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      Post-laparoscopy predictive factors of achieving pregnancy in patients treated for infertility

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          Abstract

          Introduction

          Laparoscopy is a long-established diagnostic and therapeutic method for treating women suffering from infertility. The application of this method of treatment can help achieve pregnancy only if there is correct classification of patients and evaluation of their partner’s reproductive capacity. The main predictors of achieving pregnancy in a couple treated for infertility are the woman’s age, her ovarian reserve, tubal patency, the presence of endometriosis and quality of sperm parameters.

          Aim

          To evaluate the effect of endometriosis, ovarian reserve and selected parameters of semen on the effect of achieving pregnancy in patients undergoing laparoscopy.

          Material and methods

          The most significant predictor of pregnancy in patients undergoing laparoscopy due to infertility was found to be anti-Mullerian hormone (AMH) level after laparoscopy, and the main parameters of semen partners were density, motility and morphology. The number of achieved pregnancies after the laparoscopic treatment of infertility was lower in patients diagnosed with endometriosis, and depended on the severity of the condition.

          Results

          As a result of laparoscopic treatment of endometriosis, we found a decrease in ovarian reserve measured by means of AMH.

          Conclusions

          The most important predictors of pregnancy in patients who underwent laparoscopy due to infertility are post-laparoscopy AMH levels and the main parameters of the partner’s semen: density, motility and morphology. The number of pregnancies after laparoscopic treatment is lower in patients diagnosed with endometriosis, and depends on the severity of the conditio.

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          Most cited references 16

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          Predictive value of normal sperm morphology: a structured literature review.

          The aim of the study was to conduct a structured review of the literature published on the use of normal sperm morphology, as an indicator of male fertility potential in the in-vitro fertilization (IVF) situation, and to establish the universal predictive value of this semen parameter. Published literature in which normal sperm morphology was used to predict fertilization and pregnancy, during the period 1978-1996, was reviewed. A total of 216 articles were identified by the sourcing methodology, but only 49 provided data that could be tabulated and analysed. Of these, only 18 provided sufficient data for statistical analysis. Fifteen studies used the strict criteria to evaluate sperm morphology, two used World Health Organization (WHO) guidelines and one used both the strict criteria and the WHO guidelines. All the studies (n = 10) using the 5 and 14% normal sperm morphology thresholds (strict criteria) produced positive predictive values for IVF success. In the prediction of pregnancy, 82% (9/11) and 75% (6/8) of the studies produced positive predictive values when using the 5% and 14% thresholds respectively. Aggregating the data produced around the 5% normal sperm morphology threshold (strict criteria), the overall fertilization rates were 59.3% (1979/3337; per oocyte) for the 4% group, and the overall pregnancy rates were 15.2% (60/395; per cycle) and 26.0% (355/1368; per cycle) respectively. The no-transfer rates across the 5% threshold were 24.0% (86/359; per cycle) in the 4% group. The inclusion of an accurately evaluated normal sperm morphology count as an integral part of the standard semen analysis makes this analysis still the most cost-effective means of evaluating the male factor.
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            Infertility in the light of new scientific reports - focus on male factor.

            Epidemiological data indicate that infertility is a problem of global proportions, affecting one- fifth of couples trying to conceive worldwide (60-80 mln). According to the trends observed, the problem is predicted to increase by another two million cases annually. In Poland, infertility-related issues are found in about 19% of couples, including 4% with infertility and 15% with limited fertility. Inability to conceive occurs equally in men and women (50%), irrespective of the direct cause. Although it is generally thought that reproductive issues concern women, infertility affects men and women equally. This study is an attempted to systematize knowledge about the role of the male factor in infertility, particularly current knowledge concerning the environmental factors of infertility. For this purpose, the Medline and CINAHL databases and the Cochrane Library was searched for articles published in English during the last 10 years, using the following keywords: infertility, male factor, semen examination and environmental factor of infertility.
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              • Article: not found

              WHO laboratory manual for the examination and processing of human semen

               WHO WHO (2010)
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                Author and article information

                Journal
                Wideochir Inne Tech Maloinwazyjne
                Wideochir Inne Tech Maloinwazyjne
                WIITM
                Videosurgery and other Miniinvasive Techniques
                Termedia Publishing House
                1895-4588
                2299-0054
                16 December 2016
                2016
                : 11
                : 4
                : 253-258
                Affiliations
                [1 ]Diagnostic Techniques Unit, Medical University of Lublin, Lublin, Poland
                [2 ]International Scientific Association for the Support and Development of Medical Technologies, Poland
                [3 ]Gynecology and Obstetrics Ward – Independent Public Healthcare Center, Puławy, Poland
                [4 ]Department for Women’s Health, Institute of Rural Health, Lublin, Poland
                Author notes
                Address for correspondence Artur Wdowiak MD, Diagnostic Techniques Unit, Medical University of Lublin, 4 Staszica St, 20-081 Lublin, Poland. phone: +48 604 328 383. e-mail: wdowiakartur@ 123456gmail.com
                Article
                28914
                10.5114/wiitm.2016.64640
                5299084
                Copyright: © 2016 Fundacja Videochirurgii

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                Categories
                Original Paper

                infertility, sperm, laparoscopy, endometriosis

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