gaps.

10. SARS-CoV-2 pandemic and repercussions for male infertility patients: A proposal for the individualized provision of andrological services

Synopsis: The authors propose strategies to address the impact of prolonged disruptions in andrological services during the SARS-CoV-2 pandemic, particularly for vulnerable subgroups of male infertility patients. While healthcare reorganization prioritizes critical care for COVID-19 patients, minimizing burdens on national health systems remains crucial. They emphasize the need for identifying 'time-sensitive' cases to prioritize diagnostic semen analysis and sperm banking services. Furthermore, they offer recommendations on safely resuming andrological services to ensure optimal patient care without compromising safety. Their goal is to assist authorities and healthcare providers in effectively managing and prioritizing male infertility cases during the ongoing pandemic.

11. Reproductive outcomes of intracytoplasmic sperm injection using testicular sperm and ejaculated sperm in patients with AZFc microdeletions: a systematic review and meta-analysis

Synopsis: This systematic review and meta-analysis found no significant differences in clinical pregnancy rate, abortion rate, and live birth rate between ICSI cycles using testicular sperm versus ejaculated sperm in males with AZFc microdeletions. Based on these findings, ejaculated sperm should be prioritized over testicular puncture for ICSI in the clinical treatment of severe oligozoospermia patients with AZFc microdeletions, as sperm source did not impact ART outcomes. However, due to inherent heterogeneity among the studies included more well-designed and controlled studies, particularly randomized controlled trials, are needed to further validate these results.

12. Associations between tobacco inhalation and semen parameters in men with primary and secondary infertility: a cross-sectional study

Synopsis: Smoking has been strongly linked to negative impacts on seminal parameters in infertile men. This underscores the importance of incorporating smoking cessation programs into fertility treatment protocols. Encouraging men to quit smoking could lead to significant improvements in semen quality and ultimately enhance fertility outcomes for this population.

13. Premature Chromatid Separation Trait Found During the Diagnosis of Male Infertility: A Case Report

Synopsis: Premature chromatid separation (PCS) or mosaic variegated aneuploidy (MVA) syndrome is a rare autosomal recessive chromosome instability syndrome. Heterozygous carriers of a monoallelic mutation typically have a normal phenotype, but may exhibit higher rates of PCS-positive cells. The authors present a case where a PCS carrier was incidentally diagnosed during male infertility investigation, showing PCS trait in 81 of 200 cells (40.5%). If both partners are carriers, there's a 25% risk of the child having PCS syndrome, necessitating genetic counseling before microsurgical testicular sperm extraction.

14. Exploring the role of gut microbiome in male reproduction

Synopsis: Emerging evidence suggests that the gut microbiome plays a crucial role in male reproductive health by influencing immune system activation, insulin resistance, and sex hormone secretion, which collectively regulate spermatogenesis. Additionally, interactions between the gut microbiome and testicular microbiome can affect androgen metabolism, the blood-testis barrier, and vascular inflammation linked to conditions like erectile dysfunction. Therapeutic approaches such as probiotics, prebiotics, and fecal microbiota transplantation are being explored to address male infertility. Further research is essential to uncover the precise mechanisms underlying these interactions and validate potential treatments involving microbiota modulation.

15. Geographic variation in semen parameters from data used for the World Health Organization semen analysis reference ranges

Synopsis: Significant geographic variations in sperm parameters were observed across different regions. Semen volume was lower in Asia and Africa compared to other regions, while sperm concentration was lowest in Africa and highest in Australia. Total motile sperm count (TMSC) and total motile progressive sperm count (TMPS) were notably lower in Africa compared to Europe and Australia, and also lower in Asia and the United States compared to Europe. The 5th percentile values for sperm concentration, normal sperm morphology, TMSC, and TMPS varied among regions, with the United States often showing lower values compared to Asia and Australia. These findings underscore the need for regional fertility societies to establish their own reference ranges based on local data to improve treatment outcomes.

16. The risk of birth defects is not associated with semen parameters or mode of conception in offsprings of men visiting a reproductive health clinic

Synopsis: The study found no statistically significant association between semen parameters, mode of conception (including infertility treatments and ART), and birth defects (BDs) among 2224 infants. Semen parameters like sperm concentration, motility, and total motile count showed non-significant odds ratios for BDs. The research, based on data from the TBDFR, focused on live births and stillbirths after 20 weeks gestation, limiting insights into early pregnancy losses. Despite limitations in data coverage and statistical power for certain analyses, the findings suggest that male factor infertility severity does not increase the risk of congenital anomalies, which is crucial for counselling couples concerned about semen quality and birth defect risks.

17. Neurodevelopmental Disorders in Offspring Conceived via In Vitro Fertilization vs Intracytoplasmic Sperm Injection.

Synopsis: The study analyzed 1,575,971 singleton births, finding that offspring conceived through ART, particularly using ICSI, had higher risks of autism spectrum disorder (ASD) and developmental delay compared to naturally conceived children. This risk was consistent regardless of whether infertility was attributed to male or female factors. Interestingly, male infertility itself was not linked to increased neurodevelopmental disorder risks in offspring. These findings underscore the potential impact of ART procedures on neurodevelopmental outcomes and highlight the need for further research and informed counseling for couples considering assisted reproductive technologies.

18. Assisted Reproductive Technologies: A New Player in the Foetal Programming of Childhood and Adult Diseases?

Synopsis: Assisted reproductive technology (ART) is a complex field with profound implications for individuals and society. This review outlines the potential risks associated with ART procedures, including increased chances of nonchromosomal birth defects, cardiovascular issues, musculoskeletal abnormalities, and urogenital defects in male newborns. While the long-term impact on neuropsychiatric health remains uncertain, it underscores the importance of comprehensive counseling and psychological support within multidisciplinary clinical settings for individuals considering ART.

19. Recent advances in the understanding and management of erectile dysfunction

Synopsis: Traditional therapies like lifestyle changes, oral medications, injections, and penile prostheses are effective for treating erectile dysfunction (ED). However, there's limited research on novel approaches. Alternative modalities such as external penile prostheses and low-intensity extracorporeal shockwave therapy (LI-ESWT) are promising due to their low side effects and cost-effectiveness. Further research is crucial to understand their potential role in ED management.