Abstract
A 25 years old woman with Down syndrome (DS) presented at 9 weeks gestational age. She belonged to a very supportive family. She was married to a person with normal karyotype and conceived within 3 months of marriage. Her antenatal period was uneventful, except for mild IUGR and oligohydroamnios 32 weeks onwards. At 38 weeks, she underwent induction of labor. She tolerated labor pains well but because of failure to progress, cesarean section was performed. She delivered a 2 kg male baby, who was phenotypically and genotypically normal. Screening for trisomy 21 should be offered to all women as part of routine antenatal care. This offer should include detailed counseling about the implications and limitations of the test used in the screening program. The available second trimester screening tests are the double, triple and quadruple tests. Children with Down syndrome may benefit from speech therapy, physical therapy and occupational therapy. They may receive special education and assistance in school. Full potential of Down patients can be utilized only with complete support of family and society.
Keywords: Down syndrome, Fertility, Trisomy 21, Pregnancy.

ABSTRACT

Aim:To evaluate the prognostic value of first postembryo transfer beta human chorionic gonadotropin (hCG) levels in pregnancy outcome in an assisted reproductive technology (ART) program.

Subjects: Seventy-one women with an initial beta-hCG value of greater than 5 mIU/ml postembryo transfer in the ART program were taken in to the study. The beta-hCG test was done 14 days after embryo transfer. The period of study was from January 2008 to August 2010.

Observations: A significant correlation was found in beta-hCG values between viable and nonviable pregnancies. In women who had a day 2 embryo transfer the mean beta-hCG value was 608 ± 580 mIU/ml, in comparison to women who had a day 5 transfer 1,527 ± 2,024 mIU/ml, and this was statistically significant.
Women who had a single embryo transfer had a mean betahCG level of 168 mIU/ml, two embryos 464 mIU/ml and three embryos 612 mIU /ml.
Mean beta-hCG value was highest in women who developed gestational diabetes [2,074 mIU/ml] women with pregnancyinduced hypertension (PIH) had a mean beta-hCG value of 674 mIU/ml, and with antepartum hemorrhage the value was lower 220 mIU/ml.

Conclusion: To summarize, beta-hCG level is an useful marker for prognosticating early pregnancy well being, for predicting multiple pregnancies. When interpreting the first beta-hCG level uniformly after 2 weeks of embryo transfer, day of transfer of embryos should be taken into account. The number of embryos transferred does not alter the beta-hCG level significantly. BetahCG level implications in pregnancy complications, like gestational diabetes (GDM), PIH, APH, require further research and would be a useful tool for early screening and surveillance of pregnancy.

Keywords:Beta-hCG, Maternal, Fetal, Pregnancy, Ectopic, Perinatal, Ultrasonograph.

How to cite this article: Dalal RJ, Pai H, Palshetkar N. Effectiveness of HP-hMG vs Jayachandran KD, Natarajan P, Pandiyan R. First Postembryo Transfer Beta-hCG Level and Pregnancy Outcome in an Assisted Reproductive Technology Program. Int J Infertility Fetal Med 2012;3(2): 57-62.

Source of support: Nil

Conflict of interest: None declared

ABSTRACT

Cell-free fetal DNA (cffDNA) is available in the maternal circulation throughout pregnancy and can be used for noninvasive prenatal diagnosis including, determination of fetal sex, identification of specific single gene disorders, typing of fetal blood groups (RhD), paternity determination and potentially routine use for Down’s syndrome (DS) testing of all pregnancies. I searched published literature on the PubMed and databases on Scopus interface systematically using keyword’s cffDNA, noninvasive diagnosis, fetal DNA in the maternal serum. Reference lists from the papers were also searched. cffDNA representing only 3% of the total cell-free circulating DNA in early and rising to 12% in late pregnancy, clinical investigations has already demonstrated the potential advantage, such as improving safety, earlier diagnosis and comparative ease of testing using cffDNA technology. The discovery of cffDNA circulating in the maternal serum has opened the door to noninvasive prenatal diagnosis testing with novel clinical implications.

Keywords:Cell-free fetal DNA, Noninvasive testing, Prenatal diagnosis.

How to cite this article: Ghorbian S. Applications of Cell-Free Fetal DNA in Maternal Serum. Int J Infertility Fetal Med 2012;3(2):33-39.

Source of support: Nil

Conflict of interest: None declared

Abstract
Background: The assessment of the endometrial receptivity at the time of human chorionic gonadotrophin (hCG) is one of the key factors for success of all ART procedures.
Aim: To assess, if 3D and 3D power Doppler assessment of endometrial receptivity before giving hCG, helps improving pregnancy rates in superovulation with IUI cycles.
Settings and Design: A prospective randomized study of 2500 cycles of IUI was done over a period of twelve months for pre-hCG endometrial assessment.
Method: Endometrial assessment was done on Voluson 730 Expert, (Wipro GE) using transvaginal multifrequency volume probe 5 to 9 MHz. When follicles and endometrium were considered mature by 2D US and color Doppler, 3D and 3D power Doppler assessment of the endometrium was done before giving hCG. These values were evaluated for conception and nonconception groups.
Results: Conception rates were higher, when endometrial volume was between 3 and 7 cc. In our study, we have found endometrial FI > 20 and endometrial VFI > 40 as most optimum.
Conclusions: 3D ultrasound is accurate for volume assessment of endometrium. 3D and 3D PD, when used with 2D US and color Doppler for pre-hCG endometrial assessment, it would definitely improve implantation rates in IUI cycles.
Keywords: Pre-hCG, Endometrial receptivity, 3D power Doppler.

Abstract
Chromosome imbalances are the leading cause of pregnancy loss in humans and play major roles in male and female infertility. Within the past two decades, the development and application of preimplantation genetic diagnosis (PGD) has played an important role in infertility practices worldwide. The purpose of this review is to discuss, how PGD may be applied in combating numerical chromosomal abnormalities and in Robertsonian and reciprocal chromosome translocations. We shall consider prevalence and risk of each aberration, interchromosomal effects and rationale behind use of PGD in each case. Numerical chromosome abnormalities (aneuploidy and polyploidy) in particular affect a very high proportion of preimplantation embryos (~ 50%). Given that a majority of preimplantation embryos are aneuploid, PGD can be used to screen embryos and transfer euploid embryos to improve pregnancy rates and reduce spontaneous abortions. The rationale of utilize PGD to transfer only euploid embryos would seem sound, but controversies exist surrounding application of PGD for aneuploidy detection. To this end, we will discuss the dichotomy between favorable descriptive reports and less favorable randomized clinical trial data. This review will discuss the trend towards differing sources of embryonic DNA (e.g. polar body vs blastomere vs blastocyst) as well as development of novel technologies for 24 chromosomes analysis.
Keywords: Preimplantation genetic diagnosis (PGD), Infertility, Aneuploidy.

ABSTRACT

Endometriomas account for 35% of benign ovarian cyst. Convincing evidence has emerged showing the reduced responsiveness to gonadotropins after ovarian cystectomy. Surgery should be envisaged only in the presence of large cyst or with severe symptoms. For endometriomas less than 3 cm cyst, aggressive removal of same may lead to a poor response during ovulation inductions.

Keywords:Endometrioma, Surgery, Assisted reproduction.

How to Cite:Kumar P, Balasubramanian A. Endometrioma Cyst: To Remove or Not? Int J Infertility Fetal Med 2012;3(1):26-29.

ABSTRACT

Background : Severe anemia in pregnancy results in relatively poor maternal and fetal outcome. Maternal effects are preterm labor, preeclampsia, sepsis and postpartum hemorrhage and increase need of blood transfusion. In India, the decision to recommend appropriate supplementation for IDA in pregnant women is left to the health care personnel and based on the individual maternal condition.

Objective: To assess the problems/limitations of health care practitioners to treat IDA with IV iron sucrose in pregnant women and to suggest ways forward for expansion of its use with confidence.

Materials and methods: The questionnaire included 18 questions altogether related to treatment, influencing factors for treatment, risk factors, attitutes and awareness about parenteral iron sucrose supplementation. All data were entered into an electronic database without personal identifiers to maintain confidentiality. The data was analyzed by using SPSS version 17.0.

Results:The survey consisted of responses from 107 health care professionals from urban and rural practitioners in India. Out of 107, 28.1% respondents said that the majority of the anemic patients were between 9.9 and 7.0 mg/dl Hb-moderate category. A total of 78 (72.90%) said that they would recheck Hb levels 4 weeks after oral ion treatment for checking the patient’s response.Of the respondents, 42.52% of them said that the women were compliant and took supplementation as per prescription. All respondents agreed that there could be a mean 58% reduction of blood transfusions by using IV iron sucrose. Many respondents (74, 79.44%) expressed interest to have more information from recent research to expand the indications for use.

Conclusion:Dissemination of information related to IV iron sucrose to all practitioners and reduction in costs would help them to expand the use with confidence and avert many complications related to maternal and fetal health due to gestational anemia.

Keywords:Routine iron and folic acid supplementation, KAP, Blood transfusion, Preterm labor, IV iron sucrose postpartum hemorrhage.

How to Cite: Divakar H. Iron-deficiency Anemia in Pregnant Women: What preventing Practitioners from using IV Iron Sucrose. Int J Infertility Fetal Med 2012;3(1): 1-7.

Abstract
The current study aimed to determine the prevalence of obesity and gestational diabetes (GDM) and the association of obesity and gestational diabetes with adverse pregnancy outcomes in a population of pregnant women. Routine antenatal care included the estimation of body mass indices, assessment of blood glucose levels, including glucose challenge tests and oral glucose tolerance test, fetal growth monitoring and nutritional counseling. The prevalence of GDM and obesity in this population was 8.43% (95% CI: 7.47-9.40) and 19.49% (95% CI: 18.12-20.87) respectively. The prevalence of obesity increased to 54.63% (95% CI: 52.91-56.36), if we used the ICMR guidelines for BMI in this population. Cesarean sections (adjusted OR: 2.04, 95% CI: 1.43-2.89), large for gestational age (LGA) babies (adjusted OR: 3.82, 95% CI: 2.11-6.92) and macrosomia (adjusted OR: 20.90, 95% CI: 3.29-132.77) was associated with obesity in GDM (based on the ICMR guidelines for BMI). Results from this study indicate that gestational diabetes and obesity are increasingly important priorities for perinatal care in India.
Keywords: Gestational diabetes, Increased cesarean section rate, Obesity, Pregnancy, India.

ABSTRACT
Objective: To study the incidence of spontaneous abortions, congenital malformations, neonatal and maternal hypoglycemia after metformin therapy in pregnancy.
Design: Prospective study.
Setting: Outpatient.
Patient(s): 56 women previously oligomenorrheic, nondiabetic women with polycystic ovarian syndrome, who conceived while on metformin.
Intervention(s): Metformin 1 to 1.5 gm/day throughout pregnancy.
Main outcome: Incidence of 1st trimester abortions, gestational diabetes, teratogenicity and maternal complications, like gastritis and hypoglycemia.
Results: On metformin, the incidence of 1st trimester abortion was 11% and the incidence of gestational diabetes was 7%, which is much lower than the incidence otherwise cited for PCOS women. No major congenital abnormalities were observed.
Conclusion: Metformin therapy in pregnancy reduces the otherwise high incidence of 1st trimester abortions, and gestational diabetes in PCOS women is tolerated well and is not found to be teratogenic.
Keywords: Metformin, Polycystic ovary syndrome (PCOS), Pregnancy.
How to Cite
Palshetkar NP, Pai HD, Takhtani M, Saxena N, Bansal B, Dalal RJ. Metformin throughout Pregnancy in Women with Polycystic Ovary Syndrome: Safety and Advantages. Intl J Infert & Fetal Med. 2011;2(2):61-64

Abstract
Context: General practitioners as well as obstetricians are coming across a large number of pregnant women whose conceptions are following a period of infertility or treatment for the same. There is a controversy in the literature regarding the occurrence of adverse outcomes of pregnancy in such women.
Aims: To assess the maternal and perinatal outcome in pregnancies that occurred after a period of infertility and to compare the outcome in spontaneous conceptions with the conceptions following treatment for infertility.
Settings and Design: Retrospective analysis of hospital records of 200 pregnancies following infertility during the year 2009 in a tertiary care center in South India.
Material and Methods: All the women were divided into two groups, viz: Group 1—those who had history of infertility but conceived spontaneously and Group 2—those with history of infertility and conceived only after treatment for infertility. The main outcome measures were antenatal complications and adverse neonatal complications.
Statistical analysis: The statistical package SSPS version 15.0. Chi-square and student ‘t’ test was used for nonparametric and parametric variables.
Results: The incidence of hypertension was 60% and that of gestational diabetes was 7%. Obstetric complications included increased incidence of preterm labor (23.5%) and premature rupture of membranes (38%). There was no statistically significant difference in both groups though the medical complications especially hypertension was high in the pregnancies following spontaneous conceptions, i.e. untreated group. There was a greater demand for the NICU care mainly because of prematurity. The PNMR was (40/1000) less than the institutional rate of 72/1000 births.
Conclusions: There is increased incidence of hypertension premature rupture of membranes and preterm delivery in pregnancies following infertility. There is no significant statistical difference in the adverse pregnancy outcomes between spontaneous conception and those treated for infertility.
Key Messages: Pregnancies following infertility are at increased risk of developing hypertension and preterm labor and hence these women should be screened for the same and preventive measures to be undertaken to achieve good maternal and perinatal outcome.
Keywords: Infertility, Spontaneous conception, ART Medical and obstetrical complications, Neonatal outcome.