Wednesday 28 August 2019

Andropause: Male menopause, do you know?

Menopause, when we hear this word it is obvious that we think of pause to the periods in females. But Menopause does occur to males also. Declining in Androgen (testosterone) level with aging is referred to as Andropause or male menopause. This is very different from menopause to females, in which there is production of hormone and ovulation completely stops in a short period of time. But in Andropause there is decline in level of testosterone occur gradually.

Symptoms & Complications

It may vary from person to person. Men going through Andropause undergo symptoms like:

• Mood swing and irritability
• Depression
• Reduced sex drive
• Reduced erection or difficulty in getting erections (Erectile dysfunction)
• Increase in body fat
• Feeling of tiredness and loss of energy
• Dryness and thinning of skin

• Sleeping disturbance

Complications may be the increased risk of osteoporosis and heart related disorders.

Causes

Age is the main factor to cause decrease in the testosterone level.
Decrease in SHBG (sex hormone binding globulin), hormone that pulls out testosterone from blood, with age also lead to Andropause in males.

Conditions like Diabetes, Obesity, Liver & Kidney disease and Infections also cause decrease in hormone level at early age.

Diagnosis

To diagnose the conditions for male menopause, male fertility expert will do

• Physical Examination
• Detailed history of Symptoms and complications
• Blood tests for medical conditions (if any)

• Detect the level of testosterone in blood

Treatment

Low testosterone can be treated by Testosterone Replacement Therapy.
With the replacement therapy doctor advise you to keep maintaining the lifestyle.
Proper diet plan is provided.
Regular exercise is highly recommended.

Medications like antidepressants are prescribed.

Hormone Replacement Therapy can have some side effects associated with it, before undergoing through this procedure you must consult your fertility expert and take a brief of positive and negative effects of the treatment therapy. It may vary from person to person according to the health status. Complications includes increased risk of heart disease, it may worsen prostate cancer.



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To More Post: FET may be more vulnerable to a suboptimal environment





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Thursday 22 August 2019

“ Should we be checking on sleep pattern for fertility assessment ? ”


INTRODUCTION: Poor sleep health is a risk factor for a host of adverse health outcomes including obesity, type 2 diabetes, cardiovascular disease, depression and all-cause mortality. In reproductive epidemiology disrupted sleep patterns have been linked to a higher risk of adverse pregnancy outcomes such as gestational diabetes, stillbirth, preterm birth and low birth weight. New evidence has emerged that sleep disturbances may be associated with impaired fertility in women. Wise LA et al.1 reported short sleep duration in men was associated with reduced fecundability. Identifying modifiable determinants of infertility could provide alternatives to expensive fertility workups and treatments.

SUMMARY: Gaskins AJ2 recently (2019) found association between short sleep duration (e.g., sleeping <6 hours compared with sleeping 8 hours) and lower fecundability, a fairly robust relationship between troubled sleep and lower fecundability. The cumulative probability of pregnancy at 12 months was 64% for women with trouble in sleeping more than 50% of the time compared with 76% among women with no trouble in sleeping. However, this association was largely attenuated with additional adjustment for male partner sleep duration and when restricted to nulliparous women. 20% of women in this cohort reported troubled sleep more than 50% of the time, so not a rare exposure. According to this study, women who had troubled sleep more than 50% of the time were of lower socioeconomic status, were more likely to be from minority group and had higher levels of depression and perceived stress compared with women with no trouble sleeping. This then leads to the question of whether improving sleep could be used as an option to buffer against the adverse effects of other risk factors for delayed time to pregnancy such as depression, anxiety or low socioeconomic status.There are also systematic biases in the way that sleep is self-reported within certain subgroups, such as people with depression or obesity, who feel tired and may suspect they sleep less than the norm, regardless of their actual measured sleep. Therefore, further studies where more objective measures of sleep quality through actigraphs or more rigorous standardized measures is recommended.

CONCLUSION: From a clinical perspective, treatment of disordered sleeping would not only enhance the quality of life, but also may represent a modifiable pathway for enhancing spontaneous fertility. This article has a fascinating first look at the association between sleep health in women and time to pregnancy, it is the first longitudinal studies to enhance our knowledge on this topic further. Given the growing trend in recognizing sleep disorders and sleep deprivation as an unmet public health problem, particularly among young women, clinicians and researchers alike should be encouraged to collect information on sleep habits and consider it as one of many important factors, in addition to a healthy diet and active lifestyle, in increasing wellness and potentially fertility in women.

REFERENCES:

1.Wise L.A., Rothman K.J., Wesselink A.K., Mikkelsen E.M., Sorensen H.T., McKinnon C.J., Hatch E.E. 2018. Male sleep duration and fecundability in a North American preconception cohort study.Fertility and Sterility, 109 (3), pp. 453-459.

2.Gaskins A.J. Poor sleep and delayed time to pregnancy: a wake-up call for physicians and researchers? (2019).Fertility and Sterility, Available online from :https://doi.org/10.1016/j.fertnstert.2019.02.125


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Monday 19 August 2019

FET may be more vulnerable to a suboptimal environment

“Can outdoor air pollution affect the FET and fresh ET outcome in IVF cycles?”

Introduction: Ambient air pollution has been associated with human infertility and IVF outcomes. Choe et al1 study indicated lower pregnancy rates in IVF cycles may be linked to ambient air pollution during controlled ovarian stimulation and the post-transfer period. Does outdoor air pollution differentially affect the outcomes of frozen–thawed embryo transfer (FET) and fresh transfer?

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Summary: Wang et al2 studied the affect of air pollution on IVF treatment cycles in 11148 patients contributing to 16290 transfer cycles between January 2013 and December 2016. The average age of the cohort was 31.5 years. Inverse distance weighting interpolation was used to estimate the daily ambient exposures to six pollutants (PM2.5, PM10, SO2, NO2, CO, O3) at an IVF clinical site, according to the data from fixed air quality monitoring stations in the city. The exposures of each cycle were presented as average daily concentrations of pollutants from oocyte retrieval to embryo transfer/cryopreservation. Exposures were analyzed in quartiles. A generalized estimating equation was used to evaluate the association between pollutants and IVF outcomes. The clinical pregnancy rate and live birth rate of the cycles was 55.1% and 47.1% respectively. Among the included cycles, 4013 patients received 5299 FET cycles, resulting in 42.7% live birth per ET, whereas 9553 patients received 10991 fresh transfer cycles, resulting in 49.2% live birth per ET. Increased SO2 and O3 levels were significantly associated with lower live birth rates in FET cycles, whereas none of the pollutants were significantly associated with lowering of IVF outcomes in fresh transfer cycles. The FET cycles in the highest quartile of SO2 and O3 exposure had significantly lower live birth rates (adjusted OR) in comparison with those in the lowest quartile. Models involving all transfer cycles and interaction terms (FET exposures) suggested that FET significantly enhanced the effects of SO2 and O3 exposure on IVF outcomes (P < 0.001). Accounting for all six pollutants, women in the highest quartile of SO2 still had the lowest live birth rates (OR 0.61, 95%CI 0.47–0.80).

Conclusion: This study implied that embryos undergoing FET may be more vulnerable to a suboptimal environment than those undergoing fresh transfer. Increased SO2 and O3 levels at the site of IVF unit were significantly associated with lower live birth rates following FET but did not affect the contemporary fresh transfer outcomes. In heavily polluted sites or seasons, fluctuation in FET outcomes may be partially explained by the dynamic changes of ambient gaseous air pollutant.

References:
1. Xin li Wang, Jiali Cai, Lanlan Liu, Xiaoming Jiang, Ping Li, Aiguo Sha, Jianzhi Ren; Association between outdoor air pollution during in vitro culture and the outcomes of frozen–thawed embryo transfer, Human Reproduction, Volume 34, Issue 3, 1 March 2019, Pages 441–451, https://doi.org/10.1093/humrep/dey386

2.Choe SA, Jun YB, Lee WS, Yoon TK, Kim SY. Association between ambient air pollution and pregnancy rate in women who underwent IVF. Hum Reprod. 2018 Jun 1;33(6):1071-1078. doi: 10.1093/humrep/dey076. PubMed PMID: 29659826.


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Tuesday 13 August 2019

Sperm quality improve by frequent ejaculation rather than abstinence


"Do we need to update IVF protocols to use semen from shorter periods of abstinence?"

introduction: Men have usually been advised to limit sexual activity to increase the chances of pregnancy. A new study suggests sperm quality and pregnancy outcomes in IVF may be improved with frequent ejaculation,

Summary: Research carried out Da Li et aVaimed to determine the effects of a short period of abstinence on the quality of ejaculated sperm, as well as its effect on the pregnancy outcomes of 500 couples undergoing EVE Major molecular differences were seen between samples of semen depending on the duration of abstinence. Ejaculates from short (1-3 hours) compared with long (3-7 days) periods of abstinence showed increases in motile sperm count, sperm vitality, normal sperm morphology, acrosome reaction  capacity,  total antioxidant  capacity,  sperm  mitochondria'  membrane  potential,  high  DNA stainability and a decrease in the sperm DNA fragmentation index (P<0.05). Sperm proteomic analysis showed 322 differentially expressed proteins (minimal fold change of ±1.5 or greater and P < 0.05), with 224 up-regulated and 98 down-regulated. These differentially expressed proteins are profoundly involved in specific cellular processes,  such as  motility and capacitation, oxidative stress and metabolism. Interestingly, protein trimethyllysine modification was increased and butyryllysine, propionyllysine and malonyllysine modifications were decreased in ejaculates from a short versus long abstinence (P < 0.051 Finally, the rates of implantation, clinical pregnancy and live births from in vitro fertilization treatments were significantly increased (by one-third in this study) in semen samples after a short abstinence. This study provides preliminary mechanistic insights into improved sperm quality and pregnancy outcomes associated with spermatozoa retrieved after a short ejaculatory abstinence.

Conclusion: These results collectively suggest that having more frequent sex produces sperm of a better quality and increases the likelihood of a successful pregnancy. Specifically, semen samples collected after only one to three hours of abstinence contained more motile sperm with a higher reproductive potential than samples collected after men who had abstained for three to seven days.

References: Zi-Qi Shen, Bei Shi, Tian-Ren Wang, Liao Liao, Xuejun Shang, Qi-fun Wu, Yi-Ming Zhou, Tie-Feng Can, Qiang Du, Xiu-Xia Wang and Da Li. Characterization of the Sperm Proteome and Reproductive Outcomes with in Vitro Fertilization after a Reduction in Male Ejaculatory Abstinence Period. Molecular & Cellular Protearnics August 20, 2018,mcp.RA117.000541; https://doi.org/10.1074/mep.RA11 2000541

Source: https://www.indianfertilitysociety.org/fertility-news-october-2018-volume-3/

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Tuesday 6 August 2019

Who should be treated by IVF in unexplained subfertility?

“Should we be trying expectant management or IVF treatment?”

INTRODUCTION: The clinical indications for IVF, initially started from bilateral tubal blockage and now has  extended to unexplained subfertility in which there is no identifiable cause or barrier to conception. There is little  evidence from randomized controlled trials that IVF is effective in these couples.Which couples with unexplained  subfertility can expect increased chances of ongoing pregnancy with IVF compared to expectant management ?

SUMMARY: Eekelen et al1 recently compared outcomes in couples with unexplained subfertility undergoing IVF  (n = 40921) from registry data to couples with the same type of subfertility on expectant management. Those  couples on expectant management (only intercourse) comprised a prospective nation wide Dutch cohort (n =  4875) and a retrospective regional cohort from Aberdeen, Scotland (n =975). They excluded couples who had tried  for less than 1 year to conceive, cases of anovulation, tubal occlusion, mild or severe endometriosis or male  subfertility. Matching of couples who received IVF and couples on expectant management based on their  characteristics to control for confounding were done. They fitted a Cox proportional hazards model including  patient characteristics, IVF treatment and their interactions to estimate the individualized chance of conception  over 1 year, either following IVF or expectant management for all combinations of patient characteristics. The  endpoint was conception leading to ongoing pregnancy, defined as a foetus reaching a gestational age of at least 12  weeks. The adjusted 1year chance of conception was 47.9% (95% CI: 45.0–50.9) after IVF and 26.1% (95% CI:  24.2–28.0) after expectant management. The absolute difference in the average adjusted 1 year chances of  conception was 21.8% (95%CI: 18.3–25.3) in favour of IVF. The effectiveness of IVF was influenced by female age,  duration of subfertility and previous pregnancy. IVF was effective in women under 40 years, but the 1 year chance  of an IVF conception declined sharply in women over 34 years. In contrast, in woman over 40 years of age, IVF was  less effective, with an absolute difference in chance compared to expectant management of 10% or lower.  Regardless of female age, IVF was also less effective in couples with a short period of secondary subfertility (1 year)  who had chances of natural conception of 30% or above.

CONCLUSION : For couples in which the woman is under 40 years of age, IVF is associated with higher chances  of conception than expectant management in unexplained subfertile couples. IVF should be used selectively based  on judgements on gain compared to continuing expectant management for a given couple.

REFERENCES :

1. R van Eekelen, N van Geloven, M van Wely, S Bhattacharya, F van der Veen, M J Eijkemans, D J McLernon. IVF for  unexplained subfertility; whom should we treat?, Human Reproduction, dez072, https://doi.org/10.1093/humrep/dez072  Published 13 June 2019.



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