Obstetrics and Gynaecology Forum - Volume 25, Issue 1, 2015
Volume 25, Issue 1, 2015
Author T.I. SiebertSource: Obstetrics and Gynaecology Forum 25, pp 1 –3 (2015)More Less
Infertility, defined as the inability of a sexually active couple to conceive after 1 year of regular intercourse without contraception, affects approximately 15% of couples, and male factors are the cause in 20%-50% of cases. Despite technological advances, the cause of male infertility is unknown in 25% of these cases. Infertility of unknown origin is classified into idiopathic male infertility and unexplained male infertility according to semen quality.
Source: Obstetrics and Gynaecology Forum 25, pp 9 –11 (2015)More Less
For men who use anabolic-androgenic steroid (AAS) a unique condition known as anabolic steroid-induced hypogonadism (ASIH) becomes a real concern. ASIH has recently been identified as a potentially underrecognized cause of hypogonadism and infertility in young men. At present there is a lack of information in the literature regarding demographics, characteristics and psychological make-up of AAS users. Furthermore there are no clear recommendations for the management of AAS-induced complications.
Source: Obstetrics and Gynaecology Forum 25, pp 15 –17 (2015)More Less
Repeated failure to conceive following the transfer of good quality embryos into a normal uterus over at least two in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) cycles defines the notion of recurrent implantation failure (RIF). The true incidence of recurrent implantation failure (RIF) is unknown. The causes can broadly be divided into embryo related and maternal causes. Whereas each cause affects implantation on its own right, recent evidence suggest that perturbation of endometrial receptivity may be the final common pathway by which implantation fails for most factors associated with recurrent implantation failure. Endometriosis is a chronic debilitating condition associated with chronic pelvic pain and subfertility in 50% of the cases. It is associated with disrupting markers of endometrial receptivity, and in 50% of cases despite assisted reproductive technology, patients remain infertile. We report a patient with severe endometriosis who underwent laparoscopic ablation and resection with good results and patent tubes. Despite her partner's normal semen analysis she could not conceive with repeated IVF attempts ultimately developing poor ovarian response and premature ovarian insufficiency. Attempts to conceive with donor oocytes were also met with failure. The advent of the endometrial receptivity array test that identifies personalised window of implantation may offer hope for patients with RIF, thereby allowing personalised embryo transfer and conception.
Source: Obstetrics and Gynaecology Forum 25, pp 19 –20 (2015)More Less
Globozoospermia is a severe form of teratozoospermia associated with the absence of the acrosome. In about 1% of round-headed spermatozoa an acrosome may persist as a rudimentary structure. It is the absence of the acrosome that renders rounded headed spermatozoa incapable of initiating oocyte activation with consequent failure to achieve fertilisation due to deficiency of phospholipase C-zeta (PLC ), the oocyte activating factor. Persistence of the acrosomal bud in globozoospermia is associated with spontaneous oocyte activation using intra-cytoplasmic sperm injection (ICSI). Assisted oocyte activation using calcium ionophore-A23187 has been the main method by which couples with globozoospermia have hope for achieving a pregnancy. The technique has a reported 60% chance of successful oocyte activation. We describe a couple with total globozoospermia who achieved fertilisation using sequential combination of motile sperm organelle morphological examination (MSOME) and intra-cytoplasmic morphologically selected sperm injection (IMSI). Fertilisation was achieved followed by transfer of four embryos as dictated by the patient's age, but all embryos failed to implant. Concerns over the possible transmission of defective genes to the offspring of couples with globozoospermia treated with ICSI/IMSI or assisted oocyte activation remains unabated. Our case demonstrates the efficacy of MSOME/IMSI as a good alternative to calcium ionophore for assisted oocyte activation in globozoospermic couples.
Source: Obstetrics and Gynaecology Forum 25, pp 23 –25 (2015)More Less
Spinal cord injury (SCI) is a unique medical condition and occurs most commonly to young men who are at the peak of their reproductive health. Only 5% of SCI patients can father a child without medical intervention. Fertility problems are mainly due to erectile or ejaculatory disturbances and poor semen quality. Semen specimens characterized by normal sperm concentration but extremely impaired motility and viability. The pathophysiology is still poorly understood, and findings vary among studies regarding the underlying cause of sperm dysfunction.
Source: Obstetrics and Gynaecology Forum 25, pp 28 –31 (2015)More Less
Recurrent pregnancy loss (RPL) frequently presents as a clinical dilemma for most clinicians caring for these desperate couples. The history and clinical assessment should be thorough and special examinations and treatment must be appropriate in accordance to the evidence of proper randomised controlled trials (RCT), to be cost effective. Emotional support has been proven to have therapeutic value. This case study focuses on the common causes, and therapeutic options available.
Source: Obstetrics and Gynaecology Forum 25, pp 33 –35 (2015)More Less
The term "HIV serodiscordant couple" refers to an HIV-seropositive person who is sexually active with an HIV-uninfected partner. Infertility affects approximately 15% of the general population but people with HIV have even greater reproductive challenges. For this reason reproductive specialists play an important role to assist these patients with their fertility needs and educating and guiding them towards a healthy lifestyle and limiting the risk to the sero-negative partner.