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Hannachi H, Elloumi H, Khlifa SB, Hamdoun M, Kacem K, Bahri O. Influence of Leukocytospermia on Semen Parameters and the Outcome of Intracytoplasmic Sperm Injection. Int J Infertil Fetal Med 2020; 11 (2):33-36.
Background: Leukocytospermia (LCS) is implicated in male infertility since it was found in 30% of the infertile male. However, its influence on semen parameters remains controversial. Aims and objectives: This study aimed to determine the impact of LCS on semen parameters and intracytoplasmic sperm injection (ICSI) results in infertile couples. Materials and methods: A retrospective clinical study was conducted at Aziza Othmana Hospital of Tunis. Sperm parameters from infertile men were studied for volume, motility, vitality, and morphology according to seminal leukocytes. Intracytoplasmic sperm injection results were also compared to those observed in a control group matched by age, ICSI indication, hormonal profile, and endometrium thickness. Results: No statistical difference was observed for all semen characteristics except the volume which was higher for the non-leukospermic group (p = 0.035). Conclusion: Intracytoplasmic sperm injection outcomes were lower in the leukospermic group than the controls but the difference was not statistically significant.
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Selvaraj P, Parpillewar M, Fidvi J. Diagnostic Hysterolaparoscopy in the Evaluation of Female Factor Infertility: A Cross-sectional Study at a Tertiary Care Hospital in Central India. Int J Infertil Fetal Med 2020; 11 (2):37-41.
Background: Infertility is a worldwide problem affecting people of all geographical location and socioeconomic status. It is estimated that globally 60–80 million couples suffer from infertility every year. The main objective of the study is to detect the diagnostic efficacy of hysterolaparoscopy in evaluating the tubal, uterine, ovarian, and pelvic pathologies causing infertility and also compare the findings of a hysterosalpingogram with diagnostic laparoscopy in evaluating the tubal factor infertility. Materials and methods: This hospital-based cross-sectional study included an evaluation of 1,456 couples presenting with complaints of infertility at the Outpatient Department of Government Medical College, Nagpur during the period of February 2016 to September 2018. After thorough gynecological examination and investigations, 130 infertile women were posted for diagnostic hysterolaparoscopy. All the data were collected on predesigned proforma and the results were tabulated and raw percentages calculated to describe the results. Results: Among the 130 infertile women, 102 women (78.46%) had primary and 28 (21.53%) had secondary infertility. The maximum number of patients belonged to the age group of 26–30 years (39.23%). About 56% of patients were in the active marriage life of 3–5 years duration. Most of them had multiple factors affecting their fertility. Out of the 130 infertile women, 32 patients (24.62%) had uterine factors, 44 patients (33.84%) had peritoneal factors, 67 patients (51.5%) had ovarian factors, and 89 patients (68.46%) had tubal factors. Only eight patients (6.15%) had normal findings in laparoscopy. Out of the 130 patients, 122 (93.84%) had more than one factor causing infertility. About 26.15% of patients had positive findings in diagnostic hysteroscopy. Conclusion: Hysterolaparoscopy provides both a panoramic view of the pelvic reproductive anatomy and also a magnified view of the pelvic organs and peritoneal surfaces. It is generally regarded as the most reliable tool in the diagnosis of tubal pathology and other intra-abdominal causes of infertility because of the correctable abnormalities like endometriosis, adnexal adhesions, and septate uterus which are usually missed, are usually identified that helps in formulating a specific plan of management.
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Andiappan M, Bushra N, Mathangi DC, Thanikachalam P. Assessing the Likelihood of Obstructive Sleep Apnea among Infertile Population Using STOPBANG and Modified Berlin Questionnaire: A Cross-sectional Study. Int J Infertil Fetal Med 2020; 11 (2):42-47.
Aim and objective: Obstructive sleep apnea (OSA), a prevalent and mostly underdiagnosed chronic condition, has been investigated for its cardiovascular, metabolic, and neurocognitive consequences in recent times. Intermittent hypoxia, a characteristic feature of OSA, is believed to play a key role in the pathogenesis of these consequences by inducing systemic as well as organ-specific oxidative stress. Indeed, oxidative stress has been recognized as a major causative factor of infertility. Provided that OSA provokes oxidative stress, infertility could be envisaged as a potential consequence in patients with severe OSA. The presence and severity of OSA and its associated risk with systemic comorbidities like diabetes, hypertension, and stroke were well established. Whereas the presence of OSA and its relationship with infertility remains elusive. Hence, the study was initiated to evaluate the prevalence of OSA among infertile people attending a tertiary care hospital compared with the general population of the same age group using two questionnaires—Modified Berlin and STOPBANG. Materials and methods: A sample of 120 subjects in the reproductive age group with a diagnosis of infertility was screened for the presence of OSA using two standard questionnaires—STOPBANG and Modified Berlin questionnaire. Results: The prevalence of high-risk OSA in infertile subjects was 7.5% by Modified Berlin and 15% by STOPBANG questionnaire. Overall predictive values of the employed questionnaire were fair (ROC area under curve) AUC 0.521 for Modified Berlin and 0.516 for STOPBANG. Multivariate logistic regression analysis revealed male gender, snoring, body mass index (BMI) >25 kg/m2, and neck circumference >40 cm as significant risk factors for moderate to severe sleep apnea among infertile subjects. Conclusion: There is increased OSA risk among infertile people and hence the clinical suspicion of OSA should be increased among infertile people with the polycystic ovarian syndrome (PCOS), oligozoospermia, hypertension, diabetes, and obesity. Clinical significance: Identification of OSA risk among infertile people forms a new perspective in the field of reproductive medicine, thereby helping us to achieve a high success rate in infertility treatment.
Androgens are converted to estrogens by the enzyme called aromatase. This process called aromatization is inhibited by a group of drugs called aromatase inhibitors (AIs). Letrozole is a nonsteroidal inhibitor that reversibly binds aromatase. Decrease in circulating estradiol level leads to release of negative feedback at hypothalamus pituitary level, thereby increasing follicle stimulating hormone (FSH) secretion resulting in stimulation of growth of ovarian follicles. Letrozole is well tolerated and is used in different protocols of ovarian stimulation. The extended spectrum of uses includes addition with gonadotrophins in poor responders, ovarian hyperstimulation syndrome (OHSS) prevention, fertility preservation in cancer patients. Due to its wide range of use, easy availability, affordability and good tolerability, Letrozole has emerged as a first line drug for ovulation induction.
Purpose: Poor responder is a quasi-cluster of patients whose management has confounded clinicians. Luteal phase stimulation as a solution is proposed on a new principle of follicular development. Case description: Mrs. X, a 34-year-old woman with an anti-Mullerian hormone (AMH) of 0.86 ng/mL and a history of failed in vitro fertilization (IVF) with the recovery of one egg was stimulated in the luteal phase. The patient\'s ovarian stimulation was done with menopur 375 IU, cetrotide 0.25 mg was added after 8 days. The stimulation lasted for 15 days. Results: There were seven oocytes recovered, two blastocysts were formed and transferred in a freeze–thaw cycle. This resulted in a live-born preterm fetus at 27 weeks in view of bleeding placenta previa. Conclusion: Luteal phase stimulation can be another reasonable solution in the long list of stimulation regimens for patients who are poor responders.