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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 : 788]


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
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 : 736]


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


 
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 : 727]


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
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 : 691]


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


 
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 : 690]


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


 
REVIEW ARTICLE
P Jyothishmathi Sharma, Manishi Mittal

Critical Analysis of the Current Assisted Reproductive Technology Guidelines

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:113-119][No of Hits : 630]


ABSTRACT

Aim: To present an overview of the current Artificial Reproductive Techniques (ART) guidelines focussing on grey zones

Introduction: Infertility is a major health and social concern in modern day India. Due to the great diversity in management protocols and absence of standard operating procedures, there is a necessity to develop country-specific guidelines for assisted reproduction. Also, there is need to curb unethical practices. Guidelines in this regard have undergone several changes over the years. It is important that adequate care is taken before the bill becomes a law so that both patients and health workers mutually benefit from ART

Overview: The present article gives an insight into the development of guidelines over the years with elaboration of the salient features of the current ART Bill under specific chapter headings, ten chapters in total. Also discussed is the recent Surrogacy Bill. In each context, critical analysis is provided that underscores the grey areas that need to be addressed. At the end of the article, certain recommendations have been put forward to aid the successful implementation of current guidelines

Clinical significance: It is imperative that all ART practitioners be well versed with the current ART guidelines as ignorance cannot be cited as an excuse under any circumstance. Also, practitioners can give valuable inputs before the bill finally becomes a law. The law must ensure that physicians are not unnecessarily persecuted in the name of patient rights, as this will lead to fearful practice, which in turn will hamper patient management.

Keywords: Artifical Reproduction, Assisted reproductive technology, Bank, Bill, Donor, Guidelines, Law, Surrogacy, Third party.

How to cite this article: Sharma PJ, Mittal M. Critical Analysis of the Current Assisted Reproductive Technology Guidelines. Int J Infertil Fetal Med 2017;8(3):113-119.

Source of support: Nil

Conflict of interest: None

Date of received: 06/09/2017

Date of acceptance: 01/10/2017

Date of publication: November 2017


 
Editorial
Kamini A Rao

Editorial

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:iv][No of Hits : 623]


ABSTRACT

Dear Readers,
Greetings and good wishes!
Advances in laparoscopic techniques have resulted in a resurgence of interest in surgical induction of ovulation. This surgical treatment has been offered to CC-resistant patients with Polycystic Ovary Syndrome (PCOS) to increase the spontaneous ovulation rate and to decrease complications from gonadotropin treatment in simple ovulation induction or in Artificial Reproduction Technology (ART) cycles.


 
CASE REPORT
Aradhana Kalra, Akshay K Nadkarni, Purnima K Nadkarni, Pooja Singh

Successful Live Births after Laparoscopic Management of Heterotypic Pregnancies in Assisted Reproductive Technology Cycles: A Tertiary Fertility Center Experience

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:125-127][No of Hits : 598]


ABSTRACT

Background: To review and analyze the incidence of heterotypic pregnancies after intracytoplasmic sperm injection (ICSI) and embryo transfer and to report pregnancy outcome after successful management of heterotypic pregnancies.

Setting: Nadkarni’s 21st Century Hospitals and Test Tube Baby Center, Surat, Gujarat, India.

Design: Retrospective study.

Materials and methods: Retrospective data were taken from hospital records from January 2013 to December 2015. A total of 2,771 patients underwent in vitro fertilization IVF/ICSI, out of which 1,455 patients were pregnant (52.5%). Out of the pregnant patients, the incidence of ectopic (EP) and heterotypic pregnancies was calculated. The etiological factors, management of heterotypic pregnancies, and their pregnancy outcome were reported.

Conclusion: Out of the 1,455 pregnant patients, there were 29 EPs (EPs: 1.99%) and 5 were heterotypic (0.34%). Laparoscopic intervention was done for all five of them and successful pregnancy outcome was reported in terms of live birth.

Clinical significance: Heterotypic pregnancy is rare and poses a diagnostic dilemma in assisted reproductive technology (ART) cycles. Serial beta-human chorionic gonadotropin (hCG) measurement is not reliable and ultrasonography may not confirm due to the presence of ovarian hyperstimulation syndrome (OHSS) or multiple cysts. Early diagnosis is ideal and good perinatal outcome can be achieved by prompt and excellent laparoscopic management of the heterotypic pregnancies.

Keywords: Cesarean section, Heterotypic, Laparoscopic salpingectomy, Tubal disease.

How to cite this article: Kalra A, Nadkarni AK, Nadkarni PK, Singh P. Successful Live Births after Laparoscopic Management of Heterotypic Pregnancies in Assisted Reproductive Technology Cycles: A Tertiary Fertility Center Experience. Int J Infertil Fetal Med 2017;8(3):125-127.

Source of support: Nil

Conflict of interest: None

Date of received: 29/06/2017

Date of acceptance: 28/08/2017

Date of publication: November 2017


 
Book Review
Kamini A Rao

Principles and Practice of Fetal Medicine

[Year:2017] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:34] [Pages No:1][No of Hits : 543]


ABSTRACT

World Clinics: Obstetrics & Gynecology
POLYCYSTIC OVARY SYNDROME
Editor: Dr Mala Arora
Review By: Dr. Kamini A. Rao
Obstetrics & Gynecology - PCOS Vol 6 No.1 is part of the World Clinics series. Other topics in the series include endometriosis, recurrent miscarriage, postpartum hemorrhage, preterm labor, preeclampsia, ovulation induction and peri menopausal health. World Clinics are periodicals of evidence based reviews which aim to enhance knowledge for application in clinical practice. More importantly it helps readers choose the best treatment options and overcome challenges in management of the disease.


 
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 : 597]


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


 
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 : 575]


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


 
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 : 566]


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


 
RESEARCH ARTICLE
MR Sandya, Pratap Kumar

Size of Endometrioma and Number does Influence the Ovarian Reserve: A Prospective Observational Study

[Year:2016] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:36] [Pages No:14-18][No of Hits : 530]


ABSTRACT

Background: Endometriosis is one of the most commonly encountered benign problems in gynecology. Ultrasound and endocrine parameters have been widely accepted as markers of ovarian reserve. Anti-Mullerian hormone (AMH) in conjugation with antral follicle counts is now believed to be an excellent measure for detecting ovarian reserve. Surgical approach has a fundamental role in the management of endometriosis. The loss of normal follicles can be studied by histopathological assessment of the cyst wall. The postoperative decline in the ovarian reserve is believed to have a correlation with number of endometriomas and diameter of the cyst wall.

Objective: This prospective observational study was undertaken to evaluate the effect of laparoscopic cystectomy with respect to number and size of the cyst on ovarian reserve parameters.

Materials and methods: Fifty patients undergoing laparoscopic endometrioma cystectomy were analyzed. Cysts of <5cm and >5cm and the number of cysts were studied. Statistical analysis was done using Mauchly’s test of sphericity. Anti-Mullerian hormone and antral follicle count were estimated prior to and 1 month after surgery. Pre- and postoperative values were compared and analyzed with respect to number and size of endometrioma.

Observation and results: There was an overall drop of AMH from 3.8 ± 3.01 to 2.67 ± 1.92 ng/ml (p < 0.001). The mean AMH in bilateral and unilateral endometrioma was 2.9 ± 1.7 and 3.9 ± 3.17 ng/ml respectively. Anti-Mullerian hormone dropped from 4.53 ± 3.4 to 3.19 ± 2.18 with <5 cm cyst compared with 2.4 ± 1.2 to 1.7 ± 0.85 with >5 cm cyst (p < 0.01). Overall drop in AFC was 5.17 ± 1.44 and 3.61 ± 1.61 pre- and postoperative respectively (p < 0.01). Mean drop in AFC was 2.2 and 1.2 in cyst <5 and > 5 cm respectively. Histopathological analysis showed loss of follicles in 25% of the cyst walls. This was correlating with the drop in both AMH and AFC postoperatively.

Conclusion: Size and number of cyst does affect ovarian reserve to the effect that smaller and bilateral cyst leads to a greater decline in the same.

Keywords: Anti-Mullerian hormone, Antral follicle count, Cyst size, Laparoscopic endometrioma cystectomy, Number.

How to cite this article: Sandya MR, Kumar P. Size of Endometrioma and Number does Influence the Ovarian Reserve: A Prospective Observational Study. Int J Infertil Fetal Med 2016;7(1):14-18.

Source of support: Nil

Conflict of interest: None

Date of received: 02-10-2015

Date of acceptance: 05-01-2016

Date of publication: April 2016


 
REVIEW ARTICLE
KP Suresh, Sri Yasaswini, K Reshma

Application of Randomization Techniques for an Unbiased Assessment of Outcome in Clinical Studies

[Year:2016] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:27] [Pages No:94-98][No of Hits : 529]


ABSTRACT

In human clinical trials and biological experiments, randomization has been extensively used as a method of experimental control. It insures against the accidental bias and helps in preventing the selection bias. In treatment assignments, it eliminates the source of bias and produces the comparable groups, thereby expressing the likelihood of chance as a source for the difference of end outcome by permitting the use of probability theory. This study covers different methods of randomization and the use of online statistical computing web programming www.randomization. com for generating the randomization schedule. Issues related to randomization are also discussed in this study.

Keywords: Block, Covariate, Patient, Qucikcalc, Randomization, Stratified, Treatment.

How to cite this article: Suresh KP, Yasaswini S, Reshma K. Application of Randomization Techniques for an Unbiased Assessment of Outcome in Clinical Studies. Int J Infertil Fetal Med 2016;7(3):94-98.

Source of support: Nil

Conflict of interest: None

Date of received: 17 April 2016

Date of acceptance: 29 May 2016

Date of publication: September 2016


 
ORIGINAL RESEARCH
G Pallavi, Praveena Pai, Pratap Kumar, Arun G Maiya, Preetha Ramachandra

Bioelectric Impedance Analysis of Visceral Fat in Women with Polycystic Ovarian Syndrome and the Effect of Exercise: A Pilot Study

[Year:2016] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:27] [Pages No:89-93][No of Hits : 511]


ABSTRACT

Aims: To determine the body fat distribution in 30 women with polycystic ovarian syndrome (PCOS) using bioelectric impedance analysis (BIA) and assess the effect of a 2-month structured exercise on body fat, menstrual function and fertility outcomes.

Materials and methods: Thirty women with PCOS underwent assessment of body composition with BIA. Their body mass index (BMI), total body fat (TBF), visceral fat (VF) and subcutaneous fat were analyzed. Two-month structured exercises were advised based on individual exercise tolerance. The postexercise parameters were reassessed. Outcome measures studied were improvement in BMI, TBF, VF, subcutaneous fat, menstrual functions, and fertility outcomes.

Results: A significant reduction in BMI, VF and subcutaneous fat was found in these women after exercise. Results were further analyzed after dividing them into three groups based on their BMI (normal, overweight, and obese). There was a significant reduction in all parameters (BMI, TBF, visceral and subcutaneous fat) in the overweight group. In the obese group, there was a significant drop in BMI and VF and to a lesser extent in the TBF. In women with normal BMI, a significant drop was noted in TBF only. On follow-up, five women reported regularization of their menstrual cycles and four others managed to conceive.

Conclusion: Total body fat and VF can be cost-effectively measured by a simple tool called BIA. Tailor-made exercises based on individual tolerance are effective in improving these parameters even when done over a short duration. These improvements do positively impact the menstrual dysfunctions and subfertility.

Clinical significance: These findings will help in better management of women with PCOS and ensure optimal improvement in menstrual dysfunction and fertility outcomes.

Keywords: Bioelectric impedance analysis, Polycystic ovarian syndrome, Visceral fat.

How to cite this article: Pallavi G, Pai P, Kumar P, Maiya AG, Ramachandra P. Bioelectric Impedance Analysis of Visceral Fat in Women with Polycystic Ovarian Syndrome and the Effect of Exercise: A Pilot Study. Int J Infertil Fetal Med 2016;7(3):89-93.

Source of support: Nil

Conflict of interest: None

Date of received: 13 May 2016

Date of acceptance: 19 June 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 : 2317]


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 : 2116]


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 : 1654]


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 : 1627]


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 : 1254]


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 : 1124]


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


 
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 : 1106]


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
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 : 1090]


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


 
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 : 1076]


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


 
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 : 1075]


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


 
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 : 901]


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


 
Editorial
Kamini A Rao

Editorial

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:vii][No of Hits : 856]


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.


 
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 : 675]


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 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 : 643]


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


 
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 : 634]


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


 
CASE REPORT
Akhila Vasudeva, Sapna V Amin, Rajagopal Kadavigere, Katta M Girisha, Lavanya Rai

Prenatal Diagnosis of Intracranial Tumors and the Difficulties in Prognostication: A Report of Three Cases

[Year:2015] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:52] [Pages No:88-91][No of Hits : 589]


ABSTRACT

Prenatal diagnosis of intracranial tumors generally implies a poor prognosis. We present three such cases, where prognostication was difficult. We attempted to correlate our prenatal counseling with postnatal follow-up/postabortal diagnosis. In the first case, tumor was diagnosed at 37 weeks. Ultrasound and fetal/neonatal MRI suggested a malignant intraventricular tumor. Anticipating guarded prognosis, parents refused neurosurgical intervention. At 1 year, child has normal neurodevelopment. Further magnetic resonance imagings (MRIs) show tumor shrinkage, pointing to a benign tumor. In case two, a choroid plexus tumor was diagnosed at midtrimester anomaly scan. Since it was difficult to rule out a malignant tumor, pregnancy was terminated. However, MRI, autopsy, and histopathology confirmed a choroid plexus papilloma, which is known to have good prognosis. In case three, prenatal MRI showed features of neurological involvement in tuberous sclerosis. However child has no neurological manifestations at 1 year of age. Hence, prognostication of prenatally diagnosed brain tumors remains a challenge.

Keywords: choroid plexus papilloma, congenital brain tumor, fetal intracranial tumor, fetal mri, prenatal diagnosis, prognosis of congenital brain tumor.

How to cite this article: Vasudeva A, Amin SV, Kadavigere R, Girisha KM, Rai L. Prenatal Diagnosis of Intracranial Tumors and the Difficulties in Prognostication: A Report of Three Cases. Int J Infertil Fetal Med 2015;6(2):88-91.

Source of support: Nil

Conflict of interest: None

Date of received: 05-05-15

Date of acceptance: 15-06-15

Date of publication: August 2015


 
Research Article
Shyamala Guruvare, Barnali Basu, Lavanya Rai, Leslie Lewis, Shripad Hebbar, Prashanth Adiga

Relationship of Time Interval between Antenatal Corticosteroid Administrations to Delivery with Respiratory Distress in Preterm Newborns

[Year:2015] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:43] [Pages No:128-132][No of Hits : 579]


ABSTRACT

Objectives: To assess the relationship of time interval between antenatal corticosteroid administration and delivery with respiratory distress in premature newborns.

Settings: Tertiary level teaching hospital

Population: Preterm deliveries between 28 and 34 weeks in the period of April 2011 to January 2013 where the mothers received one course of corticosteroid prophylaxis and fulfilled the selection criteria.

Materials and methods: Perusal of the hospital records was made to gather antenatal information and the details of delivery and the newborn. The patients were divided based on the number of doses of steroids received into three groups. The patients receiving complete steroid prophylaxis was further divided based on the time interval between steroid administration and delivery into five groups: 0 to 7 days, 8 to 14, 15 to 21, 22 to 28, 29 days and beyond. We looked for association between neonatal respiratory outcomes and steroid-delivery intervals using Statistical Package for the Social Sciences version 16 (SPSS, Chicago, USA). Regression model was used to control for the confounding variables.

Results: There were 284 women who delivered preterm (up to 34 weeks of gestation) between April 2011 and January 2013 and fulfilled the selection criteria. The babies who received one (48) or no dose of steroids (14) had a higher incidence of respiratory distress than the ones who received a complete dose. This was statistically significant for babies born up to 32 weeks.

Among the rest 222 babies who received complete steroid prophylaxis, 138 (62%) of the neonates born were admitted in NICU, respiratory distress was seen in 62 (28%). Eleven (5%) of the babies required intubation and 22 (9%) required surfactant therapy; there were 12 (5%) neonatal deaths. Multivariable logistic regression analysis showed a slightly increased risk of respiratory morbidity with increased interval from administration to delivery (OR–0.87 for 8–14 days, 1.79 for 15–21 days and 0.16 for 22–28 days).

Conclusion: The risk of respiratory distress in preterm newborns increases beyond 2 weeks interval between antenatal corticosteroid administration and delivery.

Keywords: Antenatal steroids, Delivery interval, Respiratory distress.

How to cite this article: Guruvare S, Basu B, Rai L, Lewis L, Hebbar S, Adiga P. Relationship of Time Interval between Antenatal Corticosteroid Administrations to Delivery with Respiratory Distress in Preterm Newborns. Int J Infertil Fetal Med 2015;6(3): 128-132.

Source of support: Nil

Conflict of interest: None


 
Review Article
Ayesha Ahmad, Tamkin Khan Rabbani, Suman Kumar

Epilepsy: Special Consideration in Women

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:11-14][No of Hits : 547]


ABSTRACT

Epilepsy is one of the most common chronic neurological disorder complicating pregnancy. The article reviews various management issues in women in preconceptional, antenatal and postnatal period. An online search was carried out for articles on epilepsy in women and different aspects relating to contraception, conception, antenatal, intranatal and postnatal management. The available guidelines on the subject were also reviewed.

Keywords: Epilepsy, Anti-epileptic drugs, Seizures, Convulsion, WWE .

How to cite this article: Ahmad A, Rabbani TK, Kumar S. Epilepsy: Special Consideration in Women. Int J Infertil Fetal Med 2015; 6(1):11-14.

Source of Support: Nil

Conflict of Interest: None

Date of Received: 18-01-15

Date of Acceptance: 28-02-15

Date of Publication: April 2015


 
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 : 546]


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


 
Research Article
PR Preetha, Mohan S Kamath, TK Aleyamma, K Muthukumar

Influence of Sperm Morphology on the Outcome of Assisted Reproductive Technique— Intracytoplasmic Sperm Injection Cycles: A Retrospective Analysis

[Year:2015] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:43] [Pages No:122-127][No of Hits : 531]


ABSTRACT

Aim: The aim of this study was to evaluate the influence of spermatozoa morphology on ICSI cycle outcome parameters in couples with male factor infertility.

Design: Retrospective study.

Setting: University-level tertiary care center.

Patients and methods: One hundred and forty-eight couples with male factor infertility who had undergone intracytoplasmic sperm injection (ICSI) cycle from 2010 to December 2012 were included in this analysis. The semen samples of the male partners were classified according to the three predictive categories of the Tygerberg strict criteria: excellent prognosis (> 14% morphologically normal spermatozoa), good prognosis (5-14%) and poor prognosis (< 5%).

Main outcome measures: The primary outcome was the embryo quality rate.

Results: Patients in the poor prognosis subgroups exhibited de.cits in spermatozoa concentration, motility and total motile fraction. The variations in the outcome parameters of fertilization rate, embryo development rate and embryo quality did not correlate with sperm morphology.

Conclusion: Our study suggests that Kruger’s strict morphology criteria of the fresh semen sample is not a good predictor for the ICSI cycle outcome.

Keywords: Embryo quality rate, Intracytoplasmic sperm injection, Sperm morphology.

How to cite this article: Preetha RP, Kamath MS, Aleyamma TK, Muthukumar K. Influence of Sperm Morphology on the Outcome of Assisted Reproductive Technique-Intracytoplasmic Sperm Injection Cycles: A Retrospective Analysis. Int J Infertil Fetal Med 2015;6(3):122-127.

Source of support: Nil

Conflict of interest: None


 
Case Report
Ravi Nirmalkumar Rajdeo, Kishor Taori, Jawahar Rathod, Nekee Navin Sejpal

Cor Triloculare Biventriculare with Ventricular Septal Defect: Prenatal Diagnosis

[Year:2015] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:40-42][No of Hits : 521]


ABSTRACT

Cor triloculare biventriculare is a very rare congenital cardiac anomaly in which there is complete absence of interatrial septum resulting in three-chambered heart. It can be associated with various other congenital abnormalities like ventricular septal defect, polysplenia, Ellis-van creveld syndrome or persistent left-sided superior vena cava. Here we report a case of antenatal diagnosis common atrium and ventricular septal defect in a fetus of average gestational age of 29 weeks in a primigravida.

Keywords: Cor triloculare biventriculare, Ventricular septal defect, Common atriu.

How to cite this article: Rajdeo RN, Taori K, Rathod J, Sejpal NN. Cor Triloculare Biventriculare with Ventricular Septal Defect: Prenatal Diagnosis. Int J Infertil Fetal Med 2015;6(1):40-42.

Source of Support: Nil

Conflict of Interest: None

Date of Received: 25-01-15

Date of Acceptance: 18-03-15

Date of Publication: April 2015


 
Research Article
Asifa Majeed, PS Divyashree, Kamini A Rao

Clinical Outcomes of Tamoxifen and Clomiphene Citrate in Intrauterine Insemination Cycles

[Year:2015] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:43] [Pages No:118-121][No of Hits : 506]


ABSTRACT

Background: Both selective estrogen receptor modulators, tamoxifen and clomiphene have been used for ovulation induction for patients with anovulatory infertility. The aim of this study is to compare the effectiveness of tamoxifen to clomiphene on clinical outcome in intrauterine insemination (IUI) cycles.

Materials and methods: It is a retrospective clinical study. Two hundred and seven women undergoing IUI cycles from July 2013 to July 2014 at Milann―The fertility centre, Bengaluru, India were analyzed. Tamoxifen was administered in the dose of 40 mg starting from day 2/3 of the menstrual cycle for a period of 5 days and clomiphene citrate (CC) was administered in the dose of 100 mg from day 2/3 of menstrual cycle for 5 days. Monitoring of ovulation was done by transvaginal ultrasound from day 5/6 till dominant follicle size was more than 18 mm. Highly purified human chorionic gonadotrophin (hCG) in the dose of 5000 IU was given. Double insemination was done at 24 and 36 hours. Luteal phase support was given in form of dydrogesterone 10 mg twice a day for 14 days. Serum beta-hCG was done after 14 days.

Result: In our study, 76 patients recieved clomiphene citrate (37%) and 126 patients received tamoxifen (62.9%). Both the groups were comparable in terms of age, period of infertility, FSH, LH, antral follicle count and their human menopausal gonadotropin (hMG) requirement (Table 1). Thirteen patients (23.6%) in CC group and 42 patients (76.4%) in tamoxifen group had positive serum beta hCG result. p-value was found to be significant (p = 0.016) (Table 2).

Conclusion: Tamoxifen was associated with better endometrial thickness and pregnancy rate when compared to clomiphene citrate in ovarian stimulation in IUI cycles.

Keywords: Anovulation, Clomiphene citrate, Intrauterine insemination cycles, Ovarian stimulation, Tamoxifen.

How to cite this article: Majeed A, Divyashree PS, Rao KA. Clinical Outcomes of Tamoxifen and Clomiphene Citrate in Intrauterine Insemination Cycles. Int J Infertil Fetal Med 2015;6(3):118-121.

Source of support: Nil

Conflict of interest: None


 
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 : 5422]


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


 
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 : 2114]


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


 
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 : 2039]


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


 
Case Report
Sandhya Krishnan

Globozoospermia

[Year:2014] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:31] [Pages No:27-29][No of Hits : 1544]


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 : 1496]


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 : 1382]


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


 
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 : 1369]


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
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 : 1250]


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 : 1222]


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


 
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 : 1096]


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 : 975]


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 : 899]


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 : 843]


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


 
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 : 838]


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 : 832]


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


 
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 : 819]


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
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 : 788]


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


 
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 : 780]


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


 
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 : 725]


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 : 724]


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


 
Editorial
Kamini A Rao

Editorial

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:vii][No of Hits : 694]


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.


 
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 : 646]


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 : 627]


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 : 584]


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.


 
ORIGINAL ARTICLE
Uma Pandey

To Study the Maternal and Neonatal Outcomes of Pregnancies complicated by Rheumatic Heart Disease

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:92-94][No of Hits : 539]


ABSTRACT

Objectives: To study the maternal and neonatal outcomes of pregnancies complicated by rheumatic heart disease (RHD).

Materials and methods: A retrospective study was carried out in the obstetric and cardiology outpatients department of Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India over a period of 1 year (Dec 2011-2012) involving 96 pregnant patients with rheumatic heart disease. Their maternal and fetal outcomes were reviewed.

Results: A total of 96 pregnant mothers with heart disease presented to us during the period of 1 year (Dec 2011-2012). Majority of the pregnant mothers had mitral stenosis n = 46 (47%). Rest of the patients had multivalve disease. Pulmonary arterial hypertension was found to be in 28 patients (29%). Atrial thrombus was seen in the echocardiography of one patient. Mitral valve replacement was done before pregnancy in 16 mothers (16%); these gravid mothers were put on low-molecular weight hepanin (LMWH) and during the midtrimester on the Acitrom. There was one patient admitted with atrial fibrillation. New York Heart Association (NYHA) class I and II heart disease progressed in two patients to class III and IV. There was no maternal or fetal mortality in this study. There were 24 cesarean sections (25%) done out of which 8 were for intrauterine growth restriction (IUGR) (32%), rest were due to maternal reasons. There were 12 preterm deliveries. Four fetuses had intraventricular hemorrhage.

Conclusion: Despite no maternal and neonatal mortality, pregnancy in women with heart disease is associated with significant maternal and neonatal morbidities.

Keywords: pregnancy, rheumatic heart disease, maternal outcome, fetal outcome, cardiac complication.

How to cite this article: Pandey U. To Study the Maternal and Neonatal Outcomes of Pregnancies complicated by Rheumatic Heart Disease. Int J Infertil Fetal Med 2014;5(3):92-94.

Source of support: Nil

Conflict of interest: None

Date of Received: 19-11-14

Date of Acceptance: 26-11-14

Date of Publication: September 2014


 
CASE REPORT
Suganya Achar, Arulmozhi Ramarajan

Term Pregnancy following Myomectomy for Leiomyomatosis

[Year:2014] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:38] [Pages No:107-109][No of Hits : 527]


ABSTRACT

Uterine fibroids are common during reproductive age. These are found in up to 77% of women. They may be asymptomatic or may present with pain, menorrhagia, infertility or recurrent pregnancy loss. Symptomatic fibroids often mandate surgical management. These situations pose a challenge when encountered in women undergoing fertility treatment. Achieving a pregnancy following myomectomy depends on the size, number and proximity to the endometrium of the fibroids.
Here is the case of a 28-year-old lady, with multiple fibroids, who presented with severe dysmenorrhea and menorrhagia for many years and inability to conceive in 3 years after marriage. She underwent extensive myomectomy. The entire endometrial surface was studded with seedling fibroids, which were scooped out along with much of the endometrium. A diagnosis of uterine leiomyomatosis was made. Three months after surgery, an ultrasound scan of the pelvis showed a bulky uterus of normal contour, endometrial thickness of 7 mm, and multiple tiny fibroids. One year later, she presented with a viable pregnancy of 7 to 8 weeks. She delivered a healthy baby at term.

Keywords: Fibroids, Leiomyomatosis, Myomectomy, Pregnancy.

How to cite this article: Achar S, Ramarajan A. Term Pregnancy following Myomectomy for Leiomyomatosis. Int J Infertil Fetal Med 2014;5(3):107-109.

Source of support: Nil

Conflict of interest: None

Date of Received: 08-11-14

Date of Acceptance: 14-11-14

Date of Publication: September 2014