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Objectives To examine the risks of neonatal and infant mortality in relation to infertility treatment and to quantify the extent to which preterm delivery mediates this relationship. Design Cross-sectional study. Setting United States, 2015–2018. Patient(s) A total of 14,961,207 pregnancies resulting in a singleton live birth. Intervention(s) Any infertility treatment, including assisted reproductive technology and fertility-enhancing drugs. Main Outcome Measure(s) Neonatal ( Result(s) Any infertility treatment was documented in 1.3% (n = 198,986) of pregnancies. Infertility treatment was associated with a 51% increased risk of neonatal mortality (RR 1.51, 95% CI 1.39–1.64), with a slightly higher risk for early neonatal mortality (RR 1.57, 95% CI 1.43–1.73) than late neonatal mortality (RR 1.33, 95% CI 1.11–1.58). These risks were similar for pregnancies conceived through assisted reproductive technology and fertility-enhancing drugs. The mediation analysis showed that 72% (95% CI 59–85) of the total effect of infertility treatment on neonatal mortality was mediated through preterm delivery. In a sensitivity analysis, following corrections for exposure misclassification and unmeasured confounding biases, these risks were higher for early, but not for late, neonatal mortality. Conclusion(s) Pregnancies conceived with infertility treatment are associated with increased neonatal mortality, and this association is largely mediated through preterm delivery. However, given the substantial underreporting of infertility treatment, these associations must be cautiously interpreted.

The long and challenging drug development process begins with discovery biology for the selection of an appropriate target for a specific indication. Target is a broad term that can be applied to a range of biological entities such as proteins, genes, and ribonucleic acids (RNAs). Although there are numerous databases available for mining biological entities, publicly available searchable, downloadable databases to aid in target selection for a specific disease or indication (e.g., developing contraceptives and infertility treatments) are limited. We report the development of the Contraceptive and Infertility Target DataBase (https://www.citdbase.org), which provides investigators an interface to mine existing transcriptomic and proteomic resources to identify high-quality contraceptive/infertility targets. The development of similar databases is applicable to the identification of targets for other diseases and conditions.

Background: Previous studies have examined the factors that predict whether a patient will discontinue infertility treatments. However, little is known about a patient’s chances of pregnancy after dropping out.Method: Drawing from a nationwide Internet survey in Japan with 1,930 respondents, we used data from 199 individuals (109 women and 90 men) who had undergone an infertility treatment. Besides conducting a descriptive analysis to examine the probability of pregnancy after the treatment, we estimated linear probability models to investigate the extent to which the probability of pregnancy was affected by dropping out after controlling for a couple’s attributes.Results: Among the 199 respondents who had experienced an infertility treatment, 91 (45.7% of the entire sample) became pregnant during the treatment, and 108 (54.3%) dropped out. Among these 108 dropouts, 66 (33.2%) eventually became pregnant. After controlling for a couple’s attributes, we found that treatment discontinuation reduced the probability of pregnancy by 35.4% (standard error: 5.0%). A relatively limited reduction in the chances of pregnancy was also observed after a patient dropped out of any of the three treatment stages (timed intercourse, artificial insemination with the husband’s semen, and in vitro fertilization).Conclusions: The results suggest that dropping out from infertility treatments does not preclude any chance of a future pregnancy; in fact, the chances remain relatively high. Further analysis of a patient’s chances of pregnancy after dropping out is required to evaluate the effectiveness of infertility treatments appropriately. Additionally, more follow-up attention should be provided to dropout patients.

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it.

PURPOSE OF REVIEW This article highlights the multiple intersections between obstetric/gynecologic issues and neurologic disorders. RECENT FINDINGS Neurologic issues can arise related to contraceptive medications, infertility treatments, pregnancy, and menopause. This article explores these areas in chronologic order, beginning with women's neurologic conditions that overlap their reproductive years and those that may occur during pregnancy and continuing through menopause. For each disorder, the epidemiology, pathophysiology, complications, and best sex-based treatment are described. Recent findings and treatments are highlighted. SUMMARY Obstetric and gynecologic disorders may present with neurologic symptoms, so it is important for neurologists to understand these intersections to deliver the best care for our female patients.

Although infertility is now recognized as a disease by multiple organizations including the World Health Organization and the American Medical Association, private insurance companies rarely include coverage for infertility treatments. In this review, the authors assess the current state of care delivery for male infertility care in the United States. They discuss the scope of male infertility as well as the unique burdens it places on patients and review emerging market forces that could affect the future of care delivery for male infertility.

The great rubella epidemic has been sometimes occurred in Japan. We compared the prevalence of rubella antibody in women with pregnancies conceived by infertility treatments and those conceived spontaneously. We reviewed the obstetric records of the Japanese nulliparous women with pregnancies conceived by infertility treatments who had deliveries at Japanese Red Cross Katsushika Maternity Hospital from 2014 to 2018. There were no significant differences in the rate of women whose rubella antibody titer < 8 or < 32, respectively between the 2 groups with pregnancies conceived by infertility treatments and conceived spontaneously (titer < 8: 4.1 vs. 3.4%, p = 0.58: titer < 32: 17.3 vs. 15.3%, p = 0.45). It is necessary to thoroughly implement the preconception care concerning the risk of congenital rubella infection for women who are undergoing infertility treatments especially in Japanese obstetricians., Journal of Preventive Medicine and Hygiene, Vol. 61 No. 4 (2020): 2020614

The concept that a father’s wellbeing at the time of conception influences the development and long-term health of his offspring is now well established. However, the mechanisms underlying the paternal programming of offspring health are not fully defined. While sperm-mediated effects on offspring development have been investigated in detail, the significance of seminal plasma has been over-looked. Typically, the seminal plasma is viewed as a simple medium, with a main role to transport sperm into the female reproductive tract at the time of conception. However, a more sophisticated role for seminal plasma in the modulation of the maternal periconception cell-signalling, inflammatory and immunological physiology is emerging. Seminal plasma comprises a complex mix of nutrients, proteins, signalling molecules and cell-free genetic material which all interact with the endometrium to regulate gene expression, vascular remodelling, leukocyte recruitment and the priming of regulatory T cells (Tregs). These seminal plasma effects on the maternal periconception environment all act to facilitate uterine remodelling, embryo implantation and fetal development. Evidence is now emerging that poor paternal lifestyle factors such as diet, can modify these essential uterine responses, altering fetal development and ultimately long-term offspring health. The use of animal models has enhanced our understanding of the effects of seminal plasma on maternal uterine physiology, embryo development and offspring health. However, further studies are needed to define the interaction between seminal plasma components and female reproductive tissues in humans. Such studies will be central in providing better information and infertility treatments to intending parents.

Obstacles in health-care service delivery and attitudinal barriers contribute to women being vulnerable to increased social and psychological costs resulting from infertility in developing countries. The present study uses quantitative data to examine women’s infertility experiences and its impact on their quality of life (QoL). Women seeking infertility treatments from reproductive health-care centres in Baluchistan, Pakistan participated in the study. Findings demonstrate that infertility has a significant influence on women’s health and QoL, irrespective of age, education, years in marriage, economic background and types of infertility. Given that women also experience several additional social consequences of infertility, such as a husband’s second marriage, fear of divorce, intimate-partner violence, social stigma and family pressure for a male child, social workers must comprehend the economic, social and cultural factors associated with infertility and its influence on health status and QoL. Findings have implications for prioritising an integrative intervention plan at the micro, mezzo and macro levels of practice to address the gaps and inequalities in the health care of infertile couples.

The conclusion of the Human Fertilisation and Embryology Authority that ‘add-on’ therapies in IVF are not supported by high-quality evidence has prompted new questions regarding the role of the randomized controlled trial (RCT) in evaluating infertility treatments. Critics argue that trials are cumbersome tools that provide irrelevant answers. Instead, they argue that greater emphasis should be placed on large observational databases, which can be analysed using powerful algorithms to determine which treatments work and for whom. Although the validity of these arguments rests upon the sciences of statistics and epidemiology, the discussion to date has largely been conducted without reference to these fields. We aim to remedy this omission, by evaluating the arguments against RCTs in IVF from a primarily methodological perspective. We suggest that, while criticism of the status quo is warranted, a retreat from RCTs is more likely to make things worse for patients and clinicians.

Acquiring oocyte competence requires optimal mitochondrial function and adequate ATP levels. In this context, CoQ10 supplementation may improve human oocyte quality and subsequent reproductive performance given its role in ATP synthesis and mitochondrial protection from ROS oxidative damage. In infertility treatments, CoQ10 therapy can be orally supplied to promote a more favorable environment for oocyte development in vivo or by its addition to culture media in an attempt to improve its quality in vitro. Human clinical studies evaluating the impact of CoQ10 on reproductive performance are summarized in this review, although the available data do not clearly prove its ability to improve human oocyte quality. The main objective is to provide readers with a complete overview of this topic’s current status as well as the keys for potential future research lines that may help to take this therapy to clinical practice. Indeed, further clinical trials are needed to confirm these results along with molecular studies to evaluate the impact of CoQ10 supplementation on oxidative stress status and mitochondrial function in human gametes.

Study question Is maternal infertility treatment associated with an increased risk of neonatal and infant mortality when compared to natural conception? Summary answer Infertility treatment is associated with a 70% increased adjusted risk of neonatal mortality. This association is strongly mediated by preterm delivery. What is known already The number of assisted reproduction technology (ART) cycles performed in the United States (US) increased by 39% from 142,435 cycles in 2007 to 197,737 in 2016. Within this growing experience, several studies described an increased risk of preterm delivery, low birth weight, congenital malformations, neonatal intensive care unit admission, stillbirth, and perinatal mortality among singletons conceived through ART compared to those conceived naturally. Experts have called for ART patients to be advised of potential increased risk for adverse perinatal outcomes and for obstetricians to manage these pregnancies as high risk. Study design, size, duration This is a cross-sectional study of 11,289,466 pregnancies in the United States (US) from 2015–2017 that resulted in a non-malformed singleton live birth. The exposure group includes births resulting from any infertility treatment method, including ART and fertility-enhancing drugs. The control group includes births resulting from natural conceptions. The primary outcomes measured were neonatal (within 1 month), post-neonatal (1 month to a year), and infant (up to 1 year) mortality. Participants/materials, setting, methods Pregnancies (n = 11,289,466) resulting in a non-malformed singleton live birth in the US from 2015–2017. Associations were estimated from log-linear Poisson regression models with robust variance. Risk ratio (RR) and 95% confidence interval (CI) were derived as the effect measure with adjustments for confounders. The impact of exposure misclassification and unmeasured confounding biases were assessed. A causal mediation analysis of the infertility treatment-mortality association with preterm delivery ( Main results and the role of chance Any infertility treatment was documented in 1.3% (n = 142,215) of singleton live births during the study period. Any infertility treatment was associated with a 70% increased adjusted risk of neonatal mortality (RR 1.70, 95% CI 1.54–1.88), with an even higher risk for early neonatal (RR 1.82, 95% CI 1.63–2.05) than late neonatal (RR 1.37, 95% CI 1.11–1.69) mortality. These risks were similar among pregnancies conceived through ART and treatment with fertility-enhancing drugs. The mediation analysis showed that 68% (95% CI 59–81) of the total effect of infertility treatment on neonatal mortality was mediated through preterm delivery. In a sensitivity analysis, following corrections for exposure misclassification and unmeasured confounding biases, these risks were higher for early neonatal (bias-corrected RR [RRbc] 2.94 95% CIbc 2.16–4.01), but not for late neonatal (RRbc 1.04, 95% CIbc 0.68–1.59) mortality. Limitations, reasons for caution Limitations of the study include the potential underreporting of infertility treatment on birth certificates and potential confounding from sociodemographic characteristics that were not accounted for in this study. Wider implications of the findings: Pregnancies conceived with infertility treatment are associated with increased neonatal mortality and this association is mediated by the increased risk of preterm delivery. Knowledge of this risk should be shared with prospective couples consulting for fertility care in order to best provide adequate informed consent. Trial registration number Not applicable

Background: Many infertile couples seek Assisted Reproductive Technologies (ART) to achieve pregnancy. However, a high proportion of them dropout treatment due to different reasons. In the present study we aimed to evaluate the dropout/continuity rate of infertility treatments and related factors among Iranian couples.Methods: The present retrospective cohort study was conducted on 380 eligible infertile women in four groups (95 people in each group) based on causes of infertility (male, female, unexplained, both) from April 2018 to March 2019 in infertility centers of Qom. The individuals had at least one unsuccessful IVF/ICSI (In Vitro Fertilization/ Intra Cytoplasmic Sperm Injection) or FET (Frozen Embryo Transfer) cycle. Participants were considered as treatment discontinuer if they did not refer to the infertility clinics at least six months after the failure of treatment. The research data were collected using medical records and telephone interviews.Results: Incidence dropout rate of infertility treatments was 42.9%. Related factors in dropout were number of unsuccessful treatments (PConclusions: Dropout rate of infertility treatments was relatively high; and some demographic factors were associated with treatment continuation. It seems that couples, who have primary infertility and one unsuccessful infertility treatment, were at a greater risk of dropout and its consequences. This phenomenon can be due to the lack of awareness and adequate information.

Hidradenoma papilliferum (HP) is a benign pathologic finding that has been described primarily in the vulvar region. While thought to arise from ectopic tissue along the mammary line, it is now known to also arise from mammary-like anogenital glands (MLG), which are part of the normal anogenital cellular and glandular milieu. Previous work has demonstrated the relationship between HP and hormone receptors, but this has not been documented in a clinical setting. In this case, we present HP in a patient undergoing infertility treatments, presenting with a painful, enlarging anal mass. Upon histopathologic review, the mass was found to be an HP with no malignant changes. This unique case adds to the existing literature on perianal HP. While this case follows the known clinical and histological patterns of HP, the unique temporal relationship to in vitro fertilization (IVF) treatment supports previous in vitrowork on the relationship between HP and hormone receptors.

This piece of work aims to provide a clear picture of the available alternatives to the intending infertilecouples and how far surrogacy is acceptable as an alternative to the prolonged infertility treatments thatultimately lead to depression symptoms like anxiety and other expressed emotional patterns. It’s a bestowedpower on women to cherish the experience of motherhood but unfortunately not all the women are luckyenough to conceive and enjoy the joyous feeling of being a mother and experiencing motherhood. It’susually a dubious decision to make for the intending infertile couples whether to continues with the infertilitytreatments to have a child of their own or opt for an alternative like Surrogacy or Adoption. This article statesthe need of taking up an alternative before it’s too late and emphasizes on the reasons for taking up surrogacyas an alternative above the other available ones and also mentions the reasons why couples do not opt forsurrogacy so that one takes care of the same while choosing the same. The procedure to be followed by suchcouples while selecting this alternative has also been stated so that they find themselves in a better positionthan the once suffering to get through.

A childless woman who lives in a society with pronatalist values can be in a vulnerable position. In 2006, only 1.9% of Lithuanians expressed positive attitudes about childlessness, and 84.6% valued it negatively (Stakuniene and Maslauskaite 2008), signalling the pronatalist tendency of Lithuanian society. However, some studies confirm a shift from traditional to more individualistic familial attitudes (Kanopienė et al. 2015). This chapter investigates the relationship between childless women from two generations in Lithuania and the children of these women’s relatives or friends. The analysis is based on 40 semi-structured qualitative interviews conducted in 2017–2018 with single and coupled women between the ages of 28 and 71 who are voluntarily and involuntarily childless. The women of reproductive age were considering their intentions to have or not have children in the future, and some were going through infertility treatments; women over 50 reflected on permanent childlessness. Most of the interviewed women were involved in taking care of their siblings’ or close relatives’ children during a period in their lives, and in some cases, these women became substitute parents. Only a few women stated that they avoided contact with children in their personal lives.

Motility is one of the most important factors in sperm migration toward egg. Therefore, sperm separation based on motility increases the chance of the best sperm selection in the process of infertility treatments. Unfortunately, it is now vastly done by conventional procedures which lack certain delicacy and precision and increase the risk of damage to sperm cells. Microfluidic systems, on the other hand, can sort sperm in a less intrusive way. However, microfluidic techniques have yet to receive widespread adoption in clinical settings, not only due to their relatively cumbersome operation, but also their extremely low outcome, leaving them inefficient in practice. Here we propose a microchamber-based microfluidic platform that can separate progressive motile sperm from nonviable sperm and debris as well as trapped nonprogressive sperm in the microchambers. Our platform is operated in a short period of time (Significance StatementAssisted Reproductive Technologies require efficient, minimally invasive, and fast methods of sperm separation. Centrifugation methods used in clinics and biological research labs, fall short in these aspects as they are low-yield, intrusive to sperm’s DNA, and time consuming. We have developed a microchamber-based microfluidic platform for high-throughput separation of progressive motile sperm from undiluted raw semen samples. The method was further optimized to increase the concentration of collected samples. Higher concentration of collected samples combined with higher motility of the separated sperm compared to those in raw semen, make it a suitable choice in clinical applications, fertility diagnostics, and fundamental research.

For most infertile couples, in vitro fertilization (IVF) represents the only chance to conceive. Given the limited success of IVF procedures, novel approaches are continuously tested with the aim of improving IVF outcomes. Growing attention is devoted today to the potential benefit of natural antioxidants in the optimization of infertility treatments. This review summarizes current data in this context, focusing on both experimental studies on oocytes/embryos and clinical trials on antioxidants supplementation. Based on information gained from experimental studies, antioxidant supplementation may have beneficial effects on IVF outcomes in terms of quality and cryotolerance of in vitro produced embryos, together with positive effects on in vitro maturation oocytes and on early embryonic development. Unfortunately, from the clinical side, there is a paucity of evidence favoring the protective qualities of antioxidants. Among the antioxidants considered, coenzyme Q10 may be regarded as one of the most promising for its positive role in rescuing the oxidative stress-induced damages, but further data are needed. It is concluded that further trials are necessary to characterize the potential clinical value of antioxidants in IVF treatments.

Real-world data regarding live birth rates (LBRs) and infertility in women with multiple sclerosis (MS) are lacking. This study compared LBRs, infertility diagnoses, and infertility treatments in women with and without MS.Using a retrospective US administrative claims database, patients 18-55 years with MS were matched 1:1 to patients without MS to compare LBRs, infertility diagnoses, and infertility treatments used between cohorts.Overall LBRs were lower in women with MS (n=96,937) versus women without (n=96,937; 5.0% vs 7.0%; p0.0001). A greater proportion of women with MS than without had a diagnosis of infertility (8.5% vs 8.1%; p=0.0006). Fewer women with MS than without used any infertility treatment (1.0% vs 1.2%; p=0.0002). Among women with or without MS who received infertility treatments, no significant difference was observed in LBRs with oral (32.2% vs 31.5%; p=0.8536) or injectable (44.0% vs 49.3%; p=0.2603) treatment.Women with MS had a lower LBR, received more infertility diagnoses, and were less likely to receive infertility treatment than women without MS. There was no difference in LBRs following infertility treatment. Claims-data studies provide valuable exploratory analyses that reflect interactions between patients and the healthcare system.

Polycystic ovary syndrome (PCOS) is a common cause of female infertility affecting multiple aspects of a women's health.The aim of this review is to summarize the existing evidence on the treatment of PCOS patients and to examine the actual available therapies to overcome the problem of infertility and improve the outcome of pregnancy. We analyse different treatment strategies such as lifestyle modification, bariatric surgery, insulin sensitizing agents, inositol, clomiphene citrate (CC), aromatase inhibitors, gonadotrophins, laparoscopic ovarian drilling, and assisted reproductive techniques (ART).Lifestyle modification is the best initial management for obese PCOS patients seeking pregnancy and insulin sensitizing agents seem to have an important role in treating insulin resistance. Up to now, CC maintains a central role in the induction of ovulation and it has been confirmed as the first-line treatment; the use of gonadotrophins is considered the second-line in CC resistant patients; laparoscopic ovarian drilling is an alternative to gonadotrophins in patients who need laparoscopy for another reason. However, in anovulatory patients, ART represents the only possible alternative to obtain pregnancy. Larger and well-designed studies are needed to clarify the best way to improve the outcome of pregnancy in PCOS women.

Uterus transplantation (UTx) is the only available treatment for absolute uterine factor infertility (AUFI), which is caused by either absence (congenital or after hysterectomy) or presence of a non-functioning uterus. Uterus transplantation became a clinical reality after more than 10 years of structured animal-based research. Aside from gestational surrogacy, this procedure is the only alternative for women with AUFI to attain genetic motherhood. In the Middle East, North Africa and Turkey (MENAT) region, out of a population of around 470 million, more than 100,000 women of fertile age are estimated to suffer from AUFI. Introduction of UTx as an infertility treatment in this region will certainly differ in specific countries from ethical, religious and legal standpoints depending on culture and religion. The MENAT region is the cradle of three religions and the geographic area encompasses a variety of cultures and religions with different views on assisted reproduction. In light of these issues, the aim of this article is to give an overview of the research-based development of UTx and its clinical results up until today as well as to explore how UTx would fit into current infertility treatments in the MENAT region, with its existing multifaceted religious perspectives.

Multiple sclerosis (MS) is an autoimmune inflammatory disorder of the central nervous system. It is common in the reproductive period and can lead to infertility and significant disability. The treatment on multiple sclerosis is recently more successful and enables better quality of life, therefore rising hope and desire for the future parents, also in terms of successful infertility treatments. In this context the couples should be managed concerning the detrimental effect of the disease itself on fertility, detrimental effect of the drugs used for treatment on gonads and in terms of the implementation of drugs used for ovarian stimulation and their impact on the basic disease (MS). Article finds solutions on the legal outcomes in situations where infertility treatments may negatively impact the progress of MS, as well as the solutions on how to (successfully) provide infertility treatments to the patients with MS. It proposes interdisciplinary approach between gynecologists and neurologists to perform required weighting of benefits and risks (burdens), deriving from specific action or treatment, whereas for the patients who shall not undergo infertility treatments due to their medical status, related to MS, it proposes storage of gametes under conditions, set by the law.

A couple is considered to be infertile if unable to conceive after 12 months of unprotected sexual intercourse. An extended body of literature supports that infertility and infertility treatments contribute to emotional, social, sexual, and relational issues that can have a negative impact on each partner's well-being and on the couple relationship. Recent findings suggest that a dyadic approach should be used when working with couples coping with these stressors. However, most research to date has focused on the association between infertility and individual's psychological outcomes, rather than on the experience of infertility-related stress and coping from a relational perspective. Consequently, assuming that infertility is a dyadic stressor and that the ability of the partners to cope with this experience is the result of both individual and relational coping strategies, this study aimed to investigate dyadic coping and marital adjustment among couples at the beginning of an Assisted Reproductive Technology (ART) treatment. A sample of 167 heterosexual couples (N = 334) undergoing ART treatment at the fertility clinic of a large hospital in Milan from January to December 2017 was recruited. Each participant completed self-reported questionnaires examining marital adjustment (Dyadic Adjustment Scale) and dyadic coping (Dyadic Coping Questionnaire). Demographics and clinical variables were also collected. Data were analyzed using the Actor Partner Interdependence Model (APIM), testing the effect of each partner's dyadic coping style on their own and their partner's marital adjustment. Results revealed that both women and partners' scores on positive dyadic coping styles (common, emotion-focused, problem-focused, and delegated dyadic coping) contributed to higher marital adjustment. This result suggests that couples unable to engage in this type of reciprocal supportive behaviors and those unsatisfied with their coping efforts may be more vulnerable while undergoing ART treatments. Furthermore, findings highlighted some gender differences for stress communication and negative dyadic coping suggesting the presence of specific dynamics within couples facing an ART treatment. Implications for clinical practice and future research are discussed.

Sildenafil has had a dramatic influence on the field of sexual medicine over the past 20 years. Not only have phosphodiesterase-5 (PDE5) inhibitors improved the treatment of erectile dysfunction (ED), they have indirectly contributed to the treatment of male factor infertility. A review of the literature between 1998 - 2018 was performed using PubMed with regards to sildenafil and male infertility. Numerous studies have demonstrated sildenafil’s safety and efficacy for treating ED. Sildenafil does not alter semen parameters, and, in fact, may positively affect semen parameters. Sildenafil is helpful for treating ED caused by the psychological stress of infertility treatments. Sildenafil has improved the treatment of ED and may have a benefit on semen parameters. This has aided in the management of male factor infertility, and has contributed to hundreds of thousands of pregnancies that would have been more difficult, as it was before its advent.