The Endometrial Microbiome and Its Impact on Human Conception

Changes in the female genital tract microbiome are consistently correlated to gynecological and obstetrical pathologies, and tract dysbiosis can impact reproductive outcomes during fertility treatment. Nonetheless, a consensus regarding the physiological microbiome core inside the uterine cavity has not been reached due to a myriad of study limitations, such as sample size and experimental design variations, and the influence of endometrial bacterial communities on human reproduction remains debated. Understanding the healthy endometrial microbiota and how changes in its composition affect fertility would potentially allow personalized treatment through microbiome management during assisted reproductive therapies, ultimately leading to improvement of clinical outcomes. Here, we review current knowledge regarding the uterine microbiota and how it relates to human conception.

Communication Experiences of Pekanbaru City Patients Receiving In Vitro Fertilisation (IVF) Treatment in Malaysia Fertility Clinics

Doctor-patient communication is important in all medical consultations including for In Vitro Fertilisation (IVF) treatment. An unfavourable communication experience can cause a patient to stop taking the treatment, move to another local fertility clinic, or even seek treatment abroad. There are still few studies documenting communication experiences of patients with infertility seeking reproductive treatment in other countries. This study aimed to describe the communication experiences of Indonesian IVF patients receiving IVF treatment from medical practitioners in fertility clinics in Malaysia. This study used Benner's interpretive phenomenology framework in its approach and when analysing the results. Data collection was carried out using in-depth and semi-structured interviews with 11 IVF patients from Pekanbaru city Indonesia who received IVF treatment in fertility clinics in Malaysia. This study found three main themes shared by the IVF patients’ communication experiences: 1) memorable experiences (friendliness and caring, empathy, honesty and openness, clarity and adequacy of the information, and easiness of communication; 2) less memorable experiences (less interpersonal communication, less warm non-verbal communication, and miscommunication); and 3) communication barriers (English). These findings have important implications for both the prospective patients receiving cross-border fertility treatment in the future and for service providers providing fertility treatment to improve doctor-patient communication. Keywords: Health communication, doctor-patient communication, communication experience, infertility, cross-border reproductive care, in vitro fertilisation treatment.

Two sides of a coin: women’s experiences and providers’ perceptions of assisted conception in urban India

Background: The uptake of assisted reproductive treatments has increased radically in urban India. We aimed to understand women’s lived experiences of assisted conception, and ART providers’ perception of their patients’ experiences.Methods: This study was cross-sectional and we used a qualitative approach and key informant interviews to understand the experiences of women and the treatment providers. Participants were ten women who had conceived through assisted reproductive treatment and ten ART providers. The data was analyzed using Braun and Clarke’s thematic analysis method.Results: During the treatment process, women felt consumed by their need to conceive. They reported that it was difficult for them to focus on other equally important aspects of their life. Stress, depression and anxiety associated with the uncertainty of their treatment outcome were prevalent. Women were also worried about miscarriage, safety and health of their baby, and forming an attachment with their fetus during the pregnancy. Providers’ concurred that women experience significant mood fluctuations in the form of stress, anxiety and depression which impacts treatment adherence and outcome. Women who have adequate spousal and family support are able to navigate the ART process better than women who lack social support.Conclusions: Findings imply the need for screening and brief psychological interventions at different stages of fertility treatment and during the antenatal and postnatal period to enhance women’s emotional well-being.

The Impact of Postponed Fertility Treatment on the Sexual Health of Infertile Patients Owing to the COVID-19 Pandemic

Background: With the onset of the coronavirus disease 2019 (COVID-19) pandemic at the beginning of 2020, all non-essential medical treatments were suspended, including fertility treatments. As a unique group in society, patients with infertility may be more sensitive and vulnerable in the face of pressure and crisis. However, to the best of our knowledge, there have been no reports on the influence of postponed fertility treatment on the sexual health of infertile patients owing to COVID-19. Therefore, this study aimed to investigate whether postponed fertility treatment resulting from COVID-19 affects the sexual health of patients with infertility.Methods: A total of 1,442 participants were included for analysis in this large-scale study. Those with postponed fertility treatment were categorised as group A (n = 474), whereas those whose fertility treatment was not delayed were in group B (n = 968). The sexual health and psychological well-being were compared between the two groups.Results: The total Female Sexual Function Index score and five domains of female sexual function (arousal ability, vaginal lubrication, orgasm, satisfaction, and coital pain) were significantly lower in group A than those in group B (p < 0.05). The International Index of Erectile Dysfunction score and Premature Ejaculation Diagnostic Tool score were significantly higher in group A than those in group B (p < 0.05).Conclusions: Delaying fertility treatment obviously affects patients' sexual and mental health. Through a structural equation model, we observed that postponed fertility treatment mediates sexual health by regulating psychological distress and couple relationship quality.

Infertility Riding on Polycystic Ovarian Syndrome (PCOS): A Review of Treatment Modalities

Polycystic ovarian syndrome (PCOS) is the commonest cause of anovulatory infertility. Depending on the population studied between 5 and 18% of women of reproductive age suffer from PCOS, however not all of them are anovulatory or experience subfertility. PCOS has been associated with numerous reproductive and metabolic abnormalities. Despite enormous advances in the management of reproductive dysfunction, insight into the metabolic implications of PCOS is limited by the lack of uniform diagnostic criteria, the heterogeneity of the condition and the presence of confounders including obesity. Obesity clearly has a role in long term health and may best predict both reproductive and metabolic dysfunction as well as negatively affect the response to treatment in women with PCOS. Diabetes, cardiovascular disease and cancer are also at the forefront of any risk assessment or comprehensive treatment strategy for these women. Lifestyle modifications including dietary changes, increased exercise and weight loss are appropriate first line interventions for many women with PCOS. Pharmaceuticals including metformin, lipid lowering agents and oral contraceptives should be tailored to the individual’s risk profile and treatment goals. The fertility treatment in women with subfertility and PCOS aimed to safely induce monofollicular ovulation resulting in the birth of a singleton child. Women with PCOS undergoing fertility treatment are at risk of multi-follicular development as well as ovarian hyper-stimulation syndrome (OHSS), so they must be carefully counselled and monitored during fertility treatment. It is imperative that prior to embarking on fertility treatment, a patient’s health and weight is optimised. This chapter will explore the latest evidence for fertility treatments for women with PCOS.