International Journal of Infertility & Fetal Medicine

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Volume 15, Number 1, January-April 2024
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EDITORIAL

Kamini A Rao

Editorial

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:2] [Pages No:iv - v]

   DOI: 10.5005/ijifm-15-1-iv  |  Open Access | 

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RESEARCH ARTICLE

Anu Manivannan, Radha Vembu, Monna Pandurangi, Sanjeeva R Nellepalli

A Prospective Cohort Study on the Impact of Delaying Ovulation Trigger on Assisted Reproductive Technology Outcomes

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Assisted reproductive technology outcome, Follicle size, Oocyte maturation, Ovulation trigger

   DOI: 10.5005/jp-journals-10016-1328  |  Open Access |  How to cite  | 

Abstract

Aims and background: The optimal size of the leading follicle at which ovulation trigger should be given in the gonadotropin-releasing hormone (GnRH) antagonist protocol has not been validated yet. We carried out this study to assess the role of delaying ovulation triggering, with the leading follicle beyond 20 mm, in enabling the maturation of medium-sized follicles during controlled ovarian stimulation (COS). Materials and methods: A total of 427 infertile women between the age-group 21 and 45 years, undergoing COS with flexible GnRH antagonist protocol were included, and before stimulation, they were categorized into three groups, namely predicted poor (group I), normal (group II), and hyper (group III) responders. On the day of the trigger, all three groups were further split into two subgroups based on the leading follicle diameter (subgroup A: <20 mm and subgroup B: ≥20 mm), and assisted reproductive technology (ART) outcomes were analyzed between the subgroups. Results: The number of oocytes retrieved [6.8 ± 3.9 vs 4.0 ± 2.7, 95% confidence interval (CI): 1.10–4.44; p = 0.001], the number of metaphase II oocytes among them (4.6 ± 3.1 vs 2.8 ± 1.9; 95% CI: 0.48–3.06; p = 0.008) and the resultant total number of embryos available for freezing (3.5 ± 2.6 vs 2.2 ± 1.7; 95% CI: 0.17–2.41; p = 0.024) and the number of grade I embryos (2.0 ± 1.9 vs 1.1 ± 1.4; 95% CI: 0.15–1.77; p = 0.021) were significantly increased in group IB when compared to group IA. The cycle outcomes were marginally improved, though not significant, in subgroups IIB and IIIB when compared to subgroups IIA and IIIA, respectively. Oocyte maturation rate and fertilization rate were comparable between the subgroups. Conclusion: Delaying the trigger for oocyte maturation has a role in improving the outcomes in poor responders. Clinical significance: Delaying the ovulation trigger in enabling the maturation of medium-sized follicles leads to clinically better yield of oocytes and good quality embryos in predicted poor responders.

267

RESEARCH ARTICLE

Ronak V Manikawala, Jigna Desai

Role of Genetics in Human Infertility

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:9] [Pages No:6 - 14]

Keywords: Azoospermia factor microdeletions, Infertility, Karyotyping

   DOI: 10.5005/jp-journals-10016-1329  |  Open Access |  How to cite  | 

Abstract

Aim: To study the role of genetics in human infertility. Materials and methods: We collected 60 male and 41 female blood samples from infertile couples and carried out a cytogenetic study in both males and females, whereas molecular study was done in only male subjects. Standard Giemsa banding karyotyping protocol was followed for the cytogenetic study. For azoospermia factor (AZF) microdeletion studies, deoxyribonucleic acid (DNA) isolation was followed by multiplex polymerase chain reaction (PCR) using AZF-specific sequence tagged site (STS) markers. Results: In the female cytogenetic study, no structural or chromosomal abnormalities were found; three (7.31%) had polymorphic variants. In males, one (1.6%) had autosomal structural 46, XY, t (3; 17) (p25; q22), one (1.6%) had sex chromosomal numerical abnormalities 47, XXY (12)/46, XX (8) and four (6.66%) had the polymorphic variant. Two males and two females had 9qh+ with other normal chromosomal constitutions. In the same way, two other types of polymorphism were also observed, that is, 21pS+ in one male and one female, whereas 22pS+ was observed in one male subject. The translocation 46, XY, t (3; 17) (p25; q22) we have found is unique. In male blood samples, we studied six gene mutations named AZFa (sy84), AZFa (sy86), AZFb (sy127), AZFb (sy134), AZFc (sy254), and AZFc (sy255). We have observed deletions in eight subjects with a microdeletion frequency of 13.33%, where seven (87.5%) were azoospermic, and one (12.5%) was oligozoospermic. Most found microdeletions were AZFb (sy127) in three males and AZFb (sy134) in three males. AZFa (sy86) and AZFa (sy254) deletions were found in one male. Conclusion: As per our knowledge, there is one novel translocation 46, XY, t (3; 17) (p25; q22) in one male patient from our research. We have also found AZF microdeletions in oligozoospermic and azoospermic patients. The results indicate the importance of karyotyping and microdeletion screening in chromosome Y for infertile couples before advising them of costlier treatments. Clinical significance: The present investigation is a valuable consideration for prognosis, which can be helpful for counseling couples and minimizing the potential risk of transmission of genetic abnormalities to future generations.

380

RESEARCH ARTICLE

Ansha Patel, PSVN Sharma, Pratap Kumar

Accepting Finite Disappointments amidst Infinite Hopes—Treatment-related Concerns in Infertile Women Seeking Medically Assisted Reproductive Treatments: A Clinic-based Cross-sectional Study from India

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:11] [Pages No:15 - 25]

Keywords: Assisted conception, In vitro fertilization, India, Infertility, Stress, Women

   DOI: 10.5005/jp-journals-10016-1330  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this study was to devise a measure to estimate the treatment-related concerns in women seeking fertility treatments. We also aimed to compare the women with and without psychiatric morbidity in their treatment experiences. Settings and design: This study has a cross-sectional design, and the survey was conducted on 300 participants visiting the study site. Measures: The International Classification of Diseases (ICD) was used to assess for psychiatric comorbidity. Treatment concerns were assessed using the “treatment-related concerns scale for infertility (TRC-I)” devised by the investigators for this research. Statistical analysis: Statistical Package for the Social Sciences (SPSS)—16 was used for descriptive data analysis, and Chi-square was used for univariate analysis to evaluate the associations between psychiatric comorbidity and treatment concerns. Results: Our data suggests that women (especially those with psychiatric comorbidities) are considerably impacted by immediate physical, financial, emotional, and interpersonal outcomes from treatments. Discussion: Women had serious concerns with lack of certainty of pregnancy, the side effects, fear, anxiety, and pain arising out of procedures, unmanageable emotional distress during intrauterine insemination (IUI)/in vitro fertilization (IVF) cycles, disturbances in their sexual functioning, financial strain, treatment continuation, and lastly the social implications of infertility. They were minimally bothered with the repeated blood tests and normalcy of the baby born. Those with psychiatric comorbidities were more concerned over repeated IUI/IVF cycles, recoveries, pain, fear, anxiety, and social stigma and voiced out to seek professional psychological support. Conclusion: Flexibility in treatment planning, stability in clinical relationships, and staff support, along with psychological, informational, and spousal help, serve as important sources of positive treatment experiences.

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RESEARCH ARTICLE

Meera Shivasekar, Arul Senghor Kadalangudi Aravaanan, Vinodhini Vellore Mohanakrishnan, Anuradha Murugesan

Effect of Physical Activity on Markers of Insulin Resistance in Infertile Women with Polycystic Ovary Syndrome

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:5] [Pages No:26 - 30]

Keywords: Adiponectin, Homeostatic Model Assessment-adiponectin, Metabolic equivalents of task, Physical activity 150 minutes/week, Resistin

   DOI: 10.5005/jp-journals-10016-1331  |  Open Access |  How to cite  | 

Abstract

Objective: Regular physical activity (PA) regulates important interactive pathways linking energy balance, neuroendocrine function, and hypothalamic pituitary ovarian axis. Consistent physical activities are known to improve insulin sensitivity which exerts its effects via adipokines. The purpose of the study is to determine insulin resistant (IR) status and the effect of brisk walking on the levels of adipocytokines in women with polycystic ovarian syndrome (PCOS). Design: It is a prospective study. Materials and methods: The study included 143 married women with PCOS (as per Rotterdam's criteria) and 110 married women as controls with at least one child through natural conception. Anthropometric measurements were documented. Adiponectin and resistin were analyzed. Homeostatic Model Assessment of IR (HOMA-IR) and HOMA-adiponectin were calculated to assess IR. A follow-up task of 150 minutes/week of PA of brisk walking of moderate intensity was advised for 12 weeks and the status was reassessed. Results: Infertile women with PCOS, hypoadiponectinemia, and hyperesistinemia with elevated markers of IR (HOMA-IR and HOMA-adiponectin) were observed. The baseline data were compared with estimates after 12 weeks, it was found that adiponectin levels were increased with 4.75% weight loss, and decreased levels of resistin, HOMA-IR, and HOMA-adiponectin were observed. Participants who met 150 minutes/week of brisk walking revealed an increase in adiponectin levels and a strong positive correlation (r = 0.76) was observed with regression analysis of metabolic equivalents of tasks (METs) PA with adiponectin levels. Diagnostic sensitivity and specificity of adiponectin at a cutoff value of 7.3 µg/mL with 150 minutes/week of PA were found to be 93.8 and 82.1%, respectively. It was observed a 16.6% reduction of HOMA-IR and 29% of HOMA-adiponectin in the women who completed 12 weeks of PA had statistically significant p-values. An ovarian follicular study revealed positive ovulation in 80% of the participants with >150 minutes/week of brisk walking. Conclusion: Brisk walking of 150 minutes/week resulted in increased adiponectin levels. Beneficial adiponectin facilitates the ovulatory menstrual cycle and thereby the chance of ovulation is increased in PCOS women.

284

RESEARCH ARTICLE

Novy Yanthi, Achmad K Harzif, Mila Maidarti, Evy Yunihastuti, Gita Pratama

Knowledge and Behavior in Human Immunodeficiency Viruses and Reproductive Health of Human Immunodeficiency Viruses-infected Serodiscordant Couples in the Capital City of Indonesia

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:8] [Pages No:31 - 38]

Keywords: Assisted reproductive technology, Educational status, Human immunodeficiency virus infections, Reproductive health, Reproductive techniques, Sexual behavior

   DOI: 10.5005/jp-journals-10016-1332  |  Open Access |  How to cite  | 

Abstract

Aims and background: Human immunodeficiency viruses (HIV) have emerged as a widespread crisis, posing a substantial obstacle to both development and public health. Serodiscordant couples of reproductive age encounter an even greater challenge, requiring comprehensive, and accurate information on cohabitation dynamics and measures to safeguard HIV-negative partners from infection. Simultaneously, they maintain equal reproductive rights. The objective of this study is to describe the understanding and behaviors related to HIV and reproductive health among serodiscordant couples receiving care at the HIV-integrated center of Dr Cipto Mangunkusumo National General Hospital in Jakarta, Indonesia. Materials and methods: This study is a cross-sectional descriptive observational study. The study was conducted on 108 respondents. The evaluation of knowledge and behavior levels involved the administration of a validated questionnaire to eligible research participants meeting specific inclusion and exclusion criteria. Results: Among the 108 participants, 59% demonstrated a high degree of HIV knowledge, while 76% exhibited a moderate level of knowledge regarding reproductive health. In terms of behavior, 39.8% consistently used condoms, 41.7% engaged in multiple sexual partnerships, and 10.2% reported engaging in anal intercourse. Notably, 96% adhered to a regular regimen of antiretroviral medications, and none utilized assisted reproductive technology. Additionally, 54.6% of respondents maintained an ongoing reproductive plan, while 39.8% of those with living children had not verified their child's HIV status. Conclusion: The majority of participants demonstrate a solid understanding of HIV, but there is room for enhancement in reproductive health knowledge. There is a need for improved accessibility to information and education on reproductive health, particularly in the context of assisted reproductive technology for HIV serodiscordant couples, in Indonesia.

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RESEARCH ARTICLE

Deeksha Yadav, Sudha Mishra, Anjoo Agrawal

Assess the Quality of Life and Emotional Distress among Infertile Women in a Tertiary Care Center

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:11] [Pages No:39 - 49]

Keywords: Emotional distress, Infertility, Quality of life, Women

   DOI: 10.5005/jp-journals-10016-1333  |  Open Access |  How to cite  | 

Abstract

Background: Infertility is a major life crisis that causes serious mental health problems and stressful experiences for infertile couples. Aim: This study aimed to assess the quality of life (QOL) and emotional distress of infertile women and determine the correlation between them and their association with variables. Materials and methods: A cross-sectional study was conducted on 115 subjects diagnosed with infertility who were attending the infertility clinic of the Department of Obstetrics and Gynecology of a tertiary care teaching center in North India. QOL and emotional distress were assessed with the fertility of QOL (FertiQOL) and depression, anxiety, and stress (DASS) scale 42 questionnaires. Sociodemographic and clinical details were also obtained from the infertile women by using a semistructured sociodemographic pro forma. Result: Most of the infertile women reported poor QOL and severe emotional distress, with a mean FertiQOL score of 45.42 (15.59) and a mean DASS score of 78 (13). QOL was negatively correlated with emotional distress. Sociodemographic and clinical variables were significantly associated with QOL and emotional distress. Conclusion: The finding of this study revealed that infertile women had significantly poor QOL as well as severe emotional distress. There is a need to incorporate psychological interventions into routine practice at infertility clinics, which is beneficial. However, it is clear that psychological interventions and counseling by liaison nurses for women with infertility have the potential to decrease anxiety and depression and may well lead to significantly higher pregnancy rates.

354

RESEARCH ARTICLE

Anoop Venkatapura Bylaswamy, Juvaina Puthiyakam, Jyoti Ramesh Chandran, Ellezhuthil Devarajan

Indications and Complications of Amniocentesis in 16–20 Weeks in a Tertiary Center in Northern Kerala: A Descriptive Study

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:3] [Pages No:50 - 52]

Keywords: Absent/hypoplastic nasal bone, Amniocentesis, Positive soft markers in second-trimester ultrasound, Prenatal genetic diagnostic testing

   DOI: 10.5005/jp-journals-10016-1335  |  Open Access |  How to cite  | 

Abstract

Aim and background: Chromosomal anomalies frequently occur. Around the world, at least 7.6 million kids are born every year with severe genetic or congenital deformities. One of the biggest problems in contemporary perinatology is the diagnosis of chromosomal abnormalities in fetuses. Trisomies 21, 18, 13, monosomy X, and other sex chromosome aneuploidies are the most prevalent chromosomal abnormalities found in infants. Prenatal diagnostics use a number of approaches to assess a fetus's health and condition. Invasive and non-invasive procedures can be used to diagnose pregnancies. Our objective was to identify indications and complications of amniocentesis. Materials and Methods: A total of 111 pregnant women of gestational age between 16th and 20th weeks who either had abnormal first-trimester scan at 11–14 weeks with positive aneuploidy markers or abnormal mid-trimester anomaly scan with findings suggestive of underlying chromosomal disorders or intrauterine infections were referred from Department of Obstetrics and Gynecology to Department of Radiodiagnosis in Government Medical College, Kozhikode, to undergo amniocentesis to determine the fetal chromosomal structure, numerical aberrations, or translocations. Results: The most common indication for amniocentesis was absent/hypoplastic nasal bone (78%), followed by the combination of absent/hypoplastic nasal bone with increased nuchal fold thickness (7%), smaller percentages including fetal ventriculomegaly (2%), combination of absent/hypoplastic nasal bone with short femur(1%). The complication rate was very minimal; only one patient had a bloody tap. None of the patients had any other complications, such as miscarriages/bleeding per vagina. Mild pain in the abdomen was experienced by a few patients. Conclusion: The most common indication for amniocentesis was absent/hypoplastic nasal bone, followed by a combination of absent/hypoplastic nasal bone with increased nuchal fold thickness. The complications were very minimal. Clinical significance: Amniocentesis is a safe procedure with minimal to no complications. Hence, it can be advised to patients with a positive screening test.

208

RESEARCH ARTICLE

Abhijeet Kumar, Sanjay Sharma, Sanjay Singh, Madhusudan Dey, Pranjali Dhume, Surjeet Dwivedi

Assessment of Fetal Hydronephrosis Using the Urinary Tract Dilation Classification System: Implications for Postnatal Treatment and Parental Counseling

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:5] [Pages No:53 - 57]

Keywords: Fetal hydronephrosis, Neonatal outcomes, Parental counseling, Postnatal treatment, Urinary tract dilation classification

   DOI: 10.5005/jp-journals-10016-1334  |  Open Access |  How to cite  | 

Abstract

Introduction: Fetal hydronephrosis is a condition characterized by the dilation of the urinary tract in the fetus, which can have various underlying causes and outcomes. The prevalence of this condition ranges from 1 to 2%, and most cases resolve on their own. The goal of detecting fetal hydronephrosis is to differentiate between physiological and pathological types to provide appropriate treatment and advice. Various grading systems have been used to assess the severity of hydronephrosis, but their diagnostic consistency has been limited. In 2014, a new classification system called the multidisciplinary consensus on the categorization of prenatal and postnatal urinary tract dilation (UTD) classification system was introduced to address these limitations. Objective: This study aimed to use the UTD classification system to categorize antenatal fetal hydronephrosis and evaluate the need for postnatal treatments such as antibiotics or surgery. The study also assessed the use of the UTD system for parental counseling. Materials and methods: The study was conducted at the maternal and fetal medicine center over a 3-year period. Pregnant women with a diagnosis of fetal hydronephrosis before 22 weeks of gestation were included in the study. Fetuses were classified into low-risk (UTD A1) and high-risk (UTD A2) groups based on the UTD system. Postnatal follow-up and treatment were performed according to the UTD classification. Results: Out of 124 cases of fetal hydronephrosis, 80% were classified as low-risk (UTD A1), and 20% were classified as high-risk (UTD A2–3). The low-risk group showed favorable outcomes, with 70% of the fetuses exhibiting no evidence of hydronephrosis postnatally. In contrast, most fetuses in the high-risk group required additional imaging and treatment. The need for antibiotics and surgery increased significantly with higher UTD classification. Discussion: The study results demonstrate that the UTD classification system is correlated with the risk of neonatally verified hydronephrosis, the need for postnatal imaging, and the requirement for active treatment. This classification system allows for better parental counseling and helps in making informed decisions regarding treatment and follow-up. Conclusion: The UTD classification system is a reliable and practical method for assessing fetal hydronephrosis. Fetuses in the low-risk group have favorable outcomes, while those in the high-risk group require closer monitoring and treatment. The UTD system provides valuable information for parental counseling and guides the need for further care after an initial diagnosis. However, the study has limitations due to its small sample size and retrospective design, highlighting the need for larger, multicenter studies to validate these findings.

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RESEARCH ARTICLE

Minakshi Pounikar, Priyal Shrivastava

Comparison of Fresh vs Frozen Embryo Transfer in Terms of Early Pregnancy Outcome

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:4] [Pages No:58 - 61]

Keywords: Assisted reproduction technique, Early pregnancy loss, Fresh embryo transfer, Thawed embryos

   DOI: 10.5005/jp-journals-10016-1339  |  Open Access |  How to cite  | 

Abstract

Aims and background: Recently, storing all embryos has become a new dictum of improving the overall success of in vitro fertilization (IVF); however, contradictory data is found in the literature, especially about its impact on early loss of pregnancy in comparison to the practice of fresh transfer of embryos. In this study, we tried to analyze early pregnancy loss as a primary outcome along with total live births as a secondary outcome among selected women undergoing fresh and frozen embryo transfer (FET). Materials and methods: In this prospective observational study, 60 consecutive women seeking IVF treatment for fresh/FET were recruited. Within group I, fresh, and in group II, FET was done. The main outcome parameter was early pregnancy loss. Student's t-test was implemented, and calculation was done using the p-value. Results: In group I, early pregnancy loss was 10%, out of which 3.3% were chemical pregnancies, 3.33% were missed abortions, 3.3% were complete abortions, and live births were 33.3%. In group 2, 30% could not continue till 20 weeks. Around 6.66% were chemical pregnancies, 3.33% had blighted ovum, 6.66% with no cardiac activity, 3.33% missed abortion at 7–9 weeks, 3.33% at >9–11 weeks, and 6.66% second-trimester abortions. Live births achieved were 43.3%. Conclusion: Fresh embryo transfer is associated with a lower miscarriage rate (MR), that is, 10%, but a lesser live birth rate (LBR), that is, 33.3%, than frozen-thawed embryo transfer, where it is 30% and 43.3%, respectively. Clinical significance: On the basis of this study, it can be stated that early pregnancy losses are more in frozen cycles against fresh transfer; however, statistically, the difference is nonsignificant.

213

RESEARCH ARTICLE

Muralikrishnan Nambiar, Athulya Sreenivas, Anupama Suresh Y, Anjali Mundkur, Nida Zahoor

Oxytocin and Tranexamic Acid Combination in Laparoscopic Myomectomy: An Innovative Method to Reduce Intraoperative Blood Loss

[Year:2024] [Month:January-April] [Volume:15] [Number:1] [Pages:3] [Pages No:62 - 64]

Keywords: Laparoscopy, Laparoscopic myomectomy, Minimally invasive surgeries

   DOI: 10.5005/jp-journals-10016-1337  |  Open Access |  How to cite  | 

Abstract

Myomectomy has been performed mainly through two routes—laparotomy and laparoscopy. Laparoscopy is considered the gold standard. We aim to compare the effect of the combination of intravenous tranexamic acid and oxytocin, with tranexamic acid alone in laparoscopic myomectomy. It was a retrospective study done at a hospital in Kerala, India, from October 2018 to September 2022. At our center, either intravenous tranexamic acid or a combination of intravenous oxytocin and tranexamic acid was administered during laparoscopic myomectomy as a routine practice to reduce blood loss during surgery. We had a total of 150 patients. Out of this, 75 received an intravenous infusion of 1 gm of tranexamic acid and 75 received an intravenous infusion of a combination of 20 units of oxytocin and 1 gm of tranexamic acid. Among the 75 patients who received tranexamic acid alone, 12 had an excessive intraoperative hemorrhage and among the 75 who received a combination of oxytocin and tranexamic acid, seven had excessive blood loss during surgery. The mean duration of surgery in patients who received intravenous tranexamic acid alone was 2 hours 30 minutes ± 18 minutes and in patients who received a combination of oxytocin and tranexamic acid the duration was 1 hour 30 minutes ± 18 minutes. Mean blood loss in patients who received tranexamic acid alone was 300 mL and in those who received a combination of oxytocin and tranexamic acid, it was 150 mL (p-value < 0.001). The mean change in hemoglobin was 0.6 gm% in patients who received tranexamic acid alone and 0.3 gm% in patients who received a combination of oxytocin and tranexamic acid. The mean fall in hematocrit in patients who received tranexamic acid alone was 2.4 and in patients who received a combination of oxytocin and tranexamic acid was 1.2 (p-value < 0.001).

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