Infertility-related reproductive health knowledge and help-seeking behaviour in African countries

¹Correspondence address. E-mail: silke.dyer{at}uct.ac.za Data from African countries indicate that men and women attributeinfertility to traditional beliefs about health and diseaseas well as to biomedical causes, although appropriate knowledgeof the latter is frequently lacking. Infertility is a dreadedcondition and as a result help-seeking is often intense andpersistent. Most of the help-seeking is undertaken by womenand both traditional and modern biomedical health services areaccessed. There are, however, many barriers to effective andaffordable biomedical infertility care, many of which are relatedto poor resources and lack of infrastructure, and as a resultthe need for infertility treatment is often unmet. Advancesin the quality of care require greater commitment to the problemof infertility in African countries, the provision of healtheducation as an integral part of infertility management, theintegration of infertility services into reproductive healthcare programmes and defining the role of assisted reproductivetechnologies in low resource settings. At the same time theimportance of traditional health services in infertility managementshould be recognized.     

Medical and socio-cultural aspects of infertility in the Middle East

³ Correspondence address: E-mail: giserour{at}thewayout.net The Middle East (ME), an area rich in history and traditionwith >300 million population, includes 18 heterogeneous countriesconcerning resources, income per capita, available healthcareservices, population density, growth rate, birth rate, totalfertility rate and life expectancy. There is a high prevalenceof infertility in the ME because of post-partum infection, unsafeabortion, iatrogenic tubal and pelvic infertility, tuberculosis,schistosomiasis and high incidence of male factor infertility.It is argued that in the ME, the solution to the problem ofinfertility is its prevention, and population control shouldtake precedence over infertility treatment. However, for a successfulfamily planning program and adoption of small family norms,couples should be reassured that they will be helped to achievepregnancy should they decide so. Prevention and treatment ofinfertility are of particular significance in ME because a womansocial status, her dignity and self-esteem are closely relatedto her ability to have children. Also there is gender sufferingof infertility in the ME. One of the stumbling blocks to acceptanceof assisted reproductive technology (ART) as a line of treatmentof infertility was the unacceptability to the main religiousgroups of the involvement of a third party in the act of procreation.Practices of ART in the ME have many common features and littledifferences. A mechanism had to be found to provide low-costART to the needy.     

Reproductive research in non-human primates at Institute of Primate Research in Nairobi, Kenya (WHO Collaborating Center): a platform for the development of clinical infertility services?

³ Correspondence address. Tel: +32-16-34-36-24; Fax: +32-16-34-36-07; E-mail: thomas.dhooghe{at}uz.kuleuven.ac.be The Institute of Primate Research (IPR; www.ipr.or.ke) is aWHO collaborating center for research in reproductive biology,infectious diseases and ecology/conservation. It includes afully equipped surgical complex, >5000 square feet of laboratoryspace, a quarantaine facility, library, conference room, administrativeoffices, etc. More than 500 primates can be housed at IPR, mainlybaboons. Reproductive research at IPR is applied to endometriosis,assisted reproduction, prevention of heterosexual transmissionof HIV and includes the investigation of immunocontraceptivesand placental retroviruses. Reproductive research capacitiesof IPR include: videolaparoscopic surgical equipment, surgicalexperience, endometrial biopsies and uterine flushes, ovarianstimulation, laparoscopic oocyte aspiration, hormonal analysesin baboon blood and urine, sperm assessment, in vitro cultureand reproductive immunological investigations. During the lastyears, simultaneously with the development of baboon IVF, therehave been contacts with several Kenyan gynecologists at thelevel of KEMRI (Kenya Medical Research Institute), KOGS (KenyanObstetrical and Gynecological Society), Kenyatta National Hospitaland Aga Khan Hospital in Nairobi to develop clinical infertilityservices including low-budget high-quality IVF in Nairobi. Thelogic behind this initiative is that the Kenyans trained innon-human primate embryology, and IVF would be natural partnersto develop human IVF in Kenya.     

The spatiotemporal expression changes of 16 epididymis-specific genes induced by testosterone, heat, and combination treatment in cynomolgus monkey

The experimental infertility model of treatments involving testicular warming, testosterone implant, and a combination of the two was developed to confirm a synergistic action induced by the combination treatment on germ cell apoptosis in cynomolgus monkey testis. Using this model, the spatio-temporal expression changes of 16 reported or novel genes in epididymis were investigated to examine the treatment's effect on epididymal genes. It was demonstrated that these region-specific genes, some of which were not regionally fixed, changed greatly with these treatments. The expression levels of these epididymal genes fluctuated, and the expression of most of the genes returned to nearly normal level at the end of treatments. Moreover, the expression changes resulting from the combination treatment were not more significant than those resulting from the single treatment. This suggests that the combination treatment has an antagonistic action on the expression of epididymal genes and that its effect is not as adverse on epididymis as that of the two single treatments.     

Effects of vitamin E and beta-carotene on sperm competitiveness

Sperm are particularly prone to oxidative damage because they generate reactive oxygen species (ROS), have a high polyunsaturated fat content and a reduced capacity to repair DNA damage. The dietary compounds vitamin E and beta-carotene are argued to have antioxidant properties that help to counter the damaging effects of excess ROS. Here in, we tested the post-copulatory consequences for male crickets (Teleogryllus oceanicus) of dietary intake of these two candidate antioxidants. During competitive fertilisation trials, vitamin E, but not beta-carotene, singularly enhanced sperm competitiveness. However, the diet combining a high vitamin E dose and beta-carotene produced males with the most competitive ejaculates, possibly due to the known ability of beta-carotene to recycle vitamin E. Our results provide support for the idea that these two common dietary compounds have interactive antioxidant properties in vivo, by affecting the outcomes of male reproductive success under competitive conditions.     

Polymorphisms of the human PUMILIO2 gene and male sterility

The highly conserved Pumilio protein plays crucial roles in fertility of many organisms acting as a repressor of translation, and causing infertility when mutated. Although one of two human Pumilio homologs, PUMILIO2 is expressed mainly in the germ line, its role in mammalian germ cell development has not been reported yet. To shed light on the role of PUMILIO2 in development of the human male germ line, we screened this gene for mutations in 137 patients presenting a variety of phenotypes with spermatogenic failure. The first variant, we identified was a single base substitution within intron 15 (IVS15 + 6G > A). This variant was found in three azoospermic males, the second allele being the wild type. However, this variant was also present among fertile males, as frequently as in the patients. Although location of IVS15 + 6G > A substitution in close proximity to the canonical donor splice site GT, indicates that its influence on splicing cannot be excluded, our preliminary cDNA analysis has not revealed evidence of a splicing abnormality of PUMILIO2 pre-mRNA carrying this variant. Nevertheless, this study provides new interesting variant containing a donor splice site variant, which can be relevant for understanding of splicing mechanism of mammalian genes. The second variant, c.774 C > T transversion (Y258Y) in exon 6 was found only in one patient, but an influence on PUMILIO2 function is not obvious. Altogether, this study shows that variation in the PUMILIO2 gene is very low and it seems improbable that mutations of this gene significantly contribute to male infertility in humans.     

Molecular identities of human sperm proteins reactive with antibodies in sera of immunoinfertile women

Antisperm antibodies (ASA) can cause infertility in both men and women. It is important to delineate the sperm antigens against which these ASA are directed. Sperm proteins were separated by 2D gel electrophoresis and transferred to nitrocellulose membrane and incubated with sera from fertile women or immunoinfertile women having ASA. The corresponding immunoreactive peptide spots were cored from the gel and analyzed by the two-dimensional (2D) gel electrophoresis/matrix-assisted laser desoprtion ionization-time of flight-mass spectrometry and liquid chromatography-mass spectrometry (MALDI-TOF-MS/LC-MS). A total of 68 spots belonging to 38 different proteins and their isomers were identified. Fourteen of these proteins and their isomers reacted with both the fertile and immunoinfertile sera. Twenty-four of these proteins reacted specifically only with the immunoinfertile sera and not with the fertile sera. Among them was a novel protein designated as a hypothetical protein FLJ32704 (accession # Q96MA6). An immunodominant sequence (amino acid 151-159) of this protein was identified and a nonamer peptide based upon this sequence (IQTLG1TPR) was synthesized and examined for its immunoreactivity. This synthetic peptide reacted with 90% (36/40) of immunoinfertile sera and not with any of the fertile sera (0/40) in the enzyme-linked immnosorbent assay (ELISA). In conclusion, using the 2D gel electrophoresis/MALDI-TOF-MS/LC-MS procedure, we have identified several known and at least one novel antigen against which the antibodies are present in sera of immunoinfertile but not fertile women. Some of these antigens may find applications in specific diagonsis and treatment of infertility/immunoinfertility, and in the development of new generation of contraceptive modalities including contraceptive vaccines.     

Rescue of infertile transgenic rat lines by intracytoplasmic injection of cryopreserved round spermatids

Transgenic male rats carrying human alpha-lactalbumin with thymidine kinase gene (line name; LAC3) were found to be infertile due to expression of the transgene in the testes. Furthermore, it was not possible to maintain the line even by the use of intracytoplasmic sperm injection (ICSI). Therefore, round spermatids prepared from the LAC3 rats were microinjected into strontium-activated oocytes using a Piezo-driven micromanipulator. Of 263 oocytes microinjected with LAC3 spermatids, 244 (92.8%) survived the injection and 96 (39.3%) developed to the 2-cell stage. Three viable offspring were born after transfer (1.4%, 3/219), and two offspring carried the LAC3 transgene. In the control experiment using spermatids of Wistar rats, similar proportions of post-injection survival (91.3%, 241/264), cleavage (40.2%, 97/241), and development into offspring (0.5%, 1/206) were obtained. Thus, this paper reports not only the first rat offspring derived from round spermatid injection but also the practical application of the microinsemination technique to the rescue of transgenes of infertile transgenic male rats.     

"He won't be my son": Middle Eastern Muslim men's discourses of adoption and gamete donation

In the Sunni Muslim world, religious mandates prohibit both adoption and gamete donation as solutions to infertility, including in the aftermath of in vitro fertilization (IVF) failures. However, both of these options are now available in two Middle Eastern countries with significant Shi'ite Muslim populations (Iran and Lebanon). On the basis of fieldwork in multisectarian Lebanon, I examine in this article attitudes toward both adoption and gamete donation among childless Muslim men who are undertaking IVF with their wives. No matter the religious sect, most Muslim men in Lebanon continue to resist both adoption and gamete donation, arguing that such a child "won't be my son". However, against all odds, some Muslim men are considering and undertaking these alternatives to family formation as ways to preserve their loving marriages, satisfy their fatherhood desires, and challenge religious dictates, which they view as out of step with new developments in science and technology. Thus, in this article I examine the complicated intersections of religion, technology, marriage, and parenthood in a part of the world that is both poorly understood and negatively stereotyped, particularly in the aftermath of September 11, 2001.     

Low frequency of infertility among workers in a borate processing facility

In order to rule out the possibility of omitting some individuals in the study at field visits described in previous articles, either because of the reluctance of the subject or because of his appointment elsewhere, fertility and infertility states of borate workers of the Borax and Acid Plants in Bandirma, Balikesir are given. Balikesir is one of the four provinces with large borate deposits of Turkey, and Bandirma is 1 of its 19 districts. This county is relatively far away from borate deposits, and drinking water piped out through the springs has a boron amount between 0.10 and 0.82 ppm B. That the participants are occupationally exposed to the mineral in essence is therefore conceivable. At the first phase of the investigation, 191 workers were interviewed, as detailed previously. Among these, there were six infertiles of the primary type with a rate 3.1%. Boron-unrelated infertile couples among sibs were found to be 2.6–3.6%, and 3.2% for three-generation marriages—none being higher than those revealed in different sets of controls. In the second stage of work, computerized files of all workers of the facility and all employees of the general management sharing the same location were checked without an interview. Twenty-four subjects (3.4%) out of 712 workers were childless versus 2.7% among 108 employees, and 2.2% among 91 workers of a distantly located sulfuric acid plant of the same complex. The differences were not significant, and these recent findings support the conclusion already reached almost unambiguously that boron exposure at the present levels does not interfere with human reproduction.