[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:1] [Pages No:iv - iv]
A Study to Evaluate the Implantation and Clinical Pregnancy Rates in Patients Undergoing Sequential Frozen Day 3 Embryo and Day 5 Blastocyst Transfer
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:4] [Pages No:55 - 58]
Keywords: Clinical pregnancy rate, Embryo transfer, Sequential transfer
DOI: 10.5005/jp-journals-10016-1296 | Open Access | How to cite |
Background: Sequential transfer is a technique in which cleavage stage embryo(s) and blastocyst(s) are transferred sequentially in the same cycle. It prevents the potential disadvantage of cycle cancellation due to the nonformation of a blastocyst. The present study is undertaken to evaluate the implantation and clinical pregnancy rates in patients undergoing sequential transfer and to assess the success rates in different categories of patients. Materials and methods: A retrospective multicentric case series study was done on patients undergoing intracytoplasmic sperm injection (ICSI) cycles at GarbhaGudi IVF centers in Bengaluru. A total of 155 women had undergone frozen embryo sequential transfer of day 3 embryos and day 5 blastocysts. During frozen embryo transfer (ET), conventional hormone replacement therapy (HRT) downregulated HRT, and mild stimulation protocols were used to prepare the endometrium. Adequate luteal phase support was given for 14 days, and pregnancy was confirmed by doing serum human chorionic gonadotropin (hCG). Results: The majority underwent HRT (76.13%) protocol. The average endometrial thickness on the day of the hCG administration was 8.68 ± 1.13. The clinical pregnancy rate was 67.1 with 73.34% singletons, 22.86% twins, and 3.81% triplets. The study reported 57.14% ongoing pregnancies, 34.28% live births, and only 20% abortions. Conclusion: Sequential transfer resulted in better clinical pregnancy and birth rates. It also had the advantage of blastocyst transfer without exposing the whole cycle to the risk of cancellation.
Neurological Disorders Complicating Pregnancy and its Obstetric Outcomes
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:6] [Pages No:59 - 64]
Keywords: Antiepileptic drugs, Cesarean section, Epilepsy, Neurological disorders, Pregnancy, Seizures
DOI: 10.5005/jp-journals-10016-1308 | Open Access | How to cite |
Objective: To find the common neurological disorders complicating pregnancy and their obstetric outcome. Materials and methods: This was a retrospective study conducted over a period of 3 years and included all pregnant women with a diagnosis of neurologic disorders who were admitted to the Obstetrics and Gynecology Department at St John's Medical College, St John's National Academy of Health Sciences (SJNAHS), Bengaluru, Karnataka, India. The study was carried out from January 2016 to December 2018. Results: A total of 60 patients with neurologic disorders were identified during the study period of 3 years. In our study, 57 (95%) women were in the 20–35-year age-group, and the majority were primigravida 38 (63.3%). A total of 56 women (93.3%) delivered at term. A total of 28 (46.6%) women had a cesarean section, and 27 (45%) had a vaginal delivery. Among the neurologic disorders in pregnancy, 36 (60%) women had epilepsy, seven (11.6%) cerebrovascular diseases, six (10%) polio survivors, and four (6.6%) central nervous system (CNS) infections. A total of 16 (44.4%) women with epilepsy (WWE) were seizure-free in index pregnancy, 15 (41.6%) had relapse of seizures during present pregnancy, and five (13.8%) had been newly diagnosed with epilepsy in the index pregnancy. There were no maternal or perinatal deaths. Conclusion: Multidisciplinary approach in a tertiary care center improves both maternal and fetal outcomes.
Spinal Anesthesia-facilitated Sexual Intercourse as a Treatment Option for Refractory Vaginismus and its Effect on Female Sexual Dysfunction, Penetration Cognition, and Coital Pain
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:5] [Pages No:65 - 69]
Keywords: Female sexual function, Spinal anesthesia, Vaginismus
DOI: 10.5005/jp-journals-10016-1309 | Open Access | How to cite |
Objective: To evaluate the role of spinal anesthesia facilitated sexual intercourse under controlled conditions in couples with vaginismus and its effect on female sexual function, penetration cognition, and pain. Methods: A cross-sectional comparative study was carried out from January 2017 to December 2019. For this study, we included women who had been married for 2 years but had not consummated their marriage due to vaginismus. The primary outcome measure in this study was successful sexual intercourse. Secondary measures included improvement in female sexual function, penetration cognition, and pain. Results: During the study period, 10 couples satisfied the inclusion criteria. Vaginismus continued in only one couple at the 12-month follow-up. The sexual function changed significantly (p = 0.005). Penetration cognition score domains improved significantly at follow-up. The pain for tampon insertion score dropped significantly from 9.20 (8.0–10.0) to 5.20 (4.00–7.00), p = 0.005 on the first follow-up. The coital pain had a significant drop from the initial score of 9.20 (8.0–10.0) to 2.1 (1.00–3.00), p = 0.004. Five out of the 10 couples were pregnant at the final follow-up, and three delivered vaginally. Conclusion: Our comparative study shows that spinal anesthesia can be used as a last resort management option in women suffering from vaginismus.
The Ongoing Challenge of Achieving Precise Diagnosis of Fetal Chromosome Disorders by FISH in Autopsies
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:5] [Pages No:70 - 74]
Keywords: Abortion, Anatomic pathology, Birth defects, Fetal diseases, Fluorescence in situ hybridization, Neonatal–perinatal medicine, Spontaneous
DOI: 10.5005/jp-journals-10016-1311 | Open Access | How to cite |
Introduction: Chromosome abnormalities are an important cause of fetal and perinatal deaths. Molecular testing can be a useful tool in preconception counseling in selected families. However, such testing is neither routine nor mandatory at many healthcare centers; a number of factors can contribute to the lack of genetic and chromosome diagnoses. Materials and methods: We performed an observational analytical study on 42 paraffin-embedded samples from fetal autopsy tissue with the suspected chromosomal disorder; we tested the efficacy of the fluorescence in situ hybridization (FISH) probe to ascertain the presence of common chromosome abnormalities. Results: Use of the FISH technique in paraffin-embedded tissue has been standard practice in oncopathology; there now exists standardization of these probes in fetal and neonatal tissue. Our study analyzes various difficulties we encountered with the FISH probe when used for chromosome abnormalities diagnoses in fetal autopsies, and we conclude with pertinent recommendations for improving test outcomes. Conclusion: Simultaneous occurrence of chromosome disorders and advanced maceration is common; maceration interferes with the proper performance of the FISH test; however, we view this diagnostic tool as appropriately functional when used under specific conditions.
The Role of Progesterone/Estradiol (P4/E2) Ratio in Predicting Assisted Reproductive Technology (ART) Outcome in Agonist Cycles with Elevated Progesterone Levels on Trigger Day: A Prospective Study
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:5] [Pages No:75 - 79]
Keywords: Assisted reproductive technology, Clinical pregnancy, Progesterone elevation, Progesterone/estradiol ratio
DOI: 10.5005/jp-journals-10016-1313 | Open Access | How to cite |
Aim: Progesterone (P4) rise on the day of the trigger is often regarded as a poor prognostic factor in assisted reproductive technology (ART) cycles. We aimed to identify the utility of the progesterone/estradiol (P4/E2) ratio as a predictor of pregnancy outcome in the subgroup of patients with P4 elevation. Materials and methods: We conducted a prospective study on women with normal basal hormonal parameters who underwent ART utilizing the long downregulation protocol. Serum P4 and E2 were assayed on the day of the trigger. The role of P4 elevation and the role of the P4/E2 ratio in those with elevated P4 were analyzed with respect to ART outcome using the t-test and Mann–Whitney U test. Receiver operating characteristic (ROC) curve analysis was done to identify a cutoff value of the P4/E2 ratio below which a good prognosis could be predicted. Results: We included 422 patients. The pregnancy rate was 42.4%. Elevated P4 > 1.5 ng/mL was seen in 20.4%. The P4/E2 ratio was higher in nonpregnant patients when compared to pregnant patients and was statistically significant (0.56 ± 0.81 vs 0.4 ± 0.61 and p = 0.001). The cutoff value for P4/E2 ratio by ROC curve analysis was 0.463, with a negative predictive value of 69.6%. Those with elevated P4 > 1.5 ng/mL and P4/E2 ratio >0.463 had a significantly lower pregnancy rate than those with normal (<1.5 ng/mL) P4 levels (45.4% vs 32%, and p = 0.03). Conclusion: Progesterone/estradiol (P4/E2) assay on the day of human chorionic gonadotropin (HCG) assumes significance in predicting pregnancy outcomes in patients undergoing ART, especially those with elevated P4 levels. If the P4 level is high on the day of HCG, it is better to see P4/E2 ratio before the routine cancellation of the transfer. Clinical significance: The clinical practice of freezing all the embryos in those with elevated P4 on the day of the trigger could be restricted to only those with elevated P4/E2 ratio also.
Effect of Biochemical Changes on Female Infertility, Especially “Leptin and Adiponectin” in Eastern Uttar Pradesh
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:5] [Pages No:80 - 84]
Keywords: Adiponectin, Folic acid stimulating hormone, Infertility, Leptin, Obesity, Prolactin, Testosterone
DOI: 10.5005/jp-journals-10016-1314 | Open Access | How to cite |
Background: Infertility is one of women's most serious clinical problems during their reproductive lives. However, a high body mass index (BMI) and obesity are linked with unhealthy eating patterns and a sedentary lifestyle and have contributed to infertility. Obesity, on the other hand, has been linked to a high rate of infertility over the last 10 years. Additionally, low levels of sex hormones follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estrogen, progesterone, and testosterone play a significant role in causing infertility, which has a significant impact on the reproductive system. Adipokines are produced by adipose tissue, and adipocytes, including adiponectin and leptin, affect the reproductive organs. Therefore, to comprehend infertility more deeply, it is crucial to assess adipokines and sex hormones. So, the current study involved evaluating the effectiveness and level of adiponectin and leptin in infertility and fertile women of the same reproductive age, along with other hormones like insulin, insulin resistance, FSH, LH, testosterone, and prolactin. Materials and methods: This study took 56 fertile women to act as a control in their reproductive years as controls and 100 women who have experienced infertility. Cases considerably outperformed controls regarding —BMI, waist-to-hip (W/H) ratio, insulin, and insulin resistance. Results: Follicle-stimulating hormone (FSH), LH, prolactin, and testosterone levels in cases were higher than in controls. But though adiponectin levels were lower in patients than in controls, leptin levels were higher. Conclusion: Given that adipokines are regulated by sex hormones, they likely contribute to infertility.
Altered Sperm Analysis, Where Are We Now? The Reality of the Reproductive Medicine Unit of a Tertiary University Center
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:9] [Pages No:85 - 93]
Keywords: Azoospermia, Infertility, Intracytoplasmic, Male, Oligospermia, Sperm injections, Sperm retrieval, Varicocele
DOI: 10.5005/jp-journals-10016-1315 | Open Access | How to cite |
Background: In the last decades, a substantial decline in sperm counts has been described. We aim to evaluate clinical outcomes of treatment strategies in patients referred to andrology due to abnormal sperm parameters. Materials and methods: Observational descriptive study performed at one country's largest public reproductive unit during 5 years (2015–2019). Patients were selected according to the World Health Organization (WHO) criteria for sperm analysis. Results: A total of 670 patients were included, with a median age of 35 (18–54) years old. During the infertility investigation, 15 patients were diagnosed with Klinefelter syndrome and two with a disorder of sexual development (46, XX). Three malignant testicular tumors were identified. Among treatments applied—varicocele correction was the most frequent (31.49%, n = 210), followed by antioxidant therapy (11.04%, n = 74). Posttreatment sperm analysis was obtained in 255 cases, demonstrating an improvement in 58.04% (n = 148), including normalization in 6.67% (n = 17) of men. An assisted reproductive technique (ART) was performed in 45.97% (n = 308), with a clinical pregnancy rate per initiated cycle of 26.92% (n = 91). Among azoospermic patients (19.55%, n = 131), there was a higher exposure to heat (p = 0.02) and a higher prevalence of previous testicular surgery (p = 0.002), and orchitis (p = 0.022). Varicocele was more frequent in non-azoospermic patients (p = 0.007), while Y chromosome microdeletions and chromosomal alterations were mostly found in azoospermic patients (p = 0.004 and p < 0.001, respectively). Conclusion: Even in patients with a poor prognosis a priori, improvements in sperm parameters or sperm retrieval might be achieved after treatment, namely low-grade varicocele correction. Clinical significance: An adequate investigation of male infertility can improve reproductive outcomes and contribute to an early diagnosis/secondary prevention of tumors.
Evaluation of Fetomaternal Outcome in Advanced Age-group Mothers: A Comparative Prospective Study in a Tertiary Care Maternity Hospital in Kashmir Valley
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:6] [Pages No:94 - 99]
Keywords: Advanced age, Adverse, Fetomaternal, Pregnancy, Risks
DOI: 10.5005/jp-journals-10016-1316 | Open Access | How to cite |
Aim: The study was aimed to investigate the effect of maternal age on fetomaternal outcomes in primigravida singleton women aged above 35 years vs the younger age-group of 22–35 years. Materials and methods: The study was carried out for a period of 18 months in the Department of Obstetrics and Gynaecology, Government Medical College, Srinagar, Jammu and Kashmir, India. The data were prospectively collected on 209 primigravida singleton pregnant women admitted to the hospital and were divided into two groups, one above 35 years and the other between 22 and 35 years. The fetomaternal outcome of each pregnancy was recorded and exported on the data editor of Statistical Package for the Social Sciences (SPSS) version 20.0. The comparative analysis between the two groups was done using the Student's independent t-test or Mann–Whitney U test. Results: Comparative analysis between two groups of primigravida singleton pregnant women showed that advanced-age pregnancy was significantly associated with increased incidence of gestational hypertension (38.6 vs 22.4%, p = 0.018), antepartum hemorrhage (APH) (21.1 vs 9.9, p = 0.031), spontaneous abortions (17.5 vs 7.2%, p = 0.027%), and cesarean delivery rate (64.3 vs 46.3, p = 0.042) as compared to younger age-group. Advanced-age pregnancy was associated with adverse fetal outcomes like low birth weight (26.2 vs 13.2%, p = 0.047), preterm delivery (38.1 vs 22.1%, p = 0.029), intrauterine fetal demise (IUFD) (16.7 vs 6.6%, p = 0.047), and intrauterine growth retardation (IUGR) (33.3 vs 16.21%, p = 0.016) as compared with younger age-group. Conclusion: This study shows a strong association of advanced maternal age with adverse fetomaternal outcomes, and the rising trend of delaying pregnancy makes it imperative to educate women about the risks of advanced-age pregnancy and the need for specialized care during the antenatal period.
Hysteroscopy: An Essential Tool in the Workup of Infertility
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:5] [Pages No:100 - 104]
Keywords: Hysteroscopy, Intrauterine abnormalities, Primary infertility, Secondary infertility
DOI: 10.5005/jp-journals-10016-1317 | Open Access | How to cite |
Introduction: Uterine cavity pathologies often lead to decreased rates of infertility. Correction of these anomalies has been associated with improved pregnancy rates. Diagnostic hysteroscopy can be performed with minimal discomfort and superior sensitivity, and specificity in the evaluation of the uterine cavity, even before in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). To date, there are many centers where hysteroscopy is being ignored as an essential preliminary workup. This study was done to evaluate the importance of hysteroscopy in the workup of such infertile women. Aim: To study the role of hysteroscopy in the workup of infertility. Objectives: Hysteroscopic evaluation of infertile patients fulfilling the inclusion criteria. To determine the importance of hysteroscopy in treating endometrial lesions. Materials and methods: A retrospective cohort study was done at a tertiary care hospital in Himachal Pradesh, India, for a period of 12 months, where case sheets of 90 patients, who underwent hysteroscopy as a workup of infertility, were assessed. Inferences were noted and conclusions were made. Statistical analysis was performed using Fisher's exact test. The p-value of <0.05 was considered significant. Results: Among a total of 90 patients included in the study, 65 patients (72.2%) presented with primary infertility, and the remaining 25 patients (27.8%) had secondary infertility. Normal findings on ultrasound were seen in 65 patients (72.2%). This was in contrast to 38 patients (42.2%), who had normal hysteroscopic findings. This revealed that hysteroscopy had a greater sensitivity and a 30% higher rate of detection of uterine abnormalities as compared to the ultrasound done routinely in the infertility workup. Therapeutic hysteroscopy was performed in 29 cases (32.22%) to correct uterine cavity defects and to improve fertility rates. Hence it was found that hysteroscopy can diagnose uterine cavity defects even in patients with normal ultrasound findings. Therefore hysteroscopy should be used as a primary tool in the infertility workup. Conclusion: This study concluded that routine infertility workups should include hysteroscopy as a primary tool.
Recurrent Neurodevelopmental Disorders in Subsequent Pregnancies in a Couple with Third-degree Consanguineous Marriage: Case Report
[Year:2023] [Month:May-August] [Volume:14] [Number:2] [Pages:3] [Pages No:105 - 107]
Keywords: Case report, Consanguineous, Neurodevelopmental, Pregnancies
DOI: 10.5005/jp-journals-10016-1312 | Open Access | How to cite |
Introduction: There is a poor understanding of the molecular mechanisms of neurodevelopmental and metabolic morbidity affecting the fetus in pregnancy. Case description: The case has two living children, born of a third-degree consanguineous marriage, both affected by neurodevelopmental disorders. Studies have shown maternal inflammation in pregnancy was attributed to increased neurodevelopmental disorders in the baby. Subclinical inflammation in our patient was seen by histopathology of the placenta showing maternal inflammatory response stage-I grade-I. Other multifactorial causes should be evaluated preconceptionally. Subclinical inflammation in our patient, as seen by histopathology of the placenta, shows maternal inflammatory response stage-I grade-I. Conclusion: Follow-up of the baby prompt antepartum surveillance, along with postnatal metabolic screening for neurodevelopmental diseases, needs to be stressed to detect any central nervous system (CNS) abnormalities in the present pregnancy.