International Journal of Infertility & Fetal Medicine

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2022 | May-August | Volume 13 | Issue 2

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Original Article

Muhammad Lutfi, Agung Dewanto, Shofwal Widad, Irwan Taufiqurrachman, Ardhanu Kusumanto, Nuring Pangastuti, Supak Silawani

Expression of GnRH Receptor Type-II Correlates with Proliferation Activity in Endometriosis

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:37 - 41]

Keywords: Endometriosis, GnRH agonist, GnRH receptor type-II, Proliferation

   DOI: 10.5005/jp-journals-10016-1253  |  Open Access |  How to cite  | 


Background: Global estimated prevalence of endometriosis is about 10 to 15% of women in reproductive age. This chronic inflammatory ectopic endometrium causes pain symptoms and is also attributed to infertility problems. Even though advances in endometriosis management have been developed, cumulative recurrence rate of endometriosis is still as high as 55% after 5 years of therapy with GnRH agonist. Therefore, further investigations are continuously needed to improve treatment outcome in endometriosis, especially through better understanding of the disease pathophysiology. Methods: This cross-sectional study was aimed to describe the expression of GnRH receptor type-II (GnRHR-II) with immunohistochemical staining. Semiquantitative analysis of protein expression was performed with histological scoring (H-score). Moreover, the expression level of GnRHR-II was then compared to Ki-67 protein expression, a marker of cell proliferation. Results: We found a positive correlation between GnRHR–II expression with Ki–67 protein (Pearson correlation score 0.56, 95% CI: 0.15–0.80, p = 0.01). Interestingly, our results also found that the expression of GnRHR–II was also significantly higher in groups of subjects with larger endometriosis tissue size (p = 0.02). Conclusion: Our study showed an evidence of extrapituitary expression of GnRH receptor type-II. Endometriosis consistently expressed GnRHR-II and might play important role in the regulation of proliferation. Our results may trigger further explorations of GnRH receptor-targeted therapy that selectively inhibit proliferation pathway.


Original Article

Anura Dissanayake

Significance of Evaluating Immature Germ Cells during Semen Analysis

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:42 - 46]

Keywords: Immature germ cells, Leukocytes, Semen analysis, Sperm chromatin immaturity

   DOI: 10.5005/jp-journals-10016-1217  |  Open Access |  How to cite  | 


Aim: The clinical significance of evaluating non-sperm cells, which include spermatogenic and non-spermatogenic cells, commonly known as “round cells” is not well established. This study aimed to assess the clinical significance of distinct identification of immature germ cells (IGCs) in semen, and their relationship with semen parameters and chromosome maturity. Materials and methods: A prospective laboratory-based study was carried out using 140 semen samples collected from males attending the subfertility clinic. Semen analysis (SA), evaluation of immature cells, and leukocytes were performed according to standard protocols. The percentage of IGCs calculated by the ratio of IGCs to sperm was used in evaluating above relationships. Results: Immature germ cells were detected in all semen samples with the mean (SD) 26.09 (23.80)%. Significant increase in IGCs was evident in pathozoospermic group (assessed by triple defects; sperm count, motility, and morphology) compared to normozoospermics; mean (SD), 37.75 (29.95)% vs 18.57 (14.95)%, p < 0.01. Analysis of correlations showed that the decrease in concentration, progressive motility, and normal morphology of spermatozoa were associated with increase in percentage of IGCs, and increased IGCs were accompanied with the significant increase in sperm head immaturity. Differentiation between normozoospermia and pathozoospermia was fairly probable or acceptable at the cut-off value of 15.5% of IGCs using ROC curve, with 0.659 sensitivity and 0.281 specificity. Conclusion: A high count of IGCs in semen is a good indicator for detecting disturbed testicular niche compartments, and those changes may manifest as pathozoospermia. Clinical significance: Identifying the different etiologies for this specific situation would help in the proper management of those patients.


Original Article

Chitra Thyagaraju, Archana Naidu, Latha Chaturvedula

Comparison of Low-dose Human Menopausal Gonadotropins with Clomiphene Citrate for Ovarian Stimulation in Intrauterine Insemination: A Randomized Clinical Trial

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:47 - 51]

Keywords: Clomiphene citrate, Human menopausal gonadotropins, Intrauterine insemination, Ovarian stimulation

   DOI: 10.5005/jp-journals-10016-1278  |  Open Access |  How to cite  | 


Introduction: Intrauterine insemination (IUI) is the treatment of choice for unexplained and mild male factor infertile couples not responding to ovulation induction (OI). Clomiphene citrate (CC) is the most common OI used but the success of pregnancy is very low due to its antiestrogenic effects. Gonadotropins are the second line of treatment in CC-resistant cases but they had the disadvantage of being costly with the risk of multiple pregnancies and ovarian hyperstimulation. However, low-dose human menopausal gonadotropins (hMG) have been found to be effective in these conditions with less risk of side effects. Objectives: To assess the efficacy of ovarian stimulation of low-dose hMG and CC with IUI on pregnancy rate in unexplained infertility. Materials and methods: The study was randomized control clinical trial conducted at a tertiary care hospital in South India. A total of 224 patients were randomized to two groups: the low-dose hMG group (75 IU) and CC group (100 mg). Women aged between 25 and 30 years with either unexplained or mild male factor infertility were included. All women were monitored for a follicular response, endometrial thickness, and ovulation. IUI procedure was done after 36–42 hours after HCG trigger. Statistical analysis was done using SPSS version 22 with Chi-square test and student t-test as statistical tests. Results: The demography characteristics like age, duration of infertility, cause of infertility were almost similar in both groups. Compared to ovarian stimulation with CC, hMG stimulation was associated with more number of dominant follicles (2.2 ± 0.5 vs 1.9 ± 0.4) (p = 0.001), increased endometrial thickness (10 ± 1.3 mm vs 7.8 ± 0.15 mm and better pregnancy rate (31.2% vs 16.9%). Conclusion: Low-dose human menopausal gonadotropins have a better pregnancy rate (31.2%) in comparison to clomiphene citrate (16.9%) when used for ovulation induction with IUI in patients with unexplained infertility and mild male factor infertility. Low-dose hMG was associated with more dominant follicles and better endometrial thickness which may lead to favorable reproductive outcomes. Clinical significance: Low-dose gonadotropins can be considered for ovarian stimulation in IUI for better pregnancy rate and without any side effects, especially in low-resource settings.


Original Article

Seshachalam Rathakrishnan Gayathri

Serum PAPP-A and Maternal Risk Factors in Prediction of SGA: A Retrospective Study

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:4] [Pages No:52 - 55]

Keywords: Combined screening, Retrospective study, Risk factors, SGA, Singleton

   DOI: 10.5005/jp-journals-10016-1283  |  Open Access |  How to cite  | 


Aim: Assess the predictive value of first-trimester serum PAPP-A and maternal risk factors in the occurrence of small for gestational age (SGA) newborn in our local South Asian population. Materials and methods: Retrospective case series of antenatal women with singleton gestation who underwent the first-trimester combined screening from January 2013 to December 2015 and had regular checkups and delivered with us. The maternal characteristics analyzed include basic demographics, medical history, medication history, obstetric history, and value of PAPP-A MoM. The neonatal outcome analyzed includes gestational age at delivery, and the birth weight of the baby. Women were divided into three groups as low, intermediate, and high risk and outcomes were analyzed. Statistical analysis was done using Fisher's exact test and unpaired t-test. Results: Of the 1,017 antenatal women, 590 met inclusion criteria, of which 40 women delivered SGA, and 550 women delivered non-SGA newborns. Of the 38 antenatal women where PAPP-A MoM ≤ 0.415 MoM, four and 34 delivered SGA, and non-SGA newborns, respectively. Of the 590 women, 507 were low risk, and 77 and six belonged to intermediate and high risk, respectively. 57.14% of the intermediate-risk and 100% in the high-risk group received aspirin. Twelve newborns were SGA in the intermediate-risk and no SGA in the high-risk group. The detection rate for SGA with low PAPP-A in our study was 10%, similar to the study by Nicholaides et al., where the detection rate was 12%. Conclusion: In the absence of past, current risk factors and a PAPP-A >0.415 MoM, the negative predictive value for SGA was 94.47%. Clinical significance: Assessment of risk factors for SGA fetus at booking helps to provide the earliest effective intervention for prevention of SGA.



Sedigheh Pakseresht, Mahsa Salimi Kivi, Morvarid Ghassab Shirazi, Zahra Atrkar Roshan

Relationship between Hope and Stress with Reproductive Outcome in Women Undergoing In Vitro Fertilization Treatment: A Cross-sectional Study

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:56 - 60]

Keywords: Hope, Infertility, In vitro fertilization, Stress

   DOI: 10.5005/jp-journals-10016-1282  |  Open Access |  How to cite  | 


Background: Infertility has many psychological effects on infertile couples’ mental health. Stress and hopelessness are the most important factors that may affect the success of in vitro fertilization (IVF) in these couples. This study is aimed at investigating the relationship between stress and hope with reproductive outcomes in women undergoing IVF treatment. Materials and methods: In this cross-sectional study, 186 women who were referred to infertility centers in Rasht undergoing IVF were selected by convenience sampling between May and October 2019. Data collection tools included a demographic questionnaire, Standard Newton's Infertility Stress, and Snyder hope scale was used to measure infertility stress and hope. β-subunit of human chorionic gonadotropin was measured in relation to reproductive outcome 14–16 days after IVF. Results: The mean age of participants was 33.24 ± 6.23 years. The main causes of infertility were females (41.4%), males (21%), females and males (23.7%), and unknown (14%). Pregnancy success after IVF was 35.5%. The results revealed that the total stress score was 161.06 ± 29.001, and the mean score of hope was 51.39 ± 7.47. According to the results of logistic regression, there was a significant relationship between age and reproductive outcomes (p = 0.036). However, there was no significant relationship between study concepts and reproductive outcomes after IVF. Conclusion: According to the findings of the present study, stress and hope were not significantly correlated with the success of IVF; although the level of hope in this study was good, stress is high in these individuals.



Preyaporn Onsod, Watcharapa Jaranasaksakul, Prapatsorn Areesirisuk, Rachanee Parinayok, Budsaba Rerkamnuaychoke, Takol Chareonsirisuthigul

Rapid Molecular Karyotyping for Products of Conception by BACs-on-beads Technology

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:6] [Pages No:61 - 66]

Keywords: BACs-on-Beads, Prenatal diagnosis, Products of conception

   DOI: 10.5005/jp-journals-10016-1287  |  Open Access |  How to cite  | 


Aim: Bacterial artificial chromosomes (BACs)-on-beads (BoBs) technology detects aneuploidy, chromosome gains, and losses. The Prenatal™ BoBs detect common aneuploidies and nine microdeletion syndromes. The KaryoLite™ BoBs additionally detect alterations in the p and q arm of all chromosomes. We evaluated BoBs technology for the product of conception (POC) screening. Materials and methods: A total of 265 fresh POC were evaluated by the different BoBs (233 KaryoLite™ BoBs, nine Prenatal™ BoBs, and 23 of both). Results: BoBs detected chromosomal abnormalities in 142 samples (53.58%). The most frequent chromosome abnormality was trisomy 21 (17.61%), followed by monosomy X, trisomy 16, and trisomy 22 (14.08%). Twenty-three samples (13 normal and 10 abnormal), which used both KaryoLite™ and Prenatal™ BoBs kits, were concordant. Moreover, BoBs techniques had no failure rate. Conclusion: BoBs technology is a potentially useful method for diagnosing common aneuploidies and microdeletion syndromes in conception products. This method's advantage over cell culture includes quicker results and a lower failure rate.



Rashmi Vohra, Monna Pandurangi, Sanjeeva R Nellepalli, Radha Vembu, Siddhartha Nagireddy

3D Vascularity: A Novel Predictor of FET Success?

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:67 - 71]

Keywords: Cohort study, Embryo transfer, Infertility, Pregnancy rates, 3D power Doppler

   DOI: 10.5005/jp-journals-10016-1286  |  Open Access |  How to cite  | 


Introduction: Endometrial blood flow reflects uterine receptivity. A study was done to look for a better predictor of endometrial receptivity with a novel 3D technique. Materials and Methods: Prospective cohort study was done on 203 women undergoing frozen embryo transfer (FET) cycles in a tertiary care center for a period of 2 years from November 2018 to November 2020 to see the correlation of endometrial and subendometrial blood flow assessed by 3D power Doppler. Various indices endometrial volume, subendometrial volume and their vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were obtained and compared between the pregnant and nonpregnant groups. The primary outcome was clinical pregnancy and ongoing pregnancy rates. Results: Out of 203 patients, 121 patients achieved pregnancy with a pregnancy rate of 59.6%. The endometrial and subendometrial volume was comparable between the two groups. Endometrial VI (3.3 ± 1.2 vs 2.8 ± 0.6; p < 0.01), FI (24.9 ± 3.0 vs 23.1 ± 2.7; p < 0.01) and VFI (1.4 ± 0.5 vs 1.1 ± 0.3; p < 0.01) were significantly higher in pregnant as compared to nonpregnant group. There was a significant difference in subendometrial VI (5.2 ±1.5 vs 4.4 ±1.9; p < 0.01), FI (26.0 ± 3.5 vs 25.0 ± 3.7; p = 0.04) and VFI (2.7 ± 1.1 vs 2.2 ± 0.6; p < 0.01) between two groups. Receiver operating characteristic (ROC) curves were plotted for these parameters and cut-off values were calculated. At the cut-off value of endometrial VFI of 1.18, gave sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 71.9%, 75.6%, 81.3%, 64.5%, and 73.4%, respectively while at the cut-off value of subendometrial VFI of 2.35, gave sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 66.9%, 63.4%, 72.9%, 56.5%, and 65.5%, respectively. A cut-off value of endometrial VFI of 1.18 and subendometrial VFI of 2.35, gave ongoing pregnancy rates of 67.3% and 59.5%, respectively. Conclusion: Endometrial and subendometrial vascularity by 3D power Doppler can be a useful novel parameter in predicting pregnancy in FET cycles.



Tengiz Verulava, Marina Pirtskhalava

Fertility Awareness and Knowledge among Infertile Women in Georgia: A Cross-sectional Study

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:6] [Pages No:72 - 77]

Keywords: Awareness, Fertility, Infertility, In vitro fertilization

   DOI: 10.5005/jp-journals-10016-1284  |  Open Access |  How to cite  | 


Aim: Infertility has an impact on both demographics and social events. The study aims to evaluate fertility knowledge, awareness, and practices among infertile women. Materials and methods: Quantitative cross-sectional study design was used. The study population included 105 infertile women that referred to the specialized infertility clinic in Tbilisi (Georgia). Results: Respondents used to visit doctors to get treatment for their infertility at a very late stage. The treatment was financially affordable for only 20% of patients. A significant part of respondents (42.9%) were smokers, which indicates that they have lack of knowledge about the effects of lifestyle factors on fertility. The majority of respondents (78%) were aware that fertility declines with age; however, only 21% of participants could correctly identify the critical age threshold of 36 years, after which it becomes difficult to achieve pregnancy. The fertile window in the menstrual cycle was missed by approximately 77% of participants. On inquiry regarding the ovulatory period, it was found that only 12.6% (n = 12) were aware that the mid-cycle is the most likely phase to achieve pregnancy. Most respondents (93%) believed that past history of pill intake was associated with infertility. People often incorrectly attribute infertility to contraceptive pill use. The majority of respondents (53%) believed that it was possible to achieve pregnancy at 50 years, either naturally or with the help of assisted reproductive technique with self-oocytes. Conclusion: The study demonstrated a low level of public awareness. It is advisable to increase the affordability of infertility treatment and improve reproductive education initiatives to increase fertility awareness. Increasing the level of knowledge of risk factors and fertility practices has important public health implications and may help to decrease the incidence of infertility. Targeted fertility education and public enlightenment programs may help in reducing the number of women experiencing infertility and also enable timely referral for assisted fertility treatment.



Maya Rathnasabapathy, Deviga Subramani

Content Validity of a Scale Measuring Psychosocial Stress Factors among Infertile Women in Treatment

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:4] [Pages No:78 - 81]

Keywords: Content validity, Infertility, Psychosocial, Stress

   DOI: 10.5005/jp-journals-10016-1285  |  Open Access |  How to cite  | 


Infertility is highly prevalent in women. While women are focusing on self-development and financial independence before starting a family and the age of marriage is on the rise resulting in infertility. It is vital to understand and explore the emotional difficulties women experience at this stage. Thus, the researcher conducted in-depth interviews with 20 infertile women from infertility clinics and, using related reviews, generated 135 items. On the basis of repetition and representativeness of the construct, the scale was reduced to 95 items which were validated. The content validity using both qualitative and quantitative methods ensured the representativeness and validity of the scale. The researcher procured expert opinions for each item of the scale, and content validity ratio (CVR) and content validity index (CVI) was obtained. The scale was given to 11 experts representing Gynecology and Psychology; and was requested to comment on the items on the basis of “Relevance,” “Clarity,” and “Necessity.” Thus, the experts had to check if the items represented the psychosocial sources of stress infertile women experienced during treatment and they also were pertaining to the dimensions. The CVR, CVI, and Kappa values were calculated. The items with CVR of 0.75 and above were retained, with 0.50 and below eliminated, and between 0.75 and 0.50 were modified and retained. The CVI for Relevance and Clarity indicates that 75 of the items are “appropriate” and five items required revision; 74 of the items are “Clear,” and six items required revision. Thus, the number of items was 80 after content validity. The Fleiss's Kappa value of 1 for “Necessity,” “Relevance,” and “Clarity” indicates that the inter-rater agreement of the scale is “almost perfect agreement.”



Sharmistha Sarkar, TK Aleyamma, Mohan S Kamath

Unraveling Chronic Endometritis: A Review

[Year:2022] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:82 - 86]

Keywords: Recurrent implantation failure, Recurrent pregnancy loss, Unexplained infertility, Transvaginal sonography

   DOI: 10.5005/jp-journals-10016-1279  |  Open Access |  How to cite  | 


Chronic endometritis (CE) is a pathology associated with persistent inflammation of the endometrial lining. The symptomatology of CE is usually mild or absent. CE is emerging as one of the main causative factors for altering the endometrial receptivity, which negatively impacts the process of implantation. It is mainly associated with unexplained infertility, recurrent miscarriages, and recurrent implantation failures. While immunohistochemical CD 138 staining is the gold standard for the diagnosis of CE, conventional tissue staining, hysteroscopy, transvaginal color Doppler, and culture sensitivity are other useful diagnostic modalities. Targeted or empirical antimicrobial therapy is effective for treatment in women with CE. Reproductive outcomes may improve following treatment with antimicrobial agents.


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