International Journal of Infertility & Fetal Medicine

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2020 | September-December | Volume 11 | Issue 3

EDITORIAL

Editorial

[Year:2020] [Month:September-December] [Volume:11] [Number:3] [Pages:1] [Pages No:00 - 00]

PDF  |  DOI: 10.5005/ijifm-11-3-iv  |  Open Access |  How to cite  | 

Original Article

Shanthi Ethirajan, Mangala Lakshmi Pritem

Study on Knowledge and Practice of Periconceptional Intake of Folic Acid among Antenatal Mothers at Saveetha Medical College Hospital, Tamil Nadu

[Year:2020] [Month:September-December] [Volume:11] [Number:3] [Pages:4] [Pages No:57 - 60]

Keywords: Folic acid, Nutritional supplements in pregnancy, Periconceptional period, Planned pregnancy, Prevention of neural tube defects

PDF  |  DOI: 10.5005/jp-journals-10016-1212  |  Open Access |  How to cite  | 

Abstract

Background: Neural tube defects (NTDs) are one of the common congenital malformations. Neural tube defects are preventable with folic acid (FA) supplementation periconceptionally. Knowledge about FA and its periconceptional intake among women of reproductive age, pregnant women, and healthcare providers is important for timely supplementation, thereby preventing NTDs. Aim and objective: To assess the knowledge about FA and its benefits and their actual intake of FA periconceptionally among pregnant women at Saveetha Medical College and Hospital. Study design: A cross-sectional descriptive study was conducted at Saveetha Medical College and Hospital in the year 2017. Materials and methods: Two hundred pregnant women attending Antenatal Outpatient Department willing to participate in the study were interviewed with a structured questionnaire and responses were collected and analyzed. Results: Among 200 pregnant women, 153 (76.5%) women had heard about FA and mostly from healthcare providers (94.7%). Sixty-one women (30.5%) and nine women (4.5%) were aware of the benefits of FA in neural development and anemia prevention, respectively. Nine (4.5%) were able to mention a diet rich in FA and 15 (7.5%) women knew the dose of FA. Only 32 women (16%) took FA periconceptionally, whereas 150 women (75%) took FA only after the diagnosis of pregnancy. Among them, 164 women took the tablets regularly. Eighteen women (9%) did not take FA during pregnancy. Out of 131 women (65.5%) who had planned pregnancy, only 48 women (36%) had taken periconceptional FA. Conclusion: Awareness about FA and its importance of periconceptional intake is low among women in this population. The practice of periconceptional intake of FA is less which may be due to a lack of knowledge about the benefits of FA. Health education, awareness programs, planned pregnancy, and preiconceptional counseling can help in optimizing the periconceptional FA intake.

REVIEW ARTICLE

Rutvij Jay Dalal, Sahil Gupta, Akanksha P Mishra

Artificial Intelligence in Assisted Reproductive Technology: Present and Future

[Year:2020] [Month:September-December] [Volume:11] [Number:3] [Pages:4] [Pages No:61 - 64]

Keywords: Artificial intelligence, Artificial reproduction technology, Assisted reproductive technique

PDF  |  DOI: 10.5005/jp-journals-10016-1208  |  Open Access |  How to cite  | 

Abstract

Artificial intelligence (AI) has found its way into medicine in the form of robotics, operational and computational tools. We have software to store and recall a patient\'s history instantly and algorithms to decide the course of treatment depending on past data. We have robots performing surgeries and witnessing systems to help prevent human errors. There have been significant advancements in the incorporation of AI in the artificial reproduction technology (ART) labs. In vitro fertilization (IVF) at present is a very subjective science, depending on the expertise and experience of the operators, mainly embryologists. Automation and AI are expected to bring about a more calculated, computed, and standardized approach to IVF. Presently, AI is used in the IVF lab for witnessing, data collection, record maintenance, and selecting the best possible embryo for transfer. Continuous research is being undertaken towards bringing more and more automation in the form of robotics. Artificial intelligence in ART is a very exciting upcoming field of research. Our review enlists the present AI in an ART lab and its future prospects.

CASE SERIES

Venus Bansal, Muskaan Chhabra, Boreddi H Bhavani

Does Number Matter: A Case Series of Gestational Trophoblastic Disease with Coexistent Live Pregnancies Post-multiple Embryo Transfer after In vitro Fertilization–intracytoplasmic Sperm Injection

[Year:2020] [Month:September-December] [Volume:11] [Number:3] [Pages:7] [Pages No:65 - 71]

Keywords: β-hCG, Embryo transfer, Gestational trophoblastic disease, In vitro fertilization, Vesicular mole

PDF  |  DOI: 10.5005/jp-journals-10016-1211  |  Open Access |  How to cite  | 

Abstract

Aim and objective: We present three cases of multiple pregnancies associated with hydatidiform mole occurring after in vitro fertilization (IVF)–intracytoplasmic sperm injection (ICSI). Background: The phenomenon of molar pregnancy coexisting with higher-order pregnancies after IVF–ICSI is extremely rare as assisted reproduction techniques allow us to directly assess gametes and ICSI curtails any chances of dispermic fertilization. Case description: Three cases are discussed each of which was managed differently according to gestational age and parity of the patient. Individualization of management along with strict follow-up is necessary in such cases. Conclusion: A high index of suspicion must be kept for the possibility of coexistent molar pregnancy, especially in multiple conceptions occurring after IVF–ICSI. Even though rare, if diagnosed early, appropriate management can help avoid catastrophic complications and preserve future fertility. Clinical significance: No clear guidelines exist at present regarding the management of molar pregnancies coexisting with IVF–ICSI conceptions and many factors unique to these pregnancies need to be addressed. The possibility of severe complications like massive bleeding may necessitate the termination of a precious pregnancy. The high possibility of gestational trophoblastic neoplasia and the need for long-term follow-up may delay further cycles and deny the couple a chance at their own genetic baby. Mole can recur in subsequent pregnancies and this also requires detailed patient counseling with an option for use of preimplantation genetic diagnosis techniques.

CASE REPORT

Roopa Padavagodu Shivanada, Shyamala Guruvare, Shubha Rao, Radhakrishnan Periyasamy

Conjoint Twins: “Constant Togetherness” a Sign of Double Trouble

[Year:2020] [Month:September-December] [Volume:11] [Number:3] [Pages:4] [Pages No:72 - 75]

Keywords: Conjoint twins, Constant togetherness, Diagnostic dilemmas, Double trouble, Pandora box

PDF  |  DOI: 10.5005/jp-journals-10016-1207  |  Open Access |  How to cite  | 

Abstract

Introduction: Conjoint twins are a rare form of twins. Its incidence ranges from 1 in 50,000 to 1 in 100,000 live births. Associated with multiple anomalies, it has very high morbidity and mortality. Ultrasound has not only overcome the diagnostic dilemmas and pitfalls but has helped to characterize the site, extent of conjoining which often decides the prognosis and offers varying outcomes when surgical separation is attempted. Case description: A Gravida 3 Para 1 Living 1 abortion 1 with previous LSCS at 13 weeks presented for the first time to confirm pregnancy. Ultrasound showed monochorionic twin pregnancy. Two cranial vaults, thorax with 2 cardia were seen separately. The abdomen of the twins was not clearly discernible. Twin B had a cystic swelling in the umbilical area and the lumbosacral area. A working diagnosis of conjoint twins with umbilical cord cyst and meningocele was made. The patient was counseled about the prognosis. The patient opted for termination of pregnancy. An autopsy showed an omphalopagus type of conjoint twins with sharing of the intestines from the ileocecal region with omphalocele at the joining site and meningomyelocele in twin B. Conclusion: Diagnosing conjoint twins is a dilemma. Once diagnosed a “Pandora box” is opened. The trouble starts here, with its classification, extent of duplication, and looking for other associated anomalies. When diagnosed, early termination of pregnancy is an option. The late diagnosis makes management difficult with increased risks in preterm labor, intrauterine death, stillbirths, cesarean delivery, and problems of surgical separation with varying prognoses.

CASE REPORT

Parameswara Iyer Ramesh, Gopinathan Kannoli, Soumya Nair, Asha Anil Menon

A Rare Presentation of Heterotopic Pregnancy Presenting at Different Periods in the Same Embryo Transfer Cycle

[Year:2020] [Month:September-December] [Volume:11] [Number:3] [Pages:3] [Pages No:76 - 78]

Keywords: Artificial reproductive techniques, Embryo, Heterotopic pregnancy, Implantation potential

PDF  |  DOI: 10.5005/jp-journals-10016-1209  |  Open Access |  How to cite  | 

Abstract

Background: Heterotopic pregnancy (HP) is a rare complication of conceptions following ovarian stimulation. Its incidence is increasing with the use of assisted reproductive techniques (ART). Case description: We are reporting a rare presentation of bilateral ectopic pregnancies together with intrauterine pregnancy which resulted from the transfer of three embryos in a single fresh transfer cycle. The presentation was unique because the pregnancies presented at different times. The intrauterine pregnancy (miscarriage) and the left ectopic pregnancy (EP) presented earlier and the right EP presented late. This is possibly due to the differential implantation and growth potential of the three embryos obtained from a single ART cycle. The patient had to undergo laparoscopy twice in a gap of 12 days. Conclusion: A high index of suspicion will help to decrease the consequences of HP, especially in ART cycles. Elective single embryo transfer would be the best preventive measure. Clinical significance: An early diagnosis of HP will help to prevent the dilemmas associated with it. Meticulous sonography and careful inspection of the contralateral tube should be the dictum in cases of HP.

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