INCREASING DURATION OF FERTILITY IN WOMEN WITH ENDOMETRIOSIS

Introduction: Infertility is one of the common clinical symptoms in women with endometriosis. Limited ways to diagnose endometriosis, symptoms of endometriosis considered normal and overlap with other diseases that cause delaying treatment that increase the duration of infertility. This study purpose to analyze the differences in duration of infertility to women with endometriosis and without endometriosis. Method: This study is observational analytical research with retrospective case-control designed by looking at medical records in Fertility Clinic Graha Amerta RSUD Dr. Soetomo Surabaya. Total samples in this research are 50 women with infertility, it is divided into 25 people with endometriosis and 25 people without endometriosis. In the medical records, we can see the duration of infertility in each sample. Results: The duration of infertility >3 years occurs in women with and without endometriosis (72% and 80%). In bivariate analysis using the chi-square test, there was no difference that showed increasing duration of infertility (P = 0.508) between women with endometriosis and without endometriosis. Conclusion: There was no differences in the duration of female infertility with endometriosis and without endometriosis

Hubungan Anti-Mullerian Hormone (AMH) pada Long dan Short Protocol Terhadap Fertilization Rate Pasien In Vitro Fertilization (IVF)

Abstrak Tujuan: Untuk mengevaluasi pengaruh kadar anti-mullerian hormone (AMH) dengan fertilization rate (FR) dan menilai perbedaan pengaruh jenis protokol (long protocol (LP) dan short protocol (SP)) pada tiap tingkat cadangan ovarium terhadap FR pada pasien in vitro fertilization (IVF) dengan Intracytoplasmic Sperm Injection. Metode: Data sekunder dari rekam medis pasien yang menjalani IVF di Aster Fertility Clinic Rumah Sakit Umum Pendidikan dr. Hasan Sadikin pada tahun 2016-2020 dan Bandung Fertility Centre Rumah Sakit Ibu Anak Limijati pada tahun 2018-2019. Penelitian ini analitik observational dengan metode Cohort retrospektif. Hubungan antara dua data kategorik diuji dengan uji chi-square dan uji Kruskal-Wallis digunakan pada data numerik dengan distribusi yang tidak rata pada lebih dari 2 kelompok, Hasil: Hasil data diperoleh nilai rerata kadar AMH secara keseluruhan adalah 3.30 ng/ml dengan rerata capaian FR sebesar 71.97%. Berdasarkan metode IVF yang dipilih, mayoritas pasien menjalani pengobatan SP 54.4% (rerata FR 72.80%) dibandingkan dengan LP 45.6% (rerata FR 70.97%). Tidak ditemukan hubungan yang bermakna antara kadar AMH dengan FR, dinyatakan dengan nilai p=0.977. Kadar AMH terhadap FR bila dipisahkan menurut protokol terapi yang diberikan tidak menunjukkan perbedaan yang bermakna pada masing-masing protokol (LP p=0,763; SP p=0,843). Mengenai hubungan antara protokol IVF dengan FR juga tidak diperoleh perbedaan yang signifikan secara statistik dengan nilai p=0,27 (RR 1.17 (0.62-2.15); CI 95%). Penggobatan menggunakan LP (p=0,770) maupun SP (p=0.845) tidak memberikan pengaruh yang bermakna terhadap FR pada setiap kategori AMH. Kesimpulan: Tidak ada pengaruh kadar AMH dan protokol terapi terhadap FR. Kata kunci : In Vitro Fertilization, Fertilization Rate, Anti-Mullerian Hormone, Protokol Stimulasi Ovarium

Diagnostic Accuracy Study Comparing Hysterosalpingo-Foam Sonography and Hysterosalpingography for Fallopian Tube Patency Assessment

Introduction: Simplified ultrasound-based infertility protocols that appear to provide enough information to plan effective management have been described. Thus, the objective of this study is to compare the diagnostic accuracy of the hysterosalpingo-foam sonography (HyFoSy) in tubal patency testing with the traditional hysterosalpngography (HSG) for establishing a new diagnostic strategy in infertility. Material and Methods: Prospective observational diagnostic accuracy was performed in a private fertility clinic in which 106 women undergoing a preconceptionally visit were recruited. All of them had low risk for tubal disease, had performed an HSG and were negative for Chlamydia trachomatis antibody. Main outcome measures were tubal patency and pain grade. Results: Evaluation of tubal patency by HyFoSy showed a total concordance with the results of the previous HSG in 72.6% (n = 77), and a total discordance for 4.7% (n = 6), with the inter-test agreement Kappa equal to 0.57, which means moderate concordance. Among the patients, 59.1% did not report pain during the procedure, while the remaining 48.1% indicated pain in different degrees; patients usually report less pain and only 6.6% described more pain with HyFoSy than with HSG (OR 6.57 (CI 95% 3.11–13.89)). Clinical outcomes after performing HyFoSy were not affected. Conclusions: HyFoSy is in concordance with HSG regarding tubal patency results and it is a less painful technique than HSG. HyFoSy is more economical and can be performed in an exam room only equipped with an ultrasound scanner. Based on these results, HyFoSy could be the first-choice diagnostic option to assess tubal patency in patients with low risk of tubal disease.

Kin-making in the Reproductive Penumbram: Surrogacy in Aotearoa New Zealand

<p>As many as one in four New Zealanders experience infertility. Some choose to pursue surrogacy as an option to make a family because traditional surrogacy and gestational surrogacy are legal in Aotearoa New Zealand on an altruistic basis. Straddling the two reproductive worlds – ‘traditional’ and ‘technological’ – surrogacy in Aotearoa New Zealand offers us a ripe site for analysis and rethinking how kinship is made and unmade within what I refer to as the reproductive penumbra. Surrogacy as a reproductive practice exists outside of, or in the shadows of, heteronormative reproduction and mainstream Euro-American kinship. Surrogacy also asks people to enter an unknown reproductive space and navigate myriad processes, institutions, and legislations to realise their plans to make kin non-normatively. Drawing on three years of multi-sited ethnographic fieldwork, in this thesis I unpack what kin-practices, narratives, rituals, rules, and relationships are mobilised within and between the various landscapes involved in surrogacy in Aotearoa New Zealand. I outline how people make kin in the multiple shadows they inhabit and move through during their surrogacy journeys. These range from the intimate and inter-personal relationships in the surrogacy community, the fertility clinic, and inside the embryology laboratory, to the institutional and regulatory processes and the state. Through their negotiation of these spaces that are situated in the shadows of the colonial state, everyday legality, and motherhood ideologies, intended parents and surrogates disrupt, to varying degrees, pervasive ideas about kinship with different interpretations and enactments of reproductive participation. Through detailed narratives of people wanting to and helping make kin in the shadows, this research on surrogacy complicates societal understandings of the co-constructed nature of kinship, motherhood, and reproductive medicine. Rather than positioning kin-making in shadows as inherently negative, this thesis celebrates the potentiality and plurality of reproduction that underpins and emerges from surrogacy.</p>

Telomere Distribution in Human Sperm Heads and Its Relation to Sperm Nuclear Morphology: A New Marker for Male Factor Infertility?

Infertility is a problem affecting an increasing number of couples worldwide. Currently, marker tests for male factor infertility are complex, highly technical and relatively subjective. Up to 40% of cases of male factor infertility are currently diagnosed as idiopathic therefore, there is a clear need for further research into better ways of diagnosing it. Changes in sperm telomere length have been associated with infertility and closely linked to DNA damage and fragmentation, which are also known to be related to infertility. However, telomere distribution is a parameter thus far underexplored as an infertility marker. Here, we assessed morphological parameters of sperm nuclei in fertile control and male factor infertile cohorts. In addition, we used 2D and 3D fluorescence in situ hybridization (FISH) to compare telomere distribution between these two groups. Our findings indicate that the infertile cohort sperm nuclei were, on average, 2.9% larger in area and showed subtle differences in sperm head height and width. Telomeres were mainly distributed towards the periphery of the nuclei in the control cohort, with diminishing telomere signals towards the center of the nuclei. Sperm nuclei of infertile males, however, had more telomere signals towards the center of the nuclei, a finding supported by 3D imaging. We conclude that, with further development, both morphology and telomere distribution may prove useful investigative tools in the fertility clinic.

P–472 Single mothers by choice - experiences of single women seeking treatment at a public fertility clinic in Denmark: A pilot study

Study question Are single women in fertility treatment stigmatised and what do they experience? Summary answer The women did not feel stigmatised. They experienced self-blame and negative thoughts about themselves, despite experiencing empowerment and receiving positive reactions from families and friends. What is known already Since 2007, medical doctors in Denmark have been permitted to offer medically assisted reproduction (MAR) also to single women. Denmark is a welfare state with a public health care sector providing MAR free of charge, 240 days of paid parental leave, and public full-time day-care. There has been an increase in the number of single women deciding to have children through the use of MAR. These women are referred to as ‘single mothers by choice’ (SMC), and they have been criticised for being selfish when raising a child without a father. Previous studies have shown how SMC can feel stigmatised. Study design, size, duration: Semi-structured qualitative interviews at a public fertility clinic in Copenhagen, Denmark. Data collection took place between September and October 2020. Participants/materials, setting, methods The participants were single and childless women (N = 6) undergoing MAR at the Fertility Clinic, Rigshospitalet in Copenhagen, Denmark. Five women received IVF and one received IUI. The women were between 30 and 40 years old and were all residents in the Capital Region of Denmark. The interviews were audiotaped, anonymised, and transcribed in full. Data were analysed using qualitative content analysis. Main results and the role of chance Single women did not differ from cohabiting women seeking MAR in relation to their experiences and attitudes towards motherhood. Four main themes were identified; (1) Experiences of single women seeking fertility treatment, (2) Emotions associated with becoming a single mother by choice, (3) The decision of becoming a single mother by choice, and (4) Family formation – a social interaction. The women would have preferred to have a child in a relationship with a partner and the shattered dream about the nuclear family has caused a wide range of experiences and emotions. The women did not feel stigmatised but they all had an awareness of the prejudices other people might have towards single mothers by choice. Hence, they were ready to defend their choice if necessary. On the other hand, they had received positive reactions and the process of becoming a single mother by choice was influenced by their social relations with family and friends. Despite their dream of the nuclear family the women choose to become SMC because motherhood was of such importance and they feared they would otherwise become too old to have children – the biological clock was ticking. Limitations, reasons for caution The participants were recruited from a public fertility clinic in the Capital Region of Denmark and may not be representative of all single women seeking MAR. Results might not be transferable to other countries with a different cultural context regarding the societal acceptance of different ways to establish a family. Wider implications of the findings: This study contributes to the understanding of the experiences of single women seeking fertility treatment in a welfare state where there are no differences in the possibilities for different social classes to seek MAR in the public health care sector. Trial registration number N/A