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ORIGINAL ARTICLE
Sumi Thomas, Vivek P Vithayathil, Achamma Chandy, Thaiparambil K Aleyamma, Mohan S Kamath

Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:93-96][No of Hits : 611]


ABSTRACT

Introduction: Ovulation induction in women with polycystic ovarian syndrome (PCOS) can be carried out with drugs, such as clomiphene citrate (CC), which remains the first-line treatment option, and surgery, such as laparoscopic ovarian drilling (LOD), which is usually recommended as one of the second-line treatment options. Laparoscopic ovarian drilling may avoid or reduce the need for gonadotropins and at the same time reduce ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.

Aim: We aimed to evaluate the effectiveness of LOD in clomiphene- resistant women and to identify the clinical factors that might predict its success.

Study design: Retrospective analysis in a tertiary level infertility unit.

Materials and methods: All CC-resistant PCOS women who underwent LOD over a 10-year period were included. Polycystic ovarian syndrome was defined as per the Rotterdam criteria. The follow-up period was up to 3 years post-LOD. Outcomes, such as onset of regular cycles, spontaneous pregnancies, and live births were recorded.

Results: A total of 59 PCOS women who underwent LOD and were available for follow-up were included in the study. Majority of the patients were less than 30 years of age with a body mass index (BMI) > 24 kg/m2. Out of those, 12 conceived (20.3%) spontaneously and 14 (23.7%) had regular menstrual cycles after the procedure. The live birth rate was 16.9% (10/59). We did not find any association of clinical factors, such as age, BMI, type of infertility, and history of irregular cycles with LOD success.

Conclusion: Laparoscopic ovarian drilling can be offered as a treatment option in select group of CC-resistant women with reasonable success. Post-LOD, for those who do not have resumption of regular cycles, alternate method of ovulation induction can be initiated.

Keywords: Clomiphene resistance, Laparoscopic ovarian drilling, Polycystic ovarian syndrome.

How to cite this article: Thomas S, Vithayathil VP, Chandy A, Aleyamma TK, Kamath MS. Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis. Int J Infertil Fetal Med 2017;8(3):93-96.

Source of support: Nil

Conflict of interest: None

Date of received: 02/07/2017

Date of acceptance: 29/08/2017

Date of publication: November 2017


 
ORIGINAL ARTICLE
Purvi K Khanuja, Juby A Sunny, Sunita B Pawar, Vandana Nimbargi

Study on Infertility—Etiology, Medication Therapy Management, and Outcomes at a Tertiary Care Hospital

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:106-112][No of Hits : 582]


ABSTRACT

Aim: The aim of the article is to study infertility—etiology, medication therapy management, and outcomes in a tertiary care hospital.

Objectives: The purpose of this study was to compare the outcomes of standard aetiology wise treatment protocols of infertility and the various causes which may be a contributing factor to infertility.

Materials and methods: A prospective observational study was conducted for 6 months at a tertiary care hospital. Couples diagnosed with infertility, aged 18 to 49 years were enrolled in the study. Details like couple’s sociodemographic data, etiology, risk factors associated with infertility, management with current medications, procedures, and outcomes were documented using predesigned infertility proforma.

Results: Females had an age group of 19 to 38 years with an average age and standard deviation (SD) of 25.64 ± 4.07 years, whereas male patients had an age of 24 to 43 years with a mean age and SD of 30.59 ± 4.17 years. Primary infertility was 59.13% and secondary infertility 40.86%. In women with infertility, ovulatory disorders were the chief cause, followed by unexplained factor, uterine tubal, and more than one cause, whereas in males semen abnormalities were the major cause of both primary and secondary infertility, followed by unexplained, anatomical, more than one cause. Medical therapy involving drugs like clomiphene, gonadotropins, and a combination was administered to females. Males received lycopene, L-carnitine, ubidecarenone, zinc, and astaxanthin. Intrauterine insemination (IUI) was performed in 28 patients. From the available data of 100 couples undergoing management for infertility in the 6 months study period, 19 patients conceived, i.e., 19% showed conception.

Conclusion: The present study shows etiological and pathological causes of infertility. The study highlights positive results with standard treatments.

Clinical significance: To identify hidden social, medical, pathological, and other confounding causes leading to infertility.

Keywords: Clomiphene, Gonadotropins, Intrauterine insemination, Observational study, Ovulation induction, Primary infertility, Secondary infertility.

How to cite this article: Khanuja PK, Sunny JA, Pawar SB, Nimbargi V. Study on Infertility—Etiology, Medication Therapy Management, and Outcomes at a Tertiary Care Hospital. Int J Infertil Fetal Med 2017;8(3):106-112.

Source of support: Nil

Conflict of interest: None

Date of received: 09/07/2017

Date of acceptance: 12/08/2017

Date of publication: November 2017


 
ORIGINAL ARTICLE
Shipra Nigam, Kundavi Shankar, Thankam R Varma

Role of Low-dose Human Chorionic Gonadotropin in Follicular Phase for Thin Endometrium in Frozen Embryo Replacement Cycles in in vitro Fertilization/ Intracytoplasmic Sperm Injection Patients: A Pilot Study

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:101-105][No of Hits : 567]


ABSTRACT

Introduction: One of the most challenging problems in in vitro fertilization (IVF) is patient with thin endometrium. The objective of the study was to ascertain whether daily human chorionic gonadotropin (hCG) for 7 days with estrogen in hormone replacement frozen embryo transfer (FET) cycles during follicular phase can increase the endometrial thickness (ET) and reduce the cancellation of cycles.

Materials and methods: Twenty-five infertile patients with resistant thin endometrium who had antagonist protocol and planned for frozen embryo replacement were recruited. These patients had prior attempts to thicken their endometrium which had failed. All the patients received estrogen daily from D2/3 of cycle. On day 8 or 9 of estrogen administration, 200 IU of hCG was given daily for 7 days. After 7 days on hCG priming (D14/15), ET was measured and progesterone was started accordingly. Identification of an intrauterine gestational sac with fetal heart beat by transvaginal ultrasonography constituted clinical pregnancy.

Results: Mean ET increased significantly from 5.84 to 7.61 mm (p < 0.01). About 72% of patients had more than 20% improvement in their ET after hCG priming. About 76% achieved an ET more than 7 mm. Overall, 50% became pregnant. The ongoing pregnancy rate was 40%.

Conclusion: A total of 200 IU hCG endometrial priming for 7 days in the proliferative phase of hormone replacement cycles for FET is a highly promising approach to thicken thin endometrium with failed prior attempts.

Keywords: Human chorionic gonadotropin in in vitro fertilization/ intracytoplasmic sperm injection cycles, Human chorionic gonadotropin, Thin endometrium.

How to cite this article: Nigam S, Shankar K, Varma TR. Role of Low-dose Human Chorionic Gonadotropin in Follicular Phase for Thin Endometrium in Frozen Embryo Replacement Cycles in in vitro Fertilization/Intracytoplasmic Sperm Injection Patients: A Pilot Study. Int J Infertil Fetal Med 2017;8(3):101-105.

Source of support: Nil

Conflict of interest: None

Date of received: 21/06/2017

Date of acceptance: 17/07/2017

Date of publication: November 2017


 
CASE REPORT
Harsha Bhadarka, Nayana H Patel, Yuvraj D Jadeja, Kruti B Patel, Niket Hitesh Patel, Molina N Patel

First Case of Successful Implantation and Live Birth after Double Trophectoderm Biopsy before and after Vitrification on the Same Cohort of Blastocyst

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:120-124][No of Hits : 545]


ABSTRACT

Introduction: To report the first case of live birth after double trophectoderm biopsy before and after vitrification on the same cohort of blastocyst in our knowledge.

Design: Case report.

Patient: A 36-year-old female with a history of 13 years of active married life for treatment of infertility.

Main outcome measure: Live birth after double trophectoderm biopsy.

Results: Double biopsy pre- and postvitrification and its positive outcome.

Conclusion: Preimplantation genetic screening and diagnosis (PGS/PGD), though an invasive procedure on the embryos, when done meticulously would not dampen the implantation potential of the embryo and second biopsy could be a feasible option to salvage embryos with inconclusive or suspected falsepositive PGS/PGD reports.

Keywords: Blastocyst, Double trophectoderm biopsy, In vitro fertilization/intracytoplasmic sperm injection, Preimplantation genetic screening and diagnosis, Vitrification.

How to cite this article: Bhadarka H, Patel NH, Jadeja YD, Patel KB, Patel NH, Patel MN. First Case of Successful Implantation and Live Birth after Double Trophectoderm Biopsy before and after Vitrification on the Same Cohort of Blastocyst. Int J Infertil Fetal Med 2017;8(3):120-124.

Source of support: Nil

Conflict of interest: None

Date of received: 19/07/2017

Date of acceptance: 07/08/2017

Date of publication: November 2017


 
ORIGINAL ARTICLE
Rishi R Vohra, Shivam Priyadarshi, Neeraj Aggarwal, Nachiket Vyas, Sher S Yadav, Vinay Tomar

Study to evaluate Association of Tobacco Chewing and Smoking with Semen Parameters

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:97-100][No of Hits : 521]


ABSTRACT

Introduction: Many studies have shown deleterious effects of tobacco abuse in any form on semen quality. We studied the association of tobacco chewing, smoking, and their combination on semen characteristics.

Materials and methods: Our study was performed on 216 normal asymptomatic healthy males (49 controls, 54 smokers, 55 tobacco chewers, and 58 consuming both) in the age group of 24 to 35 years. The effect on semen parameters was analyzed.

Results: Consuming both forms of tobacco individually and in combination had statistically significant effect on sperm morphology, progressive motility, and semen concentration. Other parameters show nonstatistically significant decline compared with controls.

Conclusion: As smoking and chewing tobacco negatively affect quality of semen, strategies should be developed to direct attention of the general population toward its effect on fertility status of male.

Keywords: Semen, Smoking, Tobacco.

How to cite this article: Vohra RR, Priyadarshi S, Aggarwal N, Vyas N, Yadav SS, Tomar V. Study to evaluate Association of Tobacco Chewing and Smoking with Semen Parameters. Int J Infertil Fetal Med 2017;8(3):97-100.

Source of support: Nil

Conflict of interest: None

Date of received: 09/07/2017

Date of acceptance: 21/08/2017

Date of publication: November 2017


 
ORIGINAL RESEARCH
Ruaa E Alabd, Kefah H Abdulmajeed, Hayder G Oufi

Diet and Women Fertility: A Descriptive Cross-sectional Study

[Year:2016] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:27] [Pages No:82-88][No of Hits : 535]


ABSTRACT

Aims: This work was designed to assess the role of diet and dietary habits on women fertility.

Materials and methods: This study was carried out in seven different centers and hospitals in Baghdad in the period between January and September 2014. Participants were 400 adult women selected conveniently; their age ranged from 17 to 47 years and they were divided into two groups. Group I included 300 fertile women and group II included 100 infertile women. A specific questionnaire had been designed and used for data collection.

Results: It was found that there was a significant difference in weight and body mass index (BMI) between the infertile group and control group. The mean of weights was 73.07 vs 69.06 kg for infertile and the control group respectively, while the mean BMI was 28.83 vs 26.70 for the infertile group and the control group respectively. Moreover, the infertile women consumed more of carbonated beverages, tea, chicken, and fish than the control group, while they consumed less milk and red meat than the control group. Also, the infertile group consumed less corn oil and olive oil than the control group (5 and 0% vs 21 and 2%) respectively, while they used to consume more solid fat and combined fat than the control group (2 and 6% vs 0 and 2.7%) respectively.

Conclusion: Although treatment options for infertility are available, their high cost and frequency of adverse events have motivated the identification of dietary factors related to infertility. The current study identified diet as one of the modifiable risk factors that potentially impacts fertility in the selected groups; hence, it is important to focus more on the role of diet in women fertility and increase the awareness of women to it, along with suggesting more educational programs at the primary health care level.

Keywords: Body weight, Case–control study, Diet, Infertility.

How to cite this article: Alabd RE, Abdulmajeed KH, Oufi HG. Diet and Women Fertility: A Descriptive Cross-sectional Study. Int J Infertil Fetal Med 2016;7(3):82-88.

Source of support: This study was carried out with the support of the infertility center of Al-Nahreen University, infertility center of Al-Yarmook teaching hospital, infertility center of Baghdad teaching hospital, Al-Mansour, Al-Salam, Bab Al-Muadhum, and Al-Thubat primary health care centers.

Conflict of interest: None

Date of received: 09 June 2016

Date of acceptance: 18 July 2016

Date of publication: September 2016


 
RESEARCH ARTICLE
Ratna Chattopadhyay, Shanawaz Yasmin, BN Chakravarty

Effect of Continuous 6 Months Oral Antioxidant Combination with Universally recommended Dosage in Idiopathic Male Infertility

[Year:2016] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:36] [Pages No:1-6][No of Hits : 533]


ABSTRACT

The aim of the present study was to observe the adverse effects of high level of reactive oxygen species (ROS) in idiopathic male infertility and the role of a combined antioxidant therapy for six months to overcome the detrimental effects of ROS.
A prospective study including 185 infertile male was conducted at Institute of Reproductive Medicine (IRM) from January 2014 to April 2015. All the major sperm parameters as well as ROS, antioxidant level and the effect of high ROS level were evaluated before and after the therapy.
A significant improvement in sperm motility and concentration were observed after 6 months of therapy. Antioxidant level had increased and ROS level had decreased significantly after the antioxidant treatment. Improvement in morphology and leukocyte concentration were observed though not clinically significant.

Conclusion: This combined antioxidant therapy may improve sperm quality after continuous 6 months of treatment. However, further study is needed regarding this experiment for validating the trend.

Keywords: Antioxidant, Idiopathic male infertility, Oxidative stress, Reactive oxygen spices.

How to cite this article: Chattopadhyay R, Yasmin S, Chakravarty BN. Effect of Continuous 6 Months Oral Antioxidant Combination with Universally recommended Dosage in Idiopathic Male Infertility. Int J Infertil Fetal Med 2016;7(1):1-6.

Source of support: Nil

Conflict of interest: None

Date of received: 14-11-2015

Date of acceptance: 10-01-2016

Date of publication: April 2016


 
ORIGINAL RESEARCH
DB Usha Rajinikanthan, Sathya Balasubramanyam, Thankam Varma

Comparison of in vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes in Patients receiving Recombinant Human Luteinizing Hormone vs Human Menopausal Gonadotropin Supplementation

[Year:2016] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:27] [Pages No:77-81][No of Hits : 508]


ABSTRACT

Objectives: To compare the outcome of recombinant human luteinizing hormone (rh-LH) and human menopausal gonadotropin (hMG) supplementation in women undergoing in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) with recombinant follicle stimulating hormone (FSH) in the long gonadotropinreleasing hormone (GnRH) agonist stimulation protocol.

Materials and methods: It was a retrospective analysis of the case records of 90 consecutive women who underwent nondonor IVF/ICSI cycle with long GnRH agonist. All women received recombinant FSH on day 2/3 of the programming cycle. When the level of LH was < 0.5 mIU/mL during any phase of stimulation, then addition of LH either as rh-LH or hMG is given along with recombinant FSH.

Results: The number of oocytes collected, the number of oocytes in metaphase II (MII), and fertilization rate were similar in both groups. In addition, the mean number of embryos produced per cycle and the mean number of frozen embryos per cycle were similar in both groups. The cost of gonadotropin is similar in both groups. The ongoing pregnancy rate at 12 weeks was 20.4% after rh-FSH + hMG and 29.2% after rh-FSH + rh-LH (p-value = 0.092).

Conclusion: Supplementing recombinant FSH with recombinant LH (rh-LH) when compared with hMG does not show statistically significant increase in pregnancy rates. However, this study was a pilot venture to introduce the rh-LH into our practice and further randomized study is required to substantiate its use in assistive reproductive technology.

Keywords: Follicle stimulating hormone, In vitro fertilization/ intracytoplasmic sperm injection outcome, Recombinant luteinizing hormone.

How to cite this article: Usha Rajinikanthan DB, Balasubramanyam S, Varma T. Comparison of in vitro Fertilization/ Intracytoplasmic Sperm Injection Outcomes in Patients receiving Recombinant Luteinizing Hormone vs Human Menopausal Gonadotropin Supplementation. Int J Infertil Fetal Med 2016;7(3):77-81.

Source of support: Nil

Conflict of interest: None

Date of received: 05 April 2016

Date of acceptance: 19 August 2016

Date of publication: September 2016


 
Review Article
Mohan S Kamath, Prasad Lele

Granulocyte Colony Stimulating Factor for Treatment of Thin Endometrium in Assisted Reproduction Technology Cycles

[Year:2015] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:43] [Pages No:97-102][No of Hits : 2248]


ABSTRACT

Granulocyte colony stimulating factor (G-CSF), a glycoprotein, belongs to colony stimulating factor family and mainly regulates the growth and differentiation of granulocytes. However, it also plays an important role in endometrial stromal cell decidualization, ovulation, implantation, placental metabolism, trophoblast development and endometrial regeneration. It is due to these effects, it has been used in difficult clinical scenarios, such as unresponsive thin endometrium during assisted reproductive technology treatment, repeated implantation failure and recurrent miscarriages. Most of the studies have investigated its use in thin endometrium. In this review, we have summarized the current updated evidence with regards to use of G-CSF in women with thin endometrium.

Keywords: Assisted reproductive technology, Granulocyte colony stimulating factor, Thin endometrium.

How to cite this article: Kamath MS, Lele P. Granulocyte Colony Stimulating Factor for Treatment of Thin Endometrium in Assisted Reproduction Technology Cycles. Int J Infertil Fetal Med 2015;6(3):97-102.

Source of support: Nil

Conflict of interest: None


 
Research Article
Hichem Abdessalem MAÏ, Abbassia Demmouche

A Case-Control study of Body Mass Index and Infertility in Algerian Women (Sidi Bel Abbes, West of Algeria)

[Year:2015] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:43] [Pages No:103-107][No of Hits : 2005]


ABSTRACT

Introduction: The prevalence of obesity and female infertility in Algeria has increased in past decades, and recent study are showing a relationship between body mass index (BMI) and the risk of female infertility, suggesting that obesity is a risk factor for infertility. In order to evaluate the risk of infertility associated with BMI, we conducted a case-control study.

Materials and methods: The relationship between BMI and female infertility was investigated in a case-control study of 256 infertile cases and 326 fertile control subjects. The BMI of infertile women was compared with the BMI of the control fertile group. Odds ratios (ORs) was calculated as measures of relative risk of infertility associated with BMI.

Results: Multiple analyses showed significant association between various measures of BMI and female infertility in this population. An association between BMI and infertility was observed for the overweight (25.00-29.99 kg/m2; odds ratio = 2.23; p = 0.021; 95% confidence interval, 1.52-3.25) and obese group (> 30 kg/m2; odds ratio = 3.26; p = 0.019; 95% confidence interval, 1.62-6.58) compared to the normal weight group. However, no association was found between underweight and infertility (BMI < 20 Kg/m2, odds ratio = 0.96; p = 0.063; 95% confidence interval, 0.57-1.63).

Conclusion: The present study confirms the results that the previously reported research have shown and affirm that an negative association exist between obesity and overweight with fertility, this association might be influenced by other factors, that’s why larger and more research in the Algerian population are needed.

Keywords: Algeria, Body mass index, Female infertility, Obesity, Overweight.

How to cite this article: MAÏ HA, Demmouche A. A Case- Control study of Body Mass Index and Infertility in Algerian Women (Sidi Bel Abbes, West of Algeria). Int J Infertil Fetal Med 2015;6(3):103-107.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Naina Kumar, Amit Kant Singh

Role of Anti-Müllerian Hormone in Gynecology: A Review of Literature

[Year:2015] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:52] [Pages No:51-61][No of Hits : 1486]


ABSTRACT

Anti-müllerian hormone (AMH) or Müllerian inhibiting substance (MIS), is a dimeric protein part of the transforming growth factor (TGF)-beta subfamily. It plays two important roles in follicle genesis. First, it delays entrance of primordial follicle into pool of follicles in growth and secondly, it decreases the sensitivity of ovarian follicle toward follicle-stimulating hormone (FSH). The ovary-specific expression pattern in granulosa cells of growing non-selected follicles makes AMH an ideal marker for size of the ovarian follicle pool. This review summarizes recent literature concerning AMH and its role in various gynecological conditions.

Methods: The literature regarding AMH was searched from various English language journals and published peer-reviewed articles on Pubmed, MEDLINE and Google Scholar till 2014.

Keywords: Antral follicle, Infertility, Ovarian reserve.

How to cite this article: Kumar N, Singh AK. Role of Antimüllerian Hormone in Gynecology: A Review of Literature. Int J Infertil Fetal Med 2015;6(2):51-61.

Source of support: Nil

Conflict of interest: None

Date of received: 15-05-15

Date of acceptance: 25-07-15

Date of publication: August 2015


 
Research Article
Ritvik Vasan

Novel Design of an Intrauterine Insemination Cannula

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:15-19][No of Hits : 1457]


ABSTRACT

Intrauterine insemination (IUI) is a method of assisted conception that involves transfer of fast moving sperms using an IUI cannula into the uterine cavity at the time of anticipated (or expected) ovulation, thereby increasing chance of pregnancy.
Existing cannulas are designed to be easy to use, harmless to the cervix/endometrium, capable of negotiating the cervical cavity, and to avoid the reflux of inseminate fluid. Some of the factors which influence success of pregnancy are actual number of motile sperms, number of sperms with normal morphology, volume of inseminate and sterility during procedure. This paper proposes a novel ‘completely closed loop’ design for an IUI cannula that ensures complete emptying of washed sperm during insemination, leaving no dead space while ensuring sterility during procedure.

Keywords: Intrauterine insemination, Cannula, Insemination, Catheter, Stillet.

How to cite this article: Vasan R. Novel Design of an Intrauterine Insemination Cannula. Int J Infertil Fetal Med 2015;6(1): 15-19.

Source of Support: This work was supported by Manipal Ankur, Bengaluru, India.

Conflict of Interest: None

Date of Received: 08-01-15

Date of Acceptance: 10-02-15

Date of Publication: April 2015


 
Original Article
Badanahatti Radhika, Vavilala Suseela, Praveen Kumar Nirmalan

Identification of Fetal Growth Patterns with Customized Growth Charts: A prospective study in South India

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:30-34][No of Hits : 1150]


ABSTRACT

Aim: To determine the diagnostic effectiveness of symphysis fundus height (SFH) measures plotted on customized growth charts for the identification of fetal growth patterns in a tertiary care perinatal center in south India.

Materials and methods: Serial SFH of pregnant women with singleton babies booked for antenatal care up to 22 weeks was measured from 24 weeks of gestation and plotted on customized growth charts that were developed using the gestation related optimal weight (GROW) software downloaded from www.gestation.net to identify fetal growth patterns. Fetal growth patterns were also ascertainedusing ultrasound in the antenatal period and confirmed at birth using a neonatal growth classification. The diagnostic effectiveness of SFH was compared with ultrasound and neonatal classifications using sensitivity, specificity, area under the ROC curve and likelihood ratio tests.

Results: The study included 666 pregnant women who presented at the antenatal clinics from January 2010 to October 2010. On ultrasound examination, 564 (84.6%) fetuses were AGA, 78 (11.7%) fetuses were LGA and 19 (2.9%) were SGA and 5 (0.8%) showed crossing centile from higher to lower pattern. On serial SFH measures, 426 (64.0%) of the fetuses were normal growth, 180 (27.0%) were excessive growth and 40 (6.0%) were slow growth. Serial SFH measures had a positive likelihood ratio of 4.7 (8.5 for USG) for the identification of SGA and a negative likelihood ratio of 0.06 for the detection of LGA.

Conclusion: The SFH measures plotted on a customized GROW curve have the potential to develop into a low cost screening tool to identify fetuses with altered growth. The diagnostic effectiveness of SFH plotted on customized growth charts has to be improved further through the development of appropriate customized growth charts for India before application on a larger scale.

Keywords: Fetal growth, Growth curves, SGA, LGA, Customization, Grow.

How to cite this article: Radhika B, Suseela V, Nirmalan PK. Identification of Fetal Growth Patterns with Customized Growth Charts: A prospective study in South India. Int J Infertil Fetal Med 2015;6(1):30-34.

Source of Support: The study was supported by the Fernandez Hospital Educational and Research Foundation, Hyderabad.

Conflict of Interest: None

Date of Received: 22-01-15

Date of Acceptance: 15-03-15

Date of Publication: April 2015


 
ORIGINAL ARTICLE
Prabhjot Singh Hans, Mohan Lal Swarankar, Swati Garg, Manisha Chowdhary, Karnika Tiwari

Effect of Tuberculosis on Ovarian Reserve of Patients undergoing in vitro Fertilization

[Year:2015] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:52] [Pages No:73-83][No of Hits : 1065]


ABSTRACT

Aim: To assess ovarian reserve, in infertile women with genital tuberculosis, planning to undergo in vitro fertilization (IVF) and to compare it with infertile women without genital tuberculosis, planning to undergo IVF.

Materials and methods: The study group consisted of 100 women with genital tuberculosis and the control group of 100 women who had no present or past history of tuberculosis. A diagnosis of genital tuberculosis was made based either on the results of tests performed from an endometrial aspiration sample or on histopathologic, hysterosalpingography, hysteroscopy, or laparoscopy findings. Basal ovarian reserve studies included measuring serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and E2 on day 3 of a natural cycle. On the same day, the participants underwent a transvaginal ultrasound examination by means of a two-dimensional 5.0 MHz probe fitted to a Toshiba Famio 5. Ovarian volume and number of antral follicles were estimated for each ovary on the same day of hormonal assessment. Control participants underwent the same tests on day 2 or 3 of their menstrual cycle. Unpaired or independent t-test and Chi-square test were used for statistical analysis.

Results: The present study highlights that women with genital tuberculosis have poor ovarian reserve in comparison to women of similar age without tuberculosis.

Conclusion: It can be concluded that there is no single absolute method of assessing ovarian reserve, but a combination of methods can closely predict the outcome of IVF cycles in women with genital tuberculosis.

Keywords: Genital tuberculosis, in vitro fertilization, Ovarian reserve.

How to cite this article: Hans PS, Swarankar ML, Garg S, Chowdhary M, Tiwari K. Effect of Tuberculosis on Ovarian Reserve of Patients undergoing IVF. Int J Infertil Fetal Med 2015;6(2):73-83.

Source of support: Nil

Conflict of interest: None

Date of received: 19-07-15

Date of acceptance: 25-07-15

Date of publication: August 2015


 
REVIEW ARTICLE
Praveena Joglekar Pai, Parama Sahoo, Pratap Kumar

New Insights into Infertility Associated with Polycystic Ovarian Syndrome

[Year:2015] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:52] [Pages No:43-50][No of Hits : 974]


ABSTRACT

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder which was thought to be reasonably well understood. However, new diagnostic criteria have evolved over the years just as has the management of associated infertility. Our review looks at the various diagnostic criteria for PCOS and what has prompted the need for a constant change in these. We also analyze the need for various investigations and what new evidence is out there for optimal treatment for infertility associated with this condition.

Keywords: diagnosis, hyperandrogenism, infertility, polycystic ovarian morphology, Polycystic ovarian syndrome.

How to cite this article: Pai PJ, Sahoo P, Kumar P. New Insights into Infertility Associated with Polycystic Ovarian Syndrome. Int J Infertil Fetal Med 2015;6(2):43-50.

Source of support: Nil

Conflict of interest: None

Date of received: 11-06-15

Date of acceptance: 28-07-15

Date of publication: August 2015


 
Original Article
Seneesh Kumar Vikraman, Vipin Chandra, Bijoy Balakrishanan, Amruta Gudi, Meenu Batra, Gopinathan Kannoli

Nasal Bone Length Normogram of Mid-second Trimester Euploid Fetuses of an Indian Population

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:25-29][No of Hits : 967]


ABSTRACT

Introduction: Down syndrome (DS) is the most common chromosomal aneuploidy to result in a live birth. Absent nasal bone has been consistently observed in fetuses with ds. Multiple studies have been conducted to measure and compare the nasal bone length (NBL) in different races and ethnicity and is found to vary in size. In countries, such as India where often only the second trimester scan is performed for screening of aneuploidies, NBL could be regarded as a useful marker.

Aims and objectives: To estimate the NBL of fetuses at 18 to 22 + 6 weeks gestational age in an Indian population, establish a normogram and compare it with that of the Caucasian population.

Materials and methods: Prospective observational study in a tertiary care hospital with 500 antenatal subjects after considering the inclusion and exclusion criteria.

Results: The normogram was established and found to be comparable to previously established ones for Indian subjects. The 5th centiles for 18-18.6, 19-19.6, 20-20.6, 21-21.6 and 22- 22.6 weeks of gestations were 3.4, 3. 5, 4.2, 4.3 and 5.4 mm respectively. The NBL increased with gestational age (GA), and the mean NBL was 5.48 mm. No correlation was noted with maternal age, sex of fetus or religion. The NBLs were significantly shorter than those of the Caucasian population.

Conclusion: Mean Nbl values of Indian population are less than the mean NBL of Caucasian population. This along with the GA needs to be considered in counseling patients and decisions regarding further invasive and noninvasive tests.

Keywords: Normogram, Nasal bone length, Caucasian, Down syndrome, Correlation, Regression.

How to cite this article: Vikraman SK, Chandra V, Balakrishanan B, Gudi A, Batra M, Kannoli G. Nasal Bone Length Normogram of Mid-second Trimester Euploid Fetuses of an Indian Population. Int J Infertil Fetal Med 2015;6(1):25-29.

Source of Support: Nil

Conflict of Interest: None

Date of Received: 10-02-15

Date of Acceptance: 14-03-15

Date of Publication: April 2015


 
Review Article
Divya Sardana

Review on Antagonists

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:1-10][No of Hits : 953]


ABSTRACT

Gonadotropin-releasing hormone (GnRH) antagonists have been a breakthrough in reproductive medicine. The third generation antagonists (cetrorelix and ganirelix) do not have histamine releasing capability in the used doses. The competitive blockade of GnRH receptors by GnRH antagonists leads to an immediate but reversible arrest of gonadotropin secretion. Antagonists can be used as single-dose or multiple dose protocol in a fixed or flexible approach during ovarian stimulation to prevent premature luteinizing hormone surge. The stimulation remains close to the normal cycle, and more convenient and friendly to the patient with lesser dose and duration of stimulation. Recent Cochrane analysis suggests that there is no significant difference in the live birth rate when antagonists are compared with agonists (OR 0.86) and there is a significant reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) (OR 0.43) with the use of antagonists. Gonadotropin-releasing hormone antagonists are of special benefit for use in patients with polycystic ovaries where agonist trigger can be used and OHSS can be prevented completely. Gonadotropin-releasing hormone antagonists have particular advantage in poor responders with lesser pituitary suppression in the early part of cycle. Gonadotropinreleasing hormone antagonists can be used in modified natural cycle, intrauterine insemination cycles, and frozen embryo transfer cycles. Novel uses of antagonists include suppression of established OHSS, and in various gynecological conditions (endometriosis, fibroids, precocious puberty).

Keywords: Antagonist, In vitro fertilization, OHSS, Poor responder.

How to cite this article: Sardana D. Review on Antagonists. Int J Infertil Fetal Med 2015;6(1):1-10.

Source of Support: Nil

Conflict of Interest: None

Date of Received: 11-01-15

Date of Acceptance: 15-02-15

Date of Publication: April 2015


 
Research Article
Milat Haje, Kameel Naoom

Combined Tamoxifen and L-Carnitine Therapies for the Treatment of Idiopathic Male Infertility Attending Intracytoplasmic Sperm Injection: A Randomized Controlled Trial

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:20-24][No of Hits : 932]


ABSTRACT

Aim: The aim of the present study is to evaluate the fertility outcomes of intracytoplasmic sperm injection (ICSI) as well as sperm count, motility and morphology in couples with infertile male partners exhibiting idiopathic oligoasthenozoospermia (OA) and treated with tamoxifen citrate and/or L-carnitine.

Materials and methods: In this randomized controlled trail, couples with female cause of infertility were excluded. Only couples with male cause of infertility with idiopathic OA were admitted to this study and randomly assigned into four different groups of treatments as follow: Group A (n = 45) received an anti-estrogen compound (tamoxifen 20 mg/day), group B (n = 20) received L-carnitine (1000 mg/day), group C (n = 34) received tamoxifen 20 mg/day plus L-carnitine 1000 mg/day, whereas group D (n = 29) received placebo. Treatments were continued for 3 to 6 months.

Results: Treatment groups of A, B, and C showed an overall improvement in the tested parameters of sperm when compared to the control group that showed an overall reduction in those parameters after termination of the treatment. In this context, sperm count increased from 7.58 ± 2.93 × 106/ml before treatment to 10.81 ± 1.84 × 106/ml after treatment in group A (p = 0.016). Similarly, sperm count increased from 5.32 ± 2.09 × 106/ml to 8.92 ± 2.29 × 106/ml in group C (p = 0.01). Patients from group C did not only have an improved total motility of sperm from 8.03 ± 1.59% to 13.78 ± 3.85% (p = 0.045) but also an improved sperm normal morphology from 0.88 ± 0.45% to 1.99 ± 0.71% (p = 0.026). Patients from group A or C exhibited an improved ICSI outcomes when compared to those in patients from group B or D (48.9 or 48.3 vs 16.6 or 20, respectively, p = 0.46).

Conclusion: It is concluded that administration of tamoxifen and L-carnitine can improve both sperm parameters of fertility and ICSI outcomes. Combined tamoxifen and L-carnitine treatments result in maximum therapeutic effect in men with idiopathic OA.

Keywords: Tamoxifen, L-Carnitine, Male infertility, ICSI .

How to cite this article: Haje M, Naoom K. Combined Tamoxifen and L-Carnitine Therapies for the Treatment of Idiopathic Male Infertility Attending Intracytoplasmic Sperm Injection: A Randomized Controlled Trial. Int J Infertil Fetal Med 2015;6(1):20-24.

Source of Support: Nil.

Conflict of Interest: None

Date of Received: 10-01-15

Date of Acceptance: 25-03-15

Date of Publication: April 2015


 
Editorial
Kamini A Rao

Editorial

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:vii][No of Hits : 831]


ABSTRACT

Dear Readers,
Greetings and good wishes!!
Gonadotropin-releasing hormone (GnRH) antagonists can be used to prevent luteinizing hormone surge during controlled ovarian stimulation without hypoestrogenic side effects, flare up, or long downregulation period associated with agonists. It acts through competitive binding to pituitary GnRH receptors, which allows their use at any time during the follicular phase. It is well-proven that it is associated with lower incidence of ovarian hyperstimulation syndrome and it has got comparable clinical outcomes with agonist protocols. To throw more light on this matter, we have a review article by Dr. Divya Sardana on antagonists.


 
Original Article
Divya Sardana

Assessment of Uterine Receptivity by the Subendometrial-Endometrial Blood Flow Distribution Pattern in Frozen-thawed Embryo Transfer Cycles

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:35-39][No of Hits : 809]


ABSTRACT

Objective: To investigate the correlation of blood flow detected by 2-Dimensional Power Doppler (2D-PD) sonography in the subendometrial-endometrial unit with the pregnancy outcome in frozen-thawed embryo transfer (FET) cycles.

Study design: Prospective non-randomized observational study.

Materials and methods: A total of 127 patients undergoing their first FET cycle were recruited and prepared using hormone replacement therapy. All patients were evaluated for subendometrial-endometrial blood flow by 2D-PD once the endometrium was ≥ 7 mm thick. Progesterone supplement was added and transfer of 2 to 3 cleavage stage good quality embryos was done after 3 days.

Results: The difference in the BMI, FSH, LH and endometrial thickness of women in the three zones was not statistically significant (p > 0.05). However, women with blood flow in zone 1 were of older age as compared to women in zone 3 with a statistically significant difference (p = 0.0001). In the present study, the overall pregnancy rate was 35.43% (45/127). Women having blood flow in zone 3 or 4 showed a rising trend of pregnancy rate as compared to those in zone 1 and 2 although it was not statistically significant (p = 0.15). But, clinical pregnancy and implantation rates were significantly higher in women with zone 3 or 4 penetration compared with zone 1 or 2 penetration (p = 0.03 and 0.01, respectively).

Conclusion: The subendometrial-endometrial vascularity has a useful predictive value for pregnancy outcome in FET cycles. However, larger studies are needed to reach definite conclusion.

Keywords: Power doppler, Frozen-thawed embryo transfer, Subendometrial-endometrial unit.

How to cite this article: Sardana D. Assessment of Uterine Receptivity by the Subendometrial-Endometrial Blood Flow Distribution Pattern in Frozen-Thawed Embryo Transfer Cycles. Int J Infertil Fetal Med 2015;6(1):35-39.

Source of Support: Nil.

Conflict of Interest: None

Date of Received: 12-01-15

Date of Acceptance: 25-02-15

Date of Publication: April 2015


 
Case Report
Lakshmidevi Muralidhar, Shreedhar Venkatesh, Pramila Pandey

Squamous Cell Carcinoma in Dermoid Cyst

[Year:2015] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:43] [Pages No:133-135][No of Hits : 571]


ABSTRACT

Mature cystic teratoma or dermoid cyst constitutes about 10 to 20% of all ovarian tumors in the reproductive age group. Malignant transformation is seen in these tumors in about 1 to 2%. Squamous cell carcinoma (SCC) constitutes about 75 to 85% of malignant transformation. Imaging characters and serum tumor markers are two important modalities to differentiate benign and malignant lesions. We are presenting a rare case of SCC arising from mature teratoma. The aim of this presentation is to stress on the significance of preoperative risk assessment of SCC in mature cystic teratoma in postmenopausal age group for optimal treatment.

Keywords: Dermoid cyst, Squamous cell carcinoma and malignancy.

How to cite this article: Muralidhar L, Venkatesh S, Pandey P. Squamous Cell Carcinoma in Dermoid Cyst. Int J Infertil Fetal Med 2015;6(3):133-135.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Igor Victorovich Lakhno

Novel Possibilities for the Diagnosis of Fetal Distress in Pre-eclamptic Women

[Year:2015] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:52] [Pages No:62-66][No of Hits : 560]


ABSTRACT

Objective: Fetal deterioration has been known as a result of acute or chronic disturbances in the system of ‘motherplacenta- fetus’. Pre-eclampsia (PE) is a maternal gestational disease caused by abnormal placentation that could provoke fetal distress.

Aim: The aim of the investigation was to survey the accuracy of fetal distress diagnostics in case of traditional cardiotocography (CTG) waveform evaluation and electrocardiography (ECG) parameters analysis obtained from maternal abdominal signal before and during labor in pre-eclamptic patients.

Materials and methods: One hundred and thirty-nine pregnant ladies at 32 to 40 weeks of gestation were enrolled in the study. There were 30 women with physiological pregnancy and normal fetal condition according to hemodynamic Doppler values and fetal ECG parameters in group I. In group II, 64 patients with mild and moderate PE were involved whom were performed fetal ECG noninvasive monitoring and hemodynamic Doppler. In group III, 45 patients with severe PE were monitored with fetal noninvasive ECG and hemodynamic Doppler.

Results: It was determined that fetal autonomic tone was suppressed with the relative increase of low frequency branch in pre-eclamptic patients. The increased value of the amplitude of mode and stress index was associated with abnormal myocardial adrenergic stimulation. It has induced pQ and QT shortening, increased T/QRS ratio. Fetal cardiac response was determined as gradual reduce of autonomic regulation.
The most considerable negative correlation was determined in pair Apgar score 1 vs T/QRS (R = – 0.48; p < 0.05). The QT interval duration has revealed positive correlation with Apgar score 1 (R = 0.44; p < 0.05). Additional to the conventional CTG analysis evaluation of noninvasive fetal ECG parameters has contributed to better diagnostic of distress.

Conclusion: Fetal noninvasive ECG has showed sensitivity 100.0% and specificity 93.8% and, therefore, was more accurate and convenient method for fetal monitoring than conventional CTG.

Keywords: Fetal distress, Fetal noninvasive Ecg monitoring, Pre-eclampsia.

How to cite this article: Lakhno IV. Novel Possibilities for the Diagnosis of Fetal Distress in Pre-eclamptic Women. Int J Infertil Fetal Med 2015;6(2):62-66.

Source of support: Nil

Conflict of interest: None

Date of received: 18-06-15

Date of acceptance: 22-07-15

Date of publication: August 2015


 
Case Series
Nupur Garg, Deepika Krishna, Suvarna Rathor, Kamini A Rao

Ovarian Torsion: A Gynecological Emergency

[Year:2015] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:43] [Pages No:136-140][No of Hits : 540]


ABSTRACT

Ovarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. Timely investigation and management can make the difference between ovarian loss and salvage, an outcome of great importance in the population of reproductive age females. Our case series is about clinical presentation and management approach of adnexal torsion in a tertiary care fertility center. Adnexal torsion was found mainly in the reproductive age during poststimulation postovulatory period in all cases. Ultrasound was the most commonly used imaging modality. Ovarian stimulation was the risk factor seen in all the patients. Diagnosis of adnexal torsion was mostly clinical. Laparoscopy was the preferred method of surgical intervention. Ovarian conservation was possible in all cases except one.

Keywords: Color Doppler sonography, Laparoscopy, Ovarian torsion.

How to cite this article: Garg N, Krishna D, Rathor S, Rao K. Ovarian Torsion: A Gynecological Emergency. Int J Infertil Fetal Med 2015;6(3):136-140.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Manizheh Karami, Fatemeh Lakzaei, MohammadReza Jalali Nadoushan

Naloxone Breeding Effectiveness in Rat Suffering from Nitric Oxide-induced Polycystic Ovary Syndrome

[Year:2015] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:52] [Pages No:67-72][No of Hits : 505]


ABSTRACT

Background and objective: Polycystic ovary syndrome (PCOS) can be induced in Wistar rats by over production of nitric oxide (NO). This study evaluated the efficacy of naloxone on the breeding characteristics of rats suffering from nitric oxide induced PCOS.

Materials and methods: Twenty-four female Wistar rats (200–250 gm) were kept as virgin under standard conditions. They were divided into four groups (n = 6). One group of the animals received L-arginine (50 mg/kg) intraperitoneally (i.p.) for 9 days/once a day. Another group was administered naloxone hydrochloride (0.4 mg/kg, i.p.) prior to injection of L-arginine. The third group was injected solely naloxone. Control group received saline solution (1 ml/kg, i.p.). After the treatments, all female rats were coupled with the intact males. They were then separated by observation of vaginal plaques; it was considered as day 0 of pregnancy. Eventually, they were operated on days 18 to 19 of the gestation to collect the animals’ ovaries. The samples were studied for pathological evidence. The fetal number and weight along with the fetal crown-rump length (CRL) were measured.

Results: The ovaries obtained from the L-arginine treated group had large cysts with thickened granulosa cell layer in contrast to those of the control or naloxone treated rats (p < 0.0001). The number of fetus though showed a decrease in the L-arginine treated rats (3 ± 1), but the fetal weight or fetal CRL did not change (p > 0.05).

Conclusion: This study may clearly illustrate the polycystic characteristics in the L-arginine treated group. It may particularly display the breeding efficacy of naloxone in rats with PCOS.

Keywords: Breeding, L-Arginine, Naloxone, Nitric oxide, PCOS, Rat.

How to cite this article: Karami M, Lakzaei F, Nadoushan MRJ. Naloxone Breeding Effectiveness in Rat Suffering from Nitric Oxide-induced Polycystic Ovary Syndrome. Int J Infertil Fetal Med 2015;6(2):67-72.

Source of support: Nil

Conflict of interest: None

Date of received: 20-06-15

Date of acceptance: 28-06-15

Date of publication: August 2015


 
ORIGINAL ARTICLE
Richa Aggarwal

The Effect of Doxycycline on Pus Cells and Oxidative Stress in Male Patients with Leukocytospermia

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:95-99][No of Hits : 3569]


ABSTRACT

Objective: The World Health Organization (WHO) has defined leukocytospermia as > 106 WBC/ml of semen. However, the clinical significance of leukocytospermia is currently a subject of controversy. Evidence from several recent studies indicates that leukocytospermia could significantly contribute to oxidative stress and male infertility. Several clinical trials have investigated the efficacy of antibiotic therapy to treat patients with pyospermia in an attempt to improve fertility. Currently, doxycycline is the most common antibiotic used to treat pyospermia though larger trials are needed to demonstrate its efficacy in treating pyospermia.

Materials and methods: Hundred male partners with semen analysis showing the presence of significant leukocytospermia (WBC > 1 × 106/ml), sterile semen culture and satisfying the inclusion and exclusion criteria were enrolled in the study and given doxycycline 100 mg bd for 14 days. Semen analysis for pus cells and oxidative stress (ROS) measurement was done before and after the treatment.

Results: Mean pus cell count before and after treatment with doxycycline was 2.28 ± 1.26 × 106/ml and 1.21 ± 0.58 ×106/mL respectively, the effect being statistically significant (p < 0.05). Resolution of leukocytospermia was seen in 61.4% (54/88) cases after doxycycline treatment. Mean oxidative stress (RLU/ sec/million sperms) before and after doxycycline therapy was 79.72 ± 133.9 and 25.44 ± 47.8, the difference being significant (p < 0.05).

Conclusion: Study results show that treatment with broad spectrum antibiotic like doxycycline leads to significant decrease in the number of pus cells present in semen thereby significantly decreasing the oxidative stress.

Keywords: oxidative stress, male infertility, leukocytospermia, Doxycycline, reactive oxygen species.

How to cite this article: Aggarwal R. the Effect of Doxycycline on Pus Cells and Oxidative Stress in Male Patients with Leukocytospermia. Int J Infertil Fetal Med 2014;5(3):95-99.

Source of support: Nil

Conflict of interest: None

Date of Received: 01-04-14

Date of Acceptance: 11-12-14

Date of Publication: September 2014


 
Review Article
Harpreet Kaur, Kamini A Rao

Fibroids and Infertility

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:1-7][No of Hits : 1969]


ABSTRACT

Fibroids are the commonest benign tumors of female genital tract. Though fibroids may not be a sole cause for infertility in majority of cases, but it has been seen that there is an improvement in pregnancy rates after myomectomy. Fibroids that distort the uterine cavity and large intramural fibroids are shown to be associated with adverse effects on reproductive function. Available evidence suggests that submucosal, intramural, and subserosal ?broids interfere with fertility in decreasing order of importance. In infertile women and those with recurrent pregnancy loss, myomectomy should be considered only after a thorough evaluation has been completed. Medical management of fibroids has no role in treatment of fertility rather it might lead to delay in the final treatment for infertility. Preoperative medical treatment with a GnRH agonist should be considered for women who are anemic and those undergoing hysteroscopic myomectomy. Subserosal fibroids have least effect on fertility, so they do not need removal before infertility treatment.

Keywords: Fibroids, infertility, myomectomy, In vitro fertilization.

Keymessage: Fibroids are important cause of infertility; Removal of submucousal fibroids is warranted before IVF.

Search methodology: Data were sourced from the electronic database PubMed, MEDLINE, OVID, Cochrane Database of systematic reviews and published guidelines on fibroids and infertility. Abstracts from papers and posters presented at the international meetings, published and unpublished studies, and expert opinion was considered.

How to cite this article: Kaur H, Rao KA. Fibroids and infertility. Int J Infertil Fetal Med 2014;5(1):1-7.

Source of support: Nil

Conflict of interest: None

Date of Received: 30-03-14

Date of Acceptance: 20-04-14

Date of Publication: April 2014


 
Original Article
Minakeshi Rana, sharda patra, Manju Puri, Shubha Sagar Trivedi

Fetomaternal Outcome in Preterm Premature Rupture of Membrane

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:18-21][No of Hits : 1943]


ABSTRACT

This prospective observational study was carried out to study the fetomaternal outcome in women with preterm premature rupture of membrane (PPROM) between 24 and 36 weeks of gestation.

Materials and methods: A total of 150 pregnant women between 24 and 36 weeks gestation with PROM were subjected to detailed history and examination. Each patient was followed till her delivery and fetomaternal outcome was recorded gestation-wise between 24 and 28 weeks (n = 15), 28 and 32 weeks (n = 30), 32 and 34 weeks (n = 90), and 34 and 36 weeks (n = 15).

Result: The mean latency period from membrane rupture to delivery decreased from 15 days at 24 to 28 weeks, 11 days at 28 to 32 weeks to 4.4 days at 32 to 34 weeks to 2.1 days at 34 to 36 weeks. Majority of women delivered vaginally. The rate of spontaneous labor increased as the gestational age at admission increased, the difference between rate of spontaneous labor of 67% at 28 to 32 weeks and 86% at 34 to 36 weeks was statistically significant (p = 0.001). The indications for induction of labor were intrauterine fetal death, gross oligohydramnios, and clinical chorioamnionitis. The most common complication was clinical chorioamnionitis (6%) and postpartum sepsis (6%). The perinatal outcome was favorable in majority of cases and improved with the increase in gestational age at PROM. The overall perinatal mortality was 9.3%.

Conclusion: Management of PPROM involves complete evaluation of risks and benefits of conservative management. Wherever possible, the treatment should be directed toward conserving the pregnancy with prophylactic use of antibiotics and steroids thereby reducing fetal-maternal morbidity and mortality. However, termination of pregnancy should be considered at the earliest suspicion of chorioamnionitis.

Keywords: Preterm premature rupture of membranes, chorioamnionitis, maternal outcome, neonatal outcome.

How to cite this article: Rana M, patra s, Puri M, Trivedi SS. Fetomaternal Outcome in Preterm Premature Rupture of Membrane. Int J Infertil Fetal Med 2014;5(1):18-21.

Source of support: Nil

Conflict of interest: None

Date of Received: 10-09-13


 
Case Report
Sandhya Krishnan

Globozoospermia

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:27-29][No of Hits : 1484]


ABSTRACT

Globozoospermia is a severe form of terato-zoospermia characterized by round-headed acrosome-less spermatozoa. The main problem is low fertilization rate due to lack of acrosome. We report successful pregnancy outcome of intracytoplasmic sperm injection (ICSI) treatment in a case of globozoospermia.

Keywords: Globozoospermia, male infertility, round-headed sperm cells.

How to cite this article: Krishnan S. Globozoospermia. Int J Infertil Fetal Med 2014;5(1):27-29.

Source of support: Nil

Conflict of interest: None

Date of Received: 09-02-14

Date of Acceptance: 18-03-14

Date of Publication: April 2014


 
Editorial
Kamini A Rao

Editorial

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:iv][No of Hits : 1471]


ABSTRACT

A few months ago, TOG, "The Obstetrician & Gynecologist", the official journal of the Royal College of Obstetrician and Gynaecology (RCOG) published an article by Jolly Joy and Neil McClure entitled "The art of reviewing a paper". As an editor, I cannot overemphasize the importance of such an article. Despite the routine publication of peer-reviewed articles in all quality journals, there is no formal training for peer reviewers. The article by Joy and McClure takes you through the basic principles and responsibilities of the review process while emphasizing the importance of ensuring quality control in a fair and appropriate way that justifies the reviewer’s responsibility to the author as well as to the editor of the journal. The point that I would like to put across here is that every editor needs a strong team of reviewers who respond promptly and ensure that the submission is reviewed and returned within the stipulated time frame. An invitation to review an article is a recognition of your standing in your area of expertise and undoubtedly an honor. However, while recognizing the invitation as an honor, many practicing clinicians also consider it an unnecessary burden on their time, leading to inordinately delayed responses. Delays in the review process due to indifference of peer reviewers remain the bane of every editor. I would like to appeal to all reviewers to devote your time and expertise selflessly in the interest of raising the quality of our publications.


 
Original Article
Sushil Kachewar, Sidappa G Gandage, Hemant J Pawar

An Untold Story of Indian Fetal Middle Cerebral Artery Peak Systolic Velocities

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:8-11][No of Hits : 1324]


ABSTRACT

Although noninvasive diagnosis of anemia in fetus by measuring the middle cerebral artery peak systolic velocity (MCA-PSV) is practised and extensively researched in the developed world, such studies from the developing world are rare. India is the home for many hemoglobinopathies and cases of Rh alloimmunization are also reported here. Hence, it is expected that fetal anemias will be quite common. So in addition to an awareness about the correct method of measuring MCA-PSV and knowledge about changes that occur in the waveforms with advancing gestational age, it is important to know the normal values at various gestational ages in an Indian setting. Demonstrating these normal values was the primary goal of the current study.

Context: Fetal anemia can be adequately tackled only if it is diagnosed on time. Fetal MCA-PSV has the potential to reliably predict fetal anemia. Scientific studies across the globe are a testimony to this fact. As such studies from rural setups are lacking, this study was initiated.

Aims: To demonstrate the normal values of fetal MCA-PSV at various gestational ages in an Indian setting by using the standard internationally accepted protocol.

Settings and design: The ultrasound wing of radiodiagnosis department of a rural medical college was the site of this study. Permission from institutional research cell and ethical committee was obtained for study on fetal MCA-PSV. Written informed consent from every pregnant mother who participated in the study was also obtained. A cross-sectional and prospective observational study was conducted over the last 9 months.

Materials and methods: A total of 60 measurements of fetal MCA-PSV were conducted in normal 20 pregnant women referred for routine obstetric scan at 12, 24, and 36 weeks of gestation respectively, by a single radiologist on color Doppler ultrasound machine. In each fetus the proximal MCA, soon after its origin, was evaluated.

Statistical analysis: The observations were entered in Microsoft Excel sheet and statistical analysis was done by using SPSS statistical software version 12. The relation between fetal MCAPSV and gestational age was studied using the Karl Pearson?s correlation coefficient. The significance of difference was studied using the t-test.

Results: MCA-PSV increased with increasing gestational age, suggesting positive correlation between the two. Better waveforms and increasing PSV were visualized with advancing gestational age.

Conclusion: Fetal anemia can be accurately predicted only if the MCA-PSV is scientifically measured and compared with normal values in a given setting. This study demonstrates the normal values at various gestational ages in an Indian setting.

Keywords: Fetal anemia, Middle cerebral artery peak systolic velocity, Doppler.

How to cite this article: Kachewar S, Gandage SG, Pawar HJ. An Untold Story of Indian Fetal Middle Cerebral Artery Peak Systolic Velocities. Int J Infertil Fetal Med 2014;5(1):8-11.

Source of support: Nil

Conflict of interest: None

Date of Received: 07-06-13

Date of Acceptance: 03-04-14

Date of Publication: April 2014


 
Original Article
Sailaja Devi Kallur, Nuzhat Aziz

Do Fetal Monitoring Tests predict Adverse Perinatal Outcomes in Pregnant Women with Absent End Diastolic Flow? A Retrospective Study

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:22-26][No of Hits : 1194]


ABSTRACT

Aim: To determine the ability of fetal monitoring tests to predict adverse perinatal outcomes in absent end diastolic flow (AEDF) babies.

Materials and methods: A retrospective cohort study of pregnant women with AEDF during the period 2001 to 2009. Fetal monitoring tests of interest included amniotic fluid index (AFI), nonstress tests (NST), and Doppler flow studies. Adverse perinatal outcomes included perinatal/neonatal mortality, necrotizing enterocolitis, respiratory distress syndrome, and grades III/IV intraventricular hemorrhage. Sensitivity, specificity, likelihood ratios, adjusted odds ratios, area under the receiver operator characteristic curves (AUROC) and the 95% confidence intervals were determined.
Study included 142 women with AEDF who delivered before 34 weeks. Indications for delivery included abnormal AFI in 6 (4.23%), worsening Doppler in 31 (21.83%), and abnormal NST in 48 (33.80%). An adverse fetal event was noted in 107 [75.35%, 95% confidence interial (CI) 68.18%, 82.53%]. Birth weight adjusted odds for an adverse perinatal outcome decreased (Odds ratio: 0.79, 95% CI: 0.56, 1.10, p = 0.16) with an increase in each week of gestation. Fetal monitoring tests did not have clinically meaningful positive/negative likelihood ratio or significant AUROC.

Conclusion: Current fetal monitoring tests are more useful to identify noncompromised fetuses than to identify fetal distress. Delaying delivery till 34 weeks might improve outcomes.

Keywords: Absent end diastolic flow, Fetal monitoring, Diagnostic tests, Perinatal outcomes, Neonatal death.

How to cite this article: Kallur SD, Aziz N. Do Fetal Monitoring Tests predict Adverse Perinatal Outcomes in Pregnant Women with Absent End Diastolic Flow? A Retrospective Study. Int J Infertil Fetal Med 2014;5(1):22-26.

Source of support: Nil

Conflict of interest: None

Date of Received: 31-09-2013

Date of Acceptance: 04-04-14

Date of Publication: April 2014


 
Original Article
Asokan Keloth Manapatt, Latha Anoop, Deepna Tharammal, Aiswarya Sathyapal, Yasmeen Muneer

Pattern of Prolactin Secretion after Normal Vaginal Delivery and in Cesarean Delivery

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:15-17][No of Hits : 1167]


ABSTRACT

Prolactin (PRL) is hormone of multiple biological actions and is best known for its role in milk production. This hospital-based study was undertaken to review the impact of PRL hormone in vaginal delivery and cesarean delivery. Our study is meant to create awareness in the society to promote breast feeding and the importance of promoting normal vaginal delivery whenever possible. In this study, we investigated the serum PRL values using enzyme-linked immunoflow assay method in 101 women who underwent normal (56) and cesarean delivery (45) in obstetrics and gynecology department of Kannur Medical College, Anjarakandy. Serum PRL at 24 and 48 hours blood sample was estimated among the two groups, mean PRL in vaginal delivery 24 hours 359.46 ± 119.70 ng/ml, 48 hours 386.67 ± 135.66 ng/ ml and in cesarean delivery 24 hours 245.49 ± 115.49 ng/ml, 48 hours 282.92 ± 69.59 ng/ml. The values of serum PRL are found to be significantly higher in the vaginal delivery group (p < 0.001) as compared with the cesarean section group. Through this study, we concluded that the mothers who delivered by cesarean section had decreased PRL levels than the women who delivered vaginally which may have a significant role in establishment of breastfeeding.

Keywords: PRL, glycoprotein, lactogenesis, hypoprolactinemia, Enzyme-linked immunoflow assay, vaginal delivery, cesarean section.

How to cite this article: Manapatt AK, Anoop L, Tharammal D, Sathyapal A, Muneer Y. Pattern of Prolactin Secretion after Normal Vaginal Delivery and in Cesarean Delivery. Int J Infertility Fetal Med 2014;5(1):15-17.

Source of support: Nil

Conflict of interest: None

Date of Received: 25-03-14

Date of Acceptance: 01-04-14

Date of Publication: April 2014


 
REVIEW ARTICLE
Arveen Vohra, Kamini A Rao

Luteinizing Hormone in Controlled Ovarian Stimulation

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:75-86][No of Hits : 1144]


ABSTRACT

The role of follicle stimulating hormone (FSH) in assisted reproductive technology is well understood, though there is still no published consensus on the need for exogenous luteinizing hormone (LH) in controlled ovarian stimulation. There is a dilemma regarding the usefulness of LH supplementation in controlled ovarian stimulation despite growing understanding of the LH and FSH interrelation and their effects on fertilization and implantation. This review revisits the physiological role of LH, LH receptors and the concept of LH therapeutic window. With the availability of LH activity from different sources, there is a need to understand the differences between recombinant human LH (r-HLH), human menopausal gonadotropin and human chorionic gonadotropin (hCG). It has been observed that adjuvant r-HLH provides precise control over the dose of LH bioactivity administered to target the therapeutic window. This review discusses about the various patient subgroups that may benefit from LH supplementation. The use of r-HLH is recommended in women with poor response in a previous cycle or suboptimal follicular growth in an ongoing ovarian stimulation cycle by day 6 to 8 of stimulation. Exogenous LH administration should also be considered in women at risk of suboptimal response, specifically age > 35 years and women treated with GnRH analogues (agonists or antagonists) during ovarian stimulation causing over suppression of endogenous LH and FSH pituitary secretion. Further research is needed to identify LH polymorphisms, adequate dosing, cost efficacy, need for rLH and hCG supplementation in different patient profiles for maximum benefit during controlled ovarian stimulating (COS).

Keywords: Luteinizing hormone, IVF, ovarian stimulation, recombinant LH, LH window, LH deficiency.

How to cite this article: Vohra A, Rao KA. Luteinizing Hormone in Controlled Ovarian Stimulation. Int J Infertil Fetal Med 2014; 5(3):75-86.

Source of support: Nil

Conflict of interest: None

Date of Received: 28-11-14

Date of Acceptance: 10-12-14

Date of Publication: September 2014


 
Original Article
Sonal Panchal, CB Nagori

Correlation of Ovarian and Stromal Volumes to Fasting and Postprandial Insulin Levels in Polycystic Ovarian Syndrome Patients

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:12-14][No of Hits : 1018]


ABSTRACT

Background: Patients with polycystic ovarian syndrome (PCOS) are believed to have large ovaries due to increased stroma. They also have derangement in luteinizing hormone (LH) and testosterone levels and high insulin resistance. As insulin resistance is thought to be associated with androgen and stromal excess, correlation was expected between insulin resistance and stromal excess.

Aim: To assess if ovarian and stromal volumes in PCOS patients have any correlation with fasting and postprandial insulin levels.

Materials and methods: A prospective study of 153 subfertile patients was done over a period 18 months. After detailed history, clinical examination and informed consent of all patients were scanned by two-dimensional (2D) on day 3 of the cycle. Patients were divided into PCOS and non-PCOS groups according to Rotterdam criteria. Patients with hormonal derangements other than PCOS were excluded from the study.
Patients were assessed by three-dimensional (3D) ultrasound (US) for ovarian and stromal volumes and fasting and postprandial insulin levels were checked on the same day.

Results: With Pearson correlation significance level of 0.354 (2 tailed) correlation for ovarian volume to fasting insulin was 0.588, for ovarian volume to postprandial insulin was 0.523, for stromal volume to fasting insulin was 0.601, and for stromal volume to postprandial insulin was 0.523. No correlation could be established in non-PCOS group.

Conclusion: In PCOS patients, a strong correlation was found between ovarian and stromal volume and fasting and post prandial insulin levels.

Keywords: Polycystic ovarian syndrome, Ovarian volume, Stromal volume, Insulin levels.

How to cite this article: Panchal S, Nagori CB. Correlation of Ovarian and Stromal Volumes to Fasting and Postprandial Insulin Levels in Polycystic Ovarian Syndrome Patients. Int J Infertil Fetal Med 2014;5(1):12-14.

Source of support: Nil

Conflict of interest: None

Date of Received: 12-10-13

Date of Acceptance: 10-04-14

Date of Publication: April 2014


 
RESEARCH ARTICLE
Jatin Shah, Aparna Gangadharan, Vidhi Shah

Effect of Intrauterine Instillation of Granulocyte Colony-stimulating Factor on Endometrial Thickness and Clinical Pregnancy Rate in Women undergoing in vitro Fertilization Cycles: An Observational Cohort Study

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:100-106][No of Hits : 899]


ABSTRACT

Introduction: In spite of significant advances in the field of reproductive medicine, repeated implantation failure (RIF) is a challenging and extremely disappointing problem. The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depends mainly on uterine receptivity and embryo quality. Successful evaluation of endometrial receptivity conducive to embryo implantation continues to be a challenge in assisted reproductive technology (ART). Several researcher groups have reported the successful use of granulocyte-colony stimulating factor (G-CSF) during IVF cycles in terms of achieving higher clinical pregnancy rates on account of increased endometrial thickness. Women who fail to achieve adequate endometrial thickness despite conventional treatment with high dose estrogen or those with a history of repeated implantation failures in spite of normal endometrial thickness often do not achieve pregnancy and resort to gestational surrogacy. A new therapeutic approach to achieve successful pregnancy in such patients would be very desirable.

Study objectives: To assess the efficacy of a single dose of intrauterine G-CSF on endometrial thickness, implantation and clinical pregnancy rates in women who either had a thin endometrium after estrogen priming (< 8 mm) or a history of repeated implantation failures at IVF, undergoing embryo transfer after 10 days of priming with oral estradiol and vaginal slidenafil.

Materials and methods: Two hundred and thirty-one women (between 24 and 46 years of age) undergoing IVF-ET were recruited for the study. All cases were prospectively studied at the Mumbai Fertility Clinic and IVF Center (a subdivision of Kamala Polyclinic and Nursing Home) over a period of 6 months from January to June 2014, after their written informed consent. Subgroup I consisted of 117 patients who had a persistently thin endometrium (< 8 mm) in spite of high dose oral estradiol valerate and vaginal sildenafil priming. Subgroup II consisted of 114 patients who had a history of repeated (two or more) implantation failures (RIF) at IVF-ET cycles despite adequate endometrium (≥ 8 mm). All were infused with a single dose of G-CSF (300 mcg) in the uterine cavity after 10 days of priming with oral estradiol valerate and vaginal sildenafil citrate. Endometrial thickness was reassessed 4 days after G-CSF instillation. This was followed by administration of intramuscular progesterone in oil (100 mg) daily with embryo transfer on day 5 of progesterone for all patients. All embryo transfers for patients undergoing oocyte donation or embryo donation were done at the 4-cell stage on day 2. All Frozen embryo transfers (FET) of vitrified embryos were at 8 cell stage. Estimation of serum beta hCG was at 14 days post-embryo transfer for all patients. Successful implantation and net clinical pregnancy rate was confirmed based on appearance of gestational sac on sonogram after 10 days and observation of fetal cardiac activity after 20 days of positive β-hCG results.

Results: Out of total 231 patients recruited in the study, 95% patients from subgroup I (n = 111) and 94% patients from subgroup II (n = 107) showed mean increase in endometrial thickness by at least 2.5 mm within 4 days of G-CSF single dose instillation. A total of 218 patients from both subgroups underwent S. β-hCG estimation 14 days post IVF-ET. Out of 103 β-hCG positive patients, 83 showed net clinical pregnancy (fetal cardiac activity present) giving a net pregnancy rate of 38.07% for the whole study group with 37% in the subgroup with thin endometrium (< 8 mm) and 39.25% in the subgroup with adequate (≥ 8 mm) endometrium with history of two or more failed implantation at previous IVF-ET cycles. There were no adverse events for the whole study population.

Conclusion: There can be a strong possibility with a single dose of 300 mcg intrauterine infusion of G-CSF to achieve significant increase in the endometrial thickness with higher successful pregnancy rate among infertile women under- going IVF-ET cycles with a history of a persistently thin endometrium or repeated implantation failures (rather difficult to treat patients). G-CSF could be a valuable tool to consider before advising the option of surrogacy. In the absence of a control group, our conclusions warrant conduct of further studies.

Keywords: Endometrial thickness, Granulocyte colony stimulating factor, in vitro fertilization, Embryo transfer, β-hCG.

How to cite this article: Shah J, Gangadharan A, Shah V. Effect of Intrauterine Instillation of Granulocyte Colony-stimulating Factor on Endometrial Thickness and Clinical Pregnancy Rate in Women undergoing in vitro Fertilization Cycles: An Observational Cohort Study. Int J Infertil Fetal Med 2014;5(3):100-106.

Source of support: Nil

Conflict of interest: None

Date of Received: 02-12-14

Date of Acceptance: 08-12-14

Date of Publication: September 2014


 
Editorial
Kamini A Rao

Editorial

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:vi][No of Hits : 882]


ABSTRACT

Dear Readers,
Greetings and good wishes!

The probability of success of a research project is greatly enhanced when the ‘beginning’ is correctly defined as a precise statement of goals and justification. This has to be then accomplished by proper study design, which also incorporates methods of reducing bias. To have a better understanding on how to perform the successful organized research, we have a review article by Dr KP Suresh on ‘Design and analysis of observational studies’ which explains about planning and analysis of an observational study with special emphasis on how to reduce bias.


 
Letter-to-Editor
Linda Sailo, Gnanaraj Jesudian

Single Incision Gasless Laparoscopic Surgeries and other Low-cost Minimally Invasive Techniques for Evaluation of Infertility in Rural Areas

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:30-31][No of Hits : 802]


ABSTRACT

Single incision Lift laparoscopic surgeries offer a very attractive and low cost option of evaluation of infertility in rural areas. We describe this and other minimally invasive low cost methods used in evaluation and management of infertility in rural areas.

Keywords: infertility, laparoscopic surgeries, Single incision laparoscopic surgery, Minimally invasive surgeries.

How to cite this article: Sailo L, Jesudian G. Single Incision Gasless Laparoscopic Surgeries and other Low-Cost Minimally Invasive Techniques for Evaluation of Infertility in Rural Areas. Int J Infertil Fetal Med 2014;5(1):30-31.

Source of support: Nil

Conflict of interest: None

Date of Received: 03-12-13

Date of Acceptance: 01-04-14

Date of Publication: April 2014


 
Case Report
Ashakiran Thavarsingh Rathod

Torsion of Gravid Uterus due to Uterine Asymmetry associated with Placental Abruption, Intrauterine Fetal Demise, and Maternal Shock

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:64-65][No of Hits : 774]


ABSTRACT

A 24-year-old gravida 3 para 2 living 1 with 28 weeks gestation presented with acute abdomen and shock. A diagnosis of concealed abruption with intrauterine death of fetus was made and case was taken for emergency cesarean section. It turned out to be 180° levorotation of gravid uterus with abruption. Detorsion of the uterus failed. A dead fetus was delivered through a vertical incision on posterior wall of uterus. Asymmetrically, enlarged uterus and excess liquor were the associated findings. Total hysterectomy was done for uncontrolled atonic postpartum hemorrhage. Postoperative period was uneventful. Although a rare obstetric condition, torsion of gravid uterus should be considered in the differential diagnosis of placental abruption particularly when concealed.

Keywords: Torsion, Gravid uterus, Abruption, Shock, Intrauterine fetal demise.

How to cite this article: Rathod AT. Torsion of Gravid Uterus due to Uterine Asymmetry associated with Placental Abruption, Intrauterine Fetal Demise and Maternal Shock. Int J Infertil Fetal Med 2014;5(2):64-65.

Source of support: Nil

Conflict of interest: None

Date of Received: 29-06-14

Date of Acceptance: 17-07-14

Date of Publication: May 2014


 
Original Article
Richa Sharma

Prospective Study of Effect of Body Weight on in vitro fertilization Outcome in Reproductive Age Group

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:58-63][No of Hits : 769]


ABSTRACT

Background: Various prognostic factors in assisted reproduction procedures have been described and analyzed which includes woman’s age, cause of infertility, ovarian response and uterine receptivity, the semen quality, and the body mass index (BMI). Optimal BMI is required for an optimal response. There is controversy among various reports, which is partly caused by the varying focus of investigators and differences in study designs, which led us to examine the relationship between BMI, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcome in our unit.

Objective: To study impact of BMI on IVF outcome prospectively.

Materials and methods: It is a prospective study over a period of 1 year in the age group 25 to 35 years attending the IVF clinic was conducted at a tertiary infertility center in Bangalore, India between November 2010 and October 2011.

Results: There is a close association of increased BMl in particular when BMl is > 30 kg/m2 and the reduced outcomes of IVF/ ICSI treatment in the form of decreased clinical pregnancy and higher early pregnancy loss. Furthermore, increased BMl is related to higher dosage and duration of gonadotropins requirement increased risk of cancellation and fewer collected oocytes.

Conclusion: Obesity is associated with an increased risk of early pregnancy loss. Also need of high dose of gonadotropin, less number of collected oocytes is observed. Implantation rate, pregnancy rate and miscarriage rate was comparable but live births are high in normal weight and overweight as compared to extremes of BMI. So will be appropriate to recommend life style modifications including weight loss to achieve an appropriate BMI prior to IVF.

Keywords: Body mass index, gonadotropin, IVF, pregnancy.

How to cite this article: Sharma R. Prospective Study of Effect of Body Weight on in vitro Fertilization Outcome in Reproductive Age Group. Int J Infertil Fetal Med 2014;5(2):58-63.

Source of support: Nil

Conflict of interest: None

Date of Received: 10-07-14

Date of Acceptance: 31-07-14

Date of Publication: May 2014


 
ORIGINAL ARTICLE
Shaweez Faizi, Muralidhar V Pai

Role of Midtrimester Localization of the Placenta in predicting Pregnancy Outcome

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:87-91][No of Hits : 742]


ABSTRACT

The localization of the placenta by ultrasound in the second trimester has been hypothesized to have an impact on the pregnancy, in terms of antenatal, intrapartum and postnatal outcome.

Objective: To evaluate the role of placental location in predicting the pregnancy outcome.

Materials and methods: It was a prospective observational study conducted between September 2011 and March 2013 at a tertiary care hospital. Placental location, as determined by midtrimester ultrasound in 620 antenatal women, was divided into five groups-anterior, posterior, fundal, lateral and low lying placenta-depending on where > 75% of the placental mass was located. Outcome variables, such as antenatal complications, intrapartum events and neonatal outcome in these women were studied.

Results: Out of 620 women, 274 (44.1%) had anterior, 169 (27.2%) had posterior, 98 (15.8%) had fundal, 61 (9.8%) had lateral placentae and 18 (2.9%) had placenta previa as per the last scan done at 28 weeks. Pre-eclampsia (27.9%) and antepartum hemorrhage (19.7%) were more common in lateral placenta whereas term prelabor rupture of membranes (11.2%) was more common in fundal placenta and these findings were statistically significant. The incidence of intrauterine growth restriction (IUGR) was also found to be higher in patients with lateral (16.4%) and posteriorly (16%) implanted placenta although there was no statistically significant association.

Conclusion: Among the various placental sites of implantation, lateral location of the placenta is associated with adverse antenatal outcomes like pre-eclampsia, antepartum hemorrhage and IUGR.

Keywords: Placental location, Ultrasound, Pregnancy outcome.

How to cite this article: Faizi S, Pai MV. Role of Midtrimester Localization of the Placenta in predicting Pregnancy Outcome. Int J Infertil Fetal Med 2014;5(3):87-91.

Source of support: Nil

Conflict of interest: None

Date of Received: 28-11-14

Date of Acceptance: 10-12-14

Date of Publication: September 2014


 
Original Article
Rochelle Heroina Gracias, Louis Fessy Thalakottoor, Parasuram Gopinath, Gopinathan Kannoly Karunakaran

Fertility Scoring Index: Cimar's Novel System to Predict assisted Reproductive Technology Success

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:44-57][No of Hits : 739]


ABSTRACT

Background: About 15% of all couples are infertile and require fertility treatment. With constantly improving clinical and laboratory procedures, pregnancy rates of about 30% per transfer are routinely reported. In non-donor-oocyte cycles, the percentage of in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI) cycles that result in pregnancy ranges from 18 to 45%, depending on several factors (Society for Assisted Reproductive Technology 2009). But a patients concern is about the success rate-‘What is my chance of getting pregnant’? For the success in IVF/ICSI-embryo transfer cycle there are many variables thought to be directly related to the implantation and successful outcome.

Aims and objectives:

  1. To identify independent predictors ICSI outcome.
  2. To make a composite predictive scoring system-
    1. For patient selection and counseling for assisted reproductive technology (ART).
    2. That may prove critical in counseling poor prognosis patients, about their prognosis or against IVF treatment (e.g. patients with least benefits in undergoing IVF can opt for donor oocytes/surrogacy, etc. without wasting a cycle in trial and error).
    3. Optimizing treatment by developing more customized individually tailored treatment plan with consideration to predictive factors.

Study design: The research was approved by the institutional review board. A retrospective ongoing study was performed, over a period of 3 years at a well established infertility institution. A sample size of 1020 patients was considered from two hospitals of the same institution. The patients were stimulated by different protocols specific to each patients age, AFC, etc [Polycystic ovarian syndrome (PCOS) patients showing hyperresponse in follicular study-antagonist protocol]; though a majority underwent long agonist protocol. They were evaluated and the outcome was assessed through logistic regression analysis. Several variables were taken into consideration-to name a few; age, previous pregnancy outcome, previous ART treatment if any, E2/LH/P4 [baseline values and on the day of human chorionic gonadotropin (hCG)], etc. A preferential scoring was derived to obtain a predictive scoring for pregnancy outcome.

Results: A pregnancy predicting scoring was arrived at. On considering several variables, the cut off score represented a 50% success rate of IVF/ICSI cycle.

Conclusion: Bearing in mind that fertility is independent of hospital protocols and primarily dependent on the individual woman, the derived predictive scoring can be applied to individual cohort of patients under infertility treatment and has excellent discrimination ability for assessing the likelihood of pregnancy outcome. Application of this scoring will allow individualized treatment decision-making for patients under infertility treatment.

Keywords: Fertility scoring, Infertility, Pregnancy success, Art success.

How to cite this article: Gracias RH, Thalakottoor LF, Gopinath P, Karunakaran GK. Fertility Scoring Index: Cimar’s Novel System to Predict Assisted Reproductive Technology Success. Int J Infertil Fetal Med 2014;5(2):44-57.

Source of support: Nil

Conflict of interest: None

Date of Received: 04-05-14
Date of Acceptance: 14-08-14

Date of Publication: May 2014


 
Editorial
Kamini A Rao

Editorial

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:vii][No of Hits : 671]


ABSTRACT

Dear Readers,
Greetings and good wishes!
The importance of luteinizing hormone (LH) in the biological process of follicular development and oocyte maturation cannot be overemphasized. Information regarding what is the level of LH which is optimal during controlled ovarian stimulation and which are the subsets of women who benefit from exogenous LH, if it is exogenous LH, whether it is in the form of hMG/rLH, remains elusive. Review article by Dr Arveen gives us better understanding about these elusive aspects.


 
CASE REPORT
Lakshmidevi Muralidhar, Shreedhar Venkatesh, Pramila Pandey

Partial Vaginal Agenesis with Transverse Vaginal Septum

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:110-112][No of Hits : 660]


ABSTRACT

Partial vaginal agenesis with transverse vaginal septum is rare malformation of female genital system. The reported incidence of vaginal atresia is 1:4000 to 5000 live female birth. The incidence of septum in upper one-third is 46%, middle 35%, lower 19%. Transverse vaginal septum occurs due to defect in vertical fusion of mullerian ducts during embryogenesis. Vaginal atresia occurs due to failure of canalization of sinovaginal bulbs.
We are presenting such a rare case of partial vaginal agenesis with transverse vaginal septum.
The aim of this presentation is to make the consideration of transverse vaginal septum and vaginal atresia in young girls with cryptomenorrhea and to emphasize on is meticulous evaluation and diagnosis with counselling of a minor along with parents of future reproductive outcome along with surgical difficulties anticipation and difficulties post vangioplasty.

Keywords: Partial vaginal agenesis, Transverse vaginal septum, vaginal atresia.

How to cite this article: Muralidhar L, Venkatesh S, Pandey P. Partial Vaginal Agenesis with Transverse Vaginal Septum. Int J Infertil Fetal Med 2014;5(3):110-112.

Source of support: Nil

Conflict of interest: None

Date of Received: 28-11-14

Date of Acceptance: 02-12-14

Date of Publication: September 2014


 
Case Report
Snehal Dhobale, Revathi S Rajan, Kamini A Rao

Hemoperitoneum in Third Trimester of Pregnancy: Unusual Cause-Spontaneous Rupture of Uterine Varices

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:66-68][No of Hits : 644]


ABSTRACT

Spontaneous uterine varices rupture is a very rare condition (1/10,000 pregnancies), leading to significant maternal and fetal morbidity and mortality. Though the exact etiology is still unknown, it seems to be associated with an increased in venous pressure. The rupture especially occurs in third trimester. We encounter a case of 31 years old primigravida with pain in abdomen since 1 day not relieved by medication. Abdominal ultrasound revealed hemoperitoneum. Emergency exploratory laparotomy revealed 1.5 litres of hemoperitoneum and confirmed the diagnosis of ‘spontaneous rupture of uterine varices’. The clinical presentation of spontaneous rupture of uterine varices is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. This rare condition has to be taken into account to the differential diagnosis in a pregnant woman with severe abdominal pain.

Keywords: Uterine varices, hemoperitoneum, abdominal ultrasound.

How to cite this article: Dhobale S, Rajan RS, Rao KA. Hemoperitoneum in Third Trimester of Pregnancy: Unusual Cause-Spontaneous Rupture of Uterine Varices. Int J Infertil Fetal Med 2014;5(2):66-68.

Source of support: Nil

Conflict of interest: None

Date of Received: 12-06-14

Date of Acceptance: 05-08-14

Date of Publication: May 2014


 
Review Article
KP Suresh, MR Gajendragad, H Rahman

Design and Analysis of Observational Studies

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:33-39][No of Hits : 642]


ABSTRACT

Appropriate study design forms the basis of any successful organized research. Irrespective of the underlying rationale of the research question, inappropriate design of an experiment or execution of a study may not give a valid result. As defined, the research should have the following characteristics: it should be undertaken within the framework of a set of philosophies, should have an unbiased objective and a design comprising of methods and techniques that have been tested for their validity and reliability. These principles of research clearly emphasize the need for an appropriate study design. The current review focuses on the planning and analysis of an observational study to obtain significant and accurate findings.

Keywords: Experimental design, research methodology, analysis, observational studies.

How to cite this article: Suresh KP, Gajendragad MR, Rahman H. Design and Analysis of Observational Studies. Int J Infertil Fetal Med 2014;5(2):33-39.

Source of support: Nil

Conflict of interest: None

Date of Received: 10-07-14

Date of Acceptance: 18-08-14

Date of Publication: May 2014


 
Research Article
Anuradha R Shewale, Bhavana Shewale

Preterm Delivery and Growth Restriction in Multifetal Pregnancies reduced to Twins: Case-Control Series

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:40-43][No of Hits : 594]


ABSTRACT

An adverse consequence of the widespread introduction of assisted reproductive techniques has been an exponential increase in the prevalence of multifetal pregnancies (Botting et al 1987). Such pregnancies are associated with increased risk of miscarriage and perinatal death (Kiely et al 1992). One of the options in the management of multifetal pregnancies is embryo reduction to twins which is associated with a reduction in the background risk of adverse pregnancy outcome (Evans et al 1995). The aim of the study was to compare the gestation at delivery and birth weight of surviving twins following multifetal pregnancy reduction to those in a control group of dichorionic non-reduced twins.

Materials and methods: A case control study evaluating pregnancy outcomes post embryo reduction. Study takes into account all patients with successful day three embryo transfers resulting in multifetal pregnancy. First trimester embryo reduction was carried out by intracardiac injection of KCl.

Results: A total of 26 multifetal pregnancies were reduced to twins at early gestational age (7-9 weeks). Two cases (7.6%) of miscarriage, no cases of chorioamnionitis and five cases (19.2%) of transient spotting were recorded as postoperative complications. There was no vanishing of embryos in those reduced to twins. A total of 24 patients (92.3%) with twin pregnancies took home at least one baby, while 18 (69.23%) of these took both babies home. This was analyzed and compared with a control group of women with nonreduced twins pregnancies.
The preterm delivery rate (defined as fetuses delivered before 37 weeks) in twin pregnancies was 53.8% (n = 14), with a severe preterm rate (defined as fetuses delivered before 32 weeks) of 23.07% (n = 6). One case (1.92%) of stillbirth occurred. The perinatal mortality rate was 13.46% (n = 6 newborns, and a 33-week stillbirth), mainly due to severe preterm labor. The latter group included no registered cases of newborns with congenital malformations. A total of 24 patients (92.3%) with twin pregnancies took home at least one baby, while 18 (69.23%) of these took both babies home.
In two of the 26 multifetal pregnancies reduced to twins there was miscarriage of both fetuses before 24 weeks of gestation the median interval between reduction and multifetal loss was 5 weeks.
In pregnancy reduced to twins as compared to nonreduced twins the percentage of miscarriage was slightly higher, but not statistically significant (7.6% compared to 6.9%, 0.07 × 2, P 0.8). The median gestation at delivery was lower (33.3 ± 9.2 compared to 35.67 ± 5.84 weeks, 2.26 > 2.0 t, 0.05 P) and the median weight deficit was greater (1.58 ± 0.96 compared to 1.92 ± 0.89 (4.04 > 3.37 t, 0.001 P).

Keywords: Embryo reduction, Multifetal pregnancy, Transvaginal ultrasound-guided, Preterm delivery, Growth retardation.

How to cite this article: Shewale AR, Shewale B. Preterm Delivery and Growth Restriction in Multifetal Pregnancies reduced to Twins: Case-Control Series. Int J Infertil Fetal Med 2014;5(2):40-43.

Source of support: Nil

Conflict of interest: None

Date of Received: 10-07-14

Date of Acceptance: 18-08-14

Date of Publication: May 2014


 
Case Report
Puspal De, Sudipa Chakravarty, Amit Chakravarty

1p36 Deletions in Two Cases with Thalassemia

[Year:2014] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:42] [Pages No:69-74][No of Hits : 580]


ABSTRACT

Summary: Terminal deletions in the short arm of chromosome one are generally associated with characteristic phenotype with dysmorphic features, including congenital anomalies and mental retardation with various degrees. Different outcomes depend on the sizes and locations of the deleted areas characterized by moderate to severe intellectual disability, delayed growth, hypotonia, seizures, limited speech ability, malformations, hearing and vision impairment and distinct facial features. The symptoms may vary, depending on the exact location of the chromosomal deletion but not a single reported case showed any ‘feature of anemia’.
We report here one male and one female individual with partial deletions on chromosome no. one, both at 1p36 region. Cytogenetic analysis of blood lymphocytes was studied with high resolution GTG-banding analysis, using cyto-vision software on their chromosomes. Results revealed 46, XY, del(1)(p36.21) in the male who was also diagnosed as a ‘beta thalassemia trait’ and the other case was 46, XX, del(1)(p36.3) in the female who was diagnosed as a case of ‘HbE-beta thalassemia’.
This report provides additional cases to the growing literature.

Purpose/background: Deletion 1p36 is the most common terminal deletion syndrome with an estimated occurrence of 1:5000 live births. We report two patients with 1p36 deletions among which one shows ‘atypical’ proximal interstitial deletion at 1p36.21 using HR-GTG banding analysis. Interestingly, both the patients manifest one extra clinical characteristic that is different from those seen in ‘classical’ monosomy 1p36 syndrome, is ‘microcytic anemia’.
Based on the analysis of the clinical and molecular data from our patients and those reported in the literature, we suggest that deletion 1p36.21 chromosomal abnormality may constitute yet another deletion syndrome distinct from the classical distal 1p36 deletion syndrome.
Our aim was to find out further information regarding anemia since there are previously reported cases of anemias associated with this 1p36 region-one is presence of a ‘putative tumor suppressor gene’ important in the evolution of chronic myelocytic leukemia and the other is one inherited erythroblastopenia, commonly known as ‘Diamond-Blackfan anemia’ (DBA), caused by mutation in the gene encoding ribosomal protein L11 (RPL11) to answer families’ questions in the clinical setting.

Materials and methods: Standard cytogenetic analysis was used with high resolution GTG-banding analysis, using cytovision software for karyotyping and high performance liquid chromatography (HPLC) and amplification refractory mutation system (ARMS-PCR) to detect the five common Indian β-thalassemia mutations: [IVS-I-5 (G >C), Cod 15 (G-A), Cod 8/9 (+G), Fr 41/42 (?TTCT) and Cod 26 (G-A)].

Results: Results showed 46, XY, del(1)(p36.21) in the male, additionally diagnosed as a ‘beta thalassemia trait’ and in another case 46, XX, del(1)(p36.3) in female who was diagnosed as a case of ‘HbE-beta thalassemia’.

Conclusion: These two patients with deletion 1p36 represent association with other genetic disorder which is characterized by hematological abnormalities.

Keywords: Cytogenetics, Copy number variation, Microdeletion, Thalassemia, Mental retardation, Microcephaly.

How to cite this article: De P, Chakravarty S, Chakravarty A. 1p36 Deletions in Two Cases with Thalassemia. Int J Infertil Fetal Med 2014;5(2):69-74.

Source of support: Nil

Conflict of interest: None

Date of Received: 02-06-14

Date of Acceptance: 13-08-14

Date of Publication: May 2014


 
Book Review
Mala Arora

Vaginal Hysterectomy

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:][No of Hits : 558]


ABSTRACT

Vaginal Hysterectomy

Vaginal hysterectomy is a natural orifice surgery, hence, sans a scar. It is a surgical procedure essential for the gynecologist to master. The indications are no longer restricted to prolapsed uteri. They have broadened to nondescent uteri as well as malignant uteri. Dr Shirish S Sheth has a vast experience of performing vaginal hysterectomies in the most challenging situations. His deft surgical technique makes the procedure look simple even in presence of associated pelvic pathology.


 
Review Article
Mandeep Kaur, Mala Arora

Diminished Ovarian Reserve, Causes, Assessment and Management

[Year:2013] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:45-55][No of Hits : 6254]


ABSTRACT

Diminished ovarian reserve predicts diminished ovarian response to stimulation but does not predict cycle fecundity. It has been recently defined by ESHRE, the Bologna's criteria, according to which at least two of the following three features should be present: (1) Age >40 years/any other risk factor for DOR, (2) abnormal ovarian reserve test, i.e. antral follicle count, AMH, (3) poor ovarian response in a previous stimulated cycle, i.e. less than three follicles after standard gonadotropin stimulation. Poor response to maximal stimulation on two previous occasions also defines DOR.
The treatment options are limited. Avoiding the GnRH agonist long protocol and stimulation with microdose flare or antagonist protocol yields better results. Adjuvant therapy with LH, DHEAS and growth hormone shows some benefit in improving the oocyte yield. It is advisable to perform ICSI for all obtained oocytes and some advocate assisted hatching. Pregnancy rates are, however, poor and often these patients require ovum donation. Developing tests that will diagnose DOR in a low-risk population will allow women to plan their reproductive careers early.

Keywords: Diminished ovarian reserve, Poor ovarian response, Premature ovarian failure, Poor responders.

How to cite this article: Kaur M, Arora M. Diminished Ovarian Reserve, Causes, Assessment and Management. Int J Infertility Fetal Med 2013;4(2):45-55.

Source of support: Nil

Conflict of interest: None


 
Review Article
Pankaj Desai

Predicting Obstetric Vasculopathies Through Study of Diastolic Notch and other Indices of Resistance to Blood Flow in Uterine Artery

[Year:2013] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:37] [Pages No:24-30][No of Hits : 5325]


ABSTRACT

Obstetric vasculopathies are a set of apparently heterogeneous and poorly understood conditions. Conditions like recurrent miscarriages due to fetal demise, pre-eclampsia, IUGR, recurrent still births and accidental hemorrhage all seem to have the same underlying etiopathology. They are grouped into one large set coined as 'Obstetric Vasculopathies'. Resistance to blood flow in the uterine arteries can be important and effective method to predict obstetric vasculopathies (except recurrent miscarriages). Resistance to this blood flow can be measured by the presence (and subsequent disappearance) of diastolic notch as well as the standard color Doppler indices namely Pulsatility Index (PI), Resistance Index (RI) and Systolic: Diastolic (S: D) ratio. In normal pregnancy almost always at 12 to 14 weeks of duration, the uterine artery shows presence of a diastolic notch. In high-risk subjects, disappearance of diastolic notch at midtrimester in uterine artery Doppler waveform analysis if used alone may not be a good screening method for obstetric vasculopathies. However, the combination of a diastolic notch and an abnormal resistance index in both uterine arteries at 20 weeks gestation is more accurate indicator in predicting severe pregnancy complications. These subjects are almost eight times more likely to develop either: Clinically significant hypertension and/or deliver prior to 32 weeks and/or have a perinatal demise and/or have an Infant with a birth weight of less than 1500 gm. Bilateral or Unilateral: Studying bilateral uterine artery seems to be more accurate that unilateral artery for prediction of obstetric vasculopathies. Prediction in I-Trimester: Disappearance of uterine artery diastolic notch in combination with other parameters seems to be a good test for prediction of obstetric vasculopathies particularly PIH and IUGR in I-Trimester. The advantage of such an early allows an early instituting of preventive measures. Notch Depth Index (NDI): It is calculated as the depth of the diastolic notch divided by the maximal diastolic velocity. The NDI value in the second trimester is associated with the later onset of pre-eclampsia, and is clinically more useful in predicting pre-eclampsia than the two conventional indices. Abnormal maternal uterine artery Doppler in association with elevated maternal serum AFP, HCG, Inhibin A or decreased PAPP-A identifies a group of subjects at greater risk of IUGR and gestational hypertension with proteinuria. Lowdose aspirin administered as early as 14 to 16 weeks of gestation to pregnant subjects at high risk of pre-eclampsia with abnormal uterine Doppler findings may reduce or modify the course of severe pre-eclampsia and may help in prevention of IUGR.

Keywords: Color Doppler, Pre-eclampsia, IUGR, Vasculopathies, Diastolic notch, Uterine artery.

How to cite this article:Desai P. Predicting Obstetric Vasculopathies through Study of Diastolic Notch and other Indices of Resistance to Blood Flow in Uterine Artery. Int J Infertility Fetal Med 2013;4(1):24-30.

Source of support: Nil

Conflict of interest: None


 
Research Articles
PM Gopinath, Bharti Kalra, Ajit Saxena, Sonia Malik, Kapil Kochhar, Sanjay Kalra, Hemant Zaveri

Fixed Dose Combination Therapy of Antioxidants in Treatment of Idiopathic Oligoasthenozoospermia: Results of a Randomized, Double-blind Placebo-controlled Clinical Trial

[Year:2013] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:37] [Pages No:6-13][No of Hits : 4311]


ABSTRACT

Introduction: To assess the effectiveness and safety of fixed dose combination (FDC) of antioxidants in treatment of idiopathic oligoasthenozoospermia.

Materials and methods: Placebo-controlled, Double-blind, randomized, Parallel three arm, Multicentric trial.

Setting: Fertility clinics of five centers across India.

Patients: One hundred and thirty-eight male subjects, aged between 21 and 50 years and subfertile for 1 year or more with the following baseline sperm selection criteria: Concentration <15 million/ml and total sperm motility < 40%.

Intervention(s): Eligible subjects were randomized to either of the three arms in a double-blind manner, i.e. arm 1 was given 2 tablets twice daily of FDC of antioxidants (coenzyme-Q10: 50 mg, L-carnitine: 500 mg, lycopene: 2.5 mg and zinc: 12.5 mg); arm 2 was given 1 tablet of FDC of antioxidants and one tablet of placebo twice daily and arm 3 was two tablets twice daily of matching placebo all for 180 days.

Main outcome measure(s): The primary outcome measures were improvement in sperm count and sperm motility, whereas pregnancy rate was the secondary efficacy outcome.

Results: Compared to placebo, a statistically significant improvement was seen in sperm count (14.8-26.35 in arm 1 and 14.37-24.8 million/ml in arm 2, p < 0.0001), and sperm total motility (39.2-51.6% in arm 1 and 38.4-50.1% in arm 2, p < 0.0001), at 90 days, and treatment further improved these parameters at day 180. No intergroup difference was seen between arm 1 and arm 2. Mild adverse event of upper gastrointestinal discomfort by 8 subjects (three in arm 1; one in arm 2 and four subjects in arm 3) were reported. No serious adverse event was seen in the study.

Conclusion: Exogenous administration of fixed dose combination of antioxidants is a safe and effective therapy in improving the male subfertility.

Keywords: Oligospermia, Asthenozoospermia, Ubiquinone (coenzyme Q10), L-carnitine, Zinc, Lycopene.

How to cite this article:Gopinath PM, Kalra B, Saxena A, Malik S, Kochhar K, Kalra S, Zaveri H. Fixed Dose Combination Therapy of Antioxidants in Treatment of Idiopathic Oligoasthenozoospermia: Results of a Randomized, Doubleblind, Placebo-controlled Clinical Trial. Int J Infertility Fetal Med 2013;4(1):6-13.

Source of support: Nil

Conflict of interest: None


 
Case Reports
Mohan S Kamath, Mousumi Acharya, Vandana Kamath, TK Aleyamma

Disseminated Intravascular Coagulation after Myomectomy: A Case Report and Review of Literature

[Year:2013] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:37] [Pages No:31-33][No of Hits : 3603]


ABSTRACT

Hematological complications can complicate the postoperative period following myomectomy. Clinicians should keep such rarer possibilities in mind which will help them identify the complications correctly and manage appropriately. We managed a case of disseminated intravascular coagulation following myomectomy which was promptly diagnosed and managed.

Keywords: Disseminated intravascular coagulation, Myomectomy, Leiomyoma.

How to cite this article:Kamath MS, Acharya M, Kamath V, Aleyamma TK. Disseminated Intravascular Coagulation after Myomectomy: A Case Report and Review of Literature. Int J Infertility Fetal Med 2013;4(1):31-33.

Source of support: Nil

Conflict of interest: None


 
Case Reports
Sampath Kumar Govindaraj, Lakshmidevi Muralidhar, Shreedhar Venkatesh, Rajiv Kumar Saxena

Disorder of Sexual Development with Sex Chromosome Mosaicism 46 XY and 47 XXY

[Year:2013] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:37] [Pages No:34-37][No of Hits : 3008]


ABSTRACT

Incidence of abnormalities of sex chromosome is reported to be 1 in 448 new born babies. The association between clinical phenotype and sex chromosome abnormality is highly variable. A 34-year-old unmarried female patient reported to out patient department with complaints of primary amenorrhea and occasional pain in the lower abdomen. On examination, her height was 160 cm and body mass index (BMI) was 27 kg/m2. Breast development was Tanner stage 4, pubic hair was tanners stage 1 and no axillary hair was noted. Ultrasonography showed a hypoechoic structure in the place of uterus measuring around 1.7 × 1.1 × 1.0 cm and hypoechoic structures were also noted in relation to iliac vessels suggestive of gonads. Karyotyping showed 46 XY and 47 XXY mosaicism. Bilateral gonadectomy was done and histopathology showed testicular atrophy with Leydig cell hyperplasia. This case is reported in view of the interesting clinical presentation of this rare mosaicism.

Keywords: Disorder of sexual development, Gonadectomy, Karyotype, Mosaicism.

How to cite this article:Govindaraj SK, Muralidhar L, Venkatesh S, Saxena RK. Disorder of Sexual Development with Sex Chromosome Mosaicism 46 XY and 47 XXY. Int J Infertility Fetal Med 2013;4(1):34-37.

Source of support: Nil

Conflict of interest: None


 
Case Report
Chitra Ganesh, Anjana Sridhar

A Case of Fetal Cardiac Rhabdomyoma

[Year:2013] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:66-69][No of Hits : 2995]


ABSTRACT

Rhabdomyoma is one of the commonest cardiac tumor detected in prenatal ultrasound. Though its benign and self-limiting, it has a strong association with tuberous sclerosis, and hence needs thorough evaluation not only of the fetus but of the parents for signs of tuberous sclerosis. When isolated, fetus with rhabdomyoma needs to be only followed up for any cardiac complications associated with the mass and delivered.

Keywords: Rhabdomyoma, Tuberous sclerosis, Autosomal dominant, Echocardiography, Counseling.

How to cite this article: Ganesh C, Sridhar A. A Case of Fetal Cardiac Rhabdomyoma. Int J Infertility Fetal Med 2013;4(2):66-69.

Source of support: Nil

Conflict of interest: None


 
Case Report
C Chandana, Shreedhar Venkatesh

Triple X Syndrome Woman Presenting as Premature Ovarian Failure

[Year:2013] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:28] [Pages No:96-98][No of Hits : 2896]


ABSTRACT

Triple X syndrome is a sex chromosome abnormality characterized by extra X chromosome, occurring in approximately 1 in 1,000 female births. This condition often remains undiagnosed as most of them have normal phenotype, puberty and fertility. We report a case of Triple X syndrome with normal phenotype and intelligence presented with secondary amenorrhea and diagnosed to have premature ovarian failure. This case emphasizes the need for chromosomal analysis in women presenting with premature ovarian failure leading to primary or secondary amenorrhea.

Keywords: Triple X syndrome, Premature ovarian failure, Secondary amenorrhea, Karyotyping.

How to cite this article: Chandana C, Venkatesh S. Triple X Syndrome Woman Presenting as Premature Ovarian Failure. Int J Infertility Fetal Med 2013;4(3):96-98.

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Purnima Deb, Nighat Aftab, Tasneem Rangwala

Successful Cerclage at Advanced Cervical Dilatation in the Second Trimester

[Year:2013] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:56-58][No of Hits : 2431]


ABSTRACT

The aim of our study is to verify whether some maternal features are related to pregnancy outcome of emergency cerclage when membranes are protruding through the dilated cervix. We present a retrospective review of 20 cases of emergency cervical cerclage performed over a 3 years period at Al Wasl hospital, a tertiary level centers in Dubai. Analysis shows presence of membrane prolapse with infection causing rupture of membranes, to be the strongest predictor of poor outcome. Analysis also reveals a significant association between initial white blood cell count and perinatal outcome. This information is helpful in decision making and counseling patients regarding the likely outcome.

Keywords: Emergency cerclage, Maternal features, Bacterial vaginosis, Pregnancy outcome.

How to cite this article: Deb P, Aftab N, Rangwala T. Successful Cerclage at Advanced Cervical Dilatation in the Second Trimester. Int J Infertility Fetal Med 2013;4(2):56-58.

Source of support: Nil

Conflict of interest: None


 
Original Article
Mandeep Kaur, Gautham Pranesh, Manishi Mittal, Anjali Gahlan, K Deepika, T Shashikala, Kamini A Rao

Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center

[Year:2013] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:39-44][No of Hits : 2342]


ABSTRACT

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women and its prevalence is rising. Management of the disease is usually medical and some resistant cases may require surgical treatment in the form of laparoscopic ovarian drilling (LOD). Medical management exposes the patient to increased risk of multiple pregnancy and hyperstimulation. LOD avoids the need of medical therapy or makes the ovaries more responsive to treatment.

Aim: The objective of this descriptive study was to study the outcome of LOD in patients of PCOS with clomiphene resistance in the form of clinical pregnancy and live birth rate.

Setting: Tertiary assisted conception center.

Design: Observational study.

Materials and methods: 100 patients of clomiphene resistant PCOS who underwent LOD.

Outcome measure: Primary outcome was clinical pregnancy rate and secondary outcome was ovarian hyperstimulation syndrome (OHSS) rate, multiple pregnancy rate, miscarriage rate, prevalence of hypothyroidism and live birth rate in PCOS patients.

Results: Clinical pregnancy rate-47.3%, OHSS rate-2.7%, multiple pregnancy rate-4%, miscarriage rate-6.7%, prevalence of hypothyroidism-48% and live birth rate-40.5%.

Conclusion: Patients with irregular cycles, high LH/FSH ratio usually have CC resistance. PCO patients have high prevalence of hypothyroidism and it should be specifically screened and treated. Low incidence of miscarriage rate, OHSS rate and multiple pregnancy rates is seen after LOD with 47.3% clinical pregnancy and 40.5% live birth rates. Patients with high values of LH/FSH ratio are the candidates who stay nonpregnant in spite of LOD and this information is very useful in prognosticating the patients.

Keywords: Laparoscopic ovarian drilling, Polycystic ovarian syndrome, Clomiphene, Gonadotropins, Hyperstimulation.

How to cite this article: Kaur M, Pranesh G, Mittal M, Gahlan A, Deepika K, Shashikala T, Rao KA. Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center. Int J Infertility Fetal Med 2013;4(2):39-44.

Source of support: Nil

Conflict of interest: None


 
Research Articles
Geetu Bhandoria, Samar Rudra

Anovulatory Infertility: A Prospective Study

[Year:2013] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:37] [Pages No:18-23][No of Hits : 2216]


ABSTRACT

Introduction: Anovulation is a common cause of infertility with poly cystic ovarian disease being the commonest.

Objective: To estimate the prevalence of various causes of anovulation in patients younger than 35 years of age attending infertility clinics and to ascertain the nature and extent of metabolic abnormalities and efficacy of therapy.

Materials and methods: Sixty cases of anovulatory infertility diagnosed by standard method were recruited for the study. Transvaginal sonography and hormonal profile like LH, FSH, Prolactin and Thyroid profile evaluated to establish the cause of anovulation. Menstrual history, Body Mass Index, Waist Hip ratio and presence of hirsutism, acanthosis nigricans were recorded. Metabolic parameters like lipid profile, OGTT and Glucose insulin ratio were also assessed. All parameters were reevaluated at 3 and 6 months of treatment and were statistically analyzed. Response to treatment in terms ovulation and pregnancy achieved was also analyzed.

Conclusion: Women with anovulatory infertility has shown good improvement to appropriate treatment.

Keywords:Infertility, Anovulation, Polycystic ovary syndrome, Clomiphen citrate.

How to cite this article:Bhandoria G, Rudra S. Anovulatory Infertility: A Prospective Study. Int J Infertility Fetal Med 2013; 4(1):18-23.

Source of support: Nil

Conflict of interest: None


 
Research Articles
Lakshmi Rathna Marakani, Shashikala Dasari, Sirisha Rao Gundabattula, Elizabeth Joseph

Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices?

[Year:2013] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:37] [Pages No:1-5][No of Hits : 2060]


ABSTRACT

Objective: To assess the reduction in fetal loss following transabdominal cervicoisthmic cerclage done for repeated failed vaginal cerclages and/or inaccessible cervices.

Study design: An observational study of 113 pregnancies in 90 women after transabdominal cervicoisthmic cerclage from January 1999 to December 2010 at Fernandez Hospital, Hyderabad, Andhra Pradesh, India.

Results: Mean gestational age at the time of elective transabdominal cervicoisthmic cerclage was 11.6 weeks. Patients were delivered by lower segment cesarean section (LSCS) with a mean gestational age of 36 weeks. Live birth rate was 90.5%. Incidence of mid-trimester miscarriages was 8.6% after cerclage compared with 62.9% before cerclage. Before cerclage, only 13.1% pregnancies continued beyond 28 weeks whereas after cerclage, 88.6% crossed the period of viability. Prior to cerclage, preterm delivery rate was 7.0% (as majority of the pregnancies were lost prior to period of clinical viability) and only 13.6% of these preterm babies survived. Although the incidence of preterm deliveries was 23.8% after cerclage, 80% of these preterm babies survived. Excluding first-trimester miscarriages, fetal loss was 93.3% prior to cerclage and 13.7% postcerclage. In effect, the take home baby rate among pregnancies was only 5.8% before cerclage compared with 86.7% after cerclage. Mean birth weight after cerclage was 2.5 kg.

Conclusion: Transabdominal cerclage reduces fetal loss and improves pregnancy outcome in women who had failed vaginal cerclages and in those with inaccessible cervices.

Keywords:Transabdominal cervicoisthmic cerclage, Transvaginal cerclage, Cervical incompetence.

How to cite this article:Marakani LR, Dasari S, Gundabattula SR, Joseph E. Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices? Int J Infertility Fetal Med 2013;4(1):1-5.

Source of support: Nil

Conflict of interest: None declared


 
Research Article
Meenakshi Barsaul Chauhan, Pinkey Lakra, Roopa Sangwan, Smiti Nanda, Vani Malhotra

Hysterosalpingography vs Hysteroscopy: Role in Assessment of Uterine Factor during Infertility Workup

[Year:2013] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:28] [Pages No:79-82][No of Hits : 1828]


ABSTRACT

Objective: Uterine pathologies are the cause of infertility in 15% of infertile couples and their correction is associated with improved pregnancy rates. This prospective study was carried out to compare hysterosalpingography (HSG) with hysteroscopy (HSC) in evaluation of uterine pathology.

Study design: The research was approved by the institutional review board. A total of 100 infertile women were included in the study. HSC and HSG were performed in the follicular phase and the findings were compared. Student’s t test and chi-square test were applied wherever applicable. Degree of agreement between the two procedures was calculated using kappa estimates.

Results: Thirteen percent of the women had abnormal HSG regarding the uterine cavity while 20% had abnormal HSC findings (chi-square value 1.77, p > 0.05).Out of 10% women who had normal HSG, some abnormality was found on HSC. Similarly 3% women with abnormal HSG had normal findings on HSC. Sensitivity of HSG in detecting uterine cavity abnormality was 50% and specificity 98.1%. Positive predictive value was 76.9% and negative predictive value was 88.5%.Result of HSG was false-negative in 10% of women and false-positive in 3%.

Conclusion: Hysteroscopy should be considered essential while investigating infertile women.,Since HSG provides valuables information about tubes,it may supplement the hysteroscopic assessment.

Keywords: Hysterosalpingography, Hysteroscopy, Uterine cavity.

How to cite this article: Chauhan MB, Lakra P, Sangwan R, Nanda S, Malhotra V. Hysterosalpingography vs Hysteroscopy: Role in Assessment of Uterine Factor during Infertility Workup. Int J Infertility Fetal Med 2013;4(3):79-82.

Source of support: Nil

Conflict of interest: None


 
Case Report
Nirmala Agarwal, Sweta Balani, Subhash Arya, Ratna Dua Puri

Noninvasive Management of Rhesus Alloimmunization

[Year:2013] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:59-61][No of Hits : 1758]


ABSTRACT

Rhesus alloimmunization causes fetal hemolysis, anemia and hydrops leading to stillbirth, neonatal morbidity or mortality. We describe successful management of two cases of Rh alloimmunization with high anti-D titers, by the ultrasound Doppler measurement of their peak systolic velocity in the middle cerebral artery (PSV-MCA) and multiple maternal administrations of intravenous immunoglobulin (IVIg).

Keywords: Rhesus alloimmunization, Intravenous immunoglobulin, Middle cerebral artery peak systolic velocity.

How to cite this article: Agarwal N, Balani S, Arya S, Puri RD. Noninvasive Management of Rhesus Alloimmunization. Int J Infertility Fetal Med 2013;4(2):59-61.

Source of support: Nil

Conflict of interest: None


 
Research Articles
Manjula Pochiraju, Kameswari Surampudi, Lakshmi Rathna Marakani, Shashikala Dasari, Sirisha Rao Gundabattula

A Case Control Study Comparing Risk Factors for Ectopic Gestation in Unusual and Tubal Gestations

[Year:2013] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:37] [Pages No:14-17][No of Hits : 1701]


ABSTRACT

Aim: To compare risk factors for extratubal gestations with tubal gestations.

Materials and methods: Case control design with retrospective examination of an electronic database to identify ectopic gestations. Ectopic gestations were confirmed through ultrasound examination or serum beta hCG levels. We defined an ectopic gestation as implantation of pregnancy outside uterine cavity; tubal ectopic including implantation in the tube, isthmic, ampullary, or fimbrial and extratubal ectopic including implantation in the ovaries, cervix, abdomen, interstitia or cesarean scar.

Results: Ninety-one (1.1%, 95% CI: 0.9-1.3, 1 in 90 pregnancies) of 8,203 pregnancies during the study period were ectopic gestations including 69 (0.8%, 95% CI: 0.7-1.1, 1 in 120 pregnancies) tubal gestations and 22 (0.3%, 95% CI: 0.2-0.4, 1 in 372 pregnancies) gestations in extratubal locations. Extratubal ectopic gestations were more common in women with advanced maternal age (odds ratio: 7.4, 95% CI: 1.3, 43.9, p = 0.03) compared to women with tubal ectopic gestations.

Conclusion: Risk factors for extratubal gestation did not differ from risk factors for tubal gestations except for advanced maternal age. Pregnant women with advanced maternal age have to be additionally counseled on the increased risk for extratubal gestations.

Keywords: Tubal ectopic gestation, Extratubal ectopic gestation, Risk factors, Ectopic pregnancies.

How to cite this article:Pochiraju M, Surampudi K, Marakani LR, Dasari S, Gundabattula SR. A Case Control Study Comparing Risk Factors for Ectopic Gestation in Unusual and Tubal Gestations. Int J Infertility Fetal Med 2013;4(1):14-17.

Source of support: Nil

Conflict of interest: None


 
Review Article
Nalini Mahajan

Ovarian Hyperstimulation Syndrome

[Year:2013] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:28] [Pages No:71-78][No of Hits : 1695]


ABSTRACT

ART is proven of great help to all the infertile couples anxious to get pregnant , but is not free of side effects and complications. OHSS one of the most important complication especially in cases of PCOS. Ovarian hyperstimulation syndrome (OHSS) is a potentially fatal complication of ovarian stimulation. The incidence has been estimated at 3 to 6% for moderate and 0.1 to 2% for severe OHSS. The trigger for initiation of OHSS appears to be human chorionic gonadotropin (hCG). In conception cycles symptoms may persist longer due to endogenous hCG stimulus .Vascular endothelial growth factor (VEGF), a member of the transforming growth factor superfamily, has emerged as one of the factors most likely involved in the pathophysiology of OHSS. There are various risk factors which increases the risk of developing OHSS during the stimulation like PCOS, low body weight, previous history of OHSS, etc. Primary and secondary preventive measures are been tried to reduce the risk of developing OHSS. GnRHa trigger in patients at risk revealed that incidence OHSS was reduced or totally eliminated. Use of antagonist cycle with an agonist trigger and elective vitrification of all embryos allows us to aim for an ‘OHSS Free’ clinic today.

Keywords: Ovarian hyperstimulation syndrome, Polycystic ovarian syndrome, Vascular endothelial growth factor, Antagonist, human chronic gonadotropin, Gonadotropinreleasing hormone agonist.

How to cite this article: Mahajan N. Ovarian Hyperstimulation Syndrome. Int J Infertility Fetal Med 2013;4(3):71-78.

Source of support: Nil

Conflict of interest: None


 
Original Article
Remzi Atilgan, Mustafa Ekinci, Ekrem Sapmaz, Zehra Sema Ozkan

Impact of Estradiol Monitoring on the Prediction of Intrauterine Insemination Outcome

[Year:2013] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:28] [Pages No:88-92][No of Hits : 1470]