International Journal of Infertility & Fetal Medicine

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2022 | January-April | Volume 13 | Issue 1

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Original Article

Radha Vembu

Impact of Two Doses of Agonist Trigger on Assisted Reproductive Technology Outcome

[Year:2022] [Month:January-April] [Volume:13] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Agonist trigger, ART outcome, Oocyte maturation, Serum LH

   DOI: 10.5005/jp-journals-10016-1255  |  Open Access |  How to cite  | 


Background: Serum luteinizing hormone (LH) levels are measured on trigger day and 12 hours post-gonadotropin releasing hormone (GnRH) agonist trigger for final oocyte maturation. The impact of 12-hour serum LH on the prediction of suboptimal response and outcome of assisted reproductive technology (ART) is controversial. Aim: To evaluate the impact of two doses of agonist trigger 12 hours apart irrespective of 12-hour serum LH levels on ART outcome. Settings and design: Retrospective cohort study at a tertiary care university hospital. Subjects and methods: Eighty-six infertile women with predicted hyper-response, administered agonist trigger 12 hours apart, and have undergone Intracytoplasmic Sperm Injection (ICSI) with frozen embryo transfer (FET) over 3 years were included. They were grouped based on 12-hour serum LH into <15 IU/L, 15–30 IU/L, and >30 IU/L. The baseline characteristics and ART outcome were compared among the three groups. Statistical analysis: SPSS 23.0 version, Chi-square test, One-way ANOVA with post hoc test. Results: The study groups were comparable with regard to baseline characteristics, oocytes retrieved, mature oocytes metaphase II (MII) (p = 0.421), day three grade-I embryos and embryos available for freezing (p = 0.419). The cumulative pregnancy rate (p = 0.753), miscarriage rate (p = 0.421) and ongoing pregnancy/cumulative live birth rate (CLBR) per retrieval (p = 0.892) were comparable. Conclusion: Administration of two doses of agonist trigger 12 hours apart is an effective solution in low-resource settings to avoid suboptimal response without compromising the ART outcome. Clinical significance: Administration of two doses of agonist trigger is an effective way to avoid suboptimal response in low-resource setting and can avoid LH estimation 12 hours post-trigger.


Original Article

Mohammed A Cheruveetil, Prasanna K Shetty, Mir Jaffar, Arya Rajendran, Muhammed Asif, Sumi Maria

Impact of Prematuration Culture on Zygote Morphology in In Vitro Maturation: An Early Clue to Embryo Competence

[Year:2022] [Month:January-April] [Volume:13] [Number:1] [Pages:10] [Pages No:5 - 14]

Keywords: Cilostamide, Nucleolar precursor bodies, Polar body, Prematuration culture, Pronuclear zygote, Pronuclei

   DOI: 10.5005/jp-journals-10016-1251  |  Open Access |  How to cite  | 


Background: The study was undertaken to gain insight into the morphology of pronuclear oocytes developed through prematuration culture with cilostamide. The criteria such as position and orientation of pronuclei (PN), the size and distribution of nucleolar precursor bodies (NPB), alignment of polar body (PB), and the cytoplasmic halo have been included in the study. Objective: To elucidate the effect of cilostamide on zygote morphology in prematuration culture. Study design: A prospective analysis of pronuclear zygote morphology developed through IVM with prematuration culture using cilostamide conducted from April 2018 to March 2020. Materials and methods: The present study comprised of 57 zygotes, obtained from the in vitro matured oocytes of 63 patients aged between 25 and 35 years, who underwent controlled ovarian stimulation for IVF/ICSI. Results: In pronuclear morphology, the central juxtaposed position was higher in the experimental group (77.1%) than in the control group (54.5%). The Group 1 NPB distribution was statistically significant in the experimental group (51.4%) as compared to the control group (22.7%) (p = 0.03). Besides, Group 3 NPBs were lower in the experimental group (11.4%) when compared to the control group (36.4%) (p = 0.02). The α-type polar body distribution was significantly higher in the experimental group (65.7%) (p = 0.03). Cytoplasmic halo was noted in the experimental (60%) and control (45.5%) groups (p > 0.05). Conclusion: The results indicate that prematuration culture using cilostamide for synchronizing nuclear and cytoplasmic maturation yielded a better pronuclear zygote morphology.



Harpreet Singh, Anubhuti Chitkara, Jayashree Bhattacharjee

Occurrence of Insulin Resistance with Recurrent Pregnancy Loss of Unknown Etiology in North Indian Hospital-based Women Population: A Pilot Study

[Year:2022] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:15 - 17]

Keywords: HOMA-IR, Insulin resistance, Pregnancy outcome, Recurrent pregnancy loss (RPL), Unexplained etiology

   DOI: 10.5005/jp-journals-10016-1256  |  Open Access |  How to cite  | 


Objective: Recurrent pregnancy loss (RPL) has been defined as occurrence of two or more clinically recognized spontaneous consecutive pregnancy losses prior to the 20th gestational weeks according to new guidelines of the American Society of Reproductive Medicine. Although multiple factors have been explained for RPL but still in most of the cases no etiology is found. Study design: It was a prospective analytical observational study. It was conducted on 100 nonpregnant women in reproductive age-group 20–30 years, 50 women, with history of two or more consecutive spontaneous abortions in study group and 50 women with at least one live birth and no history of recurrent abortions in control group. These two groups were matched for age and BMI. All the women underwent various examinations like ultrasound pelvis for ruling out any uterine anomaly, hysteroscopy, antiphospholipid profile, hormonal profile, screening for DM, and thyroid disorders, HOMA–IR was calculated for insulin resistance. Result: A significant difference (<0.0001) was observed in fasting blood sugar and serum insulin levels in the case and control groups (<0.0005). HOMA–IR was also found to be significantly increased in RPL group (p ≤ 0.0005). Conclusion: Insulin resistance and hyperinsulinemia may be an important risk factor in women with idiopathic RPL.



Ramanjit Kaur, Kamlesh Gupta, Gauravdeep Singh

Ultrasound Detection of Fetal Structural Anomalies during First Trimester Nuchal Translucency Scan in Conjunction with Traditional 18–22 Weeks Anomaly Scan

[Year:2022] [Month:January-April] [Volume:13] [Number:1] [Pages:5] [Pages No:18 - 22]

Keywords: Fetal anomalies, First trimester, Nuchal translucency, Ultrasound

   DOI: 10.5005/jp-journals-10016-1252  |  Open Access |  How to cite  | 


Aim and objective: The purpose of this study is to assess the value of performing a detailed examination of the fetus for structural anomalies in a two stage screening process at first trimester nuchal translucency (NT) scan and mid trimester anomaly scan in general population. Materials and methods: An observational study was conducted on 400 pregnant females referred to Department of Radiodiagnosis and Imaging in our hospital for NT scan at 11–13+6 weeks of gestational age. All women enrolled in the study were again subjected to traditional 18–22 weeks anatomy scan on follow up. Results: In our study, total 400 pregnant women were enrolled. Overall congenital anomaly prevalence in study population was 6.7%. Out of which 66.6% anomalies were detected in first trimester. While 35.7% of the anomalies were detected in second trimester anomaly scan. Combined use of NT and second trimester scan detected almost all of the congenital anomalies. However, many of the total anomalies among them were detected earlier in first trimester NT scan. Conclusion: Early scan can be very helpful in early diagnosis of fetal anomalies. But as many abnormalities cannot be evident in early pregnancy due to ongoing fetal development, second trimester anomaly scan should also be performed along with early screening as two stage screening process.



Atri Pal

POSEIDON 1 and 2: Probable Causes and Proposed Treatment Strategies? An Evidence-based Update

[Year:2022] [Month:January-April] [Volume:13] [Number:1] [Pages:5] [Pages No:23 - 27]

Keywords: BOLOGNA criteria, Dual trigger, FSH receptor polymorphism, LH receptor polymorphism, Poor ovarian responders, POSEIDON classification

   DOI: 10.5005/jp-journals-10016-1257  |  Open Access |  How to cite  | 


Aim and objective: To elucidate the cause of poor ovarian response to controlled ovarian hyperstimulation during in vitro fertilization in women with good ovarian reserve and the potential treatment options for them. Background: There has been a steady increase in number of in vitro fertilization (IVF) cycles being performed across the world. An important step of IVF is controlled ovarian hyperstimulation (COH), with an aim to achieve multifollicular response. Conventionally the protocol and gonadotropin dose is tailored to ensure adequate oocyte yield and minimize complications. Studies suggest that maximizing oocyte yield increases the cumulative LBR. However, in spite of high dose of gonadotropin usage during COH, many women have poor response (<4 oocytes retrieved) and/or low oocyte yield (4–9 oocytes retrieved). Patient-Oriented Strategies Encompassing Individualize D Oocyte Number (POSEIDON) criteria to classify poor responders were introduced in 2016 to achieve better stratification of poor responders and achieve an individualized treatment approach for the patients. Review results: Some of the proposed reasons include suboptimal gonadotropin dose, gonadotropin receptor resistance due to gonadotropin receptor polymorphism and issues with ovulation trigger. Two most studied single nucleotide polymorphism are those at position 307 and 680 of exon 10 of Follicle stimulating hormone receptor. Some studies have demonstrated that homozygous Asparagine at position 680 required lesser gonadotropin dose and had more oocyte yield in normoovulatory women compared with other variants at position 680. However, other studies have reported contradictory findings. Similarly contradictory results have been reported from various studies regarding ovarian response with respect to variants at locus 307. Some of the proposed treatments for patients with unexpected responders include increasing the dose of Inj. FSH, adding Inj. Luteinizing hormone receptor (LH) to ovarian stimulation, use of dual trigger, synchronizing the follicular cohort, use of adjuvants during IVF, and dual stimulation. Conclusion: The exact reason for such a response is still unclear although role of FSH/LH polymorphism has been studied extensively. However, no specific FSH/LH polymorphism has been consistently been associated with such unexpected hyporesponse. There is no high quality evidence for other proposed treatment options.



Muhammad A Zucha, Anastasia Feliciana, Pritania Astari

Pregnancy Rate after Tubal Reanastomosis: A Case Presentation and Systematic Review

[Year:2022] [Month:January-April] [Volume:13] [Number:1] [Pages:6] [Pages No:28 - 33]

Keywords: Female sterilization, Pregnancy rate, Tubal microsurgery, Tubal reanastomosis

   DOI: 10.5005/jp-journals-10016-1254  |  Open Access |  How to cite  | 


Tubal reanastomosis is an option to recanalize fallopian tubes after previous sterilization. Several factors may be important in defining the success rate afterwards. This paper aimed to describe our experience performing tubal reanastomosis, and discuss the fertility outcome through a systematic literature review. We successfully performed tubal reanastomosis that resulted in pregnancy within 1 year after the procedure. Microsurgical tubal reanastomosis was performed with four-stitch technique. In addition, we conducted systematic searching to describe the efficacy of tubal reanastomosis in reversing the fertility status. MEDLINE database was searched with keywords: tubal reanastomosis, sterilization, and fertility. According to our criteria and search protocol, 16 studies were found, including 8,584 subjects. Data of pregnancy rate of those studies were collected to determine a cumulative pregnancy rate. According to our systematic review, we found tubal reanastomosis may result in successful conception of 70.27% of patients. Moreover, microsurgical tubal reanastomosis has comparable outcome in comparison to minimal invasive surgical approach. Therefore, tubal reanastomosis with microsurgery may be provided to reverse fertility status in low-resource settings. Our results mainly impact on patients who underwent tubal sterilization but need a fertility reversal. Our shared technique may be used as an important insight for the surgical approach. More importantly, pregnancy rates from the systematic review may be used as evidence-based prediction number of pregnancies.



Nupur Shah

Fetal Jacob Syndrome (47XYY): An Uncommon Association of Fetal Pulmonary Atresia with Ventricular Septal Defect

[Year:2022] [Month:January-April] [Volume:13] [Number:1] [Pages:2] [Pages No:34 - 35]

Keywords: 47XYY, Fetal ultrasound, Genetic counseling, Jacob syndrome, PA-VSD, Prenatal diagnosis, Pulmonary atresia with VSD, Sex chromosomal aneuploidy

   DOI: 10.5005/jp-journals-10016-1250  |  Open Access |  How to cite  | 


Jacob syndrome is a sex chromosome aneuploidy comprising of an extra Y choromosome usually diagnosed late in postnatal life or never diagnosed throughout the life. Its prenatal diagnosis is usually accidental due to lack of specific fetal phenotype. The case presented here is that of a prenatally diagnosed Jacob syndrome associated with pulmonary atresia and ventricular septal defect (PA-VSD) which is an uncommon fetal phenotype, not reported in the literature so far.


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